how to compare and contrast research articles

OASIS: Writing Center

Writing a paper: comparing & contrasting.

A compare and contrast paper discusses the similarities and differences between two or more topics. The paper should contain an introduction with a thesis statement, a body where the comparisons and contrasts are discussed, and a conclusion.

Address Both Similarities and Differences

Because this is a compare and contrast paper, both the similarities and differences should be discussed. This will require analysis on your part, as some topics will appear to be quite similar, and you will have to work to find the differing elements.

Make Sure You Have a Clear Thesis Statement

Just like any other essay, a compare and contrast essay needs a thesis statement. The thesis statement should not only tell your reader what you will do, but it should also address the purpose and importance of comparing and contrasting the material.

Use Clear Transitions

Transitions are important in compare and contrast essays, where you will be moving frequently between different topics or perspectives.

Examples of transitions and phrases for comparisons: as well, similar to, consistent with, likewise, too
Examples of transitions and phrases for contrasts: on the other hand, however, although, differs, conversely, rather than.

For more information, check out our transitions page.

Structure Your Paper

Consider how you will present the information. You could present all of the similarities first and then present all of the differences. Or you could go point by point and show the similarity and difference of one point, then the similarity and difference for another point, and so on.

Include Analysis

It is tempting to just provide summary for this type of paper, but analysis will show the importance of the comparisons and contrasts. For instance, if you are comparing two articles on the topic of the nursing shortage, help us understand what this will achieve. Did you find consensus between the articles that will support a certain action step for people in the field? Did you find discrepancies between the two that point to the need for further investigation?

Make Analogous Comparisons

When drawing comparisons or making contrasts, be sure you are dealing with similar aspects of each item. To use an old cliché, are you comparing apples to apples?

Example of poor comparisons: Kubista studied the effects of a later start time on high school students, but Cook used a mixed methods approach. (This example does not compare similar items. It is not a clear contrast because the sentence does not discuss the same element of the articles. It is like comparing apples to oranges.)
Example of analogous comparisons: Cook used a mixed methods approach, whereas Kubista used only quantitative methods. (Here, methods are clearly being compared, allowing the reader to understand the distinction.

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Comparing and contrasting in an essay | Tips & examples

Comparing and Contrasting in an Essay | Tips & Examples

Published on August 6, 2020 by Jack Caulfield . Revised on July 23, 2023.

Comparing and contrasting is an important skill in academic writing . It involves taking two or more subjects and analyzing the differences and similarities between them.

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When should i compare and contrast, making effective comparisons, comparing and contrasting as a brainstorming tool, structuring your comparisons, other interesting articles, frequently asked questions about comparing and contrasting.

Many assignments will invite you to make comparisons quite explicitly, as in these prompts.

Compare the treatment of the theme of beauty in the poetry of William Wordsworth and John Keats.
Compare and contrast in-class and distance learning. What are the advantages and disadvantages of each approach?

Some other prompts may not directly ask you to compare and contrast, but present you with a topic where comparing and contrasting could be a good approach.

One way to approach this essay might be to contrast the situation before the Great Depression with the situation during it, to highlight how large a difference it made.

Comparing and contrasting is also used in all kinds of academic contexts where it’s not explicitly prompted. For example, a literature review involves comparing and contrasting different studies on your topic, and an argumentative essay may involve weighing up the pros and cons of different arguments.

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As the name suggests, comparing and contrasting is about identifying both similarities and differences. You might focus on contrasting quite different subjects or comparing subjects with a lot in common—but there must be some grounds for comparison in the first place.

For example, you might contrast French society before and after the French Revolution; you’d likely find many differences, but there would be a valid basis for comparison. However, if you contrasted pre-revolutionary France with Han-dynasty China, your reader might wonder why you chose to compare these two societies.

This is why it’s important to clarify the point of your comparisons by writing a focused thesis statement . Every element of an essay should serve your central argument in some way. Consider what you’re trying to accomplish with any comparisons you make, and be sure to make this clear to the reader.

Comparing and contrasting can be a useful tool to help organize your thoughts before you begin writing any type of academic text. You might use it to compare different theories and approaches you’ve encountered in your preliminary research, for example.

Let’s say your research involves the competing psychological approaches of behaviorism and cognitive psychology. You might make a table to summarize the key differences between them.

Or say you’re writing about the major global conflicts of the twentieth century. You might visualize the key similarities and differences in a Venn diagram.

A Venn diagram showing the similarities and differences between World War I, World War II, and the Cold War.

These visualizations wouldn’t make it into your actual writing, so they don’t have to be very formal in terms of phrasing or presentation. The point of comparing and contrasting at this stage is to help you organize and shape your ideas to aid you in structuring your arguments.

When comparing and contrasting in an essay, there are two main ways to structure your comparisons: the alternating method and the block method.

The alternating method

In the alternating method, you structure your text according to what aspect you’re comparing. You cover both your subjects side by side in terms of a specific point of comparison. Your text is structured like this:

Mouse over the example paragraph below to see how this approach works.

One challenge teachers face is identifying and assisting students who are struggling without disrupting the rest of the class. In a traditional classroom environment, the teacher can easily identify when a student is struggling based on their demeanor in class or simply by regularly checking on students during exercises. They can then offer assistance quietly during the exercise or discuss it further after class. Meanwhile, in a Zoom-based class, the lack of physical presence makes it more difficult to pay attention to individual students’ responses and notice frustrations, and there is less flexibility to speak with students privately to offer assistance. In this case, therefore, the traditional classroom environment holds the advantage, although it appears likely that aiding students in a virtual classroom environment will become easier as the technology, and teachers’ familiarity with it, improves.

The block method

In the block method, you cover each of the overall subjects you’re comparing in a block. You say everything you have to say about your first subject, then discuss your second subject, making comparisons and contrasts back to the things you’ve already said about the first. Your text is structured like this:

Point of comparison A
Point of comparison B

The most commonly cited advantage of distance learning is the flexibility and accessibility it offers. Rather than being required to travel to a specific location every week (and to live near enough to feasibly do so), students can participate from anywhere with an internet connection. This allows not only for a wider geographical spread of students but for the possibility of studying while travelling. However, distance learning presents its own accessibility challenges; not all students have a stable internet connection and a computer or other device with which to participate in online classes, and less technologically literate students and teachers may struggle with the technical aspects of class participation. Furthermore, discomfort and distractions can hinder an individual student’s ability to engage with the class from home, creating divergent learning experiences for different students. Distance learning, then, seems to improve accessibility in some ways while representing a step backwards in others.

Note that these two methods can be combined; these two example paragraphs could both be part of the same essay, but it’s wise to use an essay outline to plan out which approach you’re taking in each paragraph.

If you want to know more about AI tools , college essays , or fallacies make sure to check out some of our other articles with explanations and examples or go directly to our tools!

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Some essay prompts include the keywords “compare” and/or “contrast.” In these cases, an essay structured around comparing and contrasting is the appropriate response.

Comparing and contrasting is also a useful approach in all kinds of academic writing : You might compare different studies in a literature review , weigh up different arguments in an argumentative essay , or consider different theoretical approaches in a theoretical framework .

Your subjects might be very different or quite similar, but it’s important that there be meaningful grounds for comparison . You can probably describe many differences between a cat and a bicycle, but there isn’t really any connection between them to justify the comparison.

You’ll have to write a thesis statement explaining the central point you want to make in your essay , so be sure to know in advance what connects your subjects and makes them worth comparing.

Comparisons in essays are generally structured in one of two ways:

The alternating method, where you compare your subjects side by side according to one specific aspect at a time.
The block method, where you cover each subject separately in its entirety.

It’s also possible to combine both methods, for example by writing a full paragraph on each of your topics and then a final paragraph contrasting the two according to a specific metric.

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10.7 Comparison and Contrast

Learning objectives.

Determine the purpose and structure of comparison and contrast in writing.
Explain organizational methods used when comparing and contrasting.
Understand how to write a compare-and-contrast essay.

The Purpose of Comparison and Contrast in Writing

Comparison in writing discusses elements that are similar, while contrast in writing discusses elements that are different. A compare-and-contrast essay , then, analyzes two subjects by comparing them, contrasting them, or both.

The key to a good compare-and-contrast essay is to choose two or more subjects that connect in a meaningful way. The purpose of conducting the comparison or contrast is not to state the obvious but rather to illuminate subtle differences or unexpected similarities. For example, if you wanted to focus on contrasting two subjects you would not pick apples and oranges; rather, you might choose to compare and contrast two types of oranges or two types of apples to highlight subtle differences. For example, Red Delicious apples are sweet, while Granny Smiths are tart and acidic. Drawing distinctions between elements in a similar category will increase the audience’s understanding of that category, which is the purpose of the compare-and-contrast essay.

Similarly, to focus on comparison, choose two subjects that seem at first to be unrelated. For a comparison essay, you likely would not choose two apples or two oranges because they share so many of the same properties already. Rather, you might try to compare how apples and oranges are quite similar. The more divergent the two subjects initially seem, the more interesting a comparison essay will be.

Writing at Work

Comparing and contrasting is also an evaluative tool. In order to make accurate evaluations about a given topic, you must first know the critical points of similarity and difference. Comparing and contrasting is a primary tool for many workplace assessments. You have likely compared and contrasted yourself to other colleagues. Employee advancements, pay raises, hiring, and firing are typically conducted using comparison and contrast. Comparison and contrast could be used to evaluate companies, departments, or individuals.

Brainstorm an essay that leans toward contrast. Choose one of the following three categories. Pick two examples from each. Then come up with one similarity and three differences between the examples.

Romantic comedies
Internet search engines
Cell phones

Brainstorm an essay that leans toward comparison. Choose one of the following three items. Then come up with one difference and three similarities.

Department stores and discount retail stores
Fast food chains and fine dining restaurants
Dogs and cats

The Structure of a Comparison and Contrast Essay

The compare-and-contrast essay starts with a thesis that clearly states the two subjects that are to be compared, contrasted, or both and the reason for doing so. The thesis could lean more toward comparing, contrasting, or both. Remember, the point of comparing and contrasting is to provide useful knowledge to the reader. Take the following thesis as an example that leans more toward contrasting.

Thesis statement: Organic vegetables may cost more than those that are conventionally grown, but when put to the test, they are definitely worth every extra penny.

Here the thesis sets up the two subjects to be compared and contrasted (organic versus conventional vegetables), and it makes a claim about the results that might prove useful to the reader.

You may organize compare-and-contrast essays in one of the following two ways:

According to the subjects themselves, discussing one then the other
According to individual points, discussing each subject in relation to each point

See Figure 10.1 “Comparison and Contrast Diagram” , which diagrams the ways to organize our organic versus conventional vegetables thesis.

Figure 10.1 Comparison and Contrast Diagram

The organizational structure you choose depends on the nature of the topic, your purpose, and your audience.

Given that compare-and-contrast essays analyze the relationship between two subjects, it is helpful to have some phrases on hand that will cue the reader to such analysis. See Table 10.3 “Phrases of Comparison and Contrast” for examples.

Table 10.3 Phrases of Comparison and Contrast

Create an outline for each of the items you chose in Note 10.72 “Exercise 1” and Note 10.73 “Exercise 2” . Use the point-by-point organizing strategy for one of them, and use the subject organizing strategy for the other.

Writing a Comparison and Contrast Essay

First choose whether you want to compare seemingly disparate subjects, contrast seemingly similar subjects, or compare and contrast subjects. Once you have decided on a topic, introduce it with an engaging opening paragraph. Your thesis should come at the end of the introduction, and it should establish the subjects you will compare, contrast, or both as well as state what can be learned from doing so.

The body of the essay can be organized in one of two ways: by subject or by individual points. The organizing strategy that you choose will depend on, as always, your audience and your purpose. You may also consider your particular approach to the subjects as well as the nature of the subjects themselves; some subjects might better lend themselves to one structure or the other. Make sure to use comparison and contrast phrases to cue the reader to the ways in which you are analyzing the relationship between the subjects.

After you finish analyzing the subjects, write a conclusion that summarizes the main points of the essay and reinforces your thesis. See Chapter 15 “Readings: Examples of Essays” to read a sample compare-and-contrast essay.

Many business presentations are conducted using comparison and contrast. The organizing strategies—by subject or individual points—could also be used for organizing a presentation. Keep this in mind as a way of organizing your content the next time you or a colleague have to present something at work.

Choose one of the outlines you created in Note 10.75 “Exercise 3” , and write a full compare-and-contrast essay. Be sure to include an engaging introduction, a clear thesis, well-defined and detailed paragraphs, and a fitting conclusion that ties everything together.

Key Takeaways

A compare-and-contrast essay analyzes two subjects by either comparing them, contrasting them, or both.
The purpose of writing a comparison or contrast essay is not to state the obvious but rather to illuminate subtle differences or unexpected similarities between two subjects.
The thesis should clearly state the subjects that are to be compared, contrasted, or both, and it should state what is to be learned from doing so.

There are two main organizing strategies for compare-and-contrast essays.

Organize by the subjects themselves, one then the other.
Organize by individual points, in which you discuss each subject in relation to each point.
Use phrases of comparison or phrases of contrast to signal to readers how exactly the two subjects are being analyzed.

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how to compare and contrast research articles

The professor says to compare and contrast A and B ...

Determining the Structure of your Essay:

Determining the structure of your essay is the most important step towards conducting and presenting to the reader a well-developed comparison. Students are often asked to compare things in twos. For example, compare these two articles, or two characters in a novel, or a film and a novel or an article and a poem... The possibilities are endless.

When you are faced with the task of having to compare and contrast, it can be overwhelming. You're thinking about two pieces of writing that you know are different, and perhaps there are some similarities, too, but how can you suddenly start talking about them both? Which one should I talk about first? Which one should I talk about last?

Sometimes, comparisons are done in the following manner:

You pick one article to describe: Article A. Then you talk about Article B. Perhaps at the end, you talk about the similarities in both articles.

This format will consist of three main parts: A, B, and, finally, their similarities.

Although this format is an acceptable way of making comparisons, and it is sometimes used to present well-developed "compare and contrast" essays, the format has its weaknesses that can jeopardize an effective comparison.

What could happen when you use this format and you completely isolate Article A from Article B is that you make it more difficult to compare. Your final essay might end up divided in two parts: half of the paper talks about only Article A and the second half talks about only Article B . You do not want to split your essay into a description of Article A and a description of Article B because then it will be harder to compare them since you invested most of your energy into describing them and not comparing them.

How to avoid the "Split Essay": A Second Option for Comparison

The best way to avoid the Split Essay is to unify both split ends. Do not discuss Article B at the end. Talk about both A and B from the beginning. The question now is:

What do I do to eliminate the Split?

Break it down:

You do not get rid of the gap between the two halves of the essay that are split. You simply break it down . This is done by finding common themes, or points of comparison in Article A and Article B. Once you find those points of comparison, you can discuss each individual theme and how each shows up in Article A and B . Consider the following questions:

What major themes are discussed in each of the essays?
What doe the writer of Article A say about the first theme, and how is this similar to or different than what the writer of Article B says about the same topic?
What conclusions can you make about these differences or similarities?

After developing a thorough explanation of the first theme, you can mow move on to discuss the second theme that appears in both essays and write about it. Ideally, each theme will be discussed thoroughly in its own paragraph, explaining how each is similar or different in Article A and Article B

During the seventies, Gabriel Garcia Marquez wrote his most famous novel, One Hundred Years of Solitude , in which he discussed themes regarding the solitude of Latin America.

In 1982, Marquez received the Nobel Prize in Literature for his novel and wrote a speech for this occasion. In his speech, he called attention to Latin American economic struggles and their historical context.

In 1990, Enrique Krauze, a Mexican economist, published an article in which he discussed the same topic: problems in Latin American economics.

The prompt says:

Compare and contrast Enrique Krauze's essay to the speech written by Marquez.

Possible approaches:

Option #1: Text by text comparison

First paragraph:

A: An explanation of Marquez's entire speech

Second paragraph:

B: An explanation of Krauze's entire essay

Third paragraph:

Similarities or differences

(this might lead to the "Split Essay" comparison)

Option #2: Point by point comparison

The breakdown: Finding common themes or points of comparison:

• Neoliberalism (free trade)

• US involvement

• Proposed solutions to the problems (macro or micro economy?)

A: Krauze's opinion on neoliberalism

B: Marquez's opinion on neoliberalism

A: US involvement good or bad? According to Marquez

B: US involvement good or bad? According to Krauze

Whatever other theme that stands out as significant for explaining the differences of opinions.

Sample paragraph:

Enrique Krauze and Gabriel Garcia Marquez take different positions in regards to the implementation of more neoliberalist policies in Latin American countries. While Krauze argues the need to expand open trade in Latin America to improve its economy, Marquez opposes this idea and argues that an open trade economy would only aid foreign investors in further exploiting the natural resources in Latin America. Krauze's support of neoliberalism is based on the idea that through a macro economy, the "undeveloped" countries will soon see the light at the end of the tunnel. On the other hand, Marquez rebuts this argument, claiming that the World Bank and the International Monetary Fund, which forced neoliberalist policies onto Latin American countries, only served to increase their foreign debt.

Notice how the beginning of this paragraph discusses only one theme: neoliberalism. Also notice how the writer was able to incorporate both articles and not just one. Pay attention, too, to the use of words and phrases that juxtapose or suggest comparison. These words establish links between A and B .

Handout created by Rubén Garibaldo, Student Learning Center, University of California, Berkeley

Handout revised by Carolyn Swalina, Student Learning Center, University of California, Berkeley

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

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Writing Resources

The matrix method for literature reviews.

This handout is available for download in DOCX format and PDF format .

What is the Matrix Method, and why should I use it?

Using a review matrix enables you to quickly compare and contrast articles in order to determine the scope of research across time. A review matrix can help you more easily spot differences and similarities between journal articles about a research topic. While they may be helpful in any discipline, review matrices are especially helpful for health sciences literature reviews covering the complete scope of a research topic over time. This guide focuses on the review matrix step in the literature review process and offers tips on how to use it effectively.

Organize your sources

Once you complete your research, organize your source by date in order to make it easier to see changes in research over time.

Begin by creating the blank matrix. The matrices can be easily constructed using table-making software such as Microsoft Excel, Word or OneNote, Google Sheets, or Numbers. Every review matrix should have the same first three column headings: (1) authors, title, and journal, (2) publication year, and (3) purpose.

Table headings and one sample entry showing "authors, title, and journal" in column A, "publication year" in column B, and "purpose" in column C.

Be aware that it may be difficult to determine purpose from just a cursory review of the article. In some cases, it may be necessary to first read the paper fully to identify its purpose.

Choose your remaining column topics

Next, carefully read all your articles. Note any important issues you identify. The following broad categories provide some suggestions for determining your own subject headings:

Methodological

Methodology is often an important question. For example, if you are looking at tests of an Ebola vaccine beyond human subjects, it will be important to note what type of animal the test was carried out on, i.e. macaques or mice.

Content-specific

Consider noting what was actually studied. For example, when looking at the effectiveness of traditional Chinese medicine in the treatment of illnesses, it would be important to note what illness was being studied.

Geographical

It may be important to note where the research was completed. For example, if you want to compare the effects of the AIDS epidemic in different countries, you would use country as a column heading.

There are many ways to choose your column headings, and these are just a few suggestions. As you create your own matrix, choose column headings that support your research question and goals.

Do not include column headings that are explicit in your research question. For example, if you are looking at drug use in adolescents, do not include a column heading for age of study participants. If the answer will be the same for every study, it's generally a bad choice for a column heading.
Do not try to fully complete a review matrix before reading the articles. Reading the articles is an important way to discern the nuances between studies.

Credit: Adapted from David Nolfi, “Matrix Method for Literature Review: The Review Matrix,” Duquesne University, https://guides.library.duq.edu/matrix , 2020.

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Writing A Compare/Contrast Paper

TIP Sheet WRITING A COMPARE/CONTRAST PAPER

A compare and contrast essay examines two or more topics (objects, people, or ideas, for example), comparing their similarities and contrasting their differences. You may choose to focus exclusively on comparing, exclusively on contrasting, or on both-or your instructor may direct you to do one or both.

First, pick useable subjects and list their characteristics. In fact, their individual characteristics determine whether the subjects are useable. After that, choose a parallel pattern of organization and effective transitions to set your paper above the merely average.

1. Picking a subject Focus on things that can obviously be compared or contrasted. For instance, if you are examining an idea (political or philosophical) examine the opposite of that idea. Or, if you are examining a person, like a president, pick another president for comparison or contrast. Don't try to compare a president and a cab driver, or existentialism and a legislative bill on car tax refunds.

2. Listing characteristics Divide a piece of paper into two sides. One side is for the first subject, the other for the second subject. Then, begin to list the similarities and differences that immediately come to mind. Concentrate on characteristics that either are shared or are opposing between the two subjects. Alternately, you may construct a Venn diagram of intersecting circles, listing the subjects' differences to either side and their similarities where the circles intersect. Keep in mind that for a balanced paper, you want to make point-by-point, parallel comparisons (or contrasts).

Similarities between my math and English instructors: Both are welcoming and available to students. Both are organized and keep a neat office. Both are knowledgeable and professional.

Differences between my math and English instructors Math teacher listens to classic rock. English teacher listens to jazz. Math teacher drinks Earl Grey tea. English teacher drinks strong black coffee. Math teacher likes to chat about movies. English teacher sticks to business.

As you create your list, is it clear why you are comparing and contrasting these two subjects? Do you have a preference for one or the other? If so, make sure you are evaluating each side fairly. A point-by-point list helps you maintain balance.

Once you have a list, decide whether there are more similarities or differences between the topics. If there are more similarities, concentrate your paper on comparing. If there are more differences (or if, as in the example above, the differences are simply more interesting), concentrate on contrasting. If there is a balance of similarities and differences, you might concentrate on discussing this balance.

3. Organizing There are at least two ways to organize a compare/contrast essay. Imagine you are examining Robert E. Lee and Ulysses S. Grant, both Civil War generals. In your list you have uncovered important points of dissimilarity between them. Those points are their background, personalities, and underlying aspirations. (Call these three points A, B, and C.) You have decided to contrast the two subjects.

Here is one way to organize the body of this paper, addressing points A, B, and C for each subject. This paper will follow parallel order–A, B, and then C–for each subject:

A. Lee's background B. Lee's personality C. Lee's underlying aspirations

A. Grant's background B. Grant's personality C. Grant's underlying aspirations

However, here is another way to organize the same paper:

A. Lee's background A. Grant's background

B. Lee's personality B. Grant's personality

C. Lee's underlying aspiration C. Grant's underlying aspiration

For a shorter paper, the above might represent three paragraphs; if you are writing a long paper and have a great deal of information, you may choose to write about each point, A, B, and C, in separate paragraphs for a total of six. However you decide to organize, make sure it is clear why you are examining this subject. You might be able to compare apples and oranges, for example, but why would you? Include any insights or opinions you have gathered. And yes, in general, three is the magic number. While there is no hard-and-fast rule that precludes creating a paper based on two points, or four, or five, a three-point discussion is manageable, especially for complex or abstract subjects. At the same time, a three-point structure helps you avoid oversimplifying, especially when addressing controversial topics in which discussions tend to become polarized–right or wrong, black or white, for or against. Three-point treatments encourage discussion of the middle ground.

4. Signaling transitions Learn to use expressions that precisely convey contrast or comparison. These expressions, or transitions, signal contrast:

on the contrary on the other hand however otherwise whereas still yet

These expressions signal comparison:

as well as both like in common with likewise also

Signal words such as these help the reader understand the relationships between your sentences, paragraphs, and ideas. In particular, if you are both comparing and contrasting, signal words help sort out what's what. Second only to effective organization, effective use of these expressions will go a long way toward helping produce a good compare/contrast paper.

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Sophomore Research: Compare & Contrast

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Comparative Analysis

A comparative paper asks that you compare at least two (possibly more) items. These items will differ depending on the assignment. You might be asked to compare:

positions on an issue (e.g., responses to midwifery in Canada and the United States)
theories (e.g., capitalism and communism)
figures (e.g., GDP in the United States and Britain)
texts (e.g., Shakespeare’s Hamlet and Macbeth)
events (e.g., the Great Depression and the global financial crisis of 2008–9)

Although the assignment may say “compare,” the assumption is that you will consider both the similarities and differences; in other words, you will compare and contrast .

University of Toronto

Comparing and Contrasting - UNC Writing Center

Comparing and Contrasting Handout - UNC-CH Writing Center

Finding Similarities and Differences

Write down as many ideas as you can about your two topics.

Use a Venn diagram or a Chart when writing down similarities and differences.

Venn Diagrams can be key for a visualization of comparing two or more items. To make a Venn diagram, simply draw a circle for each item you are comparing/contrasting and overlap them. In the central area, list the traits that all items have in common.

Charts are more useful when you have specific criteria in mind. To make a chart, list the names of items across the top of each column then list the criteria in each row. You will then have a box to describe each of the criteria for each item.

Pick out the three best ideas to show the three main ways the two items are similar or different for the focus of your paper.

Questions to Ask

Some Questions to consider when looking for similarities or differences between your two topics.

Who had something to do with your topic?
What happened to your topic?
Where did your topic take place?
When did your topic happen?
Why did your topic happen?
How did your topic happen?

Signal Transitions for Compare/Contrast

on the contrary
on the other hand

These expressions signal comparison :

in common with

Transitions Handout - UNC-CH Writing Center

Point by Point Comparison Outline Format

The most popular form of compare/contrast papers, Point by Point Outlines focus on the topics of similarities or differences and then view each item in comparison. This method can support any number of items to compare as it will be the topics that form the paragraphs.

Point by Point Outline Format

1. Introduction a. Introduce Items (works/objects) b. Thesis Statement i. Topic 1 ii. Topic 2 iii. Topic 3 iv. Etc. 2. Topic 1 a. Summary of Topic i. Relation to Item 1 ii. Relation to Item 2 iii. Etc. 3. Topic 2 a. Summary of Topic i. Relation to Item 1 ii. Relation to Item 2 iii. Etc. 4. Topic 3...4...5...etc. a. Summary of Topic i. Relation to Item 1 ii. Relation to Item 2 iii. Etc. 5. Conclusion a. Restate Thesis b. Summarize how you proved your argument

Example: Point by Point Outline

1. Introduction a. Introduce Items i. First Work – The Lord of the Rings Trilogy had ample preparation time, budget, and a generous release schedule but used practical effects to attain greater realism and focused more on story telling rather than “filmable moments” that added little to the plot. ii. Second Work – The Hobbit Trilogy did not have the preparation time, budget, or generous release schedule in order to be successful films. b. Thesis Statement i. When comparing the Lord of the Rings Trilogy and the Hobbit Trilogy, it is clear that preparation time, budget, special effects, and a well-spaced release schedule can have a tremendous effect on film quality. 2. Preparation Time a. Hobbit Trilogy Examples b. Lord of the Rings Examples 3. Budget a. Hobbit Trilogy Examples b. Lord of the Rings Examples 4. Release Schedule a. Hobbit Trilogy Examples b. Lord of the Rings Examples 5. Practical Effects/CGI a. Hobbit Trilogy Examples b. Lord of the Rings Examples 6. Conclusion a. Restate Thesis b. Summarize how you proved your argument

Texas State Technical College

Subject Comparison Outline Format

This style of paper focuses more on the items themselves rather than focusing on the points. This can lead to a weaker argument as to why one item is superior to another or be nothing more than a list of points with no connection between the two items. Not recommended for comparing/contrasting more than two items.

Subject Outline

1. Introduction a. Introduce Items (works/objects) b. Thesis Statement i. Supporting Point 1 ii. Supporting Point 2 iii. Etc. 2. Explanation of First Item (work/object) a. Information on Supporting Point 1 b. Information on Supporting Point 2 c. Etc. 3. Explanation of Second Item (work/object) a. Information on Supporting Point 1 b. Information on Supporting Point 2 c. Etc. 4. Conclusion a. Restate Thesis b. Summarize how you proved your argument

Example: Subject Outline

1. Introduction a. Introduce Items i. First Work – The Lord of the Rings Trilogy had ample preparation time, budget, and a generous release schedule but used practical effects to attain greater realism and focused more on story telling rather than “filmable moments” that added little to the plot. ii. Second Work – The Hobbit Trilogy did not have the preparation time, budget, or generous release schedule in order to be successful films. b. Thesis Statement i. When comparing the Lord of the Rings Trilogy and the Hobbit Trilogy, it is clear that preparation time, budget, special effects, and a well-spaced release schedule can have a tremendous effect on film quality. 2. Lord of the Rings Trilogy a. Preparation Time b. Budget c. Release Schedule d. Practical Effects/CGI 3. Hobbit Trilogy a. Preparation Time b. Budget c. Release Schedule d. Practical Effects/CGI 4. Conclusion a. Restate Thesis b. Summarize how you proved your argument

Compare Then Contrast Outline Format

Compare Then Contrast : Useful for when your assignment asks you to both compare AND contrast items. Each paragraph immediately focuses on discussions of similarities and weaknesses. While this method works best for short answer or essays, it is possible to take each similarity/difference and turn it into its own paragraph.

Compare Then Contrast Outline

1. Introduction a. Introduce Items (works/objects) b. Thesis Statement i.Topic 1 ii. Topic 2 iii. Topic 3 iv. Etc. 2. Similarities between Works/Objects a. Similarity 1 b. Similarity 2 c. Etc. 3. Differences between Works/Objects a. Difference 1 b. Difference 2 c. Etc. 4. Summary as to why one work/object is better than the other a. Supporting Point 1 b. Supporting Point 2 c. Etc. 5. Conclusion a. Restate Thesis b. Summarize how you proved your argument

Example: Compare Then Contrast Outline

1. Introduction a. Introduce Items i. First Work – The Lord of the Rings Trilogy had ample preparation time, budget, and a generous release schedule but used practical effects to attain greater realism and focused more on story telling rather than “filmable moments” that added little to the plot. ii. Second Work – The Hobbit Trilogy did not have the preparation time, budget, or generous release schedule in order to be successful films. b. Thesis Statement i. When comparing the Lord of the Rings Trilogy and the Hobbit Trilogy, it is clear that preparation time, budget, special effects, and a well-spaced release schedule can have a tremendous effect on film quality. 2. Similarities a. Release Schedule b. Budget 3. Differences a. Preparation Time b. Practical Effects/CGI 4. Conclusion a. Restate Thesis b. Summarize how you proved your argument

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Writing for Success: Compare/Contrast

LEARNING OBJECTIVES

This section will help you determine the purpose and structure of comparison/contrast in writing.

The Purpose of Compare/Contrast in Writing

Comparison in writing discusses elements that are similar, while contrast in writing discusses elements that are different. A compare-and-contrast essay, then, analyzes two subjects by comparing them, contrasting them, or both.

The Structure of a Compare/Contrast Essay

Thesis Statement: Organic vegetables may cost more than those that are conventionally grown, but when put to the test, they are definitely worth every extra penny.

Here the thesis sets up the two subjects to be compared and contrasted (organic versus conventional vegetables), and it makes a claim about the results that might prove useful to the reader.

You may organize compare-and-contrast essays in one of the following two ways:

According to the subjects themselves, discussing one then the other
According to individual points, discussing each subject in relation to each point

The organizational structure you choose depends on the nature of the topic, your purpose, and your audience.

Given that compare-and-contrast essays analyze the relationship between two subjects, it is helpful to have some phrases on hand that will cue the reader to such analysis.

Phrases of Comparison and Contrast

Writing an Compare/Contrast Essay

After you finish analyzing the subjects, write a conclusion that summarizes the main points of the essay and reinforces your thesis.

Compare/Contrast Essay Example

Comparing and Contrasting London and Washington, DC

By Scott McLean in Writing for Success

Both Washington, DC, and London are capital cities of English-speaking countries, and yet they offer vastly different experiences to their residents and visitors. Comparing and contrasting the two cities based on their history, their culture, and their residents show how different and similar the two are.

Both cities are rich in world and national history, though they developed on very different time lines. London, for example, has a history that dates back over two thousand years. It was part of the Roman Empire and known by the similar name, Londinium. It was not only one of the northernmost points of the Roman Empire but also the epicenter of the British Empire where it held significant global influence from the early sixteenth century on through the early twentieth century. Washington, DC, on the other hand, has only formally existed since the late eighteenth century. Though Native Americans inhabited the land several thousand years earlier, and settlers inhabited the land as early as the sixteenth century, the city did not become the capital of the United States until the 1790s. From that point onward to today, however, Washington, DC, has increasingly maintained significant global influence. Even though both cities have different histories, they have both held, and continue to hold, significant social influence in the economic and cultural global spheres.

Both Washington, DC, and London offer a wide array of museums that harbor many of the world’s most prized treasures. While Washington, DC, has the National Gallery of Art and several other Smithsonian galleries, London’s art scene and galleries have a definite edge in this category. From the Tate Modern to the British National Gallery, London’s art ranks among the world’s best. This difference and advantage has much to do with London and Britain’s historical depth compared to that of the United States. London has a much richer past than Washington, DC, and consequently has a lot more material to pull from when arranging its collections. Both cities have thriving theater districts, but again, London wins this comparison, too, both in quantity and quality of theater choices. With regard to other cultural places like restaurants, pubs, and bars, both cities are very comparable. Both have a wide selection of expensive, elegant restaurants as well as a similar amount of global and national chains. While London may be better known for its pubs and taste in beer, DC offers a different bar-going experience. With clubs and pubs that tend to stay open later than their British counterparts, the DC night life tend to be less reserved overall.

Both cities also share and differ in cultural diversity and cost of living. Both cities share a very expensive cost of living—both in terms of housing and shopping. A downtown one-bedroom apartment in DC can easily cost $1,800 per month, and a similar “flat” in London may double that amount. These high costs create socioeconomic disparity among the residents. Although both cities’ residents are predominantly wealthy, both have a significantly large population of poor and homeless. Perhaps the most significant difference between the resident demographics is the racial makeup. Washington, DC, is a “minority majority” city, which means the majority of its citizens are races other than white. In 2009, according to the US Census, 55 percent of DC residents were classified as “Black or African American” and 35 percent of its residents were classified as “white.” London, by contrast, has very few minorities—in 2006, 70 percent of its population was “white,” while only 10 percent was “black.” The racial demographic differences between the cities is drastic.

Even though Washington, DC, and London are major capital cities of English-speaking countries in the Western world, they have many differences along with their similarities. They have vastly different histories, art cultures, and racial demographics, but they remain similar in their cost of living and socioeconomic disparity.

KEY TAKEAWAYS

A compare-and-contrast essay analyzes two subjects by either comparing them, contrasting them, or both.
The purpose of writing a comparison or contrast essay is not to state the obvious but rather to illuminate subtle differences or unexpected similarities between two subjects.
The thesis should clearly state the subjects that are to be compared, contrasted, or both, and it should state what is to be learned from doing so.
There are two main organizing strategies for compare-and-contrast essays.
Organize by the subjects themselves, one then the other.
Organize by individual points, in which you discuss each subject in relation to each point.
Use phrases of comparison or phrases of contrast to signal to readers how exactly the two subjects are being analyzed.
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Successful Writing. Provided by : Anonymous. Located at : http://2012books.lardbucket.org/books/successful-writing/s14-07-comparison-and-contrast.html . License : CC BY-NC-SA: Attribution-NonCommercial-ShareAlike
Comparing and Contrasting London and Washington, DC. Authored by : Scott McLean. Located at : http://2012books.lardbucket.org/books/successful-writing/s14-07-comparison-and-contrast.html . License : CC BY-NC-SA: Attribution-NonCommercial-ShareAlike
Table of Contents

Instructor Resources (Access Requires Login)

Overview of Instructor Resources

An Overview of the Writing Process

Introduction to the Writing Process
Introduction to Writing
Your Role as a Learner
What is an Essay?
Reading to Write
Defining the Writing Process
Videos: Prewriting Techniques
Thesis Statements
Organizing an Essay
Creating Paragraphs
Conclusions
Editing and Proofreading
Matters of Grammar, Mechanics, and Style
Peer Review Checklist
Comparative Chart of Writing Strategies

Using Sources

Quoting, Paraphrasing, and Avoiding Plagiarism
Formatting the Works Cited Page (MLA)
Citing Paraphrases and Summaries (APA)
APA Citation Style, 6th edition: General Style Guidelines

Definition Essay

Definitional Argument Essay
How to Write a Definition Essay
Critical Thinking
Video: Thesis Explained
Effective Thesis Statements
Student Sample: Definition Essay

Narrative Essay

Introduction to Narrative Essay
Student Sample: Narrative Essay
"Shooting an Elephant" by George Orwell
"Sixty-nine Cents" by Gary Shteyngart
Video: The Danger of a Single Story
How to Write an Annotation
How to Write a Summary
Writing for Success: Narration

Illustration/Example Essay

Introduction to Illustration/Example Essay
"She's Your Basic L.O.L. in N.A.D" by Perri Klass
"April & Paris" by David Sedaris
Writing for Success: Illustration/Example
Student Sample: Illustration/Example Essay

Compare/Contrast Essay

Introduction to Compare/Contrast Essay
"Disability" by Nancy Mairs
"Friending, Ancient or Otherwise" by Alex Wright
"A South African Storm" by Allison Howard
Student Sample: Compare/Contrast Essay

Cause-and-Effect Essay

Introduction to Cause-and-Effect Essay
"Cultural Baggage" by Barbara Ehrenreich
"Women in Science" by K.C. Cole
Writing for Success: Cause and Effect
Student Sample: Cause-and-Effect Essay

Argument Essay

Introduction to Argument Essay
Rogerian Argument
"The Case Against Torture," by Alisa Soloman
"The Case for Torture" by Michael Levin
How to Write a Summary by Paraphrasing Source Material
Writing for Success: Argument
Student Sample: Argument Essay
Grammar/Mechanics Mini-lessons
Mini-lesson: Subjects and Verbs, Irregular Verbs, Subject Verb Agreement
Mini-lesson: Sentence Types
Mini-lesson: Fragments I
Mini-lesson: Run-ons and Comma Splices I
Mini-lesson: Comma Usage
Mini-lesson: Parallelism
Mini-lesson: The Apostrophe
Mini-lesson: Capital Letters
Grammar Practice - Interactive Quizzes
De Copia - Demonstration of the Variety of Language
Style Exercise: Voice

Features for Creative Writers
Features for Work
Features for Higher Education
Features for Teachers
Features for Non-Native Speakers
Learn Blog Grammar Guide Community Events FAQ
Grammar Guide

Comparing and Contrasting: A Guide to Improve Your Essays

Walter Akolo

Essays that require you to compare and contrast two or more subjects, ideas, places, or items are common.

They call for you to highlight the key similarities (compare) and differences (contrast) between them.

This guide contains all the information you need to become better at writing comparing and contrasting essays.

This includes: how to structure your essay, how to decide on the content, and some examples of essay questions.

Let’s dive in.

What Is Comparing and Contrasting?

Is compare and contrast the same as similarities and differences, what is the purpose of comparing and contrasting, can you compare and contrast any two items, how do you compare and contrast in writing, what are some comparing and contrasting techniques, how do you compare and contrast in college level writing, the four essentials of compare and contrast essays, what can you learn from a compare and contrast essay.

At their most basic, both comparing and contrasting base their evaluation on two or more subjects that share a connection.

The subjects could have similar characteristics, features, or foundations.

But while a comparison discusses the similarities of the two subjects, e.g. a banana and a watermelon are both fruit, contrasting highlights how the subjects or items differ from each other, e.g. a watermelon is around 10 times larger than a banana.

Any question that you are asked in education will have a variety of interesting comparisons and deductions that you can make.

Compare is the same as similarities.

Contrast is the same as differences.

This is because comparing identifies the likeness between two subjects, items, or categories, while contrasting recognizes disparities between them.

When you compare things, you represent them regarding their similarity, but when you contrast things, you define them in reference to their differences.

As a result, if you are asked to discuss the similarities and differences between two subjects, you can take an identical approach to if you are writing a compare and contrast essay.

In writing, the purpose of comparing and contrasting is to highlight subtle but important differences or similarities that might not be immediately obvious.

By illustrating the differences between elements in a similar category, you help heighten readers’ understanding of the subject or topic of discussion.

For instance, you might choose to compare and contrast red wine and white wine by pointing out the subtle differences. One of these differences is that red wine is best served at room temperature while white is best served chilled.

Also, comparing and contrasting helps to make abstract ideas more definite and minimizes the confusion that might exist between two related concepts.

Can Comparing and Contrasting Be Useful Outside of Academia?

Comparing enables you to see the pros and cons, allowing you to have a better understanding of the things under discussion. In an essay, this helps you demonstrate that you understand the nuances of your topic enough to draw meaningful conclusions from them.

Let's use a real-word example to see the benefits. Imagine you're contrasting two dresses you could buy. You might think:

Dress A is purple, my favorite color, but it has a difficult zip and is practically impossible to match a jacket to.
Dress B is more expensive but I already have a suitable pair of shoes and jacket and it is easier to move in.

You're linking the qualities of each dress to the context of the decision you're making. This is the same for your essay. Your comparison and contrast points will be in relation to the question you need to answer.

Comparing and contrasting is only a useful technique when applied to two related concepts.

To effectively compare two or more things, they must feature characteristics similar enough to warrant comparison.

In addition to this they must also feature a similarity that generates an interesting discussion. But what do I mean by “interesting” here?

Let’s look at two concepts, the Magna Carta and my third grade poetry competition entry.

They are both text, written on paper by a person so they fulfil the first requirement, they have a similarity. But this comparison clearly would not fulfil the second requirement, you would not be able to draw any interesting conclusions.

However, if we compare the Magna Carta to the Bill of Rights, you would be able to come to some very interesting conclusions concerning the history of world politics.

To write a good compare and contrast essay, it’s best to pick two or more topics that share a meaningful connection .

The aim of the essay would be to show the subtle differences or unforeseen similarities.

By highlighting the distinctions between elements in a similar category you can increase your readers’ understanding.

Alternatively, you could choose to focus on a comparison between two subjects that initially appear unrelated.

The more dissimilar they seem, the more interesting the comparison essay will turn out.

For instance, you could compare and contrast professional rugby players with marathon runners.

Can You Compare and Contrast in an Essay That Does Not Specifically Require It?

As a writer, you can employ comparing and contrasting techniques in your writing, particularly when looking for ideas you can later apply in your argument.

You can do this even when the comparison or contrast is not a requirement for the topic or argument you are presenting. Doing so could enable you to build your evaluation and develop a stronger argument.

Note that the similarities and differences you come up with might not even show up in the final draft.

While the use of compare and contrast can be neutral, you can also use it to highlight one option under discussion. When used this way, you can influence the perceived advantages of your preferred option.

As a writing style, comparing and contrasting can encompass an entire essay. However, it could also appear in some select paragraphs within the essay, where making some comparisons serves to better illustrate a point.

What Should You Do First?

Before you compare two things, always start by deciding on the reason for your comparison, then outline the criteria you will use to compare them.

Words and phrases commonly used for comparison include:

In writing, these words and phrases are called transitions . They help readers to understand or make the connection between sentences, paragraphs, and ideas.

Without transition words writing can feel clumsy and disjointed making it difficult to read. ProWritingAid’s transition report highlights all of a documents transitions and suggests that 25% of any sentences in a piece include a transition.

So, how do you form all of this into a coherent essay? It's a good idea to plan first, then decide what your paragraph layout will look like.

Venn diagrams are useful tool to start generating ideas. The, for your essay, you need to choose between going idea by idea and going point by point.

Using a Venn Diagram

A Venn diagram helps you to clearly see the similarities and differences between multiple objects, things, or subjects.

The writing tool comprises two, or more, simple, overlapping circles in which you list down the things that are alike (within the overlapping area) and those that differ (outside the overlapping area).

It’s great for brainstorming ideas and for creating your essay’s outline. You could even use it in an exam setting because it is quick and simple.

Going Subject by Subject

Going subject by subject is a structural choice for your essay.

Start by saying all you have to say on the first subject, then proceed to do the same about the second subject.

Depending on the length of your essay, you can fit the points about each subject into one paragraph or have several sections per each subject, ending with a conclusion.

This method is best for short essays on simple topics. Most university-level essays will go point by point instead.

Going Point by Point

Going point by point, or alternating, is the opposite essay structure from going subject by subject. This is ideal when you want to do more direct comparing and contrasting. It entails discussing one comparison point at a time. It allows you to use a paragraph to talk about how a certain comparing/contrasting point relates to the subjects or items you are discussing.

Alternatively, if you have lots of details about the subject, you might decide to use a paragraph for each point.

An academic compare and contrast essay looks at two or more subjects, ideas, people, or objects, compares their likeness, and contrasts their differences.

It’s an informative essay that provides insights on what is similar and different between the two items.

Depending on the essay’s instructions, you can focus solely on comparing or contrasting, or a combination of the two.

Examples of College Level Compare and Contrast Essay Questions

Here are eleven examples of compare and contrast essay questions that you might encounter at university:

Archaeology: Compare and contrast the skulls of homo habilis, homo erectus, and homo sapiens.
Art: Compare and contrast the working styles of any two Neoclassic artists.
Astrophysics: Compare and contrast the chemical composition of Venus and Neptune.
Biology: Compare and contrast the theories of Lamarck and Darwin.
Business: Compare and contrast 2 or more business models within the agricultural industry.
Creative writing: Compare and contrast free indirect discourse with epistolary styles.
English Literature: Compare and contrast William Wordsworth with Robert Browning.
Geography: Compare and contrast the benefit of solar panels with the benefit of wind turbines.
History: Compare and contrast WWI to WWII with specific reference to the causes and outcomes.
Medicine: Compare and contrast England’s health service with America’s health service.
Psychology: Compare and contrast the behaviorist theory with the psychodynamic theory.

So, the key takeaways to keep in mind are:

Have a basis for comparison. The two things need to have enough in common to justify a discussion about their similarities and disparities.

Don’t go back and forth when using the block method. The best way to write your essay is to begin with a paragraph discussing all the facets of the first topic. Then, move on to another paragraph and talk through all the aspects of the second subject.

You can use both alternating and blocking techniques. Combining the two approaches is also an option. You can apply the alternating method in some paragraphs, then switch and use the block method. This method will help you offer a much deeper analysis of the subjects.

Have a reason for comparing the two things. Only select the points of comparison that resonate with your purpose.

Comparing and contrasting are essential analytical skills in academic writing. When your professor issues you with such an essay, their primary goal is to teach you how to:

Engage in critical thinking
See and make connections between words or ideas
Move beyond mere descriptions or summaries to developing interesting analysis
Get a deeper understanding of the subjects or items under comparison, their key features, and their interrelationships with each other.

The benefits of comparing and contrasting

Ultimately, your essay should enlighten readers by providing useful information.

Want to use ProWritingAid with your classroom? Download this free book now:

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Check every email, essay, or story for grammar mistakes. Fix them before you press send.

Walter Akolo is a freelance writer, internet marketer, trainer, and blogger for hire. He loves helping businesses increase their reach and conversion through excellent and engaging content. He has gotten millions of pageviews on his blog, FreelancerKenya, where he mentors writers. Check out his website walterakolo.com.

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4.1: Introduction to Comparison and Contrast Essay

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The key to a good compare-and-contrast essay is to choose two or more subjects that connect in a meaningful way. Comparison and contrast is simply telling how two things are alike or different. The compare-and-contrast essay starts with a thesis that clearly states the two subjects that are to be compared, contrasted, or both. The thesis should focus on comparing, contrasting, or both.

Key Elements of the Compare and Contrast:

A compare-and-contrast essay analyzes two subjects by either comparing them, contrasting them, or both.
The purpose of writing a comparison or contrast essay is not to state the obvious but rather to illuminate subtle differences or unexpected similarities between two subjects.
The thesis should clearly state the subjects that are to be compared, contrasted, or both, and it should state what is to be learned from doing so.
Organize by the subjects themselves, one then the other.
Organize by individual points, in which you discuss each subject in relation to each point.
Use phrases of comparison or phrases of contrast to signal to readers how exactly the two subjects are being analyzed.

Objectives: By the end of this unit, you will be able to

Identify compare & contrast relationships in model essays
Construct clearly formulated thesis statements that show compare & contrast relationships
Use pre-writing techniques to brainstorm and organize ideas showing a comparison and/or contrast
Construct an outline for a five-paragraph compare & contrast essay
Write a five-paragraph compare & contrast essay
Use a variety of vocabulary and language structures that express compare & contrast essay relationships

Example Thesis: Organic vegetables may cost more than those that are conventionally grown, but when put to the test, they are definitely worth every extra penny.

Graphic Showing Organization for Comparison Contrast Essay

Sample Paragraph:

Organic grown tomatoes purchased at the farmers’ market are very different from tomatoes that are grown conventionally. To begin with, although tomatoes from both sources will mostly be red, the tomatoes at the farmers’ market are a brighter red than those at a grocery store. That doesn’t mean they are shinier—in fact, grocery store tomatoes are often shinier since they have been waxed. You are likely to see great size variation in tomatoes at the farmers’ market, with tomatoes ranging from only a couple of inches across to eight inches across. By contrast, the tomatoes in a grocery store will be fairly uniform in size. All the visual differences are interesting, but the most important difference is the taste. The farmers’ market tomatoes will be bursting with flavor from ripening on the vine in their own time. However, the grocery store tomatoes are often close to being flavorless. In conclusion, the differences in organic and conventionally grown tomatoes are obvious in color, size and taste.

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How to Write a Compare and Contrast Essay

Last Updated: May 12, 2023 Approved

This article was co-authored by Megan Morgan, PhD . Megan Morgan is a Graduate Program Academic Advisor in the School of Public & International Affairs at the University of Georgia. She earned her PhD in English from the University of Georgia in 2015. wikiHow marks an article as reader-approved once it receives enough positive feedback. This article has 29 testimonials from our readers, earning it our reader-approved status. This article has been viewed 3,099,859 times.

The purpose of a compare and contrast essay is to analyze the differences and/or the similarities of two distinct subjects. A good compare/contrast essay doesn’t only point out how the subjects are similar or different (or even both!). It uses those points to make a meaningful argument about the subjects. While it can be a little intimidating to approach this type of essay at first, with a little work and practice, you can write a great compare-and-contrast essay!

Formulating Your Argument

Step 1 Pick two subjects that can be compared and contrasted.

You could pick two subjects that are in the same “category” but have differences that are significant in some way. For example, you could choose “homemade pizza vs. frozen grocery store pizza.”
You could pick two subjects that don’t appear to have anything in common but that have a surprising similarity. For example, you could choose to compare bats and whales. (One is tiny and flies, and the other is huge and swims, but they both use sonar to hunt.)
You could pick two subjects that might appear to be the same but are actually different. For example, you could choose "The Hunger Games movie vs. the book."

Step 2 Make sure that your subjects can be discussed in a meaningful way.

For example, ask yourself: What can we learn by thinking about “The Hunger Games” and “Battle Royale” together that we would miss out on if we thought about them separately?
It can be helpful to consider the “So what?” question when deciding whether your subjects have meaningful comparisons and contrasts to be made. If you say “The Hunger Games and Battle Royale are both similar and different,” and your friend asked you “So what?” what would your answer be? In other words, why bother putting these two things together?

A “Venn diagram” can often be helpful when brainstorming. This set of overlapping circles can help you visualize where your subjects are similar and where they differ. In the outer edges of the circle, you write what is different; in the overlapping middle area, you write what’s similar. [2] X Trustworthy Source University of North Carolina Writing Center UNC's on-campus and online instructional service that provides assistance to students, faculty, and others during the writing process Go to source
You can also just draw out a list of all of the qualities or characteristics of each subject. Once you’ve done that, start looking through the list for traits that both subjects share. Major points of difference are also good to note.

For example, if you are comparing and contrasting cats and dogs, you might notice that both are common household pets, fairly easy to adopt, and don’t usually have many special care needs. These are points of comparison (ways they are similar).
You might also note that cats are usually more independent than dogs, that dogs may not provoke allergies as much as cats do, and that cats don’t get as big as many dogs do. These are points of contrast (ways they are different).
These points of contrast can often be good places to start thinking about your thesis, or argument. Do these differences make one animal a superior type of pet? Or a better pet choice for a specific living situation (e.g., an apartment, a farm, etc.)?

Show readers why one subject is more desirable than the other. Example: "Cats are better pets than dogs because they require less maintenance, are more independent, and are more adaptable."
Help readers make a meaningful comparison between two subjects. Example: "New York City and San Francisco are both great cities for young professionals, but they differ in terms of their job opportunities, social environment, and living conditions."
Show readers how two subjects are similar and different. Example: "While both The Catcher in the Rye and To Kill a Mockingbird explore the themes of loss of innocence and the deep bond between siblings, To Kill a Mockingbird is more concerned with racism while The Catcher in the Rye focuses on the prejudices of class."
In middle school and high school, the standard format for essays is often the “5-paragraph form,” with an introduction, 3 body paragraphs, and a conclusion. If your teacher recommends this form, go for it. However, you should be aware that especially in college, teachers and professors tend to want students to break out of this limited mode. Don’t get so locked into having “three main points” that you forget to fully explore your topic.

Organizing Your Essay

Subject by subject. This organization deals with all of the points about Topic A, then all of the points of Topic B. For example, you could discuss all your points about frozen pizza (in as many paragraphs as necessary), then all your points about homemade pizza. The strength of this form is that you don’t jump back and forth as much between topics, which can help your essay read more smoothly. It can also be helpful if you are using one subject as a “lens” through which to examine the other. The major disadvantage is that the comparisons and contrasts don’t really become evident until much further into the essay, and it can end up reading like a list of “points” rather than a cohesive essay. [4] X Trustworthy Source University of North Carolina Writing Center UNC's on-campus and online instructional service that provides assistance to students, faculty, and others during the writing process Go to source
Point by point. This type of organization switches back and forth between points. For example, you could first discuss the prices of frozen pizza vs. homemade pizza, then the quality of ingredients, then the convenience factor. The advantage of this form is that it’s very clear what you’re comparing and contrasting. The disadvantage is that you do switch back and forth between topics, so you need to make sure that you use transitions and signposts to lead your reader through your argument.
Compare then contrast. This organization presents all the comparisons first, then all the contrasts. It’s a pretty common way of organizing an essay, and it can be helpful if you really want to emphasize how your subjects are different. Putting the contrasts last places the emphasis on them. However, it can be more difficult for your readers to immediately see why these two subjects are being contrasted if all the similarities are first.

Introduction. This paragraph comes first and presents the basic information about the subjects to be compared and contrasted. It should present your thesis and the direction of your essay (i.e., what you will discuss and why your readers should care).
Body Paragraphs. These are the meat of your essay, where you provide the details and evidence that support your claims. Each different section or body paragraph should tackle a different division of proof. It should provide and analyze evidence in order to connect those proofs to your thesis and support your thesis. Many middle-school and high-school essays may only require three body paragraphs, but use as many as is necessary to fully convey your argument.
Acknowledgement of Competitive Arguments/Concession. This paragraph acknowledges that other counter-arguments exist, but discusses how those arguments are flawed or do not apply.
Conclusion. This paragraph summarizes the evidence presented. It will restate the thesis, but usually in a way that offers more information or sophistication than the introduction could. Remember: your audience now has all the information you gave them about why your argument is solid. They don’t need you to just reword your original thesis. Take it to the next level!

Step 3 Outline your body paragraphs based on subject-to-subject comparison.

Introduction: state your intent to discuss the differences between camping in the woods or on the beach.
Body Paragraph 1 (Woods): Climate/Weather
Body Paragraph 2 (Woods): Types of Activities and Facilities
Body Paragraph 3 (Beach): Climate/Weather
Body Paragraph 4 (Beach): Types of Activities and Facilities

Step 4 Outline your body paragraphs based on point-by-point comparison.

Introduction

Step 5 Outline your body paragraphs based on compare then contrast.

Body Paragraph 1: Similarity between woods and beaches (both are places with a wide variety of things to do)
Body Paragraph 2: First difference between woods and beaches (they have different climates)
Body Paragraph 3: Second difference between woods and beaches (there are more easily accessible woods than beaches in most parts of the country)
Body Paragraph 4: Emphasis on the superiority of the woods to the beach

Step 6 Organize your individual body paragraphs.

Topic sentence: This sentence introduces the main idea and subject of the paragraph. It can also provide a transition from the ideas in the previous paragraph.
Body: These sentences provide concrete evidence that support the topic sentence and main idea.
Conclusion: this sentence wraps up the ideas in the paragraph. It may also provide a link to the next paragraph’s ideas.

Putting It All Together

Step 1 Use your brainstorming ideas to fill in your outline.

If you are having trouble finding evidence to support your argument, go back to your original texts and try the brainstorming process again. It could be that your argument is evolving past where it started, which is good! You just need to go back and look for further evidence.

For example, in a body paragraph about the quality of ingredients in frozen vs. homemade pizza, you could close with an assertion like this: “Because you actively control the quality of the ingredients in pizza you make at home, it can be healthier for you than frozen pizza. It can also let you express your imagination. Pineapple and peanut butter pizza? Go for it! Pickles and parmesan? Do it! Using your own ingredients lets you have fun with your food.” This type of comment helps your reader understand why the ability to choose your own ingredients makes homemade pizza better.

Reading your essay aloud can also help you find problem spots. Often, when you’re writing you get so used to what you meant to say that you don’t read what you actually said.

Avoid bias. Don't use overly negative or defamatory language to show why a subject is unfavorable; use solid evidence to prove your points instead.
Avoid first-person pronouns unless told otherwise. In some cases, your teacher may encourage you to use “I” and “you” in your essay. However, if the assignment or your teacher doesn’t mention it, stick with third-person instead, like “one may see” or “people may enjoy.” This is common practice for formal academic essays.
Proofread! Spelling and punctuation errors happen to everyone, but not catching them can make you seem lazy. Go over your essay carefully, and ask a friend to help if you’re not confident in your own proofreading skills.

Sample Body Paragraphs

Step 1 Write a body paragraph for a point-by-point compare and contrast essay.

"When one is deciding whether to go to the beach or the woods, the type of activities that each location offers are an important point to consider. At the beach, one can enjoy the water by swimming, surfing, or even building a sandcastle with a moat that will fill with water. When one is in the woods, one may be able to go fishing or swimming in a nearby lake, or one may not be near water at all. At the beach, one can keep one's kids entertained by burying them in sand or kicking around a soccer ball; if one is in the woods, one can entertain one's kids by showing them different plans or animals. Both the beach and the woods offer a variety of activities for adults and kids alike."

Step 2 Write a body paragraph for a subject-by-subject compare and contrast essay.

"The beach has a wonderful climate, many activities, and great facilities for any visitor's everyday use. If a person goes to the beach during the right day or time of year, he or she can enjoy warm, yet refreshing water, a cool breeze, and a relatively hot climate. At the beach, one can go swimming, sunbathe, or build sandcastles. There are also great facilities at the beach, such as a changing room, umbrellas, and conveniently-located restaurants and changing facilities. The climate, activities, and facilities are important points to consider when deciding between the beach and the woods."

Sample Essay Outline

Community Q&A

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About This Article

To write a compare and contrast essay, try organizing your essay so you're comparing and contrasting one aspect of your subjects in each paragraph. Or, if you don't want to jump back and forth between subjects, structure your essay so the first half is about one subject and the second half is about the other. You could also write your essay so the first few paragraphs introduce all of the comparisons and the last few paragraphs introduce all of the contrasts, which can help emphasize your subjects' differences and similarities. To learn how to choose subjects to compare and come up with a thesis statement, keep reading! Did this summary help you? Yes No

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Published: 26 March 2024

Comparison of metagenomic next-generation sequencing and conventional culture for the diagnostic performance in febrile patients with suspected infections

Hui Yang 1 ,
Nannan Xu 1 ,
Meichen Yan 2 ,
Lulu Yang 1 ,
Sai Wen 1 ,
Shanshan Wang 1 ,
Chunmei Qu 1 ,
Xuying Yang 3 &
Gang Wang 1

BMC Infectious Diseases volume 24 , Article number: 350 ( 2024 ) Cite this article

Metrics details

Timely and accurate identification of pathogens is crucial for appropriate treatment and prognosis of infectious diseases. As an increasingly popular pathogen detection method, the performance of metagenomic next-generation sequencing (mNGS) in detecting pathogens in febrile patients with suspected infection requires further exploration.

This study included 368 febrile patients with suspected infections who were admitted to the Infectious Disease Department of Qilu Hospital, Shandong University between January 5, 2021 and April 14, 2023. Both mNGS testing and conventional culture were performed in all patients. Clinical data of enrolled patients were collected, and the diagnostic performances of mNGS and culture were compared.

Of the 368 enrolled patients, 231 were finally diagnosed with infection and 137 were with diseases other than infection. The sensitivity (58.01% vs. 21.65%, p < 0.001) and negative predictive value (54.67% vs. 42.9%) of mNGS were superior to those of culture. In contrast, the culture exhibited higher specificity (99.27% vs. 85.40%, p < 0.001) and positive predictive value (98.84% vs. 87.01%) than mNGS. Among infected patients with positive mNGS results, 64 received adjusted antibiotic therapy including treatment transitions, antibiotic downgrading, and combination therapy. Among them, 9 had additional antifungal drugs and 21 patients had a treatment turning point based on the mNGS results and these patients recovered and discharged due to timely antibiotic adjustment. Both positive rates of puncture fluid mNGS and tissue mNGS were higher than those of culture in the patients who had prior antibiotic use, and this difference was statistically significant ( p = 0.000).

mNGS is more sensitive and accurate than traditional culture, making it ideal for identifying pathogens and screening infectious diseases, especially for those with uncultivated or difficult-to-cultivate species. Early diagnosis allows for prompt treatment with targeted antibiotics, and mNGS is recommended when samples are limited.

Peer Review reports

Introduction

Fever refers to the body’s temperature that is higher than the normal range due to an increase in set-point temperature in the hypothalamus. Common causes of fever include infections, autoimmune disorders, hematological abnormalities, neoplasms, and unidentified factors. Distinguishing between infectious and non-infectious diseases is crucial in febrile patients, as unidentified infections can lead to delayed or insufficient treatment, prolonged hospital stays, recurrent hospitalizations, heightened mortality rates, and increased disability rates [ 1 ]. A study conducted by Rudd et. al . revealed that infections account for over 20% of global deaths, establishing it as one of the foremost causes of mortality on a global scale [ 2 , 3 ], especially in cases with sepsis which results in approximately 5 million deaths per year worldwide. Early identification and aggressive treatment of infection is critical for patient survival and prognosis [ 4 , 5 ].

Pathogens play a pivotal role in the development of infectious diseases, and comprehending their etiology is imperative for effective disease management and ultimate outcome. Presently, diagnostic techniques for identifying pathogens encompass culture, serological tests, pathological examinations, and pathogen sequencing [ 6 ]. Serological tests and pathological tests are convenient and expeditious but not suitable for all pathogens. Culture-based methods offer the advantage of broad applicability across a diverse spectrum of pathogens, enabling the assessment of drug sensitivity and resistance. Nevertheless, the time-intensive nature of culture, typically spanning 1–5 days, may delay treatment initiation, especially for slow-growing microorganisms, such as fungi and mycobacteria. Moreover, the positive rate of culture is notably diminished in individuals with prior antibiotic exposure [ 7 ], and not all pathogens can be acquired using conventional culture techniques. Conventional pathogen detection methods are inadequate to meet the clinical need. Metagenomic next-generation sequencing (mNGS) is an emerging molecular diagnostic approach and offers several advantages, such as rapid detection, independence from antibiotic influence, and the capability to identify clinically uncommon, challenging-to-cultivate, and novel pathogens [ 8 , 9 ]. Nonetheless, it is costly, susceptible to host DNA interference, and necessitates specialized equipment, proficient technicians, and extensive bioinformatics expertise. The interpretation of results poses a significant challenge [ 10 , 11 ].

Presently, the existing research on the effectiveness of conventional culture and mNGS diagnostics primarily relies on limited sample sizes, specific sample types, or infection sites [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. There is a notable dearth of comprehensive studies encompassing diverse sample types, and the clinical utility of mNGS and conventional culture in the context of infectious diseases remains subject to evaluation. In order to assess the merits and drawbacks of these two diagnostic approaches, the present study gathered mNGS and culture data from febrile patients with suspected infections to assess the diagnostic performance of different detection methods.

Study objects

This retrospective analysis gathered clinical data from patients who admitted to the Infectious Diseases Department of Qilu Hospital, Shandong University due to fever and suspected infection between January 5, 2021, and April 14, 2023. The ultimate diagnosis of patients was ascertained through retrospective review by three proficient infectious disease physicians based on the patient's medical history, diagnostic tests, imaging examinations, pathological findings, and treatment outcomes. The comprehensive dataset comprises various essential variables, such as patient demographics (gender, age, admission date, height, weight, and Body Mass Index, BMI), clinical diagnosis and medical history, serum albumin levels, sample type, detection results and duration of culture and mNGS, as well as antibiotic usage and modifications.

Inclusion criteria

The inclusion criteria for patient enrollment are as follows: (1) patients exhibiting fever (≥ 37.3 °C) and suspected infections upon admission who underwent both conventional culture and mNGS procedures; (2) patients with a time interval of less than 24 h between the collection of the same sample type for culture and mNGS; (3) complete mNGS and culture were conducted for sample types, including blood, puncture fluid, tissue, bronchoalveolar lavage fluid (BALF), and cerebrospinal fluid (CSF).

Exclusion criteria

Patients were excluded from the study if they met any of the following criteria: (1) patients with a definitive infection diagnosis upon admission and a confirmed pathogen; (2) individuals with incomplete mNGS or culture data, or a time lapse exceeding 24 h between mNGS and culture; (3) cases with mNGS and culture conducted using samples, such as sputum or urine; (4) patients with incomplete clinical data.

Conventional microbiological culture

Samples including blood, CSF, BALF, puncture fluid, and tissues were processed in the microbiology laboratory. Positive culture specimens were identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF). The VITEK II compact system was used for drug sensitivity testing and AST-GN334, AST-GN335 and AST-GP639 drug sensitivity cards were used to determine the minimum inhibitory concentration (MIC). Antibiotic susceptibility testing was performed in accordance with the guidelines outlined by Clinical and Laboratory Standards Institute (CLSI).

Metagenomic next-generation sequencing

Blood samples were transported to the laboratory within a temperature range of 6 °C to 35 °C. Other fluid samples were aseptically sealed, stored at -20 °C, or transported using dry ice to the testing laboratory. A 200 µL volume of sample was utilized for DNA extraction and purification using QIAamp DNA Micro Kit (QIAGEN, Hilden, Germany) following the instructions. The concentration and quality of the DNA were assessed using the Qubit 3.0 fluorometer (Invitrogen, Q33216) and agarose gel electrophoresis (Major Science, UVC1-1100). DNA library was constructed using Qiagen's QIAseq Ultralow Input Library Kit (QIAGEN, Hilden, Germany) according to the guidelines. The quality of the libraries was evaluated using the Qubit 3.0 fluorometer (Invitrogen, Q33216) and the Agilent 2100 Bioanalyzer (Agilent Technologies, Palo Alto, USA). The qualified DNA libraries were sequenced on the Illumina Nextseq 550 platform (Illumina San Diego, USA).

Adapters, low-quality, low-complexity, and short sequences were removed from the raw data after sequencing. Subsequently, the SNAP software was employed to eliminate human sequences based on human reference database (hg38). The remaining data were then aligned against microbial genome databases using the Burrow-Wheeler Alignment. The microbial composition within the samples was analyzed to identify the pathogens.

Result interpretation criteria

Positivity for mNGS/culture was defined as a positive result obtained from mNGS/culture, and were confirmed as causative pathogens by clinicians. Conversely, negativity was defined as the absence of any pathogen detected by mNGS/culture. Contamination was defined as the pathogens were detected by mNGS/culture, which were not consistent with clinical diagnosis, and had not been clinically confirmed, and was not considered to be the pathogen of clinical disease. Given the inability of conventional culture to capture viral pathogens, this study specifically concentrated on comparing bacterial and fungal findings. Viruses detected by mNGS were not included in the further analysis.

Statistical methods

Statistical analysis was performed using SPSS 25.0 software. Paired sample T-tests were utilized for comparing continuous variables between two groups, while the chi-squared test or Fisher's exact test were employed for categorical variable comparisons. The clinical diagnosis was considered as the gold standard, and McNemar's test was employed to compare the sensitivity and specificity of paired mNGS and culture. Kappa consistency tests were utilized to evaluate the consistency between the two diagnostic methods. Logistic regression was applied to calculate odds ratios and their corresponding 95% confidence intervals. A p -value of less than 0.05 was defined as statistically significant.

General clinical characteristics

A total of 368 patients were eventually included in this retrospective study (Fig. 1 ). The majority of specimens consisted of blood samples (48.37%), followed by puncture fluid (19.30%), tissue (11.41%), BALF (11.14%), and CSF (9.78%) (Fig. 2 a). The median age of patients was 57 years (range: 10–92), and 215 were male (58.40%). The 231 patients (62.78%) were finally diagnosed with infectious diseases, while 137 (37.22%) had diseases other than infections. The rates of comorbidity for diabetes, cardiovascular diseases, and obesity in patients with infections were higher than that in non-infected patients. The 58.05% of infected patients were aged more than 60 years, significantly higher than non-infected patients (32.12%) (chi-squared test, p = 0.003). Some of these febrile patients with suspected infections were diagnosed with "unknown cause of fever" upon admission, while others were diagnosed with "consciousness disorders", "unknown cause of fever after valve replacement surgery", "unknown cause of back pain", and so on. The distribution of infection sites varied, with bloodstream infections accounting for the highest proportion (27.71%, 64/231), followed by pulmonary infections (23.38%, 54/231). Other sites of infection encompassed the central nervous system, liver, spinal joints, skin soft tissues, muscles, etc. Detailed demographic information is presented in Table 1 .

Flowchart of febrile patients with suspected infections enrolled

Comparison of diagnostic performance between mNGS and culture. a Percentage of different sample types; b The histogram for omparison of positive rate between mNGS and culture in different sample types; c The four-grid table of diagnostic performance for mNGS and culture using clinical diagnosis as the gold standard

Diagnostic performance of mNGS vs. culture

The overall positive rate of mNGS was 36.41% (134/368). The positive rates varied by sample type, with puncture fluid having the highest rate at 71.83%, followed by BALF (53.54%), tissue (47.62%), CSF (19.44%), and blood (17.98%). In contrast, the overall positive rate of culture was 13.59% (50/368), with puncture fluid culture had the highest positive rate (29.58%), followed by tissue (21.43%), BALF (14.43%), blood (7.30%), and CSF (2.78%) (Fig. 2 b). Puncture fluid consistently had the highest positive rate by both mNGS and culture. Additionally, the contamination rate of mNGS (5.43%) was higher than that of culture (0.27%), with the most common contaminants being Propionibacterium acnes , Staphylococcus hominis , and Corynebacterium .

In the infectious diseases group, the mNGS results were positive for 134 patients (58.01%, 134/231), while the culture results were positive for 50 patients (21.65%, 50/231). In the non-infectious diseases group, mNGS showed 117 negative (85.40%, 117/137) and 20 contaminated results (14.60%, 20/137); culture showed 136 negative (99.27%, 136/137) and 1 contaminated results (0.73%, 1/137). Overall, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mNGS were 58.01%, 85.40%, 87.01%, and 54.67%, respectively. The sensitivity, specificity, PPV, and NPV of culture were 21.65%, 99.27%, 98.84%, and 42.9%, respectively. The sensitivity and NPV of mNGS were higher than those of conventional culture (McNemar's test: 58.01% vs. 21.65%, p < 0.001; 54.67% vs. 42.9%). Conversely, the specificity and PPV of culture were higher than those of mNGS (McNemar's test: 99.27% vs. 85.40%, p < 0.001; 98.84% vs. 87.01%) (Fig. 2 c). The diagnostic performance of different samples were shown in Supplementary Table 1 .

The average reporting time of mNGS in our hospital was 24 h (range: 20–36 h), significantly shorter than the results with the initial blood culture and genus identification time frame by MALDI-TOF among the 50 infected patients (45.28 h, ranging from 22 to162 hours), with a p value that is 0.000 (T-tests).

Consistency between mNGS and culture

In our study, mNGS and culture were both positive in 45 patients (12.23%, 45/368). Among these cases, mNGS and culture showed completely matched results in 26 patients, partial consistency in 12 patients, and complete inconsistency in 7 patients. Conversely, a total of 194 cases (52.72%, 194/368) yielded negative results by both tests. Additionally, 123 cases (33.42%, 123/368) were positive in mNGS but negative in culture, while 6 cases (1.63%, 6/368) were positive in culture but negative in mNGS (Fig. 3 a). Details are outlined in Table 2 . The agreement between positive mNGS and culture results among patients with infection was relatively low, with a kappa value of 0.234 (Kappa consistency tests) (Fig. 3 b).

The consistency between mNGS and culture. a The consistency ratios of mNGS and culture testing; b Rose diagram of the concordance of pathogens detection by different methods; c The consistency appraisal of mNGS with culture; d The frequency distribution of pathogens spectrum detected by mNGS and culture

Among the 231 patients with infectious diseases, 88 were identified to have single pathogen infection by mNGS, while 46 patients were detected with infections of multiple pathogens by mNGS. Among the 88 patients with a single pathogen identified through mNGS, 29 were also culture positive, with 25 cases showing concordance between culture and mNGS results. Three cases exhibited complete inconsistency, and one patient's blood culture yielded two distinct pathogens. Among the 46 patients with multiple pathogens detected by mNGS, 15 were culture positive. Among these, three cases demonstrated complete inconsistency between mNGS and culture, while the remaining 12 patients had all their cultured pathogens within those identified by mNGS (Fig. 3 c).

The most common bacteria identified by mNGS were Klebsiella pneumoniae ( n = 33), Streptococcus ( n = 26), Escherichia coli ( n = 20), Staphylococcus aureus ( n = 11), and Enterobacter ( n = 10). As pergillus , Candida , and Mucor were the predominant fungi. Furthermore, there were also atypical pathogens detected by mNGS, including Mycobacterium tuberculosis , non-tuberculous mycobacteria (NTM), Brucella , Pneumocystis , Nocardia , Chlamydia , and Coxiella . The most frequently detected bacteria by conventional culture were K. pneumoniae ( n = 13), E. coli ( n = 10), S. aureus ( n = 8), Enterococcus and Streptococcus . Few atypical pathogens and fungi were detected by culture (Fig. 3 d).

Modification of antibiotic treatments based on mNGS

Among the cohort of patients with infections, a total of 134 cases yielded positive results for mNGS. Of these cases, 64 patients experienced adjusted antibiotic treatments based on mNGS testing. This modification encompassed an escalation in antibiotic usage for 41 patients, discontinuation of one or two antibiotics for 2 patients, and a complete alteration in the antibiotic regimen for 21 patients (Table 3 ). Notably, among patients with adjusted antibiotics, 14 were identified to have single or multiple anaerobic bacteria, such as Bacteroides fragilis , Prevotella , and Parvimonas micra . As a result, the utilization of anaerobic bacterial treatment in clinical therapy was enhanced. Furthermore, mNGS prompted the prescription of antifungal drugs for 9 patients and 21 patients had a treatment turning point because of mNGS results.The pathogens detected in these instances frequently posed difficulties in cultivation or eluded identification through conventional culture techniques, encompassing Brucella , Pneumocystis jirovecii , NTM, M. tuberculosis , Coxiella burnetii , Rickettsia felis , and Aspergillus . These patients recovered and discharged due to timely antibiotic adjustment.

This study encompassed a cohort of 71 cases with puncture fluid samples and 42 cases with tissue samples. With the exception of 5 cases where tissue samples were procured via surgical procedures, the remaining samples were acquired under the guidance of ultrasound or computed tomography(CT). Among the total of 113 puncture fluid and tissue samples, 15 cases were categorized as non-infection cases, while the infection group comprised 98 cases, as determined by the final clinical diagnosis. Among the 98 infected patients, 6 had not been administered antibiotics before mNGS collection, while 92 had a recent history of antibiotic use prior to collection (Supplementary Fig. 1 ).There were 92 infected patients with a recent history of antibiotic use, the positive rate of mNGS was 75.00%, significantly higher than that of culture (28.26%, p = 0.000).

Pathogens play a crucial role in the etiology of infectious diseases, and timely identification of these pathogens is instrumental in determining appropriate infection management strategies, thereby impacting disease outcomes. Presently, conventional cultures and mNGS are common techniques for pathogen identification. This retrospective study aimed to comprehensively assess the diagnostic efficacy of conventional cultures and mNGS in diagnosing febrile patients with suspected infections. The analysis encompassed 368 cases across five different specimen types, with the objective of offering improved guidance for selecting diagnostic methods in clinical practice.

Across all patients, the positive rate of mNGS was 36.41%, which was lower than previously reported [ 15 , 19 , 20 ]. This discrepancy can be attributed to the specific definition of mNGS positivity employed in our study, which required the identification of pathogens through mNGS and subsequent clinical confirmation. The methodology employed in this study diverges from categorizing all instances of pathogen detection as positive outcomes, thereby resulting in a lower positivity rate when compared to previous investigations. Among infected patients, the positive rate of mNGS was 58.4%, while conventional culture yielded a positive rate of 21.6%. The results were the similar as in previous research [ 12 , 15 , 21 ]. There are several reasons for the higher positive rate of mNGS. Firstly, mNGS serves as an impartial diagnostic approach that identifies DNA/RNA information within specimens through sequencing techniques, regardless of the pathogen activity level. Secondly, most of our patients have previously been hospitalized and given antibiotics, which can reduce the positive rates of culture [ 7 , 22 ]. Lastly, infectious diseases do not always lend themselves to conventional culture methods, such as fastidious bacteria, anaerobic bacteria and pneumocystis [ 15 , 23 ].

In the present study, the sensitivity of mNGS was determined to be 58.01%, surpassing that of culture (21.65%). Conversely, culture demonstrated a specificity of 99.27%, which exceeded that of mNGS. These observations align with previous research [ 12 , 19 ]. The NPV of mNGS was 54.67%, higher than that of culture. When conventional cultures are unable to definitively exclude infection, mNGS can be a supplementary or parallel test to detect the pathogens. In this study, 137 patients were finally diagnosed as non infectious diseases based on their negative mNGS and negative culture results, as well as the judgment of clinicians combined with clinical data. The definitive diagnosis reduced unnecessary antibiotic use, thereby reducing antibiotic related adverse reactions and antimicrobial resistance [ 24 ].

Among 231 infected patients in this study, the most frequently detected bacteria by culture are K. pneumoniae , E. coli , and S. aureus , aligning with the findings reported in the Lancet's 2022 publication [ 3 ]. The prevalence of fungal infections has been on the rise in recent years especially in immunocompromised individuals with the growing population of solid organ or haematopoietic stem cell transplantation (HSCT) and the increasing number of patients who suffered the AIDS without timely treatment. Additionally, the incidence of NTM is rapidly increasing, posing a considerable public health concern. Thus, mNGS has become a valuable adjunct in identifying fungi and NTM [ 25 , 26 , 27 ]. In this study, mNGS prompted modifications to antibiotic strategies in 64 patients, a total of 43 patients had their antibiotic dosages adjusted based on mNGS detection, including treatment transitions, antibiotic downgrading, and combination therapy. These positive mNGS identified pathogens include pathogens difficult to cultivate such as Bacteroides fragilis , Prevotella , Nocardia , Aspergillus , etc., promoting the transition from empirical therapy to targeted therapy. It also included common bacteria such as Escherichia coli , Klebsiella pneumoniae , and Staphylococcus aureus , reducing unnecessary antibiotic combinations and promoting appropriate antibiotic use, and 21 patients experienced a therapeutic turning point as a result of the mNGS results. The identified causative agents in these cases predominantly included Brucella , Pneumocystis , NTM, M. tuberculosis , Streptococcus pneumoniae , Bartonella , Rickettsia , and Aspergillus . Notably, mNGS exhibited a higher sensitivity compared to culture in detecting these atypical or challenging-to-culture pathogens [ 12 , 14 , 28 ].

Moreover, mNGS offers expedited outcomes, with an average reporting duration of 24 h, enabling early clinical diagnosis and treatment. This holds significant importance for septic individuals, as timely implementation of targeted antimicrobial therapy is imperative for improving outcomes and reducing mortality [ 5 , 29 ]. From another perspective, although early bacterial identification of positive specimens could be achieved for culturing positive patients through MALDI-TOF, the average time was still longer than mNGS, and the difference was statistically significant. mNGS had advantages in terms of detection duration, sensitivity, and guidance for early clinical treatment, but it lacked the sensitivity and resistance of antibiotics in vitro, resulting in missing drug sensitivity data and enzyme production data. It could assist in the selection of the right antibiotics, but to some extent, it might not necessarily be able to select the most appropriate antibiotics.

The positive rate and sensitivity of mNGS and culture using puncture fluid in this study were the highest among different sample types. One of the reasons lies in that patients received ultrasound or CT scans before puncture, which indicated localized abscesses or infectious/inflammatory lesions to some extent. In some cases, patients may present with severe infections requiring specialized medical interventions, such as ultrasound or CT-guided aspirations and surgical specimen collection. These samples often have limited quantities and cannot be repeatedly acquired. Furthermore, a significant number of patients receive antibiotic treatment prior to the paracentesis. Currently, less studies have focused on comparing the diagnostic efficiency between mNGS and conventional culture using puncture fluid. Our study findings indicate that in patients with a previous antibiotic usage, both mNGS and culture demonstrated the ability to detect responsible pathogens in specific cases. Nevertheless, the positive rate of mNGS was notably higher than that of culture, and this disparity was statistically significant. These results suggest that the influence of a history of antibiotic use on culture outcomes is more pronounced compared to mNGS. Based on the aforementioned findings, we propose mNGS to detect pathogens when clinical specimens are difficult to collect especially in patients with a history of antibiotic use.

According to Fig. 3 a and b, it can be concluded that NGS and culture have relatively low consistency, especially in non-aseptic specimens such as tissue, BALF and puncture fluid. These samples necessitate meticulous analysis of culture and mNGS outcomes. The overall contamination rate of mNGS in this study was 5.43%, higher than that of culture (0.27%). However, there was no statistical significance. Despite rigorous disinfection protocols at the puncture site before blood collection, contamination from skin flora remains unavoidable [ 1 , 30 ]. It is imperative to incorporate clinical presentation, physical signs, imaging, serology, and even pathological findings to make informed determinations regarding colonization, pathogenicity, and contamination, thereby enabling the selection of the most efficacious antibiotic treatment regimen.

Limitations

This retrospective study encountered missing data, including height, weight, and paired culture with mNGS, resulting in the exclusion of certain case data from the analysis. The majority of patients had a history of antibiotic usage before specimen collection, leading to a decreased positive rate, particularly for culture. Additionally, the relatively small number of CSF, BALF, and tissue specimens compared to puncture fluid specimens and peripheral blood specimens, posed challenges in conducting subgroup analysis. To better assess the diagnostic performance of mNGS compared to culture, more rigorous prospective studies are needed.

In this study, mNGS exhibited superior sensitivity and NPV than conventional culture in detecting pathogens. mNGS particularly excelled in identifying microorganisms that are challenging to culture or cannot be cultured, as well as in detecting pathogens in specimens that are difficult to obtain through puncture or intraoperative procedures promoting targeted and precise treatment in clinical practice. mNGS also demonstrated a higher negative exclusion value when screening infectious diseases. However, clinicians should exercise caution and be mindful of colonization, contamination, and pathogenicity when interpreting detected pathogens, given their high sensitivity. While conventional culture can guide antibiotic selection, it has a lower positivity rate and longer culture periods. Therefore, the choice between these methods in clinical practice should be determined by the specific needs of the patient to ensure accurate pathogen diagnosis.

Availability of data and materials

The original data and materials presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Abbreviations

Body Mass Index

Bronchoalveolar lavage fluid

Cerebrospinal fluid

Matrix-assisted laser desorption ionization-time of flight mass spectrometry

Minimum inhibitory concentration

Clinical and Laboratory Standards Institute

Positive predictive value

Negative predictive value

Non-tuberculous mycobacteria

Computed tomography

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Hui Yang, Nannan Xu, Lulu Yang, Sai Wen, Shanshan Wang, Chunmei Qu, Ke Xu & Gang Wang

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GW designed the framework of the paper. Material preparation, data collection and analysis were performed by HY, NX, LY, SW, SW, CQ and KX. The first draft of the manuscript was written by HY. GW, XY and MY edited and revised the manuscript. All authors read and approved the final manuscript.

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Additional file 1: supplementary figure 1..

The diagnostic performance for different methods of puncture fluid and tissue samples after using antibiotics.

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Yang, H., Xu, N., Yan, M. et al. Comparison of metagenomic next-generation sequencing and conventional culture for the diagnostic performance in febrile patients with suspected infections. BMC Infect Dis 24 , 350 (2024). https://doi.org/10.1186/s12879-024-09236-w

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Study protocol
Open access
Published: 25 March 2024

The ARIA trial protocol: a randomised controlled trial to assess the clinical, technical, and cost-effectiveness of a cloud-based, AR tificially I ntelligent image fusion system in comparison to standard treatment to guide endovascular A ortic aneurysm repair

James Budge 1 , 2 ,
Tom Carrell 3 ,
Medeah Yaqub 4 ,
Hatem Wafa 5 ,
Matt Waltham 3 ,
Izabela Pilecka 4 ,
Joanna Kelly 4 ,
Caroline Murphy 4 ,
Stephen Palmer 6 ,
Yanzhong Wang 5 &
Rachel E Clough 1

Trials volume 25 , Article number: 214 ( 2024 ) Cite this article

41 Accesses

Metrics details

Endovascular repair of aortic aneurysmal disease is established due to perceived advantages in patient survival, reduced postoperative complications, and shorter hospital lengths of stay. High spatial and contrast resolution 3D CT angiography images are used to plan the procedures and inform device selection and manufacture, but in standard care, the surgery is performed using image-guidance from 2D X-ray fluoroscopy with injection of nephrotoxic contrast material to visualise the blood vessels. This study aims to assess the benefit to patients, practitioners, and the health service of a novel image fusion medical device (Cydar EV), which allows this high-resolution 3D information to be available to operators at the time of surgery.

The trial is a multi-centre, open label, two-armed randomised controlled clinical trial of 340 patient, randomised 1:1 to either standard treatment in endovascular aneurysm repair or treatment using Cydar EV, a CE-marked medical device comprising of cloud computing, augmented intelligence, and computer vision. The primary outcome is procedural time, with secondary outcomes of procedural efficiency, technical effectiveness, patient outcomes, and cost-effectiveness. Patients with a clinical diagnosis of AAA or TAAA suitable for endovascular repair and able to provide written informed consent will be invited to participate.

This trial is the first randomised controlled trial evaluating advanced image fusion technology in endovascular aortic surgery and is well placed to evaluate the effect of this technology on patient outcomes and cost to the NHS.

Trial registration

ISRCTN13832085. Dec. 3, 2021

Peer Review reports

Administrative information

Note: the numbers in curly brackets in this protocol refer to SPIRIT checklist item numbers. The order of the items has been modified to group similar items (see http://www.equator-network.org/reporting-guidelines/spirit-2013-statement-defining-standard-protocol-items-for-clinical-trials/ ).

Introduction

Background and rationale {6a}.

Endovascular aneurysm repair (EVAR) has rapidly replaced open aortic surgery due to perceived advantages in patient survival, reduced postoperative complications, and shorter hospital lengths of stay [ 1 ]. Endovascular surgery is planned using 3D reconstructions of pre-operative computed tomography (CT) scans to assess access and determine the optimal type, configuration, and sizing of the implantable medical device. The surgery itself is ‘image-guided’ using 2D X-ray fluoroscopy and injection of nephrotoxic contrast material to visualise blood vessels (see Fig. 1 ).

Graphic showing the 3D information the surgeon has preoperatively, and the intra-operative 2D fluoroscopy in current standard of care endovascular surgery

Despite the potential advantages of EVAR over open surgery, there are significant concerns related to the variability in planning and sizing, high doses of ionising radiation and nephrotoxic contrast material, imprecise visualisation and device positioning, unpredictability of individual patient outcomes, and inconsistent outcomes between hospitals and regions leading to controversy over cost-effectiveness [ 2 , 3 ]. Device positioning error can require secondary interventions and cause serious and even fatal complications [ 4 ].

Previous solutions to improve visualisation during EVAR have included manually aligned, operating table-tracked 3D-2D image overlay. Cydar-EV image fusion is a CE-marked medical device, which instead of a table-tracked overlay uses computer vision to fuse pre-procedural 3D images with intra-operative 2D fluoroscopy automatically and in real-time (see Fig. 2 ). The key advantage of this type of image fusion is that it gives the surgeon real-time fully integrated 3D visualisation throughout the EVAR procedure with much greater spatial accuracy than achieved by previous technology [ 5 ]. The computer vision is a form of artificial intelligence using NHS Digital-approved, GDPR-compliant high-performance cloud computing. Cydar-EV uses only existing patient data (i.e. no new imaging) and is designed not to change clinical workflows. There is no requirement for user interaction, no additional ionising radiation or iodinated contrast. It is agnostic to existing X-ray imaging equipment and can be used on fixed or mobile X-ray systems.

Overview of steps in Cydar EV image fusion; pre-procedural 3D images are fused with intra-operative 2D fluoroscopy automatically and in real-time to produce the combined image shown during the surgery

Approximately 5000 EVAR procedures are performed each year in the UK, with an average cost of £19k [ 6 , 7 ]. EVAR is under an existing NHS care pathway and reduces mortality from 4.7 to 1.7% compared to open surgery, with faster return to normal activities on discharge [ 1 ].

Establishing computer vision-powered image fusion as the standard of care in endovascular surgery could directly benefit patients and health and care services by:

Reducing procedure times compared to standard procedures and thus improve efficiency of resource use in the NHS

Reducing patient exposure to anaesthesia and ionising radiation, lowering surgical site infection, and reducing adverse events

Improving procedural success with more precise device positioning compared to current practice

Reducing x-ray exposure to patients and staff and reducing the use of nephrotoxic contrast agent, improving renal function

Reducing capital expenditure—Cydar-EV can be easily implemented without the need for linked capital expenditure on new fixed imaging or hybrid operating room (cost to NHS ~£2–5m)

A multi-centre observational study (109 patients) examining safety, performance, usability, and efficacy of Cydar-EV was performed 2014–2015. These data were used in the successful application for CE marking. The primary outcomes were as follows:

Robustness: 2802 images were analysed, yielding a positive predictive value of 1, with a lower 95% CI of 0.998.

Accuracy: tested against the gold-standard data (Tomazevic 2002), the root-mean-square-error was 0.21 mm (max 0.62 mm) [ 8 ].

Speed: the mean time taken to return and display an updated 3D overlay in response to patient/table/X-ray set movement was 8.395 s (7.232 s excluding network latency); this has since been significantly reduced to < 4 s.

Usability: external usability testing in accordance with IEC 62366 validated the display of the 3D overlay information.

Patient benefit was observed by a significant reduction in the amount of X-rays used, with a mean reduction in X-ray fluoroscopy screening time of 35% ( p = 0.013), a 41% reduction in the amount of iodinated contrast used ( p = 0.008), and a nearly 1 h reduction in mean operating time (17%, p = 0.06) [ 9 ]. A further prospective observational cohort study of 119 patients was conducted at Duke University Medical Centre. This reported a mean reduction in procedure time of 17% ( p = 0.04), with Cydar-EV and a reduction in the number and duration of unexpectedly very long operations [ 10 ]. There was also significantly better renal function after the procedure and at 30 days, an indirect metric of the effect of less nephrotoxic contrast agent, and better device positioning. There are no known additional risks of using Cydar EV in comparison to standard treatment. Interruption of the Internet connection during the procedure is possible but rare (< 0.001%).

Demonstrating Cydar-EV improves the outcomes of endovascular surgery at a lower cost for the NHS would be a key demonstration of the potential of digital technology (cloud-computing, big-data, AI) to improve precision and consistency of outcomes for image-guided surgery. It would establish a new concept of data-guided surgery to deliver intelligent planning and outcome analysis, aggregating and learning from existing data to improve the precision, consistency, and transparency of patient outcomes for stakeholders across the NHS: patients, commissioners, hospitals, and clinical teams.

Objectives {7}

The overarching aim of this trial is to evaluate the clinical, technical, and cost-effectiveness of a novel type of medical device comprised real-time cloud computing, AI, and computer vision (Cydar EV) compared to standard treatment in endovascular aortic aneurysm repair.

Primary objective

The primary objective is to assess the effect of Cydar EV on procedure time in comparison to standard treatment in endovascular aortic aneurysm repair.

Secondary objectives

The secondary objectives of this study are to evaluate the following:

Procedural efficiency, as assessed by:

Anaesthetic duration

X-ray dose per procedure

Contrast dose per procedure

Consumable use per procedure

Technical effectiveness, as assessed by proximal and distal seal zones at least 10 mm and no evidence of endoleak

Patient outcomes, as assessed by:

Length of ICU admission

Length of HDU admission

Post-operative length of hospital stay

30-day mortality

Re-intervention—primary hospital visit/further admission (HRG/procedure code)

Adverse events (category, LoS, HDU, ICU, general ward)

Quality of life (EQ5D)

Cost-effectiveness, as assessed by:

Total resource use and costs

Quality-adjusted life years (QALYs)

Incremental cost per QALY

Trial design {8}

The ARIA trial is a multi-centre, open label, two-armed, parallel groups randomised controlled clinical trial that assigns patients with a clinical diagnosis of abdominal aortic aneurysm and/or thoraco-abdominal aneurysm suitable and fit for endovascular treatment, to either repair using standard treatment or treatment using Cydar-EV. The trial will randomise at a 1:1 ratio and is powered to assess superiority of the intervention. The trial flow diagram is shown in Fig. 3 .

Flow diagram of ARIA trial design

Methods: participants, interventions, and outcomes

Study setting {9}.

The trial will be conducted in 10 centres in the UK over 36 months. Three hundred forty patients will be recruited.

Asymptomatic patients will be identified for inclusion at the time of their clinic appointment, while symptomatic or rupture patients will be identified for inclusion at the time of presentation. Patients that present on an urgent or emergency basis will be required to provide written informed consent, after either reading the patient information leaflet or it being read to them by an individual independent of the trial team and the patient’s family.

The expected recruiting sites are as follows:

Leeds Teaching Hospitals NHS Trust

Manchester University NHS Foundation Trust

Liverpool University Hospitals NHS Trust

University Hospital Derby

North Bristol NHS Foundation Trust

Frimley Health NHS Foundation Trust

Imperial Healthcare NHS Trust, London

Guy’s and St Thomas’ NHS Foundation Trust, London

University Hospital Southampton

Brighton and Sussex University Hospitals

Eligibility criteria {10}

Below are the inclusion and exclusion criteria of the ARIA trial.

Inclusion criteria:

Clinical diagnosis of AAA or TAAA suitable for endovascular treatment, as determined by CT imaging and a local treating team multidisciplinary review

Patient is confirmed fit for endovascular repair as determined by the operating team

CT imaging must be in accordance with Cydar EV: Instructions for Use

Written informed consent (patients lacking capacity or unable to speak English will not be enrolled)

Age 18 years and above at the time of consent

Exclusion criteria:

Patients unable to provide written informed consent

Informed consent {26a}

Written informed consent will be obtained by the principal investigator or designee at each site, following explanation of the trial procedures. Discussions about trial participation may take place during an in-person consultation or remotely, i.e. during a telephone or video consultation. The participant information sheet can be sent by post or email ahead of the in-person or remote consultation. Full consent will be given in writing, and the signed original consent forms will be retained on site. Randomisation will only take place once the completed consent form has been received and countersigned.

Additional consent provisions for collection and use of participant data and biological specimens {26b}

No additional consent will be undertaken as part of this trial.

Interventions

Explanation for the choice of comparators {6b}.

The control comparator used in the ARIA trial will be endovascular aortic aneurysm repair using X-ray fluoroscopy imaging, which represents the reference standard in England.

Intervention description {11a}

Patients in the intervention arm of the ARIA trial will undergo endovascular aneurysm repair guided by Cydar-EV. Cydar EV provides tools to:

Import and visualise CT data

Segment and annotate vascular anatomy from CT data

Place and edit virtual guidewires and measure lengths on them

Make measurements of anatomical structures on planar sections of the CT data

Produce an operative plan from measurements and segmentation of preoperative vessel anatomy

Overlay planning information such as preoperative vessel anatomy onto live fluoroscopic images, aligned based on the position of anatomical features present in both

Non-rigidly transform the visualisation of anatomy when intra-operative vessel deformation is observed

Post-operatively review data relating to procedures where the system was used

Intervention training

Training on the Cydar-EV product will be as per the Cydar CE marking and Quality Assurance procedures.

Intervention delivery

Procedures will be performed under local, regional or general anaesthesia (likely ratio: 1:1:8). Procedures can be undertaken using either a mobile C-arm in a surgical operating theatre, a dedicated fixed fluoroscopy set, or in a hybrid operating room. Patients may go to the ward, HDU, or ICU following the procedure, according to local protocol. Routine pre-operative CT aortic imaging will be used to determine general suitability for endovascular repair, including assessment of landing zones for fixation and sealing, and procedure type and device selection.

Criteria for discontinuing or modifying allocated interventions {11b}

Cross-over to Cydar EV from standard care will only be permitted in the context of a procedure duration greater than 8 h or where the patient is in extremis and the surgeon believes that using the Cydar technology may be beneficial to complete the procedure. In these circumstances, the Cydar equipment may be used at the discretion of the operating surgeon, and this information must be captured in the reporting system.

Strategies to improve adherence to interventions {11c}

Reasons for non-compliance could include Cydar EV device failure, Internet failure, surgeon error, failure to communicate correct randomisation allocation to the surgeon, cross-over, and failure to upload images to Cydar EV, or a non-Cydar-trained surgeon performs the procedure. The patient could impact compliance if they express a wish to withdraw between randomisation and surgical procedure or in the event of death.

Relevant concomitant care permitted or prohibited during the trial {11d}

There is no restriction on concomitant care during the trial.

Provisions for post-trial care {30}

Post-trial care will follow routine NHS practice in each centre. In centres where ultrasound imaging is used as the 4–12-week follow-up and/or at 1 year, these patients will be required to undergo one additional CT angiography. This deviation from standard care has been noted in the application for ethical approval for the study.

Outcomes {12}

Primary outcome.

Primary efficacy parameter of the study is procedure duration, measured as the time between insertion of the first wire (after percutaneous access achieved, if applicable) at the beginning of the endovascular procedure to the last frame of the completion angiogram. This will be recorded (in minutes) at the time of the procedure by the local research team.

Secondary outcomes

Procedural efficiency:

Anaesthetic duration—the time between the beginning of induction and the end of emergence. This will be documented at the time of the procedure by the local research team in minutes.

X-ray dose per procedure—fluoroscopy time (FT) (seconds), dose area product (DAP) (Gy.cm2) and cumulative air kerma (CAK) (mGy) should be recorded and documented at the time of the procedure by the local research team. The imaging system used should also be recorded.

Contrast dose per procedure—the volume (ml) and concentration (mgI/ml) of the iodinated contrast material used should be recorded by the local research team at the time of the procedure in minutes.

Consumable use in the operating theatre for endovascular aortic aneurysm repair—name of device, unit and quantity used, blood products used; details to be completed by nurse in the operating theatre or research nurse at the time of the procedure.

Technical success:

Proximal and distal seal zone at least 10mm and no evidence of endoleak. This will be documented by the imaging CoreLab team on review of the CT images acquired post-operatively and at 4–12 weeks and at 52 weeks.

Patient outcomes:

Length of ICU/HDU admission—date and time from admission to date and time of discharge from ICU/HDU; documented by the local research team during the time of admission; ICU and HDU admissions should be documented separately

Postoperative length of hospital stay—date of procedure to date of discharge from hospital (nights); documented by the local research team during the time of admission.

30-day mortality—death of the participant within 30 days of the primary procedure; documented by the local research team; to include date of death (dd/mm/yy) and cause.

Re-intervention—any procedure open surgical or endovascular undertaken within 1 year of the primary endovascular aortic aneurysm repair procedure (binary outcome). The type, timing, and number of procedures should also be recorded by the local research team.

Adverse events—hospitalisation for any reason within one year of the primary endovascular aortic aneurysm repair; the type of event should be documented and classified as one of the following: musculoskeletal, urological, neurological, ophthalmological, cardiovascular, gastro-intestinal, hepato-pancreato-biliary, dermatological, or other by the local research team, with information captured to understand if linked to re-intervention. For each hospitalisation, the following should also be captured:

Day case, elective, non-elective

Length of hospital stay—date of admission to date of discharge (nights)

Length of ICU/HDU admission (if applicable)—date and time from admission to date and time of discharge from ICU/HDU

Quality of life—differences in quality of life between intervention and the comparator group and changes in quality of life post-surgery will be measured using data from the patient-completed EQ5D-3L [ 11 ] instrument. EQ-5D-3L is a validated measure of health-related quality of life, consisting of a five-dimension health status classification system and a separate visual analogue scale. EQ-5D-3L data will be obtained through face-to-face or telephone interview with the participant at baseline, pre-discharge, 4–12 weeks, and at 12 months follow-up.

Quality-adjusted life years (QALYs)—quality of life will be measured by the EQ-5D-3L instrument as described above. In order to be used in the calculation of quality-adjusted life years (QALYs), the EQ-5D-3L dimension scores will be converted to utilities using the relevant value set for England. Quality-adjusted life years (QALYs) gained in both groups, over the time horizon of the trial, will be calculated using the area under the curve method.

Participant timeline {13}

Figure 4 lays out the trial participant time line of enrolment, intervention, and assessment.

Schedule of enrolment, interventions, and assessments of patients in the ARIA trial

Sample size {14}

There is no known minimum clinically important difference (MCID), and part of the aim of the study is to better characterise the clinical benefit to patients. The study is therefore powered on the basis of a minimum economically meaningful difference. Previous work at Duke [ 9 ] reported data on the primary outcome, procedure time, and found a mean difference of 22.5 min (17%) for patients with an abdominal aortic aneurysm treated with Cydar-EV 109.6 (34.2) and standard 2D fluoroscopy imaging 132.1 (69.2) minutes. This is a meaningful difference in the NHS context as this time reduction per case would allow four rather than three EVAR procedures to be performed per day, which is a productivity increase of 33% at the same capacity. The SD for procedure time increases with the mean and so we have assumed a t -test for ratio of means 1.2 (fold change), assuming a lognormal distribution for the calculations. Therefore, a sample size of 153 patients per arm with a 1:1 allocation ratio (2 × 153 = 306) would give us 90% power at the 2-sided 5% significance level to detect this difference (PASS 15 Power Analysis and Sample Size Software (2017)). Since our primary outcome measure requires the procedure to be completed, we need to inflate the sample size for possible: (i) loss post randomisation, pre-procedure (est. 7.5%), and (ii) on-table death and cross-overs (where surgeons may use the intervention in a control arm patient and additional assistance is required to complete the operation) (est. 2.5%). These inflate the sample size to 170 per arm. The final randomisation target is therefore 2 × 170 = 340. The Duke data also showed using Cydar-EV in TAAA showed larger reductions in operating time than for AAA. We have powered on the more conservative difference since the relative proportions of AAA/TAAA patients anticipated in our proposed trial is unknown.

Recruitment {15}

Evidence-based site selection was used to confirm the eligibility of each centre to participate in the trial using volumes of endovascular repair of infra-renal and thoraco-abdominal aortic aneurysms listed on the National Vascular Registry as well as a record of satisfactory patient outcomes and strong clinical engagement. During the trial, the team will maintain regular contact with the sites, undertake regular site visits, and ensure there are adequate numbers of randomisers at sites and that Cydar EV is installed in as many rooms as required. These will be supplemented by in person local principal investigator and research nurse meetings where site teams can hear the experience of other sites and problems and tips and tricks to ensure strong participant recruitment can be shared.

Assignment of interventions: allocation

Sequence generation {16a}.

Once baseline assessments are complete, participants will be randomised in a 1:1 ratio using the method of minimisation. Randomisation is at the patient level and is performed using a web-based bespoke randomisation system set up by the King’s Clinical Trials Unit (KCTU) at King’s College London. Randomisation is minimised by the following factors:

Procedure urgency: emergency or elective

Procedure type: simple (repair of infra-renal aneurysm ± internal iliac embolisation) or complex (all other types of AAA and TAAA repair, to include branched and fenestrated devices)

The procedure is as follows: on receipt of the baseline questionnaire, the trial coordinator electronically submits details of each participant to the CTU. This includes participant ID number, site, initials, and date of birth. The system immediately notifies the relevant study nurse and records the randomisation outcome. The trial coordinator does not receive the randomisation outcome.

Concealment mechanism {16b}

Minimisation will incorporate a random component to assure allocation concealment.

Implementation {16c}

Patients will be enrolled in the ARIA trial by the local trial team at each of the participating sites as per the described consenting procedure. The allocation sequence generation will be implemented via the Kings College Trial Unit (KCTU) web-based randomisation system. The randomisation of participants will be performed post-consent, after checking their eligibility. The signed consent form will be made available for the operating team to review, along with the randomisation result. Participants will be randomised to Cydar-EV image fusion for guidance or standard imaging techniques in a ratio of 1:1 post-consent and confirmation of eligibility.

Randomisation procedure

Study site staff delegated to undertake the randomisation procedure will generate a unique patient identification number (PIN) using the Elsevier MACRO EDC system and randomise the patient using the KCTU web-based randomisation system.

Assignment of interventions: blinding

Who will be blinded {17a}.

Due to the nature of the intervention, it is not possible to blind all members of the trial team. Table 1 lays out the blinding status of the research team in this study.

Procedure for unblinding if needed {17b}

Emergency unblinding is not required in this study.

Data collection and management

Plans for assessment and collection of outcomes {18a}, source data worksheets.

Sites will be provided with source data worksheets containing the relevant data required to be transcribed to the MACRO EDC system and the randomisation system. Training will be provided by the ARIA trial manager.

CT aorta image reading

CT imaging data will be uploaded to the ARIA trial image analysis virtual CoreLab, which is a cloud-based system. Images will be read in a blinded manner by two readers, with more than 5 years of experience of aortic image analysis and with experience of aortic endovascular surgical planning. They will securely log into the cloud-based Cydar vault where the CT image data will be housed and analyse the pre- and post-operative CTs to determine technical success. Data from this analysis will be entered onto a part of the MACRO EDC system inaccessible to sites. Twenty image data sets will be used to assess the inter- and intra- observer repeatability coefficients for the variables in the CT read protocol.

Plans to promote participant retention and complete follow-up {18b}

Participants will be seen in routine NHS follow-up clinics. If visits have not been scheduled by the end of the week 4–12 and week 52 visit windows, the study site staff will contact the participants by telephone to collect the EQ-5D (telephone version) and follow-up data, and attempts will continue to schedule a follow-up visit. Data will be collected and entered, even if follow-up clinic assessments are outside the optimal visit windows and the date noted.

Data management {19}

Authorised staff at sites will transcribe baseline and follow-up data from the source data worksheets. A full audit trail of data entry and any subsequent changes to entered data will be automatically date and time stamped, alongside information about the user making the entry/changes within the system.

Security (EDC)

Systems access will be strictly restricted through user-specific passwords to the authorised research team members. Participant initials and partial date of birth (mm/yyyy) will be entered into the systems. Hospital number, email address, participant names and addresses, and full postcodes will not be entered into the EDC system. Trial sites will maintain a master patient log linking participant identifiers to study numbers. No data will be entered unless a participant has signed a consent form to participate in the trial.

Data quality processes

At the database design stage, validations will be programmed into the systems to minimise data entry errors by querying the data entered in real time with sites. The CI team will undertake appropriate reviews of the entered data, in consultation with the project analyst, where appropriate for the purpose of data cleaning and will request amendments to the MACRO EDC system data as required. No data will be amended independently of the study site responsible for entering the data. No data can be amended in the randomisation system; however, CI or delegate (e.g. trial manager) may request King’s Clinical Trials Unit to add notes against individual participant entries to clarify data entry errors. Any errors should be reported by site staff to the trial manager as soon as possible once they are detected. The trial manager will onward report errors to KCTU and retain records in the TMF. Site monitoring visits will be conducted by the trial manager.

Confidentiality {27}

When consent forms are signed, a copy will be provided to the patient, a copy will be filed in the medical records, and the original will be retained in the Investigator Site File. Participant initials and date of birth will be entered into the study database, but no more identifying information will be collected outside the recruiting study site. Within site, an Investigator Site File will be maintained by the site PI. Participants will be fully identifiable within these files.

Plans for collection, laboratory evaluation, and storage of biological specimens for genetic or molecular analysis in this trial/future use {33}

There are no biological specimens that will be taken as part of this trial.

Statistical methods

Statistical methods for primary and secondary outcomes {20a}.

The analyses will be carried out according to the statistical analysis plan written before any outcome data are inspected. A CONSORT diagram will describe the patient flow and exclusions. Baseline demographic and clinical data will be summarised by randomisation trial arm.

Statistical methods for primary outcome

As the primary outcome is procedure duration and we envisage 7.5% loss of patients between randomisation and procedure, the primary analysis will be a per-protocol (PP) analysis based on procedure time. The primary analysis will be conducted after completion of first follow-up (at 4–12 weeks) which will include procedure time as well as the secondary outcome data available at this time. Sensitivity analysis with multiple imputation for missing data will also be conducted alongside the per-protocol analysis. No significance tests will be performed for baseline comparison. The primary outcome measure is likely to have a skewed distribution and therefore if necessary and possible the data will be normalised using an appropriate transformation. The data will then be analysed using linear regression techniques with stratification (minimisation) factors included as covariates. If a suitable transformation cannot be found, the data will be analysed using quantile regression to allow us to include the addition of the stratification factors as covariates.

Statistical methods for secondary outcomes

A similar analysis will be undertaken for the secondary outcomes including quality of life scores. Binary outcomes will be compared between arms using logistic regression adjusting for stratification factors. Outcomes will be reported as adjusted differences in means (or median) or odds ratios for continuous and binary data respectively. All tests will be two sided and will be assessed at the 5% significance level. Safety outcomes will be reported as patient proportions and rates within and between arms with 95% confidence intervals using exact methods where appropriate.

Interim analyses {21b}

There will be no planned formal interim analyses of the primary and secondary outcomes. However, we will conduct further analyses of secondary outcomes at the completion of the 52-week follow-up for all the patients.

Methods for additional analyses (e.g. subgroup analyses) {20b}

We will use data collected during this study for further analyses investigating the following topics:

Image analysis—a CoreLab will perform imaging analysis of technical outcomes and anatomy as seen on the 2 postoperative CTs.

Health economic analysis will be performed to examine the cost-effectiveness of the Cydar EV system. This will include an analysis of the systems efficiency that the Cydar EV system may allow.

Quality of life between the two groups will be assessed using the area under the curve method.

Methods in analysis to handle protocol non-adherence and any statistical methods to handle missing data {20c}

Compliance with intervention will be recorded in the source data worksheets and transcribed to the EDC system. Reasons for non-compliance would include device failure, surgeon error, or failure to communicate correct randomisation allocation to the surgeon. The patient could only impact compliance if they express a wish to withdraw between randomisation and surgical procedure. Missingness will be reported and reasons for missingness explored. Although a low percentage of missing data is anticipated, a sensitivity analysis of the primary outcome will be undertaken in order to assess the impact of the exclusion of participants with missing intraoperative data in the primary analysis. In this view of the sample size, a modelling approach will be taken rather than multiple imputation.

Plans to give access to the full protocol, participant-level data, and statistical code {31c}

The investigator(s) will permit trial-related monitoring, audits, and REC review by providing the sponsor(s) and REC direct access to source data and other documents (e.g. patients’ case sheets, blood results, imaging reports, trial protocol, statistical code, and etc.).

Oversight and monitoring

Composition of the coordinating centre and trial steering committee {5d}.

The trial will be coordinated through the KCTU with the CI being supported by the trial management group (TMG) who are made of the following members: Cydar lead investigator, KCTU operations director, KCTU data centre lead, KCTU senior statistician, KCTU junior statistician, KCTU trial manager, trial health economist, Cydar project manager, and the KCL clinical research fellow. The TMG is responsible for the study coordination, data quality, and budget management. The TMG members will meet at least monthly throughout the trial. The CI will chair the TMG. Minutes will be taken by the trial manager and retained in the TMF. The TMG will review recruitment to the study across all study sites and will take appropriate action in the event the study recruitment rate is lower than anticipated.

The TSC is an executive committee, reporting to the funder (NIHR) and the sponsor. Independent members will be independent of both the sponsor organisations and of any recruiting study sites. The terms of reference of the TSC will be agreed at the first meeting, prior to start of recruitment. Meetings will be scheduled approximately 2 weeks after each data monitoring committee (DMC) meeting. Minutes will be taken by the trial manager and retained in the TMF. The trial manager will prepare reports to the TSC. The trial may be prematurely discontinued by the co-sponsors or chief investigator on the recommendation of the trial steering committee.

Composition of the data monitoring committee, its role and reporting structure {21a}

The data monitoring committee (DMC) will be composed of three independent members: a statistician and two clinicians. The DMC is an advisory committee, reporting to the trial steering committee. They will receive a report of recruitment and serious and non-serious adverse events and a summary of accumulated clinical data from the trial statistician and will meet in person or by telephone. The DMC will meet at least annually during the study, approximately 2 weeks prior to the TSC. Members will be independent of the sponsor organisations and of any recruiting study sites. The DMC will work to the DAMOCLES guidance and a DMC charter will be agreed at the first meeting outlining responsibilities, reporting, meeting frequency, documentation, and other matters. The trial statistician will prepare reports for the DMC.

Adverse event reporting and harms {22}

Adverse events will be categorised as per the medicines for human use (Clinical Trials) regulations 2004 and amended regulations 2006. Where any adverse event occurs, the relationship with the investigational product will be assessed to determine the relationship and be judged as, definitively, probably, possibly, unlikely, not related, or not assessable. All SAEs, SARs, and SUSARs will be reported immediately (and certainly no later than 24 h) by the investigator to KCTU. The chief investigator will report relevant SAEs to the ethics committee.

Frequency and plans for auditing trial conduct {23}

Monitoring of this trial will ensure compliance with Good Clinical Practice and will be managed by the trial manager at King’s College London. The investigators will permit trial-related monitoring, audits, REC review, and regulatory inspections by providing the sponsors, regulators, and REC direct access to source data and other documents (e.g. patients’ case sheets, blood results, imaging reports, trial protocol, statistical code, and etc). KCTU will prepare a monitoring plan for approval by the TMG. Recruiting study sites will have a site initiation visit prior to recruitment of the first participant and regular site visits thereafter to verify the data.

Plans for communicating important protocol amendments to relevant parties (e.g. trial participants, ethical committees) {25}

The trial manager will be responsible for preparing and submitting protocol amendments to the ethics committee and the HRA and circulating updated document versions to recruiting study sites, co-applicants, the TMG, TSC, and DMC, and (where relevant) the funder. Site investigators will be responsible for communicating relevant information to study participants.

Dissemination plans {31a}

The primary analysis will be conducted after completion of first follow-up (at 4–12 weeks) which will include procedure time as well as the secondary outcome data available at this time and published in a peer reviewed open source medical journal as early as possible. The 52-week secondary outcomes will be published in a further paper when all outcome data collection is complete. Recruiting sites will be informed of the results and will be asked to disseminate the findings to participants. Patient groups will be informed of the results for dissemination among their members. The sharing dataset will be passed to the trial chief investigator by the analyst, and all future data sharing will be managed as per the head contract and associated collaboration agreements.

Not applicable. We have no practical or operational issues to report that involve performing the study.

Trial status

The current trial protocol version is 1.3 and was published on 24 May 2023. Recruitment began 4 May 2022 and is expected to be completed by 31 December 2023.

Availability of data and materials {29}

Data will be available for sharing upon request for future scientific research, subject to approval by the co-sponsors.

Abbreviations

Abdominal aortic aneurysm

Chief investigator

Computerised tomography

Data monitoring committee

Electronic data capture

General practitioner

Good clinical practice

High-dependency unit

Intensive care unit

Intention to treat

King’s Clinical Trials Unit

Medicines and Healthcare products Regulatory Agency

Principal investigator

Participant information sheet

Per protocol

Research ethics committee

Research nurse

Thoraco-abdominal aortic aneurysm

Trial manager

Trial management group

Trial statistician

Trial steering committee

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Acknowledgements

The ARIA trial team would like to thank the principal investigators at each of the trial sites: Morad Sallam Guy’s and St Thomas’ NHS Foundation trust, Marcus Brooks North Bristol NHS Trust, Simon Neequaye Liverpool University Hospitals NHS Foundation Trust, Waquar Yusuf Brighton and Sussex Univeristy Hospitals NHS Trust, Rosemary Darwood Leeds Teaching Hospitals NHS Trust, Ganesh Kuhan and Peter Bungay University Hospitals of Derby and Burton NHS Foundation Trust, Ferdinand Serracino-Inglott Manchester University NHS Foundation Trust, Benjamin Patterson University Hospital Southampton NHS Foundation Trust, Colin Bicknell Imperial College Healthcare NHS Trust, and David Gerrard Frimley Health NHS Foundation Trust.

The authors acknowledge support from the Department of Health and Social Care (DHSC) through the National Institute for Health and Care Research (NIHR) MedTech Co-operative award for Cardiovascular Diseases to Guy’s & St Thomas’ NHS Foundation Trust in partnership with King’s College London.

This project is funded by the National Institute for Health and Care Research (NIHR) under its Invention for Innovation (i4i) Programme (Grant Reference Number NIHR201004). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

The NIHR does not have a role in the collection, analysis, or interpretation of the data or writing of the manuscripts.

Author information

Authors and affiliations.

School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK

James Budge & Rachel E Clough

St George’s Vascular Institute, St George’s University, London, UK

James Budge

Cydar Medical Limited, Cambridge, UK

Tom Carrell & Matt Waltham

King’s Clinical Trials Unit, King’s College London, London, UK

Medeah Yaqub, Izabela Pilecka, Joanna Kelly & Caroline Murphy

Department of Population Health Sciences, King’s College London, London, UK

Hatem Wafa & Yanzhong Wang

Centre for Health Economics, University of York, York, UK

Stephen Palmer

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Contributions

RC is the chief investigator; she along with TC conceived the study. RC led the proposal and protocol development. JB, MY, HW, MW, IZ, JK, SP, and YW contributed to the study design and development of the protocol. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rachel E Clough .

Ethics declarations

Ethics approval and consent to participate {24}.

Individual participants will consent to participate. The trial will be conducted in compliance with the principles of the Declaration of Helsinki (1996) and the principles of GCP and in accordance with all applicable regulatory requirements including but not limited to the Research Governance Framework and the Medicines for Human Use (Clinical Trial) Regulations 2004, as amended in 2006 and any subsequent amendments.

This protocol and related documents have been submitted for review to Health Research Authority (HRA) and Research Ethics Committee (REC). MHRA approval is not required as Cydar-EV is CE Marked as a medical device and is being used as intended. The chief investigator will submit an end of study report at the conclusion of the trial to the REC.

Consent for publication {32}

Not applicable—no identifying images or other personal or clinical details of participants are presented here or will be presented in reports of the trial results. The participant information materials and informed consent form are available from the corresponding author on request.

Competing interests {28}

Tom Carrell is a Cydar Medical company employee.

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Budge, J., Carrell, T., Yaqub, M. et al. The ARIA trial protocol: a randomised controlled trial to assess the clinical, technical, and cost-effectiveness of a cloud-based, AR tificially I ntelligent image fusion system in comparison to standard treatment to guide endovascular A ortic aneurysm repair. Trials 25 , 214 (2024). https://doi.org/10.1186/s13063-023-07710-5

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Received : 31 July 2023

Accepted : 06 October 2023

Published : 25 March 2024

DOI : https://doi.org/10.1186/s13063-023-07710-5

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Mustang Mach-E News

2024 Ford Mustang Mach-E reportedly gets another price adjustment to keep it competitive

Dealer bulletin shows smaller increases over the price cuts the 2023 model got.

A month ago, Ford dropped prices on the 2023 Mustang Mach-E , then introduced some tasty incentives to keep itself in second place on the EV popularity list behind Tesla . Cars Direct reports that Ford sent its dealers a bulletin this week that will keep 2024 Mustang Mach-E pricing close to the 2023 MSRPs. According to the outlet, original pricing for the 2024 model year would have eliminated the cuts, making them anywhere from $3,600 to about $6,000 more expensive than the outgoing model. In this EV economy, that won't work. Prices still go up, however, the situation's much friendlier than it could have been. According to that dealer bulletin, here are the new MSRPs for the 2024 Mach-E, and their differences from current 2023 Mach-E pricing, after the current $1,800 destination charge:

Select RWD: $41,795 ($100)
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Premium Ext. Range Battery AWD: $51,795 ($1,100)
GT: $55,795 ($1,600)

If you'll notice, the California Route 1 isn't listed among the options. Cars Direct wrote , "According to Ford's website, the Mach-E Premium and California Route 1 are no longer available to order due to high demand." We're not sure what's happening behind the scenes of Ford's retail site, but when we checked it to write this post, we couldn't find the 2024 Mach-E listed, only the 2023, so the Premium is still available — on the site, at least. A Ford spokesperson confirmed omission of the Premium and California Route 1 trims, though, citing "unprecedented demand."

Separately, playing around with the configurator, we also noticed the entry-level 2023 Mach-E Select AWD trim with the $3,000 extended-range battery is no longer an option, either.

All this could be a reason to stick with a 2023 instead of the new newness, since Ford's incentives still apply. At the time of writing, a banner at the top of the 2023 Mach-E configurator calls attention to 0% APR financing for 72 months on all trims and $3,000 cash back on the GT trim for buyers, or $7,500 cash toward a lease on any 2023 trim.

Finally, the same bulletin puts a price to the trail-happy 2024 Mustang Mach-E Rally : $61,795 after destination. There's some confusion here, since the bulletin also listed the Mach-E Rally with a $1,500 option code. Cars Direct wasn't sure if the $1,500 is included in the stated MSRP, or if that $1,500 represents a mandatory upgrade that comes with the rally. Because the information was coming from an internal communication, Ford wouldn't clarify the numbers, only saying we'd get official MSRPs "in a couple of weeks."

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How do I compare and contrast theories and ideas in my literature
How do I compare and contrast theories and ideas in my literature review or research paper? Last Updated: Mar 29, 2022 Views: 28122. ... See the links below to access the tutorial and to get additional explanation of how to compare and contrast ideas, topics, and resources. Links & Files. Writing Help Guide - The Literature Review;
Writing for Success: Compare/Contrast
The Structure of a Compare/Contrast Essay. The compare-and-contrast essay starts with a thesis that clearly states the two subjects that are to be compared, contrasted, or both and the reason for doing so. The thesis could lean more toward comparing, contrasting, or both. Remember, the point of comparing and contrasting is to provide useful ...
4.1: Compare and Contrast
Comparison and contrast could be used to evaluate companies, departments, or individuals. Exercise 1. Brainstorm an essay that leans toward contrast. Choose one of the following three categories. Pick two examples from each. Then come up with one similarity and three differences between the examples. Romantic comedies.
Comparing and Contrasting: A Guide to Improve Your Essays
An academic compare and contrast essay looks at two or more subjects, ideas, people, or objects, compares their likeness, and contrasts their differences. It's an informative essay that provides insights on what is similar and different between the two items. Depending on the essay's instructions, you can focus solely on comparing or ...
4.1: Introduction to Comparison and Contrast Essay
4.1: Introduction to Comparison and Contrast Essay. The key to a good compare-and-contrast essay is to choose two or more subjects that connect in a meaningful way. Comparison and contrast is simply telling how two things are alike or different. The compare-and-contrast essay starts with a thesis that clearly states the two subjects that are to ...
How to Write a Compare and Contrast Essay
Compare and contrast essays examine topics from multiple viewpoints. This kind of essay, often assigned in middle school and high school, teaches students about the analytical writing process and prepares them for more advanced forms of academic writing. Compare and contrast essays are relatively easy to write if you follow a simple step-by-step approach.
How to Write a Compare and Contrast Essay (with Pictures)
The first step to writing a successful compare and contrast essay is to pick two subjects that are different enough to be compared. There are several things to consider when choosing your subjects: You could pick two subjects that are in the same "category" but have differences that are significant in some way.
Instructional Approaches to Improving Students' Writing of Compare
Writing in the compare-contrast text structure presents unique problems for students (Spivey, 1990, 1991), and students' ability to write compare-contrast compositions seems to be resistant to change (Englert & Thomas, 1987). Students ' difficulties in writing compare-contrast may be related to: (a) ability (Hiebert et al.,
Comparison-and-contrast in research articles of applied linguistics: A
This article reports on a corpus-based study that examined the comparison-and-contrast markers in research articles of applied linguistics. The main argument is that comparison-and-contrast in academic writing functions as a rhetorical act that realises text organisation or dialogic contraction and as a cognitive act that fulfils representational changes and knowledge creation.
What Is a Compare and Contrast Essay? Simple Examples To Guide You
A compare and contrast essay is a type of analytical essay that explores the similarities and differences between two subjects. We guide you through one with some examples.
Comparison-and-contrast in research articles of applied linguistics: A
The present study views comparison-and-contrast as the builder and transmitter of scientific knowledge. • The present study builds a comparison-and-contrast frame for research articles of applied linguistics.. The frame consists of three core (i.e. Comparative_item, Dimension and Agent) and two non-core (i.e. Evaluation and Indication) frame elements.
PDF Comparing and Contrasting
Recognizing comparison/contrast in assignments Some assignments use words—like compare, contrast, similarities, and differences—that make it easy for you to see that they are asking you to compare and/or contrast. Here are a few hypothetical examples: Compare and contrast Frye's and Bartky's accounts of oppression.
Comparison of metagenomic next-generation sequencing and conventional
In contrast, the culture exhibited higher specificity (99.27% vs. 85.40%, p < 0.001) and positive predictive value (98.84% vs. 87.01%) than mNGS. Among infected patients with positive mNGS results, 64 received adjusted antibiotic therapy including treatment transitions, antibiotic downgrading, and combination therapy.
The ARIA trial protocol: a randomised controlled trial to assess the
Background Endovascular repair of aortic aneurysmal disease is established due to perceived advantages in patient survival, reduced postoperative complications, and shorter hospital lengths of stay. High spatial and contrast resolution 3D CT angiography images are used to plan the procedures and inform device selection and manufacture, but in standard care, the surgery is performed using image ...
Jesus' Resurrection Confronts and Comforts
The resurrection is true. According to Lifeway Research's 2022 State of the Theology study, around 1 in 3 Americans doubt the biblical accounts of Jesus' physical resurrection, including 23% who say they are false. Most people who deny the resurrection do so because of the "utter uniqueness of the claim," says Johnston, who also serves ...
2024 Ford Mustang Mach-E reportedly gets another price ...
Cars Direct reports that Ford sent its dealers a bulletin this week that will keep 2024 Mustang Mach-E pricing close to the 2023 MSRPs. According to the outlet, original pricing for the 2024 model ...

OASIS: Writing Center

Address Both Similarities and Differences

Make Sure You Have a Clear Thesis Statement

Use Clear Transitions

Structure Your Paper

Include Analysis

Make Analogous Comparisons

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Comparing and Contrasting in an Essay | Tips & Examples

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Table of contents

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The alternating method

The block method

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Jack Caulfield

10.7 Comparison and Contrast

The Purpose of Comparison and Contrast in Writing

Writing at Work

The Structure of a Comparison and Contrast Essay

Writing a Comparison and Contrast Essay

Key Takeaways

Comparing and Contrasting

The professor says to compare and contrast A and B ...

Sometimes, comparisons are done in the following manner:

How to avoid the "Split Essay": A Second Option for Comparison

What do I do to eliminate the Split?

Writing Resources

What is the Matrix Method, and why should I use it?

Organize your sources

Choose your remaining column topics

Methodological

Content-specific

Geographical

Writing A Compare/Contrast Paper

Sophomore Research: Compare & Contrast

Comparative Analysis

Comparing and Contrasting - UNC Writing Center

Finding Similarities and Differences

Questions to Ask

Signal Transitions for Compare/Contrast

Point by Point Comparison Outline Format

Subject Comparison Outline Format

Compare Then Contrast Outline Format

LEARNING OBJECTIVES

The Purpose of Compare/Contrast in Writing

The Structure of a Compare/Contrast Essay

Writing an Compare/Contrast Essay

Compare/Contrast Essay Example

KEY TAKEAWAYS

Instructor Resources (Access Requires Login)

An Overview of the Writing Process

Using Sources

Definition Essay

Narrative Essay

Illustration/Example Essay

Compare/Contrast Essay

Cause-and-Effect Essay

Argument Essay

Comparing and Contrasting: A Guide to Improve Your Essays

Walter Akolo

What Is Comparing and Contrasting?

Can Comparing and Contrasting Be Useful Outside of Academia?

Can You Compare and Contrast in an Essay That Does Not Specifically Require It?

What Should You Do First?

Using a Venn Diagram

Going Subject by Subject

Going Point by Point

Examples of College Level Compare and Contrast Essay Questions

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4.1: Introduction to Comparison and Contrast Essay

Key Elements of the Compare and Contrast: