One Flew over the Cuckoo Nest Critical Analysis - 1633 Words

One flew over the cuckoo nestâ€Å"One Flew Over the Cuckoo’s Nest† The film â€Å"One flew Over the Cuckoo’s Nest† accurately depicts and presents the various psychological issues, such as the use of psychosurgery, institutionalism inside the psychiatric hospital and the medical and societal attitudes towards patients during the 1960s. Set in 1963, the film uses characters – patients and authority figures alike – and setting to accurately depict various aspects of psychological treatments, theories and concepts applied, before more ethical practices were introduced later in the 20th century. The film itself was extremely powerful in presenting the methods it used by psychiatric asylums to treat its patients, and was credited with tarnishing the†¦show more content†¦It is in this context that the film â€Å"One Flew Over the Cuckoo’s Nest† is identified as a possible medium to investigate the nature and effect of a psychiatric system as accurately portrayed through this particular film, The film dep icts the psychiatric system as rigid, leaving â€Å"patients† with little room to express their individuality. The effect of the staff-members’ behaviour on the â€Å"patient’s† psychotherapeutic growth, highlights the staff’s ignorance and lack of knowingness of their individual responsibility, contributing to the psychopathology of not only the â€Å"patients†, but also the system as a whole. The interactional style of the psychiatric staff, as portrayed in the film, serves to contribute to the deterioration of the mental and psychological well-being of the â€Å"patients†, thus inhibiting their psychological growth. The majority of â€Å"One Flew over the Cuckoo’s Nest† takes place in the Day Room of the hospital. The setting adds to the feeling of confinement, with the men often resorting to playing games of chess or resorting to cards to pass their time. The space of the institution itself is characterised by an obs ession with routines, and adherence to control and confinement – that is, under Nurse Ratchet’s control. Medicine time, music time, recreation time – each are strictly designated andShow MoreRelatedOne Flew Over The Cuckoos Nest Speech Act Theory Essay1281 Words   |  6 PagesKen Kesey forms the intricate relationships among the characters in the novel One Flew Over the Cuckoo’s Nest by the unique use of perspective and speech. Throughout the novel, Kesey depicts this connection between the public world and the seemingly closed off society inside the mental institution. This creates two separate spheres separated by a few walls and doors. Kesey goes on to form a unique perspective in the novel, told by a paranoid schizophrenic, with the narrator’s caricature-likeRead MoreThe Characters of One Flew Over the Cuckoos Nest in Film and Novel935 Words   |  4 PagesThe Characters of One Flew Over the Cuckoos Nest in Film and Novel One Flew Over the Cuckoo’s Nest was a critically acclaimed novel written by Ken Kesey and later on a movie adaptation, directed by Milos Forman, which was similarly critically acclaimed earning itself an extremely high 96% on rotten tomatoes. However said appraisal of both works, does not excuse the gleaming errors and artistic licensing seen throughout the entirety of the film. Granted there were no major plot holes and alterationsRead MoreKen Kesey s One Flew Over The Cuckoo s Nest1629 Words   |  7 PagesKesey’s One Flew Over The Cuckoo’s Nest is a timeless classic. This novel has been subject to analysis through many different literary lenses: feminist, Marxist, and of course, psychoanalytic. One Flew Over The Cuckoo’s Nest provides a plethora of evidence when it comes to using the psychoanalytic lens. The lens in question deals with the teaching of Sigmund Freud. When reading this novel, the audience sees quite clearly that the world of psychology p lays an impactful role in One Flew Over The Cuckoo’s

Follicular And Mantle Cell Lymphomas Health And Social Care Essay Free Essays

string(319) " purging perchance of import ; unproved Whether it has maior consequence on results ; value of post-transplantation RTX uncertain ; talker recommends handling rate 3 FL per protocols for DLBCL Questions and replies: consequence of length of i ¬\?rst remittal on recommendations for ASCT – in other diseases \( e\." follicular lymphoma 2nd most common type of lymphoma in United States ; diagnosticians able to name PL with less information and more duplicability than any other type of lymphoma ; FLs vary in character ; cutaneal ( follicle centre cell ) lymphomas normally curable with local therapy ; duodenal and paediatric -both rare indolent diseases ; make good with minimum therapy ; by and large non do of decease in affected patients Grade 3 follicular lymphoma: presently defined by figure of big ( blast ) cells per high-power field ( HPF ) ; method tolerably accurate in FL, and most consistent ; grade 1, lt ; 5 big cells per HPF, grade 2, 5 to 15 per HPF, and grade 3, gt ; 15 per HPF ; duplicability survey — -diagnosis of FL by diagnosticians gt ; 90 % consistent, but well less accurate in finding class: class 3 FL farther classified as 3A ( big cleaved cells ) and 3B ( blast cells ) ; nevertheless, limited truth in finding class may bespeak limited duplicability in separating 3A fr om 3B ; distinctniess of class 3B ( Sloan-Kettering survey ) — -maximum standardised consumption ( [ SUV ] of fluorodeoxy glucose on antielectron emanation imaging [ PET ] ) in class 3 FL more similar to SUV in patients with diffuse similar to SUV in patients with diffuse big B cell lymphoma ( DLBCL ) than grade 1 or 2 FL ; Harris survey — per centum of Ki-67 stain-positive cells increased With increasing class of FL, with grade 3 FL staining near to degrees seen in DLBCL ; several surveies showed that some patients with FL grade 3 treated with cyclophosphamide, doxorubicin, Oncovin ( oncotic ) and Pediapred ( CHOP ) or CHOP like regimens had response to therapy similar to that of patients with DLBCL ; ability to bring around this group justifies handling all patients with grade 3 FL with regimens used to handle DLBCL.Low-grade FL: multiple effectual interventions available ( best one as yet unknown ) : ticker and wait – lupus erythematosus favored ; single-agen t Leukeran or cyclophosphamide — no longer used ( most patients treated with combination therapy ) ; local radiation therapy ( RT ) — used in patients with localised disease: total-body irradiation — out of favour ; patient Immunity and FL ( Rosenberg survey ) — showed self-generated slirinkage of FL in many patients ; multiple surveies show patients with fewer macrophages have better endurance than patients with high degrees ( may explicate shrinking without intervention ) ; vaccinum survey — -without intervention ) ; vaccinum survey — subset of patients who made antibodies had duplicating of progression-free endurance ( PFS ; suggests possibility of use of _relationship between FL and environment ) ; Gallic survey – inauspicious consequence of high macrophage degrees eliminated in patients treated with rituximab ( RTX ; suggests changing microenvironment as possible mechanism of action of interventions, including autologous root cell organ transplant [ ASCT ] ) ; ASCT non considered intervention for FL until late ( despite informations ) ASCT as salvage therapy: Chemotherapy, Unpurged and Purged ( CUP ) test – patients randomized to CHOP chemotherapy ( CTX ) entirely, or ASCT ( with or without purged marrow ) plus CHOP, in patients who had failed on Leukeran or other CTX ; patients in both organ transplant weaponries had important advantage in PFS and overall endurance ( OS ) ; survey indicates ASCT effectual therapy before RTX ; consequences decline after insistent intervention ; 3 of 4 upfront ASCT surveies in patients with FL show extremely important advantage in PFS ( no agvantage in OS ) , but upfront ASCT non done in United States ; St. Bart’s/Dana Farber and UNMC informations — – of patients Farber and UNMC informations — of patients treated with ASCT ( pre-RTX, largely grades 1 and 2 ) , somewhat lt ; 50 % had 10-yr freedom from disease patterned advance Possible functions of RTX in FL: remedy of FL ( rid ofing demand for organ transplant ) -Stanford survey update, UNMC survey, and Surveillance, Epidemiology and End Results ( SEER ) data show betterment in FL endurance over past 3 decennaries ; RTX of import subscriber to alter ( although other factors possible ) ; Cochrane meta-analysis — patients given RTX in initial therapy had extremely important survival advantage ; UNMC informations analysis suggests patients with low-grade FL and initial intervention with RTX had superior endurance, compared to patients having RTX at other times or non at all ; Primary RTX and Maintenance ( PRIMA ) survey – care RTX increased opportunity of continued remittal by 20 % ; consequence larger in patients with complete response ( CR ) than in those with partial response ( PR ) ; Swiss survey — demonstrated survival advantage with merely 4 extra doses of RTX ; analysis of PET informations from PRIMA survey — negative findings on PET seen in 92 % of patients with true CR ; one-third of patients with unsure CR PET-positive ; 20 % of patients with progressive disease 20 % of patients with progressive disease PET-negative ; PET negativeness best forecaster of result ; RTX improves endurance of FL, but unclear Whether it cures high proportion of patients with low-grade FL, ASCT after RTX therapy: Spanish survey and Collaborative Trial in Relapse Aggressive Lymphoma ( CORAL ) — — – patients with DLBCL treated with RTX before ASCT # 50 % more likely to be cured than patients with no RTX ; perchance due to bring around rate of patients after RTX therapy ( ie, patients still necessitating ASCT after RTX probably had more immune disease ) ; German surveies – patients witlt FL randomized to ASCT V care with interferon ( IFN ) af ter initiation with CHOP ; patients who got CHOP plus RTX ( R-CHOP ) and ASCT had somewhat better endurance than patients on IFN ; patients without RTX had much better endurance with ASCT than with IFN ; Cleveland study – no important difference in endurance after ASCT betweett patients with relapsed FL who had received RTX in past and those who had non In vivo purge: no direct informations available on effects on ASCT results ; UNMC informations — patients treated with monoclonal antibodies ( MAB ) and RTX earlier cell aggregation had better results after ASCT ( ill-defined how much betterment due toMAB V RTX ) ; Gallic survey – patients treated with MAB for salvage therapy had better results ; other surveies -majority of patients had no tumour cells ( per polymerase concatenation reaction [ PCR ] ) after RTX Post-transplantation care: small informations available ; several surveies showed important proportions of patients had delayed neutropenia or hypoganimma gloibulinemia if treated with RTX after ASCT ; no inerease in mortality seen with RTX, but it gives no advantage ( and increases trouble for patients ) ‘Conclusions: public-service corporation of RTX in FL remains ill-defined ; ASCT remains best tratment in younger healthier patients for relapsed FL ; best given after first intervention failure ; vivo purging perchance of import ; unproved Whether it has maior consequence on results ; value of post-transplantation RTX uncertain ; talker recommends handling rate 3 FL per protocols for DLBCL Questions and replies: consequence of length of i ¬?rst remittal on recommendations for ASCT – in other diseases ( e. You read "Follicular And Mantle Cell Lymphomas Health And Social Care Essay" in category "Essay examples" We will write a custom essay sample on Follicular And Mantle Cell Lymphomas Health And Social Care Essay or any similar topic only for you Order Now g, Hodgkin lymphoma ) , patients do less good with brief initial remittal and ASCT, but likely better than with alternate likely better than with alternate therapies ; if patient immature and healthy, talker would still offer ASCT ; talker would discourse ASCT with immature healthy patients who have had really long or really brief remittals ; PET as tool to place faineant class 3 FL — unknown if patients with low SUVmaX should hold different intervention ; differences in diagnosing of class 3 FL add complexness to determination for intervention ; upfront allotransplantantation for FL — -best intervention to eliminate FL ; limited by 20 % to 30 % freshman mortality ( mortality decreases with age of patient ) Minimal Residual Disease in Follicular and Mantle Cell Lymphoma: -Foundation: CHRISTINE POTT, MD. absence of residuary lymphoma mass on imagination and bone marrow biopsy ( low sensitiveness ) referred to as clinical remittal ; analysis of minimum residuary disease ( MRD ) below clinical remittal reveals different dynamicss of lymphoma ( may specify those who will get worse, and those with remedy or who will get worse, and those with remedy or long-run remittal ) ; MRD techniques — extremely sensitive and loosely applicable ; may assist clinicians understand disease dynamicss on molecular degree ; allow polish of clinical presenting Benefits of MRD analysis: provides possible alternate parametric quantity for clinical response ; integrates biologic Features of tumour ; rei ¬Ã¢â‚¬Å¡ects pharmacogenetic traits and dose strength achieved in single patients ; identifies prognostic subgroups in B cell lymphoma ; independent predictive factor ; of import tool for indivtdualizing intervention Assessment of MRD ) : cytogenetics and fluorescent unmoved hybridisation ( FISH ) non sufficiently sensitive ( more utile for initial diagnosing and appraisal of malignant lymphoma ) ; flow cytometry and PCR chief methods ; i ¬Ã¢â‚¬Å¡ow cytometry — loosely applicable, fast, and provides quantitative consequences ; nevertheless, malignant lymphoma has partly unstable markers ( non reproducible in many patients ) ; in FL, sensitivenesss vary harmo nizing to benign hematogones ; consensus PCR — easy, rapid to perform.inexpensive, and stable, but non quantitative ; has low sensitiveness ; immunogen-based allele-specii ¬?c PCR — most advanced method ; sensitive, with- most advanced method ; sensitive, with quantitative consequences ; specific and extremely consistent ; nevertheless, labour-intensive and expenslve.PCR markers: irnntunoflobttlin cistrons — -heavy concatenation ( IgH ) an visible radiation concatenation ( IgK ) ; applicable in B cell non-Hodgkin lymphoma, chronic lymphocytic leukaemia, and acute leukaemia ; T cell receptor cistrons — – potentially available for T non-Hodgkin lymphomas and acute lymphoblastic leukaemia ; chromosomal translocations — T ( 1/14 ; 18 ) for FL ; T ( 11 ; 14 ) fer mantle cell lymphoma ( MCL ) ; translocations serve as marks in # 80 % of B cell lymphomas, in 60 % to 70 % of FL, and 30 % to 40 % af MCL ; these techniques quantify MRD in # 80 % of patients ; imrnunoglobulin heavy-chain venue – mast loosely applicable marker, rearrangement of V, D, and ] H parts in normal development of B cells ; sequence in this junctional part Acts of the Apostless as ‘DNA ‘ i ¬?ngerprint of cell ( identifiable by consensus PCR ) ; monoclonal rearrangement in lymphoma identified by gene-scan form with monoclonal extremum ; sequencing of monoclonal rearrangement allows allele-specific primer design to aim single patient ‘s sequence ; translocation marks — – T ( 14,18 ) breaktpoints in marks — T ( 14,18 ) breakpoints in different locations in cistron ; can measure # 70 % of patients with major breakpoint part ; assay developed by Biomed 2 Group usage to measure other countries ; translocations act as molecular markers ( eg, t [ 11 ; 14 ] ) Prognostic relevancy of MRD: shown in early surveies ; betterment in curative options led to increase in surveies look intoing MRD as alternate parametric quantity for forecast ; FL surveies — showed accomplishment of molecular remittal associated with improved forecast, irrespective of whether patients received ASCT, CTX, or rituximab Floridas: Lopez-Guillermo survey — – showed accomplishment of molecular remittal possible with standard-dose CTX without antibodies ; failure-free endurance significantly better in patients who achieve both clinical and molecular remittal ; Italian survey — -PCR negativeness associated with improved forecast in patients treated with CHOP entirely or R-CHOP ; Gribben survey — updated consequences show patients with sustained MRD negativeness ( by PCR ) after ASCT have continued long-run endurance ; recent Italian survey ( .2008 ) — – PCR negativeness most of import predictive factor both in patients treated with R- factor both in patients treated with R-CHOP and those who received RTX plus high-dose consecutive CTX ; outcomes improved with molecular remittal MCL: fewer surveies available ; several surveies conclude MRD has no predictive consequence in MCL ; relevancy seen after debut of RTX and ASCT ; monocentric survey — – patients consecutive monitored for MRD after R-CHOP, root cell mobilisation with dexaBEAM ( dexatnethasone_ carmustine [ BCNU ] , etoposide, cytarabine [ Ara-C ] and Alkeran ) before ASCT ; MRD ) negativeness associated with longer PFS ( 92 minute, vs 24 minute in MRD~positive patients ) and OS ; European web tests – MRD analysis done in patients under and gt ; 65 year of age after initiation with immuno-CTX ; patients accomplishing clinical and molecular remittal have significantly longer continuance of response, irrespective of whether MRD achieved in blood or hone marrow ; molecular response after initiation superior predictive factor, compared to Mantle Cell International Prognostic Index ( MIPI ) mark and accomplishment of clinical response.Summary: PCR identifies low- and poor-risk groups in FL and MCL ; PCR holds true in multivariate analysis and is true in multivariate analysis and is independent of pretherapeutic hazard factors ; MRD negativeness achievable without ASCT Timing of MRD appraisal in FL: available surveies show relevant clip points for obtaining predictive informations ; German Lymphoma Study Group test – rating at diagnosing allowed presentation of association between low degree of go arounding lymphoma cells and molecular response ; MRRD dynamicss during initiation ( after 4 intervention rhythms ) showed that patients with rapid decrease of go arounding lymphoma cells have high chance of clinical remittal, compared to patients with slow response ; PFS with molecular remittal significantly greater than that with clinical remittal entirely ; postremission clip point of import if MRD used as foster parametric quantity ; multivariate analysis shows MRD ) better predictive factor than RTX treatnient, ASCT, or pretherapeiitic FL International Prognostic index ( FLIPI ) hazard factors ; extra informations analysis showed MRD position helps to define patients with different forecasts independent of clinical remittal position ; sustained MRD position — — forecast significantly better in patients with sustained molecular patients witch sustained molecular response in first twelvemonth after ASCT or intervention with interferon, compared to patients who developed MRD positiveness within first twelvemonth after ASCT or during care therapy.Timing of MRD appraisal in MCL: predictive relevancy shown after initiation and in postremission period ; increasing MRD ) degrees predict backsliding ; aged patients who stay in molecular remittal on care intervention have significantly longer continuance of response.Who should have MRD ) intervention: no current application of MRD ) to patients non enrolled in clinical tests Decisions: accomplishment of molecular remittal appropriate curative end for new clinical tests and interventions ; MRD appears executable for steering intervention, cut downing costs, and diminishing side effects ; identifies patient subgroups with durable remittals ; MRD allows individua lized hazard appraisal and intervention Future functions of MRD: rating of new intervention theoretical accounts and substances: designation of non respondents _for possible early intervention intensification ; way of care intervention ; usage in pre-emptive therapies ; orienting intervention to single hazard proi ¬?les. Mentions: 1. Auto organ transplant for patients with Follicular Lymohoma in the epoch of rituximab: -JAMES O.ARMITAGE, MD. 2. Minimal Residual Disease in Follicular and Mantle Cell Lymphoma: -Foundation: CHRISTIANE POTT, MD. Auto organ transplant for patients with Follicular Lymohoma in the epoch of rituximab: -JAMES O.ARMITAGE MD: 2ND Subject RENAL ISSUES Abstraction The ends of this plan are to better the surgical and medical direction of locally advanced nephritic cell carcinoma and to avoid complications during public presentation of transdermal nephrolithotomy ( PNL ) . After hearing and absorbing this plan, the clinician will be better able to: 1. Surgically pull off locally atlvancetl nephritic cell malignant neoplastic disease by separating between the demand for extremist V partial nephrectomy and acknowledging the indicants for lymphadenectomy. 2. Choose the most apprepriate drugs, based 0n their meachanisms of action, for the medical intervention of nephritic malignant neoplastic disease. 3. Sumarize the current position of neoadjuvant and accessory intervention ef nephritic malignant neoplastic disease. 4. Better his or her surgical technique for PNL. 5. Acknowledge the possible complications of PNL and their intervention, including hemorrhage, hurts to next variety meats, hypotension, infection, and delayed bleeding. Surgical direction of locally advanced nephritic cell carcinoma: – STEVEN C. CAMPBELL, MD, PhD: Background: 10 % to 20 % of all kidney malignant neoplastic disease ; strong informations run uping combination of surgery and systemic intervention best ; systemic intervention both neo adjuvant and adjuvant ; dei ¬?nition of locally advanced — kidney malignant neoplastic disease widening into adrenal secretory organs, venous system, regional nodes, or next variety meats ; T3a, T3b, T3c, T4, or node positive but MO ; divergent pathology — – lymphoma { see biopsy ) ; adrenocortical malignant neoplastic disease ( endocrinologist rating ) ; sarcoma ; transitional cell Carcinoma ( cystoscopy ) Preoperative steps: complete bowl readying because hemi colectomy may be required ; obtain consent for splenectomy, distal pancreaticlotomy, and partial hepatectomy ; in instance these processs necessary to obtain negative borders ; little per centum require preoperative embolization to minimise blood loss ; co-ordinate with vascular, Cardiovascular, and hepatic sawboness. Surgery: venous engagement — for degree 1 thrombi, topographic point Stansky clinch ; level 2 thrombi require consecutive clamping inferior vein cava ( lVC ) below, contralatera nephritic vena, and IVC above ; for degree 3, mobilise liver to obtain entree to retrohepatic IVC and clamp above and below tumour ; exposure — critically of import ; chevron scratch most common ; little per centum need thoracoabdominal incisien ; as necessary to let for en block deletion ( cardinal ) Lymphadenectomy: lymph node dissection controversial ; for lymphadenectomy, usage same templet as for testicle malignant neoplastic disease ; European organisation fo research and intervention of malignant neoplastic disease ( EORTC ) survey — showed no difference in complications or endurance between extremist nephrectomy with lymphadenectomy and extremist nephrectomy without lymph node dissection ; study criticized because extent 0f lymph node dissection non good defined and analyze groups may hold had low hazard for lymph node engagement ( ascertainment prejudice ) ; Mayo clinic survey — gt ; 1600 patients ; showed 5 parametric quantities prognostic of increased likeliness of lymph node engagement, 1 ) atomic class 3 or 4, 2 ) sarcomatoid constituent, 3 ) really big 4 ) locally advanced tumour phase, and 5 ] tumour mortification ; seek to find ; parametric quantities preoperatively ( when possible ‘ ) , perform intraoperative frozen subdivision of lymph node, so make up one’s mind if lymph node dissection needed ; talker ‘s attack — normally performs lymph node, dissection on younger patients but non on ; older frail patients ; forecast for node-positive malignant neoplastic disease — hapless ; 0 % to 20 % 5-yr endurance ; bulky lymph nodes may be worse prognostically than metastatic: disease ; patients with stray venous engagement have 40 % to 50 % remedy rates ; most T3a patients do good, but at higher hazard than patients with organ-confined disease ; other predictive considerations – histology ; border position ; tumour class ; algorithms availalale for anticipation of result. Medical Management of Locally advanced Renal Cell Carcinoma: -BRIAN I.RINI, MD.Mechanism of action of drugs for nephritic malignant neoplastic disease: mammalian mark of rapamycin ( mTOR ) inhibitors — these involve tract that regulates cell proliferation and metamorphosis in response to enviromental factors, associating cell growing factor receptor signaling via phosphatidylinositol-3-kinase ( Pl-3K ) to cell growing, proliferation, and an-giogenesis ; these drugs have non been studied as neoadjuvants or adjuvants ; vascular endothelial growing factor ( VEGF ) inhibitors -more relevant curative tract ; VEGF is cardinal regulator of physiologic angiogenesis ; more drugs available against VEGF, and they by and large have greater consequence ; bulk of nephritic cell carcinomas characterized laic mutant of V0n Hippel-Lindau ( VHL ) tumour suppresser cistron, ensuing it accretion of hypoxia-inducing factor ( HIF ) ; HIF is critical written text factor that leads to activation of m any mark genes.including VEGF ; VEGF is go arounding protein that binds to endotheliel cells and leads to permeableness, migration, and proliferation of tumour blood vas cells ; inhibitors of VEGF tract include little molecules that inhibitVEGF receptor and agents such as bevacizumab, sunitinib, and sorafenib. Neoadjuvant surveies: retrospective experience — 17 patients with kidney malignant neoplastic disease with primary tumour in topographic point ; intervention with sunitinib produced 30 % average volume decrease in tumour size ; growing curves show most decrease occurs in first 2 to 4 rhythms of intervention, so i ¬Ã¢â‚¬Å¡at period, so growing sketchs. Prospective test: patients with biopsy-proven kidney malignant neoplastic disease and unresectable priamary tumours ; treated with suntinib for 4 wk on drug and 2 wk off ; worsened clinically while off drug for 2 wk ; hence. intervention changed to uninterrupted dosing ; histology preponderantly clear cell carcinoma but non entirely, and most had metastatic disease ; about tierce of patients converted to resectable position ; gt ; 70 % had somee tumour shrinking ; shrinking averaged 19 % ( # 1.5 % centimeter ) ; greatest consequence on clear cell carcinoma. Goal of neoadjuvant therapy: to bring forth cytoreduction of tumour ; avoiding high morbidity of extremist nephrectomy and leting intervention with partial nephrectomy. Safety: neoadjuvant therapy does non adversely affect surgical result ; in MD Andersen survey of # 6O patients who received targeted therapy ( largely bevacizumab ) so underwent cytoreductive neph1’ectonty, damage of superficial wotind mending 20 times more common in those who received targeted therapy than in matched controls ; so far ( gt ; 100 patients ) , no big safety signals, eg, hemorrhage, coagulating. Accessory therapy: United States test of 1900 patients presently in advancement ; postnephrectomy patients randomized to 1 year of sunitinib, sorafenib, or placebo ; efficaciousness informations still several old ages off. Drumhead: -aggressive surgical direction basis of intervention for locally advanced kidney malignant neoplastic disease ; neoadjuvant VEGF-targeted intervention may take to enhanced feasibleness of resection in same patients ; stillinvestigational: no effectual adjuvant intervention for kidney malignant neoplastic disease at present.How to Avoid Cemplications While executing Transdermal Nephrolithotomy: — -MARSHALL L.STOLLER, MD. Background: key to success in transdermal nephrolithotomy ( PNL ) is for endourologist to derive appropriate entree ; make non trust on radiotherapist to execute ; appropriate landmarks are 2 i ¬?ngerbreadths sidelong from paraspinous.muscle and 2 finger’s breadths below 12th rib ; 9 in 10 times puncture site in Petit ‘s trigon ; place patient prone with thorax blosters and articulatio genuss flexed ; utilize general. anaesthesia in instance of demand to entree airway ; extradural does non work { excessively hard to change over to general anaesthesia if desperately necessary ) ; radiologists puncture straight up and down, aiming nephritic pelvic girdle, but this does non enable urologist to make transdermal prcedure ; urine return dues non vouch entree to allow calyx. Nephrostomy tube entree: usage echography to assist direct needle ; purpose pelt posteriur calyx ; Technique for lower pole puncture: follow landmarks described above, , purpose for midaxillary line, progress acerate leaf, and draw C- arm toward you ; if needle below intended mark on x-ray, needle non steep plenty ; if needle above intended mark, travel deeper Technique for upper pole puncture: travel C- arm off from you ( indicates deepness and how far to progress acerate leaf ) coni ¬?rming entry: return of piss ; injection of retrograde methylene blue ; transition of i ¬Ã¢â‚¬Å¡oppy tip guidewire ( if needle in anterior calyx, K- wire does non progress beyond calyx into nephritic pelvic girdle ) ; ultrasonographic verification: injection of dilute contrast. Avoiding shed blooding complications: occur as consequence of progressing sheath excessively far ; distend piece of land merely to roll uping system ; go forth sheath somewhat outside roll uping system ; progressing excessively far cracks infundibulum. Other complications: pulsatile bloody outflow, rapid venous drainage into vena cava, fecal matters, air, gall ; inconsequential if recognized before dilation ; merely draw needle out and make another puncture ; make non necessitate to halt instance. Localization: text editions recommend taking for most inferior calyx ; survey of computed imaging ( CT ) from 100 patients showed 42 patients had 2 lower pole calyces and 59 had 3 lower pole calyces ; most median calyx will be anterior 93 % to 95 % of clip ; lower pole entree should be directed to most sidelong calyx ; if entree into posterior calyx non achieved, successful PNL non probably, because angle of anterior confronting calyx excessively short. Dilation: do non come in roll uping system, but attack every bit near as possible to roll uping systern ; rock should non be seeable on initial entry ( should he gt ; 0.25 centimeter beyond ) ; guidewires – guarantee length adequate ; denominate working wires and safety wires: hydrophilic guidewires go in easy but besides fall out easy ; J gt ; tipped guidewires do non punch roll uping system ; safety – urologist should have on lead spectacless to protect eyesfrom radiation and from sprinkling. Tips on technique: puncture easier in patients with history of PNL because kidney fixed ; in PNL-naive patients, kidney moves off from progressing tip { disconnected gesture required ) ; talker uses 18-gauge acerate leafs ( non 25~gauge ) ; uses really small fluoroscopy ; every bit long as wire moves back and Forth, exchange catheter can be advanced ; to minimise radiation, i ¬Ã¢â‚¬Å¡uoroscopy used merely when near roll uping? system ; catheter can be made less stiff by dunking it into microwaved saline or madestiffer by dunking it into ice slush. Amplatz system jobs: misidentify to progress Amplats sheath beyond cone ( likely to do hemorrhage ) ; go forth sheath outside roll uping system ( it will work its manner in during lithotripsy ) ; ldnked Dotter catheter ; fascial dilator unmatched with sheath ; inadequately advanced fascial sheath ; buried sheath in corpulent patients ( place sutura on terminal of sheath to ease retrieval ) ; balloon — – used merely in United provinces ( pneumatic lithoclast used in other states less expensive guarantee equal skin scratch ; as ballon dilates radially, it shortens lorigitudinally Complicating hurts: -bowel — set up separate drainage ( intestine separated from urinary system ) ; dual J and Foley catheters placed ; skin scratch enlarged and penrose drain placed ; patient placed on ternary antibiotics and low-roughage diet ; alert waiting ; bulk of hurts digressive ( non through-and-through ) , so colostomy non necessary ; postprocedural hemorrhagic — find whether due to hemorrhagic or infected daze ; temperature unreliiable ; organic structure temperature should be gt ; 3S % ; temperature of 36A ° to 37A °C indicates possible sepsis ; infective complications — -appropriate antibiotic ; fulminant disease may be related to high endotoxin concentrations: low- force per unit area irrigation system ; hypothermia may confound diagnosing of urosepsis ; ticker for peripheral vasoconstriction bespeaking haemorrhagic daze V peripheral vasodilation bespeaking infected daze ; hurts to next variety meats — lung ( look into post procedural ch est X- beam ) ; incidence of pleural hurts # 12 % ( increases with supracostal puncture ) ; expression for pnettiuothorait or hydrothoralsi ( look for clear cost phrenic Angier on chest X ray ; intervention individualized ; see chest tubing ) ; liver † or spleen hurts ; vascular hurts ; delayed bleeding — in talker ‘s pattern, occurs in 1A °/o of instances ; disconnected brisk shed blooding due to pseudo aneurism ; occurs 6 wk after process ; dainty by ace selective angioembolizatien ( microcoils ) ; hazards include arterial dissection, nontarget embolization, and contrast-induced kidney disease ; highest hazard in diabetics Drain: nephrostomy tubes Council-tip: easy to rewire Endopyelotomy tubing: 14 Gallic to 8 Gallic ; can be hard to put Circle nephrostomy tubing: 2 entree piece of lands ; good for drawn-out drainage ; less likely to be dislodged.Foley balloon catheter: cut tip off ( like Councill catheter ) Pull-string: Cope-like tubings ; turn and draw out at same clip to avoid laceration of infundibulum. Malecot tubing: entrapment can happen in little nephritic pelvic girdle due to strong collagen span that forms through i ¬Ã¢â‚¬Å¡anges of tubing ; tissue must be cut in order to retreat entrapped tubing. Tract closing: tubeless — talker sees no advantage ; with or without dual J catheter ; styptic: agents and i ¬?brin sealers ( eg, FloSeal, Tisseel ) ; may restrict tract bleeding ; preplace occlusion balloon in roll uping system ; cauterant may diminish hemorrhage ; skin closing — better decorative consequence without Skin closing ; nephrostomy tubing — with or without skin suturas ; easy dislodged ; when tubing removed, do certain sutura comes with it ; place more than one nephrostomy tubing if necessary. How to cite Follicular And Mantle Cell Lymphomas Health And Social Care Essay, Essay examples

Social Security Essays - Withholding Taxes, , Term Papers

Social Security Social Security is a hot topic of debate today, since most American's believe that the system is near collapse. The trust fund that Americans have been paying into for Social Security is likely to dry up in 2029 due to the large number of baby boomers heading into retirement. Franklin Roosevelt set up Social security to help the people that had worked and Struggled all their lives in honest toil. Social security was set up to accomplish two main goals. The first goal of Social Security is to act as a disability or life insurance policy that protects almost all Americans. Currently, there are seven million survivors of deceased workers and four million disabled Americans that receive income support from Social Security. The second goal is to provide lifetime retirement benefits that rise with inflation. Social Security payments for retirees are needed to keep half of the elderly Americans above the poverty line. A large number of baby boomers believe that they won't see a dime's worth of Social Security benefits, and most younger people assume that once they have reached retirement the program will be gone. There have been many proposed solutions to the Social Security problem. A first possible solution is to dramatically change the Social Security Payroll Tax. Another proposal is to change amount of benefits of the provided by Social Security. A third reform proposal includes investing Social Security money in stocks either by the government investing the money or by setting up mandatory IRA investing. Another major development in the future of Social Security is the recent proposals made by President Clinton's Advisory Committee on Social Security. In January of this year the Advisory Committee on Social Security presented a report of strategies to save Social Security. Shortly after the 261 page report was released there was a huge increase of debates and criticism over the future of Social Security. The issue facing American today is when and how to reform Social Security. Although the American public and political groups are unwilling to accept the burdens of social security reform, extensive reform is needed soon to continue paying the current benefits to American citizens. A change in the Social Security tax is a possible factor of reform to bring the Social Security program back on track. Currently the Social Security tax is a flat-rate tax paid on all employment earnings up to a specified limit. Due to inflation the limit is increased every year currently it is just over $60,000. This tax is much harder on a lower income individual because the higher income individual is only taxed on their income that is below a certain amount set every year. It has been proposed that if the limit on the payroll tax were lifted, two-thirds of the projected Social Security deficit would be eliminated. Once the limit on the payroll tax is lifted a rise in the tax rate of the employers and the employees by 1.1% is predicted to be enough to solve Social Security's problems. This is assuming that two evasive actions take place. First the government will have to keep its hands of this extra tax revenue gained by the tax increases. Second the proposed solution will only have a chance to work if it is started immediately while the baby boomers are still able to add a little more cash to the trust fund for there own retirement. This solution isn't likely to be implemented by today's political system. The advisory council on Social Security would not pursue the lift of the limit because the support of the wealthy voters for Social Security reform would be lost. Americans are also weary of Social Security tax increases. The middle and lower class voters would also not support a Social Security tax increase. A recent poll by Money magazine found that 70% of the public is unwilling to pay more tax than the current 6.2% rate. Another proposed solution to Social Security's problems is a to decrease the amount of benefits received by retirees. The first way to reduce the amount of benefits that are being paid out is to adjust the CPI. Sen. Daniel Monynihan of New York (Dem.) has proposed that a 1.1% cut in annual cost-of-living adjustments for pensioners would be a reasonable solution to Social Securities problems. The adjustment of the CPI would reflect the belief by many economists that the CPI overstates current inflation. He claims that this would almost completely solve the problems in the Social Security program by insuring that the expected inflow

Film Comparison - A Dolls House essays

Film Comparison - A Doll's House essays In class, we were shown two film versions of Ibsen's play, "A Doll's House." The first, starring Anthony Hopkins, was a more strict adaptation of the play. The second, featuring Jane Fonda, presented a broader vision of the play by using additional scenes and dialogue to expand the viewer's understanding of the characters and their dilemmas. For simplicity's sake, this essay shall refer to the films as "strict" or "broad" respectively, in order to identify them. First, the original play's impressions are quite different from the film versions in the reading. A reader is left only to the benefit of her own imagination while reading a play. It seems actually more like listening to an old fashioned radio show because it is mostly dialogue. But there aren't even tones of voice with which we interpret so much conversation. There are no rehearsed or measured pauses which create a very frenetic impression of many of the characters – especially Nora. Nora comes across as a top spinni ng out of control. Her husband reads as disinterested, his affections just that, affected. Christine is not anchored into the plot as well as she is in film. Strangely, Grogstad seems even more threatening on paper than on film. My conclusion, as one not accustomed to plays or theatre is that a script is the original physical reality of a play but that it takes the winds of theatrical talent to breathe life into it. The characters seem one-dimensional. The author may have his intentions but the soul of each performance and the spirit in which it speaks its truths to the audience varies. That variation depends on exactly what the director wants the audience to perceive. The strict film adaptation confined itself largely to a set approximating a stage set. It began literally at the beginning without embellishing. Without an introduction, the plot is hard to grasp and it is much easier to criticize the characters for surface impressions than to empathize or und...

Mexico and United States Foreign Policy Relations

Mexico and United States Foreign Policy Relations Mexico was originally the site of various Amerindian civilizations such as the Mayas and the Aztecs. The country was later invaded by Spain in 1519 which led to a prolonged colonial period that would last until the 19th century when the country finally gained its independence at the end of the war of independence. Mexican-American War The conflict was sparked when the U.S. annexed Texas and the Mexican government refused to recognize the secession of Texas which was the precursor to the annexation. The war, which began in 1846 and lasted for 2 years, was settled via the Treaty of Guadalupe Hidalgo which led to Mexico giving up even more of its land to the US, including California. Mexico further transferred some of its territories (southern Arizona and New Mexico) to the U.S. via the Gadsden Purchase in 1854. 1910 Revolution Lasting for 7 years, the 1910 revolution ended the rule of the dictator president Porfirio Diaz. The war was sparked when the U.S.-supported Diaz was proclaimed the winner of the 1910 elections despite mass popular support for his rival in the election Francisco Madero. After the war, the various groups that made up the revolutionary forces splintered as they lost the unifying goal of unseating Diaz - leading to a civil war. The U.S. intervened in the conflict including the involvement of the U.S. ambassador in the plotting of the 1913 coup dà ©tat which overthrew Madero. Immigration A major issue of contention between both countries is that of immigration from Mexico to the U.S. The September 11th attacks increased the fear of terrorists crossing over from Mexico leading to a tightening of immigration restrictions including a U.S. Senate bill, heavily criticized in Mexico, supporting the construction of a fence along the Mexican-American border. North American Free Trade Agreement (NAFTA) NAFTA led to the elimination of tariffs and other trade barriers between Mexico and the U.S. and serves as a multilateral platform for cooperation between both countries. The agreement increased trade volume and cooperation in both countries. NAFTA has come under attack from Mexican and American farmers and the political left claiming that it hurts the interest of local small farmers in both the U.S. and Mexico. Balance In Latin American politics, Mexico has acted as a counterweight to the policies of the new populist left characterized by Venezuela and Bolivia. This led to charges from some in Latin America that Mexico is blindly following U.S. commands. The biggest disagreements between the left and current Mexican leadership is whether to enlarge American-led trade regimes, which has been Mexicos traditional approach, versus a more regional approach favoring Latin American cooperation and empowerment.

Critically appraise whether recent judicial decisions reinforcing Coursework

Critically appraise whether recent judicial decisions reinforcing - Coursework Example Most of the businesses use forms that have special terms and standard legal language on backs or bottom of the documents governing sales and purchases. This is more so to the business men who focuses more on the commercial transactions than legal doctrine. When the recent judicial decisions are used, the court uses the first and last short approaches in determining the effectiveness of the contract. In practice The boilerplate language is classically in small print, covering business contingencies which arise rarely2. Through the application of the recent judicial decisions, some major disparities are identified in the legal doctrine resulted from discrepancies in some conditions that accompany replies and offers3. This case is similar to the case between Mr. Jones, company by the name of CMP and Ricoh [Ricoh UK Limited v Jones (2010) EWHC 1743 (Ch). According to the agreement, no one was supposed to have any contact with any client except through Ricoh. Mr. Jones had no reciprocal o bligation to deal with the clients without Ricoh. Later there arose a dispute over tenders to supply MFDs outside the country for a company which had been a regular customer for CMP.4 The court dismissed this on the basis that, the parties were operating on the same levels of distribution chain. The Uniform Commercial Code has much consideration on the offers accepted when the sellers sends written confirmations of acceptance to the buyer5. Another similar cases involved Manchester CC v Gibson [1979] 1 WLR 294. Gibson was an occupier and tenant of a council house and he wished to purchase the house under the â€Å"right to buy scheme†. He received a letter from the council informing him of the willingness of the council to sell the house. Later, the political control of the council changed resulting to revoke of the policy of the right to buy. It was held by the House of Lords that the council never made the offer to sell and, therefore, there could be no valid acceptance. 6 The above scenario can also be related to a case of Manchester CC v Storer 3 All ER 824. In the case, the council had sent an application to purchase a house which was about to be completed. When he completed the form as the instructions required, the council refused to sign and to return the application as they had agreed. When the case was taken to the court, the judge held that, the contract was formed.7 The judicially and the international legal community have tried to find satisfactory ways of deciding the terms of controlling an agreement.8 Another similar case involved Ex- Cell- O corporation (England) Ltd v Butler machine Tool Co. Ltd [1979] 1 WLR 401. Later, a dispute occurred when each company used separate standard form. One company used a form with a price variation which had a clause while the other company used a contract form without a price variation clause. In the case, the House of Lords held that, the contract was based on Ex- Cell- O corporation’s terms be cause it had included an acknowledgement strip which was signed by both parties.9 According to Section 2(207) of The Uniform Commercial Code10, it is assumed that the merchants do not read or understand the terms which are contained on the exchanged forms between the parties involved. This section of contract Law is similar to Article 19 of CISG which emphasizes on the irresponsibility of the merchants for getting clear information of the contract agreement11. In 1975, the United States Court resolved a case between Manning Fabrics Inc. 441 F. Supp., and Lea Tai

Haqqani Network Research Paper Example | Topics and Well Written Essays - 2000 words

Haqqani Network - Research Paper Example The Haqqani Network operates under the supervision of Maulvi Jalaluddin Haqqani, a highly dangerous fighter and anti-soviet resistance commander, and his son Sirajudin Haqqani, who now handles the important affairs of this enemy network. This group has been existing in Pakistan since Soviet era and is spread across Kabul (Clarke, R, 2011, p.105). The Haqqani Network is claimed to have been in alliance with many intelligence groups such as Central Intelligence Agency (CIA), Osama Bin Laden and Saudi Arabia’s Spy Service (Takashi, 2012, para.2). The Haqqani Network runs under the leadership of Haqqani family. Jalaluddin Haqqani and his sons now lead this insurgent group. Acording to Mazzetti, Shane & Rubin (2011) the Haqqani family is the Sopranos of the Afghanistan war, a family that made out its earnings and rose from the bottom through exercise of all kinds of illegal activities like trafficking, kidnapping, extortion, and so forth (para. 1). That being said, they are also reported to acquire protection money from the American reconstruction funding that was particularly aimed at construction of schools and roads in Afghanistan. With increasing network horizon and an enormously vast web of connections, this group has many top-tier leaders that operate different parts of the group secretly. That being said, the pioneer of the group, Jalaluddin Haqqani is considered a chief figure in the leadership of this network. Jalaluddin acted as a mujahedin leader in his fight against Soviet forces where he received significant help from the ISI and CIA (Bowman, 2009, p.26). The leader himself focused more upon his hometown Zadran, which is a central territory that connects nine tribally linked districts at the border of Paktika, Khost and Paktia province. Since the leader Jalaluddin has turned old and weak due to illnesses, most of the network’s responsibilities and activities have been transferred upon