Two Scavengers and Nothings Changed Essay Example

Two Scavengers and Nothings Changed Essay Both Two Scavengers and Nothings Changed are protesting against issues of discrimination between different classes of society and different races. In Two Scavengers Ferlinghetti is protesting against the inequalities within a democracy, and how its not democratic but more ruled by class. In Nothings Changed we are shown Africa when the apartheid law was still in place and a protest about the way black people are treated there. The imagery used by both poets highlights there protests against the unfairness of society. Two Scavengers is set in San Francisco which is meant to be a democratic society however there is a small gulf in the high seas of this democracy. The use of this metaphor emphasizes how society is still ruled by class. Ferlinghetti says the gulf is small which indicates it should be easy to cross the over to a democratic society. However, paired with the high seas, it becomes hard to cross. It is dangerous to try and break out of the different classes and it is easier and almost safer to remain in the same kind of society. We will write a custom essay sample on Two Scavengers and Nothings Changed specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Two Scavengers and Nothings Changed specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Two Scavengers and Nothings Changed specifically for you FOR ONLY $16.38 $13.9/page Hire Writer The use of the word democracy is sarcastic, there shouldnt be a gulf in a democracy, especially in a place like San Francisco that should keep everyone equal. Similarly there is an invisible divide in apartheid Africa, shown in Nothings Changed, where although No sign says it is they still know where they belong. Apartheid is over when the poem had been written, however, like in Two Scavengers there is still inequality between the two classes of people. The white people still believe that the black people dont belong there. It highlights the invisible divide between the two cultures. It is meant to be equal now however the black people realize that the white people dont want them and know where they belong. Afrika uses himself in first person to speak for the whole group using the word we. Hes speaking up for the black people and although they are angry at is they accept it. Even though its not a law anymore and there is no sign the divide between them is great. Furthermore Ferlinghetti uses a simile to compare one of the garbage men to a gargoyle Quasimodo. Quasimodo was an ugly character but had a very good heart. This shows that although today society is mostly ruled by appearances, inside some people there can be kindness and compassion. A gargoyle is used to scare away evil in churches. It shows that the man protects the city by keeping it clean. He may seem insignificant and Quasimodo like, but without him the cool couple wouldnt be living in a clean city. Likewise Afrika may be suggesting that the black people are like purple flowering, amiable weeds. Weeds always come back, and can only be removed by properly digging up the roots. This suggests that the black people have roots in Africa and refuse to be taken away. Since the weeds are amiable it suggests they are friendly. The juxtaposition of calling weeds amiable highlights that appearances can be deceiving and although the black people may be trodden on they will still come back stronger each time. In both poems, Ferlinghetti and Afrika use the materials plastic and linen to accentuate the difference between rich and poor. It again shows that although there should be no difference because of race and class it still exists. In Two Scavengers the garbage men are wearing red plastic blazers as opposed to the linen suit the man in the Mercedes is wearing. This links to Nothings Changed where the poorer working mans cafi has a plastic tables top, whereas in the white peoples cafi linen falls off the table. Plastic is a cheap material that is considered unattractive. However it is very hard to tear and break which shows that although society and race considers them to be poorer than everyone else, they are stronger than others. Linen is more associated with richer, well off people. It is malleable and can be shaped into almost anything. This suggests that the richer, higher people in society do what they can to fit in. They change themselves to fit what society demands. In both poems it shows that the richer people have a lot of linen, more than what they need. The man has a three-piece linen suit and in the cafi in Nothings changed excess linen falls from the table. This shows that although its not needed the well off people need to show that they can afford it, and that they are better off than other people. The poets both structure the poems in different ways to get through there protest against inequality in there society. Ferlinghetti has no punctuation throughout the poem except for the comma in the title. The comma could stress the separation between rich and poor and how different they are. The lack of punctuation could show that the cycle is never-ending, and even though the democracy is there it is not enforced and therefore will always dictate how society is. The poem is also laid out in a fragmented way suggesting the broken nature of society. The haphazard lines could also illustrate how fragile democracy is, and how easily it could collapse. With the last word of the poem being democracy it could also suggest that society is built on democracy yet along the way things have changed causing it to become easily collapsible. The lines also overlap but never touch which shows the social divide between both rich and poor. In Nothings Changed the title and the last line of the poem are the same. Throughout the poem Afrika is describing the way that although the apartheid law is no longer in place it still dictates the way society is run, showing that at the beginning of the poem nothings changed and then at the end still nothings changed. By using it as the title and the ending line of the poem it provides a visual image for the reader showing that things are still the same. Also in the middle of the poem there is the two line stanza, No sign says it is: but we know where we belong. It is almost separate from the rest of the poem which draws the readers attention to it. It could be that this is Afrikas main point of the poem so he deliberately draws our attention to it. Both poems show the injustice in the society they live in, and how although the divide was abolished it is still there, invisible but prominent. In Two Scavengers the only thing separating the cool couple from the garbage men is the jobs they do. Both the man in the Mercedes and the young garbageman wear sunglasses, are about the same age and have long, shoulder-length hair. They are both similar yet because of social class the garbage man is considered ugly. This makes us consider the fact that they arent interchangeable. One of them has money and the other doesnt and although that is only a little detail, in a society ruled by class is become a big one. In Nothings Changed the amiable weeds are being outgrown by the Port Jackson trees. They are both plants yet because the trees are better looking, and considered less troublesome they become better than the weeds, indicating the white people are better than the black people.

5 Great TED Talks to Inspire Your Writing

5 Great TED Talks to Inspire Your Writing If you have never heard a TED Talk, or been part of the audience of one, you are missing out on a truly powerful experience. This is especially true if you are an artist and entrepreneur for your work. TED (an acronym for Technology, Entertainment and Design) is a nonprofit organization devoted to spreading ideas in the form of short, powerful talks. The topics span everything from business and science to creativity and self-help and are led by people who are highly successful in their respective businesses or creative careers.So take a moment to listen through the best ones Ive found that are led by successful writers to inspire your own work. You wont be disappointed and it will likely be the most productive 18 minutes (or less) you spend today.Amy Tan: Where Does Creativity Hide?Amy Tan is the author of The Joy Luck Club, The Kitchen Gods Wife and The Hundred Secret Senses. Her works explore mother-daughter relationships and the Chinese American experience, and for this TED Talk, she discusses the creative process. For writers looking for answers in how to tap into the creative process, this talk is a great way to fine-tune your senses.Beginning with details about an essay she wrote at the age of 11, Tan discusses her own process of creation- particularly, how out of nothing, comes something. As a background for how she was taught, she speaks of how her mothers belief in fate or curses developed after her father and brother passed six months apart. She had this notion of death all around her, and her mother believed she would be next. When you focus on death, Tan notes, you become creative in a survival sense.Tan asks her audience to entertain the question of why things happen, how things happen, and how do they influence things to happen? With these questions, Tan introduces what she calls the cosmology of my own universe as its creator and notes that creativity is a sense of ones inability to repress the dark matter, the uncertainty principle (am I a fraud ? is my writing not meaningful anymore?), and the observer effect. In these, she notes that creative people have multiple levels of anxiety and ambiguity- you dont know what is happening, but you know its happening.Finally, she points out that as a creator, you notice disturbing hints from the universe. Writers get these hints/clues that have been both obvious and have not been. You begin to notice it more often and you learn to apply it. She discusses the thought process of her own trip to Burma and the book that would result. There, her chance encounters turned into an absolute necessary in writing a story.Elizabeth Gilbert: Your Elusive Creative GeniusIn this TED Talk, American author Elizabeth Gilbert, author of Eat, Pray, Love, begins with a discussion of how something peculiar has happened in her career to recalibrate her relationship with her work. After Eat, Pray, Love, which became a mega sensation, she notes that everywhere she goes, people treat her like shes doomed, like shes never going to be able to top the success of that book. She notes that there is always a fear-based reaction: What about the humiliation of rejection? Is she heading for the scrap heap of broken dreams?She then questions what is it about creative ventures that worry people? She notes the grim death of magnificent, creative minds who have died young and often at their own hands. Many seem really undone in their creativity and it is a common assumption that artistry will ultimately lead to anguish. According to Gilbert, this is a dangerous assumption.She then speaks of how in ancient Greece and Rome, people believed that creativity was a divine attendant. Greece called it daemons and Rome called it genius, but in both cases, it was a magical, divine entity that lived in the walls of an artists studio. When great art happened, it was due to a persons daemon or genius, something that was outside of the ability of the artist alone.Gilbert notes that this is a psychological construc t to protect writers from narcissism or anxiety about success. With the beginning of rational humanism, people believed art came from the self. The artist was the genius instead of having a genius visit him or her. According to Gilbert, this new thought creates unmanageable expectations for performance that has been killing off artists for the past 500 years and she asks: Can we go back to an ancient understanding of the relationship between humans and creative mystery?Andrew Stanton: The Clues to a Great StoryAndrew Stanton is an American film director, screenwriter, producer and voice actor who has created award-winning screenplays with Pixar. His film work includes co-writing Pixars A Bugs Life (1998), along with Finding Nemo (2003) and its sequel Finding Dory (2016). He is also the brains behind WALL-E (2008) and Disneys John Carter (2012), as well as the co-writer on all four Toy Story films and Monsters, Inc. (2001)Beginning with an off-kilter joke (NSFW, dont say I didnt warn you!) about a man in the Scottish Highlands, Stanton suggests that storytelling is joke telling. The best storytelling involves the teller knowing the ending, and everything that is said- from the first to the last- affirming the human connection.He then discusses the greatest story commandment: make me care, emotionally and aesthetically. Starting from the ending of his personal story to how he learned storytelling, he discusses how he used this method in the fantasy/science fiction film that he co-wrote and directed, John Carter. He notes that, as with this movie, all good stories should begin by giving you a promise that it will lead you somewhere meaningful by the end.He then discusses WALL-E, which earned him two Academy Awards for Best Animated Feature, and how storytelling without dialogue is the most inclusive form of storytelling. The audience actually wants to work for their meal, they just dont want to know theyre actually doing that, he says. Thus, this is the job of th e storyteller and the unifying theory of his screenplay, Finding Nemo, which won him a nomination for Best Original Screenplay. He notes that as with this movie, the best characters are the ones who are trying to scratch an unknown itch.Finally, he discusses how change is fundamental in a story. If stories go static, they die. This TED Talk is so full of valuable advice, youll want to watch it twice just to catch everything from this gifted screenwriter.Misan Sagay: Why you should writeI write because Im a wrinkle, says Misan Sagay, a former emergency room doctor who made her writing debut with the 1999 film, The Secret Laughter of Women.To explain this statement, Sagay discusses the reason she writes and the reason her audience (which is us) should write too. She notes that we are joined to all of our immediate families by stories. Stories bind us. Were likewise bound to our human family by stories, and film is the major narrative artform of our times.She tells how when growing up, she never saw herself on screen. Going to the cinema was like looking at a family photograph album and she was not there, and she wondered why she was not there. She felt this as an ache. The Black films made at the time were predominantly male, violent, and contained drugs. Here she was- a Black woman who loved Jane Austen, and she was nowhere to be found on-screen.This compelled her to become a storyteller because she realized that in order to see her story in cinema, to even see someone who looks like her, she would need to create it. And her story would be full of choices that are the sum total of who she is.In this goal, she said she soon felt like a wrinkle in a smooth sheet†¦someone was always trying to smooth her over and convince her to accept the status quo. She mentions hearing advice such as, You cannot make a film with a black female lead. Nobody wants to hear about slavery, it makes people uncomfortable. There is no audience.However, she has always refused to acc ept that. And with that background, she asks the audience, what story do you have to tell? Your story will never be made unless you choose to put it out there. And so begins the authors journey.Sagay was eventually successful in her endeavor, with the 2013 British drama Belle, which she wrote in 2013. The film tells the story of Belle, the daughter of an enslaved African and a British admiral. It delves into the untold stories of African descendents, especially women, in British society in the late 1700s. It was Sagays Jane Austen on screen, just like she was compelled to write when younger.Now as a member of the Academy of Motion Picture Arts and Sciences, Sagay is also a member of the Wolfe pack: a group of 50 leading female screenwriters working in Hollywood seeking to draw other women into the screenwriting business.Simon Van Booy: How To Write Your Novel In Under 20 minutesDont let the title fool you- this is not a discussion of how to write a novel in 20 minutes (thats impossi ble). However, in this 20-minute discussion, author Simon Van Booy answers the question: Why should anyone write a novel?Some background on Van Booy: his short story collection, Love Begins in Winter, won the 2009 Frank OConnor International Short Story Award. He is also a best-selling author of nine fiction titles, along with three anthologies of philosophy. He founded Writers for Children in 2013 and through it, helps young people build confidence in their storytelling abilities.For this particular TED Talk, he begins by noting that being a commercial success is not the same as being a literary success. In fact, in many cases, the literary greats were unsuccessful during their times. But one thing they did, he notes, is that they followed their core- that inner voice that guides you as a writer and becomes stronger and clearer the more you write. Writing frees you from fear and with wisdom comes autonomy. Being a commercial success isnt anywhere in that equation.For his specific a dvice for getting a novel written, he offers these six steps:Create a unique place, time and conditions for your writing to take place. He suggests that you have a place thats exclusively yours and that no one else uses, or a place in which you do nothing else but write (so no Internet surfing!). He advises that you treat it the way priests treat sacred relics. Your work is a holy object and the location you write is where youre going to give birth to and kill your characters. It is where youre going to exorcise your demons.Since all writers need to read, dont read anything you dont love. Dont read what you think you should read, make sure that the book on your nightstand is something that inspires you and sparks your spirit. He notes that being inspired is such an exciting part of life.Sketch and sketch often, just like artists. Take a notebook with you, sketch things, put a paragraph there, go out, go into the woods, visit thrift stores, go nowhere for no reason and write things d own that move you in your heart.Character and plot are easy if you make it real. As youre writing, be sure to include bits of real life and weave it together while getting rid of the seams. Merge the characters life with your own.Only tell 20% of what happened. Your story doesnt need to be a characters complete life, it can be only part of it- but a year that changed the character in some way.Keep rewriting until you stop changing things. If a chapter can be removed without disrupting the flow of the story, it is superfluous. If it cannot, congratulations, you have a good chapter- and only after multiple revisions and rewriting sessions will you find out which.

Accounting Theory Question

What is positive accounting theory? how does it differ from normative accounting theory? what was/were the major dissatisfaction(s) with normative accounting theory which led to the development of a positive theory accounting? 2. Explain the meaning of an efficient market. what is meant by the following terms: weak-form efficiency, semistrong-form efficiency, strong-form efficiency? which form is the most important to accounting research? why? Explain the important of examining the impact the profit on share prices for financial analysis. can this analysis be used to make abnormal returns from the share markets? 4. Does study of the information content of profits announcements explain why firms use particular accounting practice? does it help to predict which firms will use particular accounting practices? 5. Give reasons that non-linear model relating unexpected returns to share prices would provide a more precise estimate of the earnings response coefficient (ERC). . Why would share prices have a greater reaction to the profit announcement released by small firm compared with those released by large firms? do you think this research has any implications for measurement issues in accounting or for formulation of accounting standards? 7. outline the research that has been undertaken on the impact of permanent and temporary increases in profits. why is this research important? 8. how will risk and uncertainty affect the valuation of a firm and, through this valuation model, the ERC? . The impact of profits for valuation has diminished over the years. what is the impact? how was the research adjusted to reflect this fact? 10. Outline a research project which explain how share prices are determined. would this project include factors other than accounting data? Briefly explain the outline the research of mechanistic hypothesis. what are the implications of the research? 12. Why would financial analysis be fooled by accounting numbers and provide optimistic and biased estimates of profits? an you offer a positive economic reason for their actions? 13. outline the different procedures that can be used to determine whether accounts have quality accruals or whether they create more noise. 14. what are the two main explanations for the association between the choice of high-quality auditor and a lower cost of debt or equity capital? 15. why do we have to be carefull drawing conclusions about causality based on studies using archival data?

Motorsports about formala 1 Research Paper Example | Topics and Well Written Essays - 2000 words

Motorsports about formala 1 - Research Paper Example The type of racing is popular in the UK and neighboring countries within the region. What makes the racing interesting to majority of the citizens there are the types of cars presented to compete in different races conducted at different times of the calendar (Mastromarco & Runkel, (n.d.). In fact, speed with which these cars are driven has captured citizens attention because the racing involves highly trained drivers and teams who unlike other ordinary individuals, are able to control the racing cars at speeds which is difficult for common drivers to achieve. Moreover, almost three quarter of formula one racing events are always conducted in the Europe further giving it popularity in the region of the world than in any other regions where motor racing is conducted. The history of formula one racing is traced back to a century back in 1946 when racing of motor cars was first introduced as an idea. Form then to date, formula one has greatly evolved motor racing as sport receiving similar audience as those in football or other related sports. The idea raced in 1946 was matured in1950 when the first motor racing was conducted. After this, several motor racing events were conducted in different parts of the globe and with each New Year, changes were adopted on the nature of motor racing. The effects are seen today as motor racing has become a highly commercialized sport and through it individuals are earning bucks hence turning it as their main source of livelihood. However, in the 50s in spite of motor racing being held at different parts of the globe, very little if no concentration was given towards the sports as it was not commercialized and individuals taking part in the racing activities had little to benefit from the races which were conduct ed. In 1993, motor sport racing was ending toward decline because majority of the individuals who were participating in the race s had diverted their attention to other sports or activities which could

Lincoln and civil rights Essay Example | Topics and Well Written Essays - 3500 words

Lincoln and civil rights - Essay Example Lincoln who essentially came from relatively humble beginnings after being born in a log cabin, married Nancy Hanks in the year 1806. However, when the Lincoln family moved to Indiana, Nancy Hanks Lincoln died of what was by then referred to as â€Å"milk sick†2 (McPherson, 2). Lincoln’s Early Interest in the Abolition of Slave Labor The poem â€Å"The Negro Speaks of Rivers† written by Langston Hughes, as he sat by the window looking at a passing train and thinking about the issue of slavery is thought to have primarily been responsible for invoking the common legend that, Abraham Lincoln as a young man actually witnessed a slave auction at the large slave market that was found in New Orleans. Being sold down the river at the large slave market in New Orleans was considered by many slaves to be one of the worst fates that could possibly befall them. It is thought that after witnessing the slave auction, Lincoln resolved to one day overthrow slavery3 (Leach, 12). The Link Between Slavery and Lincoln’s Childhood and Lifestyle In a similar fashion to the slaves of his time, Lincoln was only able to get a few months of formal schooling. However, due to his relatively insatiable voracity and appetite for learning, Lincoln was virtually able to teach himself whatever he wanted by using books. Lincoln first ran for the Illinois legislative position in the year 1832 but did manage to clinch the seat however, he successfully managed to be elected to the position for a total of four elections in a row ranging from the year 1834 to the year 1838. It was mainly during this time that Lincoln took to studying law in his own free time and finally managed to become a lawyer at the age of 27. Lincoln was finally able to win a seat in the country’s house of representatives in the year 1846, after he had successfully managed to serve his tenure, Lincoln got offered the chance to be governor in Oregon which was basically a newly formed state, he however declined the post and opted to return to Illinois and devote himself to his law practice after what he considered to be his retirement from politics. The Missouri Compromise, its Effect on Slavery and Its Prompting of Lincoln to Return to Politics The Missouri compromise was essentially passed back in the year 1820 in the United States Congress. The compromise was reached between the anti-slavery factions and the pro-slavery factions in the government. The compromise sought to reach an agreement as pertaining to the regulation of slavery mainly in the western territories of the country. In the agreement, all forms of slavery were essentially prohibited in the state of Louisiana with the exception of the regions within the boundaries of the newly proposed state of Missouri. The compromise proposed by this law was seen to considerably incense Lincoln who had been brought up by parents that belonged to a church that openly opposed the idea of slavery. Lincoln was personally se en to have relatively strong opinions in regards to the subject. In this regard, Lincoln was once quoted as claiming that every time he happened to hear someone openly arguing for the promotion of slavery in the country, he almost always felt an urge to have slavery tried on the individual in question personally4 (Guelzo, 182). During the next presidential elections, Lincoln joined the Republican party and travelled to the city of New York where he gave a speech that has come to be referred to as the â€Å"

The problem of Brain-drain Essay Example for Free

The problem of Brain-drain Essay Brian Drain refers the situation when highly qualified and trained people leave a country to permanently settle in some other country. It is also referred to as Human capital flight. The problem of Brain-drain, in our age, has become very elusive. The developing countries like India are desperately in need of talents, especially in the field of science and technology but for one reason or the other the talents and fleeing their countries, leaving their native lands impoverished in the process. Thus it is an extremely serious problem, for on the solution of it depends upon the destiny of the poorer countries. India can be taken as an instance in point. After independence this country is engaged in difficult struggle against poverty. But struggles cannot be launched in papers; they require armies of trained personnel – the scientists, technical knowhow and specialists in the field of planned development. If, instead of contributing to the prosperity of India, the Indian scientists, research scholars, engineers, doctors and economists immigrate to other countries, it is difficult to see how India can implement her development plans and attain her goal of prosperity. In ancient times the scholars of one country visited neighboring countries, and they often stayed there for years, both learning and teaching. The great scholars of China and Persia and other scholars from the West visited India during her prosperous days in the past and wrote memoirs which are precious materials for Indian history. But these were not considered brain drain then. For when Hiuen Tsang came to India or Shilbhadra visited Tibet, staying there for many years, their absence from their own countries did not make much difference. On the contrary, their experiences and wisdom gained from their visits enriched their countries. Such exchanges benefited the countries in those days and built a bridge of understanding and amity when communication between even the neighbours was not easy. In the under-developed countries like India, the ambitious and highly educated people found it very difficult to climb the peak, for the obstacles were many and the bureaucratic bungling was irritating. Hence, the alarming exodus started in the fifties and in the seventies the brain-drain appeared  to be complete. Hundred of talents emigrated to the U.S.A. and Europe which assured them of great opportunities for getting to the top, of secure and comfortable living, of satisfaction and of glory in their respective fields. If the emigrants could have all those assurances they would not think of fleeing their country. But the problem is that a developing country like India could hardly afford to accommodate so many ambitious people, nor could the scope be made broad enough to secure affluence for all. Some of them, after training and experiences in foreign countries, return home with individual drams and when they fail to fit in with the evolving patterns at home, despair drives them away again. But India needs these professionally trained people, so they should be persuaded to stay in India and be content with less lucrative jobs. When India is rich enough to reward them, they would not find much to complain about. All these people are among the fortunate few, enjoying the privilege of education, while some eighty percent of Indians languish in dark hovels – poor, ignorant and superstitious. It is they duty and responsibility of those privileged few to take them out of the morass, instead of jointing the mad rush for careerism. There may be many obstacles in their way, but their dedicated services and patriotic zeal will help them rise above them and restore to India her lost glory.

Abortion - An Unborn Child is a Human Being! :: abortion argumentative persuasive argument

Abortion - An Unborn Child is a Human Being! The founding of entire nation was forged on the principle that all men are created equal under the law. This is the essence of our Declaration of Independance and the philosophy behind the Constition. We, through history, have made certain that ALL people in this country have equality before the law. We have set uup the premise that all people are equal before the law. Lady Justice is blind to Race, Religion, _________ . We have declared that there is no such thing as sub-humans -- and that NO human being's rights are superior to another human being. If we want to live by the premises that we set up in this country, then we cannot overlook ANY human being -- NO ONE can be excluded. There are, however, a human beings that is ignored the protection to thier rights to life everyday. The aborted children. I dare the negative to PROVE that a child in her mother's wound is alive! Does the negative actually believe that a human being is alive when and only when a human being has fully developed? If this is true, then most of here are not alive. The human specie is only fully grown at adulthood, many of us here are not adults yet -- and by that definition, it wouldn't matter if your shot and killed on the street because "your not fully developed". We are a stage in development -- teenager -- just like a child is, just like a toddler is, just like an old man is, and just like a aborted child is. There is no magical transformation that occurs when a child is born. He has the same basic needs to survive before he is born, and the same needs after he is born. The negative is going to attempt to make you believe that the differnce in quality of a unborn child is so great that these children do not resemble what we call alive. They want you to believe that a unborn child cannot feel pain. Can an unborn child feel pain? If it can, then does that not resemble life? If they do successfully make you accept this

Third World Dependency on First World

ECONOMIC GROWTH: A COMPELLING MOTIVE TO DEPENDENCY â€Å"Is Third World dependency on First World development, practices, and funding avoidable? † By Michael John A. San Roque ABS681M G01 Submitted to: Dr. Ma. Elena Chiong-Javier October 9, 2012 Countries of the world have been sharply divided along development. Countries that are economically buoyant, technologically advanced, and politically stable are termed ‘Developed Countries’ or ‘First World’.On the other hand, countries that are technically and economically backward and are world market’s suppliers of primary commodities are tagged ‘Developing Countries’ or commonly referred to as ‘Third World’ (Aluko & Arowolo, 2010). During the post-world war and until now, Third World countries depend greatly on First World in order to restore and improve their agricultural, technological, political, and economic conditions which are apparently known as development (Patterso n, 1999).This development has connoted at least one thing: to escape from the undignified condition called underdevelopment (Esteva, 1992). No country would say that she doesn’t want development to occur in her lands. Third World countries are â€Å"nothing that wants to be something†. It is, therefore, proper to say that Third World dependency on First World development, practices, and funding is not avoidable. This paper would present the evidences that would support the above notion.The evidences are based on the inevitable support given by Developed Countries in the form of foreign aid, technological, political, and economic advancement that the needy countries lack. Foreign Aid Foreign aid has become a focus and locus in the Third World. The Developing Countries are experiencing the different facets of development problems. First World countries offer aid through investment in the economy of the needy countries, loans, infrastructural development, funding of pover ty-reduction programs, and also through supply of military hardware at subsidised rates.One of the best examples of how a needy economy was not able to refuse a foreign aid was when the US created the The  Marshall Plan  (officially known as the  European Recovery Program,  ERP) that aided  Europe  where the  United States  gave monetary support to help rebuild European economies after the end of  World War II. That quickly revived and integrated European economies into the global economy (Remenyi, 2004). Technology Transfer Third World’s desire to minimize or eradicate the gap that separates their economy to that of the First World makes them receptive to whatever the latter does in order to advance its economy.One thing that Developed Countries have is their sophisticated technology that contributed much to the development of their industrial and agricultural sectors (Remenyi, 2004). The empirical analysis has also shown that the technological capability o f the five richest countries in the world is about 13 times better than that of the five poorest. This technological progress magnetizes the poor countries and makes them realized that if they really want to enjoy the perks of development, they must adopt the advancement in technology of the rich countries (Nazara, 2000).The importance of technology in the industrializing Indonesia’s economic development has been well established. In the era of East-Asia Miracle, the country was regarded as one of the eight economies in the region whose economic growth was founded on technical progress (World Bank, 1994). Political Ideologies The last factor that fosters inevitable dependency of Developing Countries to Developed Countries is their outstanding and influential political ideologies. The world has seen how the excellent governance and political principles brought prosperous economy to rich countries especially the United States.The liberation of countries political mind has been necessary to break the chains of underdevelopment. This has become the stimulus for the poor countries to shift from tribal forms of authority to suffrage, political parties, elected representatives, and democratization. It also paved the way for the adoption of the policy-making strategies, economic-boosting techniques, and the integration of Third World countries to global economy (So, 2011) Dependency: Contemporary Way to Economic DevelopmentThe dependency of underdeveloped countries and domination of the developed ones are reinforced as the Third World states attempt to expand their economies (Patterson,1999). In pursuit of this endeavor, the Developing Countries has opened their hands to aid, practices, and ideologies that the economically, politically, and technologically successful countries are offering making Third World dependency unavoidable. REFERENCES Aluko, F. & Arowolo, D. (2010). Foreign aid, the Third World’s debt crisis and the implication for economic devel opment: The Nigerian experience.Retrieved from http://www. academicjournals. org/ajpsir/pdf/pdf2010/April/Aluko%20and%20Arowolo. pdf Esteva, G. (1992). The Development Dictionary: A guide to knowledge as power. New Jersey: Zed Books Ltd. Ferraro, V. (1996). Dependency Theory: An Introduction. Retrieved from http://marriottschool. net/emp/WPW/pdf/class/Class_6-The_Dependency_Perspective. pdf Nazara, s. (2000). The Contribution of Technology in Economy: The Decomposition of Output Differentials in 1995-2000 Indonesian IRSAM. Retrieved from http://www. iioa. rg/pdf/Intermediate-2006/Full%20paper_Prihawantoro__Nazara. pdf Patterson, T. (1999). The Cold War, decolonization, and Third World development. In T. C. Patterson, Change and development in the twentieth century (pp. 113-150). Oxford: Berg. Remenyi, J. (2004). What is Development? In D. Kingsbury et al. , Key issues in development (pp. 22-44). NY: Palgrave Macmillan So, A. (2011). The Dependency And World-Systems Perspective. Retr ieved from http://www. eolss. net/Sample-Chapters/C04/E6-99A-36. pdf World Bank (1993).

Follicular And Mantle Cell Lymphomas Health And Social Care Essay

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 from 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-a gent 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.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 SubjectRENAL ISSUESAbstractionThe 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 of f 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 ¬?nitio n 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 c hest 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.

High Health Cost in U.S.A

High Health Cost in U.S.A The cost of health care in the United States of America (U.S.A.) has escalated recently. It is estimated that the health care cost in the United States of America account for 16.6% of its Gross Domestic Product (GDP). The U.S.A. health care cost is perceived to be the highest health care cost among the developed nations. Advertising We will write a custom research paper sample on High Health Cost in U.S.A specifically for you for only $16.05 $11/page Learn More In the recent decade, it has been noted that the rate of healthcare expenditure in United States of America has increased more than the national income as well as inflation. Despite the high healthcare cost in United States of America, it is believed that United States of America is characterized by the greatest discrimination, inequality, worst access to health care as well as poorest health care delivery. The U.S.A. should implement appropriate mechanism to leverage its high health care cost. By 20 08, the U.S.A. was spending about $7,800 per person annually as health care cost. Its health care spending was $2.4 trillion by then and was forecasted to escalate to $4.3 trillion by 2017 if appropriate strategies are not adapted. This represents a 19.7% of the U.S.A GDP. When health care cost escalate more than inflation and people’s income as witnessed in the United States of America, it becomes very difficult for residents to receive deductibles, premiums as well as copayments. High health care costs makes it very tricky for employers to offer their employees medical insurance covers, while at the same time being in a position to remain competitive especially at the current competitive market dynamic. Similarly, high health care cost as the one reflected in United States of America poses a great challenge to governments. Consequently, any government that mirror such a high health care cost faces a lot of problem to try and balance on how to cover its employees and at the same time pay for health care safety net plans for the elderly, those that earn low income as well as children (Mass-Care par. 4). The high health care cost in United States of America is caused by American commercial health care system. The United States of America treats its health care like commodity that is purchased by the government, individuals as well as businesses. Surprisingly, instead of the American health care systems being tailored in a manner to assists the Americans, it is costumed in a way to maximize profits at the expense of the Americans. The United States of America insurance companies, drug manufactures as well as the health care providers are motivated by profits. The monopoly of the single payer Health Care System makes health care coverage in United States of America to be offered as a public good to all. Advertising Looking for research paper on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More In California for example, over 6.4 million American have no health insurance. This number is expected to increase very soon if United States of America does not institute appropriate strategies to curtail the situation. The cost of physicians in United States of America is very high. A report given by Price Water Coopers in 2005 revealed that 86 percent of every $ 1 paid in health insurance premium goes to hospitals, doctors, prescription drugs as well as the outpatient care. In United Sates of America, in every $ 1 that is spent on health insurance premiums, 24 percent go to physician services. It was discovered that health cost of physicians in United States of America in 2005 increased by a rate of 7.8%. This rate was two times higher than the rate of increase of consumer price index that year which was 3.2 percent. The cost of physician was 1.9 percentage points of the 8.8 percent increase in health insurance premiums in 2005 (California Associations of Health Plans 1). Some of the factors that trigger high physician charges are Medicare and Medi-Cal reimbursements rates. Research on health care cost in various nations indicates that low Medicare and Medi-Cal reimbursements rates escalate health care cost because physicians opt to get their lost income by charging their private patients higher charges and also they recover the foregone income by performing more services. Physician salaries in United States of America are very high. Physician in U.S.A. earn three times the salaries that physician receive in other developed nations get. For instance Physician is U.S.A receives about $ 300,000 yearly, while doctors in United Kingdom get about $ 100,000 annually. The high costs that are associated with litigation and defense medicine in U.S.A also increases the health care cost in U.S.A. These costs accounts for approximately 10 percent of the total cost of physician services. The high costs of defense and litigation occurs because physicians prescri be more tests and other expensive procedures to avoid lawsuits. The high number of aging population in United States of America makes the United States of America to use a lot of money on its health care since this group is vulnerable to chronic diseases. Similarly, the high cost in health care in United States of America can be linked to increased investment in the development of medical devices that help to prolong life (California Associations of Health Plans 3). The United States of America is in a dire need to address its ever rising health care cost in order to make sure that every American is in position to access equal and affordable health care service. The sure way to ensure low cost of health care in United States of American is by the federal government enacting appropriated legislations to address high health care cost in U.S.A. Advertising We will write a custom research paper sample on High Health Cost in U.S.A specifically for you for only $16.05 $11/page Learn More The federal government should enact legislation that will leverage the salaries paid to United States of America physicians to reflect those salaries paid to doctors in other developed nations .In additional, appropriate legislation that support uniform billing and fair prescriptions should be adapted. Through these legislations, the United States of America will be in a position to cut down its high health care cost (Mass-Care par 5). California Associations of Health Plans. â€Å"Medical Costs Growing Faster Than the Economy.† 18 Feb. 2009. Web. Mass-Care. â€Å"Health Care Cost†.28. Feb 2011. Web.28 Nov. 2011

Critical evaluation of lean strategy (strength and weaknesses) Essay - 1

Critical evaluation of lean strategy (strength and weaknesses) - Essay Example Critical success factors that improve the execution procedure are distinguished through human asset reviews, administration style, hierarchical vision of organizations, cultural aspects of the organization and external forces. Lean strategy directs the company to reduce or remove waste along with whole value creation channels. This makes operations that require less human exertion, less space, fewer assets and capital, and less time to manufacture items and deliver services. This process undertakes fewer expenses and with much fewer discards and operational errors as compared to traditional business frameworks. The main objective of the lean strategy is to give perfect and ideal worth to the customer through a sound value formation process that supports no waste. Further, the paper also outlines the difficulties that organizations experience when they change their plan of action towards executing another strategy and innovative system to the organization framework that is lean strategy. For superior understanding of the lean strategy, the paper proposes definitions from the developers of the system recognized in the field. As the world is turning into a global village, internationalization and globalization have taken up the majority space in the corporate world. Now business processes have developed into more efficient and effective processes. This has made the businesses more complicated and has created the vigorous competition in every industry. In such case, strategy lends a helpful thought to corporate to efficiently adjust their business operations while remain aligned with corporate mission and vision, in order to run their successfully and gain competitive edge over others. Pace, effectiveness, and client worth are basic concerns in driving productive outcomes in company. Lean strategy is also one of the strategies that seek to manage and incorporate the operations of the different

Business Ethics Research Paper Example | Topics and Well Written Essays - 1250 words

Business Ethics - Research Paper Example One such area that a business organization should adequately address involves the issue of ethics in business. In line with this, the definition of business ethics vary based on the conception of the topic under discussion. One topic of discussion in business ethics involves the issue of child labor, which is crucial as business organizations seek to achieve a global perspective in conducting business. In effect, it is important to understand the issue of child labor, as an important topic in business ethics, and highlight approaches that business organizations take in order to deal with this issue. To begin with, it is crucial to understand the concept of child labor. There are varying international principles provided by labor organizations, such as ILO, which provide different definitions of intolerable and tolerable forms and definitions of child labor. For tolerable work, the ILO Convention No. 138 (1973) identifies work that does not make children fail to attend school with the work being light and harmless to the growth and development of the child as tolerable work (ILO, n.d.). Consequently, the convention stipulates the right age for this work being 13 years although the age can go down to 12 years depending on various circumstances such as the economic situation of the child and their family, which is crucial since such work can be crucial for the growth and the development of the child in question (UNICEF, 1997). On the other hand, intolerable work is abusive and dangerous with the work being exploitive on children. In this case, the ILO Convention No. 182 (1999) identifies child labor as any form of slavery or practices that are similar to slavery with actions related to the sale of children, debt bondage using children, serfdom, and the involvement of children in armed conflicts (ILO, n.d.). Importantly, this definition covers the use of children in issues related to child prostitution, using children in illegal activities, and in other areas that might harm the growth and development of children in regard to their moral values, health, and their safety. At this juncture, it is crucial to point out this convention, and other international codes and standards such as the UN convention on the rights of children, define a child as any individual below the age of 18 years (UNICEF, 1997). Nonetheless, it is important to point out that perceptions about child labor may vary depending on the culture although business organizations should use the definitions provided by ILO and other international organizations such as the UN. According to data from the International Labor Organization, one in every seven children is in some form of child labor. This puts the figure at 218 million children involved in child labor, which is a decrease from the 240 million children involved in labor in 2002 (ILO, 2006). Nonetheless, it is crucial to point out that this is not ethical practice in business since children are supposed to enjoy their child hood and not working under harmful conditions. In line with this, these children work in various sectors of the global economy with these sectors located in various parts of the world. However, a majority of these children work in the agricultural sector, which is a result of the non-regulation of this sector in terms of regulating the human resource capital working in the sector (Kolk & Tulder, 2002). In