Critically discuss how knowledge of the chronic radiation induced long Essay - 1

Critically discuss how knowledge of the chronic radiation induced long term side effects have impacted on current treatment practices - Essay Example Wallace and Lorrie (2002) observe that fatigue is the most common and severe of all side effects of radiotherapy. Side effects caused because of radiotherapy are so dangerous that some result in serious permanent disabilities, death, or even some short-term side effects to the cancer infected patients who are undergoing radiation. Patients can evade this menace if doctors or radiologists take careful precautions. However, these prevention methods depend on the type of cancer that one is suffering from. It is worth noting that the intensity of side effects of radiotherapy treatment depends on which target tissues the treatment is being directed. The side effects may be minimal according to the type of tissue receiving the treatment. This paper explores the techniques of treating cancer, their side effects and the modifications in place to reduce the impacts on patients in future. The research paper will focus on fatigue, as the most serious side effect in treatment of cancer. Fatigue is the most serious side effect caused by radiotherapy. It is common among patients suffering from cancer, undergoing radiotherapy. This is an observation made by Wallace and Lorrie (2002) in their research. Fatigue has, among many, the following symptoms: loss of energy, being weak, problem of thoughts and being too moody. Fatigue comes because of the following techniques of radiotherapy during prostate cancer treatment. During radiotherapy, most of the cells usually die. This causes destruction of blood vessels around the tumors. This interferes with transport of blood into the tissues. Inadequate oxygen in cells lowers rate of respiration hence low energy quantities in the body. Discussed below are improved radiotherapy techniqu es, aimed to reduce the said fatigue. 3D conformal radiotherapy uses computer technology and radioisotope to concentrate the high radiation dose to the tumors while deterring the

Schools as Organisations Essay Example for Free

Schools as Organisations Essay Outcome 1 1. 3) Explain the post 16 options for young people and adults. The opportunities for pupils aged 16 and over have traditionally been either to leave school and start employment, or to stay and continue with their education. Although many pupils do still choose one of these options, it is likely there will be more opportunities available as there has been an increased government focus on and funding of education for 14 to 19 year olds, and in particular a focus on reducing the number of young people not in education, and employment or training post 16. Under the old labour government it was that by the end of the September of the year that each young person leaves compulsory education, they will have a place in further learning available. The September guarantee was implemented nationally in 2007 and was later extended so that 17 year olds who have completed a short course or have chosen to leave the activity they selected on completing school will have the opportunity to extend their learning. The September guarantee Under the last labour government, the guarantee was the following: Full or part-time education in school, Sixth Form College, independent learning provider or Further Education College. An apprenticeship or programme-led apprenticeship, which must include both the training element and a job or work placement. Entry to employment. Employment with training to NVQ level 2 The reason behind these requirements is that by 2013, all pupils will be required to continue in education or training to at least 17 years of age. This does not mean that they will be required to remain in school, but they should be following one of the pathways above. It is possible that under the new government these may change.

Complication In Grand Multi Parity

Complication In Grand Multi Parity Grand multi parity is the condition of giving birth after the 28th weeks of gestation, following 5 or more previous viable babies. Grand multiparae is relation to obstetric performance is labeled high risk. High risk pregnancy is define as one in which the mother, fetus or newborn will be at increased risk of morbidity or mortality at or after birth. The risk to the mother and child is relatively high in first pregnancy and then this risk decline during second, third and then slowly rises with increasing parity by the sixth pregnancy risks exceeds these of 1st and after that rises steeply with each pregnancy1. Grand multiparous have been considered to be at higher risk of developing antenatal complications. These complications include gestational diabetes, hypertension, anemia, placental abruption, placenta previa, preterm labour, mal-presentation, mal-position, fetopelvic disproportion and intra-partum complication, uterine intertia, dysfunctional labour, uterine rupture, intrauterine death, marosomia and subsequent operative delivery with its consequent risk of maternal mortality and morbidity2,3. Postpartum haemorrhage also more common in grand multipara. Munim noted in her study PPH was three times more common in grand multipara4. Grand multiparity reported to increased both maternal and perinatal morbidity and mortality5,6. It is generally accepted that GMP is risk factor of obstetric complication but recently a few reports have appeared in the literature showing that this might be fiction rather than fact. Toohey et al, Fayed et al, and Kaplan et al, addressed the obstetric performance of great grand multipara but they concoluded that such women were not a high risk group7,8,9. Brunner et al, in 1992 concluded that grand multi parity should be regarded as an obstetric risk factor, mainly because of the higher frequency of placental complication and with good obstetric care there should be no advice affects to the mother or newborn10. The incidence of grand multipara has decreased in most western countries in recent years due to better socioeconomic status and high use of contraception11,12,13. In third world countries like Pakistan the large families are still common. Grand multi parity is a common problem in this part of world and when added to low socioeconomic status, it significantly increases the risk to mother and fetus8,14,15. OBJECTIVES The objective of our study were To compare obstetrical complications between grand multiparae and low parity women. To study the frequency of maternal and perinatal mortality associated with complications of grand multi parity. OPERATIONAL DEFINITION GRAND MULTIPARAE: Grand multiparae is woman who has delivered five or more babies after 28 weeks, weighing more than 500 grams. LOW MULTIPARAE: Low multiparae is woman who has delivered less than five (para 1-4). HYPOTHESIS: Obstetrical complication are more in grand multiparae than the low parity women. MATERIAL AND METHODS SETTINGS: This study was conducted in Obstetric / Gynaecology Unit-I, Civil Hospital, Karachi and Sheikh Zaid Women Hospital Larkana. DURATION OF STUDY: One year from 1st July 2008 to 31st March 2009 at Civil Hospital Karachi and 1st April 2009 to 30th June 2009 at Sheikh Zaid Women Hospital Larkana. SAMPLE SIZE: A total of 200 pregnant women were selected randomly, were divided into two groups with 100 women in each group. Group I consistent of women with parity five or more, and group II consisting of women with parity one to four. SAMPLING TECHNIQUE: Probability. SAMPLE SELECTION: Sample selection was done according to the following inclusion and exclusion. INCLUSION CRITERIA: All pregnant multiparous women. EXCLUSION CRITERIA: Primigravida. STUDY DESIGN: Comparative, cross sectional DATA COLLECTION PROCEDURE: A 200 women were admitted in our ward through out patient department or emergency, or referred by private clinics or traditional birth attendants were selected. These cases were divided into two groups. Group I consistent of 100 women of parity five or more and group II consistent of 100 women were admitted during the same period with parity one to four. On admission patients history was taken in detail. Age, parity, socioeconomic status, detailed obstetrical history, past history were recorded and previous record was received to detect antenatal complication including anaemia, PIH, APH, and malpresentation , pre-term labour. Anemia was taken as haemoglobin of 11 g/dl, PIH was defined as blood pressure of > 140/90 millimeter mercury after 20 weeks of gestation with or without protenuria on two or more occasion 6 hours apart. Bleeding from genital tract after 24 weeks gestation was taken as APH. Ultrasonography was done in non-booked cases when there was suspicious of malpresentation which was defined as presenting part of fetus in other than cephalic in relation to maternal pelvis. Preterm labour was defined as labour before 37 complete weeks gestation. During labour patients were managed according to units protocol and partogram recording was used to evaluate the progress of labour. The intrapartum complications included prolonged labour and ruptured uterus. Mode of delivery was also recorded. After delivery, the patients were monitor for 24 hours for primary PPH which was taken as blood loss estimated to be more than 500ml after normal vaginal delivery and 1000ml after caesarean section. The maternal death if any was recorded with its cause in detail. Neonates were followed for neonatal complication which included, LBW, macrosomia, perinatal death. Birth weight of < 2.5 kg was taken as LBW and > 4.2 was taken as macrosomic babies. Admission to NICU. Perinatal deaths (PND) included all intrauterine death (IUD) and early neonatal deaths (ENNDs). Data was collected through special proforma, neonatal follow up recorded was also entered in the same proforma. STATISTICAL ANALYSIS: Data analysis was performed through SPSS version-10.0. Frequencies and percentages were computed for presentation of all categorical variables of the study including age, booking status, mode of delivery, pregnancy related complications, intrapartum and postpartum complications, maternal and fetal mortality, and birth weight. Chi-square test was applied to compare age, booking status, mode of delivery, pregnancy related complications, intrapartum and postpartum complications and birth weight between low parity and high parity groups. Fishers exact test was applied to compare maternal and fetal mortality and nursery care admissions between low parity and high parity groups due to typically low expected count (< 5). Statistical significance was taken at p < 0.05. RESULTS Commonest age group in both study groups was 20 25 years in which total 76 patients were observed, however this age group was significantly higher (46% vs. 30%, p=0.001) in low parity group that high parity group while older age group of the study 36 40 years was higher in high parity group than low parity group (4% vs. 15%). So the age distribution was significantly different in two groups (Table-1). Most of the patients in my study were unbooked, i.e. 131 % (Table-2). Booking status between two groups was statistically insignificant (p=0.344). Anemia was significantly higher in high parity group than low parity group (89% vs. 62%, P = 0.001); while abruptio placentae, PIH and malpresentations were significantly higher in high parity group than low parity group (p < 0.01). Placentae previa, preterm labour and twin pregnancy were insignificant between two groups (Table-3). Out of 200 women in this study, 21 (10.5%) underwent caesarean section and 179 (89.5%) normal vaginally delivered (Figure-1). In high parity group, proportion of women who underwent caesarean section was significantly higher in high parity group than low parity group (16% vs. 5%, p=0.011). Intrapartum and postpartum complications found insignificant between two groups at p < 0.05 (Table-4). No maternal death was observed in low parity group but one (1%) maternal mortality was observed in high parity group, however difference of maternal mortality rate was insignificant (p = 0.999) between two groups (Figure-2). Significantly high number of fetal mortalities was observed in high parity group than low parity group (16% vs. 4%, P = 0.999) (Figure-3). We observed 8% NICU admissions in high parity group that was not statistically significant (p 0.213) as compared with 3% NICU admissions in low parity group (Figure-4). Table 1: AGE DISTRIBUTION (n = 200) Age (years) Group Total Low parity (n = 100) High parity (n = 100) 20 25 46* 30 76 26 30 40 29 64 31 35 10 26 36 36 40 4 15* 19 * Shows significant difference (X2 = 18.6, d.f = 3, p = 0.001) Low parity: Parity 2-4, High parity: Parity > 4 Table 2: COMPARISON OF BOOKING STATUS (n = 100) Booking Group Total Low parity (n = 100) High parity (n = 100) Booked 32 23 55 Unbooked 62 69 131 Referred 6 8 14 * Significant difference (X2 = 2.13, d.f = 2, p = 0.344) Key: Booked = 3 or more antenatal visits. Unbooked = < 3 or no antenatal visits. Table 3: COMPARISON OF PREGNANCY RELATED COMPLICATIONS BETWEEN TWO GROUPS (n = 100) Complications Group p-value Low parity (n = 100) High parity (n = 100) Anemia 62 89 0.001 Placentae Previa 5 7 0.55 Abruptio placentae 2 11* 0.018 Preterm labour 5 6 0.760 Pregnancy induced hypertension 4 14* 0.024 Malpresentation 2 15* 0.001 Twin pregnancy 2 4 0.68 * Shows statistically significant difference at p < 0.05. Figure-1: COMPARISON OF MODE OF DELIVERY BETWEEN TWO GROUPS * Significant difference (X2 = 6.44, d.f = 1, p = 0.011) Table 4: COMPARISON OF INTRAPARTUM AND POSTPARTUM COMPLICATIONS BETWEEN TWO GROUPS Complications Group p-value Low parity (n = 100) High parity (n = 100) Obstructed labour 3 4 0.70 Ruptured uterus 1 1 Retained placentae 0 2 0.50 Postpartum hemorrhage 2 4 0.68 * Shows statistically significant difference at p < 0.05 Low parity: Parity 2-4 High party: Parity > 4 Figure-2: COMPARISON OF MATERNAL OUTCOME BETWEEN TWO GROUPS * Significant difference (p = 0.999) Figure-3: COMPARISON OF FETAL OUTCOME BETWEEN TWO GROUPS * Significant difference (Fishers exact test, p = 0.005) Figure-4: COMPARISON OF NURSERY ADMISSION BETWEEN TWO GROUPS (n1 = n2 = 100) * Significant difference (Fishers exact test, p = 0.213). Low parity: Parity 2-4 High parity: Parity > 4 NICU = Neonatal intensive care unit DISCUSSION This comparative, cohort study was conducted in largest hospital of Karachi to find out whether grand multi parity is risk factor for obstetrical complication when compare to low parity. Despite of availability of modern obstetric facilities, women in our society not intend to get book for antenatal care because they are too busy at their home and lack of awareness about health care, We found in our study that most of the patients in both groups coming in Civil Hospital, Karachi were non-booked and referred from different areas with complications. Unbooked 13% and 14% referred from different areas. In our study the grand multipara were older then low parity women. Increased age of GMP women put them additional risk for complication. As our study was not age matched study. So, the age matched study should be done for the proper risk assessment. This study shows that antenatal complication such as anemia was more common in grand multiparae. A Salick, et all also found same result in th eir studies 16. Anemia is more common in grand multipare because of poor nutrition, repeated pregnancies, low socioeconomic status. Pregnancy induced hypertension (PIH) was more common in our study, these women were relatively older than low parity and my study was not age matched study. Munim S, et al., found in her study statistically significance difference in the induced of the PIH that was 15.4% in grand multipare compared to the 9.3% in low parity women 4. Although the patients in here study were booked patients, she reported that higher prevalence of these complications may be explained on the increased age of these women. In spite of increased incidence of PIH the superimposed pre-eclampsia and eclampsia was no more common in my study.4. Regarding the antepartum haemorrhage, abruptio placentae is more common in GMP. Although number of placenta previa was increased in grand multi parity than low parity but not statistically significant. Heija AA, also found in his study that abruptio placentae is more common in grand multipareae. He state that the high parity is significant etiological determinant of placental abruption 2. The malpresentation was more common in grand multipare especially breech was more common than the low parity. Malpresentation in grand multipara is common because increasing laxity of anterior abdominal wall musculature, failing to act as a brace to encourages and maintain a longitudinal lie, encourages malpresentation 17. Preterm labour was same in both groups. Aziz FA, studied the grand multipare Sudanese women and found the incidence of pre-term labour was increased in these women 18. The intra partum complication like obstructed labour result was same in both groups in both cases patients was referred and reason was abnormal fetal position. we found 1 case of Ruptured uterus in each group, both these are patient were referred from private hospital, both were older age, both were mismanaged with syntocynon but low parity woman was survive and grand multiparous woman was die. Our study showed no statistical difference in postpartum haemorrhage between both groups. Page L in her series of study has reported that same result. She found no direct association between grand multiparae and PPH.63 Some other studies have shown that increased risk of PPH is associated with increased age not with increasing parity. Munim et al, noted in her study PPH was three times more common in grand multiparae 4. Our study showed caesarean section is significantly increased in grand multipare than the low parity, this because of malpresentation and obstructed labour, antepartum haemorrhage. One maternal death found in my study this unfortunate woman belong to low socioeconomic class, had obstructed labor due to macrosomic baby and mismanaged with syntocinon referred in state of shock despite of emergency laparotomy, blood transfusion, and resuscitation she could not survive because she was already anemic had bleed a lot and die due to cardiac failure. As regard the neonatal outcome parity is considered as important factor in determining the birth weight of baby. Many investigators have reported association of LBW with grand multiparae. But in my study low birth weight was common in low parity as compare to grand multiparae. There was no significant increased incidence macrosomic babies in grand multiparae, compare with international literature. In our study perinatal mortality was significantly increased in grand multi parity it mainly because of abruptio placenta, PIH, obstructed labour and preterm birth. CONCLUSION It is concluded from my study that antenatal complications like pregnancy induced hypertension, abruptio placenta, anaemia, malpresentation, Caesarean deliveries and perinatal mortality were more common in grand multiparae then the low parity group and multi parity is still a major obstetric hazards in our set up with higher incidence of complications.

Mission of God Essay -- The Bible, Genesis

Mission of God When one comes across the question â€Å"Who is God for them?† they could present a lot of definitions on what they think God is. To some, they would revere God as the Supreme Being that has created the whole universe in seven days. Some would note that He is the Loving, Caring, Sympathetic and Ever-Forgiving God that watches over us and guides us away from the darkness of our hearts. Many would state that He is the only Divine Being that everyone must obey and worship. This answer many vary if one comes from another religion, but all would agree that this God is a very special being that connects each and every one of us. But if one is asked the question â€Å"What do you think is God’s Personal Mission to us and to the world?† the answers may be unclear and even not be answered at all. This paper would try to answer this particular question by identifying and discussing the Mission of God through the passages in the Old and New Testament and the themes corresp onding to this Mission. This paper would also discuss the implications of the Mission of God to the contemporary Australian Church as an example of discussing the effects it has on the teachings of the Church. According to Jennings (2003), the mission of God can be traced from the first book of the Old Testament; the Book of Genesis. In summary, the first book tells readers how God began to create the world and the lives of the first humans He has watched, tested and protected. But looking closely in the first few chapters of the book, God presented his plans and mission for the world he has created in the first eleven chapters of this particular book. Jennings cited that God’s love is concentrated to His creations, especially in man; specifying his mission that He... ...rst travels after the time of Christ and how he came across the will of God and His mission. Most leaders in Jerusalem question the Gentiles and why they are accepted in the Church. But James, another disciple of Christ, remembered Jesus’s teachings from the books of Law, Prophets and Psalms from the Old Testament and prevented a massive argument from brewing between the Jews and Gentiles. Both authors speculate on how James got to remember this particular teaching of Christ but they both agree that James noted that the Word of God in form of the Gospel is not meant just for Jews but also for the Gentiles and other races that flock God’s church. (Wills, 1979) ; (Peters, 1972) Now that the mission of God is properly outlined in both the Old and New Testaments of the Bible, what are its implications upon the different churches that studied and valued its teachings?

How to Stop Worrying

General Outline Specific Purpose: To inform my audience on how to stop worrying and start living. Central Idea: We can stop worrying and start living by live in the moment, stop recycling the past, and stop trying to save the world. Main point 1: We can stop worrying and start living by live in the moment. Main point 2: We can stop worrying and start living by stop recycling the past. Main point 3: We can stop worrying and start living by stop trying to save the world.Introduction It is very easy to expend all of your energy worrying. I have learned that everyone worries to some extent it could be about something little like what you think you got on a test, or something big, like one of your family member is dying. One way to get out of the worry habit is to heighten your awareness of the present. Things are happening all around us every minute of the day. Why not focus on what is happening now by live in the moment.Outline of the Main Point Main point 1: We can stop worrying and st art living by live in the moment. 1. What is live in the moment? A. Live in the moment is all about living like there’s no tomorrow. 2. Several ways to live in the moment that can make us stop worrying and start living : A. Commit random, spontaneous acts of kindness – donate RM1 to a beggar, picking up a litter or complimenting someone. B.Minimize activities that dull your awareness of the moment – less use of phones and computer, instead go gardening, hiking and hanging out with friends. C. Smile when you wake up. References http://www. huffingtonpost. co. uk/2012/07/31/smiling-lowers-stress-health-benefits-laughing_n_1724400. html http://www. medicalnewstoday. com/articles/248433. php http://www. wikihow. com/Stop-Worrying-and-Start-Living www. positivelypresent. com/†¦ /15-ways-to-live-in-the-moment. html

Definition and Examples of Eponyms in English

Definition and Examples of Eponyms in English An eponym is a word that is derived from the proper name of a real or mythical person or place. Adjectives: eponymic and eponymous. Over time, the name of a well-known person (such as Machiavelli,  Italian Renaissance  author of The Prince) may come to stand for an attribute associated with that person (in Machiavellis case, cunning and duplicity). Etymology: from the Greek, named after   Pronunciation: EP-i-nim Examples and Observations We are well-armed for battle in a Machiavellian world of reputation manipulation, and one of our most important weapons is the delusion that we are noncombatants.(Jonathan Haidt, The Happiness Hypothesis: Finding Modern Truth in Ancient Wisdom. Basic Books, 2006)Jeff: You probably just Britta’d the test results.Britta: No, I doublewait! Are people using my name to mean ‘make a small mistake’?Jeff: Yes.(Joel McHale and Gillian Jacobs in Horror Fiction in Seven Spooky Steps. Community, October 27, 2011)[Alton] Brown can fill an entire episode on popcorn, teaching you how to MacGyver a nifty, cheap popper (hint: a stainless-steel bowl and some perforated foil).(Entertainment Weekly, August 14, 2009)The crowd parted reluctantly, and [Lance Armstrong] glided off, Batmanning through the crowd toward the start line.(Daniel Coyle, Lance Armstrongs War. HarperCollins, 2005)Lily: Dont Ted-out about it.Ted: Did you just use my name as a verb?Barney: Oh, yeah, we do that behi nd your back. Ted-out: to overthink. Also, see Ted-up. Ted-up: to overthink with disastrous consequences. For example, Billy Tedded-up when heTed: All right, I get it!(Matchmaker. How I Met Your Mother, 2005) Americans now nibble their way through two billion popsicles a year; their favorite flavor is a Jaggeresque red cherry.(Oliver Thring, Consider Ice Lollies. The Guardian, July 27, 2010)Sandwich: named after John Montagu, the Fourth Earl of Sandwich (1718–1792), a British politician.Cardigan: a knitted garment, such as a sweater or jacket, that opens down the front. Named after the Seventh Earl of Cardigan, James Thomas Brudenell (1797–1868), a British army officer.Andy Bernard: I really schruted it.Michael Scott: What?Andy Bernard: Schruted it. Its just this thing that people say around your office all the time. Like, when you screw something up in a really irreversible way, you schruted it. I dont know where it comes from though. Do you think it comes from Dwight Schrute?Michael Scott: I dont know. Who knows how words are formed.(Traveling Salesmen, The Office, Jan. 11, 2007)Lets not Rumsfeld Afghanistan.(Senator Lindsey Graham, quoted in Time magazine, Aug. 24, 2009)S axophone: named after Belgian instrument maker  Adolphe Sax. Other eponyms in English include boycott, braille, camellia, chauvinist, dahlia, diesel, dunce, gardenia, gerrymander, guillotine, hooligan, leotard, lynch, magnolia, ohm, pasteurize, poinsettia, praline, quixotic, ritzy, sequoia, shrapnel, silhouette, volt, watt, and zeppelin.​ Achieving Wordhood As a word,  eponymous is a bit anonymous itself. Its moment in the sun came with the release of REM’s album Eponymous, a subtle dig at musicians who name records after themselves, such as Peter Gabriel, whose first four albums are all entitled, Peter Gabriel. In short, an eponym is anything that’s ever been named after anybody. . . .But a name only crosses into true wordhood once it is no longer used as a reference. When we speak of hectoring wives and philandering husbands, it is without a picture of valiant Hector or lover-boy Philander popping into our minds, the way a bespectacled Viennese man with a pipe does when we say Freudian slip.(John Bemelmans Marciano, Anonyponymous: The Forgotten People Behind Everyday Words. Bloomsbury, 2009) Eponyms and Allusions An eponym is similar to an allusion, referring to a specific famous person to link his or her attributes with someone else. Using an eponym well can be something of a balancing act; if the person is too obscure, no one will understand your reference, but if its too well known, it may come across as a clichà ©.(Brendan McGuigan, Rhetorical Devices: A Handbook and Activities for Student Writers. Prestwick House, 2007) Skutniks When CNNs Jeff Greenfield assured the crowd, I havent planted a Skutnik here, I stopped him: I had heard of a Sputnik, the Russian word for the first Soviet satellite, but what was a Skutnik?Greenfield directed me to his book Oh, Waiter! One Order of Crow! about the media failure on election night: A Skutnik is a human prop, used by a speaker to make a political point. The name comes from Lenny Skutnik, a young man who heroically saved lives after the Air Florida plane crash in Washington in 1982 and who was introduced by President Reagan during his State of the Union speech.The introduction of heroes became a staple in presidential addresses to joint sessions of Congress. In 1995, the columnist William F. Buckley was one of the first to use the name as an eponym: President Clinton was awash with Skutniks.(William Safire, On Language. The New York Times, July 8, 2001) The Lighter Side of Eponyms First the doctor told me the good news: I was going to have a disease named after me.(Steve Martin)