Appropriate Police Response Essay Example | Topics and Well Written Essays - 1000 words

Appropriate Police Response - Essay Example The essay "Appropriate Police Response" tackles and discusses some of the most pressing issues facing the police on any given day during their tour of duty. In addition to having one of the highest suicide rates of any profession, police force members face daily risks which put life and limb in danger. Three major factors in police response are communications, use of force and professional community relations. Communications aspect is a very critical component of any police response to calls for help in emergency situations. This is because the responders have to judge correctly the situation before going in, such as a hostage situation. The point is that a police officer has to read the situation correctly in terms of its riskiness, analyze the threats to the public and to the police officer himself without resorting to unnecessary force. If the situation is diffused peacefully, then so much the better. Another case is when an officer sees a teenager carrying a knife in a dark and deserted alley but who has failed to respond when told to stop and drop the knife. This situation calls for a quick but critical thinking by asking a few questions: is the teenager a mentally-challenged youth who did not understand what he was doing, is the youth hearing-impaired and did not hear the pol ice officer or is this a young man newly arrived in America and does not understand even a few simple, basic English words? If mishandled, this situation can escalate and perhaps even turn tragic if miscommunication occurs.

Extreme Poverty and the Rights of the Poor Essay Example for Free

Extreme Poverty and the Rights of the Poor Essay Extreme poverty and the rights of the poor has been a high priority of the UN ever since its creation, yet this dilemma are still happening in many underdeveloped and developing countries. To eliminate this problem, public awareness and a genuine cooperation in the global community is required. Extreme poverty and rights of the poor goes hand in hand, because in many third world and developing nations, poor people have no rights. France encourages nations to genuinely cooperate to increase the awareness of the issue and to abolish habits of â€Å"ignoring poverty and the rights of the poor. † The eradication of poverty must begin by providing help to those most affected by the problem. The poor and uneducated makes up the majority of those without any rights, they lack access to the fastest way of escaping poverty, education; therefore, they rarely ever have a voice in their communities. France is well aware that efforts have been made to fight poverty in many regions simultaneously, including Africa, Central and South America, and the Middle East. France strongly believes that the most essential step the UN should take in order to solve this problem is to encourage all nations to provide free education to everyone. In order to reduce poverty and guarantee rights to the poor, free education must be made available to everyone, especially to those that cannot afford it. If this is achieved, people most definitely are able to have a bigger and better access to economic opportunities, a major factor in escaping poverty. In France, it is required for children from the age of 6-16 to attend school. After ninth grade, students can choose whether or not to pursue a higher education, such as high school and college, if not, they can be admitted to a technical school, then graduate from such school and have a professional career. France believe that based on the high efficiency of this method, the UN should carry out similar actions to a global scale by encouraging nations to adopt the same principle. In conclusion, France strongly believes nations must genuinely cooperate effectively in order to reduce poverty and guarantee rights to the poor. The source of this problem is believed to be the lack of access to education due to poverty. Providing free education must be the first step nations should take in order to bring an end to this problem.

Techniques for Donor Nephrectomy Analysis

Techniques for Donor Nephrectomy Analysis Laparoscopic donor nephrectomy versus robotic assisted laparoscopic donor nephrectomy: A prospective randomised comparative study Introduction: Donor nephrectomy is unique surgery which is done on person who is not a patient and come forward for purely altruistic reasons. So the margin of error in donor nephrectomy is nil and hence the stress in donor surgeon is quite high. At the same time all attempts should be done to minimize the donor morbidity to minimum. With the same intension in 1995, Ratner reported first laparoscopic living donor nephrectomy (LDN) (1) and later gradually the laparoscopic approach has become almost the standard of care for living donor nephrectomy. Randomised controlled trials (RCT) comparing the laparoscopic vs. open donor nephrectomy suggested that laparoscopic approach was associated lesser postoperative analgesic requirement and lesser hospital stay and faster returned to work compared to open approach without affecting immediate graft outcome although there was significantly increased warm ischemia time and total operative time with LDN group (2,3). So LDN was associated with dec rease in the disincentives associated with voluntary donor nephrectomy. Further course of time saw further refinement in the techniques of LDN and towards further reducing the morbidity associated with donor nephrectomy. These modifications were introduction of laparo- endoscopic single site surgery(LESS) (4), retroperitoneoscopic donor nephrectomy, robotic assisted laparoscopic donor nephrectomy (RDN) (5) and transvaginal laparoscopic donor nephrectomy (6). In 2002 Horgan first reported the RDN. The goal of this study was to compare the outcomes of LDN and RDN. Materials and methods: The study was started after approval from institutional review board. Study enrollment time was from March 2014 to February 2015.Primary end point was the postoperative visual analogue pain scores of the donors. Secondary end points were donor’s postoperative analgesic requirement, haemoglobin drop, hospital stay ,lost arterial and venous length, total operative time(TOT) , retrieval time (RT) , warm ischemia time ( WIT),. Recipient related secondary end points were graft function at serial follow up. Surgeon difficulty scores for different steps of surgery were also analyzed. Total of 45 donors were to be enrolled into the study with enrollment ratio of 1:2 for Robotic: Laparoscopy arm for establishing mean pain score difference of 1 with standard deviation of 1 to reject the null hypothesis that the robotic and laparoscopic pain score means are equal with probability (Power) of 0.871 and the type 1 error ( ÃŽ ±) of 0.05.The sample size was calculated w ith power and sample size program version 3.0.7. After written informed valid consent for inclusion in study, 45 live related voluntary kidney donor who were completely evaluated and planned for right (N=27) or left donor nephrectomy (N=18) were randomised into robotic (Da Vinci Si TM-Intuitive surgical ® ) or laparoscopic approach for donor nephrectomy with chit method.(Figure 1). Exclusion criteria were patient unwilling for inclusion in study, preemptive transplantation, body mass index (BMI)> 35kg/ square meter, multiple renal artery or veins on donor side or epsilateral adrenal adenoma. Parameters noted in all donors preoperatively were, age, gender, comorbidities, previous surgeries GFR (Cockroft-Gault), serum creatinine BMI, length of renal artery and vein ( up to level of bifurcation) on CT angiogram. RDN was done by two surgeons with expertise in robotic surgery.LDN was done by multiple surgeons (including both the surgeons performing RDN) with expertise in LDN. Bed side surgeons in RDN were the same surgeons who were performing LDN. The operative room team in both the group was same. In Right LDN, access was achieved from three 12 mm ports for camera and working and two 5 mm ports for lifting ureterogonadal packet and liver retraction. In 9 cases additional 12 mm port was placed from Pfanensteil retrieval wound for insertion of vascular stapler. In Left LDN, two 12 mm ports for camera and working and two 5 mm ports for working and lifting ureterogonadal packet were used. Three left LDN could be managed without port for lifting of ureterogonadal packet. In Left RDN, three 8mm robotic working ports and two 12mm ports ,one for robotic camera and another was for bed side surgeon working port were used. In Right RDN in addition to above ports one more 12 mm port in Pfanensteil retrieval wound for stapler insertion was used in 7 cases and one 5 mm port for liver retraction was used in all cases. The steps for the surgery were similar in LDN as well as RDN. The difficulty scores (visual analogue score 0-10; 0 being easiest and 10 being most difficult ) of donor surgeon were noted on for bowel reflection, lifting up the ureterogonadal packet, hilar dissection, upper pole dissection, clipping the ureterogonadal packet, clipping renal artery and vein, cutting renal artery and vein and retrieval of graft in laparoscopy group. The console surgeon difficulty scores were noted for bowel reflection, lifting up the ureterogonadal packet, hilar dissection, and upper pole dissection, cutting renal artery and vein in robotic cases. Bed side surgeon difficulty scores were noted for tasks done by him like clipping ureterogonadal packet, clipping of renal artery and vein and retrieval in robotic cases. A 5-7cm Pfanensteil incision is placed and deepened to the level of parital peritoneum for graft retrieval. In 2 right RDN kidney was flipped for getting longer renal artery stump. Mannitol was given intravenous before cutting ureterogonadal packets. After cutting the ureter brisk urine output was observed from cut ureter before clipping of hilar vessles. After cutting renal vein, graft was freed of lateral attachments and kept free in peritoneal cavity. After incising this parital peritoneum in Pfanensteil incision, graft is retrieved in longitudinal axis by hand introduced into peritoneum by donor surgeon in LDN and patient side surgeon in RDN. During retrieval undocking of fourth arm of robot was necessary in most of the cases with RDN. Intraoperatively noted parameters in robotic as well as laparoscopic cases were number of ports, retrieval time, warm ischemia time total operative time, length of artery and vein (Up to level of bifurcation) on bench, intraoperative complications. Retrieval time was considered from clipping of artery up to the retrieval from donor. Warm ischemia time was considered from clipping of artery up to reperfusion of kidney with perfusion fluid till the time when efflux from renal vein is clear. Docking time was noted in robotic cases. Post operative visual analogue pain scores (VAS) were noted in donor at 6 hours, 24 hours and 48 hours. Donors were discharged when they were allowed full oral diet, passed motions, ambulant and comfortable. Other donor parameters noted postoperatively were analgesic requirement in milligrams of tramadol, complication grades by Clavien –Dindo complication scale, hospital stay, haemoglobin drop, and serum creatinine at 1 month follow up. Recipient parameters noted were e GFR (Cockcroft-Gault) at 7 days, 1month, 3 month, 6 months and 9 months, graft complications, graft loss. Statistical analysis was done with Statistical package for social sciences (SPSS) version 15.0. Analysis was done for comparing RDN vs. LDN. Subgroup analysis was done to compare Right RDN vs. Right LDN and Left RDN vs. Left LDN. The Chi-square test and Student’s t-test was used for categorical and continuous variables respectively. Results: The demographic parameters in donors are as shown in table 1.Demographic parameters in right and left subgroup are shown in table 2 and 3 respectively. Both the RDN and LDN groups as well as right and left donor subgroups were similar in age, gender, BMI, preoperative renal function, previous surgeries and comorbidities and preoperative artery and vein lengths. All 15 RDN were completed without conversion to LDN or open donor nephrectomy. All 30 LDN were completed without conversion to open donor nephrectomy. There were no intraoperative complications in any of RDN or LDN. In all the RND and LDN the ureter was cut at pelvic brim level. All the recipients (N=45) in both the groups had good urine output on table after vascular anastomosis. 2 surgeons (one on console and one on patient side) were necessary in RDN compared to single donor surgeon in LDN. The difficulty score on VAS scale 0-10 for donor surgeon in LDN and console surgeon and patient side surgeon in RND is shown in table 4 for right side and table 5 for left side. The VAS score of patient side surgeon in RDN was higher in graft retrieval compared to donor surgeon in LDN in both right and left subgroup. In right subgroup, the VAS scores of RDN surgeons were less than LDN surgeon except in step of upper pole dissection and adrenal sparing which have comparable VAS scores. In left subgroup, the VAS scores of RDN surgeon and LDN surgeon are similar other than step of renal artery and vein cutting which was easier in RDN group. The analysis of intraoperative and postoperative parameters as well as recipient and graft outcomes is shown in table 6.The subgroup analysis in right and left group is shown in table 7 and 8 respectively. Donor VAS pain score at 6 hours, 24 hours and 48 hours, analgesic requirement, hospital stay was less in RDN group compared to LDN group. There was no significant difference in donor haemoglobin drop, donor complications, donor serum creatinine at 1 month, recipient eGFR at 7 days, 1month, 3 months, 6 months and 9 months or graft complications between RDN and LDN group. More ports were necessary in RDN in either of the subgroups. The total operative time was not significantly different in RDN and LDN group as well as in right and left subgroup. However the retrieval time was higher in RDN group overall as well as in both right and left subgroup. The warm ischemia time is higher in RDN group overall as well as in left subgroup. However it is not significantly different in right subgroup. There was no difference in lost length of vein during clipping in RND or LDN in both subgroups. However in right RDN longer artery length could be preserved compared to right LDN. This was not found in left subgroup. Discussion: More important than introduction of any new technology is safety associated with the technique. This is more so in transplant as there are outcomes in two persons are at stake. As found in our study the RDN is safe technique. It is associated with similar immediate and early postoperative outcomes in donors as well as corresponding recipient’s graft function. Previous literature also suggest that RDN is safe(5,8,9). Study comparing robotic versus laparoscopy suggest that robotic approach is associated with less pain than laparoscopic approach (10). The possible reason for less pain in robotic surgery is robotic arms which are pivoted around port site are moved at fixed remote centre. So there is less leverage around the port site and lesser pressure at port sites which leads to lesser trauma to abdominal wall tissues around the port. Our study suggested that RDN is associated with lesser pain score and lesser analgesic requirement compared to LDN. This also transforms into earlier recovery and discharge from the hospital. Although the voluntary kidney donors donate with altruistic approach, any donor will prefer approach which further reduces the morbidity associated with donor surgery. It is for this reason that live donor nephrectomy rates increase after advent of LDN compared to open donor nephrectomy (11, 12).RDN may further reduce morbidity associated with donor nephrectomy. Most of the transplant centres prefer left sided graft kidney over right in view of small right vein length and need for retrocaval dissection or flipping of kidney on right side to achieve good graft artery length (13, 14) which may be technically more challenging.Studies also propose that the robotic approach with its 3 Dimentional vision,7 degrees of freedom,higher magnification and enhanced dexterity compared to standard laparoscopic approach facilitate the renal hilar dissection(15). In our study we found that the VAS of donor surgeon for right hilar dissection was lesser in RDN than LDN. Right kidney was flipped in two RDN. The preserved renal artery length was more in right RDN than right LDN. The technical ease was felt in right RDN compared to right LDN in all steps other than upper pole dissection and retrieval. However it is worth noting that this technical ease did not reach level of significance in any steps of left RDN vs. LDN except cutting of renal artery and vein. Th e lost artery or vein length was not different in left RDN and LDN. This suggest that robotic approach may provide some technical advantage compared to laparoscopic on right side but not so significantly on left side.At the time of writing this manuscript and during the conduct of this study instruments like robotic vascular stapler are not available. Availability of such instruments will further reduce the role of patient side surgeon and may influence the technical ease of this surgery. It may also reduce the steep learning curve associated with LDN(9). The total operative time was not different in RDN vs. LDN. However the warm ischemia time was significantly more in Left RDN group than LDN (p=0.01, power of test for this parameter=87.8%) which is definitely a matter of concern. The retrieval time was more in RDN in both subgroups. The difference in WIT did not reach level of significance on right side.Possible cause for this increased WIT and RT is need to undock the fourth arm during retrieval. This is also a cause for increased patient side surgeon VAS during retrieval in RDN. The increase in WIT does not correlate with recipient graft function in limited range of time (16,17).In our study as well the recipient graft related complications or e GFR was not different between RDN and LDN group at 7 days,1 month ,3 month,6 month,9 month follow up . We acknowledge the limitation of our study that although it is well powered for its primary end point of post operative visual analogue pain scores of donor, it is less powered for few of the secondary end points. The longest recipient graft follow up is 1 year in our study and we don’t have any longer follow up. Last but not least ,our study does not focus on the economic aspects of comparison between RDN and LDN.The RDN increased the cost of surgery for donor nephrectomy(18).It remains to be determined if the benefits of RDN in reducing donor morbidity and technical ease associated with it out weight the cost implications associated with it. Conclusion: RDN is safe procedure and is associated with better postoperative pain scores, analgesic requirement as well as lesser hospital stay compared to LDN. Robotic approach in right donor nephrectomy is associated with more technical ease to console surgeon compared to laparoscopic donor surgeon in most of the steps of surgery and facilitates preservation of longer length of right renal artery. However there is no significant technical ease associated with left RDN compared to left LDN. Left RDN is associated with longer WIT than LDN however this does not reflect adversely into early graft function from 7 days up to 9 months.

Suffer The Little Children - S :: essays research papers

In this paper, Im going to take a formalist approach to look at language, tone and structure of Suffer the Little Children by Stephen King. This story is not just about a particular teacher or a particular student; it is more about a disturbed ladys state of mind, and my work will give emphasis to the characterization the author uses through the text. The first thing I would like to talk about is Kings use of language in this story. He begins by describing Miss Sidley as a small, constantly suffering, gimlet-eyed woman. He also mentioned that she knows she is getting old, and the word Miss before her name allowed us to know that she is not married. She is an unhappy woman. We can gather what kind of person she is from her reference to the children as monsters, bitches, evils, who have nasty little games. The diction of the story emphasizes wickedness. King uses metaphors, and almost every one of them suggests a likeness with something evil, taking for example the giggling, like the laughter of demons...or they were ringed in a tight little circle, like mourners around an open grave. Irony also exists in this story. Sidley seems to be the ideal teacher, who is efficient at her job and knows how to keep her students quite in class, when actually she is the one who has a disturbing behavior and ends up surprising her colleague in sch ool when she is found about to kill one more child. King also used an interesting style to introduce a new character to the story: Buddy Jenkins was his name, psychiatry was his game. As soon as we read it, we immeadiately know he will have a destiny such as Sidleys because that was exactly the way she was introduced (Miss Sidley was her name, teaching was her game). The writer also uses italic writing to emphasize the teachers toughts. However, the presence of one or two loose words in the middle of sentences will contribute to cause an eye effect, to catch the readers attention to those words, such as admit, change and she. King gave this story a dark tone about which theres nothing cheerful. No colors. Anyone who reads the story will be able to see an obscure atmosphere. I would like to mention that the author uses expressions such as unrestful night and solitary dinner througout the text, and the word darkness appears many times.

Authoritarianism of Taiwanese Government

According to Thomas Gold Taiwan offers a text book case of an elite-led revolution leading to social transformation. The stability of hard authoritarianism of the Taiwanese government laid the groundwork for Taiwanese development. The KMT's cohesiveness and political domination plus the economic development aid supplied by the United States also helped to provide good conditions for Taiwanese growth in the beginning. Once the KMT gained control of Taiwan they redistributed the land and launched a program of rehabilitation and industrialization. This period was responsible for the nationalization of many businesses formerly owned by the Japanese and the start of industrial production in Taiwan marked by a shift away from agriculture to industry. During the early period of industrialization Taiwan tried to create domestic markets for its goods. During the period from 1960 to 1973 Taiwan pursued export expansion in the area of industrial goods. During this period U. S. aid directed at Taiwan declined as did the islands geopolitical significance. To make up for this decline Taiwan focused on increasing its exports. The rowth of the Taiwanese economy during this period according to Gold laid the ground work for the growth of opposition movements and loosening of the KMT†S grip on power. According to Gold this was because the changes in the Taiwanese economy brought about a middle class, a better educated populace, and a dispersion of industry through out the country. The Period from 1973 to 1984 Gold calls the time of industrial upgrading and the emergence of a political opposition. During this period Taiwan faced the oil shock, and increase in export prices due to a labor shortage that doubled workers alaries, a further loss of geopolitical prestige, and the growth of dissent and political opposition. Taiwan industrially during this time improved the quality and quantity of its exports. The Taiwan industrial model was that of a elite run bureaucracy that tightly controlled its nations citizenry in authoritarian ways. This authoritarian government was able to effectively channel the energies of Taiwan toward modernization. This authoritarian government became a victim of its own success because as living and education standards rose the citizenry demanded a shift Taiwan is not a very good industrialization model for other countries to use outside of East Asia. This is because many of the factors that allowed Taiwanese industrialization were unique to Taiwan. First, Taiwan was colonized before 1950 by a developmentalist power, Japan to which is had close ties even after 1950. Second, Taiwan was the recipient of financial aid during its critical early years because of a inter-core competition for hegemony between China and the United States. Third, Taiwan benefited by having a implacable foe with a very different vision of development. Fourth, Taiwan was given breathing space following 1949, this enabled Taiwan to revive production and consolidate power without foreign powers interfering. All these factor make Taiwan unique from other nations that would try to copy it. One of the elements that nations should not copy from the Taiwan Model according to Gold is Taiwan's harsh authoritarian government which was much too strictly authoritarian and had a hard time changing as the attitudes of the Taiwanese people changed. (Gold's book was published years before the 1996 democratic elections n Taiwan) But Gold does say that Taiwan's development model does have some lessons that could be copied in other nations seeking to industrialize. These are a official commitment to development, land redistribution, fostering of agriculture, creation of extra-ministerial ministries to guide development, strategic credit allocation, collection and efficient management of data concerning the economy, investment in infrastructure and human capital, and proper allocation of foreign assistance. Taiwan's development model was a combination of an orwellian state and effective ways of industrializing.

Narrative poems Essays

Narrative poems Essays Narrative poems Paper Narrative poems Paper Essay Topic: Poetry A narrative poem always has a. characters, plot, setting b. humor c. strong images d. personification Its a. If there was a warning message set to Jimmy Jet and his TV what would it be. Not to watch or youll turn into a TV. What are the geese seen doing in the poem, the Geese The Geese are seen flying south for the winter. why does the speakers father in The Geese want to be like the Geese? A) because they are so pretty B)because they lay eggs C)because they taste good when they are cooked D)because they represent freedom and escape answer=D We know that the Geese is a lyric poem because it a)is about geese b)tells a story c)because it expresses feelings and emotions d)contains characters and dialogue answer=c In the walrus and the carpenter what does beseech mean O oysters, come walk with us! The walrus did beseech. a)command c)beg for b)scream d)question Answer=C when Jimmy jet grew pale and lean what did the author mean? A)Jimmy got thin B)Jimmy got fat c-Jimmy got tired and needed to lean against his sister d- Jimmy got sick ans. A what is a narrative poetry and what devices does it use? It uses poetic devices such as rhythm,compact language,rhyme and attention of sound. Its a form of poetry that tells a story making uses of the voices of a narrator and characters. who is the speaker in the walrus and the carpenter? the narrator what is the tone of this poem the walrus and the carpenter silly and ridiculous what are two main characters in the walrus and the carpenter doing when they are first seen? walking close at hand and both cried because there was so much sand according to the walrus and the carpenter why must the oysters end their walk? because the carpenter and the walrus are going to talk about many things what trick does the walrus and the carpenter play on the oysters they are going to give the oysters a loaf of bread, a pleasant walk, and talk along the beach. To get them away so they could eat the oysters What are the features of a lyric poem? short rhyming verses with focus on experiments or image or object while telling a story in a poetic form. In the lyric poem February Twilight What is the poet expressing feelings about? aloneness, and the person in the poem watching a star as it watched them. where is the speaker in Febr. Twilight beside a hill with new snow upon it. What does Jimmy turn into he turns into a complete tv in Jimmy jet and his tv set what is the speakers attitude towards Jimmy surprise because he watches so much tv. who is the speaker in the Geese the son of the father that watched the geese who is the author of the Walrus and the carpenter Lewis Carroll who is the author of the February Twilight Sara Teasdale Who is author of Jimmy jet and his tv set Shel silverstein Author of the geese is Richard Peck what is rhyme scheme of walrus ABCBDB rhyme scheme of February ABCB What is rhyme sheme of Jimmy Jet ABAB What is the rhyme scheme of the Geese ABAB how many stanzas in the geese 3 how many stanzas in walrus and the carpenter 18 how many stanzas are in February twilight 2 how many stazas are in jimmy jet and his tv set 5