ACPHS Water Crisis and Its Management in California Essay

Identify at least two causes of firefighter injures due to unsafe acts and then discuss the initiatives that need to be taken to reduce and/or eliminate those mishaps in the future.

Identify at least two causes of firefighter injures due to unsafe acts and then discuss the initiatives that need to be taken to reduce and/or eliminate those mishaps in the future.. I’m studying and need help with a Environmental Science question to help me learn.

Identify at least two causes of firefighter injures due to unsafe acts and then discuss the initiatives that need to be taken to reduce and/or eliminate those mishaps in the future.
Your paper must be a minimum of 2 full APA formatted pages not counting the title page, abstract page and reference page.
All writing assignments must be submitted in APA format and shall include the following: 1. Title Page 2. Abstract 3. Main Body (With proper in-text citations) to include an Introduction and Conclusion 4. Reference Page (Be sure to pay attention to the indentions for each source) Be sure to include a correct Running Head on each page.

I have included the resource
“Fire-Related Firefighter Injuries Reported to the National Fire Incident Reporting System (2012-2014
)”

Identify at least two causes of firefighter injures due to unsafe acts and then discuss the initiatives that need to be taken to reduce and/or eliminate those mishaps in the future.

Functions of the Immune System | Dengue Fever Immunity

assignment helper Functions of the Immune System | Dengue Fever Immunity. The function of the immune system is to keep contagious microorganisms, such as definite bacteria, viruses and fungi, out of the body, and to demolish any infectious microorganisms that do attack the body. The immune system is completed by a complex and imperative network of cells and organs that guard the body from infection (1). The organs of the immune system are called the lymphoid organs, which have an effect on growth, development, and the free of lymphocytes (a confident type of white blood cell) (2). The lymphatic vessels and blood vessels are main parts of the lymphoid organs, because they transmit the lymphocytes to different areas in the body and from different areas in the body. All lymphoid organs play a task in the making and also activation of lymphocytes. Layered Defense Organisms are protected by the immune system from infections with layered defenses of rising specificity. If these barriers were breached a pathogen, the innate immune system provides an immediate, but non-specific reaction. All plants and animals have Innate immune systems (3). If pathogens effectively evade the innate response, vertebrates have a third layer of protection, the adaptive immune system. The innate response activates the adaptive immune system. Surface Barriers The body of the human continuously faces attack from foreign invaders that can cause disease and infection. These invaders sort from living microbes , such as fungi, bacteria, parasites, and viruses, to dead toxins, drugs, and chemicals. As our luck, the body has many internal and external defenses that avoid most dangerous attackers from entering and causing damages. The physical layers that stay them at inlet commonly are referred to as the body’s 1st line of defense. The largest body organ is skin; is presents both a physical and also a chemical barrier against the outer environment. The skin makes a defensive cover that completely encloses around the body, shielding blood vessels, muscles, nerves, bones and organs. When tears or cuts in the outer surface of the skin, present an opening for infective organisms, glands under the skin, produce an enzyme that helps to destroy bacteria (4). Although areas of the body not covered with skin, do not unprotected. Mucous membranes, the wet layer of the respiratory system. They produce mucus, a sultry substance that catches irritants that enter through the nose. Innate immune system The cells that mediate immunity embody neutrophils, macrophages, and natural killer (NK) cells, giant lymphocytes that are not T cells but are cytotoxic. all these cells answer macromolecule and saccharide sequences distinctive to microorganism cell walls and to alternative substances characteristic of growth and transplant cells. They exert their effects by means of the complement and alternative systems, with the cells they attack oftentimes dying by osmotic lysis or cell death (5). Their cytokines also activate cells of the nonheritable immune system. a vital link in immunity in Drosophila melanogaster is a receptor supermolecule named toll, that binds plant life antigens and triggers activation of genes cryptography for antifungal proteins (6). Humeral and Chemical Barriers Some microbes penetrate the body’s protecting barriers and enter the interior tissues. There they encounter a variety of chemical substances which will stop their growth. These substances embody chemicals whose protecting effects are related to their primary perform within the body, chemicals whose principal perform is to harm or destroy invaders, and chemicals made by present bacterium (7). Inflammation Inflammation is one in every of the primary responses of the immune system to infection. The symptoms of inflammation are redness, swelling, heat, and pain, that are caused by augmented blood flow into tissue. Inflammation is made by eicosanoids and cytokines, that are released by livid or infected cells (6). Eicosanoids embody prostaglandins that manufacture fever and the dilation of blood vessels associated with inflammation, and leukotrienes that attract bound white blood cells (leukocytes). Common cytokines embody interleukins that are chargeable for communication between white blood cells; chemokines that promote chemo taxis; and interferon’s that have anti-viral effects, like motion down supermolecule synthesis within the host cell. Growth factors and cytotoxic factors may additionally be released (7). These cytokines and alternative chemicals recruit immune cells to the site of infection and promote healing of any broken tissue following the removal of pathogens. Complement System The complement system is a organic chemistry cascade that attacks the surfaces of foreign cells. It contains over twenty completely different proteins and is called for its ability to “complement” the killing of pathogens by antibodies. Complement is that the major humeral element of the innate response. several species have complement systems, as well as non-mammals like plants, fish, and some invertebrates (8),(9). Cellular Barriers Leukocytes (white blood cells) act like independent, acellular organisms and are the second arm of the innate immune system. The innate leukocytes embody the phagocytes (macrophages, neutrophils, and nerve fibre cells), mast cells, eosinophils, basophiles, and natural killer T cells. These cells identify and eliminate pathogens, either by attacking larger pathogens through contact or by engulfing so killing micro organisms (10). Adaptive immune system Lymphocytes are available in 2 major types: B cells and T cells. The peripheral blood contains 20-50% of current humorocytes; the rest move within the lymph system. Roughly eightieth of them are T cells, V-day B cells and remainder are null or undifferentiated cells. Lymphocytes constitute 20-40% of the body’s WBCs (6). Their total mass is concerning an equivalent as that of the brain or liver. (Heavy stuff ) B cells are made within the stem cells of the bone marrow; they manufacture protein and superintend humeral immunity. T cells are non antibody-producing lymphocytes that are also made within the bone marrow but hypersensitised within the thymus and constitute the idea of cell-mediated immunity. the assembly of these cells is diagrammed below. parts of the immune system are changeable and may adapt to raised attack the invasive matter (11). There are 2 fundamental adaptive mechanisms: cell-mediated immunity and humeral immunity. Lymphocytes A white blood cell is a style of white corpuscle present within the blood. White blood cells help defend the body against diseases and fight infections. when the overall defense systems of the body have been penetrated by dangerous invasive microorganisms, lymphocytes help give a particular response to attack the invasive organisms (12). Killer T cells A large differentiated t cell that functions in cell-mediated immunity by attacking and essential amino acid target cells that have specific surface antigens (6). also known as cytotoxic t cell, killer cell. Helper T cells Any of varied T cells that, when stirred up by a particular matter, unharness lymphokines that promote the activation and function of B cells and killer T cells (13). B Lymphocytes and Antibodies A b cell identifies pathogens when antibodies on its surface bind to a particular foreign matter. This antigen/antibody advanced is preoccupied by the b cell and processed by chemical process into peptides. The b cell then displays these substance peptides on its surface MHC category II molecules (14). this combination of MHC and matter attracts a matching helper t cell, that releases lymphokines and activates the b cell. because the activated b cell then begins to divide, its offspring (plasma cells) secrete scores of copies of the protein that recognizes this matter (12). different adaptive immune system The alternative adaptive immune systems in vertebrates have several similarities, but dissent therein Lucien-rich-repeat (LRR)-based variable white blood cell (VLR) receptors are employed by bone vertebrates versus the Ig-based TCR and BCR employed by jawed vertebrates. bone vertebrates have 2 VLR sorts, VLRA and VLRB, the various repertoires of that are expressed by separate lymphocytes populations (15). Immunological Memory the capability of the body’s immune system to recollect AN encounter with AN matter owing to the activation of B cells or T cells having specificity for the matter and to react more swiftly to the matter by means that of these activated cells during a later encounter (6). Passive memory Newborn infants have no prior exposure to microbes and are particularly prone to infection. many layers of passive protection are provided by the mother. throughout pregnancy, a selected style of protein, called IgG, is transported from mother to baby directly across the placenta, so human babies have high levels of antibodies even at birth, with an equivalent vary of matter specificities as their mother. Breast milk or colostrums also contains antibodies that are transferred to the gut of the baby and defend against microorganism infections until the newborn can synthesize its own antibodies (16). Active memory Long-term active memory is nonheritable following infection by activation of B and T cells. active immunity also can be generated by artificial means, through vaccination. The principle behind vaccination (also known as immunization) is to introduce AN matter from a microorganism in order to stimulate the immune system and develop specific immunity against that specific microorganism while not inflicting malady associated with that organism (17). Disorders of Human Immunity Some of the most devastating disorders which will affect the humanity are those that attack the very weaponry we’ve got against diseases, our immune system (7). These disorders can vary in severity from inflicting small rashes or a stuffy nose, to attacking important organs throughout the body, inflicting death. they can also come back from a variety of sources from the genetic passing down of traits, to infection from a malady. These immune system disorders comprise four categories: immunodeficiency, autoimmune, allergic and cancer. Immunodeficiency An immunodeficiency disorder is one in every of the many disorders that attack the immune system. In these disorders the immune system has problems that cause the system to not work correctly. again and again this can be owing to a genetic trait or congenital disorder (6). the most common immunodeficiency disorders are severe combined immunodeficiency (SCID), also known as “bubble boy” disorder, Di St. George syndrome, and ig A deficiency (18). Motor vehicle Immunity Autoimmune disorders attack the immune system by tricking the body into thinking its own organs are foreign invaders. when this happens, the phagocytes and lymphocytes activate healthy tissues and organs and destroy them. Common autoimmune diseases are lupus, scleroderma, juvenile dermatomyositis and juvenile rheumatism. The severity of AN disease can vary dramatically (19). Some could only cause localized swelling and inflammation by attacking the tissue within the joints, while others could cause death by attacking important organs. Hypersensitivity Hypersensitivity refers to excessive, undesirable (damaging, discomfort-producing and sometimes fatal) reactions made by the traditional immune system. Hypersensitivity reactions need a pre-sensitized (immune) state of the host. Hypersensitivity reactions is divided into four sorts: type I, type II, sort III and kind IV, based on the mechanisms involved and time taken for the reaction (20). Physiological Regulation Hormones can act as immunomodulators, sterilisation the sensitivity of the immune system. as an example, female sex hormones are famous immunostimulators of both adaptive and innate immune responses. Some autoimmune diseases like autoimmune disease strike women preferentially, and their onset typically coincides with pubescence. in contrast, male sex hormones like testosterone seem to be immunosuppressive. alternative hormones appear to control the immune system yet, most notably luteotropin, endocrine and alimentation (21),(22). Manipulation in medication The response is manipulated to suppress unwanted responses ensuing from autoimmunity, allergy, and transplant rejection, and to stimulate protecting responses against pathogens that mostly elude the immune system (see immunization). immunosuppressive drugs are used to control autoimmune disorders or inflammation when excessive tissue harm occurs, ANd to stop transplant rejection once an transplantation. anti-inflammatory drug drugs are typically used to control the effects of inflammation. Glucocorticoids are the most powerful of these drugs; but, these drugs can have several undesirable facet effects, like central obesity, symptom, osteoporosis, and their use should be tightly controlled (23). Lower doses of anti-inflammatory drug drugs are typically used in conjunction with cytotoxic or immunosuppressive drugs such asmethotrexate or Imuran. Cytotoxic drugs inhibit the response by killing dividing cells like activated T cells. However, the killing is indiscriminate and alternative perpetually dividing cells and their organs are affected, that causes harmful facet effects. immunosuppressive drugs like cyclosporine stop T cells from responding to signals correctly by inhibiting signal transduction pathways (24). What is dengue fever? Dengue fever is a malady caused by a family of viruses that are transmitted by mosquitoes. it’s AN acute malady of sudden onset that typically follows a benign course with symptoms like headache, fever, exhaustion, severe muscle and joint pain, swollen glands , and rash. Signs and Symptoms Many folks, especially kids and teenagers, could expertise no signs or symptoms throughout a mild case of dengue fever. when symptoms do occur, they usually begin four to ten days once the person is bitten by AN infected dipteron (25). Signs and symptoms of dengue fever most typically include: Fever, up to 106 F (41 C) Headaches Muscle, bone and joint pain Pain behind your eyes You might also experience: Widespread rash Nausea and puking Minor trauma from your gums or nose Most people recover within per week or so. In some cases, however, symptoms worsen and may become grievous. Blood vessels typically become broken and leaky, and the number of clot-forming cells in your bloodstream falls (25). this will cause: Bleeding from the nose and mouth Severe abdominal pain Persistent puking Bleeding under the skin, which can appear as if bruising? Problems along with your lungs, liver and heart Clinical Course The characteristic symptoms of breakbone fever are sudden-onset fever, headache (typically situated behind the eyes), muscle and joint pains, and a rash (25). The alternative name for breakbone fever, “break-bone fever”, comes from the associated muscle and joint pains. The course of infection is split into 3 phases: febrile , critical, and recovery. The febrile part involves high fever, typically over forty °C (104 °F), and is associated with generalized pain and a headache; this sometimes lasts 2 to seven days. At this stage, a rash occurs in 50-80% of those with symptoms. It occurs within the initial or second day of symptoms as flushed skin, or later within the course of malady (days 4-7), as a measles-like rash. Some petechiae (small red spots that do not disappear when the skin is pressed, that are caused by broken capillaries) can appear at this point, as could some gentle trauma from the secretion membranes of the mouth and nose. The fever itself is classically biphasic in nature, breaking so returning for one or 2 days, though there is wide variation in however typically this pattern truly happens (26). Causes Transmission Dengue virus is primarily transmitted by Aides mosquitoes, particularly A. aegypti. These mosquitoes sometimes live between the latitudes of 35° North ANd 35° South below an elevation of 1,000 metres (3,300 ft). They bite primarily throughout the day. alternative genus Aedes species that transmit the malady embody A. albopictus, A. polynesiensis and A. scutellaris. Humans are the primary host of the virus, but it also circulates in anthropoid primates. AN infection is nonheritable via a single bite (27). infectious agent Replication Once inside the skin, breakbone fever virus binds to Langerhans cells . The virus enters the cells through binding between infectious agent proteins and membrane proteins on the Langerhans cell, specifically the C-type lectins known as DC-SIGN, mannose receptor and CLEC5A. DC-SIGN, a non-specific receptor for foreign material on nerve fibre cells, seems to be the main purpose of entry. The nerve fibre cell moves to the nearest node (28). Meanwhile, the virus ordination is replicated in membrane-bound vesicles on the cell’s endoplasmic reticulum, wherever the cell’s supermolecule synthesis equipment produces new infectious agent proteins, and the infectious agent RNA is traced (26). Severe malady It is not entirely clear why secondary infection with a unique strain of breakbone fever virus places folks at risk of breakbone fever hemorrhagic fever and breakbone fever shock syndrome. the most wide accepted hypothesis is that of antibody-dependent enhancement (ADE). the exact mechanism behind ade is unclear. it may be caused by poor binding of non-neutralizing antibodies and delivery into the incorrect compartment of white blood cells that have eaten the virus for destruction. there is a suspicion that ade is not the only mechanism underlying severe dengue-related complications, and various lines of analysis have implied a role for T cells and soluble factors like cytokines and the complement system (25). Diagnosis Diagnosing dengue fever is tough, as a result of its signs and symptoms is easily confused with those of alternative diseases like malaria, swamp fever and enteric fever. Your doctor can seemingly raise concerning your medical and travel history. make sure to explain international visits thoroughly, as well as the countries you visited and the dates, yet as any contact you will have had with mosquitoes. bound laboratory tests can observe proof of the breakbone fever viruses, but test results sometimes come too late to assist direct treatment selections . (25),(27) Classification The World Health Organization’s 2009 classification divides dengue fever into 2 groups: uncomplicated and severe. The 1997 classification divided breakbone fever into undifferentiated fever, dengue fever, and breakbone fever hemorrhagic fever. breakbone fever hemorrhagic fever was divided additional into grades I-IV. Grade I is that the presence only of easy bruising or a positive bandage test in someone with fever, grade II is that the presence of spontaneous trauma into the skin et al, grade III is that the clinical proof of shock, and grade IV is shock so severe that pressure and pulse cannot be detected. Grades III and IV are noted as “dengue shock syndrome (27). Prevention All control efforts ought to be directed against the mosquitoes. it’s important to take control measures to eliminate the mosquitoes and their breeding places. Efforts ought to be intense before the transmission season and through epidemics (25),(27). (1) stop dipteron bites: (a) breakbone fever Mosquitoes Bite throughout the Daytime – defend Yourself from the Bite (b) Wear full-sleeve clothes and long dresses to cover the limbs. (c) Use repellents – care ought to be taken in victimisation repellents on young kids and elders. (d) Use dipteron coils and electrical vapor mats throughout the daytime to stop breakbone fever. (e) Use dipteron nets to safeguard babies, old folks et al who could rest throughout the day. The effectiveness of such nets is improved by treating them with permethrin. Curtains also can be treated with insecticide and decorated at windows or doorways, to repel or kill mosquitoes. (f) Break the cycle of mosquito-human-mosquito infection. Mosquitoes become infected once they bite people that are sick with breakbone fever. dipteron nets and dipteron coils can effectively stop more mosquitoes from biting sick folks and help stop the spread of breakbone fever. (2) stop the multiplication of mosquitoes: Mosquitoes that spread breakbone fever live and breed in stagnant water in and around houses. (a) Drain out the water from desert/window air coolers (when not in use), tanks, barrels, drums, buckets, etc. (b) remove all objects containing water (e.g. plant saucers, etc.) from the house. (c) All stored water containers ought to be unbroken lined in any respect times. (d) Collect and destroy discarded containers within which water collects, Treatment There aren’t any specific treatments for dengue fever. Treatment depends on the symptoms, variable from oral rehydration therapy reception with shut follow-up, to hospital admission with administration of intravenous fluids and/or insertion. a decision for hospital admission is often based on the presence of the “warning signs” listed within the table on top of, especially in those with preexisting health conditions (27),(29). Conclusion Three immune parts interact to provide a confluence of symptoms that outline DHF/DSS. breakbone fever virus initially infects immature nerve fibre cells through the mediation of DC-SIGN. Infected nerve fibre cells contribute to pathological process through production of metalloproteases and cytokines (30). Downstream of nerve fibre cells T-cells become activated and generate the very cytokines concerned in tube-shaped structure leak and shock in addition to activating soul cells. protein enhancement is mediated by Fc receptors that are conspicuously on mature nerve fibre cells. infectious agent replication mediated by antibodies is increased 100-fold. in addition their effects on breakbone fever replication, antibodies to infectious agent epitopes cross react with cell a supermolecule that has the result of stimulating CD8 soul cells and production of cytokines and anaphylatoxins. Anaphylatoxins is generated directly through infectious agent proteins or through formation of AN antibody-complement advanced. Anaphylatoxins in turn can alter the reactivity of T-cells. Functions of the Immune System | Dengue Fever Immunity

Family Law Answers to Problem Questions

Family Law Introduction The law of divorce is governed under the Matrimonial Causes Act 1973 where it provides the sole ground for divorce, namely that the marriage between Jason and Sandra has broken down irretrievably.[1] Nevertheless, in order to establish irretrievable breakdown, Jason will have to show that one of the five facts listed in section 1(2) of the MCA 1973 has been established on proof (Richards v Richards)[2]. Meanwhile, it is notably that the court in England and Wales is given a wide power in determining the arrangement of children between the Jason and Sandra. Since Jason and Sandra are married, they both have parental responsibility for Joyce and Tom[3]. Their parent responsibilities will not be terminated even if the court grants them a decree of divorce. By virtue of CA 1989, the focus is on the welfares of the children[4] and thus the welfare checklist set out in section 1(3) of CA 1989 will be taken into account by the court in deciding whether to grant share residence to Jason and Sandra and to limit Sandra’s contact with Joyce and Tom. Divorce between Jason and Sandra Since the marriage between Jason and Sandra has lasted seven years, Jason is not restricted by the absolute bar on the presenting of petition for divorce within one year of marriage imposed by section 3(1) of the MCA 1973. Jason is allowed to petition for divorce if he is able to establish one of the five facts set out in section 1(2) of the MCA 1973. Adultery and Intolerability: section 1(2)(a) The first possible fact that Jason would rely on is that if adultery and intolerability contained in section 1(2)(a) of MCA 1973. In order to successful in this claim, Jason would have to show that Sandra has committed adultery and he finds it intolerable with her. In Dennis v Dennis[5], adultery is defined as a voluntary act of sexual intercourse between Sandra and another person who is of the opposite sex. On the fact, Jason’s brother saw Sandra and Craig having dinner at a local restaurant and then leaving the restaurant together late at night, holding hands and getting into the car. According to Sapsford v Sapsford[6], It is unlikely that this incident is sufficient to constitute a ground of adultery as there is no evidence of sexual intercourse between Sandra and Craig. However, following the case of Farnham v Farnham[7], Jason would want to raise a rebuttable presumption that Sandra has committed sexual intercourse with Craig by using the circumstantial evidence of inclination and opportunity. However, it is unlikely this claim will be successful as the circumstances does not in any sense suggest that Sandra and Craig have indulged in sexual intercourse. Further, it must be noted that, adultery is a serious accusation to make and thus the courts have always insisted on strong evidence to allow such accusation.[8] Even if adultery can be established, Jason would have to show that he finds it intolerable to live with Sandra while the intolerability need not follow from Sandra’s adultery (Clearly v Clealy)[9]. According to Goodrich v Goodrich[10], the intolerability test is to be accessed subjectively and thus Jason could rely on the fact that he cannot cope with Sandra’s increasingly volatile behaviour and claims that it is intolerable to live with Sandra. Unreasonable Behaviour: section 1(2)(b) A more realistic option for Jason is section 1(2)(b) of MCA 1973, where it provides that Jason can rely on the ground of ‘unreasonable behaviour’ if he can establish that Sandra’s behaviour is such that it is unreasonable for him to continue living with her. According to Livingstone- Stallard[11], the focus is not on the gravity of the behaviour per se but on its impact on Jason. Following O’Neill v O’Neill[12], the test under s.1(2) is to be accessed both objectively and subjectively, the objective aspect concerns whether Jason is reasonably expected to stay with Sandra , while the subjective part takes into account the personalities of Jason and Sandra. Since we are told that Sandra’s behaviour becomes increasingly volatile, the chance that Jason will succeed in this claim would increase. It is likely that Sandra’s unreasonable behaviour can be established, it is then necessary to look at the character of Jason and Sandra and decide whether they can be expected to stay together reasonably (Ash v Ash)[13]. It can be pointed out that Sandra is having an adulterous relationship with Craig and this it might not be reasonable to expect Jason to live with her. At this point, it is arguable that the court will grant a decree of divorce on the ground of s.1(2)(b) based on Sandra’s behaviour that makes Jason cannot be reasonably expected to stay with her. Arrangements in relation with Joyce and Tom By virtue of section 2(1) of CA 1989, both Jason and Sandra owe parent responsibilities toward Joyce and Tom. Such responsibility is defined in section 3(1) as ‘all rights, duties, powers and responsibilities and authority which by law a parent of a child has in relation to the child and its property’. This right continue even after Jason and Sandra divorce. Nevertheless, under section 1(5) if CA 1989, Jason and Sandra are required to file a statement of arrangements for the children, detailing the measures that have been resolved between them and also the unresolved issues. On the facts, there are two issues to be considered in regards with Joyce and Tom: who should the children stay with and the extent of Sandra’s contact with the children. In regards with these unresolved issues, the court is able to make the child arrangements order under section 12 of the Children and Families Act 2014 which replaces the orders previously knowns as residence orders and contact orders contained in section 8 of Children Act 1989. The change of terminology supposed to move away from emphasis of ‘resident’ and ‘non-resident’ parent and shift the focus onto the children’s welfare[14]. In the other words, the court will take into account the welfare checklist set out in section 1(3) of the CA 1989. The Welfare checklist includes the ascertainable wishes feelings of Joyce and Tom; their physical, emotional and educational needs; the likely effect on Joyce and Tom in their circumstances; Joyce and Tom’s ages, sex, backgrounds and other relevant characteristics; any harm which they have suffered or are at risk of suffering; and how capable Jason and Sandra and Craig are meeting Joyce and Tom’s needs. We are told that Joyce is five years old and Tom is at an age of three. They are still young and might not be able to express their true wishes and feelings with regards to the issue of residence and contact and thus it is unlikely that the court will give weight to their wishes (Stewart v Stewart)[15]. In regards with their needs, even though there no presumption that a child’s emotional and physical needs are best met by the mother, the case law has showed a preference for keeping young children with their mother [Re S (a minor) (Custody)][16]. However, in Re H (A Minor)[17], it was held that the time has changed and that many fathers were as capable as mother of looking after small children and this may lead to a decision that in favour of Jason. Further, the facts that Sandra is under depression and her plan to move in with Craig, who is also has anger management issues will be taken into consideration under section 1(3)(e) by the court. Lastly, the capabilities of Jason and Sandra in meeting Joyce and Tom’s needs will be considered as well. Here, it is likely that Jason would have a good chance of obtaining a residence order as the facts that Sandra and Craig is starting a new relationship and there is no evidence that Craig seems to fit the stereotype of the replacement father. However, even if the court grants a residence order in favour of Jason, the parental responsibility of Sandra towards Joyce and Tom will not be terminated. According to Re R (A Minor)(Contact), Sandra will be granted a generous contact with Joyce and Tom because the court is on the view that ‘it is a right of a child to have a relationship with both parents wherever possible’.[18] The fact that both Sandra and Craig are under anger management course will deny Jason’s claim that Sandra has a mental condition that makes her inappropriate to be in contact with Joyce and Tom. (1500 words) Part 2 Introduction In 1956, the concept of no-fault divorce was first put forward by the Morton Commission in their report on the basis that the divorce law prior to that date has encouraged acrimony between the parties.[19] Such approach was taken by a series of Law Commission reports and led to the Introduction of Divorce Act 1969, which was later consolidated to the legal provision in use today, namely the Matrimonial Causes Act 1973. Section 1(1) of MCA 1973 provides that irretrievable breakdown of marriage is the only ground for divorce and this can only be established if one of the five facts listed in section 1(2) of the MCA 1973. There are two no fault facts that can be relied to establish divorce, namely the two years’ separation with the respondent’s consent to the divorce [section 1(2)(d)] and the five years’ separation [section 1(2)(e)]. However, the facts that the number of petition under these no-fault facts are much lesser than the fault facts of adultery [section 1(2)(a)] and unreasonable behaviour [section 1(2)(b)] raises a question that whether the law of divorce in England and Wales can really be described as one of ‘no-fault’? This essay will argue that identifying who is at ‘fault’ is still very much a feature of the divorce system in Wales and such element can be proved decisive in determining issues such as division of financial assets, child contact and residence. Such approach was also put forward by John Eekelaar that the law that the current law of divorce is ‘deeply corrupting by the law itself’ as the individuals are prevented from accessing to their legal rights conferred on them by law.[20] Application of ‘no-fault’ divorce In order to obtain a speedy divorce, it is more likely that the parties to a relationship would be more willing to rely on fault- based divorce. The courts have taken a strict approach in allowing a non-fault divorce and the degree of separation does not limit to the normal notion of physical contact but it also involves mental element. For instance, in Mouncer v Mouncer, regardless the facts that the parties were slept in separate bedrooms, it was held that they were living apart as they continued to spend time with their children together.[21] At this point, it can be concluded that the law has failed to provide an effective method of no-fault divorce and this forces the party to a relationship to initiate a divorce claim by alleging fault on the part of the other party. In the other words, the law has failed to fulfil its original objective that to enable the parties of a marriage to end their relationship with minimum bitterness and hostility. Fault remains as an important exists that dominate the law of divorce in England and Wales today. Despite its decisive role in establishing a ground for divorce, the courts have also emphasised ‘fault’ of the parties in determining the consequences of a relationship breakdown. Division of financial assets and Child contact and residence According to Thorpe J in Dart v Dart, the court are given wide discretion to make orders which suits the needs of individual cases, albeit guided by the various factors set out in the statutory framework. With regards to the financial distribution on marriage breakdown, section 25(1) of the MCA 1973 required the court to take into account to all circumstance of the case, whereby section 25(2)(g) provides that the conduct of the parties is one of the factors that should be considered. Even though, it is arguably that the introduction of no-fault divorce by MCA 1973 reduced the significance of fault in determining the distribution of property, but by reviewing the case law, the outcome of the reform is somehow disappointing. In K v K, the court held that the husband was not entitled to his wife’s assets due to the facts that he had sexually abused his wife’s grandchildren.[22] Also, in H v H (Financial Relief: Attempted Murder as conduct), the wife was given a greater priority in the financial distribution because the husband had attacker her with knives and was convicted of attempted murder.[23] It is apparent that the fact that a spouse has behaved very badly will inevitably affect his or her entitlement to a greater priority in the financial distribution, and this encourages further animosity between the parties. As a result, section 25(2)(g) was highly criticised as it undermines the aim of the law to remove incentive to make allegations of fault in order to divorce peacefully. On the other hand, it must be noted that, by virtue of section 2(1) of Children Act 1989, the parental responsibility of the parties remains even after divorce. In determining the issue in relation to child contact and residence, the welfare checklist set out in section 1(3) of CA 1989 plays a prominent role in the decision making. Within the checklist, there is no reference to the ‘fault’ element at the part of the parents, but the courts are tend to grant the relevant order in favour of the ‘innocent’ parent with the conception that it will be the children’s best interest not to stay or even in contact with the ‘fault’ parent, particularly in the cases of domestic violence. Conclusion In conclusion, it is undeniably that the approach to divorce in England and Wales cannot be described as one of ‘no-fault’ as the ‘fault’ element is still playing a prominent role in relation with the issues of divorce and its consequences. Nevertheless, we are not arguing a reform towards a purely no-fault divorce because, as according to Deech, this will give too much freedom to the individual and give them a wrongful thought that divorce something can be obtained easily.[24] Instead, we are saying that the system of divorce should be balanced between a mixed mechanism with both ‘fault’ and ‘no-fault’ ground for divorce[25] but not letting the ‘fault’ feature dominate the whole system alone. (1041 words) Bibliography Table of Cases Ash v Ash [1972] 1 All ER 582 Clearly v Clealy [1974] 1 All ER 498 Dennis v Dennis [1955] P 153 Farnham v Farnham [1925] 133 LT 320 Goodrich v Goodrich [1971] 2 All ER 1340 H (A Minor), Re (1980) 2 FLR 253 H v H (Financial Relief: Attempted Murder as conduct) [2006] 1 FLR 990 K v K [2010] EWCA Civ 125 Livingstone- Stallard v Livingstone- Stallard [1974] Fam 47 Mouncer v Mouncer [1972] 115 SJ 327 O’Neill v O’Neill [1975] 1 WLR 1118 R (A Minor)(Contact), Re [1993] 2 FLR 762 Richards v Richards [1972] WLR 1073 S (a minor) (Custody), Re [1991] 2 FLR 388 Sapsford v Sapsford [1954] P 394 Serio v Serio (1983) 4 FLR 756 Stewart v Stewart [1973] 1 Fam 107 Table of Legislation Children Act 1989, s.1 Children Act 1989, s.2 Children Act 1989, s.3 Children Act 1989, s.8 Children and Families Act 2014, s.12 Matrimonial Causes Act 1973, s. 1 Matrimonial Causes Act 1973, s. 3 Matrimonial Causes Act 1973, s. 25 Secondary Sources Books Gilmore S and Glennon L, Hayes and Williams’ Family Law (4th edn, OUP 2014) Articles Deech R, ‘Divorce- A Disaster?’ [2009] FLR 1048 Eekelaar J, ‘Family Law- Keeping us “On Message”’ [1999] CFLQ 387 Law Commission, Family Law: The Ground for Divorce (Law Com No 192) [1] Matrimonial Causes Act, s.1(1). [2] [1972] WLR 1073. [3] Children Act 1989, s.2(1). [4] Ibid, s.1. [5] [1955] P 153. [6] [1954] P 394. [7] [1925] 133 LT 320. [8] Serio v Serio (1983) 4 FLR 756. [9] [1974] 1 All ER 498. [10] [1971] 2 All ER 1340. [11] [1974] Fam 47. [12] [1975] 1 WLR 1118. [13] [1972] 1 All ER 582. [14] Children Act 1989, s.1(1). [15] [1973] 1 Fam 107. [16] [1991] 2 FLR 388. [17] (1980) 2 FLR 253. [18] [1993] 2 FLR 762, Butler- Sloss LJ. [19] Royal Commission on Marriage and Divorce (Cmd 9878, 1956). [20] John Eekelaar, ‘Family Law- Keeping us “On Message”’ [1999] CFLQ 387. [21] [1972] 115 SJ 327. [22] [2010] EWCA Civ 125. [23] [2006] 1 FLR 990. [24] Ruth Deech, ‘Divorce- A Disaster?’ [2009] FLR 1048. [25] Law Commission, Family Law: The Ground for Divorce (Law Com No 192).

Esophagram Barium Swallow Analysis

Esophagram Barium Swallow Analysis. Two common radiographic procedures of the upper GI system involving the administration of contrast media are the esophagram, or barium swallow, as it is sometimes referred to, and the upper GI series. Each of these procedures is described in detail, beginning with the esophagram. This examination is used for the patient who have high dysphagia or definite oesophageal symptoms, or have quite often had a normal OGD but are still symptomatic, quite often a motility disorder may be the cause. Esophagram or barium swallow, is the common radiographic procedure or examination of the pharynx and esophagus, utilizing radiopaque contrast medium may be used. The purpose of an esophagram is to study radiographically the form and function of the swallowing aspects of the pharynx and esophagus. No major contraindications exist for esophagrams except possible sensitivity to the contrast media used. the technologist should determine whether the patient has a history of sensitivity to barium sulfate or water soluble contrast media. Known aspiration during ingestion (although this can be overcome by using non-ionic water soluble contrast). The contrast agent for barium swallow is barium sulphate suspension 250% w/v or water soluble contrast medium. Barium sulphate are, high atomic number, not soluble in water, used to coat the lining of organs, supplied in different thicknesses. Used in esophogram, UGI, Small Bowel, Lower GI or BE. History of barium sulphate is starting with, lead substrate-toxic, bismuth subnitrate-toxic, thorium-radioactive, barium sulphte-inert(goes in and comes out the same – not absorbed). Barium sulphate mixture are contraindicated if any chance exists that the mixture might escape into the peritoneal cavity. This escape may occur through a perforated viscus or during surgery that follos the radiographic procedure. in either of these two cases, water soluble, iodinated contrast media should be used. Two example of this type gastrografin and Gastroview. Both of these water soluble contrast agent can be easily removed by aspiration before or during surgery. if any of this water-soluble material escape into the peritoneal cavity, the body can readily absorb it. Barium sulfate, on the other hand, is not absorbed. One drawnback to the water soluble materials is their bitter taste. Although these iodinated contrast media sometimes are mixed with carbonated soft drinks to mask the taste, they often are used “as is” or diluted with water. The patient should be forewarned that the taste may be slightly bitter. The technologist should be aware that water soluble contrast agents travel through the GI tract faster than barium sulfate. The shorter transit time of water soluble contrast agents should be kept in mind if delayed images of the stomach of duodenum are ordered. If there is any query that the patient may aspirate, the initial swallow is best carried out using a water-soluble contrast medium, although aspiration of barium has been considered by some to be relatively harmless. Aspiration may not be suspected but unsuspected ‘ silent aspiration’ may be found. The more common pathologic indications for an esophagram procedure suchas, achalasia also term cardiospasm, is a motor disorder of the oesophagus in which peristalsis is reduced along the distal two thirds of the esophagus. Achalasia is evident at the esophagogastric sphincter because of its inability to relax during swallowing. The thoracic esophagus may also lose its normal peristaltic activity become dilated (megaesophagus). Video and rapid digital fluoroscopies are most helpful in diagnosis of achalasia. Anatomic anomalies may be congenital or caused by disease, such as cancer of the esophagus. Patients suffering from a stroke often develop impaired swallowing mechanisms. certain foods and contrast agents are administered during the examination to evaluate swallowing patterns. A speech pathologist may witness the study to better understand the speech swallowing patterns of the patients. Video and digital fluoroscopy are used during these studies. Barrett’s esophagus, or barrette syndrome, is the replacement of the normal squamos epithelium with columnar-lined epithelium ulcer tissue in the lower oesophagus. This replacement may produce a structure of the distal oesophagus. In advanced cases, the development of a peptic ulcer in the distal esophagus may occurs. The esophagram may demonstrate subtle tissue change in the esophagus, but nuclear medicine is the modality of choice for this condition. the patient is injected with technetium 99m pertechnetate to demonstrate the shift in tissue types in the esophagus. Carcinoma of the oesophagus includes one of the most common malignancies of the oesophagus, adenocarcinoma. advanced symptoms include dysphagia (difficulty in swallowing) and localized pain during meals and bleeding. Other tumors of the oesophagus include carcinosarcoma, which often produces a large, irregular polyp, and pseudocarcinoma. Dysphagia is difficulty in swallowing. This difficulty may be due to a congenital or acquired condition, a trapped bolus of food, paralysis of the pharyngeal or esophageal muscle, or inflammation. Narrowing or an enlarged, flaccid appearance of the esophagus may be seen during the esophagram, depending on the cause of the dysphagia. Video and digital fluoroscopy are the modalities of choice. Esophagram and endoscopy are performed to detect these tumors. The esophagram may demonstrate atropic changes in the mucosa due to the invasion of the tumor as well as stricture. Because the esophagus is empty most of the time, patients need no preparation for an esophagram only, all clothing and anything metallic between the mouth and the waist should be removed, and the patient should wear a hospital gown. Before the fluoroscopic procedure a pertinent history should be taken and the examination carefully explained to the patient. The first part of an esophagrams involves fluoroscopy with a positive-contrast medium. The examination room should be clean, tidy and appropriately stocked before the patient is escorted to the room. The appropriate amount and type of contrast medium should be ready. esophagrams generally use both thin and thick barium. Additional items useful in the detection of a radiolucent foreign body are cotton balls soaked in thin barium, barium pills or gelatine capsules filled with BaSO4, marshmallows. After swallowing any one of these three substance, the patient is asked to swallow an additional thin barium mixture, because the esophagram begins with the table in the vertical position, the footboard should be in place and tested for security. lead aprons, compression paddle, and lead gloves should be provided for the radiologist, as well as aprons for all other personnel in the room. proper radiation methods must be observed at all times during fluoroscopy. With the room prepared and the patient ready, the patient and radiologist are introduced and the patientis history and the reason for the exam discussed. The fluoroscopic examination usually begins with the general survey of the patient’s chest, including heart, lungs and diaphragm, and the abdomen. During fluoroscopy, the technologist’s duties, in general, are to follow the radiologist’s instructions, assist the patient as needed, and expedite the procedure in any manner possible, because the examination is begun in the upright or erect position, a cup of thin barium is placed in the patient’s left hand close to the left shoulder. The patient then is instructed to follow the radiologist’s instructions concerning how much to drink and when. The radiologist observes the flow of barium with the fluoroscope. Swallowing (deglutition) of thin barium is observed with the patient in various positions. Similar positions may be used while the patient swallows thick barium. The used of thick barium allows better visualization of mucosal patterns and lesion within the esophagus. The type of barium mixture to be used, however is determined by the radiologist. After the upright studies, horizontal and trendelenburg positions with thick and thin barium may follow. The pharynx and cervical esophagus are usually studied fluoroscopically with the spot films, whereas the main portion of the esophagus down to the stomach is studied both with fluoroscopy and with post fluoroscopy “overhaed radiograph”. the diagnosis of possible esophageal reflux or regurgitation or gastric contents may occur during fluoroscopy or an esophagram. One or more of the following procedures may be performed to detect esophageal reflux. First, breathing exercise the various breathing exercises are all designed to increase both the intrathoracic and the intraabdominal pressures. The most common breathing exercise in the valsalva maneuver. The patient is asked to take a deep breath and, while holding the breath in, to bear down as though trying to move the bowels. This maneuver forces air against the closed glottis. A modified valsalva maneuver is accomplished as the patient pinches off the nose, closes the mouth, and tries to blow the nose. The checks should expand outward as though the patient were blowing up a balloon. A Mueller manoeuvre can also be performed as the patient exhaled and then tries to inhale against a closed glottis. With both methods, the increase of intraabdominal pressure may produced the reflux of ingested barium that would confirm the presence of esophageal reflux. The radiologist carefully observes the esophagogastric junction during these manoeuvres. Second is water test that done with the patient in the supine position and turned up slightly on the left side. This slightly LPO position fills the fundus with barium. The patients are asked to swallow a mouthful of water through a straw. Under fluoroscopy the radiologists closely observe the esophgogastric junction. A positive water test occurs when significant amounts of barium regurgitate into the esophagus from the stomach. A compression paddle can be placed under the patient in the prone position and inflated as needed to provide pressure to the stomach region. The radiologist can demonstrate the obscure esophagogastric junction during this process to detect possible esophageal reflux. The toe-touch manoeuvre is also performed to study possible regurgitation into the esophagus from the stomach. Under fluoroscopy the cardiac orifice is observed as the patient bends over and touches the toes. Esophageal reflux and hiatal hernias are sometimes demonstrated with the toe-touch manoeuvre. If the patient is a female, then a menstrual history must be obtained. Irradiation of an early pregnancy is one of the most hazardous situations in diagnostic radiography. X-ray examinations such as the upper GI series that include the pelvis and uterus in the primary beam and include fluoroscopy should only be done on a pregnant female when absolutely necessary. In general, abdominal radiographs of a known pregnancy should be delayed at least until the third trimester or, if patient’s condition allows (as determined by the physician), until after the pregnancy. This waiting period is especially important if fluoroscopy, which greatly increase patient exposure is involved. Potential difficulties that may arise out of a Barium Swallow is discomfort of air insufflation. Poor tolerance of swallowed gas mixture can make for poor stomach and oesophageal distension. Where buscopam injection is used to relax bowel for better pictures, patients may experience some blurring of vision. Tendency of barium to cause constipation in the days following the procedure. Need for an interpreter in non-English speaking patients. Disadvantages of Barium Swallow Useful for functional assessment – allows the assessment of motility, reflux and distension. In comparison to gastroscopy, barium swallow is safer. Available resource. It is difficult to compare costs between barium studies and endoscopy and they may be of comparable costs. However is some centres barium studies are much more accessible to GPs and may be arranged with much less delay for the patient than gastroscopy. Not as comprehensive or accurate method for diagnosis of some conditions in comparison to gastroscopy. Not able to take samples or provide treatment as part of the procedure. Radiation exposure. Dose is 2 – 3 millisieverts compared with chest film 0.06 millisieverts and background radiation of 2millisieverts per year. Users of ionising radiation are required to inform all women of child bearing age about the risks of radiation in pregnancy. Pregnancy is a relative contraindication to the use of radiation but generally in the context of the barium enema the urgency is such that can delay or choose alternative investigation. Esophagram Barium Swallow Analysis