Estimation of Mound Height in Endoscopic Treatment of VUR

Estimation of Mound Height in Endoscopic Treatment of VUR A Numerical Study to Precise the Estimation of the Good Mound Height in Endoscopic Treatment of VUR Author(s):  Mehdi Shirazi1, Zahra Jahanabadi2, Zeinab Hooshyar5, Zahra Mortazavinia4, Alireza Mehdizadeh3, Mojtaba Taherisadr6 Abstract Purpose: it seems that there is no definite and standard index to ascertain the technique and volume of injection in order to increase the success rate of endoscopic VUR treatment. In this study, we introduced a novel method to numerically define the relationship between some indexes in order to determine optimum mound height promise to standardize the injection technique in this kind of treatment. Material and method: The main purpose of this study is to construct a finite element simulation of intramural ureter and injected mound which aims to numerically define the relationship between indexes which have influence in VUR endoscopic treatment. Using linearization software and numerically simulation data the relationship between effective indexes has been derived. Result: By linearization of the effective parameters of different finite element models, the relationship between effective parameters in filling phase is derived as: H=0.7456D+ 0.02174L +0.01846. This equation depicts adequate injected mound height as a function of internal diameter and intramural length, H=f(L,D). Conclusion: Using numerical simulation, we introduced the novel formula to predict the height of injected mound in endoscopic VUR treatment. As a result of this study, in order to increasing the success rate of this treatment, the ratio of mound height to intramural ureter diameter should be approximately 74% (~3/4). Keywords: Mound height, Endoscopic treatment, Vesico ureteral reflux, Finite element model Introduction Vesico ureteral reflux (VUR) is a major disorder of childhood declared by retrograde urine flow from the bladder toward the kidney, predisposing patients to UTI and renal scarring and in long term leading to renal insufficiency and hypertension[1]. Current treatment options include close observation with urinary chemoprophylaxis, minimally invasive endoscopic subureteral injection of bulking agents and open or laparoscopic reimplantation[2]. The prophylactic antibiotic approach is proper for uncomplicated reflux (grade I-III without significant renal scarring or breakthrough infection)[3]. This type of treatment doesn’t cure VUR and has some problems such as patient noncompliance and increased antibiotic resistance[4]. Surgical reimplantation of the ureter is an invasive method[5] and already used for patients with high grade reflux, children with breakthrough UTI and children with reflux and developed renal scarring[6]. Endoscopic subureteral injection of bulking agents was introduced by Matouscheck as an evolution in treatment of reflux with a high success rate and minimal invasion[6], [7]. The substance used as a bulking material should be biocompatible, nonantigenic, nonmigratory and non-toxic with minimal local inflammation[8]. Multiple techniques on injection have been described. These methods include subureteral needle placement[8], intraureteral needle placement[9], [10] or some combinations of these. During recent years, several studies have been done to determine success or failure of endoscopic treatment, and various injection techniques have been introduced. Puri et al., described â€Å"volcano† appearance as the main sign of success of injection[11]. The proper shape was demonst rated by adequate coaptation of the ureteral orifice and by its location in the bladder below the ureteral orifice and/or along the waldeyer’s sheat[12], [13]. Despite all the studies carried out to determine the success or failure of endoscopic treatment, such as description of volcano appearance, injection technique in combination with hydrodistention, increasing injected volume, use of intraoperative cystogram with a simulated voiding phase, there is no definite and standard index to ascertain the technique and volume of injection in order to increase the success rate. In this study, we introduced a novel method to numerically define the relationship between some indexes in order to determine optimum mound height promise to standardize the injection technique. Materials Method In this study, a computational simulation was proposed to simulate the intramural ureter and injected mound which aims to numerically define the relationship between indexes which have influence in retrograde urine flow from intramural ureter. Geometry of the numerical model Fig. 1 illustrates diagrammatic representation of the functional anatomy of the ureterovesical junction and urinary anti reflux mechanism as the accumulation of urine within the bladder will lead to the tight closure of the portion of the ureter in between, thus preventing the backward return of urine to the kidneys, urinary anti reflux mechanism. In Fig. 1, P, D, H and L are intravesical pressure, intramural ureter diameter, injected mound height, and intramural ureter length, respectively. Section â€Å"A† in Figure 1 depicts the cross section of the intramural ureter with injected mound. The geometrical data of intramural ureter and ureterovesical junction were utilized as per Table 1. Materials Properties and Boundary Conditions Material properties for the intramural ureter wall were assumed to be linear elastic, isotropic, incompressible, and homogeneous with Young’s modulus of 10 Kpa [18]. The injected mound was modeled as a rigid volume as shown in Fig. 3. The boundary conditions for the wall were (1) the bottom surface of intramural wall was fixed at the connection to the internal bladder wall. (2) The upper wall was assumed to be free such that the deformation would occur due to the intravesical pressure and contribute to the tight closure of the portion of the ureter in between. Solution Method The ANSYS 11 software was employed to simulate the intramural ureter with injected mound in voiding phase. The intravesical pressure was applied on the upper portion of the intramural wall. The upper bound of intravesical pressure was considered to be 160 CmH2 O to encompass both male and female intravesical voiding pressures[15], see Table 1. The 8-Node structural solid mesh has been utilized in finite element model to have adequate adoption with this geometry and material behavior. 3 Results Fig. 2 illustrates the total deformation of the intramural ureter with injected mound in voiding phase. As shown, the intramural ureter has been closed due to the intravesical pressure. Fig. 3 shows the deformed and undeformed intramural wall in resting and voiding phase. As shown, in voiding position the injected mound height is high enough for the intramural ureter to be closed due to the intravesical pressure and prevents retrograde urine flow. In the first attempt, keeping the intramural ureter length constant, by changing intravesical pressure and internal diameter, the adequate injected mound height leading to tight closure of intramural ureter was obtained. By linearization of the effective parameters of about 30 different finite element models, the primary relationship between injected mound height, intravesical pressure and internal diameter of intramural ureter was defined as bellow, H=f(D,P) H=-0.0000003219P+0.7864D+0.000233(4) According to this relationship, it has been inferred that intravesical pressure coefficient is minute in comparison with coefficient of other effective parameters and it shows that changing the intravesical pressure plays an insignificant role in adequate injected mound height. In order to investigate the more effective indexes on injected mound height, the intramural length has been considered as one of variable parameters in finite element modeling. Varying internal diameter, intramural length and linearization of obtained data, the relationship between parameters was derived as: H=0.7456D+ 0.02174L +0.01846(5) This equation depicts optimum mound height as a function of internal diameter and intramural length, H=f(L,D). 4Discussion Endoscopic treatment of VUR was introduced more than 25 years ago and since then many different substances and injection techniques have been used with different results[13]. Choosing endoscopic treatment is reasonable, as it has many advantages, such as technical simplicity, greater acceptance of patients and parents and significant decrease in post- operation complications[7]. By improving the injection techniques the rate of endoscopic treatment has significantly increased as compared with open ureteral reimplantation[2]. During the recent years, many studies have been done to increase the ability to identify factors predicting success with the endoscopic subureteral injection[19]. At 2003, Puri et al.[11] described â€Å"volcano† appearance as the main sign of success of injection. The proper shape was demonstrated by adequate coaptation of the ureteral orifice and by its location in the bladder below the ureteral orifice and/or along the waldeyer’s sheat[12]. In different studies conducted by Lavelle et al.[12] and Yucel et al. [20], it was found that a subjectively proper mound appearance was highly predictive of injection success, but it should be noted that the morphology and location of the mound are not perfectly predictive of injection success or failure, as the mound seems perfectly adequate in some injections but the injection is not successful; also, the imperfect mound morphology does not necessarily imply injection failure[12]. Moreover, Ellworth PI et al. showed no correlation between the presence of a mound on post-injection ultrasound and the success of injection[19]. Some research agrees that an intraureteral injection technique in combination with hydrodistention results in higher success rates but this is controversial[9],[10],[20],[21]. The effect of injected volume on increasing the success rate is also controversial. Mathew D et al. showed that increasing the injection material volume will improve the success of subure teric injection[22] but other centers have shown that higher injection material volume doesn’t necessarily increase the treatment success rate[21]. So the effect of the injected volume in association with improved success rate remain unclear[12]. To determine the treatment success or failure, Tarry WF et al. described the utility of an intraoperative cystogram with a simulated voiding phase, but they demonstrated that an introperative cystogram can only detect de novo contralateral reflux but is not a proper method to predict the final success of injection[6]. Despite all the mentioned studies, still there is no definite and standard index to ascertain the technique and volume of injection, and also there is no quantitative index for determining the proper mound size and shape. So, we have conducted a study aiming to define an optimum injection mound by finite element modeling. In this study, we introduced a novel method to numerically define the relationship between some indexes in order to determine optimum mound height promise to standardize the injection technique in VUR treatment. It should be noted that due to every patient individual properties of intramural, it is not logical to consider similar injected mound height for all VUR treatment cases. Thus, it is needed to state the adequate injected mound height based on individual indexes of each case. The Intravesical pressure, intramural ureter diameter and length are some of these effective indexes. By specifying the relationship between all of these effective factors, the adequate and optimum injected mound height can be determined which can contribute to more success in treatment of VUR. In addition, it can help to save the needed injected mound height and make this injection method more economical. The results of this study show that the intravesical pressure has an insignificant effect on the required injected mound height. However, intramural length plays an important role on it in comparison with Intravesical Pressure. Moreover, the ratio of mound height to intramural ureter diameter is approximately 0.74 (~3/4), which is drawn that in order to have successful VUR treatment, it is needed that about 74% of intramural ureter diameter be filled with the injected mound. It should be mentioned that in Department of Urology of Shiraz University for the first time, an innovative method, introduced by Taheri et al.[23], is used to measure the injected mound height to assure the adequate injected mound height. In this method by adjusting camera, laparoscopy lens and imaging screen, it would be possible to measure the injected mound height as a ratio of projected picture on the screen. This study has served some limitation. The realistic cross section of intramural ureter has star shape. However, because of some limitation in finite element modeling, the circular one considered. Furthermore, we considered computational simulation only in voiding phase, although VUR may occur in resting phase. Conclusion In this study using numerical simulation, we introduced the novel formula to predict the height of injected mound in endoscopic VUR treatment. As a result of this study, in order to increase the success rate of this tevhnique, the ratio of mound height to intramural ureter diameter should be approximately 74% (~3/4). Moreover, clinical study has been conducted to ascertain the accuracy of this obtained height. Fig. 1Diagrammatic representation of the functional anatomy of the ureterovesical junction Fig. 2Intramural ureter displacement in voiding phase Fig. 3Deformed and undeformed intramural urine wall References Lenaghan, D., et al., The natural history of reflux and longterm effects of reflux on the kidney. J Urol, 1976. 115(6): p. 728-30. Cerwinka, W.H., et al., Radiologic features of implants after endoscopic treatment of vesicoureteral reflux in children. AJR Am J Roentgenol, 2010. 195(1): p. 234-40. Harper, L., et al., Postoperative cystography and endoscopic treatment of lowgrade vesicoureteral reflux. J Laparoendosc Adv Surg Tech A, 2008. 18(3): p. 461-463. Hsieh, M.H., et al., Treatment of Pediatric Vesicoureteral Reflux Using Endoscopic Injection of Hyaluronic Acid/Dextranomer Gel: Intermediate-term Experience by a Single Surgeon.j urology, 2010. 76(1): p. 199-203. Elder, J.S., et al., Pediatric Vesicoureteral Reflux Guidelines Panel Summary Report on the Management of Primary Vesicoureteral Reflux in Children. j urology, 1997. 157(5): p. 1846-1851. Perlmutter, A.E., et al., Utility of an intraoperative cystogram with a simulated voiding phase after endoscopic treatment of vesicoureteral reflux. W V Med J, 2008. 104(4): p. 22-4. Rivilla, F., Endoscopic treatment of vesicoureteral reflux in a paediatric surgery ambulatory unit. Vol. 7. 2011. 132-5. Bae, Y.D., et al., Endoscopic Subureteral Injection for the Treatment of Vesicoureteral Reflux in Children: Polydimethylsiloxane (Macroplastique ®) versus Dextranomer/Hyaluronic Acid Copolymer (Deflux ®). Korean J Urol, 2010. 51(2): p. 128-131. Gupta, A. and W. Snodgrass, Intra-Orifice Versus Hydrodistention Implantation Technique in Dextranomer/Hyaluronic Acid Injection for Vesicoureteral Reflux. J urology, 2008. 180(4): p. 1589-1593. Kirsch, A.J., et al., The modified sting procedure to correct vesicoureteral reflux: improved results with submucosal implantation within the intramural ureter. J urology, 2004. 171(6 Pt 1): p. 2413-2416. Puri, P., et al., Treatment of Vesicoureteral Reflux by Endoscopic Injection of Dextranomer/Hyaluronic Acid Copolymer: Preliminary Results. J urology, 2003. 170(4): p. 1541-1544. Routh, J.C. and Y. Reinberg, Predicting Success in the Endoscopic Management of Pediatric Vesicoureteral Reflux. Uro, 2010. 76(1): p. 195-198. Lavelle, M.T., M.J. Conlin, and S.J. Skoog, Subureteral injection of Deflux for correction of reflux: Analysis of factors predicting success. Uro, 2005. 65(3): p. 564-567. Yeung CK, G.M., Duffy PG, Ransley PG., Nat<

Biological Determinism :: essays research papers

Biological Determinism 1. According to the author of the article "All in the Genes?", there is no intrinsic causality between genetics and intelligence. The author analyses different aspects of biological determinism, and supplies many examples, which illustrate aspects of this problem that are being discussed since the time when these ideas became popular. He does not agree with biological determinist that the intellectual performance of a person depends on genes inherited from his parents. There are a lot of different theories about intellectual capabilities. All these theories reflect different points of views, depending on the period of time the authors of these theories lived. The author argues for the theory that in the nineteenth century , artificial barriers in social hierarchy prevented people from achieving higher intellectual performance. In the end of XX century, in most places these barriers were removed by the democratic processes, and nothing artificial can stand between the natural sorting process and social status of the people. These changes can not be considered as historical because the age of democracy is just two hundred years , and the time when inequality between classes and between people was a natural situation is almost as long as the history of the world . The author insists that there is no connection between environmental differences and genetics. In support of his idea the author state that any Canadian student can perform better in mathematics than some ancient professors of mathematics. The author comes to the conclusion that changes in a cultural environment are the main factor that determines level of intellectual performance, not inherited combination of parent's genes . He argues that genetic differences that appear in one environment may easily disappear in another. A theory that twins were raised in different social conditions will have the same level of intellectual performance because identical genetics constitution was used by the ideologist of biological determinism. The author rejects this theory because from his point of view, all these cases cannot be considered as always reliable on a close look, in most cases, twins were raised by the members of the same family or in other words, not in a diametrical opposite level of society. The author believes that there is no convincing measure of the role of genes in influencing human behavioural variation. During the argumentation of questions of biological determinism, the author supports his idea with numerous examples. He gives examples of supporters of bio determinism and outlines that these examples are not reliable. One of the fallacies of biological determinism is the result of IQ testing. According to some scientist only 20% of performance depend on environment and other 80%

Fetal Rights Essay

The government sees the rights of the human fetus as a complex topic, along with civil and human rights. In most states fetuses are not given entitlements because it can be seen as a violation of the privileges of the woman carrying the fetus. As of today the U. S. Supreme Court does not recognize the fetus as a person under the Fourteenth Amendment of the U. S. Constitution (Constitution). In the Declaration of Independence it is stated that the government is in place to give the U. S. people, â€Å"life, liberty, and the pursuit of happiness,† as part of societies’ inalienable rights. In the entitlements of a fetus – a combination of a sperm and an egg – which many believe becomes a human being at the moment of conception. If this is the case then the fetus is entitled to these same privileges. Society should be able to go against the government in the case of fetal rights because they deserve to be treated as any other U. S. citizen. The citizens of the U. S. should fight for the rights of the fetuses because that is where every human being’s life began. The treatment of these unborn infants throughout pregnancy affects the overall health, both physical and mental, throughout their lifetime. Society and government officials need to put themselves in the situation of the disabled or mentally ill children that are born into this world with a preventable defect had they been taken care of properly within the womb. When a woman is pregnant they harbor another life that is completely innocent and should be treated as so. The fetus deserves to be given the same inalienable rights that those already born into this world receive, despite the wishes of the carrier. The acknowledgement of the human fetus and determining whether or not it has certain rights varies from state to state. In 1987 in the state of California, these rights were put to a test in the case of People vs. Stewart (Maternal). In this case Ms. Stewart had been charged with child abuse because she had been stated to have â€Å"willfully omitting to furnish medical services. † Her actions caused the child to be born with cranial damage and then died in the following two months (Maternal). In 1986 the judge charged her offense for harming this child in its’ fetus state, but on February 26, 1987 the charge was revoked. A new judge was assigned from the state of California and came upon the conclusion that Ms.  Stewart could not be penalized because she was in the state of pregnancy (Maternal). It was seen that Ms. Stewart was in the right when abusing her own body therefore affecting the fetus because she was committing an action to herself and a fetus without rights. The debate of the fetus and the rights it has conflict with those of woman rights. In some states, women’s rights in the terms of pregnancy include the ability to have an abortion under certain circumstances such as: rape, drug-abuse, or incest (Isaacs). This element arose in the case of Roe vs. Wade when identifying the personal rights and the role of prevention from the government (Brant ed. ). Society should be able to recognize the difference between a woman who is unable to carry a baby, for whatever reason, and the abuse of the child within the womb and the affects after birth. If fetuses were given the same inalienable rights as other U. S. citizens that have already been born into then the abuse of these infants would be put to an end. The gynecologist who sees after these women as they go through pregnancy would be able to protect the fetus from harm if the mother revealed the use of substance abuse during pregnancy. Currently, if a mother confesses to the doctor she is misusing a substance during pregnancy the doctor is not able to prevent this from continuing, as it would violate the woman’s rights. Infants born with an addiction to drugs or alcohol would be put to a halt completely because the mother would be unable to take part in these actions, as she would be in turn harming the fetus. The doctors would have the right to place these women in the hospital for the duration of the pregnancy to prevent further drug use. Today much of society is unaware that the fetus is given certain rights, but they seem to be overruled by the maternal rights of the mother (Isaac). If society was well informed of the treatment of these children maybe there would begin to be a movement to give these infants the rights they deserve. The opinions of the concerned and well informed citizens needs to be heard by government officials and even by the mothers who continue to choose to harm themselves and their child throughout pregnancy. The words and concern of fellow citizens could stop the ill treatment of the fetuses and given them the rights they are entitled to from the moment of conception. If citizens came together and drew a line on the rights for both parties and if health care was reformed to provide more affordable birth control so pregnancy could be prevented. If the future mothers were able to receive help for their substance abuse early on then they could be sent to rehabilitation centers before becoming pregnant. These ideas could help become the solution for the mothers and the fetuses.

The Things They Carried Book Report

The Things They Carried Book Report Free Online Research Papers I read a book called â€Å"The Things They Carried† by a man named Tim O’Brien. In this book O’Brien wanted to show his readers about his past war times and what him and his platoon had to endure day after day. He wanted the readers to understand that war is much different than just being out killing people. His main goal was to express the hardship he endured and the guilt he receives even after doing something right. In the book O’Brien would explain how everyday he would have to carry his weapon, Pictures of family, water, food, medical supplies, knives and many other things. Not only would he and his platoon have to carry all of their equipment, but also they would have to walk miles on end while they carry it. His platoon changed their schedule to avoid detection. They would move only at night and during the day rest. When someone goes to war its not all about ‘go over there and kill everyone so we can win’. Our troops kill only if their life is in danger. After each kill the soldier has to endure guilt. Not all soldiers are like that. Some change as O’Brien explains in this book. After a soldier kills a few he becomes immune to the guilt and treats the dead just as if they were alive. O’Brien explains that all the men in his platoon would go to the dead and shake their hand and talk to them. He was new to this whole war thing at the time and was disgusted in seeing them treat the men/women with such disrespect. A soldier’s job is to obey his commands, to protect himself and his country; if the only way he can accomplish that is to kill he will. Killing to survive and save others lives in our world’s eyes is right but to a soldier its way different. It’s different because the kill is on his back and not ours. He will never be able to forget his first kill. His whole life he will have to live with this false guilt. This is why we need to support our troops. Research Papers on "The Things They Carried" Book ReportCapital PunishmentHarry Potter and the Deathly Hallows EssayThe Hockey GameArguments for Physician-Assisted Suicide (PAS)Book Review on The Autobiography of Malcolm XTrailblazing by Eric AndersonEffects of Television Violence on Children19 Century Society: A Deeply Divided EraGenetic EngineeringQuebec and Canada

Marquis de Lafayette, French and American Revolutionary

Marquis de Lafayette, French and American Revolutionary Gilbert du Motier, Marquis de Lafayette (September 6, 1757–May 20, 1834) was a French aristocrat who gained fame as an officer in the Continental Army during the American Revolution. Arriving in North America in 1777, he quickly formed a bond with General George Washington and initially served as an aide to the American leader. Proving a skilled and dependable commander, Lafayette earned greater responsibility as the conflict progressed and played a key part in obtaining aid from France for the American cause. Fast Facts: Marquis de Lafayette Known For: French aristocrat who fought as an officer for the Continental Army in the American Revolution, and later, the French RevolutionBorn: September 6, 1757 in Chavaniac, FranceParents: Michel du Motier and Marie de La Rivià ¨reDied: May 20, 1834 in Paris, FranceEducation: Collà ¨ge du Plessis and the Versailles AcademySpouse: Marie Adrienne Franà §oise de Noailles (m. 1774)Children: Henriette du Motier, Anastasie Louise Pauline du Motier, Georges Washington Louis Gilbert du Motier, Marie Antoinette Virginie du Motier Returning home after the war, Lafayette served in a central role during the early years of the French Revolution and helped write the Declaration of the Rights of Man and the Citizen. Falling from favor, he was jailed for five years before being released in 1797. With the Bourbon Restoration in 1814, Lafayette began a long career as a member of the Chamber of Deputies. Early Life Born September 6, 1757, at Chavaniac, France, Gilbert du Motier, Marquis de Lafayette was the son of Michel du Motier and Marie de La Rivià ¨re. A long-established military family, an ancestor had served with Joan of Arc at the Siege of Orleans during the Hundred Years War. A colonel in the French Army, Michel fought in the Seven Years War and was killed by a cannonball at the Battle of Minden in August 1759. Raised by his mother and grandparents, the young marquis was sent to Paris for education at the Collà ¨ge du Plessis and the Versailles Academy. While in Paris, Lafayettes mother died. Gaining military training, he was commissioned as a second lieutenant in the Musketeers of the Guard on April 9, 1771. Three years later, he married Marie Adrienne Franà §oise de Noailles on April 11, 1774. In the Army Through Adriennes dowry he received a promotion to captain in the Noailles Dragoons Regiment. After their marriage, the young couple lived near Versailles while Lafayette completed his schooling at the Acadà ©mie de Versailles. While training at Metz in 1775, Lafayette met the Comte de Broglie, commander of the Army of the East. Taking a liking to the young man, de Broglie invited him to join the Freemasons. Through his affiliation in this group, Lafayette learned of the tensions between Britain and its American colonies. By participating in the Freemasons and other thinking groups in Paris, Lafayette became an advocate for the rights of man and the abolition of slavery. As the conflict in the colonies evolved into open warfare, he came to believe that the ideals of the American cause closely reflected his own. Coming  to America In December 1776, with the American Revolution raging, Lafayette lobbied to go to America. Meeting with American agent Silas Deane, he accepted an offer to enter American service as a major general. Learning of this, his father-in-law, Jean de Noailles, had Lafayette assigned to Britain as he did not approve of Lafayettes American interests. During a brief posting in London, he was received by King George III and met several future antagonists, including Major General Sir Henry Clinton. Returning to France, he obtained aid from de Broglie and Johann de Kalb to advance his American ambitions. Learning of this,  de Noailles sought aid from King Louis XVI who issued a decree banning French officers from serving in America. Though forbidden by King Louis XVI to go, Lafayette purchased a ship, Victoire, and evaded efforts to detain him. Reaching Bordeaux, he boarded Victoire and put to sea on April 20, 1777. Landing near Georgetown, South Carolina, on June 13, Lafayette briefly stayed with Major Benjamin Huger before proceeding to Philadelphia. Arriving, Congress initially rebuffed him as they were tired of Deane sending French glory seekers. After offering to serve without pay, and aided by his Masonic connections, Lafayette received his commission but it was dated July 31, 1777, rather than the date of his agreement with Deane and he was not assigned a unit. For these reasons, he nearly returned home; however, Benjamin Franklin dispatched a letter to General George Washington asking the American commander to accept the young Frenchman as an aide-de-camp. The two first met on August 5, 1777, at a dinner in Philadelphia and immediately formed a lasting rapport.   First meeting of the Marquis de Lafayette and George Washington, 1777. Library of Congress Into the Fight Accepted onto Washingtons staff, Lafayette first saw action at the Battle of Brandywine on September 11, 1777. Outflanked by the British, Washington allowed Lafayette to join Major General John Sullivans men. While attempting to rally Brigadier General Thomas Conways Third Pennsylvania Brigade, Lafayette was wounded in the leg but did not seek treatment until an orderly retreat was organized. For his actions, Washington cited him for bravery and military ardour and recommended him for divisional command. Briefly leaving the army, Lafayette traveled to Bethlehem, Pennsylvania to recuperate from his wound. Recovering, he assumed command of Major General Adam Stephens division after that general was relieved following the Battle of Germantown. With this force, Lafayette saw action in New Jersey while serving under Major General Nathanael Greene.  This included winning a victory at the Battle of Gloucester on November 25 which saw his troops defeat British forces under Major General Lord Charles Cornwallis. Rejoining the army at Valley Forge, Lafayette was asked by Major General Horatio Gates and the Board of War to proceed to Albany to organize an invasion of Canada. Before leaving, Lafayette alerted Washington about his suspicions regarding Conways efforts to have him removed from command of the army. Arriving at Albany, he found that there were too few men present for an invasion and after negotiating an alliance with the Oneidas he returned to Valley Forge. Rejoining Washingtons army, Lafayette was critical of the boards decision to attempt an invasion of Canada during the winter. In May 1778, Washington dispatched Lafayette with 2,200 men to ascertain British intentions outside Philadelphia. Further Campaigns Aware of Lafayettes presence, the British marched out of the city with 5,000 men in an effort to capture him. In the resulting Battle of Barren Hill, Lafayette was skillfully able to extract his command and rejoin Washington. The following month, he saw action at the Battle of Monmouth as Washington attempted to attack Clinton as he withdrew to New York. In July, Greene and Lafayette were dispatched to Rhode Island to aid Sullivan with his efforts to expel the British from the colony. The operation centered on cooperation with a French fleet led Admiral Comte de dEstaing. This was not forthcoming as dEstaing departed for Boston to repair his ships after they were damaged in a storm. This action angered the Americans as they felt that they had been abandoned by their ally. Racing to Boston, Lafayette worked to smooth things over after a riot resulting from dEstaings actions erupted. Concerned about the alliance, Lafayette asked for leave to return to France to ensure its continuance. Granted, he arrived in February 1779 and was briefly detained for his earlier disobedience to the king. Virginia Yorktown Working with Franklin, Lafayette lobbied for additional troops and supplies. Granted 6,000 men under General Jean-Baptiste de Rochambeau, he returned to America in May 1781. Sent to Virginia by Washington, he conducted operations against the traitor Benedict Arnold and shadowed Cornwallis army as it moved north. Nearly trapped at the Battle of Green Spring in July, Lafayette monitored British activities until the arrival of Washingtons army in September. Taking part in the Siege of Yorktown, Lafayette was present at the British surrender. Return to France Sailing home to France in December 1781, Lafayette was received at Versailles and promoted to field marshal. After aiding in planning an aborted expedition to the West Indies, he worked with Thomas Jefferson to develop trade agreements. Returning to America in 1782, he toured the country and received several honors. Remaining active in American affairs, he routinely met with the new countrys representatives in France. French Revolution On December 29, 1786, King Louis XVI appointed Lafayette to the Assembly of Notables which was convened to address the nations worsening finances. Arguing for spending cuts, he was one who called for the convening of the Estates General. Elected to represent the nobility from Riom, he was present when the Estates General opened on May 5, 1789. Following the Oath of the Tennis Court and the creation of the National Assembly, Lafayette joined the new body and on July 11, 1789, he presented a draft of the Declaration of the Rights of Man and the Citizen. Lieutenant General Marquis de Lafayette, 1791. Public Domain Appointed to lead the new National Guard on July 15, Lafayette worked to maintain order. Protecting the king during the March on Versailles in October, he diffused the situation- although the crowd demanded that Louis move to the Tuileries Palace in Paris. He was again called to the Tuileries on February 28, 1791, when several hundred armed aristocrats surrounded the palace in an effort to defend the king. Dubbed the Day of Daggers, Lafayettes men disarmed the group and arrested many of them. Later Life After a failed escape attempt by the king that summer, Lafayettes political capital began to erode. Accused of being a royalist, he sunk further after the Champ de Mars Massacre when National Guardsmen fired into a crowd. Returning home in 1792, he was soon appointed to lead one of the French armies during the War of the First Coalition. Working for peace, he sought to shut down the radical clubs in Paris. Branded a traitor, he attempted to flee to the Dutch Republic but was captured by the Austrians. Marquis de Lafayette, 1825. National Portrait Gallery Held in prison, he was finally released by Napoleon Bonaparte in 1797. Largely retiring from public life, he accepted a seat in the Chamber of Deputies in 1815. In 1824, he made one final tour of America and was hailed as a hero. Six years later, he declined the dictatorship of France during the July Revolution and Louis-Phillipe was crowned king. The first person granted honorary United States citizenship, Lafayette died on May 20, 1834, at the age of 76. Sources Unger, Harlow Giles. Lafayette. New York: Wiley, 2003.Levasseur, A. Lafayette in America in 1824 and 1825; or, Journal of a Voyage to the United States. Trans. Godman, John D. Philadelphia: Carey and Lea, 1829.Kramer, Lloyd S. Lafayette and the Historians: Changing Symbol, Changing Needs, 1834–1984. Historical Reflections / Rà ©flexions Historiques 11.3 (1984): 373–401. Print.Lafayette in Two Worlds: Public Cultures and Personal Identities in an Age of Revolutions. Raleigh: University of North Carolina Press, 1996.

Euthanasia in Terminal Illness Essay Example | Topics and Well Written Essays - 750 words

Euthanasia in Terminal Illness - Essay Example Included in the topics to be covered are the different approaches that present the reasons for undertaking or employing euthanasia. Historical Roots of Euthanasia The history of euthanasia can be traced back to the reign of the Greeks and Romans when the term originated. Though it is meant to imply a good death, euthanasia is often deemed with negativity since it can be translated as physician-assisted suicide and compared to other ethical and moral social issues such as abortion, capital punishment, and issues related to beginning or ending of human life (McDougall, Gorman and Roberts, 2008, p.2). During the first to firth century, Greeks and Romans are allowed to access poison and choose death. The rise of the influence of Christianity during the Roman Empire had a great impact on the view on euthanasia. Death regardless of what reason was prohibited. During the middle ages, 5th to 15th century, the Catholic Church stressed the religious condemnation of euthanasia and that sufferin g is a sign of spiritual virtues of martyrdom. Then the Renaissance (14th to 17th century) came and changed the view on euthanasia through the discovery of modern scientific knowledge that are still influential in the present era. Thus, there is diversification of view on euthanasia since the church is still against the issue (McDougall, Gorman and Roberts, 2008, p.3-4). The view on euthanasia continuously changed as the Age of Reason came in during the 18th century. Scientific prowess opened the mind of the people regarding the need of every person to have a choice regarding death. In 1798, six colonies ceased the legal penalties for attempted suicide. The open mindedness of the authorities though made a frightening turn during the pre-WW II and Nazi Germany (1920-45) when the secretly approved government program that killed handicapped, mentally ill and people un asylums became the onset of Hitler’s Euthanasia Programme that even included people of least capability to defen d themselves regardless of being healthy such as women and children (p.5). With the foundations of views and beliefs from the previous eras, the perspective toward euthanasia in the present era became divided. This is the main reason why it became a personal issue to decide on whether or not euthanasia should be applied. Law and medical ethics mandate the guidelines for euthanasia while the person himself and the relatives hold the decision to apply it. Philosophical Roots of Euthanasia Euthanasia is one of the main concerns in the field of medicine based on the fact that it is a controversial issue in ethics. The ethical question lies in the death of a person. If the person himself/herself consented for the act, there is a question the person’s right to take his/her own life. If the act is the decision of the relatives or the medical professionals since it may be the only solution left for the patient, there is a question on their right to decide the time when a person shoul d die (Andersen and Taylor, 2007, p.552).

Ethical Dilemmas Assignment Example | Topics and Well Written Essays - 250 words

Ethical Dilemmas - Assignment Example Due to her experience and her reputation on evaluation, Fiona is the best person to deal with the case as she will combine her prowess with the interests of her department and come up with a sound decision. Ethical behavior is not so much a matter of following principles as of balancing competing principles (Stake & Mabry, 1998). I would ensure that ethical values are observed and that they are balanced with the commissioner’s goals. I would critically assess the Human services program, how funds are used, whether there are areas where funds were wasted and if some projects are not benefitting the program. I would then moderate the usage of funds in the projects, ensure that all the resources are used effectively, and get rid of projects that are not important to the program. As a result, I would have cut back on the meaningless projects, retained useful projects, and ensured that there was effective use of resources. Fiona’s benefits after the evaluation process include job security during the commissioner’s period in office. There may also be other advantages such as salary increments and more jobs from the commissioner’s office. She will also able to make decisions based on her principles and the needs of the branch even if she is expected to cut back on the budget eventually. The implications include judgment from her team who may think that she is being influenced when making decisions. They may not trust her decisions in future. She will also start questioning her principles and wondering if she made the right decision. The agency shall benefit because its most urgent needs shall be met during the budget cuts. However, program cuts may lead to the loss of jobs because it may get rid of some projects that would have been important to the program in the long