Clinical Assessment And Circumferential Treatment Of...

Lymphedema is the swelling of soft tissues as a result of the accumulation of protein-rich fluid in the extracellular spaces. Secondary lymphedema is precipitated by an event causing blockage or interruption of the lymphatic vessels. It is a potential complication that may affect quality of life of patients treated for breast cancer. Life-long risk factors of post-breast cancer lymphedema are related to the extent of axillary node involvement, type of breast surgery, and radiation therapy, as these factors decrease lymphatic drainage and increase stasis of fluid in the areas of skin and subcutaneous tissues that drain to those regional lymph nodes. Breast cancer- related lymphedema (BCRL) can involve the arm and hand, as well as the†¦show more content†¦In addition to invasive breast cancer, 60,290 new cases of in situ breast cancer weare expected to occur among women in 2015. Moreover, an estimated 40,290730 breast cancer deaths weare expected in 2015 [2]. However, as a result of advances in early detection and treatment, compared to today breast cancer patients can expect survival that is similar to age-matched women without the disease, [3]. Tthe 5-year relative survival for women diagnosed with localized breast cancer has increased from 80% in the 1950s to 899% today [2]. Although breast cancer treatments, including surgery, radiotherapy, chemotherapy, and hormonal therapy, have improved patients outcomes, they cause patients to potentially suffer from substantial adverse effects [34]. One complication of these treatments is lymphedema, a chronic health problem, troublesome to both patients and health professionals [5]. Lymphedema describes a set of pathological conditions in which there is an accumulation of protein-rich fluid in soft tissues as a result of the interruption of lymphatic flow [46, 7]. It is most commonly found in the extremities; however, it also can be found in the head, neck, abdomen, lungs, and genital regions [58]. Although the incidence of breast cancer-related lymphedema is unclear due to differences in diagnoses, the different characteristics of the patients studied, and

Iron Crowned Chapter 16 Free Essays

string(71) " nervous note in his voice, mirrored by the others’ expressions\." Kiyo asked no questions when I called Enrique back and told him I’d be out of town and out of contact for a while – but that I trusted him to carry on. Really, Kiyo said little at all as we hurried back to my house. Within minutes, I had a small satchel packed, and then we were off to the Otherworldly crossing. We will write a custom essay sample on Iron Crowned Chapter 16 or any similar topic only for you Order Now No matter what ups and downs had occurred in our relationship, he knew me well. He knew I had to act on this immediately. The questions began once I reached my castle. â€Å"How the hell,† I began, â€Å"did this happen?† I was in one of the receiving rooms, Kiyo by my side as I stared down Shaya and some of the soldiers who manned the grounds. Rurik was with them, which gave me mixed feelings. I was glad he was back from Dorian’s. I trusted him more than any other military guy around here. That being said, there was a petty part of me that held him responsible. How could someone as capable as him have let this happen? He grimaced, as though guessing my thoughts. â€Å"A small group sneaked onto our grounds, overpowered her guards †¦ and took her.† He hesitated. â€Å"She only had two with her, Your Majesty. As you’ll recall, her escort was lightened. Still. There is no excuse.† I hadn’t witnessed this kind of diplomacy and respect from Rurik since †¦ well, actually, I’d never really witnessed it. With Dorian? Yes. Not with me. Jasmine’s abduction had really gotten to Rurik, no question. I was pretty sure he was taking it personally. But I’d also caught the slight meaning in his carefully worded comment about her lightened guard. That had been my call. I had done it in response to her good behavior and had let her outside more. I’d known it was a potential security risk – but not one that involved her leaving against her will. â€Å"We’re at war,† I said. â€Å"Regardless of her guard, this whole place should have been under lock-down.† He nodded, face growing grimmer. â€Å"As I said, there’s no excuse. I take full responsibility.† I waved a hand dismissively. â€Å"It’s too late now. I know you’re doing your job. Don’t lay yourself out for the slaughter. Volusian said there was a note?† Shaya handed me a piece of rolled parchment. Kiyo leaned over my shoulder as I read it silently to myself: To Eugenie, Usurper Queen of the Thorn Land, Daughter of Tirigan Stormi, King: As you no doubt know by now, I have your sister within my custody. If you wish her returned to you alive, you and the Oak King will surrender unconditionally to me. You will cease hostilities immediately, withdraw your armies, and cede your lands. Additionally, you will turn over the alleged Iron Crown to me. If you do not comply with these terms, your sister will be executed at noon, three days from the receipt of this letter. For now, she is alive, and I have given her into the keeping of my nephew Cassius. I await your response. Sincerely, Katrice, Queen of the Rowan Land, Beloved of the Gods I looked up at the many watching eyes. â€Å"‘Given her into the keeping of my nephew Cassius.’ Does that mean what I think it does?† Shaya grimaced. â€Å"That is the nephew she wanted you to marry.† â€Å"Why execute Jasmine then?† I demanded. â€Å"Why not marry her off to Cassius? Isn’t that a waste of one of Storm King’s daughters?† â€Å"Katrice hates you,† said Kiyo softly. â€Å"At this point, she probably doesn’t even care about the prophecy. She wants to get back at you, hurt you, and if that means killing Jasmine, then it’s probably an acceptable loss – especially if she tries to then give you to Cassius after this ‘surrender.'† â€Å"So I’d get to live?† Kiyo shrugged. â€Å"Longer suffering.† â€Å"Why choose her as a hostage though?† I didn’t know why I was arguing the logic here. None of it mattered. Only the outcome did. â€Å"Everyone knows we don’t get along.† â€Å"Everyone also probably knows that’s been changing a little,† said Kiyo. â€Å"You brought her to Dorian’s.† â€Å"And,† added Shaya, â€Å"a royal family member usually makes the best hostage in these situations.† These situations. For a moment, I nearly swayed on my feet, wanting to close my eyes and pass out. It had nothing to do with the heat. It was this. All of this. This situation always repeating itself. Me and Jasmine, cursed by our blood, always to be used and captured as possessions in a greater game. I’d hated Aeson, but at least he’d lured Jasmine into some pretense of love before taking advantage of her. But what about this Cassius? He’d make no attempts at kindness. This was all about punishment and revenge, after all. Had he already raped Jasmine? Was he doing it now? A sickening memory of Leith came to mind, one sharp and clear in spite of the drugged state I’d been in during my ordeal with him. Moments later, it was replaced by an image of this faceless Cassius lowering himself over a cowering Jasmine†¦. I pushed my weakness aside, steadying myself and bringing the world back into focus. I turned to Rurik. â€Å"How far are our armies spread out? How soon could we get them together and march on her? I want to raze that bitch’s lands and burn her castle to the ground! I want to have the fucking wrath of heaven rain down on her and – â€Å" I cut myself off, as startled at my words as the others were. Where had that rage come from? Well, the situation, obviously. I wouldn’t want anyone thrown to Katrice’s nephew before facing execution. But it occurred to me in that moment that my reaction was also †¦ personal. Somewhere, in the ups and downs of our dysfunctional family, I’d come to care about Jasmine. My anger came from the loss of her. â€Å"Easy, Eug,† said Kiyo, resting a hand on my arm. There was a nervous note in his voice, mirrored by the others’ expressions. You read "Iron Crowned Chapter 16" in category "Essay examples" I’d once been told that when I was angry, I resembled my father. I took a deep breath and pushed back any further outbursts. â€Å"Leading a massive army in – while deserved – wouldn’t be †¦Ã¢â‚¬  Rurik was still treading lightly, still choosing words carefully. â€Å"Well, Katrice was already in wartime mode, heavily guarded. After this? The lands outside her home probably have triple the guard they did before.† â€Å"But if our force was large enough †¦Ã¢â‚¬  I began. Rurik nodded. â€Å"True. It’s possible. Especially if †¦ especially if my lord Dorian’s armies were involved.† He looked uneasy at mentioning Dorian, but I could see a considering look on Rurik’s face. I had a feeling we shared the same puzzle. Would Dorian lend forces to help me? Possibly not, not if his anger overrode any devotion to me. On the other hand, Dorian was still in this war, and I knew him well enough to think he might welcome a full-out march on her castle. Rurik knew that too. â€Å"With his forces, it’s possible,† Rurik said at last. â€Å"But Katrice’s would be defending. It would be bloody. It would be ugly.† He didn’t sound opposed to that, per se. He was a military man; ugly battles were the way of the world. But we all knew that wasn’t ideal. My mind spun. Part of me wanted that large force to beat on Katrice because I thought she deserved it. This was about more than revenge, however. It was about Jasmine. I needed to go with the plan most likely to get her back, and an invading army wasn’t it. It would take a smaller group, just as she’d no doubt sent here, one that could slip in. We were heavily guarded, but with the assorted petitioners and refugees always coming and going, it was no wonder Jasmine’s kidnappers had slipped in. Katrice undoubtedly had a similar stream of people coming to her in these times, but she’d probably be on high alert with them too. â€Å"Imanuelle,† I said, realizing too many moments of silence had passed. â€Å"Can you get me Imanuelle?† It was this, finally, that took the group’s eyes off me – because they all exchanged astonished looks. Kiyo’s face grew troubled. â€Å"That’s your plan?† Kiyo asked. â€Å"Assassinate Katrice? Eugenie, you’re better than that.† He’d apparently heard of Imanuelle. â€Å"I am,† I agreed. â€Å"And smarter. Get her for me.† That was to Shaya, who nodded and then shot a look at a hovering servant. He gave a hasty bob of his head and darted out of the room. â€Å"Ready to repeat history?† I asked Kiyo. â€Å"It’ll be like raiding Aeson’s all over again.† â€Å"You’re going †¦ No. Eugenie, you can’t go there.† I gestured to Rurik and began moving for the exit. â€Å"You heard him. We can’t get in with a large force – not easily.† â€Å"Yes, I get that,† said Kiyo, following after me. â€Å"But you can’t go.† â€Å"I have to go,† I countered. Rurik had hurried along after us. â€Å"He’s right. Send someone else. I’ll go. We’ll sneak in and take her.† I came to an abrupt halt, nearly causing both men to run into me. â€Å"I’m going. This is my responsibility. Besides, who else around here can match me magically?† I peered back and forth between their faces, daring them to challenge me. â€Å"Even so,† said Rurik, â€Å"if you’re discovered, you’ll be outnumbered. And you’re an enemy queen. In wartime. Walking right into your enemy’s stronghold. I can’t allow this.† â€Å"It’s not your place to allow me to do anything!† I snapped. â€Å"Or you either.† I turned to Kiyo for that, guessing his words. â€Å"We won’t be discovered. Not if Imanuelle’s as good as she claims.† I was so tired of men telling me what I could and couldn’t do. I left them and stalked off down the hallway toward my bedroom. Neither followed me right away, but I just barely heard Rurik mutter to Kiyo, â€Å"Well, if she’s caught, she will get a massive army descending on Katrice, at least. My lord Dorian wouldn’t permit anything less.† The flaw in my plan, as it turned out, was waiting on Imanuelle. After our last meeting, she’d left my kingdom, and finding her wasn’t easy. You couldn’t just openly summon a famed assassin. Girard was at my court, however, and apparently had secret ways of sending messages to his sister. I didn’t ask any questions about his means, so long as she showed up. Waiting for her gave us time to plan strategy. Once my advisors grudgingly accepted that I’d be going personally – and once Rurik accepted that he would not be accompanying me – they fell in line to pool their knowledge about Katrice’s castle. I’d joked earlier to Kiyo about this being like our break-in to Aeson’s †¦ but really, it was true. This time, we had no guide personally to take us in. We had to rely on anecdotal knowledge from those who had been there and could make best guesses at where Jasmine might be held. And that was presuming Katrice was actually keeping her on-hand. Perhaps the most surprising part of all of this was Kiyo’s acquiescence. I’d expected protests about my safety or perhaps a diplomatic solution. But, no. He realized the importance of saving Jasmine. And he too knew this was probably our best shot – at least on such short notice. â€Å"You should know,† Rurik told us later, â€Å"that you aren’t going to be able to bring Volusian.† He, Kiyo, Shaya, and I were in my bedroom, which I’d made my makeshift war headquarters. â€Å"Why not?† I asked. That was a surprise. I’d been counting on his muscle, something I had to admit I’d missed while fighting for the crown. What was the point of an undead minion if I couldn’t put him to good use? â€Å"He can go in with us invisibly.† Rurik shook his head. â€Å"Everyone knows about him. Katrice does. She’ll have people on-hand who can sense him. She’ll also probably have those with the power to banish him. Enough of them united together could.† â€Å"You have a lot of faith in her,† I noted dryly. Volusian was hard to banish – I couldn’t do it – but Rurik had a point. Get enough magic-users together, and they could eventually pull it off. He gave me a twisted smile. â€Å"She’s not stupid. And she has advisors. Not as good as yours, of course, but they would have thought everything over before kidnapping Jasmine.† A knock on the door interrupted any response I might have made, and after I called entry, a servant showed Imanuelle in. â€Å"Finally,† I said. She swept in, clad in billowing red silk pants and a matching, midriff-showing top. The assassin arched an eyebrow and gave me an amused look as she put her hands on her hips. â€Å"I don’t wait around on your every command, Thorn Queen. And last time we spoke, you made it pretty clear, you didn’t want me around. Have you finally come to your senses? From what I hear, now’s a pretty good time to get rid of Katrice.† Imanuelle paused carefully. â€Å"Although, getting rid of her before now would have been even better. Would have saved you and your sister a lot of trouble.† I bit off any snide remarks. â€Å"We can’t have Katrice killed. I’m pretty sure the instant her people found her dead, Jasmine would be next. I need you to sneak in and get Jasmine out of there.† Imanuelle’s cocky smile dropped. â€Å"That’s not what I do. I kill. I don’t rescue.† â€Å"I’ll do the rescuing. You need to get me and Kiyo in. Disguise us with this so-called power you keep bragging about. Or is masking more than one person out of your skill-set?† â€Å"I can do it,† she said, narrowing her eyes. â€Å"But it’ll cost you.† â€Å"We can afford it,† I said, trying to ignore the pained look crossing Shaya’s face as she no doubt added up mental ledgers. Imanuelle said nothing for several moments as she pondered it all. â€Å"Just you two?† â€Å"Yes. And you, of course,† I added. â€Å"Do you have any idea where you’re going in there?† she asked. Kiyo and I exchanged looks. â€Å"Kind of,† I said. â€Å"Kind of.† Imanuelle snorted. â€Å"Fine. I’ll do it. But I’m only there to disguise you. I’m not fighting if you get caught.† â€Å"You don’t have to,† I assured her. â€Å"We’ll protect you.† This brought another scoff and a haughty curl of her lip. â€Å"If they detect us, I can get myself out of there, believe me. You’ll be on your own.† How to cite Iron Crowned Chapter 16, Essay examples

Applied Project Management for Enterprise Resource- myassignmenthelp

Question: Discuss about theApplied Project Management for Enterprise Resource System. Answer: An Enterprise Resource System(ERP) is nothing but a software package which allow an organization for efficient management of its available resources which is inclusive of material, people and lastly equipment. PMBOK is not defined by a rigid life cycle instead of that it is defined by a sequence of phases which consists of following phases like initiation, Planning, Execution, monitoring and closing phase. The implementation of ERP system has become new way to achieve supply chain management and to have competitive advantage from it. PMBOK stands for project management body of management of knowledge which is used by various project managers for analyzing different success factors which take place during the implementation of a project. The critical factor generally consists of planning and involvement and commitment of various higher management and stakeholder management (da Silva Gomes, 2013). As per PMBOK, project management generally focuses on the application of knowledge and pr oper tools to activities on project to meet the needs of various project. Scope management is important in a project because it helps in checking the scope of project in a proper and define way and it helps project managers and executive to provide the right quantity of work which is required for successful implementation of a project (Gomes, 2013). PMBOK state project scope as the right amount work which is needed to be completed for providing the right amount of work, services with proper function. There are three phases of project scope management that are planning, controlling and lastly closing. There are two steps involved in management of scope of project that are defining the requirements of project and understanding the needs of the project. The needs of a project are an important factor for setting up of timeline of the project and having goals of project. For proper defining of scope, it is essential for establishing the requirements of a project. The steps involved in defining the scope of project are project of objectives, goals, sub-phases, resource, budget and schedule. Scope can be controlled by checking the particular ERP product, explaining in details that how the features of product will help the business activity (da Silva Gomes, 2013). A scope is generally less valuable if the project team and various stakeholders related to the project do not get an idea that how ERP will support the business. There may be cases in which the features of ERP product is in scope with limited functionality. ERP market has grown a lot in recent years and a number of manufacturing firms like automotive, oil and pharmaceutical organization have already adopted ERP solution and making ERP ruling over the various organization. In the early days various ERP solution like finance and accounting and manufacturing are the most popular ERP modules (Gomes, 2013). On the contrary various domains like plant maintenance, HR and service module have also started using ERP. Various industrial sectors like cement, power and food have implemented ERP solution for satisfying their needs. SME are considered to be the largest user of ERP in the current market all around across the globe. SME segment mainly aims in providing low cost ERP solution like eresource ERP which mainly work in country specific location and providing large pool for skilled and technical talents (da Silva Gomes, 2013). Many times these benefits are quite difficult to prove on grounds of statistics as they impossible to calculate in practical. Soft benefits are inclusive of transparency, comfort in work life, change in attitude. Various organization must set their objectives before the implementation which is followed by calculating the achievements after ERP implementation. For fulfilling the needs of ERP system the following tools must be integrated in it. These tools are data management, data warehouse, information management, Application and interface with proper permission control, workflow management, reporting, communication, analytical, resource allocation and task scheduling tool. Data management/ data warehouse / information management tool: Data storage and management of information with proper workflow in various departments are considered as a backbone of any ERP system. Various solution and tools are available for proper storage of data which is inclusive of databases from various organization like Oracle and Sybase (da Silva Gomes, 2013). As per the needs of an industry an appropriate one is selected. A manufacturer can easily transactional database to be more useful as the transaction moves through different status on the contrary a content writing company can find CMS repository system with version control for satisfying their requirements. Application and interface with suitable permission control: Data storage and management mainly requires read only or process of editing to access the process of data. After the manufacturing of item, it is marked as inventory and after that stock management team marks it as ready for sale (Gomes, 2013). For achieving this easy use of application and interface are proved to be an important part of ERP system are used which have definite control and permissions. In a similar way a content ERP tool is used by editor to make any changes in the content for review and only the editor has the right to make any changes. Workflow management tool: An ERP system consist of multiple modules of data where data updates and actions tends to follow a logical sequence which can satisfy the needs of business. Workflow works in a similar way as the mind controls the various functions of body. A workflow with proper access at many levels is considered to be important for any ERP solution. Communication tool: Communication is considered to be a mandatory tool for any system working in various departments. ERP systems offer various tools which works on the principle of instant messaging, chat and generation of mail. Analytical tool: Analytical tool can be integrated with an ERP system for achieving business intelligence, prediction of analysis and analysis related to data mining. These tools are used for achieving better decision with available data. References da Silva Gomes, R.M., 2013. Contributions of the PMBok to the Project Management of an ERP System Implementation.Revista de Gesto e Projetos,4(2), p.153. Gomes, R.M.D.S., 2013. Contributions of the PMBOK to the Project Management of an ERP System Implementation.