The American Government Built Correctional Institutions

The American Government built correctional institutions for the sole purpose of teaching malefactors how to live without breaking the law. However, prisons fail to fulfill their one duty. Too many people once released from prison return to prison within a short period of time. A staggering percentage of inmates used drugs prior to arrest, but because they receive subpar rehabilitation within prison walls, they still suffer a drug addiction when they get released. Severe mental disorders plague many of today’s prisoners, and the Government should assign them to a proper mental institution instead of a correctional facility. Even though prisons intend to cease violence, violence still occurs within prison walls. Correctional institutions should incorporate the upper three levels of Maslow’s Hierarchy of Needs into their system to help inmates realize their true potential. The current system of correctional facilities fails to succeed because they place a group of dangerou s deviants into a building deprived of hope instead of using peaceful methods to change the mindset of inmates for the better. Drugs play a tremendous role in the world of crime. In 2004, the United States Department of Justice stated 64% of Federal prisoners and 70% of State prisoners regularly used drugs. 25% of current inmates felt intoxicated on drugs when they committed whatever crime got them in jail. Narcotics not only cause addiction problems, but they also motivate crime. Contrabands lead to crimeShow MoreRelatedThe Overcrowding Of The Correctional Facilities1730 Words   |  7 Pagesfrom cruel and unusual punishment (Boylan, 2015, p. 558). At the time California’s correctional institutions were at double their capacity, housing over 155, 500 prisoners in only 33 institutions (Specter, 2010, p. 194). The overcrowding of correctional facilities is one of the biggest problems facing corrections policy makers in the United States. The overcrowding of prisons is not jus t an American problem. Correctional facilities in Ontario and the Prairie Provinces are experiencing overcrowding atRead MorePrivatization of American Prisons1661 Words   |  7 Pagesjustice system is facing, and government should not delegate coercive authority to private entities. History of Prison Privatization: In the United States of America, prison privatization began to increase in popularity around the late 19th century. There are many reasons that the idea became increasingly entertained. These reasons include the egregious overcrowding of government run facilities, citizens forceful promotion of policies to further increase the American prison population, and increasingRead MoreThe Law Enforcement And The Judicial System870 Words   |  4 Pagesenforcement and the judicial system to punish people who have violated the law. Often times people commit crimes that carry jail or prison sentences. This requires governments at the federal, state, and local level to establish facilities to house these individuals. In 2013 the total number of adults in some phase of the correctional system was around seven million, whether it be jail, prison, or probation and parole (BJS, 2015). Being incarcerated is the punishment; being locked away, separatedRead MoreCorrectional Facilities And The Cor rectional Facility1645 Words   |  7 PagesIntroduction The correctional facilities in the United States of America are composed of operators that own or manage correctional facilities and halfway houses. Correctional facilities serve to confine and rehabilitate prisoners and may be classified as minimum, medium or maximum security facilities. The prisoners contained in the facilities may participate in educational and vocational programs as well as in paid programs or work release programs through the industry. Correctional facilities areRead MoreCorrections in teh Criminal Justice System1076 Words   |  4 PagesWhen most people hear the term, â€Å"corrections† they probably think of prisons, striped uniforms, cellblocks, armed guards, and surly prisoners. Part of American corrections is prisons, but corrections is much more than that. Corrections includes prisons, jails, halfway houses, group homes, probation, parole, intensive supervision, electric monitoring, restitution programs, victim-offender mediation, and even the d eath penalty. Corrections can be defined as all that society does to and with offendersRead MoreEarly Correctional History : The Rise Of The Modern Penitentiary System1409 Words   |  6 PagesEarly correctional history is normally put in a large category from 2000 B.C. to 1800 A.D. (Allen, 2010). This period obviously covers a lot of ground both in time and technological advances along with cultural standards. This period ranges from ancient Babylonia and Samaria, Rome, Medieval Europe, Renaissance Europe, to the rise of the modern penitentiary system in America. Throughout this time, there were many different practices and philosophies, but one or two underlying factors might be notedRead MoreSolving The Problem Of An Aging Prison Population1250 Words   |  5 Pages Solving the Problem of an Aging Prison Population Joshua N. Handy American Military University Abstract The American correctional system is facing many emerging issues. One of these issues is the exponential increase in aging offenders. In the past few decades, the number of geriatric offenders incarcerated has multiplied at an increasing rate. This essay addresses the issue of aging offenders in the correctional system; the problems that these offenders create and the underlying issuesRead MoreCorrections Trend873 Words   |  4 Pagesalternate correction systems as a developing trend. In today’s society the jails and prison pretty much function with the same protocol. In the past the history of the State prisons began at the Walnut Street Jail in 1790, it was the actually first American penitentiary located in Philadelphia. Punishments such as the pillory and hanging were carried out in public. In the past, the Old Stone Jail in Philadelphia held old and young, black and white, men and women all together. In Chester County, theRead MoreFederal Prisons And Its Effects On The United States3590 Words   |  15 Pagesbudget did not allow for prison expansion so, as a result, they needed more investment from companies. Plus, the extreme overcrowding in federal prisons assured the government they needed to find a way to solve the issue on hand. In order to reduce spending in prisons, the government turned to private organizations to begin running correctional facilities with more efficiency which allows for less overcrowding in federal prisons and less tax dolla rs needed to run a prison, but soon causes its downfallRead MoreThe Prison Industrial Complex ( Tabibi )965 Words   |  4 Pages social historian Mike Davis was the first to coin the term prison industrial complex, in his research of the California penal system in the 1990s. The prison industrial complex refers to the coinciding relationship between corporations, government, correctional communities, and their collective economic interest in prison expansion and high rates of incarceration (Davis, 2003a). That is, each of these components benefit economically from perpetuating the notion that increasing crime rates are the

The Impact Of Art Through The Eyes Of Holocaust - 2041 Words

Alex Harvey 23 March 2015 The Impact of Art through the Eyes of Holocaust Inmates/Non-Inmates While there are many surviving documents from the Holocaust, arguably the most important sources are witness testimonies, which are accessible to us through the medium of art. In chapter one â€Å"I am a Camera† in Depiction and Interpretation: The Influence of the Holocaust on the Visual Arts, Ziva Amishai-Maisels discusses two categories of artists: â€Å"inmates† who were actual witnesses to the atrocities, and â€Å"non-inmates†. In this essay, I will explore and contrast the ways in which inmates and non-inmates represented the Holocaust and the Jewish people; for inmate artists, their stylistic choices were influenced by their motivation to resist dehumanization and maintain their dignity by using these works to affirm their life, and non-inmate subject matter reflects themes such as anger towards Hitler and Jewish resistance. I will contrast non-inmate artists Max Weber and William Gropper with inmate artists Bedrich Fritta and Leo Haas to argue that wh ile some may feel that there is no way that Holocaust art can represent what life was like for those who lived through the Holocaust, art by inmates is able to provide an in-depth understanding of Holocaust experience in ways that non-inmate art cannot. Inmates The Theresienstadt camp was a model camp in Czechoslovakia where prominent Jews were chosen to work, specifically commissioned artists. In this camp where Bedrich Fritta and LeoShow MoreRelatedAnalysis Of Maus By Art Spiegelman1100 Words   |  5 PagesThe devastating era of the Holocaust will always be remembered from the scars it left behind. The series Maus, written by Art Spiegelman, puts the Holocaust in a different perspective for readers. Vladek Spiegelman, a survivor of the Holocaust told the journey of his survival to his son, Art Spiegelman. Initially, I assumed this graphic novel would be about the racism, torture, and injustice the Jewish faced during the Holocaust by the Germans, but the book was more than that. Reading these booksRead MoreSymbolism Of The Film And The Mouse Hole1386 Words   |  6 Pages Very often an author or a director shares his or hers message with the reader or viewer with the help of certain symbols. In the novel Maus and the film Schindlerâ⠂¬â„¢s List, both Art and Spielberg use symbolism to show the true meaning of what happened during the Holocaust. Both the film and novel share similar and different symbols. Two of the biggest symbolic details of the novel and film is The little girl in the red coat who appeared throughout the film and the mouse hole which was talked aboutRead MoreMaus, By Spiegelman, And How They Survived The Holocaust1180 Words   |  5 Pageslots more of something else. But these strips are exactly what they are.† This quote was said by renowned American cartoonist Art Spiegelman, on his best-selling graphic novel, Maus, published by Pantheon Books in 1986. The anomalous novel depicts the life and story of Art Spiegelman’s Polish born parents - Vladek and Anja Spiegelman, and how they survived the Holocaust. In his novel, the Jews are portrayed as mice, the Poles as pigs, and Germans as cats. The story alternates between the parents’Read MoreAnalysis Of Maus By Art Spiegelm an1175 Words   |  5 Pages This report is based on the best-selling graphic novel Maus, written by renowned American cartoonist Art Spiegelman. The book was originally published in 1986 by Pantheon Books. The anomalous novel depicts the life and story of Art Speigelman’s Polish born parents - Vladek and Anja Speigelman and how they survived the Holocaust. In his novel, the Jews are portrayed as mice, the Poles as pigs, and Germans as cats. The story alternates between the parents’ struggles and the present day strainedRead MoreAnalysis Of The Complete Maus By Art Spiegelman1454 Words   |  6 PagesThe comic book memoir The Complete Maus, written by Art Spiegelman and narrated by both Spiegelman father and son, is a unique novel because it is the first of its kind. The novel received a decent amount of varying reactions from the public but was recognized and rewarded the Pulitzer Prize in 1992 for the originality of the book. A comic strip genre mixed with the memoir of the holocaust, from Art’s father’s first-hand experience, throws a whole different wave of emotions and feelings about theRead MoreUnderstanding The Holocaust and Preventing it Happening Again1025 Words   |  5 PagesUnderstanding The Holocaust and Preventing it Happening Again The human tragedy of the Holocaust was the systematic annihilation of millions of Jews by the Nazi regime during World War II. The adversity of this persecution influenced not only the European arena, but also peoples from all over the globe and their ideas. The impact caused by this ethnic cleansing was enormous. Peoples lives were drastically changed as they were persecuted and tortured. Families were taken out of their homes andRead MoreWorld War I And II1057 Words   |  5 Pagescentury, World War I and II, left a lasting impact on society economically, politically, and socially. As we have read in detailed archives on both world catastrophes, the nature in which violence shaped society after the war varied greatly. Ernst Jà ¼nger in Storm of Steel shares his heroic memoirs from fighting on the German front in World War I. Art Spiegelman tells the very personal and emotional story of his father, a survivor of World War II’s Holocaust. Throughout the war, Ernst reminds us ofRead MoreComparison And Contrast Of Maus And When The Emperor Was Divine1405 Words   |  6 PagesKalniesha Joseph Professor Lothes Lit 237 December 17, 2015 Fall 2015 Comparison and Contrast of Maus and When the Emperor was Divine Art Spiegelman’s Maus, the book was evolved around second generation trauma in father and son relationship. The novel, When the Emperor was Divine by Julie Otsuka was about a five different narrative perspective with the family s internment experience in the voices of the mother, daughter, son, and father. Each of the characters have their section for the bookRead MoreAnalysis Of Maus And The Sandman By Neil Gainman1454 Words   |  6 Pagesspecific context. Our education curriculums are heavily relied on reading comprehension, which has proven to be a struggle for visual learners. Graphic novels offer value, variety, and new medium for literacy that acknowledges the impact of visuals. Novels such as Maus by Art Spiegelman and The Sandman (vertigo) by Neil Gainman, not only appeal to visual learners, but are useful across all curriculums. Maus and The Sandman offer different style narratives and visuals that reflect the diverse natureRead MoreHistory: The Holocaust a Human Error Essay864 Words   |  4 Pagesdifferent. The Holocaust was so intesely horrific, so widespread, and such a strong point in history. Learning about it allows us to identify signs of such events and prevent them. We have developed entire vocabularies in order to recognize these. Genocide and pogram are both terms that are an example of this. They were formed in order to try to eliminate any possibility of history repeating itself. Indeed, the mere creation of words doesnt seem a legitimate measure to take, yet the impact such an action

The News Industry in Light of the Internet Free Essays

The introduction of the virtual communication medium has impacted many industries of the world. This has been mostly due to the widespread use of the internet as well as the easy access, navigation and availability of this medium for the customers. The internet medium has become a new mode for branding, establishing relations with friends, contacts and clients as well as reaching out to the customer. We will write a custom essay sample on The News Industry in Light of the Internet or any similar topic only for you Order Now This paper however focuses on how the internet and its evolution have impacted the News industry. The changes that have taken place in the News industry are explored and a prospective future of the news industry is provided in the highlight of present scenario. Impact on News Industry The presence of the internet has spawned an information revolution all around the world. This is directly impacting the news industry in world by changes the roles and identities of the press as the main product that is provided by the news industry is the dispersion of information to the public. The ease of navigation and information dispersion provided in the internet has enables anyone at all to be a source of information. Many community websites have been created by local journalists and web programmers which provide information on current events, happenings as well as a brief overview of the regional news through these websites to the consumers. Moreover the internet has a global audience and it is possible for people anywhere in the world to access the information as long as it is available on the internet. With the increased popularity and traffic that is going on the internet, the trend for people accessing news related information form the internet ahs also increased. People are now accessing online feeds of current affairs, world news, and weather as well as lifestyle news from popular news sites on the internet. This means that the news industry is facing a reduction in the demand and sales of news papers. People find it much more convenient to access news on the internet at their comfort without having to subscribe or pay for it. However some website and news providing companies online do ask for subscription but it is usually a one time process and does not require significant investment of money or time. The changing lifestyles of the people pertaining to their orientation towards technology and the increase in popularity and demand of gadgets like PDAs, hand held smart phones, and internet based communication devices is enabling consumers to access information form anywhere at any time by just logging on to the internet. Changes in the News Industry Over the period of time the News industry has had to face many challenges pertaining to technology. These came in the form of the radio and the television. However the news industry adapted to these changes and incorporated them in its infrastructure. The internet industry also proposes similar challenges to the News industry and as has been observed, it has made significant changes to the nature of the industry. In the online documentary of ‘News War’ by Frontline, the American News Industry is analyzed. Specific interviews from industry leaders and prominent figures in the news and media industry are depicted. According to the documentary it was highlighted that the core audience of the News industry is decreasing. This is mostly due to the fact that the main audience for the industry is getting old, and the younger generation tends to seek News and related information through the internet and other mediums. According to a survey states in the documentary that American people who are under the age of 25 usually tend to seek information through shows like The Daily Show. (‘News War’, Frontline) The companies in the news industry on the other hand are recruiting similar popular program like the Daily show in their news and journalism segments on their channels in order to improve their ratings. The impact for this has been that the renowned journalists are refusing to continue their contracts with the news companies. One such example is Ted Coppel from ABC Nightline. In drastic actions the News paper owners are also cutting down their field staff. Dean Baquet the previous Managing Director for Tribune said â€Å"†The people who own newspapers †¦ are beholden to shareholders† and â€Å"They want for the paper to be highly profitable, and sometimes that view of what a newspaper is supposed to be and my view, which is that a newspaper is a public trust, sometimes they come into conflict.† (‘News War’, Frontline) Jeff Fager from 60 Minutes clearly stated that the future of the news industry lies with collaboration with the internet medium. He mentioned that â€Å"We haven’t seen the model for how broadcast journalism is going to end up on the Internet, but †¦ it has to go there. I mean, you don’t see anybody between 20 and 30 getting their news from the evening news; you see them getting it online.† (‘News War’, Frontline) However such notions are put of by the internet news providers the like of Yahoo and a Google as they claim that they only report on the news which is reported through the reputable news channels. As a result of the channels and the news industry is to stop investing in their field staff and their infrastructure then the whole of the news industry is going to fail, including the online news providers. As a result collaboration between the current news industry and the internet news providers is essential for the future of the company. John Carrol form Los Angeles time supported this notion by stating that â€Å"I estimate †¦ that 85 percent of the original reporting that’s done in the United States is done by newspapers. They’re the people who are going out and knocking on doors and rummaging through records and covering events and so on. And most of the other media that provide news to people are really recycling news that’s gathered by newspapers.† (‘News War’, Frontline) Future of the News Industry Internet has made way with the gatekeeper of information making it accessible to all. The future of the News industry is very dynamic as the internet provides the industry with unlimited opportunities pertaining to communication which can be used as a business process as well as a product offering by the companies in the news industry. However the presence of the internet is also changing the way journalists, politicians and consumers conduct their business and carry out their activities as a result in the future it is also possible for newspapers as we know them to be eliminated. However instead of it new technologies and products which dispense news will come about. The most recent of these products is the emergence of online blogs, RSS feeds to websites and online newspapers. A prosperous news industry is only able to exist if the companies in the industry strive to adapt to the technology of internet instead of fight against it. References â€Å"How the net is transforming news†, BBC Online, 2006, accessed November 30, 2007 from http://news.bbc.co.uk/1/hi/technology/4630890.stm â€Å"News War†, Frontline, 2007, accessed November 30, 2007 from http://www.pbs.org/wgbh/pages/frontline/newswar/view/ Cryns, D.S., â€Å"Impact of the Internet: Newspaper Industry†, 2002, University of Maryland, accessed November 30, 2007 from http://www.grin.com/en/preview/8270.html Hendriks, P., â€Å"Newspapers, a Lost Cause: Strategic Management of Newspaper Firms in the United States and the Netherlands†, 1999, Publisher: Kluwer Academic Pub, ISBN-10: 079235608X Hudson, K., â€Å"The impact of blogs on the news industry†, accessed November 30, 2007 from http://www.helium.com/tm/70207/before-popularity-blogging-internet How to cite The News Industry in Light of the Internet, Essay examples The News Industry in Light of the Internet Free Essays The introduction of the virtual communication medium has impacted many industries of the world. This has been mostly due to the widespread use of the internet as well as the easy access, navigation and availability of this medium for the customers. The internet medium has become a new mode for branding, establishing relations with friends, contacts and clients as well as reaching out to the customer. We will write a custom essay sample on The News Industry in Light of the Internet or any similar topic only for you Order Now This paper however focuses on how the internet and its evolution have impacted the News industry. The changes that have taken place in the News industry are explored and a prospective future of the news industry is provided in the highlight of present scenario. Impact on News Industry The presence of the internet has spawned an information revolution all around the world. This is directly impacting the news industry in world by changes the roles and identities of the press as the main product that is provided by the news industry is the dispersion of information to the public. The ease of navigation and information dispersion provided in the internet has enables anyone at all to be a source of information. Many community websites have been created by local journalists and web programmers which provide information on current events, happenings as well as a brief overview of the regional news through these websites to the consumers. Moreover the internet has a global audience and it is possible for people anywhere in the world to access the information as long as it is available on the internet. With the increased popularity and traffic that is going on the internet, the trend for people accessing news related information form the internet ahs also increased. People are now accessing online feeds of current affairs, world news, and weather as well as lifestyle news from popular news sites on the internet. This means that the news industry is facing a reduction in the demand and sales of news papers. People find it much more convenient to access news on the internet at their comfort without having to subscribe or pay for it. However some website and news providing companies online do ask for subscription but it is usually a one time process and does not require significant investment of money or time. The changing lifestyles of the people pertaining to their orientation towards technology and the increase in popularity and demand of gadgets like PDAs, hand held smart phones, and internet based communication devices is enabling consumers to access information form anywhere at any time by just logging on to the internet. Changes in the News Industry Over the period of time the News industry has had to face many challenges pertaining to technology. These came in the form of the radio and the television. However the news industry adapted to these changes and incorporated them in its infrastructure. The internet industry also proposes similar challenges to the News industry and as has been observed, it has made significant changes to the nature of the industry. In the online documentary of ‘News War’ by Frontline, the American News Industry is analyzed. Specific interviews from industry leaders and prominent figures in the news and media industry are depicted. According to the documentary it was highlighted that the core audience of the News industry is decreasing. This is mostly due to the fact that the main audience for the industry is getting old, and the younger generation tends to seek News and related information through the internet and other mediums. According to a survey states in the documentary that American people who are under the age of 25 usually tend to seek information through shows like The Daily Show. (‘News War’, Frontline) The companies in the news industry on the other hand are recruiting similar popular program like the Daily show in their news and journalism segments on their channels in order to improve their ratings. The impact for this has been that the renowned journalists are refusing to continue their contracts with the news companies. One such example is Ted Coppel from ABC Nightline. In drastic actions the News paper owners are also cutting down their field staff. Dean Baquet the previous Managing Director for Tribune said â€Å"†The people who own newspapers †¦ are beholden to shareholders† and â€Å"They want for the paper to be highly profitable, and sometimes that view of what a newspaper is supposed to be and my view, which is that a newspaper is a public trust, sometimes they come into conflict.† (‘News War’, Frontline) Jeff Fager from 60 Minutes clearly stated that the future of the news industry lies with collaboration with the internet medium. He mentioned that â€Å"We haven’t seen the model for how broadcast journalism is going to end up on the Internet, but †¦ it has to go there. I mean, you don’t see anybody between 20 and 30 getting their news from the evening news; you see them getting it online.† (‘News War’, Frontline) However such notions are put of by the internet news providers the like of Yahoo and a Google as they claim that they only report on the news which is reported through the reputable news channels. As a result of the channels and the news industry is to stop investing in their field staff and their infrastructure then the whole of the news industry is going to fail, including the online news providers. As a result collaboration between the current news industry and the internet news providers is essential for the future of the company. John Carrol form Los Angeles time supported this notion by stating that â€Å"I estimate †¦ that 85 percent of the original reporting that’s done in the United States is done by newspapers. They’re the people who are going out and knocking on doors and rummaging through records and covering events and so on. And most of the other media that provide news to people are really recycling news that’s gathered by newspapers.† (‘News War’, Frontline) Future of the News Industry Internet has made way with the gatekeeper of information making it accessible to all. The future of the News industry is very dynamic as the internet provides the industry with unlimited opportunities pertaining to communication which can be used as a business process as well as a product offering by the companies in the news industry. However the presence of the internet is also changing the way journalists, politicians and consumers conduct their business and carry out their activities as a result in the future it is also possible for newspapers as we know them to be eliminated. However instead of it new technologies and products which dispense news will come about. The most recent of these products is the emergence of online blogs, RSS feeds to websites and online newspapers. A prosperous news industry is only able to exist if the companies in the industry strive to adapt to the technology of internet instead of fight against it. References â€Å"How the net is transforming news†, BBC Online, 2006, accessed November 30, 2007 from http://news.bbc.co.uk/2/hi/technology/4630890.stm â€Å"News War†, Frontline, 2007, accessed November 30, 2007 from http://www.pbs.org/wgbh/frontline/film/newswar/ Cryns, D.S., â€Å"Impact of the Internet: Newspaper Industry†, 2002, University of Maryland, accessed November 30, 2007 from http://www.grin.com/en/catalog/business-economics/business-economics-marketing-corporate-communication-crm-market-research/ How to cite The News Industry in Light of the Internet, Essay examples

Simple Partial Cystectomy Urology Surgery -Myassignmenthelp.Com

Question: Discus About The Simple Partial Cystectomy Urology Surgery? Answer: Introduction Abdominoperineal resection (apr). In this surgical procedure, parts of the GI tract like the Anus, rectum and sections of sigmoid colon are removed via an incision in the abdomen. In this process, the end of the intestine is connected to the stoma called colostomy, or the opening in the abdomen, through which the bodily wastes are collected in a disposable bag, placed outside the body. Cancerous lymph nodes can be removed in this surgery (Cancer.gov, 2018). Here the surgeon first divides the blood vessels supplied to the colon and rectum, after which the sigmoid colon and rectum is freed from the surrounding tissues, and then removed from the rest of the large intestine. After preparing the colon and rectum for removal, the perineal region (between the legs) is operated to remove the anus, after which the anus, along with the colon and rectum is removed from the body. 1a (ii): low anterior resection (lar). Low Anterior Resection (LAR) surgery is used in the treatment of rectal cancer. nursing procedure, the cancerous part of the rectum is surgically removed; the remaining portion of the rectum is connected back to the colon to enable normal movement of bowel. The surgery can be done by two different techniques, depending on the number and type of incisions made of the abdomen: Open Surgery: In this technique, a long incision is made on the abdomen (or belly), and the cancerous part of the rectum is removed through this incision. Minimally Invasive Surgery: Here many small incisions are made in the abdomen, through which surgical instruments and a video camera is inserted, to remove the cancerous part of the rectum. Robotic devices can be used in this procedure by the surgeons to help with the surgery. After the removal of the cancerous part of the rectum, the remaining part of the rectum is connected back to the colon using stitches or metal staples. The region where the two ends of rectum and colon are connected is known as the anastomosis (Mskcc.org, 2018). 1a (iii): proctocolectomy. Total proctocolectomy with ileostomy is a surgical procedure in which the entire large intestine and rectum is removed (Medlineplus.gov, 2018). The surgical procedure can either be an open surgery or laparoscopic surgery (also called keyhole procedure). The complete colon, rectum and anus are removed, and are also called a Pan-Proctolectomy. The blood and vessels and lymph nodes associated the part of the bowel are also removed. Along with the abdominal incisions, another incision is made near the bottom, to remove the anus. The rest of the bowel (consisting of the small intestine) is utilized to make an ilesotomy on the right side of the abdomen. The complete surgical procedure takes approximately three to four hours. (Birminghambowelclinic.co.uk, 2018). 1a (iv): hartmanns procedure. In this surgical procedure, part of the sigmoid colon and/ or the rectum is removed. It is generally performed on patients suffering from bowel cancer or diverticular diseases (Birminghambowelclinic.co.uk, 2018). The surgery can be either done laproscopically or as open surgery. In the process, the bowel is made free from the surrounding attachments from the abdominal cavity, followed by the division of blood vessels. After this, the bowel is incised, and the segment that is diseased is then removed. The colon is the brought to the surface of the skin, and is stitched to it, to form a colostomy. The rectum is closed using stitches or staples and placed back in the pelvic region. This surgery can be reversed by another surgery later on (Sussexsurgical.co.uk, 2018). 1a (v) cystectomy. The procedure can be of different types, like: radical cystectomy. Where the bladder and the fatty tissues around it is removed with a wide margin. The nearby pelvic organs (like prostrate in case of male patients, uterus and part of vaginal wall in case of female patients) are also removed. It is used for invasive or advanced cancer of the bladder (Kcurology.com, 2018). After the removal of the bladder, urinary diversion is done to restore the continuity of urinary tract. The urinary diversion can be of three types: Neobladder (connecting a new bladder to existing urethra), Continent Diversion (ureters connected to pouch with catherizable stoma) and ileal Conduit (short segment of small intestine connecting ureters to skin) Partial Cystectomy. Here a part of the bladder is removed, while preserving the rest of the bladder. It is utilized in case of benign lesions on the wall of bladder (Kcurology.com, 2018). Simple Cystectomy. Here the entire bladder is removed, but the adjacent fatty tissue and pelvic organs are preserved (Kcurology.com, 2018). Thus, the prostrate, seminal vesicles and urethra in male and urethra, uterus and anterior wall of vagina in female is left intact. This also keeps potency conserved (Urology.ucla.edu, 2018). 1a (vi) pelvic Excenteration. Anterior Pelvic Excentration. In this surgery, organs from the urinary and gynecologicsystem are removed, in order to treat cancer in the cervix or other organs in the urinary or gynecologicsystem (Mskcc.org, 2018). This procedure can be performed if irradiation therapy has failed (atlasofpelvicsurgery.com, 2018). The bladder and urethra is removed and hence a new place is needed for the elimination of urine. Urinary diversion is created for collecting the urine, and can be either is in the form of ileal conduit or urinary pouch. The ovaries, fallopian tubes and uterus are also removed (mskcc.org, 2018). Posterior Pelvic Excentration In this surgery, organs from the gastrointestinal and gynecological systems are removed to treat cancer of cervix or other organs in the gastrointestinal or gynecologic system. Part of the large intestine along with the rectum and anus are removed, and the remaining of the large intestine is brought to the surface of the abdomen to create a colostomy, attached with a pouch to collect stool, and the ovaries, fallopian tube and uterus are also removed (Mskcc.org, 2018). Total Pelvic Excentration. This surgery involves bloc resection of pelvic organs including reproductive organs, urinary bladder and the recto sigmoid. It is used to treat advanced primary or locally concurrent forms of cancer (Diver, Rauh-Hain Carmen, 2018). Indications for the surgery: 1b (i) abdominoperineal resection. This surgery is commonly used to treat cancer located low in the rectum or in the anus, or cases of distal tumors or poor sphincter function (Perry Connaughton, 2007). This surgery can also be used in case of severe traumatic injury to the rectum (Augusta.edu, 2018). 1b (ii) low anterior resection (lar). This surgery is used to treat stage 1, 2 and 3 cancers in the upper part of the rectum (that connects to the colon). The American Society of Colon and Rectal Surgeons (ASCRS) have outlined the parameters of the usage of colectomy to treat different conditions/indications (Emedicine.medscape.com, 2018). The different indications for colon resection are: Colorectal Cancer, Colonic Diverticular Disease, Trauma, Inflammatory Bowel Disease, Bowel infarction, Slow-transit constipation and Polyposis syndromes. 1b (iii): proctocolectomy. This surgery removes the diseased part of the bowel, thereby significantly improving the quality of life of the patients. This procedure can be used to cure ulcerative colitis, (Cdhb.health.nz, 2018). This surgery is also used when all other forms of treatment fails to treat the problems with large intestine, and is common surgical procedure for patients suffering from inflammatory bowel diseases like ulcerative colitis and Crohns Disease. Additionally, this surgery can also be performed in case of colon or rectal cancer, familial polyposis, bleeding of intestine, birth defects that cause damage to the intestine or other forms of intestinal damage due to injury or accidents (Medlineplus.gov, 2018). 1b (iv): hartmanns procedure. Hartmans procedure was initially developed to treat distal colonic adenocarcinoma, however other indications that calls for this procedure have progressed with time, including: Complicated Diverticulitis (stage I, II, III and IV), Recto sigmoid Cancer, Ischemia, Volvulus, Iatrogenic Perforation of the colon, Lymphoma, Metastatic Cancer in the Pelvis, Crohns Disease, Trauma due to accident or injury, Anastomotic dehiscence, Pseudomembranous colitis, Rectal prolapsed, Leiomyosarcoma, Ulcerative Colitis, Radiation Injuries, Retroperitoneal bleeding, Pneumatosis cystoides and For colon resection for patients who are haemodynamically unstable, immune-compromised or malnourished (Emedicine.medscape.com, 2018). 1b (v:) cystectomy. 1b.5.1: simple and partial cystectomy. Upper tract diversion can be used for the treatment of benign lower tract pathology or upper tract obstruction. Other indications for simple cystectomy include: radiation cystitis, interstitial cystitis, cyclosphosphamide cystitis, severe incontinence, neurogenic bladder, severe trauma to urethra and upper urinary tract obstruction. It can also be done to treat attenuation of bladder diverticuli, genitourinary sarcomas, manage urachal carcinomas and palliation of severe local symptoms, as well as to manage colovesical or vesicovaginal fistula and localized endometriosis of the bladder (urologysurgery.wordpress.com, 2018). 1b.5.2: radical cystectomy. Indications for radical cystectomy include: invasive bladder cancer, resectable locoregional metastases, superficial bladder tumors; Stage-pT1; grade-3 tumors that does not respond to BCG vaccine therapy; palliation for pain and primary adenocarcinoma (Emedicine.medscape.com, 2018). 1b (vi): pelvic Excenteration. Indications for pelvic Excenteration includes: Cervical Cancer, Uterine Cancer, Vulvar Cancer, Ovarian Cancer, Vaginal Cancer and Pallation (Diver, Rauh-Hain del Carmen, 2018). Specific Risks: 1c (i): abdominoperineal resection. Specific risks associated with Abdominoperineal Resection are: Intra abdominal or pelvic abscess, Nerve Injury, Urologic Injury, Perineal Wound and Ostomy, Risk of peroneal nerve injury, Brachial plexus injury, Damage to autonomic nerves, Injury to hypo gastric nerves, Sexual dysfunction in male, Bladder injuries and Perineal herniation(Perry Connaughton, 2007; Murrell et al.,2005). 1c (ii): low anterior resection (lar). Risks of LAR includes: Anastomosis leakage, Postoperative ileus, Frequent Stools, Urinary and stool incontinence, Ventral hernia, Damage to autonomous nerves that can cause bladder paralysis, erectile and ejaculatory dysfunction and vaginal dryness. (Oncolex.org, 2018). 1c (iii): proctocolectomy. Possible complications arising from this surgical procedure include: Damage to adjacent organs and nerves to the pelvic region, Infection of lungs, urinary tract and abdomen, Formation of scar tissues blocking small intestine, Breaking of wound or poor healing., Reduced absorption of nutrients from food and Phantom rectum (medlineplus.gov, 2018). The complications can include: infection and delayed healing of perineal wound, obstruction of small bowel, urinary retention, sexual dysfunction, stomal complications, pelvic infection as well as misdiagnosis. Additional physiological effects like dehydration, electrolyte abnormality, urinary and gall stone formation can also occur due to ileostomy (Dozois, 2004) 1c (iv): hartmanns procedure. The common complications due to bowel surgery include bleeding (that can persist for few days), infection (inside the abdomen, lungs, bladder as well as in the surgical wound), Bowel Obstruction (due to internal scar tissues and causes a blockage of bowel movement and passing of wind, pain or cramps in abdomen and nausea/vomiting). Other complications include wound hernia (due to bowel obstruction), deep vein thrombosis (due to reduced mobility) (Cdhb.health.nz, 2018). 1c (v): cystectomy. The rate of urination can increase after cystectomy. Removal or bladder and surrounding organs can also change the normal function of the body. In men it can cause erectile dysfunctions, and menopause in women (cancercouncil.com.au, 2018). Other short term complications can include acidosis, leaking urine or stool, bowel obstruction and kidney infection, and long term conditions like obstruction to ureters or intestine, renal failure, complication with stoma, scar tissue formation in the intestine (webmd.com, 2018). Risks for urinary tract infection and urinary tract septicemia were also reported by van Hemelrijck et al., (2013). 1c (vi): pelvic excenteration. Common complications of this surgical procedure include sepsis, thrombo embolic disease, and cardiopulmonary failure. Other complications include loss of blood, fluid shift, urinary infection, wound infection, anastomotic leak, fistulae, small bowel obstruction and urethral obstruction. Death can also occur in rare cases (less than 5%) and more significant among women older than 65 years of age (Diver, Rauh-Hain del Carmen, 2018). Type of Stoma/Diversion- 1d (i): abdominoperineal resection. The type of stoma created in this surgical procedure is End-Colostomy, since it involves bringing the gastrointestinal tract to the surface of the abdomen, cuffing it back on itself and suturing it to the operating on the skin, and the colon and rectum is removed. 1d (ii): low anterior resection (lar). The type of stoma created in this surgical procedure is loop ileostomy, where a loop of the small intestine is bought to the surface of the skin in the form of the stoma, from which gas and waste from the intestine passes out, collected in pouch stuck to the skin at the opening of the stoma (uhn.ca, 2018). 1d (iii): proctocolectomy. The type of stoma created in this surgical procedure is an end ileostomy, since the complete colon and rectum is removed through the incision in the abdomen, and the end of the small intestine is brought to the surface of the skin through the incision, creating the opening or stoma through which the waste exits (nhs.uk, 2018). 1d (iv): hartmanns procedure. In the Hartmans procedure, end colostomy type of stoma is created since in the procedure, parts of the large bowel or rectum is removed. It can be temporary or permanent. 1d (V): Cystectomy. Three types of diversions that can be made in a Cystectomy surgery are: Ileal Conduit (where a section of the intestine is removed, secured to skin through a small opening to create a stoma, and an ostomy bag is used to collect urine), Neobladder (creates a new bladder using a portion of small intestine, with the ureters connected at the top of the bladder and urethra at the bottom of it) and Continent Cutaneous Urinary Reservoir (where the urethra exits the abdominal skin through stoma, instead of being connected to the bladder) (Washington.edu, 2018). 1d (VI): Pelvic Excenteration. The type of diversion created in Pelvic Excenteration includes Urinary Diversion (also called wet colostomy, as the urine and feces are eliminated through a single stoma), Fecal Diversion (as a permanent end colostomy, as the anal sphincter is removed), Neovagina (reconstructing a part of the vagina), Pelvic Floor Coverage (Diver, Rauh-Hain del Carmen, 2018). How Restorative Proctolectomy differs from Proctolectomy: In Restorative Proctolectomy, the entire large intestine is removed, and an internal pouch or reservoir is made using the small intestine, within which fecal discharge is stored, and is connected to the anus. This pouch is called the J-Pouch or ileo anal pouch (Sofo, Caprino, Sacchetti Bossola, 2016). This is different from Proctolectomy in which the entire large intestine and rectum is removed, and results in the formation of end ileostomy, through which the waste is discharged. Immediate post operative and long term characteristics of the output- 3.1: ileostomy. The stoma created by ileostomy would be pink, moist and slightly shiny. The output/ discharge from the stoma might be a thin or thick liquid, or even semi solid, but not solid like stool. The density of the exudates will depend upon the diet and medications. Some gas might also be discharged. The pouch should be emptied 5 to 8 times a day (Medlineplus.gov, 2018). 3.2: colostomy. If the rectum and anus are intact in the colostomy procedure, mucus is produced at the lining of the bowel to help the passage of stool. The longer the section of the bowel left, more is the discharge of mucous. The mucous can vary between clear, egg white to sticky glue like. This can occur every few week or several times daily (nhs.uk, 2018). 3.3: ileal conduit. Urine and some mucus are the main output. It will be in the form of continuous drainage. The mucous is formed by the segment of the intestine used to make the ileal conduit or urine pocket (Cancer.org, 2018). How Loop stoma and end stoma are made and why: 4.1: end stoma. In end colostomy, the colon and rectum is removed, and the remaining portion of large intestine is brought near the surface of the abdomen to create the stoma. It can be temporary or permanent (Coloplast.com.au, 2018). 4.2: loop stoma. In loop colostomy, the intestine is lifted above the skin and fixed in place using stoma rod. Cut on the intestine loop is then rolled and sewn to the skin to form two stomas. In case of loop ilesotomy, a loop from small intestine is lifted above the skin, and fixed with a stoma rod. Cut on the loop is rolled up and sewn to the skin to form two stomas (Coloplast.com.au, 2018). Continent Urinary Diversions: 5a.1: indiana pouch. This is a continent catherizable urine pouch. The pouch is formed from the caecum, ascending colon, and ileum. The ileum is then sewn to the skin of the abdomen (on the right side) (columbiaurology.org, 2018). 5a.2: the koch pouch. This is also called continent ileostomy. During the surgery, the small intestine is joined to an internal reservoir or pouch made from small intestine. A one way valve ensures the leakage of waste to the outside. The pouch is emptied using a catheter. The stoma is protected using stoma cap (Ouh.nhs.uk, 2018). 5a.3: mitrofanoff. This procedure is used to allow drainage of bladder, in situations where voiding or self catherization is not possible. The procedure creates a catheter channel into the bladder to empty it. This is done by forming a channel between the abdominal wall and the bladder to allow drainage. Mitrofanoff is made using the appendix or the fallopian tube. The continent mechanism is provided by tunneling one end of Mitrofanoff to the wall of the bladder to create a valve, and the other end passed through the skin of the abdomen to form stoma (mitrofanoffsupport.org.uk, 2018). Indiana Pouch 5b.1: immediate care. After surgery, tubes, drains and other equipments are used, and intravenous line is used for fluid and medicine. Abdominal drains such as stoma tube, suprapubic tube, stents, Jackson Pratt Drain, Foley Catheter, and NasoGastric Tube can be used. For pain control, medications will be used, to keep the pain limited to mild, and enable mobility. Walking is suggestible to speed recovery, and restoration of bowel function, and prevent blood clot or pneumonia. Drainage from the incisions might also occur, which would need cleaning and dressing (uwhealth.org, 2018). 5b.2: long term care. For long term care, the incision should be washed daily, gently with soap and water. Mucous buildup at the stoma should be wiped using plain warm water daily if required. Care should be taken cleaning near the stitches, and little bleeding might also occurs, which is normal. The stoma can be uncovered during bathing, once it has healed completely, but never should be scrubbed. After removal of tubes, a small gauze dressing can be used to cover the stoma. The tubes must also be cleaned daily with mild soap and water. It should be flushed 2-3 times every day to prevent plugging with mucous. The bags would also require changing or emptying of its contents. Self catherization will also be required on the long run, to be done by the patient. The diet should also be soft until the first visit after surgery, and 8-12 glasses of water should be drank every day (uwhealth.org, 2018). References: atlasofpelvicsurgery.com.(2018).Anterior Exenteration.Atlasofpelvicsurgery.com. management 1 February 2018, from https://www.atlasofpelvicsurgery.com/10MalignantDisease/16AnteriorExenteration/cha10sec16.html augusta.edu (APR).(2018).Abdominoperineal Resection Surgery (APR). 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