Anesthesia and Cancer, Friend or Foe? A Narrative Review

Cancer remains the leading cause of death worldwide with close to 10 million deaths reported annually. Due to growth of the advanced age cohort in our population, it is predicted that the number of new cancer cases diagnosed between now until 2035 is to reach potentially 24 million individuals, a staggering increase in a relatively short time period. For many solid tumors, surgical resection along with chemotherapy is the best available approach to a potential cure which leads to almost 80% of cancer patients undergoing at least one surgical procedure during the course of their disease. During surgical intervention, the exposure to general anesthesia can be lengthy, complex and often involves various modalities resulting in an important question as to the role, if any, anesthesia may play in primary recurrence or metastatic conversion. Many components of the stress and inflammatory responses exhibited in the perioperative period can contribute to cancer growth and invasion. The agents used to induce and maintain general anesthesia have variable interactions with the immune and neuroendocrine systems and can influence the stress response during surgery. Thus, debating the best type of anesthesia that would help to attenuate sympathetic and/or pro-inflammatory responses while modulating cytokine release and transcription factors/oncogenes remains at the forefront. This may affect inducible cancer cell survival and migratory abilities not only intra-operatively, but also during the immediate post-operative phase of recovery. The ultimate question becomes how and whether the choice of anesthesia may influence the outcomes of cancer surgery with two major approaches being considered, i.e., regional and general anesthesia as well as the various hypnotics, analgesics and sympatholytics commonly used. In this review, we will address the latest information as to the role that anesthesia may play during cancer surgery with specific focus on primary recurrence and metastasis.

Is the Universe on Our Side?

America cannot go on this way without risking the end of constitutional democracy. We have already entered post-liberalism. But there is something to be done. We can launch a new story, and thus begin to recover normal public life, by asking the ultimate question bequeathed to us by Bernard Lonergan: Is the universe on our side? Asking an ultimate question restores faith in questioning itself. That kind of questioning ends the Age of Evasion. We ask Lonergan’s question through a loose cultural entity he called “cosmopolis.” As long as we agree to live by our answer to this question, even a no can contribute to the healing of American public life.

Utopien des Übergangs. Don Quixote und Zarathustra

The subject of this article points beyond a purely literary or literary-historical approach. The question is, whether and how a human being is able to change the (social) conditions of their life by changing himself through transition into another form of existence. In order to overcome established (social) conditions and one’s self, it is necessary to begin with a vision, a utopian dream. Those who pursue the utopian dream of overcoming their current (social) conditions must acknowledge their own good and evil, that is, their position vis-a-vis equality and justice, law and morality. The person itself, and its personality, is revealed in the relation between the utopia of changing its current way of life and its social reality. The ultimate question is: what is the essence of humanity, the ecce homo? Both the transition into a new form of being and the utopian dream differ decisively in Don Quixote and Zarathustra. It is not my concern to compare them as literary figures.

Utopien des Übergangs. Don Quixote und Zarathustra

The subject of this article points beyond a purely literary or literary-historical approach. The question is, whether and how a human being is able to change the (social) conditions of their life by changing himself through transition into another form of existence. In order to overcome established (social) conditions and one’s self, it is necessary to begin with a vision, a utopian dream. Those who pursue the utopian dream of overcoming their current (social) conditions must acknowledge their own good and evil, that is, their position vis-à-vis equality and justice, law and morality. The person itself, and its personality, is revealed in the relation between the utopia of changing its current way of life and its social reality. The ultimate question is: what is the essence of humanity, the ecce homo? Both the transition into a new form of being and the utopian dream differ decisively in Don Quixote and Zarathustra. It is not my concern to compare them as literary figures.

ENGLISH INSURANCE LAW REFORMS: LESSONS FOR SOUTH AFRICA

Insurance law in the United Kingdom (UK) has recently undergone significant reforms. Until 2015, insurance law in the United Kingdom was still largely regulated by the Marine Insurance Act 1906. This meant that a statute created over a hundred years ago was still regulating insurance law. The need for the more recent reforms was evidently dire. The Law Commission undertook an investigation that highlighted the need for new insurance laws. The result was the enactment of the Insurance Act 2015. There are some significant changes in the new Act concerning fraudulent claims, breaches of good faith and the duty of disclosure. The new laws appear to be much more pro-policyholder than was the case in the previous regime. This article undertakes a detailed analysis of these reforms and also presents a comparison with South African laws. The ultimate question is whether South Africa can learn anything from the recent reforms to UK insurance law.

The myths and mysteries of leadership in higher education

In his seminal work “How Colleges Work” Bob (Robert) Birnbaum poses the ultimate question on the paradox of universities and colleges in the US. How comes, he asks, is it that they are amongst the largest industries in the country with an unparalleled reputation for diversity and quality, but are also regarded as poorly managed. In this paper I explore the evidence for a relationship between leadership, management and performance, or not.

Two Student Perspectives on Clinical Medical Education During the COVID19 Pandemic

In the age of COVID19, the ultimate question in healthcare became who was essential and who was not. Basically, who could be cut from the roster in patient care? Unfortunately, as medical students, many of us did not make that cut, and as rotations were continually evolving and changing, students from even the same institution had varying experiences. Third-year clerkships are defined by the direct patient care and hands-on learning students get, but in the age of COVID19, “hands-on learning” has been a bit hard to come by. Hence, COVID has caused many changes in the way medicine is being taught and practiced. This article will detail the experiences of two medical students from the same institution, working in different locations for their third-year clerkships. We contrast our rural and urban experiences as students in the time of COVID and display the varying experiences students are having during this time. We touch on the potential ramifications for these wide varieties of experiences from students across the U.S. and how this will affect sub-internships and residency applications.

Assessing the explanatory power of naturalism in addressing ultimate questions

A typical scientist has no responsibility other than to explain how a natural event occurred. However, when a philosopher asks about the conditions under which a scientist’s explanation is true, he is, in fact, raising an ultimate question, the concept which Karl Popper used for the first time. Answering this question requires that no elements are neglected in the explanation, and no significant factors in the explanation are overlooked. In other words, in explainingphenomenon, at any level of its explanation, there should be no remainder. These requirements can be achieved through the full explanation. In the present article, by drawing on concepts such as theory-ladenness of observation, underdetermination of theory by evidence, and the role of models and metaphors in developing a scientific theory, it is illustrated thatcomplete explanation includes both a scientific explanation and personal explanation. A personal explanation comprises mental properties such as belief, desire, and intention, which are irreducible to physical properties. Therefore, we cannot provide a personal explanation while restricting ourselves to scientific methods. Consequently, it is argued in this article first, the personal explanation is irreducible to a scientific explanation. Second, the personal explanation is inevitable in order to provide a full explanation. Third, (methodological) naturalists claim that the ultimate judgment of what is natural and unnatural is possible only by scientific inquiry. Finally, accepting these three premises entails the inability of a naturalist to answer ultimate questions.