Melanoma is a cancer that forms in the melanocytes (Brashers, Huether, & McCance, 2020).  According to Poklepovic and Luke, malignant melanoma is one of few cancers currently increasing in incidence.  New cases of malignant melanoma increased to more than 90,000 cases in 2018, up from approximately 74,000 cases in 2015 (Poklepovic & Luke, 2020).  In 2019, it was estimated that there would be 96, 480 diagnosed cases of melanoma in the United States, followed by approximately 7,230 deaths from the disease (Yushak et al, 2019).  A majority of diagnosed patients are treated with curative-intent surgical resection (Yushak et al, 2019).  However, patients with resected stage II or stage III melanoma are at increased risk for reoccurrence; whereas patients with stage IIA or stage IIIA disease have a melanoma-specific survival at five years of 94% or 93% (Yushak et al, 2019).  Patients with thicker primary melanomas (T3 or T4), ulceration, or more extensive lymph node involvement have a poorer prognosis (Yushak et al, 2019). 

               Standard treatment for Stage II melanoma is wide excision therapy to remove the melanoma and a margin of skin around the site and sentinel lymph node biopsy (SLNB) (Poklepovic & Luke, 2020).  If the SLNB is negative, no further treatment is necessary, but close follow-up will remain important.  If the SLNB is positive, a lymph node dissection will likely be recommended, or monitoring by ultrasound every few months (Poklepovic & Luke, 2020).  Additionally, if the SLNB is positive for cancer, adjuvant (additional) treatment with an immune checkpoint inhibitor or targeted therapy drugs (if BRAF mutation exists) may be recommended to reduce the risk of reoccurrence (Poklepovic & Luke, 2020).  In BRAF mutant melanoma, targeted therapy offers a response rate of 60-70% with a median progression-free survival from 11 to 15 months (Poklepovic & Luke, 2020). 

               Immunotherapy is treatment that includes use of medication to stimulate the patient’s own immune system to recognize and destroy cancer cells.  Immune checkpoint inhibitors target checkpoint proteins, which helps them restore the immune response against melanoma cells (American Cancer, Society, 2021).  These medications include pembrolizumab (Keytruda), nivolumab (Opdivo), atezolizumab (Tecentriq), and ipilimumab (Yervoy).  Ipilmumab has been associated with long-term survival in approximately 21% of treated patients with advanced melanoma (Poklepovic & Luke, 2020).  According to Poklepovic and Luke, pembrolizumab and nivolumab have confirmed survival outcomes and are considered the default standard of care for melanoma (2020).  Pembrolizumab and nivolumab have consistent response rates of 30-40% (Poklepovic & Luke, 2020).

               Man-made versions of Interleukin-2 (IL-2) are occasionally used to treat melanoma as well.  While IL-2 can shrink advanced melanomas, it’s not used as frequently as in the past as immune checkpoint inhibitors have shown to be more effective with fewer side effects (American Cancer Society, 2021).  For earlier stages of melanoma, if the melanoma has reached nearby lymph nodes, it is more likely to appear in another part of the body; IL-2 may be injected into tumors to prevent spread (American Cancer Society, 2021).

               Oncolytic viruses are lab altered viruses used to infect and kill cancer cells and alert the patient’s immune system to kill cancer cells.  Talimogene laherparepvec (lmlygic) is a oncolytic virus that is used to treat skin or lymph nodes that can’t be removed with surgery (American Cancer Society, 2021).  This virus is injected directly into tumors approximately every two weeks (American Cancer Society, 2021). 

               Other, less frequently used treatments include the Bacille Calmette-Guerin (BCG) vaccine and Imiquimod cream.  The BCG vaccine may be injected directly into the tumor to activate the immune system (American Cancer Society, 2021).  Imiquimod cream is applied to skin to stimulate a local immune response against the melanoma cells; it may be used in cases where surgery could be disfiguring or against melanomas that have spread along the skin (American Cancer Society, 2021). 

References

American Cancer Society. (n.d.). Immunotherapy for Melanoma Skin Cancer.

 https://www.cancer.org/cancer/melanoma-skin-cancer/treating/immunotherapy.html.

Huether, SE., McCance, K.L., & Brashers, V.L. (2020). Understanding Pathophysiology.  Elsevier.

Poklepovic, A. & Luke, J. (2020).  Considering adjuvant therapy for stage II melanoma.  Cancer (126)6, 1166-1174. https://dx.doi.org/10.1002%2Fcncr.32585.

Yushak, M., Mehnert, J., Luke, J., & Poklepovic, A. (2019). Approaches to High-Risk Resected Stage II and

               III Melanoma. American Society of Clinical Oncology Educational Book, 39.

Instructions

Based on the course’s second week of assigned readings, briefly outline the historical rise and expansion that led to the modern administrative law/regulatory system now in place here in the United States. For this assignment, you are a senior public administrator working for Federal Agency ‘X,’ and you have been asked to prepare a detailed but concise information pamphlet highlighting the historical evolution of American administrative regulations for all new employees to read as they in-process into your agency. 

Be sure to chronologically highlight key legislation, influential political leaders, and/or significant historical events that drove distinct fundamental shifts (or significant refinements/realignments) in how American’s modern federal-level administrative, regulatory functions are implemented. 

• Explain if you believe these functions are sufficiently transparent with due process and equal access as the Founding Fathers intended.
• Critically analyze the contemporary relationship between federal agency bureaucrats and the executive, legislative, and judicial branches of the federal government. From your perspective, determine if there are elements of the separation of powers that work better than others and thoroughly explain your response.

Support your assignment with at least five scholarly resources. In addition to these specified resources, other appropriate scholarly resources, including seminal articles, may be included.

Length: 3-5 pages, not including title and reference pages

Your assignment should demonstrate thoughtful consideration of the ideas and concepts presented in the course by providing new thoughts and insights relating directly to this topic. Your response should reflect scholarly writing and current APA standards. Be sure to adhere to Northcentral University’s Academic Integrity Policy.

Regardless of political affiliation, individuals often grow concerned when considering perceived competing interests of government and their impact on topics of interest to them. The realm of healthcare is no different. Some people feel that local, state, and federal policies and legislation can be either helped or hindered by interests other than the benefit to society.

Consider for example that the number one job of a legislator is to be reelected. Cost can be measured in votes as well as dollars. Thus, it is important to consider the legislator’s perspective on either promoting or not promoting a certain initiative in the political landscape.

To Prepare:

• Review the Resources and reflect on efforts to repeal/replace the Affordable Care Act (ACA).
• Consider who benefits the most when policy is developed and in the context of policy implementation.

By Day 3 of Week 3

Post an explanation for how you think the cost-benefit analysis in terms of legislators being reelected affected efforts to repeal/replace the ACA. Then, explain how analyses of the voters views may affect decisions by legislative leaders in recommending or positioning national policies (e.g., Congress’ decisions impacting Medicare or Medicaid). Remember, the number one job of a legislator is to be re-elected. Please check your discussion grading rubric to ensure your responses meet the criteria.

I need an informative speech how to adopt a dog using the temple below in APA format minimal plagiarism ? 

Begin by filling in the document attached – replace highlighted text that is presented to help you develop a strong outline with requested content 

Title of Speech: [Your title should announce the topic clearly, concisely, and creatively]

Specific Purpose:

Central Idea:

INTRODUCTION

I. (Attention) [Start with a catchy opening that gains audience’s attention. Do not simply announce the topic!]

II. (Reveal Topic) [Tell what you are going to talk about – reveal your topic]

III. (Relevancy) [Tell us why this topic is relevant/significant]

IV. (Credibility) [State your credibility: what makes you an expert on the topic? What experience do you have with it?]

V. (Preview) [Give us a preview of topics you will be discussing – this is the list of the main points below]

Transition: [include a transition statement. Simple “Let’s begin by talking about x” (name first main point) would suffice]

BODY

I. [Main Point I: In a full and complete sentence state your first main point]

A.  [Sub-point A: In a full and complete sentence state the first supporting point that provides justification for your Main Point I above]

1.  [Sub-sub-point A: In a full and complete sentence state provide support for your Sub-point A above]

2.  [Sub-sub-point B: In a full and complete sentence state provide support for your Sub-point A above[DL1] ]

3.  

B. [Sub-point B: In a full and complete sentence state the first supporting point that provides justification for your Main Point I above]

1.  

2.  

Transition: [Provide a transition that tells us that you finished talking about Main Point I, and are now mowing on to Main Point II]

II. [Main Point II: In a full and complete sentence state your second main point]

A.  [Sub-point A: In a full and complete sentence state the first supporting point that provides justification for your Main Point II above]

1.  [Sub-sub-point A: In a full and complete sentence state provide support for your Sub-point A above]

2.  [Sub-sub-point B: In a full and complete sentence state provide support for your Sub-point A above]

B. [Sub-point B: In a full and complete sentence state the first supporting point that provides justification for your Main Point II above]

1.  

2.  

Transition: [Provide a transition that tells us that you finished talking about Main Point II, and are now mowing on to Main Point III]

III. [Continue building your outline, add or remove points as you see fit]

A.  

1.  

2.  

3.  

B.

Transition: [Provide a transition that tells us that you finished talking about Main Point III, and are now mowing on to Main Point IV, if you have one]

IV.  

A.  

1.  

2.  

B.  

1.  

2.  

Transition: [Provide a transition that tells us that you finished talking about all your main points, and are ready to wrap up. You may simply state “Let’s review”]

CONCLUSION

I. [Provide a review of Main Points]

II. [End with a clincher/tag/exit line or final appeal]

REFERENCES

[DL1]Please note: every point MUST come in at least a pair. This means that for every Subpoint A you should have at least a Subpoint B. For every sub-sub-point 1, there should at least be sub-sub-point 2. Add or remove additional supporting points as you see fit. 

Make sure that you do not have anything left blank. If you do not have a third supporting point, remove the number of letter accordingly. 

. This short paper should include:

• A copy of the agreed-upon collective bargaining agreement section SECTION 25.05:  PROTECTIVE CLOTHING, EQUIPMENT, TOOLS

The Employer agrees to provide to employees any required tools and safety or protective equipment, reasonably fitted safety clothing, and devices necessary to provide protection of employees from hazardous conditions to include inclement weather encountered during the performance of official duties.  Such equipment will be provided as authorized by applicable Occupational Safety and Health Administration (OSHA) standards. The Union agrees to assist the Employer in aggressively publicizing the benefits of the use of protective devices and equipment by employees, and their adhering to good safety practices, policies, and procedures.

Management will provide a voucher to buy three (3) pairs of boots every 24 months: one (1) pair of light weight non-winter OSHA certified steel-toed boots; two (2) pairs of heavy weight insulated OSHA certified steel-toed boots. 

Management will provide a $175 voucher per employee for company logoed cold-weather gear, medium, and light weight jackets every 24 months. Management will provide the vendor that all employees must use for the purchase of boots and gear. There will be a wide selection of boots to chose from which meet the OSHA standards and are steel toe and a catalog to select gear from.  Accommodations may be made in special circumstances if the selection provided is not a fit for the employee.

Any boots that are worn out by OSHA standards, will remain the property of the employee.  Any logoed gear or jackets that are badly frayed or damaged will be returned to management. 

Employees may take their boots and gear home; however, it is the expectation that all employees are prepared for their shift, which includes the appropriate gear and footwear at all times. Failure to comply will result in the employee being sent home to get appropriate gear.  All employees will be provided storage lockers.  It is the responsibility of all employees to maintain the upkeep and cleanliness of their gear and boots.

• A personal account of the negotiating process. This account needs to include:
  • A listing of the key challenges or points of friction.
  • An analysis of the negotiating principles used by both parties and the BATNA of their own position.
  • A review on the success of interest-based compared to distributive bargaining principles.
  • An analysis of the strength of the other positions – were their positions weak and not supported well or just the opposite?
  • A reflection on how this negotiation session was different than the first one completed under Milestone One in Module Three.
  • What might need to be changed to be more successful in follow-on negotiating sessions?
  • A conclusion about the outcome – did it favor one side or the other?