In the opinion of an ENT expert, the delayed referral worsened Mr C’s prognosis and likelihood of cure. The possible diagnoses include a primary laryngeal cancer or left vocal cord palsy due to lung cancer. Any patient, particularly a heavy smoker, should be referred for an ENT opinion within three to four weeks if hoarseness or throat pain persists. Primary care expert opinion was critical of Dr W’s poor record keeping and inability to substantiate and defend her care and management of Mr C’s persistent sore throat and hoarse voice. Dr W maintained that she had taken an appropriate history and carried out an examination of Mr C’s mouth and neck. However, there was no clinical record made by Dr W as to whether this was the case the notes also held no record of whether Dr W had carried out any appropriate examination of the throat or recorded Mr C’s smoking habit. Mr C said that he was hoarse during his consultations with Dr W. The case was difficult to defend due to the poor clinical documentation. Soon after completing his outpatient radiotherapy, Mr C began a claim against Dr W. He required a laryngectomy and neck dissection of the lymph nodes with postoperative radiotherapy to his neck Mr C was told the prognosis was poor. Dr M made an urgent referral to the local hospital ENT clinic, where Mr C was diagnosed with laryngeal cancer. Dr M recorded sore throat and hoarseness over a preceding period of several months Dr M examined Mr C and found enlarged, immobile lymph nodes in the left side of Mr C’s neck. On the next occasion he visited the surgery, Mr C saw a different GP, Dr M. There was no record in the practice notes as to whether Dr W examined the throat and neck or questioned Mr C about any hoarseness. At the last of their consultations, Dr W noted that Mr C was “probably resistant to previous antibiotics” and prescribed a “stronger” antibiotic for a two week period. The documentation of the visits was limited on each subsequent occasion, Dr W diagnosed tonsillitis or a URTI. On each of these visits he saw the same GP, Dr W. Over a subsequent four-month period, Mr C attended on four further occasions. At the initial consultation, Dr W diagnosed a viral upper respiratory tract infection and recommended simple analgesia with soluble paracetamol gargles. He had smoked approximately 15 cigarettes a day since his teens. Mr C, a 59-year-old self employed painter and decorator, visited his GP surgery complaining of a sore throat and change in his voice, which was a little hoarse.
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There could be other causes why users may not be able to uninstall Nikon Camera Control Pro.
Basically, a product is offered Free to Play (Freemium) and the user can decide if he wants to pay the money (Premium) for additional features, services, virtual or physical goods that expand the functionality of the game. This license is commonly used for video games and it allows users to download and play the game for free. There are many different open source licenses but they all must comply with the Open Source Definition - in brief: the software can be freely used, modified and shared. Programs released under this license can be used at no cost for both personal and commercial purposes. Open Source software is software with source code that anyone can inspect, modify or enhance. Freeware products can be used free of charge for both personal and professional (commercial use). Individual Office 2013 apps received numerous upgrades, including streamlined UI (a flatter looking Ribbon with new animation style), better support for a touch interface, ability to import video and audio to Word documents straight from online sources, new bookmark features (including the syncing of documents and position inside documents between new computers and more).įreeware programs can be downloaded used free of charge and without any time limitations. In addition to that, Office 2013 also added support for Office Open XML (OOXML) file format, a newer version of Open Document Format, and fully integrated support for creating, writing, and editing PDF files. The biggest one was the full integration of various Cloud services into individual apps, providing users with integrated solutions for content sharing, collaboration, cloud storage, unified account management, integration with Skype, and more. Since its appearance in sales during the summer of 2011, Office 2013 has sold over 200 million copies and has served as a base of the continued development that eventually resulted in the release of the Microsoft Office 2016 suite.Īfter fully establishing Ribbon and Fluent User Interface in Office 2010, Microsoft continued rapid development and offered a wide array of notable updates in Office 2013 64 bit. Other versions of Microsoft Office 2013 64 bit can be found on Windows 10 Store, Office Mobile on now-discontinued Windows Phone platform, Office RT on now-discontinued Windows RT devices, and on modern mobile Apple iPad and Android tablet platforms. Originally introduced in 2011, this business and enterprise-oriented service pivoted with this version of Office suite to support home users and started promoting numerous value-added services such as free access to expanded cloud storage on OneDrive. Office 365 is an online-oriented version of Office suite, offering not only online access to web apps but also single license access to more persons in the household or workplace. In addition to the purchase of the retail or digital bundles, Office apps can also be purchased via Office 365 subscriptions or even purchasing of the single apps. Depending on the tier of the Office edition, users can get to the various Office apps, ranging from the smallest offering in the “Home & Student” edition to the largest “Professional Plus”. This includes the dedicated word processor (Word), a highly capable spreadsheet editor ( Excel), slideshow presentation program ( PowerPoint), database management system (Access), personal email information manager ( Outlook), notetaking program (OneNote), and many others. Microsoft Office 2013 is a suite of highly-specialized home and business productivity applications aimed to provide users of all knowledge levels to more easily handle the creation, editing, management, collaboration, sharing of documents in a work environment. Conversely, there are occasions when infidelity is just the final injustice heaped on an unfortunate partner’s shoulders. Sometimes, if a lover betrays us, we know all too well, deep down, how we have been complicit in their actions. But what you don’t offer me are mitigating circumstances. What he has given you is a guilt-free second chance to upgrade or at least diversify in terms of your romantic choices. In his current state of indulgence and confusion, he’s not to be relied upon, particularly as he’s still covering his options by remaining shacked up with his lover. Either he’s a dangerously indecisive person or is so preoccupied with his own emotional needs that he’s entirely blind to everyone else’s. Having embarked on an affair behind your back he now appears to be deceiving his mistress – I doubt she is aware of his desire to be reunited with you. You offer analysis of your husband’s possible motives in trying to reclaim you, but his approach also suggests he hasn’t learned his lesson. Nevertheless, your letter contains a few jarring notes. He’s given you a guilt-free chance to upgrade on romance in your life Life is long and love is complicated, so taking an absolute position is unhelpful. I’m not saying that what your husband has done is unforgivable – although many others might. But such seismic moments also offer the opportunity to reconsider your options. As such, it’s a good idea to take the long view. There’s no point in being naive – affairs happen and long relationships are guaranteed to come up against obstacles. It’s very forgiving of you to regard his betrayal as more of a misdemeanour than a full stop, or you are making allowances he doesn’t deserve. His behaviour falls way below the standard I’d expect of a good mate and as a spouse it’s even more disappointing. I’m surprised you still describe him as your best friend. What your husband wants, why he wants it and what he’ll do with it if he gets it is intriguing, but definitely not the most important thing. Before we start can I say how glad I am that you’re up for considering your own needs. Does he want me back because the grass isn’t greener or because he really loves me? But most importantly, I don’t know what I want. I don’t know whether I can trust or make love to him again and I don’t know what his real motives are. He remains my best friend and we have so much in common. I’m happy with my new lover, especially sexually, but I also long for the relationship I had with my husband. He is still with his girlfriend and is probably worried to leave her in case I don’t take him back. He sees me happy and free from him, which of course is more attractive than a lamenting woman. Suddenly I could endure the pain of my husband’s betrayal. Two months after this revelation, I met someone and fell in love. When asked to choose between her and me, he chose her and left me. It came as a terrible shock – I cried and cried for weeks. The dilemma Last year I found out that my husband of 20 years had been having an affair for a few months. |
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