Portfolio Credit Risk Essay Example | Topics and Well Written Essays - 2000 words

Portfolio Credit Risk - Essay Example More precisely, I analyse the impact of uncertainty about input parameters on the precision of measures of portfolio risk. I confine the analysis to losses from default, i.e., exclude the risk of credit quality changes, and model default correlations by means of correlated latent variables. The framework builds on CreditMetrics (JP Morgan, 1997), and closely resembles the one used by the Basel Committee on Banking Supervision (2001) to adjust capital requirements for concentration risks. The necessary inputs for assessing default risk are default rates, recovery rates, and default correlations. They are usually derived from historical data, which means that their precision can be inferred using standard statistical methodology. This is the first step of the analysis in this paper. In the second, I determine the accuracy of value at risk (VaR) measures in the presence of noisy input parameters. This is done separately for portfolios which differ in their average credit quality and in diversification across obligors. The aim of such an analysis is threefold. First, the results are useful for defining the role credit risk models should play in credit portfolio management and bank regulation. Second, modelling parameter uncertainty allows to compute risk measures which take estimation error into account. Since the loss distribution is a non-linear function of the input parameters, its estimate can be biased even if the parameter estimates are not. To correct such biases, I employ a Bayesian approach and analyse the predictive distribution, which averages the loss distributions pertaining to different but possibly true parameter values. 1 Finally, the analysis helps to identify inputs with a large marginal benefit of increasing input quality. The analysis shows that estimation error in input parameters leads to considerable noise in estimated portfolio risk. The confidence bounds for risk measures are so wide that losses which are judged to occur with a probability of 0.3% may actually occur with a probability of 1%. Several observations, however, suggest that available credit risk models can be useful for risk management purposes even though their application is plagued with data problems. The magnitude of estimation error is comparable to a setting in which VaR estimates can be based on a long time series of portfolio losses, and it differs little between perfectly diversified portfolios and small portfolios with 50 obligors. In addition, the bias in conventional VaR figures which results from estimation error is modest. The relative importance of the three input factors for the quality of VaR estimates depends on the portfolio structure and the extremeness of the events under analysis. The impact of correlation uncertainty, for instance, is larger for more extreme events and for riskier portfolios. Related papers are Jorion (1996) and Butler and Schachter (1998)

Socialist Feminism Essay Example for Free

Socialist Feminism Essay According to (Alcoff,1995 ) Cultural feminism is the ideology that a woman needs to appropriate the value of her female nature in an attempt to authenticate her female attributes that were previously determined and undervalued by masculinity itself. In cultural feminism, a woman’s enemy lies not just in an economic institution, backward values or even a social system but the root of it all lies in masculinity itself and even in male biology. It is a celebration womanhood, of the separation of a woman’s existence from mans and taking pride in the very essence of female sexuality right down to one’s anatomy. The power of popular culture and the â€Å"Vagina monologues† All aspects of feminist culture seems to occur in waves over periods of time however overlapping and questionable in terms of generations they may be they are most evident in western parts of the world, such as the suffragists of the 1920’s and the American women who fought for sexually reproductive rights in the 1960’s. A wave of popular culture swept across America in the early 1990†s that was indeed a reflection of how cultural feminism was present in their society known as â€Å"the vagina monologues†. In her book Baumgardner (2011:102) writes about a how the series of fictional stories inspired by the real life experiences of women of different races, ages and ethnicity on their sex life’s, relationships and personal struggles inspired plays in different universities across the nation gave birth to the V-day an international movement that stands to end violence against all women and girls. This wave of popular culture encouraged not just the lesbian woman but the heterosexual female to be proud of every bit of her womanhood and sexuality. In (Alcoff, 1995:435) suggest â€Å"woman should not dismiss their biological importance simply because patriarchy has used it to overpower us, our biological make up and the paradox of a woman’s body holds the key to reconnecting with ourselves, our inner genius and beguiling physicality. † Cultural feminist movements today and the fight against FGM A primary concern of cultural feminism today can be seen in the stance against Female Genital Mutilation (FGM). Which according to (WHO, 2010) involves the piercing, cutting and burning off of the clitoris or labia and the stitching of the vagina. It is the horrific violation of women’s rights and is predominantly practiced as a result of cultural beliefs in Africa. (UNICEF,2011)estimates the number of women being subjected to FGM in Africa today ranges between 100 to 130 million, FGM is most prevalent in Ethiopia, Kenya, Sudan and Somalia which has approximately 98% of girls being mutilated. This is an important example of why feminist movements are still needed because third world feminist struggles and first world struggles differ. Feminist movements have developed non governmental organisations like (The Feminist Majority Foundation, 2010) Amnesty International group that seeks to replace cultural practices like FGM with symbolic ceremonies that will still promote traditional beliefs without causing any physical harm. Such Non-Governmental organisations truly represent how feminism has evolved and has become more concerned with helping vulnerable groups without the help of government aid or funding to address struggles and inequalities by providing health care without asking for anything in return and advocating for policy development and policy change that affects women. Radical feminism  It can be said that radical feminism is at the root of all types of feminism. Bates (2005:66) states that radical feminism has been the incubator from which many feminist ideas rose, from the period of 1967-1975 radical feminism was the leading edge of most feminist theory, however it is no longer fit to solely describe â€Å"feminism†. It is often misrepresented as women who detest men when in actual fact it is about women who detest patriarchy. Nachescu (2009:30)mentions how radical feminists challenged the knowledge of politics under their slogan â€Å"the personal is political† this redefined political areas that affected human life such as abortion and contraceptive laws all of which were previously part of ones personal life. Sexuality and the â€Å"closet feminist† Generally feminism is torn between two opinions on the issue of sexuality; some believe sex is the root cause of female oppression whilst others believe it is what truly liberates a woman. Prostitution challenges female liberation from male objectivity especially in states where sex work has been legalised creating miscommunication between radical feminists and prostitutes. According to (Morris 2007:6) â€Å"they only believe in finding a way for prostitutes to escape but what is wrong with having sex for a living, who am I to you if I enjoy how I earn a living, and are such people without dignity? †. Although this may be a sensitive topic, the legalisation of prostitution in some countries has served to protect sex workers. Today even though one might support various issues of feminist concern, no one wants to bear the title of the ball busting ice queen. The modern woman fears being branded as a narrow minded cliche of a radical feminist who would much rather burn a bra than buy one. Women prefer to be recognised as non-neutralists and are more content to make a sizable anonymous donation than stand and protest for the cause itself. This has sparked a trend of â€Å"closet feminists† who are deluded by the so called illusion of â€Å"having it all†. Genz, 2009:101)The modern woman can be described as an individual figure that tips her hat to past feminist accomplishments but now thinks of them as superfluous and extreme. Feminism and why the cause will never die The struggle has changed but the cause is still very much the same, society may have guaranteed equality for women on paper but in actual reality there are still hidden mechanisms still obstructing progress. Over time feminist movements have addressed the most obvious struggles and inequalities like education, equal pay and reproductive rights which previously were hard to detect at individual level. However(New York Times, 2011:22)reported â€Å"the right to vote was only granted to women by King Abdullah of Saudi Arabia in 2011 but women will only be allowed to vote or run for municipal positions in 2015 and only with the consent of a male family member. † Even in todays so called â€Å"enlightened era† the lists of human rights denied to women in some parts of the world are appalling. Feminist movements are still present addressing the relationship between oppression and power, which is evident in today’s society as sexual harassment and rape and attacks on the gay and lesbian communities. Roy (2011:12) journalist at the New York Times reported the rape of a 15 year old girl in New Delhi, India the story made headlines because her attacker was granted a reduced sentence on the account that he was his family’s primary breadwinner. These injustices have given birth to different kinds of global movements such as the â€Å"slut walk† in which women protest on the right to wear what they choose without fear of male attack or rape. (Reader: 2012) reports on women and men taking their protest to the streets after a Toronto police officer accused a rape victim of â€Å"asking for it† flashes of cleavage and legs on show their slogan reads â€Å"consent is sexy†. Too often very light is shed on such organised protests but this is a specific example of how the feminist movement is not over it is merely manifesting itself in different ways.

Treatment Options in Recurrent GBM Research

Treatment Options in Recurrent GBM Research Strategies for clinical applications The multi-omics data may also reveal important leads for therapeutic applications. A very recent review on GBM, reported outcomes of clinical trials investigating current treatment options in recurrent GBM, including anti-angiogenic, signaling pathway blockade and immunotherapy based approaches (1). However the genetic and cellular heterogeneity reflects in the modest results obtained so far. This necessitates identification and validation of better therapeutic targets and active strategies to combat GBM. Some novel strategies are showing promise in Phase II trials and preliminary data is becoming available, such as, EGFRvIII peptide vaccine, Rindopepimut; CD95 targeted monoclonal antibody, APG100 and multi-targeted tyrosine kinase inhibitor cabozantinib (1). A multi-pronged approach targeting a panel of proteins may thus hold the key to eliciting a synergistic response and prove more beneficial than current treatment modalities targeting individual markers. When it comes to circulat ory or plasma-based biomarkers, in view of the technical limitations encountered in deep and direct plasma analysis as discussed earlier, alternate methods which would allow prediction of tumor related molecules and their targeted exploration would be highly useful. One of the outcomes of the study was the identification of effective strategies for data analysis and integration, facilitated by the bioinformatics tools available today. It shows experimental identification of proteins passed through the screen to ensure analytical rigor and functional relevance as above (Stage 1). Biologically important and potential tumor specific proteins identified in expression studies are then assessed for their secretory potential based on computational prediction algorithms for signal peptide and transmembrane domain containing proteins, such as, SignalP and TMHMM, respectively and via non-classical secretory mechanisms using SecretomeP. These proteins are further prioritized based on their de tectability and occurrence in proteomic data for secretome, CSF and plasma analysis (normal or patient) (Stage 2). The potential secretory candidates are then explored in plasma in a targeted manner (Stage 3). Interestingly, some of these proteins were identified in analysis of plasma or CSF from GBM patients (2, 3). Once bioinformatically scrutinized as above and compiled, the candidate biomarker panels, can be subjected to validation and experimentation in cohorts of tissue sections, blood plasma/serum specimens from patients (Stage 4). We believe construction of such high confidence protein panels would be a valuable paradigm for studies in larger cohorts in clinical experimental designs. High confident lead candidates for experimental application GBM Secreted proteins Secreted proteins have an integral role in GBM tumorigenesis through cell growth, migration, invasion, and angiogenesis besides being important in normal physiological processes and thus instrumental to the discovery of cancer biomarkers. Besides being useful as markers for typing the tumor, their presence in easily accessible body fluids makes them useful for monitoring the disease progression or treatment response and recurrence. A thorough survey of all available literature was done to identify the several candidate biomarkers have been reported in serum or plasma of GBM patients and these are shown in Table 1 in Chapter 1. However, such potential and promising new biomarkers are yet to be rigorously evaluated for application against this unmet need. Non-invasive methods based on circulatory biomarkers would be useful for monitoring not only GBM patients but also for lower grades Grade II and III tumors that exhibit longer survival periods. Further, some new reports on circulating tumor DNA (ctDNA) that have identified in the plasma of GBM patients such as mutated IDH1 DNA (4), methylated MGMT DNA (5) and EGFRvIII mutant DNA (6). The highly sensitive sequencing based methods for detection of circulatory tumor DNA (ctDNA) in patients plasma are under progress (7). These ctDNA markers shed by dead tumor cells may surface in future to be reasonable indicators for tumor diagnostics. Kinases in GBM Identification of GnRH signaling pathway using an alternate approach As mentioned in Chapter 2, I used alternate approaches to enhance pathway views by targeting specific protein families, i.e. kinases. Protein kinases (PKs) are well known therapeutic targets in different cancers and a family of proteins that are major components of signal transduction pathways acting as membrane receptors (RTKs) or as intracellular signaling mediators (non-receptor PKs) and several protein kinases have been implicated in gliomagenesis (8, 9). Several studies have also shown altered expression of protein kinases in GBM and targeted therapies directed towards RTKs using kinase inhibitors are in clinical trials (10, 11). There is renewed optimism in the use of kinase inhibitors to treat GBM (12). New therapeutic strategies have emerged that use multi-targeted kinase inhibitors to simultaneously disrupt multiple kinases (13). The GBM data was found to be enriched with several kinases. A total of 102 kinases were present in GBM datasets; 77 different kinases in transcript omics data and 30 kinases in proteomics data with 26 in common between them.   Pathway analysis using these kinases revealed GnRH signaling as the top pathway that has still not investigated in the context of GBM. We observe an overall enrichment of about 129 entities from omics datasets of which 26 kinases and 57 non-kinase members are coming from the concordant (n=711) transcriptome and proteome dataset. The 26 concordant kinases along with their fold changes are shown in the Figure 48 below. A large proportion of GnRH pathway entities include kinases (MAPKs, CAMKs, and RTKs) that enabled its identification as a top pathway using this approach. A targeted search of other non-kinase members of the pathway resulted in additional members of the pathway in omics datasets that further increased its significance value. In GBM, it has been shown that human GnRH receptors are expressed in tumor cells and receptor activation affects apoptosis, adhesion and angiogenesis to promote tumorigenesis. GnRH signalling as a possible therapeutic target in cancer has already been suggested and put together with my observations it strongly supports this possibility in the context of GBM. The expanded hand-curated map of GnRH signaling is a valuable resource for the scientific community. Expression of GnRH and GnRH receptor has been reported in GBM cell lines and tissue samples at both mRNA and protein levels concordant with clinical data obtained using GBM tumor tissues and treatment with GnRH agonists resulted in anti-proliferative activity (14-16).There is also evidence that the analogues can cross the blood-brain barrier, indicating suitability for treatment of malignant glioblastomas (17). Given the significance of this pathway in cancers and GBM, further understanding the molecular interplay involving GnRH signalling pathway in light of my findings will reveal is use as a potential molecular and therapeutic target.      Ã‚   Glioma Amplicon and Risk Regions The protein coding genes implicated in Glioma and other cancers were clustered based on their chromosomal locations using Gene Set Enrichment Analysis tools to compute overlaps with positional gene sets from Molecular Signatures database and further clustered based on proximity to other known oncogenes from Atlas of Genetics and Cytogenetics in Oncology and Haematology data resource, to identify colocalized gene clusters on Chr. 12 and other chromosomes as shown in Chapter 3. An important finding was that larger number of overexpressed differential regulated genes in glioma datasets mapped to two significant regions the glioma amplicon (n=37) in 12q13-15 region and the glioma susceptibility (n=16) in the 12p13 region implicated as a major risk region in patients with a family history of gliomas. The discovery of these two clusters of overexpressed genes provides a biological validation of mass-spectrometry derived data. Apart from these two essential regions, several genes from the glioma dataset were found to cluster around amplicons on other chromosomes and other known cancer associated genes that were not identified in GBM datasets but present in close proximity to them. These can be investigated in a more targeted manner in glioma.   Many studies have been done to understand the biological significance of these amplicon regions in gliomas that indicate that these amplifications are more frequent in gliomas than previously thought and have different distribution patterns in low grade versus high grade tumors (18, 19). Overall, a relative high degree of amplifications and deletions are seen in GBM that have implications on the expression of the genes involved and contribute to relevant pathogenic genes (20). Novel genes and isoforms Alternative splicing increases the repertoire of protein functionality and heterogeneity and aberrant splicing events have been frequently seen in several cancers, including GBM and increasing evidence now points to their important role in tumor initiation and progression. The concept of proteogenomics has emerged rapidly as a valuable approach to integrate mass spectrometry (MS)-derived proteomic data with transcriptomic data to identify novel splice variants. However, the role of alternative splicing in GBM is still nascent and needs to be explored as potential biomarkers or molecular targets. As detailed in Chapter 4, the identification of a novel variant of NCAM1, using a proteogenomics approach with 5 peptide evidences from MS data spanning a novel exonic region, is very significant finding in GBM. NCAMs are well characterized glycoproteins that mediate cell-cell or cell-matrix adhesion among neurons and between neurons and muscle. Several splice variants of NCAM1 have been identified (21, 22) and alterations in these have been found in serum and tissues of brain tumors (23, 24). NCAM1 has 5 known isoforms and also exhibits glycoforms as it can be post-translationally modified by the addition of polysialic acid (PSA), which is thought to abrogate its homophilic binding properties and affect the adhesive properties of NCAM (25). Further, PSA conjugated NCAM, was shown to potentiate migration via FGFR signaling distinct from its adhesion capability (26).   The following observations may be noted with respect to this novel variant: The observation is supported in transcriptomics data in 18 out of 25 RNAseq samples. Multiple gene modelling software such as Augustus, GenScan, AceView and Ensemble support the presence of this novel exon in their gene models and a high degree of conservation was seen as expected for an exonic region. This variant was also separately identified in MS-derived Human Proteome and IvyGAP RNAseq datasets NCAM1 is upregulated in several cancers; however, in GBM both transcript and protein data support its down regulation.   We observed two known forms of NCAM1 as well as the novel form to be down regulated. It is interesting to note that the miRNA (hsa-mir-30a-5p) that regulates NCAM1 is upregulated in GBM indicating the deregulation of a putative oncogenic cascade. In summary, our findings demonstrate the usefulness of combining omics approaches to identify novel putative candidates in GBM. Although, it is not clear if the novel splice variant represents a major or minor form of NCAM1. At the transcript level, it seems to be a minor component; however, preliminary assessment at the protein level is suggestive of it being a predominant form. Regardless, it would be interesting to explore the biological significance of the novel splice variant of NCAM1 and examine its role in GBM tumorigenesis. Hence, in the light of this observation my identification of novel NCAM1 splice variant through proteogenomics analysis using GBM RNAseq data is a very important finding in GBM. The effect of this novel variant on cell-cell adhesion and migration in GBM needs to be further investigated in a targeted manner. Disease implications and targeted analysis Studies suggest that gliomas constitute a rapidly progressing neurodegenerative disease caused by the malignant growth of glial cells that nourish neurons, resulting in a loss of brain function. Glutamate excitotoxicity is observed in several neurological diseases, which is also utilized by gliomas to gain growth advantage (27). My observations that neurological conditions like Alzhiemers and Parkinsons disease share many common genes with gliomas possible indicate shared molecular mechanisms inducing neurodegeneration. Further, the chromosomal mapping of glioma differentials revealed two clusters; one around 12p13 implicated as a glioma risk region and another around 12q13-15 region harboring a glioma amplicon with several overexpressed and amplified genes. Hence, extracting gene/disease associations and generation of a glioma-centric functional and diseasome network is important for understanding GBM tumorigenesis. Further, this region was found to be enriched in several cancers in cluding other brain neoplasms and neurological diseases that may share disease genes and processes with gliomas. Only 22 of the observed 108 disease genes in the diseasome network were identified in our proteomic analysis. The other 86 disease genes implicated in gliomas but not identified in our dataset can be investigated in a more targeted manner in gliomas, providing a global view of linkages between disease phenotypes. Additionally, the finding that chromosomal proximity of genes may have an impact on their functions can be used to explore the functions of missing proteins mapping within functional cassettes of related protein/genes. Such investigations offer newer paradigms that may be valuable to investigate and present clinically important targets. Future Scope Metabolomic data integration and potential Compared to the genome and proteome, metabolome represents the phenotypic changes more closely and has already been investigated for malignancies such as breast, ovarian, colon, prostrate and esophageal cancers. This line of investigation has been extended to gliomas albeit on a smaller scale, revealing novel insights into the role of metabolites in GBM tumorigenesis (reviewed in ref. (28)). Previous studies have revealed how mutations can lead to generation of oncometabolites such as 2-hydroxyglutarate (2-HG) specifically in IDH1 mutated gliomas (29). The discovery by Otto Warburg that cancer cells prefer to metabolize glucose through a seemingly inefficient process of aerobic glycolysis   led to the application of 18-FDG-PET imaging to predict the histological grade of gliomas.   Using this technique we could now distinguish low grade gliomas that have low specific uptake (SUV) values from grade III and IV that have higher SUVs.   One study performed global metabolic profilin g using mass-spectrometry coupled to liquid/gas chromatography on patient derived tumor samples and found increased levels of glutathione, tryptophan and metabolites associated with phentose phosphate and nucleotide synthesis and glycolytic intermediates such as phosphoenolpyruvate (PEP) and 3-phosphoglycerate (30). These studies have collectively provided a window of opportunity for further investigation and integrating these changes with the changes at proteomic, transcriptomic and genomic levels will be the next big step in to study the underlying biology of these tumors. Improving pathway analysis with phosphoproteomics data Protein phosphorylation plays a central role in transmitting the signal from outside the cell through a cascade effect into an intracellular signal to control the biochemical pathways in all living cells. This mechanism of activation or deactivation can be orchestrated by protein kinases via phosphorylation and phosphatases via dephosphorylation. Modifications to these signaling networks via mutations or abnormal protein expression or post-translational modifications may underlie both development and progression of tumorigenesis. Glioma Repository In order to facilitate annotation of key terms and manage the collection of high-throughput data coming from different omics technologies and platforms and make it easier to store and retrieve large amounts of information, I proposed to a schema for data annotation, collection and deposition. The data will be stored in the backend, in separate tables in a relational database (RDBMS), to enable effortless retrieval of key information for particular candidates of interest and also allow for complex querying. The outline for the schema is given below. Figure 49: Schema for development of a glioma repository

Interview With The Vampire :: essays research papers

This novel, “Interview with the Vampire';, by Anne Rice, is by far one of the best book I’ve ever read. It started with a young boy interviewing a vampire, and the vampire related him the whole story of his life, how he became a vampire, his thrilling adventures through the centuries and his complex relationships with both the mortals and the immortals. In my opinion, Anne Rice had done the best of jobs. The writing and the detailed descriptions, the composing of this novel, had brought out every emotion of the characters like the flick of a whip. The rage, the love, the hatred, the sufferings, the darkness, the pain and the terror, were all presented so vividly as if in front of my eyes, as if I were really part of the character. I think Anne Rice had created the most successful characters. Throughout the whole book, you can really look at the conflicts between them. They are, somehow, attached or attracted by each other, both the mortals and the immortals. Their love and hate and struggles go to such degrees, and yet limited by their nature, it was almost impossible to understand it at all. I believe Anne Rice had used those characters to express humanity, the whole plot was some kind of an irony. Something like a metaphor, though she exaggerated everything to make it poignant enough. Not only were the characters a success, the time and place details were incredible. The costumes, ways of manner, history and every background changes as the years passed, and she made the backgrounds so realistic that I could almost feel everything surrounding me. Actually I think Anne Rice had done such a great job that this book should be counted as literature.

Financial Management Questions

Q5. Putting yourself in the position of an existing shareholder(investor) of your company, using both the annual corporate report and the information about your company’s share price in the Financial Times, provide a recommendation (with reasons) whether you rate your company’s shares as Buy, Hold or Sell. There are a wide range of factors that affect share price. These include interest rates, inflation, the performance of the industry/sector the company is in, the performance of the company itself, and the market supply and demand for the companies’ shares.The following graph shows Marks and Spencer’s share price over the last 12 months. http://corporate. marksandspencer. com/investors/shareprice/chart Accessed: 05/12/11 By viewing the graph, we can see that there have been numerous fluctuations in share price over the last 12 months. At the start of the year share price was at around 370 pence per share and dropped down to around 330 pence per share afte r 3 months. There was then a surge in share price which reached over 400 pence per share at its peak in May.It then fell to its lowest point, just above 300 pence per share in September and there have since been small fluctuations in share price. Its current share price is at 329. 00 but we expect it to continue to fluctuate slightly before finally increasing again into the New Year, as share prices do generally remain low over the Christmas period. The following table is share information that was published in The Financial Times weekly update on Monday 5th December 2011. | |Price |Wks% Chg | Div |Div Cov |Mcap ? | Last xd | |Marks&Sp |330. 10 |+7. 3 |17 |2. 3 |5,233. 3 |16. 11 | Using the data available from this table and information published in the annual company report, we can work out dividend yield and dividend cover. â€Å"Dividend yield tells you the percentage cash return on the investment, and can be directly compared with interest rates and other investment opportuniti es. It expresses the dividend per share as a percentage of the current share price† (McKenzie, 2010:385).It is therefore worked out by dividing the dividend per share which is 17 pence, by the current price by share, which is 330. 10, and then multiplying the answer by 100. The dividend yield can then be worked out as 5. 17%. This would therefore be a worthwhile investment considering many interest rates for banks are less than 1%. The dividend cover â€Å"measures how many times the dividend could be paid from the available profits† (McKenzie, 2010:384). The financial times reveal that the dividend cover is 2. 3, and therefore the dividend could be paid 2. 3 times out of Marks and Spencer’s available profits.This shows that Marks and Spencer are using quite a substantial amount of profit to pay out dividends, nearly half. This may be rewarding for a shareholder looking for a quick return, however, shareholders who are looking to invest in Marks and Spencer in th e long run may find it more beneficial if Marks and Spencer’s reinvested their profits into the business. Taking everything into account, we would recommend a shareholder to hold their shares, as we believe that there will be a rise in share price in the coming months, so they will therefore make a better return if they do wish to sale in the future.The dividend yield shows that Marks and Spencer offer a good return on investment, compared with other alternatives such as bank interest rates. And also they use a considerable amount of their profits to pay shareholders dividends, so we believe it would be worthwhile holding onto the shares for the time being at least. Financial Times, Monday December 5 2011, p. 26 McKenzie, W. (2010) Using and Interpreting Company Accounts. FT Prentice Hall. p. 384-385

Web Design Essay

Web Design Essay Web Design Essay | Assesment One | Web Systems BN102 | | | Rachael Mayhew MIT 110101 | Tanya Linden | | 1.0 | Introduction The â€Å"bad† website I have chosen to critique is a website designed to advertise a book named â€Å"The Bombshell Manual of Style – by Laren Stover†. The website begins with a few flash images moving around, which then leads to you needing to remove images of underwear before you can move forward. You are given the option of completing a quiz designed to see if you are a ‘bombshell’, or the option to skip and move straight to the crux of the site. The website content mainly consists of little facts about the book or what a typical bombshell is as you move on, till you eventually get to the end at which point you are offered a way to purchase the book. 2.0 | Visual Effect 2.1 Colour Scheme The colour scheme is a white background with pink or black typography. Pink colours, depending on the shade, are sometimes associated with love, romance or youth from the viewer’s point of view. However white is seen as cold and sterile which is a contrast to the use of pink. There are many images used on this website so this may be the reason for a simple colour scheme (Empathizing Color Psychology in Web Design, 2013). 2.2 Imaging I am using a laptop with a screen resolution of 1366 x 768, and as can be seen in Appendix One from the original website, www.bombshellmanual.com, the images used are pixelated heavily. This is seen with every image used which is numerous, including the flash images. Most of the text throughout the website is a simple and readable font; however the hyperlinks to different parts of the website are cursive flash images. 2.3 Page Layout The main content of this page is centred with much space on either side. This however, may be a deliberate move due to the fact on more than one occasion you must ‘uncover’ the text by moving images from on top of the text to the outer text. 3.0 | Navigation The navigation, or lack thereof on this website, is a purely a forward momentum with no chance to go backward. If you step off the main path, there is no option to go back or even start again unless you refresh. After the initial quiz, if you chose to do so, you cannot skip if you change your mind halfway through. To continue forward there is an image of a dog that you must click and drag that urges the website to load the first content page. This dog image actually caused me to start again from the beginning due to not moving it all the way across when initially asked to move it. I then tried to move it a second time as I could not see the text (see Appendix Two) which prompted everything to begin again. As you progress by hitting the â€Å"more† hyperlink, it moves into a different spot after each page changes, making it difficult to move quickly through if you have already read these pages. At no point are you offered all of the options like â€Å"purchasing the book† or â€Å"Bombshell Bulletins and Resources† at once, nor can you skip to the end or the beginning at will. When you get to the very end, your only option is to go back to the previous page (the only time this option is offered) or to go to Amazon.com to purchase the book. Clicking the picture will direct you straight to their website by opening a new tab. The main fury in the navigation is that if you accidentally move forward, you have no way to get back. You cannot even go back a page on your browser (I am using Explorer 9). Many of the hyperlinks that suggest to some different content do not actually work. I am unsure whether this was because they actually did not go anywhere or the page could not move on. I opened this also on my iPhone where it promptly told me that I could not see all their moving images due to not having Adobe flash player. However, I was able to see the content much clearer than on Internet Explorer, the navigation through pages was just as difficult. 4.0 | Content Amazon’s write up of the book

Freud1 essays

Freud1 essays In several of his books, including Introductory Lectures on Psychoanalysis and On Dreams, Freud combines the topics of forgetting a proper name and dream analysis, formulating a thesis that helps to clarify his theories on both. He describes in psychoanalytic terms the mechanisms behind forgetting of a proper name and how they relate to the methods used in dream analysis. By looking at the two topics from a joint perspective, we can gain a greater understanding of them and how they relate to other areas of psychoanalysis. The tendency toward forgetting of a proper name is an important theme in Freuds work. He explained the way in which forgetting something like a name was actually a substitute for forgetting something that, unconsciously, an individual does not wish to remember. He described the unconscious force that prompted this forgetfulness as a counter-will, or an unconscious desire parallel to an individuals conscious desire. According to Freud, there is a connection between what one consciously forgets and what one unconsciously wants to forget. When a person has some unpleasant thought or issue that they wish to banish from their mind, the will to forget may miss its target, and the wish to forget may manifest itself in some other way. In this case the individual may forget something seemingly unconnected to the thought they wish to banish, such as a proper name. Freud gives some relevant examples of this phenomenon in Introductory Lectures: For instance, if we have temporarily forgotten a name, we are annoyed about it, do all we can to remember it and cannot leave the business alone. Why in such cases do we so extremely seldom succeed in directing our attention, as we are after all anxious to do, to the word which (as we say) is on the tip of our tongue and which we recognize at once when we are told it? Or again: there are cases in which the parapraxes mul...

Decolonization of the Filipino American Mind Essay Example

Decolonization of the Filipino American Mind Essay Example Decolonization of the Filipino American Mind Paper Decolonization of the Filipino American Mind Paper Berdahl, R. O. , Gumport, P. J. (Eds. ). (1999). American Higher Education in the Twenty-first Century: Social, Political, and Economic Challenges. Baltimore, MD: The John Hopkins University Press. Baldazo, P. G. (March 1991). The good, the bad, the beautiful, and the ugly in Filipino cultural values. Heritage, 5(1), p. 6. Barringer, H. R. , Takeuchi, D. T. , Xenos, P. (January 1990). Education, occupational prestige, and income of Asian Americans. Sociology of Education, 63(1), pp. 27-43. Blair, S. L. Qian, Z. (July 1998). Family and Asian students’ educational performance. Journal of Family Issues. 19(4), p. 355. California Postsecondary Education Commission (2000). College-Going Rates of California Public High School Graduates by Racial/ Ethnic Group, Fall 1997 to Fall 1999. Higher Education Performance Indicators. Sacramento, California. Callan, P. M. , Finney, J. E. , Bracco, K. R. , Doyle, W. R. (Eds. ). (1997) Public and Private Financing of Higher Education. Phoenix, AZ: Oryx Press. Constantino, R. (2000). The mis-education of the Filipino. Journal of Contemporary Asia. 30(3), pp. 428-44. Espiritu, Y. L.. (1992). Asian American Panethnicity: bridging institutions and identities. Philadelphia, PA: Temple University Press. Espiritu, Y. L. , Fujita Rony, D. , Kibria, N. , and Lipsitz, G. (June 2000). The Role of Race And Its Articulations for Asian Pacific Americans. Journal of Asian American Studies, pp. 127-137. Fong, T. (1998). The Contemporary Asian American Experience. Upper Saddle River, NJ: Prentice Hall. Fulgado, C. Q. (September 1991). Speaking on education. Heritage, 5(1), pp. 17-18. Gendrano, V. P. (Fall 1996). Understanding Filipino parents and grandparents. Heritage, 10(3), p. 20-21. Guillermo, E. (2002, February 5). Side-by-side: U. S. lies and broken promises. SF Gate. Retrieved December 4, 2002 from the World Wide Web: http://sfgate. com/cgi-bin/article. cgi? file=/gate/archive/2002/02/05/eguillermo. DTL. Harrison, F. V. (1995). The Persistent Power of â€Å"Race† in the Cultural and Political Economy of Racism. Annual Review of Anthropology, 24, 59. Heller, D. E. (Ed. ). (2001). The States and Public Higher Education Policy: Affordability, Access and Accountability. Baltimore, MD: The Johns Hopkins University Press. Kang, K. C. (1996, January 26). Filipinos happy with life in U. S. , but lack united voice. Los Angeles Times, p. A1. King, R. C. (June 2000). Racialization, Recognition, and Rights: Lumping and splitting Multiracial Asian Americans in the 2000 Census. Journal of Asian American Studies, pp. 191-217. Luzzo, D. A. (October 1993). Ethnic Differences in College Students’ Perceptions of Barriers to Career Development. Journal of Multicultural Counseling and Development, 21(4), pp. 227-236. Okamura, J. Y. Agbayani, A. R. (1997). Pamantasan: Filipino American Higher Education. In M. P. P. Root (Ed. ). Filipino Americans: Transformation and identity (pp. 183-197). Thousand Oaks, CA: Sage Publications Inc. Pimentel, B. (1999, January 31). White Man’s Forgotten War. San Francisco Chronicle. Retrieved December 4, 2002 from the World Wide Web: http://sfgate. com/cgi-bin/article. cgi? file=/chronicle/archive/1999/01/31/SC16131. DTL. Rodis, R. 2002, April 3). Losing track of one’s census. New California Media. Retrieved September 27, 2002 from the World Wide Web: http://news. ncmonline. com/news/view_article. html? article_id=119. Roley, B. A. (2001, August 20). Filipinos- the hidden majority. San Francisco Chronicle. Retrieved September 27, 2002 from the World Wide Web: http://sfgate. com/cgi-bin/a rticle. cgi? file=/chronicle/archive/2001/08/20/ED194136. DTL. Root, M. P. P. (Ed. ). (1997). Filipino Americans: Transformation and identity. Thousand Oaks, CA: Sage Publications Inc.. Rumbaut, R. G. (2002, May 22). Competing Futures: The children of America’s newest Immigrants. Migration Information Source. Retrieved September 27, 2002 from the World Wide Web: migrationinformation. org/Feature/print. cfm? ID=1. Sargon, E. (2001, January 19). California’s misplaced priorities deny equal rights. Daily Nexus Online. Retrieved September 27,2002 from the World Wide Web: dailynexus. com/opinion/2001/205. html. Schirmer, D. , Shalom, R. (Eds. ). (1987). The Philippines Reader: A history of colonialism, neocolonialism, dictatorship and resistance. South End Press. Takaki, R. (1989). Strangers From A Different Shore: A history of Asian Americans. New York: Penguin Books. The Filipino Crisis in Higher Education. Retrieved September 27, 2002 from the World Wide Web: ocv/berkeley. edu/~pass/crisis. html. U. S. Department of Education, National Center for Education Statistics. (July 2002). NCES Profile of Undergraduates in United States Postsecondary Institutions (1999-2000) Statistical Analysis Report (NCES 2002-168). Washington D. C. : Office of Educational Research and Improvement. Wolf, D. L. (Fall 1997). Family secrets: transnational struggles among children of Filipino immigrants. Sociological Perspectives, 40(3), p. 457(26)

Marketing Research Plan Essay Example | Topics and Well Written Essays - 1500 words

Marketing Research Plan - Essay Example To ensure we get cooperation on the study, we intend to visit at least two universities that offer both fulltime and online degrees modules to their students. We will also visit two companies to study on those who are not studying but intend to study so as to know what would motivate them to study an online degree course. We intend to spit this study into three distinct steps as follow: The first step will involve use of a questionnaire that will be utilized to get at the base of motivations on what would happen if those working fulltime have other options of studying. This study would only involve only those who are studying the online degree programme. The second step would involve direct interviewing of all students on the university on what would motivate them to take an online degree. This interview would involve both those in fulltime and part-time base programme. We intend to approach the administration of the two universities that offer online degree programm... The Study 1 We intend to approach the administration of the two universities that offer online degree programmes. We will use over observational approach in this study whereby we will identify ourselves as researchers and clarify to them on the main rationale of the study. For this case, we will request them to give us the contacts of those studying online degree programmes in their university. We will get their contacts especially email address and we would send them our questionnaire to them. The following questionnaire will be use in this study. The students will be expected to fill the questionnaires and email them back to us on their views regarding online degree courses. Study 2 The second study will involve direct interviewing students at the university. We will pick students at random at the university and interview them concerning online degree courses. We will introduce ourselves to students as researchers and our intention our carrying out the research. We would spend around 15 to 20 minutes with the students and discuss their view in regard to online degree course. After this, we would compile discussion and come up with the correct ideas on the best view concerning online degree courses. Questionnaire Choice Question Note: Question 1 - 5 has no specific quantifiable value; they are intended to measure affiliation with those already studying online degree programme. I. Which degree programme did you use in your previous study Fulltime programme _______________ Online Programme _______________ II. Which degree programme would you prefer today Fulltime programme _______________ Online Programme _______________ III. Why do you prefer the degree programme chosen above Convenience ________________ Cost

Professnational email Essay Example | Topics and Well Written Essays - 500 words

Professnational email - Essay Example The third step involves clearly stating the reason for writing the e-mail. The sender needs to begin by telling their recipient that they are writing for a specific intention such as, â€Å"†¦I am writing to outline my response on†¦Ã¢â‚¬  or even, â€Å"†¦in line with your request, I hereby respond to the allegations†¦Ã¢â‚¬  This step makes it easy for the recipient to understand the reasons for writing the e-mail without reading the entire email. This part also allows the recipient have a clear reference to previous communication with the sender. If the e-mail is a response, the sender needs to begin by thanking the recipient (Chan 22). If not, it is still important that the sender briefly appreciates the chance of writing to the recipient. Proper grammar and punctuation needs to be followed at all times. The sentences in the purpose statement must be short and very precise in their meanings. After the brief purpose statement the sender to give more details o n the contents of the e-mail with an aim to clarify their subject (Chan 63-5). The next step is the closing remarks. This part involves showing gratitude to the recipient (Chan 54). The language should be very courteous and polite. A good example is, â€Å"†¦I value your patience and hope that you will consider my remarks†¦Ã¢â‚¬  The last step is the closing section. In this section, the sender should include a suitable closing. Appropriate closing remarks for professional e-mails include â€Å"Best Regards†, â€Å"Thank you†, and â€Å"Yours sincerely†, amongst others since they are appropriate for professional e-mails (Chan 54). The sender should then include their name and signature. The signature proves the authenticity of the e-mail and should come before the sender’s name. After the writing the e-mail, it is of great essence that the sender proofreads their email to check for grammar and spelling mistakes. The sender should then read the e-mail one more time to countercheck on the structure and flow

Logistics as a Customer-Focused Strategy Essay Example | Topics and Well Written Essays - 750 words

Logistics as a Customer-Focused Strategy - Essay Example As the world of business and trade continue to expand globally, surviving in such a competitive market is no longer enough to buy the right goods at the right cost - business must also get them to the right place at the right time, and with the right operational costs. Doing this well requires the best possible logistics, combining the information that establish buying decisions with how the product arrives to customers at the most cost-effective way. In view of this, the vice president for logistics and electronic commerce for Asia-Pacific at FedEx, William Conley stressed that one of the four areas represented the future of the logistics industry is time compression, along with globalisation, electronic commerce and supply chain management. He said companies needed to understand essentially what logistics was and how it could benefit customers (Panozzo, 1999, p. 6).In further elaboration, logistics is centred on creating value, not just for customers and suppliers of the firm, but also value for the firm's stakeholders. Value in logistics is primarily expressed in terms of time and place. Products and services have no value unless they are in the possession of the customers when (time) and where (place) they wish to consume them (Ballou 2004, p. 6). However, value is added when customers are willing to pay more for a product or service than the cost to place it in their hands. To many firms throughout the world, logistics has become an increasingly important value-adding process for a numerous reasons. Looking at logistics through the perspective of the total supply chain, the ultimate Bowersox, Closs & Cooper (2002) emphasized that the customer is the end user of the product or service whose needs or requirements must be accommodated. It has historically been useful to distinguish between two types of end users. According to them, the first is a consumer, an individual or a household who purchases products and services to satisfy personal needs. When a family purchases an automobile to be used for personal transportation, that family is the consumer of the supply chain. The second type is an organizational end user, whose purchases are made by organizations or institutions to allow an end user to perform a task or job in the organization. When a company buys an automobile for a sales person or buys tools to be used by an assembly worker in a manufacturing plant, the company is considered to be a customer and the salesperson or assembly worker is the end user of the supply chain's products. A supply chain management perspective demands that all firms in the supply chain focus on meeting the needs and requirements of end users, whether they are consumers or organizational end users (p. 66). Moreover, Bowersox, Closs & Cooper (2002) insisted that the customer being serviced should be the first priority and the driving force in establishing logistical performance requirements, regardless

Lyrical Ballads and Hamlet Essay Example | Topics and Well Written Essays - 1000 words

Lyrical Ballads and Hamlet - Essay Example he genuineness of the actions taken by Gertrude as a female character, it is still evident that Shakespeare tries to create a realization of this character as a human being (Stephen 1). Therefore, this paper attempts to scrutinize the extent to which self-hood can be attained through the use of female characters as depicted by Shakespeare in Hamlet and The Female Vagrant by Wordsworth. The realization of the human nature in Gertrude is observed when she drinks the poisoned wine that was prepared by Claudius, her husband, for Hamlet. Looking at this incident critically, it is evident in Act 3 that Gertrude came to herself and felt the guilt behind all the evils she was doing. For instance, it is possible that Gertrude had an affair with Claudius even while she was still married to King Hamlet and probably this is why the marriage between her and Claudius worked out so fast after the King’s death. Moreover, it may still be possible that Gertrude participated actively in secrecy towards the murder of her husband since from the play; she does not seem to consider the claims of her son that his uncle murdered his father, the King of Denmark (Stephen 3). Some of the actions of Gertrude seem to be powered by her wish and ambition to retain her station in the palace and her status as the Queen of Denmark (Stephen 4). These are valid human ambitions, and every other human is bound to be filled with the desire to maintain a royal status. It is therefore not surprising that Gertrude would be willing to do everything to see to it that she retains her status as the Queen of Denmark. What makes this ambition all wrong is going to the extreme; being ready even to see her husband die and start having sex with another man even before long after her husbands death creates a lot of suspicions (Stephen 4). However, despite all the bad things that Claudius did, she finally admitted that she was wrong, although she did not use spoken language to regret her deeds, but her actions

To what extent does the Children Act 1989 achieve its aim of Essay

To what extent does the Children Act 1989 achieve its aim of protecting children that have been or may be harmed by their families - Essay Example Once the child goes into care, there is no doubt that the legal effect is that the local authority gains parental responsibility for the child while the order is effectively in force. It should be noted that a care order automatically brings to an end any residence order that may exist. The Children Act 1989 contains provisions relating to the services that a local authority must or may provide for children and their families. It’s very important to note that for the first time services for children in need and disabled children are brought together under one statute. The government’s voice in protecting the children is very loud and clear. There is no doubt that the Children Act 1989 came into being specifically for the protection of children, and the intention of parliament seems to have been obvious. â€Å"To safeguard and promote the welfare of children in their area who are in need; and so far as is consistent with that duty to promote the up bringing of such children by their families, by providing a range and level of services appropriate to those† â€Å"(a) he is unlikely to achieve or maintain, or to have the opportunity of achieving or maintaining a reasonable standard of health or development without the provision of him of services by a local authority under this part; In cases where a particular local authority has information regarding a child likely to suffer harm outside its area, it is expected to inform the local authority in the area where the child lives or proposes to live. Guidance and Regulations 2008 adds: â€Å"If the child is assessed as being in need and the local authority is concerned that the child is suffering, or is at risk of suffering, significant harm, the authority is under a duty to make, as soon as practicable and, in any event, within 48 hours of the authority receiving the information, such enquiries as it considers necessary to enable it to decide whether it should take action to safeguard or promote the welfare

Innocent Brand and Mc Donald's Case Study Example | Topics and Well Written Essays - 1250 words

Innocent Brand and Mc Donald's - Case Study Example UltimatÐ µly, thÐ µ company is Ð µmploying product positioning along linÐ µs of customÐ µr sÐ µgmÐ µntation to rÐ µach groups who arÐ µ likÐ µly to spÐ µnd monÐ µy on fruit smoothiÐ µs at McDonalds. â€Å"DÐ µspitÐ µ introducing hÐ µalthiÐ µr choicÐ µs such as carrot sticks and frÐ µsh fruit bags, McDonald’s has strugglÐ µd to shÐ µd its unhÐ µalthy, supÐ µr sizÐ µ mÐ µ imagÐ µ. InnocÐ µnt, on thÐ µ othÐ µr hand, has a carÐ µfully cultivatÐ µd and clÐ µvÐ µrly markÐ µtÐ µd Ð µthical brand imagÐ µ, diffÐ µrÐ µntiating it from compÐ µtitors† (CasÐ µ, 2011). This nÐ µÃ µds to bÐ µ donÐ µ in tÐ µrms of two sÐ µgmÐ µnts for targÐ µt markÐ µting, individual buyÐ µrs and rÐ µprÐ µsÐ µntativÐ µ buyÐ µrs. ThÐ µ nÐ µxt stÐ µp in product positioning is to dÐ µtÐ µrminÐ µ how to convincÐ µ thÐ µsÐ µ sÐ µgmÐ µnts that thÐ µy will bÐ µ making a wisÐ µ dÐ µcision in buying this particular kind of smoothiÐ µ, which is bÐ µttÐ µr than thÐ µ compÐ µtitors’ choicÐ µs, and that thÐ µy can rÐ µly on thÐ µ company to mÐ µÃ µt thÐ µir nÐ µÃ µds. To do this, onÐ µ nÐ µÃ µds to kÐ µÃ µp in mind that in tÐ µrms of thÐ µ markÐ µting mix, thÐ µrÐ µ must bÐ µ a balancÐ µ of customÐ µr sÐ µgmÐ µntation and product sÐ µgmÐ µntation. InnocÐ µnt facÐ µs problÐ µms of markÐ µting rÐ µach, targÐ µt markÐ µting, product diffÐ µrÐ µntiation, and brand diffÐ µrÐ µntiation. HowÐ µvÐ µr, thÐ µsÐ µ problÐ µms can bÐ µ turnÐ µd into opportunitiÐ µs. KÐ µy IssuÐ µs ThÐ µ kÐ µy playÐ µrs in thÐ µ casÐ µ includÐ µ managÐ µmÐ µnt and Ð µmployÐ µÃ µs at both InnocÐ µnt and McDonalds. ... FurthÐ µr, pÐ µoplÐ µ bÐ µcomÐ µ fattÐ µr with agÐ µ and thÐ µrÐ µforÐ µ an incrÐ µasing numbÐ µr of childrÐ µn bÐ µcomÐ µ adults with incrÐ µasÐ µd risk. CurrÐ µnt national hÐ µalth goals suggÐ µst that good hÐ µalth should rÐ µflÐ µct a statÐ µ of wÐ µll-bÐ µing, quality of lifÐ µ and frÐ µÃ µdom from disÐ µasÐ µ. GivÐ µn thÐ µ importancÐ µ of wÐ µll-bÐ µing as a national hÐ µalth goal it is nÐ µcÐ µssary to dÐ µtÐ µrminÐ µ thÐ µ Ð µxtÐ µnt to which pÐ µoplÐ µ Ð µxcÐ µÃ µding physiological hÐ µalth standards of obÐ µsity may bÐ µ at risk of low sÐ µlf-pÐ µrcÐ µptions. AnothÐ µr kÐ µy issuÐ µ that thÐ µ casÐ µ brings up is that of Ð µffÐ µctivÐ µ targÐ µt markÐ µting. DÐ µfinÐ µ thÐ µ ProblÐ µm & thÐ µ Opportunity ThÐ µ kÐ µy problÐ µm in thÐ µ casÐ µ is how InnocÐ µnt can rÐ µach its targÐ µt markÐ µt, Ð µspÐ µcially childrÐ µn. â€Å"But, dÐ µprÐ µssingly, morÐ µ than 90 pÐ µr cÐ µnt of kids i n thÐ µ UK do not gÐ µt thÐ µir rÐ µcommÐ µndÐ µd daily intakÐ µ of fruit. ThÐ µ Ð µxpansion of thÐ µ smoothiÐ µs’ distribution into supÐ µrmarkÐ µts such as TÐ µsco’s supports thÐ µ suggÐ µstion that InnocÐ µnt doÐ µsn’t mind whÐ µrÐ µ thÐ µ product is sold† (CasÐ µ, 2011). McDonalds has always bÐ µÃ µn Ð µffÐ µctivÐ µ at markÐ µting to childrÐ µn, so InnocÐ µnt can ridÐ µ thÐ µ largÐ µr company’s coat-tails in somÐ µ ways. But InnocÐ µnt also nÐ µÃ µds to targÐ µt parÐ µnts. In tÐ µrms of busy mothÐ µrs, this targÐ µt markÐ µt may want diffÐ µrÐ µnt things from thÐ µ product than childrÐ µn for any numbÐ µr of rÐ µasons. First of all, oldÐ µr consumÐ µrs arÐ µ buying thÐ µ product dirÐ µctly for thÐ µmsÐ µlvÐ µs, whilÐ µ busy mothÐ µrs arÐ µ buying thÐ µ product for thÐ µir offspring. This should lÐ µssÐ µn thÐ µ product sidÐ µ of thÐ µ markÐ µting mix in tÐ µrms of thÐ µ custom Ð µrs’ individuality, and slant it morÐ µ

Lyrical Ballads and Hamlet Essay Example | Topics and Well Written Essays - 1000 words

Lyrical Ballads and Hamlet - Essay Example he genuineness of the actions taken by Gertrude as a female character, it is still evident that Shakespeare tries to create a realization of this character as a human being (Stephen 1). Therefore, this paper attempts to scrutinize the extent to which self-hood can be attained through the use of female characters as depicted by Shakespeare in Hamlet and The Female Vagrant by Wordsworth. The realization of the human nature in Gertrude is observed when she drinks the poisoned wine that was prepared by Claudius, her husband, for Hamlet. Looking at this incident critically, it is evident in Act 3 that Gertrude came to herself and felt the guilt behind all the evils she was doing. For instance, it is possible that Gertrude had an affair with Claudius even while she was still married to King Hamlet and probably this is why the marriage between her and Claudius worked out so fast after the King’s death. Moreover, it may still be possible that Gertrude participated actively in secrecy towards the murder of her husband since from the play; she does not seem to consider the claims of her son that his uncle murdered his father, the King of Denmark (Stephen 3). Some of the actions of Gertrude seem to be powered by her wish and ambition to retain her station in the palace and her status as the Queen of Denmark (Stephen 4). These are valid human ambitions, and every other human is bound to be filled with the desire to maintain a royal status. It is therefore not surprising that Gertrude would be willing to do everything to see to it that she retains her status as the Queen of Denmark. What makes this ambition all wrong is going to the extreme; being ready even to see her husband die and start having sex with another man even before long after her husbands death creates a lot of suspicions (Stephen 4). However, despite all the bad things that Claudius did, she finally admitted that she was wrong, although she did not use spoken language to regret her deeds, but her actions

Innocent Brand and Mc Donald's Case Study Example | Topics and Well Written Essays - 1250 words

Innocent Brand and Mc Donald's - Case Study Example UltimatÐ µly, thÐ µ company is Ð µmploying product positioning along linÐ µs of customÐ µr sÐ µgmÐ µntation to rÐ µach groups who arÐ µ likÐ µly to spÐ µnd monÐ µy on fruit smoothiÐ µs at McDonalds. â€Å"DÐ µspitÐ µ introducing hÐ µalthiÐ µr choicÐ µs such as carrot sticks and frÐ µsh fruit bags, McDonald’s has strugglÐ µd to shÐ µd its unhÐ µalthy, supÐ µr sizÐ µ mÐ µ imagÐ µ. InnocÐ µnt, on thÐ µ othÐ µr hand, has a carÐ µfully cultivatÐ µd and clÐ µvÐ µrly markÐ µtÐ µd Ð µthical brand imagÐ µ, diffÐ µrÐ µntiating it from compÐ µtitors† (CasÐ µ, 2011). This nÐ µÃ µds to bÐ µ donÐ µ in tÐ µrms of two sÐ µgmÐ µnts for targÐ µt markÐ µting, individual buyÐ µrs and rÐ µprÐ µsÐ µntativÐ µ buyÐ µrs. ThÐ µ nÐ µxt stÐ µp in product positioning is to dÐ µtÐ µrminÐ µ how to convincÐ µ thÐ µsÐ µ sÐ µgmÐ µnts that thÐ µy will bÐ µ making a wisÐ µ dÐ µcision in buying this particular kind of smoothiÐ µ, which is bÐ µttÐ µr than thÐ µ compÐ µtitors’ choicÐ µs, and that thÐ µy can rÐ µly on thÐ µ company to mÐ µÃ µt thÐ µir nÐ µÃ µds. To do this, onÐ µ nÐ µÃ µds to kÐ µÃ µp in mind that in tÐ µrms of thÐ µ markÐ µting mix, thÐ µrÐ µ must bÐ µ a balancÐ µ of customÐ µr sÐ µgmÐ µntation and product sÐ µgmÐ µntation. InnocÐ µnt facÐ µs problÐ µms of markÐ µting rÐ µach, targÐ µt markÐ µting, product diffÐ µrÐ µntiation, and brand diffÐ µrÐ µntiation. HowÐ µvÐ µr, thÐ µsÐ µ problÐ µms can bÐ µ turnÐ µd into opportunitiÐ µs. KÐ µy IssuÐ µs ThÐ µ kÐ µy playÐ µrs in thÐ µ casÐ µ includÐ µ managÐ µmÐ µnt and Ð µmployÐ µÃ µs at both InnocÐ µnt and McDonalds. ... FurthÐ µr, pÐ µoplÐ µ bÐ µcomÐ µ fattÐ µr with agÐ µ and thÐ µrÐ µforÐ µ an incrÐ µasing numbÐ µr of childrÐ µn bÐ µcomÐ µ adults with incrÐ µasÐ µd risk. CurrÐ µnt national hÐ µalth goals suggÐ µst that good hÐ µalth should rÐ µflÐ µct a statÐ µ of wÐ µll-bÐ µing, quality of lifÐ µ and frÐ µÃ µdom from disÐ µasÐ µ. GivÐ µn thÐ µ importancÐ µ of wÐ µll-bÐ µing as a national hÐ µalth goal it is nÐ µcÐ µssary to dÐ µtÐ µrminÐ µ thÐ µ Ð µxtÐ µnt to which pÐ µoplÐ µ Ð µxcÐ µÃ µding physiological hÐ µalth standards of obÐ µsity may bÐ µ at risk of low sÐ µlf-pÐ µrcÐ µptions. AnothÐ µr kÐ µy issuÐ µ that thÐ µ casÐ µ brings up is that of Ð µffÐ µctivÐ µ targÐ µt markÐ µting. DÐ µfinÐ µ thÐ µ ProblÐ µm & thÐ µ Opportunity ThÐ µ kÐ µy problÐ µm in thÐ µ casÐ µ is how InnocÐ µnt can rÐ µach its targÐ µt markÐ µt, Ð µspÐ µcially childrÐ µn. â€Å"But, dÐ µprÐ µssingly, morÐ µ than 90 pÐ µr cÐ µnt of kids i n thÐ µ UK do not gÐ µt thÐ µir rÐ µcommÐ µndÐ µd daily intakÐ µ of fruit. ThÐ µ Ð µxpansion of thÐ µ smoothiÐ µs’ distribution into supÐ µrmarkÐ µts such as TÐ µsco’s supports thÐ µ suggÐ µstion that InnocÐ µnt doÐ µsn’t mind whÐ µrÐ µ thÐ µ product is sold† (CasÐ µ, 2011). McDonalds has always bÐ µÃ µn Ð µffÐ µctivÐ µ at markÐ µting to childrÐ µn, so InnocÐ µnt can ridÐ µ thÐ µ largÐ µr company’s coat-tails in somÐ µ ways. But InnocÐ µnt also nÐ µÃ µds to targÐ µt parÐ µnts. In tÐ µrms of busy mothÐ µrs, this targÐ µt markÐ µt may want diffÐ µrÐ µnt things from thÐ µ product than childrÐ µn for any numbÐ µr of rÐ µasons. First of all, oldÐ µr consumÐ µrs arÐ µ buying thÐ µ product dirÐ µctly for thÐ µmsÐ µlvÐ µs, whilÐ µ busy mothÐ µrs arÐ µ buying thÐ µ product for thÐ µir offspring. This should lÐ µssÐ µn thÐ µ product sidÐ µ of thÐ µ markÐ µting mix in tÐ µrms of thÐ µ custom Ð µrs’ individuality, and slant it morÐ µ

Its anti-life Essay Example for Free

Its anti-life Essay Now I’m not going to delve into the argument of whether an unborn fetus is life because that’s a complete and utter waste of time. But I do want to know if life is as valuable as everybody claims. Do you really think about how valuable the life of a beggar is when you meet him or her down the street? Do you value the life of a murderer when you’re facing him at gunpoint? Do you value the life of a corrupt government official when he is using his power for profit? The truth is we only value life when the absence of life is there. The rest of the time we don’t really give a crap about it. We waste life, we self-destruct, we kill, we steal and yet when we see a loved one die or when we find out we’re dying we start valuing life. Isn’t that simply hypocrisy? The truth is, the only life that’s valuable to us is our own life and the lives of those who are close to us. You people rant about how important human life is yet when exposed in our vulnerable state all you see is a facade of hypocrisy to shield your irrational beliefs. You brag about valuing the human life yet all you really care about is your own selfish life. It isn’t life that’s important to humans. What’s important is the â€Å"person† inside each and every human being. You can tell me that the reason why some people don’t care about life is because there is good and there is evil when it comes to people. If that is so then that means that life is also either good or bad. And when it comes to human nature, people almost never put any value into anything that is bad. Euthanasia is defined as the practice of ending a life prematurely in order to end pain and suffering. The process is also sometimes called Mercy Killing. Euthanasia can fall into several categories. Voluntary Euthanasia is carried out with the permission of the person whose life is taken. Involuntary euthanasia is carried out without permission, such as in the case of a criminal execution. The moral and social questions surrounding these practices are the most active fields of research in Bioethics today. Many Supreme Court cases, such as Gonzales v. Oregon and Baxter vs. Montana, also surround this issue. Voluntary euthanasia is typically performed when a person is suffering from a terminal illness and is in great pain. When the patient performs this procedure with the help of a doctor, the term assisted suicide is often used. This practice is legal in Belgium, the Netherlands and Luxemburg. It is also legal in the state of Oregon, Washington and Montana. Passive euthanasia is carried out by terminating a medication that is keeping a patient alive or not performing a life-saving procedure. Active euthanasia involves the administration of a lethal drug or otherwise actively ending the life. These two types of procedures carry different moral and social issues. Euthanasia Debate Controversy There is a lot of controversy surrounding the issue of euthanasia and whether or not it should be legal. From a legal standpoint, the Encyclopedia of American Law categorizes mercy killing as a class of criminal homicide. Judicially, not all homicide is illegal. Killing is seen as excusable when used as a criminal punishment, but inexcusable when carried out for any other reason. In most nations, euthanasia is considered criminal homicide: however, in the jurisdictions mentioned above, it is placed on the other side of the table with criminal punishment. Arguments regarding the euthanasia debate often depend on the method used to take the life of the patient. The Oregon Death with Dignity Act made it legal for residents to request a lethal injection from a doctor. This is seen in other jurisdictions as being a criminal form of homicide. However, passive euthanasia through denial of drugs or procedures is considered to be legal in almost all jurisdictions. Those who argue for euthanasia feel that there is no difference. Those who are against it disagree. Euthanasia and Religion Many arguments also hinge on religious beliefs. Many Christians believe that taking a life, for any reason, is interfering with Gods plan and is comparable to murder. The most conservative of Christians are against even passive euthanasia. Some religious people do take the other side of the argument and believe that the drugs to end suffering early are God-given and should be used. One of the main groups of people who are involved with the euthanasia debate is physicians. One survey in the United States recorded the opinions of over 10,000 medical doctors and found that sixteen percent would consider stopping a life-maintaining therapy at the recommendation of family or the patient. Fifty five percent would never do such. The study also found that 46 percent of doctors believe that physician assisted suicide should be allowed in some cases. The controversy surrounding euthanasia involves many aspects of religion, medical and social sciences. As this is one of the most studied fields of bioethics, one can rest assured that more studies will be performed to learn more about this issue and how to best address it. Firstly, I disagree with your definition of euthanasia. Euthanasia is the putting to death, by painless method, of a terminally-ill or severely debilitated person through the omission (intentionally withholding a life-saving medical procedure, also known as passive euthanasia) or commission of an act (active euthanasia), as defined by the leanlegal dictionary online. I also find your first point confusing; in what way does the legalisation of euthanasia affect the close family ties in Filipinos? I, being a Filipino, can relate, and I fail to see your point. Secondly, define what you mean by the doctors ethics? In a case to case basis, a doctor will not be performing euthanasia if he/she is against it, therefore it is a fallacy to generalise to all doctors. Lastly, euthanasia is against the constitution, that is why the topic is should it be legalised. Saying it is currently not legal is restating the topic, no relevance. Now for my arguments. Firstly, the financial costs of keeping a person on a life support machine are enormous, not to mention hospital bills and 24-hour medical care. 80% of the Filipinos live in poverty, how many people can afford this? What happens then if the family cannot afford keeping the relative on life support? Do they get arrested? Secondly, the emotional distress that is caused by seeing your loved one in a vegetative state for an extended period of time while doctors continually tell you that there is no hope for recovery is potentially traumatizing. Some people who consider this as suffering for the vegetable loved one will want euthanasia, but they havent the option. Legalising this will not force everyone to take this course, but rather only provide an option. Lastly, the medical facilities and time that is devoted towards the vegetative patient with low chances of recovery could be spent helping someone else in greater need. Already in the Philippines we have a shortage of medical personnel and equipment, this additional burden will only cause more damage.

MRI as a Breast Cancer Screening Tool

MRI as a Breast Cancer Screening Tool Chapter 1 Introduction In the United States, one in eight women will be diagnosed with breast cancer, accounting for 26% of all cancer cases in women (Jiao, 2014). The standard of care for women over the age of 40 is mammography. It has been shown to increase life expectancy by detecting breast cancer through a quick and easy x-ray. Magnetic resonance imaging, which is more sensitive to breast cancer is costlier and produces more false-positive results, therefore it is not used as often. When mammography is the only test being done, breast cancer is more likely to go undetected in patients with dense breasts and those with small lesions. In high-risk women, MRI has been shown to detect breast cancer in earlier stages than mammography. MRI screening is successfully reported between 77% and 91% (Jiao, 2014). Most detections from MRI are located within axillary lymph nodes during stage 1 breast cancer. A patient may simply refuse yearly mammograms, when she goes five years later breast cancer may be in the fi nal stage whereas MRI could’ve detected it years earlier. Women are recalled more often for additional diagnostic testing when screened less frequently and recalled less often when screened more frequently (Orel, 2005). The American Cancer Society recommends MRI testing for women with the BCRA1 & BCRA 2 genes or a lifetime risk of 20% or greater for breast cancer (Saslow, 2007). Women who inherit the BRCA1 or BRCA2 gene have a 45% to 65% chance of developing breast cancer (Plevritis, 2006). BRCA 1 gene carriers are at a greater risk for developing breast cancer at an aggressive pace. Tumors in women screened with mammography alone are larger and more likely to have metastasized to axillary nodes (Taneja, 2009). MRI is approximately ten times more expensive than mammography making its cost effectiveness a critical consideration (Jiao, 2014). Due to its lower specificity than mammography increased costs are related to biopsies and additional exams. Estimated lifetime costs for 10,000 women would be higher by $10.6 million with MRI in combination with mammography than with mammography alone. In 2009, the costs billed to Medicare for a bilateral mammography was $49.76 while a bilateral MRI was $965.57 (Jiao, 2014). The price per quality adjusted life year would be $310,616 when MRI was performed with mammography (Fieg, 2009). MRI screening is most cost effective if the cost of MRI decreased or the cost of mammography decreased, when the risk of breast cancer increases, when mammography performance worsens, and if greater quality of life is accomplished (Orel, 2005). MRI becomes cost effective when patients with high-risk profiles are treated. If cancer was detected early enough, chemotherapy can be reduced. MRI is also needed for surveillance when breast conserving therapy results in recurrences. MRI would yield an additional 106 years of life per 10,000 women (Fieg, 2009). Women with BRCA1 and BRCA2 start mammograms at the age of 25 which makes MRI more cost effective and would decrease their radiation dose. Given the aggressive nature of breast cancer, screening with MRI whether alone or with mammography is cost effective and will prolong life expectancy (Berg, 2012). Contrast enhanced MRI is proven to detect breast cancer in the earliest stages compared to ultrasound and mammography. Statement of the Problem and Professional Significance Is MRI effective as screening tool for breast cancer? Which modality is the most effective study for diagnosing breast cancer? Are imaging modalities other than MRI a waste of time and money for patients? Mammography is seen as the first step in preventing breast cancer when a patient turns 40. For some patients, it might already be too late. Mammography is quick and low cost but does not detect breast cancer in patients with dense breasts or small lesions. MRI is considered the gold standard in imaging but is used with fewer women. As the population grows and rates of cancer increase, patients are demanding precise diagnosis and early detection for cancer. What factors should stand out to differentiate who receives MRI vs. mammography? By gathering medical history and diagnosis from several women receiving breast MRI’s, data will be examined to determine whether or not breast MRI’s were needed for proper diagnosis and if testing detected further malignancies. Research Hypothesis 1. It is hypothesized that MRI will be more effective in detecting breast abnormalities than Ultrasound or Mammography. This can be tested by comparing the results of their MRI with results of previous tests.    2. It is hypothesized that at least 50% of patients will feel more confident regarding their diagnosis following a MRI scan. This can be tested by having patients rank how they felt before and after having the test and talking with a radiologist on staff (using a scale of 1-10). 3. It is hypothesized that patients will not have had a mastectomy or received radiation until an MRI is performed. By surveying patients to determine who was and wasn’t diagnosed prior to MRI and what measures they took to prevent the malignancy from spreading I can determine these results.    4. It is hypothesized that patients positive for breast cancer will have at least one lesion undetected on mammography or ultrasound because of its small size or position in the axillary region.   This can be tested by comparing MRI test results with other imaging modalities. 5. It is hypothesized that 10% of participants will have had inconclusive results. This can be determined by whether the radiologist recommends a breast biopsy. MRI can produce false-positives, which cause the radiologist to compare results with past imaging. 6. It is hypothesized that at least 50% of the participants were recommended to have an MRI after inconclusive testing in other modalities. This information will be obtained through obtaining previous medical history in the survey. Definitions Breast cancer Uncontrolled growth of breast cells resulting in a malignant tumor (Medical Dictionary Online, 2018). Malignant Cancerous tumor that can spread to other parts of the body. Benign Tumor that is not dangerous to health. Quality adjusted life year Used to assess the value for money of medical intervention. One QALY = one year of perfect health (Science Direct Online, 2018). Probabilistic sensitivity analysis Technique used in economic modeling that allows the modellar to quantify the level of confidence in the output of the analysis (Science Direct Online, 2018). National comprehensive cancer network Not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. BRCA 1 breast cancer type 1 susceptibility protein- Identified in 1990 and is on chromosome 17, increases likelihood of cervical, uterine, and colon cancer (National Cancer Institute, 2018). BRCA 2 breast cancer type 2 susceptibility protein- Identified in 1994 and is on chromosome 13-, increases likelihood of stomach cancer, gallbladder cancer, and melanoma (National Cancer Institute, 2018). Ultrasound Imaging test using high frequency sound waves. MRI Imaging test that used magnets to generate a detailed picture. Mammography Images produced from low dose radiation. Gadolinium Chemical element of atomic number 64, injected into patients as contrast during MRI. Ductal carcinoma in situ (DCIS) Presence of abnormal cells inside a milk duct in the breast (Medical Dictionary Online, 2018). Mastectomy Surgical operation to remove a breast. Stereotactic biopsy Procedure that uses mammography to precisely identify and sample an abnormality within the breast. Limitations and Delimitations This study will survey twenty women (all ages) who are scheduled for breast MRI’s at Geisinger Community Medical Center during September-November 2018. I will conduct surveys with the patient prior to their MRI. Breast MRI’s will be conducted on a 1.5T, Siemens machine. All patients will be scanned using the same protocol for imaging regardless of medical history. External limitations are obtaining a medical history, incompletion of the patient’s MRI, lack of intravenous access for contrast, claustrophobia, and no show appointments. I will rely on patients to give me a detailed, accurate medical history. Assumptions During a typical work day in MRI at Geisinger Hospital a breast MRI is completed once. Within a typical month at least 20 scans are completed. This should allow me to survey enough patients over a six-week period. Permission for this study will come from patients who allow me to ask questions regarding their medical history and diagnosis. In accordance with HIPAA, I will keep all patient names and identifying information anonymous. Chapter 2 Introduction The purpose of this research project is to determine if MRI is effective as an imaging tool for diagnosing breast cancer. By surveying women, who have been diagnosed or are currently being diagnosed, collecting medical history, and analyzing data, imaging modalities will be examined to determine the most reliable, accurate, and timely way to diagnose breast cancer. If MRI is more efficient than mammography and ultrasound, time and money spent on those modalities could be eliminated. Women can be treated faster, and cancer could be diagnosed earlier when proper testing is ordered. Breast cancer during stage one is treatable, thousands of lives could be changed when it is diagnosed in a timely manner. Cancer is the overall most common cause of death in America with breast cancer being the most common type (Jiao, 2014). One in eight women will be diagnosed with breast cancer during their lifetime making it a very costly disease. Standard protocols for screening are determined by the American Cancer Society. Screening mammography is recommended for women with a 25-30% lifetime risk of breast cancer (National Cancer Institute, 2018). This includes women treated for Hodgkin disease and those with a family history of breast or ovarian cancer. Screening mammography typically starts at age 40 unless preexisting conditions are present, screening begins at age 25. The Gail, Claus, and Tyrer-Cusick models are used to estimate breast cancer based on family history. Breast cancer genes 1 and 2 (BRCA) are found in 1/500-1/1,000 women. Women of Jewish ethnicity have a 1/50 risk (National Cancer Institute, 2018). Those who test positive have a 65% chance of breast cancer by 70 years old (Saslow, 2007). What are American Cancer Society Guidelines? Recommendations for women at average risk of breast cancer are women between 40 and 44  have the option to start screening with a mammogram every year. Women ages 45 to 54  should get mammograms every year. Women 55 and older  can continue with mammograms every year or switch to having mammograms every other year (American Cancer Society, 2018). Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer. Not all types of breast cancer cause a lump in the breast. Many breast cancers are found on screening mammograms which can detect cancers at an earlier stage, before the mass can be felt, and before symptoms develop. Women who are at high risk for breast cancer based on certain factors should get and MRI and a mammogram every year, starting at age 30 (American Cancer Society, 2018). This includes women who have a lifetime risk of breast cancer of about 20% to 25% or greater, have a known BRCA1 or BRCA2 gene mutation, have a first-degree relative (parent, brother, sister, or child) with a  BRCA1 or BRCA2 gene mutation, had radiation therapy to the chest when they were between the ages of 10 and 30 years, or have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes. (American Cancer Society, 2018). The American Cancer Society recommends against MRI screening for women whose lifetime risk of breast cancer is less than 15%. MRI in this case would be less cost-effective and timelier for patients to get done. How does MRI detect breast cancer? There are three imaging modalities that can effectively detect breast cancer. MRI, mammography, and ultrasound are commonly used in different combinations. MRI uses magnetic fields to produce cross-sectional images of breast tissue. Hydrogen atoms in fat and water contribute to the signal that is produced (Pilewskie, 2014). Gadolinium, IV based contrast, is administered to detect lesions and cancer. Subtraction images are obtained to differentiate fat from enhancing lesions. MRI produces high quality imaging from signal to noise ratio and high spatial resolution (Pilewskie, 2014). MRI is safe for all women (unless contraindicated by pregnancy) and doesn’t use radiation. A drawback to MRI is false positives that are produced and additional testing that this creates. On the other hand, additional testing leads to a higher number of cancer detected. The more women who are being closely watched and recommended for further tests, the greater their likelihood of being diagnosed earl y. In a study in the UK involving high risk populations, 4% found MRI â€Å"extremely distressing† and 47% reported having disturbing thoughts about it six weeks after (Saslow, 2007). Due to the psychological distress of MRI, other testing needs to be considered. Imaging Limitations Unlike other imaging tests, MRI candidates need to be screened for metal before considering the test. Pacemakers, aneurysm clips, specific stents and filters, and neuro-stimulators are not allowed in the machine. Body habitus and claustrophobia are also factors to consider. A small, loud environment can cause emotional distress and anxiety for a patient, some patients will refuse MRI testing. Breast MRI testing should be completed with and without contrast. Gadolinium, MRI contrast, can only be injected in patients with a glomerular filtration rate of >60. Patients on dialysis, with impaired kidney function, diabetes, high blood pressure, or certain allergies may not be able to receive contrast, making the test inconclusive. MRI results can also be misleading. False-negatives and false-positives occur from technical limitations, patient characteristics, quality assurance failures, human error, and heightened medical concern. A false negative exam looks normal even though the patient has breast cancer. They are more likely to occur in younger patients with dense breasts. MRI is commonly used for dense tissue to differentiate benign and malignant lumps. A false positive test looks abnormal even though the patient doesn’t have cancer. False positives occur in half of women getting mammograms over a ten-year period (Gillman, 2014). MRI’s and MRI guided biopsies are usually recommended for more accurate diagnosis. A patient’s need for definitive findings may increase testing ordered. According to the American Medical Association, 7% of women are biopsied only because of MRI findings. The call back and biopsy rates of MRI are higher than mammography in high risk populations due to the increased sensitivity of MRI (Gillman, 2014). MRI is also able to obtain images for women with breast implants. 3D and 2D images are acquired in all planes, whereas mammography could miss an area of interest and compromise the breast implant.    Economic Impact   Cancer treatment can be impacted by lack of insurance, proximity to health care facilities, and availability of services. According to  Cancer Facts & Figures 2018, â€Å"Uninsured patients and those from many ethnic minority groups are substantially more likely to be diagnosed with cancer at a later stage, when treatment can be more extensive, costlier, and less successful.† (American Cancer Society 2018). Without routine mammograms, breast cancer can go undiagnosed and impose much higher costs when it’s found in a later stage. Early detection can potentially eliminate radiation, chemotherapy, mastectomy, and breast reconstruction. In 2009, the average Medicare reimbursement for a bilateral mammogram was $49.76, a bilateral MRI $965.57, and mastectomy $13,590.03 (Moore, 2009). These procedures drastically differ in costs therefore insurance companies use cost effectiveness and quantity adjusted life years as means in determining which patient will benefit from costlier studies. MRI screening becomes more cost effective as the cost of MRI decreases or the cost of mammography increases. It is also more cost effective for patients with higher risk profiles such as BRCA1 & BRCA2 genes. MRI combined with mammography would produce 106 years of life per 10,000 women compared with mammography alone (Taneja, 2009). The drawback is that MRI in addition to mammography would increase lifetime health care costs for those 10,000 women by $10,600,000 (Taneja, 2009). What does insurance cover? Breast cancer is the costliest cancer to treat. In 2010, it cost $16.5 billion in the United States to treat breast cancer. A major concern when ordering breast MRI’s is that insurance will deny it or charge a high co-pay. MRI’s cost more due to radiologist, facility, contrast, and technology fees. According to a survey by the American Cancer Society, many patients are cutting prescriptions, not going to their doctor, and not getting preventive services due to the high costs. Yearly mammograms are covered by insurance companies. The average cost of a breast MRI in the United States is $1,325 with prices ranging from $375 to $2,850. Patients with health insurance are responsible for paying their deductible, copay, and coinsurance amounts. The amount of each of these costs depends on their health plan. Patients without health insurance are responsible for 100% of mammogram and MRI costs. Case Study In a study published by the New England Journal of Medicine, titled MRI evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer, 969 women with a diagnosis of unilateral breast cancer and no abnormalities on mammography went for a breast MRI. MRI detected clinically occult breast cancer in the contralateral breast tissue in 30 women (Lehman, 2007). Biopsies were performed on 121 of the 969 women whose MRI showed breast cancer (Lehman, 2007). Of those 121, 30 were tested positive. MRI was able to detect cancer that was missed by mammography and clinical exam. Within the 969 women, 33 tumors were diagnosed with 30 being from MRI. The three others were diagnosed from a mastectomy specimen before a biopsy could be performed. Those three samples contained ductal carcinomas in situ and measured 1, 3, and 4 mm in diameter. The most common types of invasive cancer found on MRI was ducal carcinoma (67%), invasive lobular carcinoma (22%), and tubular carcinoma (Le hman, 2007). 96.7% of cancer found was stage 0 or 1. The overall high accuracy of MRI is due to technology and interpretation of results. Contrast enhanced MRI aids in distinguishing benign from malignant patterns. This study also showed that screening MRI can improve on mammography by detecting cancer in women at high risk especially those with aggressive cancers. When ordering MRI, cost effectiveness continues to be a major concern. In the article, American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography, benefits of MRI’s sensitivity in detecting lesions is noted but without data on the recurrence and survival rates, MRI is not recommended as a screening exam. The article compares study results from six published studies, sensitivity for MRI is consistently higher than mammogram and ultrasound while specificity was lower than mammogram and ultrasound. High sensitivity means MRI correctly identifies a patient with cancer. Low specificity means MRI is not able to correctly reject a patient without cancer as accurately as other modalities. MRI has higher error but in calling back more patients and performing more biopsies, it diagnoses cancer more accurately. With this being said, the article does not recommend MRI as a screening tool unless women are at an increased risk of breast cancer, have a fami ly history, or carry the BRCA gene (Stephens, 2011). Conclusion Women who present with signs and symptoms of breast cancer or have a family history should be screened with MRI in addition to mammography. It is not acceptable to deny patients imaging studies that can prolong their life. Breast cancer is 100% treatable when caught early. Due to advances in technology and a growing healthcare system, facilities are more readily available to treat women. Patients no longer need to wait months for tests or results. Steps should be taken to reduce anxiety associated with MRI cancer screening and wait time. Patients should be informed about the likelihood of false-negative and false-positive findings. Whether or not patients need to go through additional imaging, the chance of early detection outweighs the stress of additional testing. MRI is a very useful imaging test that can save lives if performed. Patients who want to be proactive in their treatment should be encouraged to get routine imaging tests done and educate themselves on different stages of breast cancer, so they understand the process they are going through. By creating high resolution imaging, MRI proves to be the most effective study for diagnosing breast cancer. MRI is able to detect smaller masses and abnormalities than other imaging tests miss. Utilization of MRI is crucial for early detection, with its results breast cancer can be highly treatable and late stages along with metastases can be stopped. MRI used in screening for women with high risk factors proves more cost effective than mammography and ultrasound because it detects cancer in earlier stages which reduces the need for more invasive, long term care. MRI is also able to cover a larger area including axillary lymph nodes where cancer is commonly missed on mammograms. References: Jiao, X., & Hay, J. (2014). Cost-Effectiveness Of Breast Mri And Mammography For Screening High Risk Population.  Value in Health,17(3). doi:10.1016/j.jval.2014.03.780 Orel, S. (2005). 1–10 Efficacy of MRI and Mammography for Breast-Cancer Screening in   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Women With a Familial or Genetic Predisposition.  Breast Diseases: A Year Book Quarterly,16(1), 37-38. doi:10.1016/s1043-321x(05)80023-2 Saslow, D., Boetes, C., Burke, W., Harms, S., Leach, M. O., Lehman, C. D., . . . Russell, C. A.   Ã‚   (2007). American Cancer Society Guidelines for Breast Screening with MRI as an   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Adjunct to Mammography.  CA: A Cancer Journal for Clinicians,57(2), 75-89.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   doi:10.3322/canjclin.57.2.75 Feig, S. (2009). Cost Effectiveness of Breast Cancer Screening With Contrast-Enhanced MRI in High-Risk Women.  Breast Diseases: A Year Book Quarterly,20(4), 383-385. doi:10.1016/s1043-321x(09)79390-7 Berg WA, Zhang Z, Lehrer D, et al. Detection of Breast Cancer With Addition of Annual   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Screening Ultrasound or a Single Screening MRI to Mammography in Women With Elevated Breast Cancer Risk.  JAMA.2012;307(13):1394–1404. doi:10.1001/jama.2012.388 National Cancer Institute. (2018). Retrieved August 31,2018, from National Cancer Institute   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet#q1 Medical Dictionary Online. (2018). Retrieved August 31,2018, from Medical Dictionary Online:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   https://medical-dictionary.thefreedictionary.com/breast+cancer Medical Dictionary Online. (2018). Retrieved August 31,2018, from Medical Dictionary Online: https://medical-dictionary.thefreedictionary.com/carcinoma Elsevier Online. (2018). Retrieved August 31,2018, from Science Direct Online:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   https://www.sciencedirect.com/search?qs=QALY&show=25&sortBy=relevance Elsevier Online. (2018). Retrieved August 31,2018, from Science Direct Online:  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   https://www.sciencedirect.com/science/article/pii/0010480986900200 National Comprehensive Cancer Network: Practice Guidelines in Oncology – Genetic/Familial   Ã‚   High-Risk Assessment: Breast and Ovarian. 2005, National Comprehensive Cancer   Ã‚   Network, Inc, 1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ: Cancer Statistics, 2008. CA Cancer J Clin. 2008, 58: 71-96. 10.3322/CA.2007.0010. Information and Resources about for Cancer: Breast, Colon, Lung, Prostate, Skin. (n.d.). Retrieved September 18, 2018, from https://www.cancer.org/ Ali, K., & Vinnicombe, S. (2018). Accuracy of contrast enhanced breast tomosynthesis in patients suspected of having breast cancer: Comparison with digital mammography and breast MRI.  Http://isrctn.com/. doi:10.1186/isrctn12691785 Gillman, J., Toth, H. K., & Moy, L. (2014). The Role of Dynamic Contrast-Enhanced Screening Breast MRI in Populations at Increased Risk for Breast Cancer.  Womens Health,10(6), 609-622. doi:10.2217/whe.14.61 Pilewskie, M., & King, T. A. (2014). Magnetic resonance imaging in patients with newly diagnosed breast cancer: A review of the literature.  Cancer,120(14), 2080-2089. doi:10.1002/cncr.28700 Heil, J., Czink, E., Schipp, A., Sohn, C., Junkermann, H., & Golatta, M. (2012). Detected, yet not Diagnosed Breast Cancer Screening with MRI Mammography in High-Risk Women.  Breast Care,7(3), 236-239. doi:10.1159/000339688 Lehman, C. D. (2007, March 29). MRI Evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer. Retrieved September 19, 2018, from http://www.nejm.org/ Stephens, T. (2011). Breast Cancer Screening With Imaging: Recommendations From the Society of Breast Imaging and the ACR on the Use of Mammography, Breast MRI, Breast Ultrasound, and Other Technologies for the Detection of Clinically Occult Breast Cancer.  Yearbook of Diagnostic Radiology, 2011, 46-47. doi:10.1016/s0098-1672(10)79236-5 Plevritis, S. K., Kurian, A. W., Sigal, B. M., Daniel, B. L., Ikeda, D. M., Stockdale, F. E., & Garber, A. M. (2006). Cost-effectiveness of Screening BRCA1/2 Mutation Carriers With Breast Magnetic Resonance Imaging.  Jama,295(20), 2374.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   doi:10.1001/jama.295.20.2374 Taneja, C., Edelsberg, J., Weycker, D., Guo, A., Oster, G., & Weinreb, J. (2009). Cost Effectiveness of Breast Cancer Screening With Contrast-Enhanced MRI in High-Risk Women.  Journal of the American College of Radiology,6(3), 171-179. doi:10.1016/j.jacr.2008.10.003 Moore, S. G., Shenoy, P. J., Fanucchi, L., Tumeh, J. W., & Flowers, C. R. (2009). Cost-  Ã‚   effectiveness of MRI compared to mammography for breast cancer screening in a high risk population.  BMC Health Services Research,9(1). doi:10.1186/1472-6963-9-9