tag:blogger.com,1999:blog-32182809952855126232024-02-19T23:00:18.198-08:00Essay custom writingOutline Topic Review Paperdavidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.comBlogger44125tag:blogger.com,1999:blog-3218280995285512623.post-46206264953755652392020-09-03T21:08:00.001-07:002020-09-03T21:08:06.405-07:00Rudy - Movie Review essaysRudy - Movie Review articles Rudy is one of the most persuasive films I have seen all year. The film was delivered in 1993 and was shot on the Notre Dame grounds. Rudy Ruettiger battled all through his school years and was not perhaps the most astute young men in his group, however he generally attempted. He worked more earnestly than any normal man would to cause his fantasies to turn into a reality. I like numerous things about this film, since its so moving and interesting simultaneously. One thing I truly like about the film is the way hard he truly attempts to arrive at his objectives. A second thing I like about this film is the point at which he goes to converse with the dad at the congregation about going to Notre Dame, and the dad thinks he needs to turn into a minister as well. The genuine explanation I truly like that part is on the grounds that its so interesting. Also, a third thing I truly like about the film Rudy is the point at which the man that he works for at the Notre Dame field leaves him the way in to the room that Rudy stays in bed each night, and leaves him covers. It was extremely sweet, and it appears as though something somebody would do, all things considered. There are likewise sure things I dont like about the film. One thing I truly dont like about the film is when Rudys closest companion kicks the bucket, it is an extremely high enthusiastic piece of the story, and its additionally dismal. Something else I truly dont like about the film is the point at which his father says that its fine to watch the game from his living TV, and afterward when Rudy says, Would it be extraordinary on the off chance that I was on the field playing? Also, his dad doesnt state anything by any means. The exact opposite thing that I dont like about the film is that when Rudy chooses he needs to go to Notre Dame to play football, nobody is there for him to help his choice, not even his family, or his better half. It nearly helps me to remember my own family. By and large, I believe that Rudy is an incredible film. Also, I urge anybody to see it, as it is exceptionally persuasive and extremely evident. ... <! davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-62220768825831174692020-08-26T00:23:00.001-07:002020-08-26T00:23:10.959-07:00Case Study Nissin Essay Essay ExampleContextual analysis Nissin Essay I. Summation ( summarize of the case including hypothetical setting of the activity ) II. second bit A. Time Context ( the clasp when the activity was noted ) B. Case Viewpoint ( indentification of the existent owner of the activity ) C. Explanation of the Problem ( in a tough situation that hinder or keeps the organization from achieving its points D. Articulation of the Objectives ( finishes or outcomes that you would wish to bring through ) E. Proclamation of the Areas of Consideration ( Facts of the example in plot signifier ) F. Articulation of the Alternative Courses of Action ( A pick between at least two potential answer for work out the issue. ) ( insignificant acad requests ought to be two with focal points and drawbacks for every alternative ) . G. Proclamation of Conclusion ( the Final assurance ) H. Articulation of Recommendation ( Plans of activity introduced in Tabular signifier demonstrating exercises. doled out individual or segment and imprint day of the period of fruition ) Case Study I. Outline The Study is about the organization. Monde Nissin where the entirety of the caputs of the area comprising the said organization were assembled to reiview and talk the yearââ¬â¢s open introduction for its moment noodle line. The said gathering was started by the interest investigator of the said organization. We will compose a custom paper test on Case Study Nissin Essay explicitly for you for just $16.38 $13.9/page Request now We will compose a custom exposition test on Case Study Nissin Essay explicitly for you FOR ONLY $16.38 $13.9/page Recruit Writer We will compose a custom exposition test on Case Study Nissin Essay explicitly for you FOR ONLY $16.38 $13.9/page Recruit Writer He/She revealed that their gross incomes developing over that past twelvemonth has been an individual figure from mature ages 2006 to 2008. concerning the old mature ages which was twelvemonth 2003 to twelvemonth 2005. They talked about the activity with respect to how did their gross incomes developing lessening. a portion of the area caputs revealed that the lessening was because of increment in money related estimation of their product. The expansion in stock money related worth was because of the expansion of imported wheat. the fiscal estimation of dollar is as yet temperamental. what's more, the extra of the exchange name new distribution center. They other than said the populace in the Philippines diminished ingestion of moment noodles and different fundamentals because of increment in fiscal estimations of merchandise. Some other than said that the populace in the state today is progressively worried about their wellbeing and wellbeing. a few people are other than earth witting and a few people other than need stocks that has fluctuation. With these restrictions. the segment caputs reasoned that they ought to deliver another product which highlights wellbeing and wellbeing however the presentation of another product in the market will require significant expense. since they will recalibrate their establishments in light of the fact that their establishments are non adaptable consequently bringing about significant expense. II. A. Time Context The activity was noted in twelvemonth 2008. B. Case Viewpoint The main occupation of the Case Study is the reason the gross incomes developing of the Company declined and how to do their gross incomes developing ascent again. C. Proclamation of the Problem The organization is confronted with numerous occupations or difficulties. these are: a. The imported wheat money related worth is lifting B. The dollar stays to be flimsy c. The costs they are bringing about due to the new stockroom d. The lessening ingestion of the people with their product because of increment of the money related estimations of merchandise nutrient E. The expanding interest for stocks that has Health and Wellness benefits. stocks that are useful for nature and stocks that has changeability D. Articulation of the Objectives f. To help the organization increment its gross incomes developing E. Proclamation of the Areas of Consideration g. The organization needs to see the expansion in money related estimation of imported wheat h. The dollar that is as yet insecure I. The reducing of the masses in buying their product because of increment of money related estimation of merchandise J. The expanding interest for stocks that has Health and Wellness benefits. stocks that are useful for nature and stocks that has inconstancy. davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-28630953189169231042020-08-22T20:44:00.001-07:002020-08-22T20:44:06.839-07:00Analysis On Nike And Feasibility Of Imc Plan Marketing EssayInvestigation On Nike And Feasibility Of Imc Plan Marketing Essay Official Summary Marketing forms as we are familiar with are a basic piece of any association and it undertaking. The sole reason for some random business association is to deliver items and administration so it tends to be sold in the market and arrives at customer. Promoting is one of the procedure endeavors inside the association at the operational level with a reason. Deliberately, any types of promoting have their own advantages and restrictions. In any case, in the present plan of things, we can contemplated thus that showcasing attempt of organization have experienced gigantic change at all level. There are likewise different apparatuses and showcasing strategies that association misuse for the sole thought of befitting authoritative procedures and its promoting attempt. The reason for this report is to talk about the focal topic of ââ¬ËIMC Plan in a significant organizationâ⬠and to interface it with the ideas and hypothetical importance of the subject. We are of the sentiment that the idea of coordinated advertising correspondence is colossally in rehearsed among advertisers for the sheer component appended to it. Be that as it may, what are the IMC forms at play concerning Nike? Consequently, this report additionally endeavors to examine the many element and significance fo IMC and its different apparatuses that si at play. Furthermore, Nike is likewise considered as the association to grasp upon the domains of IMC and its significance and how far the organization IMC has been viable on a worldwide scale. Additionally, the report in parts likewise amasses the very substance to ponder the passage of Nike in UAE and to distinguish the highlights of IMC at play in UAE embraced by Nike. Presentation The idea of coordinated promoting correspondence can be comprehended as an order of advertising correspondence and its arranging that incorporates the thorough benefits of showcasing devices to the upside of the association and its advertising try. To top everything, the act of incorporated promoting correspondence likewise encourages organizations and advertisers to come out with a far reaching and vital layout of showcasing and correspondence procedure that is frequently accepted to give clearness to messages, just as lucidity and complete effect of conveyed messegges that is consistent. (Yeshin, 1998, p. 68) Thus, we accept that the reason for any showcasing try that enterprises embrace is to make a worth chain inside and remotely for its items and administrations. The production of significant worth chains accordingly requires a complete combination and practices of showcasing channels that is consistent across limits and somewhat the utilization of extensive advertising apparatuses and correspondence structures. Goal of the Study and Issue in Consideration There are endless issues with regards to the factor including incorporated promoting communication.soe of the plausible issue to be recognized can be glanced in regard of the accompanying: How has broad communications added to the factor enveloping Integrated showcasing Communication? Does the factor connected to the changing parts of correspondence in the present situation have its impact on the factor enveloping how coordinated advertising correspondence is done? davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-78550434594361968452020-08-22T06:20:00.001-07:002020-08-22T06:20:24.111-07:00What is the Meaning of Life Essay Example For StudentsWhat is the Meaning of Life? Paper What is the Meaning of Life? Paper This inquiry has astounded humankind for about as long as it has existed. This makes one wonder, if nobody has thought of an answer at this point, nobody including prodigies, for example, Isaac Newton, Albert Einstein and Stephen Hawking, at that point why ask a multi year old kid? The response to that is straightforward, I am a finished and articulate virtuoso, a super virtuoso maybe. Obviously this thought is very bizarre, and the genuine explanation one may maybe ask me is to assess my comprehension of the following: < Where am I going? < Different methods of reasoning of life < Why a few people are strict < What makes somebody strict < Why Catholics are strict < Can an individual be Christian just by being acceptable < How Catholics discover importance and reason < Vocation . By and by I think there is no significance to life and life is the thing that you make of it, however that isn't the appropriate response that is anticipated from me, truth be told the appropriate response expected of me is most likely along the lines of this What is the significance of life? What is the significance of life? Everybody has pondered about the appropriate response to this inquiry eventually in their lives, in actuality this inquiry constructs the bases of an emotional meltdowns. At around forty people begin going, whats the point, who minds any longer? What IS the significance of life? regardless of whether this is valid or not I wouldnt know, failing to have encountered a midlife emergencies myself, being, as I referenced prior, just fourteen. By and by, it is a significant inquiry. Presently before I illuminate you regarding my updated assessment of this inquiry, lets first investigate different people groups sees. Being as there are a wide assortment of individuals on this planet there are a wide assortment of answers to this inquiry. These range from the significance of life is to turn into a {insert name of clique, religion, association and so on here} to the significance of life is to eat your own foot. The inquiry at that point is which one is correct. The response to that question is, they all are. .. OK, perhaps not, yet they are okay in the individual psyche of each individual who made that solitary answer, this is additionally false however it is a awesome falsehood. In any case in the event that you yourself have no response to this inquiry, at that point you are probably going to go under one of the accompanying: Existentialist, Humanist, Materialistic, Nihilist or Religious. These are the fundamental ways of thinking of life, existentialism being the a reasoning that underlines the uniqueness and confinement of the person involvement with an unfriendly or apathetic universe, sees human presence as unexplainable, and stresses opportunity of decision and obligation regarding the outcomes of ones acts. Humanism being a way of thinking that focuses on people and their qualities, limits, and worth. Realism being the reasoning that physical prosperity and common belongings establish the most noteworthy great and most noteworthy incentive throughout everyday life. Agnosticism being the dismissal of all differentiations in good or strict worth and an ability to renounce every single past hypothesis of profound quality or strict conviction. Lastly strict which is having or demonstrating confidence in and love for God or a god. It is obviously conceivable to go under a greater amount of one of the abovementioned. There, you currently know what you are, glad? No, obviously your not, you need to know more dont you? Alright, fine.. .For what reason would somebody become strict? That is a decent inquiry. Well the response to this for the vast majority is shockingly simple, in light of the fact that they must choose between limited options, they where purified through water before they could even talk. In any case shouldn't something be said about grown-ups who get immersed? I hear you cry, well alright, I dont since Im sure youre a) not so pitiful, and b) I cannot hear you .u33961c215b7ad4eaeefbc82c3ffb1e1e , .u33961c215b7ad4eaeefbc82c3ffb1e1e .postImageUrl , .u33961c215b7ad4eaeefbc82c3ffb1e1e .focused content region { min-tallness: 80px; position: relative; } .u33961c215b7ad4eaeefbc82c3ffb1e1e , .u33961c215b7ad4eaeefbc82c3ffb1e1e:hover , .u33961c215b7ad4eaeefbc82c3ffb1e1e:visited , .u33961c215b7ad4eaeefbc82c3ffb1e1e:active { border:0!important; } .u33961c215b7ad4eaeefbc82c3ffb1e1e .clearfix:after { content: ; show: table; clear: both; } .u33961c215b7ad4eaeefbc82c3ffb1e1e { show: square; change: foundation shading 250ms; webkit-progress: foundation shading 250ms; width: 100%; haziness: 1; change: darkness 250ms; webkit-change: obscurity 250ms; foundation shading: #95A5A6; } .u33961c215b7ad4eaeefbc82c3ffb1e1e:active , .u33961c215b7ad4eaeefbc82c3ffb1e1e:hover { mistiness: 1; progress: murkiness 250ms; webkit-progress: haziness 250ms; foundation shading: #2C3E50; } .u33961c215b7ad4eaeefbc82c3ffb1e1e .focused content region { width: 100%; position: relativ e; } .u33961c215b7ad4eaeefbc82c3ffb1e1e .ctaText { fringe base: 0 strong #fff; shading: #2980B9; text dimension: 16px; textual style weight: intense; edge: 0; cushioning: 0; content design: underline; } .u33961c215b7ad4eaeefbc82c3ffb1e1e .postTitle { shading: #FFFFFF; text dimension: 16px; text style weight: 600; edge: 0; cushioning: 0; width: 100%; } .u33961c215b7ad4eaeefbc82c3ffb1e1e .ctaButton { foundation shading: #7F8C8D!important; shading: #2980B9; outskirt: none; outskirt span: 3px; box-shadow: none; text dimension: 14px; textual style weight: striking; line-stature: 26px; moz-outskirt sweep: 3px; content adjust: focus; content embellishment: none; content shadow: none; width: 80px; min-stature: 80px; foundation: url(https://artscolumbia.org/wp-content/modules/intelly-related-posts/resources/pictures/straightforward arrow.png)no-rehash; position: supreme; right: 0; top: 0; } .u33961c215b7ad4eaeefbc82c3ffb1e1e:hover .ctaButton { foundation shading: #34495E!important; } .u33961 c215b7ad4eaeefbc82c3ffb1e1e .focused content { show: table; tallness: 80px; cushioning left: 18px; top: 0; } .u33961c215b7ad4eaeefbc82c3ffb1e1e-content { show: table-cell; edge: 0; cushioning: 0; cushioning right: 108px; position: relative; vertical-adjust: center; width: 100%; } .u33961c215b7ad4eaeefbc82c3ffb1e1e:after { content: ; show: square; clear: both; } READ: Parts Emporium Persuasive Essaybut anyway, for what reason would somebody become strict willingly? This could occur for two reasons, alright, three: One) They unexpectedly choose its their business, their getting and go out to become strict in light of the fact that they have an inclination that it, Two) They need a type of pardoning or vindication on the grounds that theyve accomplished something incorrectly, and Three) By mishap, you know the kind of thing, you become truly inebriated and wake up with a spouse in Las Vegas and another religionokay possibly not, however the initial two are substantial answers. For what reason are Catholics strict? This inquiry is totally self informative, what . davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-4103042438960286992020-08-21T18:26:00.001-07:002020-08-21T18:26:04.768-07:00Albrecht Durer BiographyAlbrecht Durer Biography Essay Durer was a goldsmith, he had originated from Germany to Nurembourg in 1455 and wedded Barbara Holper. Barbaras father was Albrechts ace. Albrecht was his dads third child. He was named Albrecht due to a family custom which he has been the third delegate up until this point. Albrecht had three siblings named Laszlo, Albrecht, and Ajtos. Albrecht was apprenticed to his dad at 13 years old. His dad acquainted him with the working with metal and the utilization of apparatuses with laid the basis for his aptitude of etching. He likewise took in painting from his dad at 13 years old. He liked to attract and paint than to goldsmithing. He painted a self picture of himself at 13. This self-picture took the cautious and the precise work of the entirety of the subtleties to some him his creative ability. In 1486, Albrechts father sent him to take in painting and carpentry from Michael Wolgemut. Michael Wolgemut was an astounding painter and woodcut artist. In Michael W. s occupied shop Albrecht took in the basics of drawing, painting, and wood cutting. Albrecht additionally helped Micheal W. make a few representations for books. Michael W. presumably took Albrecht to the Netherlands, Basel, Stratsbourg, and in 1492 to Colmar in Alsace. Albrecht invested such a great amount of energy with him he called him his subsequent dad. His primary fascination was to see the ace, Martin Schongauer. Who at the time was the main German visual craftsman of the time. In transit there Albrecht discovered the ace had kicked the bucket. On his appearance Martins siblings gave him prints, drawings, and Schongauers ideal etchings from the bosses workshop. The prints, drawings, and inscriptions affected Albrechts work. Albrecht then went to Basel to remain with another sibling of Schongauer, who directed a goldsmith workshop there. Basel was the focal point of realistic creation and book distributing at that point. In Basel Albrecht made numerous contacts and contributed a marked woodcut for the cover sheet of the Letters of St. Jerome. The achievement he had from this woodcut presumably prompted another commission in Basel. In the fall of 1493, Albrecht went to Stratsbourg where he kept on working for distributers. Toward the finish of May 1494 Albrecht came back to Nurembourg. In July 7, 1494 the multi year old painter wedded Agnes Frey. Agnus was the little girl of a trader. Not long after his marriage in the fall of 1494 he took his first outing to Italy. This visit empowered him to see his old buddy Willard Pirckheimer who acquainted Albrecht with humanist idea and traditional writing. Albrecht invested a large portion of his energy of his first outing in Venice, Italy. There he met Jacopo deBarbari. deBarbari whose figures built to geometrical strategies and extents roused Albrecht to live a deep rooted investigation of hypothetical compositions. In Venice, Albrecht made drawings of fascinating figures, creatures, and did nature contemplates. On the ride home Albrecht utilized his water hues painting the scene around the Alps. Albrecht came back to Nurembourg by the mid year of 1495. With the arrival of his outing he created a lot of canvases and etchings. Albrecht utilized the vehicle of etching since that mirrored his hypothetical advantages. From around 1500 Albrechts worry for the issues of extent and point of view expanded. This activity was presumably brought about by the new contacts with the Italian works and investigation of Vitruvius. In 1502, after an extensive stretch of shortcoming Albrechts father had passed on. His dads passing had shaken him up an immensely. Not long after that Albrecht experienced discouragement fits and tormenting dreams. â⠬å ¡ His hunger for work had not been debilitated because of his dad. Peruse: The Painting of the Sistine Chapel EssayHe kept on working like nothing had occurred. The Adam and Eve painting in 1504 indicated a great deal of his strategies of etching and the development of geometrical techniques for male and female figures. The artwork Paumgartner Altarpiece shows a corresponding accentuation on the perspective on extents. All through Albrechts vocation he created pictures of family, companions and benefactors. Albrecht painted 2 significant self-representations called Prado Madrid and Alte Pinakothek, Munich. In 1505, Albrecht drew Crowned Death on a Thin Horse, the plague pestilence roused this artistic creation. Due to this plague Albrecht quickly departured from Italy in the late spring of 1505. At 34 years old he was completely developed and fruitful with his profession. After Albrecht halted in Augsburg he went to Venice to build up his work of art style. Albeit numerous individuals respected his artistic creations they said he was not as old fashioned enough. Just Giovanni Bellini recognized him of his work. Albrechts most noteworthy accomplishment at the time was Feast of the Rose Garlands, which was requested by the German shippers in Venice. In this artistic creation he joined the extravagance of Venetian shading and the huge of Italian pieces. Albrecht came back to his home of Nurembourg in February 1507. Quite a while supporter, Frederick the Wise qualified him for paint an altarpiece demonstrating the execution of 10,000 Christians by a Persian ruler. Albrecht had just made a woodcut of that subject however now he likewise painted it. For a few additional years he kept on painting demands for individuals. Albrecht began a progression of wood cuts of The Life of the Virgin. These were a progression of incredible anecdotes about the virgin. Albrecht made his wood cuts and figures move effectively in the third measurement Albrechts Life of the Virgin arrangement concurred with his developing worry for geometric structure. In his figures and wood cuts you can see the ideal work finished with a ruler and compass. You can likewise observe his reverence with the Platonic thought of the human figure. Non-romantic thought is the human body drawn with numerical recipes. In his artistic creation The Fall of Man Albrecht experienced an enthusiastically time attempting to accomplish a geometrical figure of two creatures known as man and lady. After numerous long periods of rehearsing geometrical figures Albrecht figured out how to paint a few strands of hair with only one stroke. Giovanni Bellini, one of Albrechts admirer solicited him to make a present from one of his brushes he draws the strands of hair with. Bellini was astounded when he saw the brush. Bellini said that the brissels must be isolated or separated to draw a few strands of hair on the double. Albrecht said that he drew it with a type of balance. In 1505, Nurembourg was hit with another plague sending bodies down the road in trucks. In that pre-fall Albrecht left again to go to Venice. Albrecht left his significant other behind and his aides to deal with his shop. This time he needed more cash to go so he needed to obtain from Pirckheimer to make the excursion. He went in extravagance, this time he went with ponies and an amount of stuff that incorporated his pictures he intended to sell. Albrecht offered a large portion of his works of art to Italy. In Venice, Albrecht purchased an Italian coat with the cash he got from the canvases. He likewise took some move exercises at a neighborhood school with a fine man he met. Albrecht met numerous new companions wherever he went. Albrechts just frustration of the excursion was the point at which he discovered some silver hairs on his head. Albrecht wrote to Pirckheimer saying to deal with his family and to loan cash to his mother in the event that she required it. He likewise included to advise him to not have intercourse to his significant other. Peruse: The Buck Stops (and Starts) at Business Schools EssayAlbrecht likewise revealed to Perckheimer that he should take drinks or eat from any of the Venetian painters since they all attempt to duplicate his work and they are my foes. In 1509, Albrecht got back and was chosen as an individual from Nurembourgs Grand Council. This was a gathering of 200 men of riches who now and then added to their number individual residents who had separated themselves in different manners. Albrechts new position didn't meddle with his aesthetic creation. Back in his workshop he kept on dealing with the Fall of Man etching. This etching was the image of Adam and Eve remaining with the creatures. Albrecht changed his technique from geometrical development to the principal pair of individuals. The year 1511 was exceptionally unprecedented for Albrecht. In that one year he distributed the entirety of his most prominent woodcut arrangement like The Apocalypse, The Large Passion, and The Life of a Virgin. In 1513, Albrecht was basically focusing on etching. He made a charcoal engraved self-representation of his mom with an individual, delicate message. Albrecht was likewise bustling making a gigantic woodcut Triumphal Procession and Triumphal Arch. In July 1520, Albrecht and his better half traveled to the Netherlands to see ruler, Charles V. He likewise needed to discover new markets for his work. Albrecht didn't have great accomplishment in the Netherlands yet he met individual specialists. Albrecht left inside a year and created various picture inscriptions in Nurembourg. On April 6, 1528, the multi year old kicked the bucket. At his demise his hypothetical arrangements were not completely finished. Some of them were at that point distributed. As indicated by Albrecht, catching the magnificence of the human body is the most important point of workmanship. In any case, this can't be acknowledged without information on extent and life structures, and just through geometry can be genuine magnificence be known. davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-30372449010168535732020-08-11T14:35:00.001-07:002020-08-11T14:35:03.082-07:00Postpartum Psychosis Linked to Bipolar DisorderPostpartum Psychosis Linked to Bipolar Disorder Bipolar Disorder Symptoms Depression Print Postpartum Psychosis Linked to Bipolar Disorder By Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial policy Marcia Purse Medically reviewed by Medically reviewed by Carly Snyder, MD on November 13, 2019 facebook twitter linkedin Carly Snyder, MD is a reproductive and perinatal psychiatrist who combines traditional psychiatry with integrative medicine-based treatments. Learn about our Medical Review Board Carly Snyder, MD Updated on January 28, 2020 Bipolar Disorder Overview Symptoms & Diagnosis Causes Treatment Living With In Children Your Rights Tetra Images - Jamie Grill / Brand X Pictures / Getty Images Experts estimate that 50 to 85% of all new mothers experience the baby blues, a common response to hormonal changes after the birth of a child that typically self-resolves within two weeks. However, an estimated 14% of new mothers will develop postpartum depression, a more serious condition that can include mood swings, uncontrollable crying, fatigue or exhaustion, feelings of guilt, inadequacy or worthlessness, lack of interest in the baby and other common signs of depression. Around 0.1-0.2% (thats one or two of one thousand women) will develop postpartum psychosisâ"a very serious illness that needs quick intervention, usually including hospitalization. One or two of one thousand may not sound like many until you learning that in 2018 there were approximately 3.79 million births in the United States. This translates to 3,790 to 7,580 women who may experience postpartum psychosis per year. Given the rates of suicide and infanticide related to postpartum psychosis, this estimates a risk of more than 300 infants killed and approximately 380 mothers committing suicide because of this illness each year in the U.S. alone. Causes and Risk Factors Although more studies are needed to determine the causes of postpartum illnesses, the evidence suggests that the sudden drop in estrogen levels that occurs immediately after the birth of a child plays a significant role, along with sleep disruptions that are inevitable before and after the birth. Many researchers conclude that postpartum psychosis is considered to be on the bipolar spectrum and a prior history of depression and/or anxiety is a strong risk factor. Poor social support, young age, traumatic delivery, and financial instability are other potential causative factors. One of the biggest risk factors for postpartum psychosis is a previously diagnosed bipolar disorder or schizophrenia, along with a family history of one of these conditions. Also, women who have already experienced postpartum depression or psychosis have a 20 to 50% chance of having it again at future births. Additionally, sleep deprivation worsens mood symptoms and may increase the risk of development of a postpartum mood disorder. Symptoms of Postpartum Psychosis Symptoms of postpartum psychosis are consistent with those of a bipolar I psychotic episode but have some special twists specifically related to motherhood. They include, but are not limited to: HallucinationsDelusionsPeriods of delirium or maniaThoughts of harming the baby or oneselfIrrational feelings of guiltRefusing to eatThought insertion: The notion that other beings or forces (God, aliens, the CIA, etc.) can put thoughts or ideas into ones mindInsomnia: Although studies are beginning to show that insomnia may be a cause rather than an effectReluctance to tell anyone about the symptoms If You Already Have Bipolar Disorder You should be awareâ"and so should your loved onesâ"that having a history of bipolar disorder may mean that you have a higher-than-average risk of having postpartum psychosis. Prompt treatment is essential to get postpartum psychosis under control. Under no circumstances should you spend most of your time alone with your infant, as this may lead to severe disruptions in sleep that can make a bad situation even worse. Keep in contact with your psychiatrist or therapist during the first six weeks after your childs birth. Arrange ahead of time to have your husband or partner, relatives, friends or even social workers help you care for the infant and make sure you get the rest you need. If you have to choose between breastfeeding and taking your medications, choose the medications. The sooner you get treatment for postpartum illnesses, the faster they can be controlled. davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-24207835574209262712020-06-20T22:06:00.001-07:002020-06-20T22:06:03.425-07:00Water/Environment - 825 WordsWater/Environment (Research Paper Sample) Content: Water/Environment Student's Name: Professors Name: Course Number: Date: Water/Environment Abstract The key objective of the research is about the negative impacts of the bottled water to the environment. Many people and animals are suffering from the impacts of the plastic bottles that as used to store mineral water. Based on the history and the origin of the bottled water, it is clear that the bottled water producers had no ill intention in their bottling processes but after a while, unethical competition leads to the production of unhealthy bottling of water. The best solution to the problems that are brought by bottled water is the introduction of strict policies to both water bottlers and consumers. Introduction Bottled water is the water that is stored in the plastic bottles to allow the consumer to take both the liquid and the containers. Portability is much considered by both the producers and the consumers, but the impacts to the environment are given little thought. Therefore, the bottled water has led to the problems to both animals and humans being because of the rapid increase consumption of the bottled waters in The United States and of the parts of the world. Some measures are supposed to be put in place to protect the environment against pollution that results because of the consumption of bottled water. The background With the start of the thermal resorts across the world and the recognition of therapeutic advantages f the mineral water and spring water people started to take the thermal water from the urban centers and continue to enjoy the healing features of mineral water. The commercialization and the bottling of the mineral water first started in the mid 16th century (Dege, 2011). In 1856, the Sarotage springs in New City was bottling more than 7 million bottles mainly for medicals reasons. In the United States of America, individuals consume over 30 billion bottles of water annually, and the analysis shows that over 50 billion of bottled water is consumed in the world every year. Therefore, it means that the United States consumes approximately 60% of the bottled water in the world regardless of the reason that the United States makes about 4.5% of the world population (Gleick, 2010). 1,500 of the water bottles are consumed after every second in the United States. 9.1 billion gallons were sold in 2011. The sales that was made in 2011 was the highest sale in history because it is equivalent to 29.1 gallons per person per annum. The impacts of the bottled water to the environment Water bottles can be created out of recyclable polyethylene terephthalate (PET) plastics. The PET is non-biodegradable; hence, they split down into tiny fragment over time. The fragments absorb the toxins that can contaminate or pollute the soil, waterways and sicken the animals in the society. The plastic bottles trash can absorb the organic pollutants such as PCBs and BPA (Miller, Spoolman, 2012). Based on the study which was carried by the Oceanic Conservatory, the results showed that plastic bags and plastic bottles are the most widespread kind of pollution found in most beaches and oceans in the world. The study by Oceanic conservatory analyzed that for every square mile of the ocean there are over 46,000 floating plastics such as plastic bottles. 10% of the plastics that are manufactured by the plastic manufacturing companies in the world end up in the oceans. When the plastics are floating in the oceans over time they accumulate since they are non-biodegradable; hence polluting water and affecting the living organism in the water (Miller, Spoolman, 2012). Bottled water is not safer for consumption because the most of the scientific evidence show that plastic bottles leach into the water they hold; hence, the leaching effects have been connected to the health problems such as various types of cancer and the reproductive issue (Miller, Spoolman, 2012). After the ten weeks of storage, the harmful hormone-disrupting phthalates can leach into the water which is kept in the plastic bottles or even much quick especially in the condition where the bottled water are left in an open place where there is direct sunlight. Tap water is not perfect because the purity of water depend on the source and the place where the consumers live. Based on the study which was carried by the National Resource Defense Council it was ascertained that 22% of the water tested had a nonterminal level that is over the health limit of the United States. Over 780 million people in the world which are over double of the United States population do not have access to safe an... davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-83643920607177847862020-05-23T19:13:00.001-07:002020-05-23T19:13:05.053-07:00Essay The Role of Database Administrator - 1418 Words Importance Few companies today can exist without an IT department. The IT department contains many of the companyââ¬â¢s technology experts. Almost all companies rely on computers to some degree whether it is an international conglomerate or a small startup company. Some companies are very dependent on computer systems while others use them only for accounting for payrolls and everyday computer tasks. Most organization, even the smallest company have people whose job is to make sure that the computer system is up and running or an emergency contact to call when the computer systems goes down. In the future, I want to take the head of a database administrator of an IT department whether the size of the company is small or enormous. In largerâ⬠¦show more contentâ⬠¦My career might start off as a database designer. Database designers determine what are best types of databases to solve certain problems and work with database tools in order to develop those databases. After a database designer, I could be promoted to a manager role. Knowledge managers have a much higher-level knowledge to business problems than database designers. Knowledge managers usually focus on an area like accounting and working with database designers to develop databases that meet the needs of the users. In contrast to database designers, knowledge managers handle different tasks. Knowledge managers interfere with users and database designers in order to ensure that the databases meet the needs of the users and most importantly, the company. They usually have a specialty in a field in organizing, refining or gathering. Responsibility of database jobs The responsibility of a database administrator is to serve as the link between the database designers, knowledge managers and users. The database designers are often brought in for completing specific projects and then moving onto other projects at other companies or different departments at the same company. Their job are usually finished when they finish designing the database. While they may be used in the future to perform someShow MoreRelatedTechnology Changes Role of Database Administrator1195 Words à |à 5 PagesTechnology Changes Role of Database Administrator The database administrator (DBA) is responsible for managing and coordinating all database activities. The DBAs job description includes database design, user coordination, backup, recovery, overall performance, and database security. 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One member of the group noted two key roles involved in running the administrative side of the community. These two roles may sound similar, but they have striking differences that make their variation requisite to the success of the community. The higher of the two being the ââ¬Å"Administrative,â⬠position or the admin for short. The second role is the ââ¬Å"Moderator,â⬠or mod. During normal operation, these roles share many of the same responsibilities of each other. That is davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-41487554918524294222020-05-18T09:52:00.001-07:002020-05-18T09:52:14.155-07:00A Comparative Analysis on Two Leaders - Free Essay Example Sample details Pages: 5 Words: 1517 Downloads: 7 Date added: 2017/06/26 Category Ethics Essay Type Compare and contrast essay Did you like this example? Two leaders Quality Mother Theresa Pope John Paul II Personal Values Charity Humility Selflessness Faith Voluntarism Faith Compassion Peace Unity Liberty Personal Beliefs She believed that it is our duty to care for others. She believed that Godà ¢Ã¢â ¬Ã¢â ¢s presence could be seen in every human suffering. She believed that we get easily caught up in our own problems wherein we forget how many people around us were less fortunate. She believed that doing good things does not have to be big, as even little things with great love could be sufficient. She believed that serving other before oneself will stop the selfishness and shallowness. He believed that freedom is doing what is righteous, not by doing what we prefer. He believed that every human life is part of Godà ¢Ã¢â ¬Ã¢â ¢s loving plan. He believed that democracy without values can become an open or thinly disguised totalitarianism. He believed on having no fear of moving into the unknown. He believed that the world is created for manà ¢Ã¢â ¬Ã¢â ¢s service and Godà ¢Ã¢â ¬Ã¢â ¢s glory. Personal Attitudes Selfless Loving Cheerful Humble Religious Non-bias Religious Philanthropic Determined Caring Personal Metaprograms Motivation filter Orientation filter Success indication filter Decision-making filter Convincer filter Leadership filter Energy Direction filter Performance filter Work Satisfaction filter Preferred Interest filter Abstract/Specific filter Comparison filter Challenge Response filter Time Awareness filter Focus filter Toward Motivated Both, Possibility and necessity Internal Do Automatic Self and others Both, Active and Reflective Team Player People People Abstract to specific Sameness Choice In time Others Toward motivated Both possibility and necessity Internal Do Automatic Self and others Both Active and Reflective Team player People People Abstract to specific Sameness with differences equally Choice Through time Others Quotes associated to them à ¢Ã¢â ¬Ã âThere is hunger, maybe not the hunger for a piece of bread but there is a terrible hunger for love.à ¢Ã¢â ¬Ã à ¢Ã¢â ¬Ã âWe think sometimes that poverty is only being hungry, naked and homeless. The poverty of being unwanted, unloved and uncared for is the greatest poverty. We must start in our own homes to remedy this kind of poverty.à ¢Ã¢â ¬Ã à ¢Ã¢â ¬Ã âThe most terrible poverty is loneliness and the feeling of being unloved.à ¢Ã¢â ¬Ã à ¢Ã¢â ¬Ã âWhen freedom does not have a purpose, when it does not wish to know anything about the rule of law engraved in the hearts of men and women, when it does not listen to the voice of conscience, it turns against humanity and society.à ¢Ã¢â ¬Ã à ¢Ã¢â ¬Ã âHave no fear of moving into the unknown. Simply step out fearlessly knowing that I am with you, therefore no harm can befall you; all is very, very well. Do this in complete faith and confidence.à ¢Ã¢â ¬Ã à ¢Ã¢â ¬Ã âSocial justice cannot be attained by violence. Violence kills what it intends to create.à ¢Ã¢â ¬Ã Main Decision Points in their Life At the age of 18, Mother Theresa left Skopje and went to Loreta Sisters. She was unable to see her mother and sister again. After 15 years working in the Loreto School as a teacher, she realized that she had a call to take care of the sick and the dying, the hungry, the naked, the homeless. To be Godà ¢Ã¢â ¬Ã¢â ¢s love in action to the poorest of the poor. That was the beginning of the Missionaries of Charity. She asked permission to leave Loreta Congregation and establish the new order of sisters in the streets for the poor. After his fatherà ¢Ã¢â ¬Ã¢â ¢s death, he decided to step into priesthood wherein he illegally attended seminary classes in the secret underground seminary headed by Archbishop of Krakow. In the beginning of Pope John Paul II papacy, he firmly reaffirmed the canon law prohibiting priests to actively participate in party politics. His purpose was not to reduce Catholicismà ¢Ã¢â ¬Ã¢â ¢s political influence but to unite the church and to reinforce moral authority. Memories and References Mother Theresaà ¢Ã¢â ¬Ã¢â ¢s mother Dranafile had a strong personality. Her mother taught her to be good and to be helpful. Her father died at the age of 42 wherein their family was very poor. Mother Theresaà ¢Ã¢â ¬Ã¢â ¢s mother and sister died alone because the Albanian military did not send them out the country. When he was 8yrs. old, his mother died and after four years later, his physician brother died. He lived in a disciplined way of living with routine religious observation under his fatherà ¢Ã¢â ¬Ã¢â ¢s supervision. He was hit by a German truck which he suffered from severe concussion and shoulder injury as he was left in the road for several days. He was discovered by a passerby. Based from his experienced, he believed that God has other plans for him as a confirmation of his vocation. On the 13th of May 1981, he was gunshot and was seriously wounded by an assassin. After his recovery, he offered forgiveness from the gunmanà ¢Ã¢â ¬Ã¢â ¢s actions. Personal Traits Compassionate Humane Determined Forgiving Determined Commited in his beliefs Personal Skills and Skills Sets Good interpersonal skills Good communication skills Had the capability to motivate and inspire other people. Multi-lingual speaker Effective peacemaker Collaborator Personal Strategies Believed in divine providence Discouraged fund raising and allows peopleà ¢Ã¢â ¬Ã¢â ¢s time, energy, monies and skills. To understand the poor, they must know what is poverty. They did not accept government grant, no church maintenance, salary, fees, and no income of such. Used his overseas visits to resolve numerous human conflicts that may impede the harmony between countries. He personally communicates with various parties. Maintains nonviolent and calm transactions with other religions Schedule to work on the focus areas Involvement in groupwork Short term: 19/01/2015-02/02/2015 Tasks Mon Tues Wed Thurs Fri Sat Sun Discussion with classmates 10:00AM-11: 30AM 1:30PM à ¢Ã¢â ¬Ã¢â¬Å" 2:30PM 10:00AM-11: 30AM 1:30PM à ¢Ã¢â ¬Ã¢â¬Å" 2:30PM 10:00AM-11: 30AM 1:30PM à ¢Ã¢â ¬Ã¢â¬Å" 2:30PM 10:00AM-11: 30AM 1:30PM à ¢Ã¢â ¬Ã¢â¬Å" 2:30PM WORK (5:00PM à ¢Ã¢â ¬Ã¢â¬Å" 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Library research 3:20PM-4:20PM 3:20PM-4:20PM WORK (5:00PM à ¢Ã¢â ¬Ã¢â¬Å" 9:00PM) WORK (5:00PM à ¢Ã¢â ¬Ã¢â¬Å" 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Internet research 3:20PM-5:00PM WORK (5:00PM à ¢Ã¢â ¬Ã¢â¬Å" 9:00PM) WORK (5:00PM à ¢Ã¢â ¬Ã¢â¬Å" 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Discussion with colleagues while at work 5:00PM à ¢Ã¢â ¬Ã¢â¬Å" 9:00PM WORK (5:00PM à ¢Ã¢â ¬Ã¢â¬Å" 9:00PM) WORK (5:00PM à ¢Ã¢â ¬Ã¢â¬Å" 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Long term: 09/02/2015-01/11/2015 Tasks Mon Tues Wed Thurs Fri Sat Sun Contribute at least 3 ideas in group activity 10:30AM- 11:30AM 1:30PM- 2:20PM 10:30AM- 11:30AM 1:30PM- 2:20PM WORK CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Speak in front of the class as the group representative 10:30AM à ¢Ã¢â ¬Ã¢â¬Å" 11:30AM 1:30PM à ¢Ã¢â ¬Ã¢â¬Å" 2:30PM 10:30AM à ¢Ã¢â ¬Ã¢â¬Å" 11:30AM WORK CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Do handover about clientà ¢Ã¢â ¬Ã¢â ¢s status and make suggestions to improve cares 5:00PM- 9:00PM 5:00PM- 9:00PM 5:00PM- 9:00PM CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Improve self-confidence Short term: 19/01/2015- 15/02/2015 Tasks Mon Tues Wed Thurs Fri Sat Sun Read inspirational quotes such as our daily bread 8:30AM-8:45AM 8:30AM-8:45AM 8:30AM-8:45AM 8:30AM-8:45AM 8:30AM-8:45AM 8:30AM-8:45AM WORK (5:00PM- 9:00PM) 8:30AM-8:45AM CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Have a encouraging conversation with tutor / classmate 12:00NN- 1:00PM SDL 12:00NN- 1:00PM 12:00NN- 1:00PM 12:00NN- 1:00PM WORK (5:00PM- 9:00PM) WORK (5:00PM- 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Working with workmates with various style / strategies in work WORK (5:00PM- 9:00PM) SDL WORK (5:00PM- 9:00PM) WORK (5:00PM- 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Long-term: 16/02/2015- 16/08/2014 Tasks Mon Tues Wed Thurs Fri Sat Sun Go to church to pray and attend mass for spiritual support 3:00PM- 3:30Pm 3:30PM- 4:00PM 3:30PM- 4:00PM WORK (5:00PM- 9:00PM) 11:00AM- 12:15PM Communicate with family overseas to ask for advices and encouragement through viber or facebook messenger WORK (5:00PM- 9:00PM) 2:00PM- 3:00PM 6:00PM-7:00PM 6:00PM-7:00PM 10:00PM- 11:00PM 12:00NN- 2:00PM WORK (5:00PM- 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Permanent job as nurse for residency Short term: 09/12/2014- 09/01/2015 Tasks Mon Tues Wed Thurs Fri Sat Sun Look for CAP providers in NZ aside from prospect school (EIT) 10:00AM- 11:00AM 4:00PM- 5:00PM 4:00PM- 5:00PM WORK (5:00PM- 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Make an inquiry about CAP program in one of CAP providers through emails / phone calls SCHOOL (9:00AM-3:00PM) WORK (5:00PM-9:00PM) 1:00PM- 3:00PM 4:00PM- 5:00PM 4:00PM- 5:00PM SCHOOL (9:00AM-3:00PM) WORK (5:00PM-9:00PM) 10:00AM- 11:00AM WORK (5:00PM- 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Completion of documents required for CAP school such as JP of documents and medical SCHOOL (9:00AM-3:00PM) WORK (5:00PM-9:00PM) 12:30PM-1:00PM 12:00NN-1:00PM 10:00AM-10:30AM WORK (5:00PM-9:00PM) WORK (5:00PM- 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Submission of requirements to school SCHOOL (9:00AM-3:00PM) WORK (5:00PM-9:00PM) 10:00AM- 12:00AM 4:00PM- 5:00PM 4:00PM- 5:00PM SCHOOL (9:00AM-3:00PM) WORK (5:00PM-9:00PM) WORK (5:00PM-9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Long term: 09/01/2015- 27/07/2015 Tasks Mon Tues Wed Thurs Fri Sat Sun Attend school in AGI to complete Level 6 and submission of portfolios and course works SCHOOL (9:00AM-3:00PM) SDL SCHOOL (9:00AM-3:00PM) SCHOOL (9:00AM-3:00PM) SCHOOL (9:00AM-3:00PM) WORK (5:00PM-9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Inquire to fellow colleagues at work about possible school for CAP WORK (5:00PM-9:00PM) WORK (5:00PM-9:00PM) WORK (5:00PM-9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Advance searching in the internet for places with job vacancies for nurses 12:00NN- 1:00PM 4:00PM- 5:00PM 4:00PM- 5:00PM 4:00PM- 5:00PM SCHOOL (9:00AM-3:00PM) WORK (5:00PM-9:00PM) 1:00PM- 2:00PM WORK (5:00PM-9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Donââ¬â¢t waste time! Our writers will create an original "A Comparative Analysis on Two Leaders" essay for you Create order davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-1988621350966890422020-05-12T17:38:00.001-07:002020-05-12T17:38:03.643-07:00Multiculturalism of the American Society In The Chinese in All of Us by Richard Rodriguez Free Essay Example, 1750 words In The Chinese in All of Us , Richard Rodriguez explores Multiculturalism. Rodriguez talks about the effects that multiculturalism of the American society had on his life. Being the son of Spanish speaking Mexican immigrant parents, he narrates the constant encounters he experienced while growing up in America. In defense of all the labeling and accusations he faced as a reaction to his book, which highlighted issues such as bilingual education and affirmative action, he wrote his understanding of the issue of Multiculturalism while maintaining one s own ethnic identity. He further elaborates, that though America is a blend of various cultures and it takes pride in it, it still has its own identity. America has its own individuality, its own culture. Multiculturalism in America and its impact on the American identity is constantly debated, where one side calls it the essence of American society whereas the other side considers it a threat to the American identity. (Rodriguez n. p)A merica is a multicultural society, where different cultures coexist alongside each other. Multiculturalism started as a movement at the end of the 19th century in the United States and Europe. We will write a custom essay sample on Multiculturalism of the American Society In The Chinese in All of Us by Richard Rodriguez or any topic specifically for you Only $17.96 $11.86/pageorder now The mass immigration of southern and eastern Europeans and Latin Americans were the driving forces behind it. The genesis of multiculturalism was the concept of cultural pluralism. The different features of different cultures often combine and incorporate. In this way, a cultural blend is formed which creates an environment of tolerance and respect for each other. In a multicultural society, individuals have the freedom to practice their own religion, follow their own dressing code, to eat what they want and participate in cultural practices despite its variance from the mainstream cultural norms. Since the first half of the 19th century, the United States has witnessed a constant mass immigration. These immigrants have played a pivotal role in shaping the cultural landscape of America. The immigrants having their own values, beliefs and attitudes, created their own perception of the adopted home. davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-76235355706435310432020-05-06T20:33:00.001-07:002020-05-06T20:33:16.194-07:00The Manipulation of Gender Roles in Shakespeareââ¬â¢s Othello... The Manipulation of Gender Roles in Shakespeareââ¬â¢s Othello Of Shakespeareââ¬â¢s great tragedies, the story of the rise and fall of the Moor of Venice arguably elicits the most intensely personal and emotional responses from its English-speaking audiences over the centuries. Treating the subject of personal human relationships, the tragedy which should have been a love story speaks to both reading and viewing audiences by exploring the archetypal dramatic values of love and betrayal. The final source of the tragic action in Shakespeareââ¬â¢s The Tragedy of Othello, the Moor of Venice has been attributed to various psychological, mythical, racial, social sources: Othelloââ¬â¢s status as racial outsider in Venetian society, his pagan roots inâ⬠¦show more contentâ⬠¦The most illusive character in all of Shakespeareââ¬â¢s drama, Iago is perhaps the most difficult to explore psychologically for the simple reason that he lacks a personal self. He dons and sheds gender like a closet of clothes, adorning each article as it suits hi m. Ultimately evolved from the Vice figure of the medieval English morality plays, as Bernard Spivack has convincingly argued, Iago is the Shakespeareââ¬â¢s dramatic and humanistic manifestation of the abstracted evil which governed the dramatic movement of the previous generations of English plays. The self he presents to the world is bound only by circumstance and not by constitution. One key to Iagoââ¬â¢s power is his ââ¬Å"improvisational abilityâ⬠(Gutierrez 12). Like the mythical Satan as Prince of Lies, he makes up his fabulous stories as he goes along, playing off of othersââ¬â¢ actions and reactions to his ever-spinning web of lies. Iago switches between the facades of emotion easily and fluidly. He admits and affirms his hatred of Othello in the opening lines of the play (I.i.1-9) [All citations are from the Bantam edition.] and reveals his intentions of betraying Othello at his earliest convenience (I.i.44). In the very next scene, not more than 150 lines l ater, we find Iago in his role as sycophant openly fawning before theShow MoreRelatedEssay about The Impact of Gender on Shakespeares Othello 1376 Words à |à 6 PagesThe Impact of Gender on Shakespeareââ¬â¢s Othello In the book ââ¬Å"Gender Troubleâ⬠(1990), feminist theorist Judith Butler explains ââ¬Å"gender is not only a social construct, but also a kind of performance such as a show we put on, a costume or disguise we wearâ⬠(Butler). In other words, gender is a performance, an act, and costumes, not the main aspect of essential identity. By understanding this theory of gender as an act, performance, we can see how gender has greatly impacted the outcome of the play inRead MoreAnalysis Of Othello By William Shakespeare Essay1606 Words à |à 7 PagesThe theme of power is explored in various ways throughout ââ¬ËOthelloââ¬â¢, Shakespeare uses the vulnerability of charactersââ¬â¢ flaws to allow power shifts to occur through manipulation. The Elizabethan value consensus highlights the difference in gender roles, with societal expectations being defined by the divine order. The limitations of social mobility provide a strong platform for the theme of power to be embedded upon, with characters such as Desdemona and Emilia representing the struggle that womenRead MoreGender Stereotypes in Othello Essay2033 Words à |à 9 Pagesregards to gender stereotypes. Shakespeareââ¬â¢s great play Othello uses its main characters to embody the characteristics of the stereotypical females and males according to societyââ¬â¢s liking. The stereotypical woman is loyal and faithful to her husband, while the male stereotype possesses strength, control, and dominance. This use of stereotypes enables many misperceptions to develop and build until ultimately everyone experiences downfall and destruction. Shakespeare includes the effects of gender rolesRead MoreAnalysis Of Shakespeare s Othello 1567 Words à |à 7 PagesWOMENââ¬â¢S ROLE IN SOCIETY: DISECTING THE MISOGONY IN SHAKESPEAREââ¬â¢S OTHELLO Judging Othello from a self-proclaimed feminist Audre Lordeââ¬â¢s perspective allows the reader to see the double standards women faced in the Elizabethan society. Today our society assigns gender roles to children from birth. From the baby dolls needing care and EZ Bake Oven toys, little girls are encouraged at an early onset to lead domesticated lives. Boys on the other hand, are given cars and action figures that can take rough-housingRead MoreThe Tragedy Of Othello By William Shakespeare Essay1418 Words à |à 6 Pagestragedy of ââ¬Å"Othelloâ⬠, believed to have been written in approximately 1603. The work revolves around four central characters; Othello, a Moorish general in the Venetian army; his new wife, Desdemona; his lieutenant, Cassio; and his trusted ensign, Iago. Throughout the play of ââ¬Å"Othelloâ⬠, William Shakespeare diagnoses and portrays two ills within his own society, which are undeniably still present in society today. Shakespeare portrays the i ssues of prejudice against race and prejudice against gender. In thisRead MoreJessica Foy. Othello Essay. English Iii. 14 February 2017.907 Words à |à 4 PagesJessica Foy Othello Essay English III 14 February 2017 Emilia Essay Character development is seen in almost every character in the play Othello. Most of the characters are seen tumbling in a downwards spiral of their former self; while other characters are seen becoming more powerful due to the loss of power from the people above them. One of the characters that developed from her superiorââ¬â¢s weaknesses is Iagoââ¬â¢s wife, Emilia. Emilia spends most of her time with Othelloââ¬â¢s wifeRead MoreFeminism In Othello Essay957 Words à |à 4 PagesEmilia is often named ââ¬Å"the feminist of Othelloâ⬠by scholars and critics because of her, seemingly, fiery independence among a sea of submissive women ( ââ¬Å"Act Four: The Feminist of Othelloâ⬠17). The characterization of a woman who speaks out for herself suggests that Shakespeare thought progressively; because during that time, the Elizabethan era, women were mere objects rather than human beings. The plot of Othello revolves around the misgivings of poor communication and lack o f trust among the charactersRead More Goodnight Desdemona: a Feminist Introspection of Shakespeare2482 Words à |à 10 PagesAnn-Marie MacDonaldââ¬â¢s Goodnight Desdemona (Good morningJuliet) uses intertextuality to unveil the complete Shakespearean characters of Juliet and Desdemona to reveal the feminist narrative lurking between lines of Shakespeareââ¬â¢s plays. Only through the intertextual re-examination of the Shakespearean text itself via the interjection of genre and the reassigning of dialogue, within the metatheatre, is the true feminist representation of the female Shakespearian characters unveiled from behind the patriarchalRead More Essay on the Love Story of Antony and Cleopatra1645 Words à |à 7 Pagesand Cleopatra is formally defined as a tragedy, it stands out from Shakespeareââ¬â¢s earlier tragic works. The structure of paradox within the play produces a different effect to usual tragic intensity. The characters display moods and impulse rather than pro gressing through a process of edification as in King Lear. The result from this spontaneity of character produces a lack of tragic motivation such as Macbethââ¬â¢s ambition, or of Othello-like tragic responsibility. However, like the preceding tragediesRead MoreEssay on Othello and Hedda Gabler: Breaking from Tradition1825 Words à |à 8 Pagesvarious ways, each one representing each gender differently. The representation of women has been a common and controversial subject. The female gender roles depicted in each time period have always been present in literature throughout history. These traditional female roles that society has placed on women have not always been evident. Even with different time periods, there has always been a break in the traditional female roles. Traditional female roles have always represented women as having davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-73769379191334661092020-05-06T12:44:00.003-07:002020-05-06T12:44:08.146-07:00Screening Lung Cancer Literature Review Free Essays Introduction Lung Cancer is the most common form of cancer diagnosed worldwide with respect to incidence and mortality. In 2008 in the UK, lung cancer accounted for 6% of all deaths and 22% of all deaths from cancer (Cancer Research UK, 2011). It is the leading cause of cancer related death in both men (24%) and women (21%) (Cancer Research UK, 2011). We will write a custom essay sample on Screening Lung Cancer: Literature Review or any similar topic only for you Order Now The 5-year survival rate is less than 10% in UK has not significantly improved in the past 20 years despite the advances in imaging and non-imaging diagnostic tests, surgical techniques and postoperative management, radiotherapy delivery and new chemotherapeutic agents (Ghosal et al., 2009). People who are at high-risk of having lung cancer in their life-time include smokers, ex-smokers, who have COPD and who have been exposed to industrial carcinogens such as asbestos and silica (Black et al.,2006). Due to its high prevalence and mortality rates, easily identifiable at-risk population, lung cancer appears to be an ideal candidate for mass screening (Reich et a.,2007), and hence active research has been carried on since the 1950ââ¬â¢s to detect lung cancer in an asymptomatic population at an early stage when it is localized and potentially curable (Bach et al.,2007). The efficacy of a screening programme is judged by its capability to reduce disease-specific mortality and improve survival. On reviewing the literature it is evident that lung cancer screening has been an active field of research appealing many, however also a controversial topic. It is debated mainly in terms of cost effectiveness of the services, ideal diagnostic tests, benefits, harms, influence on mortality and survival, study design, inherent biases such as lead-time bias, length time bias, overdiagnosis bias (Patz et a.,2000). Currently there is no mass screening programme in the UK. ââ¬Å"The National Institute for Health and Clinical Excellence (NICE) considers evidence of both clinical and cost effectiveness when deciding on whether or not to sanction the introduction of new NHS treatments or servicesâ⬠(Whynes ,2008). The aim of this review is to give an overview about the principles underlining screening, to synthesize and evaluate information from recent evidence provided by clinical studies and RCTââ¬â¢s for lung cancer screening and the issues pertaining to it, review the range of diagnostic test best suitable for screening and overall assess the feasibility of a screening programme and test if evidence support the hypothesis that early detection leads to reduction in mortality. Methods Identification of Studies Literature search was conducted using electronic databases such as AMED, EMBASE, Ovid MEDLINE(R), [email protected], Science Direct, Google Scholar using search terms: lung carcinoma, lung cancer screening limiting the search from 1995-2011,clinical trials for screening lung cancer was searched without any time limits and past and on-going clinical trials were identified from National Cancer Institute USA and Cancer Research UK using the clinical trials and research search tool. Lung Cancer was searched using the same search terms to identify studies. Reference list of systemic reviews and other studies was scanned. Quality of the studies was judged on their source of publication and the number of times the particular article was cited by others. Selection of papers Initial literature search on LCS resulted in a large number of papers with potential titles which were then filtered by selecting papers based on the relevance of the title to the topic and by reading the abstracts. Full papers of the relevant studies were then retrieved and reviewed. Inclusion Papers on screening for lung cancer were considered as the theme as opposed to diagnosing and staging of LC. Primary search for studies included: systemic reviews, RCTââ¬â¢s,non-randomized cohort / case-control studies, economical analysis, smoking cessation and lifestyle changes. Studies including other interventions such as CXR, sputum cytology, autofluroescence bronchoscopy, LDCT,PET, biomarkers was considered, however LDCT emerged as the modality of choice due to its technical and clinical abilities. Exclusion Papers not published in English were excluded. Data extraction and synthesis Substantive data was extracted from the papers. Methodological information regarding the information on participants regarding the entry criteria used such as age, smoking history(PY) and status i.e. current or former, sub-group of highââ¬ârisk patients with COPD and occupational based risk factors was collected. Data from the results of the studies in terms of prevalence, detection, survival and mortality rates was noted along with disease stage and follow-up period. Outcome Measures The primary outcome was to assess the influence of LCS on mortality. Secondary outcomes were the effectiveness of screening clinically and economically, and the impact of screening on lifestyle changes and smoking behavior. Screening ââ¬Å"Screening means testing people for early stages of a disease before they have any symptomsâ⬠(Cancer Research UK, 2011). Screening for LC is highly debated due to lack of evidence provided by past RCTââ¬â¢s showing reduction in mortality and due to the high costs for screening LC . WHO Screening Guidelines 1.) ââ¬Å"The condition should be an important health problem 2.) The disease should have significant mortality 3.) There should be a latent phase of the disease 4.) Intervention earlier in the disease process should improve outcomes 5.) The screening test itself should have certain characteristics 6.)The cost of finding a case using the screening technique should be considered in relation to medical expenditure as a wholeâ⬠Table 1: WHO Screening Guidelines. (Reproduced from Ghosal et al, 2009). Results Studies Included Using the electronic databases 42 studies was included and were categorized based on the nature of the study and relating to the endpoint of this review. They were categorized as: Randomized controlled trials (RCT), non randomized cohort/control studies, cost-effectiveness studies and studies that evaluated the impact of screening on smoking behavior and lifestyle. RCTââ¬â¢s On reviewing the literature 8 RCTââ¬â¢s were identified that were conducted in the past, which are current and which are on-going. Two large RCTs namely NLST (National Lung Screening Trial) (NLST Team, 2010) conducted in the USA compared LDCT and CXRââ¬â¢s among screened patients and NELSON (Dutch Belgian randomised lung cancer screening trial) (Netherlands Trial Register, 2011) is currently underway in the Netherlands comparing LDCT with no LDCT. Small RCTââ¬â¢s namely LSS (Lung Screening Study) (Gohagan et al., 2004), DEPISCAN (French pilot RCT) (Blanchon et al.,2007), DANTE (Infante et al.,2008), ITALUNG ( Pegna et al.,2009) randomized their study population into two arms in which LDCT was considered as the active arm. In the UK an randomized trial funded by the NIHR HTA called the UKLS (UK Lung Cancer Screening Trial) (Baldwin et al.,2011) is underway and is based on the initial results of the NLST. It is working closely with the NELSON trial to maximize the data available(NIHR Health Technology Assessment programme,2011).Features of these RCTââ¬â¢s with their aim and outcome have been outlined in Table 2. PLCO is a large RCT studying the impact on mortality reduction by screening patients with CXR(National cancer institute,2011). Table 2: Noteworthy RCTââ¬â¢s using LDCT for lung cancer screening. Study Ref Country Study Design Study start Year Aim of the Study Age Range No. of Subjects No. of subjects in the LDCT arm No. of subjects in the Control Arm Smoking History Study Outcome UKLS[Ongoing]( Baldwin et al.,2011)UK LDCT vs. Obs2008 The objective of the UKLS trial is to assess whether LDCTscreening and treatment of early lesions will reduce LC mortality in comparison to a control group without screening and to investigate if LC screening programme could be implemented in UK while ensuring any benefit exceeds harms in a cost-effective manner. 4000 (28000 if progression criteria met )ââ¬â ââ¬â NANA NELSON[Ongoing](Netherlands Trial register, 2011).NL-B-DK LSCT vs. Obs2003 1. To prove that in a RCT, screening with LDCT in high risk subjects will lead to a 25% decrease in lung cancer mortality. 2. To estimate the impact of lung cancer screening on health related quality of life and smoking cessation; 3. To estimate cost-effectiveness and help policy making.50-75156007915790715 cigs/day 25 years OR10 cigs/day 30 yearsNA NLST[Recent](NLST Team,2010)USA LDCT vs. CXR2003 To compare LC mortality of subjects screened with LDCT and with subjects screened with CXR.55-74530002672326733? 30 PYInitial results, shows 20 % fewer lung cancer deaths among trial participants screened LDCT compared to CXR. ITALUNG-CT (Pegna et al.,2009)Italy LDCT vs. Obs2004 ITALUNG is a population-based recruitment RCT perspective of pooling data with other RCTs in Europe andUS [14,22] contributing to the cooperative effort for the evaluation of the efficacy of low-dose CT lung cancer screening.55-6932061613159320 PYPopulation-based enrolment of high-risk subjects for aRCT of lung cancer screening with low-dose CT is feasible. The number of drop-outs in the group of subjects randomized to the active arm is low. LSS ( Gohagan et al.,2004)USA LDCT vs. CXR2002 To assessthe feasibility of conducting a large scale RCT of LDCT versus CXR for LC screening.55-74331816601658?30 PARCT comparing annual spiral CT to CXR is feasible.. DANTE( Infante et al.,2007)Italy LDCT vs. CXR + Sputum cytology2001 To determine the efficacy of lung cancer screening with low-dose CT on LC mortality.LC prevalence, incidence, stage distribution, and resectability are secondary endpoints60-74247212761196?20 PYLC Stage I detection rate in the spiral CT arm was 4 times higher than CXRââ¬â¢s.Advance stage tumors were also detected by CT. High resection rate suggests possible increase in cure rate. Longer follow up suggested. Depiscan-France[Pilot RCT results ]( Blanchon et a.,2007).France LDCT vs. CXR2002 ââ¬Å"To determine the feasibility of enrollment byGPs, investigations and diagnostic procedures by university hospital radiologists and multidisciplinary teams, data management by centralized clinical research assistants, and anticipate the future management of a large national trialâ⬠(Blanchon et a.,2007)50-75621385380? 15 cigs/day for 20 YearsThis pilot trial allows estimating that non-calcified nodules are 10 timesmore often detected by LDCT than from CXR. It concludes that enrollment by GPââ¬â¢s was difficult and expresses the need for a large co-ordinate clinical research team in a trial. Clinical Effectiveness: Studies 34 studies were included and broken down to different sub-groups: With comparators, without comparators and other methods.RCT by Garg et al.(2002) compared LDCT versus no screening among patients with COPD and smoking history. Non-randomized studies by Henschke et al.(1999,2001,2004,2006)compared LDCT with CXR Swenson et al.(2002,2003,2005) compared CT with sputum cytology, Sobue et al.,2002 compared CT with CXR and sputum cytology. Studies by Pastorino et al.(2003) and Bastarrika et al.(2005) used LDCT along with PET without any comparator group. Futher prospective, non-randomized cohort studies by Sone et al(.2001);Nawa et al.(2002); Diederich et al.(2002,2004); MacRedmond et al.(2004,2006);Novello et al.(2005);Chong et al.(2004); Menezes et al.(2009) were single arm studies using LDCT. Several of these studies have been summarized with their results elsewhere (Yau et al., 2007). A study by Chien et al. (2008)estimated the mean-sojurm time and effect of mortality reduction by LDCT .I-ECAP study (Henschke et al., 2006) reported survival rates of screen diagnosed stage I cancers.The chosen trials sample populations were predominantly male and over the age of 40(Yau et al., 2007). The participants consisted of non-smokers as well as former or current smokers and who have COPD and who have been exposed to asbestos. Other tests for LCS: In a bimodality lung cancer surveillance trial in highââ¬ârisk patients Lowen et al.,(2006) combined autofluorescent bronchoscopy (AFB)and LDCT, findings from AFB were compared to sputum cytology results .186 patients were enrolled who fulfilled the high-risk criteria and 169 completed baseline tests,7% were diagnosed with lung cancer . Bimodality surveillance could detect lung cancer and pre-malignancy in patients with multiple lung cancer risk factors despite sputum cytology findings and AFB proves to be an effective test in high-risk patients (Lowen et al., 2006). A RCT in UK called the Lung-SEARCH study is looking at detecting early LC using LDCT and fluorescence bronchoscopy in people with COPD (UKCRN,2011). In a cross-sectional study by Carozzi et al.(2009), potential use of molecular genetic markers for screening and diagnostic purposes were evaluated which could be combined with LDCT . Biomarkers detected in biological fluid help us understand the connection between genetic alternations and/or molecular pathways changes which will help us detect lung cancer earlier and reduce mortality (Carozzi et al., 2009). ââ¬Å"Multi-screening approach integrating imaging technique and biomolecular marker could be used to improve screening for lung cancer and is worth of further investigationâ⬠(Carozzi. et al.,2009) The MEDLUNG study in UK is currently underway, looking at detecting early LC amongst high-risk patients using biomarkers (UKCRN,2011) Cost Effectiveness A systemic review by Black et al., in 2006 assessed the clinical and cost-effectiveness of CT for LC screening, six studies that described full economic evaluation was identified by scanning the reference list. Further two studies evaluating the cost effectiveness in an UK and Australian setup were looked upon. Economic and mathematical models were used to calculate cost-effectiveness ratios based on study assumptions. Characteristics of the economic studies are described in Table 3. Ref. Type of evaluation synthesis Interventions Study Population Country Period of study Okamoto, 2000 CEA; Total cost for one life saved; total cost for mean life expectancy saved. Mass screening(indirect CXR for all screened sputum cytology for high-risk individuals) in 1983 1993 and CT option Age- 40-84 years Japan 5 years Marshall et al.,2000 Incremental CEA; incremental cost per LYG LDCT vs. No screening Hypothetical cohort of 100,000 high risk-individuals (60-74 years) USA 5 years Marshall et al.,2001 Incremental CEA CUA; incremental cost per LY saved and cost per QALY saved. Annual scan with LDCT vs. no screening Hypothetical cohort of 100,000 high risk-individuals (60-74 years) USA 5 years Chirikos et al.,2002 Incremental CEA; incremental cost per LYG; cost per cancer case detected. 5 annual screening with LDCT vs. no screening. Hypothetical cohort of screened and unscreened patients from general population (Age ? 45-74 years) USA 15 years Mahadevia et al.,2003 Incremental CUA; incremental cost per QALY gained. Annual screen with LDCT vs. No screening. Hypothetical cohort of 100,000 current, quitting former smokers, Age ?60; 55 % male. USA 40 years Wisnivesky et al.,2003 Incremental CEA; incremental cost per LY saved. Single scan with LDCT vs. No screening. High-risk individuals, Age ?60 USA Cost restricted to 1 year. Manser et al.,2004 Incremental CEA; incremental cost per LY saved and QALY saved. 5 annual screening with LDCT vs. no screening Hypothetical cohort of 10000 male; age ? 60 Australia 5 years Whynes, 2008 Incremental CEA; incremental cost per QALY gained Single scan with LDCT vs. no screening, if positive further diagnostic tests to be undergone. Hypothetical cohort; high-risk male population using values of test parameters from previous clinical studies. UK ââ¬â Table 3~: Characteristics of economic evaluation studies (Reproduced from Black et al., 2006) and data from other studies. Impact on Lifestyle Smoking Cessation Lifestyle is a major modifiable cause of cancer and cancer-related mortality (Aalst et al.,2010). A review based on recent evidence published by studies, Aalst et al. (2010) indicated that screening may have a positive outcome hereby promoting healthy lifestyle but also cautions us that it can also encourage people to continue or start an unhealthy lifestyle. Lung cancer screening can prove to be a teachable moment for smoking cessation and may influence people to quit smoking (Taylor et al., 2006). Discussion Mortality rates gives us the true outcome of a test as it is unconfounded by bias (Black et al.,2006). An effective screening programme should be able to identify high-risk groups depending on age, gender, lifestyle and occupation and have high sensitivity and specificity eventually resulting in reduction of mortality. Studies by Henschke et al.(2000),Nawa et a.(2002), Gohagan et al.(2004),Menezes et al.(2009) reported high sensitivity and specificity above 80%,Sone et al.(2001) and Pastorino et al.,(2003) reported low sensitivities and Swensen et al.(2002) ,Diederich et al.(2002,2004) reported low specificities. Discrepancy resided amongst studies due to the variation in the entry criteria such as age, gender, PY, high-risk sample and threshold values set (?5 ââ¬â ? 20mm) for detecting suspicious lesions which made it difficult to compare results and determine the ideal criteria for diagnosis of a screening programme. Prevalence screening with LDCT revealed that majority of cancers reported were Stage I non-small cell lung cancer (53-100 %)(Yau et a.,2007)though advance stage cancers were also reported with other histological types of cancers. ELCAP,DANTE, LSS studies along with Swensen et al.(2002) found that CT was more effective at identifying cancerous NCNââ¬â¢s than CXRââ¬â¢s.It should be noted that CT detects more peripherally located tumors than centrally located ones which are difficult to diagnose(Postmus et al.,2004). I-ELCAP study (Henschke et al.,2006) reported a 10-year survival rate of 88% for the whole series and 92% for resected stage I patients. By estimating shorter MST in conjunction with other parameters Chien et al.(2008) predicted that 15% mortality reduction can be seen for an annual LDCT screening. Initial results from NLST showed 20 % reduction in mortality in the LDCT arm, however final results are yet to be published(NLST Team,2010). This trial hereby the only RCT to date that has proved clinical effectiveness against mortality reduction. However it should be noted that operating characteristics can be influenced by high false positive and false negative rates. High FP rates due to detection of benign lesions and lack of standardized threshold for positive screen have been reported thus resulting in low PPV(Yau et al.,2007).This is one of the hurdles in implementing LDCT for LCS.True estimation of TN rates cannot be established due to incomplete follow-up of negative baseline scans and shorter follow-up duration thus leading to high NPV(Yau et al.2007). Accuracy also depends on the ability of the reporting radiologist(Sone et al.,2001). The assumption that a ââ¬Å"stage-shiftâ⬠would result in decrease in mortality needs to be more carefully evaluated as it would lead to decrease in inoperable cases and an increase in operable cases which means that LC incidence will occur as a result of overdiagnosis bias(Beplor et al.,2003). Both clinical effectiveness along with cost-effectiveness hurdle needs to be overcome (which presently poses a greater challenge) to fulfill the criteria of a screening programme(Gleeson ,2006) Inherent biases present in studies i.e. lead-time bias, length bias and over-diagnosis bias and should be accounted for in CEA and analytical methods as they can affect cost-effectiveness ratios (demonstrated by the cost-evaluation studies included) and survival and mortality benefit may be overestimated(Black et al,2006) .If evidence from LCS studies provide health gains in terms of quality and quantity of life with modest additional cost per patient, cost-effectiveness can be justified (Black et al.,2006).More complete and transparent CEA are required (Patz et al.,2000). According to the HTA report published in 2006 by Black et al., LDCT for screening LC does not meet the accepted NSC criteria due to unsatisfactory clinical and cost ââ¬âeffectiveness evidence. According to NICE the screening programme needs to pass the cost per QALY threshold of ?20,000ââ¬â30,000 per QALY (NIHCE,2005). However due to the rise in public expectations which adds additional burden on the services provided by NHS, the imbalance between demand versus supply and the rise in cost of health care services, it seems that even if NSC criteria are satisfied implementation of LDCT as a screening programme would be economically and logistically challenging with respect to the capital cost involved in setting up a multi centre nationalized screening programme Conclusion Based on this literature review, it has emerged that LDCT is the choice of screening tool for LCS, however integrated imaging with AFB and PET and advances in genomic and proteomic approaches promises to compliment the ability of CT to detect LC(Carozzi et al.2010).Economic decision-making framework should include harms of screening along with the mortality and morbidity associated with it, radiation exposure risks as a result of repeated follow-ups(Black et al.,2006) .Included studies did not account for this. Past and on-going LDCT studies need to be carefully evaluated and screening progrmme should be designed based on the countryââ¬â¢s merits and population distribution. NRCTââ¬â¢s have failed to establish reduction in mortality and hence evidence from large RCTââ¬â¢s proving the hypothesis and screening efficacy is of paramount importance for introducing a population screening progrmme. Results are awaited from these RCTââ¬â¢s. References: Andrea Lopes Pegna, Giulia Picozzi, Mario Mascalchi, Francesca Maria Carrozzi, Laura Carozzi,Camilla Comin, Cheti Spinelli , Fabio Falaschi, Michela Grazzini, Florio Innocenti, Cristina Ronchi, Eugenio Paci, 2009, Design, recruitment and baseline results of the ITALUNG trial for lung cancer screening with low-dose CT, Lung Cancer ;64 34ââ¬â40. C Black, A Bagust, A Boland, S Walker,C McLeod, R De Verteuil, J Ayres, L Bain,S Thomas, D Godden and N Waugh,2006, The clinical effectiveness and cost-effectiveness of computed tomography screening for lung cancer: systematic reviews, Health Technology Assessment; Vol. 10: No. 3. C.M. van der Aalst, R.J. van Klaveren, H.J. de Koning, 2010, Does participation to screening unintentionally influence lifestyle behaviour and thus lifestyle-related morbidity?, Best Practice Research Clinical Gastroenterology ;24 465ââ¬â478. Claudia I. Henschke, David F, Yankelevitz, Daniel M. Libby, Mark W. Pasmantier, James P Smith, Olli S. Miettinen, McGill ( ELCAP Investigators),2006,Survival of Patients with Stage I Lung Cancer Detected on CT Screening, N Engl J Med;355:1763-71. 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Francesca Maria Carozzi, Simonetta Bisanzia, Patrizia Falini ,Cristina Sani, Giulia Venturini,Andrea Lopes Pegna, Roberto Bianchi, Cristina Ronchi, Giulia Picozzi, Mario Mascalchi, Laura Carrozzi, Filomena Baliva, Francesco Pistelli, Laura Tavanti, Fabio Falaschi, Michela Grazzini, Florio Innocenti, Eugenio Paci, 2010, Molecular profile in body fluids in subjects enrolled in a randomised trial for lung cancer screening: Perspectives of integrated strategies for early diagnosis, Lung Cancer; 68 216ââ¬â221 F V Gleeson, 2006, Is screening for lung cancer using low dose spiral CT scanning worthwhile?, Thorax 61:5ââ¬â7. Gary Yau, Michael Lock, George Rodrigues, 2007, Systematic review of baseline low-dose CT lung cancer screening, Lung Cancer ;58, 161ââ¬â170. Gorka Bastarrika, Mara Jose? Garca-Velloso, Maria Dolores Lozano, Usua Montes, Wenceslao Torre, Natalia Spiteri, Arantza Campo, Luis Seijo, Ana Bele?n Alcaide, Jesu? s Pueyo, David Cano, Isabel Vivas, Octavio Cosn, Pablo Domnguez, Patricia Serra, Jose? A. Richter, Luis Montuenga, and Javier J. Zulueta, 2005, Early Lung Cancer Detection Using Spiral Computed Tomography and Positron Emission Tomography, Am J Respir Crit Care Med; Vol 171. pp 1378ââ¬â1383. Gerold Bepler, Dawn Goodridge Carney, Benjamin Djulbegovic, Robert A. Clark,Melvyn Tockman, 2003, A Systematic Review and Lessons Learned From Early Lung Cancer Detection Trials Using Low-Dose Computed Tomography of the Chest, Cancer Control; July/August : Vol.10, No.4. Gregory Loewen,Nachimuthu Natarajan, Dongfeng Tan, Enriqueta Nava4, Donald Klippenstein5, Martin Mahoney2, Michael Cummings2,Mary Reid, 2007, Autofluorescence bronchoscopy for lung cancer surveillance based on risk assessment[abstract], Thorax ;62:335-340 John K. Gohagan, Pamela M. 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Mushlin, Nachum Sicherman, Claudia Henschke, 2003, The Cost-Effectiveness of Low-Dose CT Screening for Lung Cancer* Preliminary Results of Baseline Screening, Chest;124;614-621. Kathryn L. Taylor,Lisa Sanderson Cox,Nicole Zincke, Larina Mehta, Colleen McGuire, Edward Gelmann, 2006, Lung cancer screening as a teachable moment for smoking cessation, Lung Cancer (2007) 56, 125ââ¬â134. Kavita Garg, Robert L. Keith,Tim Byers, Karen Kelly,Anne L. Kerzner, David A. Lynch, York E. Miller.2002, Randomized Controlled Trial with Low-Dose Spiral CT for Lung Cancer Screening: Feasibility Study and Preliminary Results, Radiology; 225:506 ââ¬â510 Maurizio Infante, Fabio Romano Lutman, Silvio Cavuto,Giorgio Brambilla, Giuseppe Chiesa, Eliseo Passera, Enzo Angeli, Maurizio Chiarenza, Giuseppe Aranzulla, Umberto Cariboni, Marco Alloisio, Matteo Incarbone, Alberto Testori, Anna Destro,Federico Cappuzzo, Massimo Roncalli, Armando Santoro, Gianluigi Ravasi, 2007, Lung cancer screening with spiral CT Baseline results of the randomized DANTE trial, Lung Cancer (2008) 59, 355ââ¬â363. National Lung Screening Trial Research Team, 2010, Baseline Characteristics of Participants in the Randomized National Lung Screening Trial, JNCI : Articles 1771,Vol. 102, Issue 23. National Lung Screening Trial Research Team, 2010, The National Lung Screening Trial:Overview and Study Design, Radiology: Volume 258: Number 1ââ¬âJanuary 2011. Naoyuki Okamoto, 2000, Cost-Effectiveness of Lung Cancer Screening in Japan, CANCER Supplement ;Volume 89 , Number 11. National Institute for Clinical Excellence,2005, Clinical Guideline 24: Lung cancer: the diagnosis and treatment of lung cancer London: NICE. National Cancer Institute, 2011, Prostate Cancer Research Results From the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, accessed on 19/4/11 from http://www.cancer.gov/cancertopics/factsheet/detection/plco-prostate Netherland Trial Register,2011, Dutch Belgian randomised lung cancer screening trial (NELSON),Trial Information accessed on 24/04/11 from http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=636. Peter B. Bach, MD, James R. Jett, Ugo Pastorino, Melvyn S. Tockman, Stephen J. Swensen, Colin B. Begg, 2007, Computed Tomography Screening and Lung Cancer Outcomes, JAMA. 297:953-961. Parthiv J. Mahadevia, Lee A. Fleisher,Kevin D. Frick,John Eng,Steven N. Goodman, Neil R. Powe, 2003, Lung Cancer Screening With Helical Computed Tomography in Older Adult Smokers -A Decision and Cost effectiveness Analysis, JAMA.;289:313-322. Pasic A, Postmus PE, Sutedja TG, 2004, What is early lung cancerA review of the literature. Lung Cancer ;45:267ââ¬â77. R Ghosal, P Kloer, K E Lewis,2009, A review of novel biological tools used in screening for the early detection of lung cancer, Postgrad Med J ;85:358ââ¬â363. Ravi J. Menezes, Heidi C. Roberts , Narinder S. Paul, Maureen McGregor, Tae Bong Chung, Demetris Patsios, GordonWeisbrod, Stephen Herman, Andre Pereira, Alexander McGregor, Zhi Dong, Igor Sitartchouk, Scott Boerner, Ming-Sound Tsao, Shaf Keshavjee, Frances A. Shepherd, 2010, Lung cancer screening using low-dose computed tomography in at-risk individuals: The Toronto experience, Lung Cancer ;67, 177ââ¬â183. Renee Manser, Andrew Dalton, Rob Carter, Graham Byrnes, Mark Elwood, Donald A. Campbell, 2004, Cost-effectiveness analysis of screening for lung cancer with low dose spiral CT (computed tomography) in the Australian setting, Lung Cancer ;48, 171ââ¬â185. R. MacRedmond, P.M. Logan, M. Lee, D. Kenny, C. Foley and R.W. Costello, 2004,Screening for lung cancer using low dose CT scanning, Thorax ;59pp. 237ââ¬â241. R MacRedmond, G McVey, M Lee, R W Costello, D Kenny, C Foley, P M Logan,2006, Screening for lung cancer using low dose CT scanning: results of 2 year follow up , Thorax;61:54ââ¬â56. S Sone, F Li,Z-G Yang, T Honda, Y Maruyama, S Takashima, M Hasegawa, S Kawakami, K Kubo,M Haniuda and T Yamanda, 2001, Results of three-year mass screening programme for lung cancer using mobile low-dose spiral computed tomography scanner, British Journal of Cancer ;84(1), 25ââ¬â32. Stefan Diederich, Priv Doz, Dag Wormanns, Michael Semik, Priv Doz, Michael Thomas, Priv Doz, Horst Lenzen, Nikolaus Roos, Walter Heindel,2002, Screening for Early Lung Cancer with Low-Dose Spiral CT: Prevalence in 817 Asymptomatic Smokers, RSNA, 2002. S.J. Swensen, J.R. Jett, J.A. Sloan, D.E. Midthun, T.E. Hartman and A.M. Sykes et al.,2002, Screening for lung cancer with low-dose spiral computed tomography, Am J Respir Crit Care Med 1;65 pp. 508ââ¬â513. Stephen J. Swensen, James R. Jett, Thomas E. Hartman,David E. Midthun, Jeff A. Sloan, Anne-Marie Sykes, Gregory L. Aughenbaugh ,Medy A. Clemens,2003, Lung Cancer Screening with CT: Mayo Clinic Experience, Radiology; 226:756 ââ¬â761. Stephen J. Swensen, James R. Jett,Thomas E. Hartman, David E. Midthun, Sumithra J. Mandrekar, Shauna L. Hillman, Anne-Marie Sykes, Gregory L. Aughenbaugh,Aaron O. Bungum, Katie L. Allen,2005, CT Screening for Lung Cancer: Five-year Prospective Experience, Radiology ;235:259ââ¬â265. S. Novello, C. Fava, P. Borasio, L. Dogliotti, G. Cortese, B. Crida, G. Selvaggi, P. Lausi, M. P. Brizzi, P. Sperone, L. Cardinale, F. Ferraris, F. Perotto, A. Priola, G. V. Scagliotti, 2005, Three-year ?ndings of an early lung cancer detection feasibility study with low-dose spiral computed tomography in heavy smokers, Annals of Oncology 16: 1662ââ¬â1666. Semin Chong, Kyung Soo Lee, Myung Jin Chung, Tae Sung Kim, Hojoong Kim*, O Jung Kwon*,Yoon-Ho Choi, Chong H. Rhee, 2005, Lung Cancer Screening with Low-Dose Helical CT in Korea: Experiences at the Samsung Medical Center, J Korean Med Sci; 20: 402-8. Thierry Blanchon, Jeanne-Marie Br?echot, Philippe A. Grenier, Gilbert R. Ferretti , Etienne Lemari?e, Bernard Milleron, Dominique Chagu?e, Franc?ois Laurent, Yves Martinet,Catherine Beigelman-Aubry, Franc?ois Blanchon, Marie-Pierre Revel,Sylvie Friard, Martine R?emy-Jardin, Manuela Vasile , Nicola Santelmo,Alain Lecalier, Patricia Lef?ebure, Denis Moro-Sibilot, Jean-Luc Breton, Marie-France Carette, Christian Brambilla, Franc?ois Fournel, Alexia Kieffer , Guy Frija, Antoine Flahault, 2007, Baseline results of the Depiscan study: A French randomized pilot trial of lung cancer screening comparing low dose CT scan (LDCT) and chest X-ray (CXR), Lung Cancer ;58, 50ââ¬â58. Tomotaka Sobue, Noriyuki Moriyama, Masahiro Kaneko, Masahiko Kusumoto, Toshiaki Kobayashi, Ryosuke Tsuchiya, Ryutaro Kakinuma, Hironobu Ohmatsu, Kanji Nagai, Hiroyuki Nishiyama, Eisuke Matsui, and Kenji Eguchi, 2002, Screening for Lung Cancer With Low-Dose Helical Computed Tomography: Anti-Lung Cancer Association Project, J Clin Oncol 20:911-920. Takeshi Nawa, Tohru Nakagawa, Suzushi Kusano, Yoshimichi Kawasaki, Youichi Sugawara, Hajime Nakata,2002, Lung Cancer Screening Using LowDose Spiral CT* Results of Baseline and 1-Year Follow-up Studies, Chest 2002;122;15-20. Thomas N. Chirikos, Todd Hazelton, Melvin Tockman, Robert Clark, 2002, Screening for Lung Cancer With CT*- A Preliminary Cost-effectiveness Analysis, Chest;121;1507-1514. Ugo Pastorino,Massimo Bellomi,Claudio Landoni, Elvio De Fiari, Patrizia Arnaldi, Maria Picchio, Giuseppe Pelosi, Peter Boyle,Ferruccio Fazio, 2003, Early Lung-Cancer detection with spiral CT and Positron emission tomographyin heavy smokers : 2year results, Lancet :362:593-97. UK Clinical Research Network : Portfolio Database (UKCRN), 2011, Lung-SEARCH study , accessed on 20/4/11 from S. Diederich , M Thomas , M Semik , H Lenzen ,N Roos , A Weber , W Heindel ,D Wormanns ,2004, Screening for early lung cancer with low-dose spiral computed tomography: results of annual follow-up examinations in asymptomatic smokers [abstract], Eur Radiology;.(4):691-702. http://pfsearch.ukcrn.org.uk/StudyDetail.aspx?TopicID=1StudyID=2225. UK Clinical Research Network: Portfolio Database (UKCRN), 2011,The MEDLUNG study, accessed on 20/4/11 from http://public.ukcrn.org.uk/search/StudyDetail.aspx?StudyID=4682 How to cite Screening Lung Cancer: Literature Review, Essay examples davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-56611996234060190372020-05-06T12:44:00.001-07:002020-05-06T12:44:07.394-07:00Screening Lung Cancer Literature Review Free Essays Introduction Lung Cancer is the most common form of cancer diagnosed worldwide with respect to incidence and mortality. In 2008 in the UK, lung cancer accounted for 6% of all deaths and 22% of all deaths from cancer (Cancer Research UK, 2011). It is the leading cause of cancer related death in both men (24%) and women (21%) (Cancer Research UK, 2011). We will write a custom essay sample on Screening Lung Cancer: Literature Review or any similar topic only for you Order Now The 5-year survival rate is less than 10% in UK has not significantly improved in the past 20 years despite the advances in imaging and non-imaging diagnostic tests, surgical techniques and postoperative management, radiotherapy delivery and new chemotherapeutic agents (Ghosal et al., 2009). People who are at high-risk of having lung cancer in their life-time include smokers, ex-smokers, who have COPD and who have been exposed to industrial carcinogens such as asbestos and silica (Black et al.,2006). Due to its high prevalence and mortality rates, easily identifiable at-risk population, lung cancer appears to be an ideal candidate for mass screening (Reich et a.,2007), and hence active research has been carried on since the 1950ââ¬â¢s to detect lung cancer in an asymptomatic population at an early stage when it is localized and potentially curable (Bach et al.,2007). The efficacy of a screening programme is judged by its capability to reduce disease-specific mortality and improve survival. On reviewing the literature it is evident that lung cancer screening has been an active field of research appealing many, however also a controversial topic. It is debated mainly in terms of cost effectiveness of the services, ideal diagnostic tests, benefits, harms, influence on mortality and survival, study design, inherent biases such as lead-time bias, length time bias, overdiagnosis bias (Patz et a.,2000). Currently there is no mass screening programme in the UK. ââ¬Å"The National Institute for Health and Clinical Excellence (NICE) considers evidence of both clinical and cost effectiveness when deciding on whether or not to sanction the introduction of new NHS treatments or servicesâ⬠(Whynes ,2008). The aim of this review is to give an overview about the principles underlining screening, to synthesize and evaluate information from recent evidence provided by clinical studies and RCTââ¬â¢s for lung cancer screening and the issues pertaining to it, review the range of diagnostic test best suitable for screening and overall assess the feasibility of a screening programme and test if evidence support the hypothesis that early detection leads to reduction in mortality. Methods Identification of Studies Literature search was conducted using electronic databases such as AMED, EMBASE, Ovid MEDLINE(R), [email protected], Science Direct, Google Scholar using search terms: lung carcinoma, lung cancer screening limiting the search from 1995-2011,clinical trials for screening lung cancer was searched without any time limits and past and on-going clinical trials were identified from National Cancer Institute USA and Cancer Research UK using the clinical trials and research search tool. Lung Cancer was searched using the same search terms to identify studies. Reference list of systemic reviews and other studies was scanned. Quality of the studies was judged on their source of publication and the number of times the particular article was cited by others. Selection of papers Initial literature search on LCS resulted in a large number of papers with potential titles which were then filtered by selecting papers based on the relevance of the title to the topic and by reading the abstracts. Full papers of the relevant studies were then retrieved and reviewed. Inclusion Papers on screening for lung cancer were considered as the theme as opposed to diagnosing and staging of LC. Primary search for studies included: systemic reviews, RCTââ¬â¢s,non-randomized cohort / case-control studies, economical analysis, smoking cessation and lifestyle changes. Studies including other interventions such as CXR, sputum cytology, autofluroescence bronchoscopy, LDCT,PET, biomarkers was considered, however LDCT emerged as the modality of choice due to its technical and clinical abilities. Exclusion Papers not published in English were excluded. Data extraction and synthesis Substantive data was extracted from the papers. Methodological information regarding the information on participants regarding the entry criteria used such as age, smoking history(PY) and status i.e. current or former, sub-group of highââ¬ârisk patients with COPD and occupational based risk factors was collected. Data from the results of the studies in terms of prevalence, detection, survival and mortality rates was noted along with disease stage and follow-up period. Outcome Measures The primary outcome was to assess the influence of LCS on mortality. Secondary outcomes were the effectiveness of screening clinically and economically, and the impact of screening on lifestyle changes and smoking behavior. Screening ââ¬Å"Screening means testing people for early stages of a disease before they have any symptomsâ⬠(Cancer Research UK, 2011). Screening for LC is highly debated due to lack of evidence provided by past RCTââ¬â¢s showing reduction in mortality and due to the high costs for screening LC . WHO Screening Guidelines 1.) ââ¬Å"The condition should be an important health problem 2.) The disease should have significant mortality 3.) There should be a latent phase of the disease 4.) Intervention earlier in the disease process should improve outcomes 5.) The screening test itself should have certain characteristics 6.)The cost of finding a case using the screening technique should be considered in relation to medical expenditure as a wholeâ⬠Table 1: WHO Screening Guidelines. (Reproduced from Ghosal et al, 2009). Results Studies Included Using the electronic databases 42 studies was included and were categorized based on the nature of the study and relating to the endpoint of this review. They were categorized as: Randomized controlled trials (RCT), non randomized cohort/control studies, cost-effectiveness studies and studies that evaluated the impact of screening on smoking behavior and lifestyle. RCTââ¬â¢s On reviewing the literature 8 RCTââ¬â¢s were identified that were conducted in the past, which are current and which are on-going. Two large RCTs namely NLST (National Lung Screening Trial) (NLST Team, 2010) conducted in the USA compared LDCT and CXRââ¬â¢s among screened patients and NELSON (Dutch Belgian randomised lung cancer screening trial) (Netherlands Trial Register, 2011) is currently underway in the Netherlands comparing LDCT with no LDCT. Small RCTââ¬â¢s namely LSS (Lung Screening Study) (Gohagan et al., 2004), DEPISCAN (French pilot RCT) (Blanchon et al.,2007), DANTE (Infante et al.,2008), ITALUNG ( Pegna et al.,2009) randomized their study population into two arms in which LDCT was considered as the active arm. In the UK an randomized trial funded by the NIHR HTA called the UKLS (UK Lung Cancer Screening Trial) (Baldwin et al.,2011) is underway and is based on the initial results of the NLST. It is working closely with the NELSON trial to maximize the data available(NIHR Health Technology Assessment programme,2011).Features of these RCTââ¬â¢s with their aim and outcome have been outlined in Table 2. PLCO is a large RCT studying the impact on mortality reduction by screening patients with CXR(National cancer institute,2011). Table 2: Noteworthy RCTââ¬â¢s using LDCT for lung cancer screening. Study Ref Country Study Design Study start Year Aim of the Study Age Range No. of Subjects No. of subjects in the LDCT arm No. of subjects in the Control Arm Smoking History Study Outcome UKLS[Ongoing]( Baldwin et al.,2011)UK LDCT vs. Obs2008 The objective of the UKLS trial is to assess whether LDCTscreening and treatment of early lesions will reduce LC mortality in comparison to a control group without screening and to investigate if LC screening programme could be implemented in UK while ensuring any benefit exceeds harms in a cost-effective manner. 4000 (28000 if progression criteria met )ââ¬â ââ¬â NANA NELSON[Ongoing](Netherlands Trial register, 2011).NL-B-DK LSCT vs. Obs2003 1. To prove that in a RCT, screening with LDCT in high risk subjects will lead to a 25% decrease in lung cancer mortality. 2. To estimate the impact of lung cancer screening on health related quality of life and smoking cessation; 3. To estimate cost-effectiveness and help policy making.50-75156007915790715 cigs/day 25 years OR10 cigs/day 30 yearsNA NLST[Recent](NLST Team,2010)USA LDCT vs. CXR2003 To compare LC mortality of subjects screened with LDCT and with subjects screened with CXR.55-74530002672326733? 30 PYInitial results, shows 20 % fewer lung cancer deaths among trial participants screened LDCT compared to CXR. ITALUNG-CT (Pegna et al.,2009)Italy LDCT vs. Obs2004 ITALUNG is a population-based recruitment RCT perspective of pooling data with other RCTs in Europe andUS [14,22] contributing to the cooperative effort for the evaluation of the efficacy of low-dose CT lung cancer screening.55-6932061613159320 PYPopulation-based enrolment of high-risk subjects for aRCT of lung cancer screening with low-dose CT is feasible. The number of drop-outs in the group of subjects randomized to the active arm is low. LSS ( Gohagan et al.,2004)USA LDCT vs. CXR2002 To assessthe feasibility of conducting a large scale RCT of LDCT versus CXR for LC screening.55-74331816601658?30 PARCT comparing annual spiral CT to CXR is feasible.. DANTE( Infante et al.,2007)Italy LDCT vs. CXR + Sputum cytology2001 To determine the efficacy of lung cancer screening with low-dose CT on LC mortality.LC prevalence, incidence, stage distribution, and resectability are secondary endpoints60-74247212761196?20 PYLC Stage I detection rate in the spiral CT arm was 4 times higher than CXRââ¬â¢s.Advance stage tumors were also detected by CT. High resection rate suggests possible increase in cure rate. Longer follow up suggested. Depiscan-France[Pilot RCT results ]( Blanchon et a.,2007).France LDCT vs. CXR2002 ââ¬Å"To determine the feasibility of enrollment byGPs, investigations and diagnostic procedures by university hospital radiologists and multidisciplinary teams, data management by centralized clinical research assistants, and anticipate the future management of a large national trialâ⬠(Blanchon et a.,2007)50-75621385380? 15 cigs/day for 20 YearsThis pilot trial allows estimating that non-calcified nodules are 10 timesmore often detected by LDCT than from CXR. It concludes that enrollment by GPââ¬â¢s was difficult and expresses the need for a large co-ordinate clinical research team in a trial. Clinical Effectiveness: Studies 34 studies were included and broken down to different sub-groups: With comparators, without comparators and other methods.RCT by Garg et al.(2002) compared LDCT versus no screening among patients with COPD and smoking history. Non-randomized studies by Henschke et al.(1999,2001,2004,2006)compared LDCT with CXR Swenson et al.(2002,2003,2005) compared CT with sputum cytology, Sobue et al.,2002 compared CT with CXR and sputum cytology. Studies by Pastorino et al.(2003) and Bastarrika et al.(2005) used LDCT along with PET without any comparator group. Futher prospective, non-randomized cohort studies by Sone et al(.2001);Nawa et al.(2002); Diederich et al.(2002,2004); MacRedmond et al.(2004,2006);Novello et al.(2005);Chong et al.(2004); Menezes et al.(2009) were single arm studies using LDCT. Several of these studies have been summarized with their results elsewhere (Yau et al., 2007). A study by Chien et al. (2008)estimated the mean-sojurm time and effect of mortality reduction by LDCT .I-ECAP study (Henschke et al., 2006) reported survival rates of screen diagnosed stage I cancers.The chosen trials sample populations were predominantly male and over the age of 40(Yau et al., 2007). The participants consisted of non-smokers as well as former or current smokers and who have COPD and who have been exposed to asbestos. Other tests for LCS: In a bimodality lung cancer surveillance trial in highââ¬ârisk patients Lowen et al.,(2006) combined autofluorescent bronchoscopy (AFB)and LDCT, findings from AFB were compared to sputum cytology results .186 patients were enrolled who fulfilled the high-risk criteria and 169 completed baseline tests,7% were diagnosed with lung cancer . Bimodality surveillance could detect lung cancer and pre-malignancy in patients with multiple lung cancer risk factors despite sputum cytology findings and AFB proves to be an effective test in high-risk patients (Lowen et al., 2006). A RCT in UK called the Lung-SEARCH study is looking at detecting early LC using LDCT and fluorescence bronchoscopy in people with COPD (UKCRN,2011). In a cross-sectional study by Carozzi et al.(2009), potential use of molecular genetic markers for screening and diagnostic purposes were evaluated which could be combined with LDCT . Biomarkers detected in biological fluid help us understand the connection between genetic alternations and/or molecular pathways changes which will help us detect lung cancer earlier and reduce mortality (Carozzi et al., 2009). ââ¬Å"Multi-screening approach integrating imaging technique and biomolecular marker could be used to improve screening for lung cancer and is worth of further investigationâ⬠(Carozzi. et al.,2009) The MEDLUNG study in UK is currently underway, looking at detecting early LC amongst high-risk patients using biomarkers (UKCRN,2011) Cost Effectiveness A systemic review by Black et al., in 2006 assessed the clinical and cost-effectiveness of CT for LC screening, six studies that described full economic evaluation was identified by scanning the reference list. Further two studies evaluating the cost effectiveness in an UK and Australian setup were looked upon. Economic and mathematical models were used to calculate cost-effectiveness ratios based on study assumptions. Characteristics of the economic studies are described in Table 3. Ref. Type of evaluation synthesis Interventions Study Population Country Period of study Okamoto, 2000 CEA; Total cost for one life saved; total cost for mean life expectancy saved. Mass screening(indirect CXR for all screened sputum cytology for high-risk individuals) in 1983 1993 and CT option Age- 40-84 years Japan 5 years Marshall et al.,2000 Incremental CEA; incremental cost per LYG LDCT vs. No screening Hypothetical cohort of 100,000 high risk-individuals (60-74 years) USA 5 years Marshall et al.,2001 Incremental CEA CUA; incremental cost per LY saved and cost per QALY saved. Annual scan with LDCT vs. no screening Hypothetical cohort of 100,000 high risk-individuals (60-74 years) USA 5 years Chirikos et al.,2002 Incremental CEA; incremental cost per LYG; cost per cancer case detected. 5 annual screening with LDCT vs. no screening. Hypothetical cohort of screened and unscreened patients from general population (Age ? 45-74 years) USA 15 years Mahadevia et al.,2003 Incremental CUA; incremental cost per QALY gained. Annual screen with LDCT vs. No screening. Hypothetical cohort of 100,000 current, quitting former smokers, Age ?60; 55 % male. USA 40 years Wisnivesky et al.,2003 Incremental CEA; incremental cost per LY saved. Single scan with LDCT vs. No screening. High-risk individuals, Age ?60 USA Cost restricted to 1 year. Manser et al.,2004 Incremental CEA; incremental cost per LY saved and QALY saved. 5 annual screening with LDCT vs. no screening Hypothetical cohort of 10000 male; age ? 60 Australia 5 years Whynes, 2008 Incremental CEA; incremental cost per QALY gained Single scan with LDCT vs. no screening, if positive further diagnostic tests to be undergone. Hypothetical cohort; high-risk male population using values of test parameters from previous clinical studies. UK ââ¬â Table 3~: Characteristics of economic evaluation studies (Reproduced from Black et al., 2006) and data from other studies. Impact on Lifestyle Smoking Cessation Lifestyle is a major modifiable cause of cancer and cancer-related mortality (Aalst et al.,2010). A review based on recent evidence published by studies, Aalst et al. (2010) indicated that screening may have a positive outcome hereby promoting healthy lifestyle but also cautions us that it can also encourage people to continue or start an unhealthy lifestyle. Lung cancer screening can prove to be a teachable moment for smoking cessation and may influence people to quit smoking (Taylor et al., 2006). Discussion Mortality rates gives us the true outcome of a test as it is unconfounded by bias (Black et al.,2006). An effective screening programme should be able to identify high-risk groups depending on age, gender, lifestyle and occupation and have high sensitivity and specificity eventually resulting in reduction of mortality. Studies by Henschke et al.(2000),Nawa et a.(2002), Gohagan et al.(2004),Menezes et al.(2009) reported high sensitivity and specificity above 80%,Sone et al.(2001) and Pastorino et al.,(2003) reported low sensitivities and Swensen et al.(2002) ,Diederich et al.(2002,2004) reported low specificities. Discrepancy resided amongst studies due to the variation in the entry criteria such as age, gender, PY, high-risk sample and threshold values set (?5 ââ¬â ? 20mm) for detecting suspicious lesions which made it difficult to compare results and determine the ideal criteria for diagnosis of a screening programme. Prevalence screening with LDCT revealed that majority of cancers reported were Stage I non-small cell lung cancer (53-100 %)(Yau et a.,2007)though advance stage cancers were also reported with other histological types of cancers. ELCAP,DANTE, LSS studies along with Swensen et al.(2002) found that CT was more effective at identifying cancerous NCNââ¬â¢s than CXRââ¬â¢s.It should be noted that CT detects more peripherally located tumors than centrally located ones which are difficult to diagnose(Postmus et al.,2004). I-ELCAP study (Henschke et al.,2006) reported a 10-year survival rate of 88% for the whole series and 92% for resected stage I patients. By estimating shorter MST in conjunction with other parameters Chien et al.(2008) predicted that 15% mortality reduction can be seen for an annual LDCT screening. Initial results from NLST showed 20 % reduction in mortality in the LDCT arm, however final results are yet to be published(NLST Team,2010). This trial hereby the only RCT to date that has proved clinical effectiveness against mortality reduction. However it should be noted that operating characteristics can be influenced by high false positive and false negative rates. High FP rates due to detection of benign lesions and lack of standardized threshold for positive screen have been reported thus resulting in low PPV(Yau et al.,2007).This is one of the hurdles in implementing LDCT for LCS.True estimation of TN rates cannot be established due to incomplete follow-up of negative baseline scans and shorter follow-up duration thus leading to high NPV(Yau et al.2007). Accuracy also depends on the ability of the reporting radiologist(Sone et al.,2001). The assumption that a ââ¬Å"stage-shiftâ⬠would result in decrease in mortality needs to be more carefully evaluated as it would lead to decrease in inoperable cases and an increase in operable cases which means that LC incidence will occur as a result of overdiagnosis bias(Beplor et al.,2003). Both clinical effectiveness along with cost-effectiveness hurdle needs to be overcome (which presently poses a greater challenge) to fulfill the criteria of a screening programme(Gleeson ,2006) Inherent biases present in studies i.e. lead-time bias, length bias and over-diagnosis bias and should be accounted for in CEA and analytical methods as they can affect cost-effectiveness ratios (demonstrated by the cost-evaluation studies included) and survival and mortality benefit may be overestimated(Black et al,2006) .If evidence from LCS studies provide health gains in terms of quality and quantity of life with modest additional cost per patient, cost-effectiveness can be justified (Black et al.,2006).More complete and transparent CEA are required (Patz et al.,2000). According to the HTA report published in 2006 by Black et al., LDCT for screening LC does not meet the accepted NSC criteria due to unsatisfactory clinical and cost ââ¬âeffectiveness evidence. According to NICE the screening programme needs to pass the cost per QALY threshold of ?20,000ââ¬â30,000 per QALY (NIHCE,2005). However due to the rise in public expectations which adds additional burden on the services provided by NHS, the imbalance between demand versus supply and the rise in cost of health care services, it seems that even if NSC criteria are satisfied implementation of LDCT as a screening programme would be economically and logistically challenging with respect to the capital cost involved in setting up a multi centre nationalized screening programme Conclusion Based on this literature review, it has emerged that LDCT is the choice of screening tool for LCS, however integrated imaging with AFB and PET and advances in genomic and proteomic approaches promises to compliment the ability of CT to detect LC(Carozzi et al.2010).Economic decision-making framework should include harms of screening along with the mortality and morbidity associated with it, radiation exposure risks as a result of repeated follow-ups(Black et al.,2006) .Included studies did not account for this. Past and on-going LDCT studies need to be carefully evaluated and screening progrmme should be designed based on the countryââ¬â¢s merits and population distribution. NRCTââ¬â¢s have failed to establish reduction in mortality and hence evidence from large RCTââ¬â¢s proving the hypothesis and screening efficacy is of paramount importance for introducing a population screening progrmme. Results are awaited from these RCTââ¬â¢s. References: Andrea Lopes Pegna, Giulia Picozzi, Mario Mascalchi, Francesca Maria Carrozzi, Laura Carozzi,Camilla Comin, Cheti Spinelli , Fabio Falaschi, Michela Grazzini, Florio Innocenti, Cristina Ronchi, Eugenio Paci, 2009, Design, recruitment and baseline results of the ITALUNG trial for lung cancer screening with low-dose CT, Lung Cancer ;64 34ââ¬â40. C Black, A Bagust, A Boland, S Walker,C McLeod, R De Verteuil, J Ayres, L Bain,S Thomas, D Godden and N Waugh,2006, The clinical effectiveness and cost-effectiveness of computed tomography screening for lung cancer: systematic reviews, Health Technology Assessment; Vol. 10: No. 3. C.M. van der Aalst, R.J. van Klaveren, H.J. de Koning, 2010, Does participation to screening unintentionally influence lifestyle behaviour and thus lifestyle-related morbidity?, Best Practice Research Clinical Gastroenterology ;24 465ââ¬â478. Claudia I. Henschke, David F, Yankelevitz, Daniel M. Libby, Mark W. Pasmantier, James P Smith, Olli S. Miettinen, McGill ( ELCAP Investigators),2006,Survival of Patients with Stage I Lung Cancer Detected on CT Screening, N Engl J Med;355:1763-71. Claudia I Henschke ,Dorothy I McCauley ,Prof.David F Yankelevitz, Prof.David P Naidich ,Georgeann McGuinness ,ProfOlli S Miettinen, ProfDaniel M Libby ,ProfMark W Pasmantier, June Koizumi ,ProfNasser K Altorki ,ProfJames P Smith, 1999, Early Lung Cancer Action Project: overall design and findings from baseline screening, The Lancet ;Volume 354, Issue 9173, Pages 99-105 . C.I. Henschke, D.P. Naidich, D.F. Yankelevitz, G. McGuinness, D.I. McCauley and J.P. Smith ,2001, Early Lung Cancer Action Project: initial findings on repeat screening, Cancer ;92 : pp. 153ââ¬â159. Claudia I. Henschkea , David F. Yankelevitz, James P. Smith, Daniel Libby, Mark Pasmantier, Dorothy McCauley, Georgeann McGuinness, David P. Naidich, Ali Farooqi, Madeline Vasquez, Olli S. Miettinen,2004, CT screening for lung cancer Assessing a regimenââ¬â¢s diagnostic performance, Journal of Clinical Imaging;28 317ââ¬â321. Chun-Ru Chien, Tony Hsiu-Hsi Chen, 2008, Mean sojourn time and effectiveness of mortality reduction for lung cancer screening with computed tomography, Int. J. Cancer: 122, 2594ââ¬â2599 Cancer Research UK. Cancer stats,2011,accessed on 20/04/11 from http://info.cancerresearchuk.org/cancerstats/types/lung/index.htm?script?true#mortality and http://info.cancerresearchuk.org/cancerstats/types/lung/mortality/. David K Whynes, 2008, Could CT screening for lung cancer ever be cost effective in the United Kingdom, Cost Effectiveness and Resource Allocation, 6:5. Deborah Marshall, Kit N. Simpson, Craig C. Earle, Chee-Wui Chu, 2000, Potential cost-effectiveness of one-time screening for lung cancer (LC) in a high risk cohort, Lung Cancer 32 ;227ââ¬â236. D. Marshall, K.N. Simpson, C.C. Earle, C.-W. Chu, 2001, Economic decision analysis model of screening for lung cancer, European Journal of Cancer; 37 1759ââ¬â1767. D R Baldwin,S W Duffy,N J Wald, R Page, D M Hansell, J K Field, 2010, UK Lung Screen (UKLS) nodule management protocol: modelling of a single screen randomised controlled trial of low-dose CT screening for lung cancer, Thorax 2011;66:308-313. Edward F. Patz , JR.,Philip C. Goodman ,Gerold Bepler , 2000, Cureent Concepts- ung Cancer Screening, The New England Journal of Medicine, Volume 343 Number 22. Francesca Maria Carozzi, Simonetta Bisanzia, Patrizia Falini ,Cristina Sani, Giulia Venturini,Andrea Lopes Pegna, Roberto Bianchi, Cristina Ronchi, Giulia Picozzi, Mario Mascalchi, Laura Carrozzi, Filomena Baliva, Francesco Pistelli, Laura Tavanti, Fabio Falaschi, Michela Grazzini, Florio Innocenti, Eugenio Paci, 2010, Molecular profile in body fluids in subjects enrolled in a randomised trial for lung cancer screening: Perspectives of integrated strategies for early diagnosis, Lung Cancer; 68 216ââ¬â221 F V Gleeson, 2006, Is screening for lung cancer using low dose spiral CT scanning worthwhile?, Thorax 61:5ââ¬â7. Gary Yau, Michael Lock, George Rodrigues, 2007, Systematic review of baseline low-dose CT lung cancer screening, Lung Cancer ;58, 161ââ¬â170. Gorka Bastarrika, Mara Jose? Garca-Velloso, Maria Dolores Lozano, Usua Montes, Wenceslao Torre, Natalia Spiteri, Arantza Campo, Luis Seijo, Ana Bele?n Alcaide, Jesu? s Pueyo, David Cano, Isabel Vivas, Octavio Cosn, Pablo Domnguez, Patricia Serra, Jose? A. Richter, Luis Montuenga, and Javier J. Zulueta, 2005, Early Lung Cancer Detection Using Spiral Computed Tomography and Positron Emission Tomography, Am J Respir Crit Care Med; Vol 171. pp 1378ââ¬â1383. Gerold Bepler, Dawn Goodridge Carney, Benjamin Djulbegovic, Robert A. Clark,Melvyn Tockman, 2003, A Systematic Review and Lessons Learned From Early Lung Cancer Detection Trials Using Low-Dose Computed Tomography of the Chest, Cancer Control; July/August : Vol.10, No.4. Gregory Loewen,Nachimuthu Natarajan, Dongfeng Tan, Enriqueta Nava4, Donald Klippenstein5, Martin Mahoney2, Michael Cummings2,Mary Reid, 2007, Autofluorescence bronchoscopy for lung cancer surveillance based on risk assessment[abstract], Thorax ;62:335-340 John K. Gohagan, Pamela M. Marcus, Richard M. Fagerstrom,Paul F. Pinsky, Barnett S. Kramer, Philip C. Prorok, Susan Ascher,William Bailey, Brenda Brewer, Timothy Church, Deborah Engelhard,Melissa Ford, Mona Fouad, Matthew Freedman, Edward Gelmann, David Gierada, William Hocking, Subbarao Inampudi, Brian Irons,Christine Cole Johnson, Arthur Jones, Gena Kucera, Paul Kvale, Karen Lappe, William Manor, Alisha Moore, Hrudaya Nath, Sarah Neff,Martin Oken, Michael Plunkett, Helen Price, Douglas Reding, Thomas Riley, Martin Schwartz, David Spizarny, Roberta Yoffie, Carl Zylak Kathryn L. Taylor, Lisa Sanderson Cox, Nicole Zincke, 2004, Final results of the Lung Screening Study, a randomized feasibility study of spiral CT versus chest X-ray screening for lung cancer, Lung Cancer (2005) 47, 9ââ¬â15. J M Reich, 2007, A critical appraisal of overdiagnosis: estimates of its magnitude and implications for lung cancer screening, Thorax 2008;63:377ââ¬â383. Juan P. Wisnivesky, Alvin I. Mushlin, Nachum Sicherman, Claudia Henschke, 2003, The Cost-Effectiveness of Low-Dose CT Screening for Lung Cancer* Preliminary Results of Baseline Screening, Chest;124;614-621. Kathryn L. Taylor,Lisa Sanderson Cox,Nicole Zincke, Larina Mehta, Colleen McGuire, Edward Gelmann, 2006, Lung cancer screening as a teachable moment for smoking cessation, Lung Cancer (2007) 56, 125ââ¬â134. Kavita Garg, Robert L. Keith,Tim Byers, Karen Kelly,Anne L. Kerzner, David A. Lynch, York E. Miller.2002, Randomized Controlled Trial with Low-Dose Spiral CT for Lung Cancer Screening: Feasibility Study and Preliminary Results, Radiology; 225:506 ââ¬â510 Maurizio Infante, Fabio Romano Lutman, Silvio Cavuto,Giorgio Brambilla, Giuseppe Chiesa, Eliseo Passera, Enzo Angeli, Maurizio Chiarenza, Giuseppe Aranzulla, Umberto Cariboni, Marco Alloisio, Matteo Incarbone, Alberto Testori, Anna Destro,Federico Cappuzzo, Massimo Roncalli, Armando Santoro, Gianluigi Ravasi, 2007, Lung cancer screening with spiral CT Baseline results of the randomized DANTE trial, Lung Cancer (2008) 59, 355ââ¬â363. National Lung Screening Trial Research Team, 2010, Baseline Characteristics of Participants in the Randomized National Lung Screening Trial, JNCI : Articles 1771,Vol. 102, Issue 23. National Lung Screening Trial Research Team, 2010, The National Lung Screening Trial:Overview and Study Design, Radiology: Volume 258: Number 1ââ¬âJanuary 2011. Naoyuki Okamoto, 2000, Cost-Effectiveness of Lung Cancer Screening in Japan, CANCER Supplement ;Volume 89 , Number 11. National Institute for Clinical Excellence,2005, Clinical Guideline 24: Lung cancer: the diagnosis and treatment of lung cancer London: NICE. National Cancer Institute, 2011, Prostate Cancer Research Results From the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, accessed on 19/4/11 from http://www.cancer.gov/cancertopics/factsheet/detection/plco-prostate Netherland Trial Register,2011, Dutch Belgian randomised lung cancer screening trial (NELSON),Trial Information accessed on 24/04/11 from http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=636. Peter B. Bach, MD, James R. Jett, Ugo Pastorino, Melvyn S. Tockman, Stephen J. Swensen, Colin B. Begg, 2007, Computed Tomography Screening and Lung Cancer Outcomes, JAMA. 297:953-961. Parthiv J. Mahadevia, Lee A. Fleisher,Kevin D. Frick,John Eng,Steven N. Goodman, Neil R. Powe, 2003, Lung Cancer Screening With Helical Computed Tomography in Older Adult Smokers -A Decision and Cost effectiveness Analysis, JAMA.;289:313-322. Pasic A, Postmus PE, Sutedja TG, 2004, What is early lung cancerA review of the literature. Lung Cancer ;45:267ââ¬â77. R Ghosal, P Kloer, K E Lewis,2009, A review of novel biological tools used in screening for the early detection of lung cancer, Postgrad Med J ;85:358ââ¬â363. Ravi J. Menezes, Heidi C. Roberts , Narinder S. Paul, Maureen McGregor, Tae Bong Chung, Demetris Patsios, GordonWeisbrod, Stephen Herman, Andre Pereira, Alexander McGregor, Zhi Dong, Igor Sitartchouk, Scott Boerner, Ming-Sound Tsao, Shaf Keshavjee, Frances A. Shepherd, 2010, Lung cancer screening using low-dose computed tomography in at-risk individuals: The Toronto experience, Lung Cancer ;67, 177ââ¬â183. Renee Manser, Andrew Dalton, Rob Carter, Graham Byrnes, Mark Elwood, Donald A. Campbell, 2004, Cost-effectiveness analysis of screening for lung cancer with low dose spiral CT (computed tomography) in the Australian setting, Lung Cancer ;48, 171ââ¬â185. R. MacRedmond, P.M. Logan, M. Lee, D. Kenny, C. Foley and R.W. Costello, 2004,Screening for lung cancer using low dose CT scanning, Thorax ;59pp. 237ââ¬â241. R MacRedmond, G McVey, M Lee, R W Costello, D Kenny, C Foley, P M Logan,2006, Screening for lung cancer using low dose CT scanning: results of 2 year follow up , Thorax;61:54ââ¬â56. S Sone, F Li,Z-G Yang, T Honda, Y Maruyama, S Takashima, M Hasegawa, S Kawakami, K Kubo,M Haniuda and T Yamanda, 2001, Results of three-year mass screening programme for lung cancer using mobile low-dose spiral computed tomography scanner, British Journal of Cancer ;84(1), 25ââ¬â32. Stefan Diederich, Priv Doz, Dag Wormanns, Michael Semik, Priv Doz, Michael Thomas, Priv Doz, Horst Lenzen, Nikolaus Roos, Walter Heindel,2002, Screening for Early Lung Cancer with Low-Dose Spiral CT: Prevalence in 817 Asymptomatic Smokers, RSNA, 2002. S.J. Swensen, J.R. Jett, J.A. Sloan, D.E. Midthun, T.E. Hartman and A.M. Sykes et al.,2002, Screening for lung cancer with low-dose spiral computed tomography, Am J Respir Crit Care Med 1;65 pp. 508ââ¬â513. Stephen J. Swensen, James R. Jett, Thomas E. Hartman,David E. Midthun, Jeff A. Sloan, Anne-Marie Sykes, Gregory L. Aughenbaugh ,Medy A. Clemens,2003, Lung Cancer Screening with CT: Mayo Clinic Experience, Radiology; 226:756 ââ¬â761. Stephen J. Swensen, James R. Jett,Thomas E. Hartman, David E. Midthun, Sumithra J. Mandrekar, Shauna L. Hillman, Anne-Marie Sykes, Gregory L. Aughenbaugh,Aaron O. Bungum, Katie L. Allen,2005, CT Screening for Lung Cancer: Five-year Prospective Experience, Radiology ;235:259ââ¬â265. S. Novello, C. Fava, P. Borasio, L. Dogliotti, G. Cortese, B. Crida, G. Selvaggi, P. Lausi, M. P. Brizzi, P. Sperone, L. Cardinale, F. Ferraris, F. Perotto, A. Priola, G. V. Scagliotti, 2005, Three-year ?ndings of an early lung cancer detection feasibility study with low-dose spiral computed tomography in heavy smokers, Annals of Oncology 16: 1662ââ¬â1666. Semin Chong, Kyung Soo Lee, Myung Jin Chung, Tae Sung Kim, Hojoong Kim*, O Jung Kwon*,Yoon-Ho Choi, Chong H. Rhee, 2005, Lung Cancer Screening with Low-Dose Helical CT in Korea: Experiences at the Samsung Medical Center, J Korean Med Sci; 20: 402-8. Thierry Blanchon, Jeanne-Marie Br?echot, Philippe A. Grenier, Gilbert R. Ferretti , Etienne Lemari?e, Bernard Milleron, Dominique Chagu?e, Franc?ois Laurent, Yves Martinet,Catherine Beigelman-Aubry, Franc?ois Blanchon, Marie-Pierre Revel,Sylvie Friard, Martine R?emy-Jardin, Manuela Vasile , Nicola Santelmo,Alain Lecalier, Patricia Lef?ebure, Denis Moro-Sibilot, Jean-Luc Breton, Marie-France Carette, Christian Brambilla, Franc?ois Fournel, Alexia Kieffer , Guy Frija, Antoine Flahault, 2007, Baseline results of the Depiscan study: A French randomized pilot trial of lung cancer screening comparing low dose CT scan (LDCT) and chest X-ray (CXR), Lung Cancer ;58, 50ââ¬â58. Tomotaka Sobue, Noriyuki Moriyama, Masahiro Kaneko, Masahiko Kusumoto, Toshiaki Kobayashi, Ryosuke Tsuchiya, Ryutaro Kakinuma, Hironobu Ohmatsu, Kanji Nagai, Hiroyuki Nishiyama, Eisuke Matsui, and Kenji Eguchi, 2002, Screening for Lung Cancer With Low-Dose Helical Computed Tomography: Anti-Lung Cancer Association Project, J Clin Oncol 20:911-920. Takeshi Nawa, Tohru Nakagawa, Suzushi Kusano, Yoshimichi Kawasaki, Youichi Sugawara, Hajime Nakata,2002, Lung Cancer Screening Using LowDose Spiral CT* Results of Baseline and 1-Year Follow-up Studies, Chest 2002;122;15-20. Thomas N. Chirikos, Todd Hazelton, Melvin Tockman, Robert Clark, 2002, Screening for Lung Cancer With CT*- A Preliminary Cost-effectiveness Analysis, Chest;121;1507-1514. Ugo Pastorino,Massimo Bellomi,Claudio Landoni, Elvio De Fiari, Patrizia Arnaldi, Maria Picchio, Giuseppe Pelosi, Peter Boyle,Ferruccio Fazio, 2003, Early Lung-Cancer detection with spiral CT and Positron emission tomographyin heavy smokers : 2year results, Lancet :362:593-97. UK Clinical Research Network : Portfolio Database (UKCRN), 2011, Lung-SEARCH study , accessed on 20/4/11 from S. Diederich , M Thomas , M Semik , H Lenzen ,N Roos , A Weber , W Heindel ,D Wormanns ,2004, Screening for early lung cancer with low-dose spiral computed tomography: results of annual follow-up examinations in asymptomatic smokers [abstract], Eur Radiology;.(4):691-702. http://pfsearch.ukcrn.org.uk/StudyDetail.aspx?TopicID=1StudyID=2225. UK Clinical Research Network: Portfolio Database (UKCRN), 2011,The MEDLUNG study, accessed on 20/4/11 from http://public.ukcrn.org.uk/search/StudyDetail.aspx?StudyID=4682 How to cite Screening Lung Cancer: Literature Review, Essay examples davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-52854599776522858222020-05-06T03:32:00.001-07:002020-05-06T03:32:22.033-07:00My Son My Executioner Poetry Explication Essay Example For Students My Son My Executioner: Poetry Explication Essay We twenty two and twenty five, who seemed to live forever, observe enduring life in you and start to die together In My Son, My Executioner, Donald Hall uses connotative meaning, Imagery and figures of speech to create the overall contrasting metaphors of this poem to express he sentiments and feelings every new parents experience. The two poetic devices Hall makes the most use of would have to be Imagery and metaphoric figurative language. By using tactile, organic, visual and auditory Imagery; the speaker Implants a Blvd image of a father and sons first moments and feelings as his baby Is Just astir. In the first verse he sets up the visual/adulatory scene of a new baby quiet small and Just astir. The combination of the tactile sensation when the author says l take you In my arms with the organic feel of life and love when he says and whom y body warm; not only creates strong sensory Imagery but also hold a lot of metaphoric meaning. Hall uses a variety tot figures tot speech to tell a beautiful emotional story In only three versus. Metaphoric and personification were the two most prevalent figures tot speech. The presents an executioner as a metaphor tort his son in the first line tot verse one. He also uses two metaphoric contrast when he compares his son to s death yet also our instrument of immortality in the beginning of line verse two. Sweet death is a metaphoric representation of how the child signifies the ending death of their old life as they knew it. Hall amplifies this metaphor when he say your cries and hunger document/ our bodily decay. showing that he is now thee main focus and his needs and growth document their new life of caring for him. Erase gives the metaphor all parents can relate to, about the end of ones own sell life and the beginning of a selfless one; being the sweet death. In contrast, the b also metaphorically represents our instrument of immortality beck he will carry on their name and memory. So he represents the sweet death of the old life but also of themselves now growing old, while also representing how he ensures their immortality. The speaker personif ies death when he says Oh sweet death, my son and uses apostrophe to speak to the boy and death as though the hear/understand. In order to paint the metaphoric picture and set the scene of him and his en born son, the speaker uses both denotative and connotative language. The speak starts out using both denotative and connotative language but uses denotative language to set the scene. He talks denotative about his son quiet and small a just astir to paint the picture of the innocent life of a new born baby. Also in verse en he uses connotative language in the first line when he says my son, my executioner. He is using denotation because he his actually talking about his son connotation because his son is not an executioner. My executioner has the double meaning of representing the way in which the boy is in a sense the executioner o life as he knew it. He then uses connotation in verse two mentioning sweet dead explain that this death is a good one. All throughout the poem the speaker makes of both denotative and connotative language; denotative to set up the scene and imagery and connotative to express the beautiful double sentiment to this short poem. davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-25991150914423306752020-05-03T02:05:00.001-07:002020-05-03T02:05:03.069-07:00Market Capitalisation In Australia Samples â⬠MyAssignmenthelp.com Question: Discuss about the Market Capitalisation In Australia. Answer: SWOT Analysis This report reflects the strength, weakness, opportunity and threats of Australian and New Zealand Banking group. It is the fourth largest bank by market capitalisation in Australia. Strength Financial projection of company Australian and New Zealand Banking group has been maintaining AUD 21.07 billion amount of total revenue. Furthermore, average 15% increment in done by company since last four years in its overall total turnover (Lusardi Mitchelli, 2007). Market capitalization It is evaluated that currency share price of company is traded at AUD $ 29.9 which is 30% more as compared to its face value. This level of premium in its share price has been observed due to its high brand image in market. Weakness High level of traits and penalties Company has been facing problems of high amount of penalties due to its non-compliance of banking and financial rules and regulation. Company has to deposit standard amount with the central bank which increases its overall cost of capital. Market size There are several rivals in the market such as Commonwealth Bank, Westpac Banking Corporation and National Australia Bank who have covered high market share. In addition to this, ANZ needs to make diversification in its business. Opportunity Global market share Australian and New Zealand Banking group has global market share and could increase its overall strength by tapping other international market share. Growing economy Australian economy has been showing 8% increment in its GDP since last five years. This will increase the overall investors investment capacity and will result to high cash inflow for Australian and New Zealand Banking group (Narayan, 2010). Threats Rivals offering There are several competitors such as Commonwealth Bank, Westpac Banking Corporation and National Australia Bank who have been showing high market coverage and offering high interest rate to investors. Increasing cost It becomes hard for Australian and New Zealand Banking group to offer more interest amount to investors to create value on their investment due to high cost of capital. References Lusardi, A., Mitchelli, O. S. (2007). Financial literacy and retirement preparedness: Evidence and implications for financial education.Business economics,42(1), 35-44. Narayan, P. K. (2010). Fiji's tourism industry: a SWOT analysis.Journal of Tourism Studies,11(2), 15. davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-31456748287817563042020-03-25T01:41:00.001-07:002020-03-25T01:41:02.519-07:00Plato And Forms Essays - Platonism, Form Of The Good, Plato And Forms Platos Forms The influence that Plato, the Greek philosopher born in 427 BC in Athens, has had throughout the history of philosophy has been monumental. Among other things, Plato is known for his exploration of the fundamental problems of natural science, political theory, metaphysics, theology and theory of knowledge; many of his ideas becoming permanent elements in Western thought. The basis of Platos philosophy is his theory of Ideas, or doctrine of Forms. While the notion of Forms is essential to Platos philosophy, over years of philosophical study, it has been difficult to understand what these Forms are supposed to be, and the purpose of their existence. When examining Platos forms and evaluating the theory, some conclusions have proved to be unclear and unanswered. However, the doctrine of Forms is essential to Platos philosophy. Plato came to his view of the Forms based on two premises: first, that knowledge cannot come through the senses; and second, we do nevertheless manage to know thi ngs in mathematics, for instance. Plato believed in two worlds; the empirical realm of concrete, familiar objects known through sensory experience, and the rational realm of perfect and eternal Forms. According to Plato, the empirical realm is not real, as sensory objects are not completely real. Beliefs derived from experience of such objects are therefore vague and unreliable, whereas principles of mathematics and philosophy, discovered by inner, rationalistic meditation on the Forms, constitute the only real knowledge. Such familiar, concrete things as trees, human bodies and animals, which can be known through the senses, are merely shadowy, imperfect copies of their Forms. For every sense object in the empirical world, there is a corresponding perfect Form. These Forms are nonphysical, permanent, eternal, and invisible. How then, you may ask, can one ever know of the Forms if they cannot be known by sense perception? Plato answers this question by stating that the Forms are kn own in thought. They are the objects of thought, therefore, whenever you are thinking, you are thinking of Forms. An important point to note about the Forms is the idea of permanence. The Forms are forever unchanging. An important standard of Platos theory of knowledge was that all genuine objects of knowledge be described without contradiction. Therefore, because all objects perceived by sense undergo change, an assertion can be made that such objects at one time will not be true at a later time. Because what is fully real must, for Plato, be fixed, permanent, and unchanging, he identified the real with the ideal realm of being as opposed to the empirical world of becoming. This all leads to Platos inevitable rejection of empiricism. The true definition of empiricism is, the view that holds sense perception to be the sole source of human knowledge (Jones, 369). It is obvious that this view is highly contradictive with Platos theory of Forms. He thought that propositions derived fro m sensory experience have, at most, a degree of probability; they are not certain. Pure knowledge may only be derived from certain, permanent facts. The argument is really that not only do the things we perceive change, but so do the circumstances in which we perceive them. Take this example, for instance. If I were to hold a cup of hot coffee in my left hand and a cold beer in my right, and then place both hands into a tub of lukewarm water, that same tub of water would feel cold to the left hand, and warm to the right hand. Moreover, things must often seem different to me than they do to anyone else, for the circumstances of others are rarely the same as mine. We are also liable to experience illusions, states of dreaming and hallucination, and our initial judgments are also often influenced by our expectations and biases. As a result of these circumstances, Plato supposes that we can never gain knowledge through our senses. Empiricism is rejected in Platos philosophy, contradicti ng with his theory of Forms to a large degree. Plato conceived the Forms as arranged hierarchically. A dividing line splits the rational realm into C and D. The division of C represents the lower Forms, and D represents the higher Forms, davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-20382120577234686312020-03-06T11:00:00.001-08:002020-03-06T11:00:03.727-08:00Selling Halloween Making Money with Spooky StoriesSelling Halloween Making Money with Spooky Stories Halloween in January? Yep. When you write seasonal articles you have to think six to eight months in advance. While you cozy up to a fire, staving off the chill from snow and ice outside, start making notes about seasons months from now . . . like Halloween! Halloween is my favorite holiday when else do you get to enjoy dressing up, eating candy, scaring your friends, and having spooky good fun? For the writer, Halloween is also a great holiday to make a few extra dollars as many magazines are looking for Halloween-themed articles and features. As well as running Halloween features alongside regular content, many magazines like Better Homes and Gardens release a special Halloween issue, and they need articles to fill these pages. Halloween features dont even have to be spooky or scary. Many magazines expand on Halloweens seasonality Like any seasonal feature, Halloween stories need to be pitched several months in advance, so get your spooky cap on and start submitting for next years Halloween features. Halloween Travel Have you ever explored an historic building that you knew was haunted, or enjoyed a city ghost tour hosted Missouri Lifemissourilife.com/contributor-guidelines Horizons Magazine (Alaska Airlines)alaskaairlinesmagazine.com/horizonedition/guidelines/contributor/ Craft Projects Halloween is a great time for kids and adults alike to get creative with costumes and decorative projects. If youve got a crafty idea for a spooky costume, a cute Halloween accessory, or a simple project kids can create themselves, send a tutorial in to a craft magazine. Kids and parenting magazines also often accept craft tutorials. Family Fun Magazinehttp://familyfun.go.com/magazine/contact-us-819817/ Bead Button Magazinehttp://bnb.jewelrymakingmagazines.com/en/Magazine/Submission%20Guidelines/2001/07/BeadandButton%20Submission%20Guidelines.aspx Spooky Food With harvest season in full-swing, food is definitely on our minds over Halloween. What about a spread of pumpkin-themed dishes for the family? Or recipes for healthy Halloween treats the kids will love? Food magazines love receiving innovative twists on seasonal favorites. Country Womancountrywomanmagazine.com/contributor-guidelines/ Delicious Livinghttp://newhope360.com/contact-delicious-livingà Horrible Fiction If you write fiction and are thinking of penning a classic Halloween horror tale, there are plenty of magazines waiting to receive your spooky stories. Tor.com fiction submissionstor.com/page/submissions-guidelines Apex Magazinehttp://apex-magazine.com/submission-guidelines/à Lifestyle Features Halloween definitely isnt just for kids. Adults love to dress in costume and enjoy Halloween parties and dates. Perhaps you could write a guide to grown-up Halloween parties, or a recipe for pumpkin-cocktails for a lifestyle magazine. Do you know a couple that got married on Halloween? Maybe you could write about their unusual wedding for a bridal magazine? Bust Magazinebust.com/info/submit-to-bust.html Bride and Groom Magazine (Various States)phoenixbrideandgroom.com/aboutus_writers.php Parenting Tips Between helping with costumes, keeping kids safe and helping them make healthy choices, Trick-or-Treat season can be a nightmare for parents. If youve got some tips on making trick-or-treating safer, healthier and more fun for children, parenting magazines would love to know how. Treasure Valley Family Magazinetreasurevalleyfamily.com/component/content/article/13-footer/46-editorial.html Parents Magazineparents.com/parents/file.jsp?item=/help/writers_guidelines Halloween is a great jumping-off point for a whole range of different article pitches. Magazines are always looking for content on this popular holiday, and submitting new ideas around old topics will definitely get your query a second look. Good luck, and happy haunting! davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-77996280573972740692020-02-19T02:27:00.001-08:002020-02-19T02:27:02.664-08:00Planning and Operational Processes of Apple Company EssayPlanning and Operational Processes of Apple Company - Essay Example Yet, as we look forward to a happy ending, earnings taper off and it appears as though the saga may be over after all. However, a feeling of quiet confidence gradually takes over the observer, as both Apple Computers and Jobs negotiate through each downturn with aplomb. Must a companyââ¬â¢s journey through time be so turbulent? This document tries to draw lessons from the Apple experience and to suggest stable ways for commercial firms to manage their planning and operational processes. There are two overreaching factors that seem to have influenced strategic change at Apple Computers. The first is the frenetic pace of technological change. No other industrial sector has witnessed the continuous and rapid improvements in processor speeds, storage capacity, transmission options and software development. This has been a source of strength and an opportunity for the entrepreneurial culture of Apple Computers, but it has proved to be a handful for people such as Sculley who laboured so hard to bring a semblance of order and discipline to the highly individualistic style of functioning to which die-hard company employees have become accustomed. A second factor which has affected strategy in this company has been the tumultuous and disorderly change of guard at the top. There is no precedent for such a striking founder to leave his creation while remaining in the business. Even more unusual has been the return of Jobs as a mere consultant to the company which he once owned. These moves, and indeed the manner of Sculleyââ¬â¢s departure has posed special challenges for the company. Systematic and regular environmental scanning seems to be a lacuna in the planning process at Apple Computers. Every enterprise needs a deep understanding of the values that its products and services delivered in an environment of global competitiveness (Ohmae, 1991, 61-74). The success of Jobs to see the opportunity in the graphic user interface which Xerox apparently missed, did not repeat itself when the company invested resources in Newton. davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-28745387273619445822020-02-04T03:34:00.001-08:002020-02-04T03:34:02.268-08:00Few Major Brands of Kellogg Company Essay Example | Topics and Well Written Essays - 1250 wordsFew Major Brands of Kellogg Company - Essay Example The case study is based on the analysis of marketing mix for Kellogg Company. The marketing mix is an essential business tool used by organizations to determine a product or brand offer. It is normally associated with price, product, placement, and promotion of any organization. These elements help marketers to create the market strategies and positioning of the company. The first element, product, helps a company to understand that how their offering meets the changing needs of customers. The price charged by any company is an important element to assess the sales of the products and place denotes the availability of the product. The last element, promotion, is very important to understand various ways of the positioning of the product (Borden, 1964). Marketing mix of Kellogg Company will help them to plan their marketing strategies and resource allocation (Vignali, 2001). Product: The products of Kelloggââ¬â¢s can be classified as convenience products. Convenience products are those which are purchased by consumers without much consideration. Most of them are low priced, easily available and frequently parched products (Vignali, 2001). Developing new product is extremely risky and expensive procedure for any business. To develop a new product, the company needs to assess the rapidly changing market and they need to predict the changing needs of customers (Annacchino, 2003). The Kellogg Company is very successful in developing any new product since its inception. Their first established product in the market was cornflakes and it helped them to attain the highest market share in the cereal market. Consumers generally purchase their product easily as the company holds a reputation for providing good quality products. Their existing products are very popular and generate a huge profit for the company. This financial gain helps them to invest in the de velopment of new products and sell them at low price as the cost is covered by the profit. davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-34180572417602983292020-01-26T23:58:00.001-08:002020-01-26T23:58:03.062-08:00Principles of Information SecurityPrinciples of Information Security Purpose:In order to protect against accidental or intentional damage or loss of data, interruption of College business, or the compromise of confidential information we must classify data and establish minimum standards and guidelines to ensure a secure system. Effective from: 02/02/17 Scope: This policy must be applied to all of the following: students, faculty, staff, contractors, consultants, temporary employees, guests, volunteers and all other entities or individuals with access to confidential information through the Modern College of Business and Science its affiliates/partners. Responsible Party: Database Department Information Technology Support Department Terms of Reference:Access Any personal inspection or review of the confidential information or a copy of the confidential information, or an oral or written account of such information. Confidential Information Information identified by the applicable laws, regulations or policies as personal information, individually identifiable health information, education records, personally identifiable information, non-public personal data, confidential personal information, or sensitive scientific or sponsored project information. Data Information generated in official College business. Information that is personal to the operator of a system. Disclosure To permit access to or release, transfer, distribute, or otherwise communicate any part of information by any means Incident A possibly reportable episode that may incorporate, however is not restricted to, the accompanying: Attempts to increase unapproved access to frameworks or information; Undesirable disturbances or Denial od Service; An infection spreading; Burglary, abuse or loss of electronic gear containing private data. Unapproved utilization of frameworks for handling or information gathering An office or unit cant dispose of confidential of paper information in a proper manner. Unapproved changes to framework equipment, firmware and programming. Policy Statement: The Modern College of Business and Science must aim towards making a safe environment for all in terms of data confidentiality and personnel. Information Security professionals must employ techniques which can prevent any threat from exploiting any vulnerability as much as possible. Threats could target privacy, reputation and intellectual property along with lots of other data. Data Classification In order for the policy to be entirely effective and be able to know which data protect the data must be classified into 3 categories Category 1 Data that can be freely distributed to the public. Category 2- Internal data only not meant for outsiders. Category 3- Sensitive internal only data that could affect operations if disclosed to public. Category 4- Highly sensitive internal data that could put an organization at financial or legal risk if disclosed to public. Security Prevention Measures Security prevention measures ensure security and prove comfort for the business and also the customers. Prevention measure could consist of many things. Existing Security Measures. Access control which ensure only allowed users granted permission to access the database may do so. This applies to accessing, modifying and viewing the data. Frequent SQL input validation tests are conducted in order to ensure no unauthorized users can access the database. Three separate cloud based servers are available, two of which are for back up purposes this ensures the availability of the data in the case of the intrusion on one of the servers. All servers are backed up daily. Database auditing is frequently conducted. Database log files are frequently checked to observe in case of any malicious activity. All database security is managed by a third party in order to ensure maximum security. In order to avoid Denial of Service (DOS) attacks which could affect the availability the web applications are put on different servers. Role-Based Control is used in order to make sure employees can only retrieve content from the database that they are authenticated and authorized to. Discretionary access control is only permitted to the database department as no other faculty or staff needs access or is permitted to access. Flaws which need reviewed Password policy is not implemented strictly to students which can result in the compromising of an account. Solution: Password Policy MUST be applicable to all therefore, database department must make it mandatory. No honeypotting is available. Solution: The necessary equipment and software should be purchased for this to be done. This will help the College avoid attacks in the case of SQL injection or any other database attack. No digital certificates are utilised when messages are sent across the website. Solution: Create system to have to send digital certificate/signature to ensure a better level of security. No certified security professionals are currently employed. Solution: Raise issue to Human Resources as a matter of concern and seek the hiring of a professional or train existing staff. Lack of awareness among staff and faculty regarding security in general. Solution: Conduct training for faculty and stuff on how to spot basic threat and potential intrusions etc. *After these flaws are fixed, policy MUST be reviewed and updated. iii) Added Policies Conduct penetration testing frequently and Risk Assesment, report must be generated, reviewed by Chief Information Security Officer (CISO). Vulnerabilities must be fixed. In the case of an incident CISO must be informed to take necessary action. Any employee failing to do so shall face disciplinary action. Database MUST use views rather than tables no ensure security, all entries must be predefined queries. Database remote access and other distance access must not be enabled by blocking ports such as the telnet port, FTP and others. Database password MUST be updated ever fortnight to ensure security of the password. Password strength policy must be implemented for the database ( min 8 characters, capital small, numerical, special characters). Back Ups must also be done offsite and not only on the cloud. Backing up data of Category 3 4 as mentioned above must also be done on a certain specially encrypted drive and separate from normal back ups. Group Responsibilities All the members of the College are responsible some extent of the security of their own data and other things. Below is what each group of individuals is responsible for. A. Custodians are responsible for: 1. Information Security Procedures Establishment 2. Managing authorizations 3. Recordkeeping. 4. Incident handling and reporting B. Users are responsible for: 1. Abiding the College IT policy 2. Physical security 3. Information storage 4. Information spreading and sending 5. Method of disposal of info and devices 6. Passwords 7. Computer security 8. Remote access 9. Logging off 10. Virus and malicious code protection 11. Backups 12. Incident handling and reporting C. Managers are responsible for: 1. All what users are responsible for 2. All that the custodians are responsible for 3. Sharing responsibility for information security with the employees they supervise 4. Establishing information security procedures 5. Managing authorizations 6. User training and awareness 7. Physical security 8. Incident handling and reporting D. Information Service Providers are responsible for: 1. More extensive information security requirements than individuals 2. Establishing information security procedures 3. Physical security 4. Computer security 5. Network security 6. Access controls 7. Passwords 8. Contingency planning 9. Incident handling and reporting Administrative Responsibilities A. The CISO should always be monitoring the colleges database security system to ensure no flaws or loopholes and should propose tools or mitigation strategies. S/He must do the following: 1. Creating, reviewing, and revising policies, procedures, standards. 2. Ensuring security training and awareness. 3. Overall authority for College networks and systems security. 4. Incident handling, remediation, and reporting. 5. Collaborating with the Office of Internal Audit to ensure policy conformance. Enforcement Implementation The required actions mentioned in the policies and rules must be carried out from the effective mentioned above, those who fail to comply and follow this policy shall face disciplinary action. This policy must be strictly implemented. Principles of Information Security Principles of Information Security Man in the Middle and Man in the Browser Attacks on Financial Institutions. Abstract Four decades ago, what started as a US military research initiative to build network for linking US universities and research centers is now the Internet. Today it has expanded to every corner of the globe (Privgcca, 2016). The number of Internet users has risen from few computer scientists to 3.17 billion users. It has helped in reducing costs of communication as one can easily be in touch and communicate with each other with the help of chatting, email applications and online transactions/payments (Friedman, 2014). It has also helped organizations to offer better customer service, reduce amount of paper work, increase productivity, and enable customers to perform enquiry and transactions anytime and from anywhere. This paper will be focusing on the importance of online banking/transaction security. Introduction Banking organizations have been developing for years in a broad scope and have started to replace more traditional banking techniques in certain fields such as processing cheques, making transactions and money transfers to online, therefore; payment systems are constantly undergoing radical changes. More security measures are present but the users of these systems must also be allowed decent compatibility. Due to the amount of modern day threats these banks have also been facing a vast amount of risk and vulnerability exploitations, banks are usually very concerned about two kind of attacks, man in the middle attack (MITM) and man in the browser attack (MITB). As a result, financial institutions must ensure to provide effective authentication techniques. These two attacks (MITM and MITB) will be the main concentration and the focus of the analysis will on these attacks as well. The Two Common Attacks. The Man in The Middle and Man the Browser are the very predominant attacks in the finance industry. The difficult part is identifying each type of attack and taking precautionary measures from either attack. MITM occurs when a hacker can see and modify the communication between the client and the bank, it makes both parties believe they are directly communicating with each other to deceive but there is usually an attacker eavesdropping. Therefore, this is very common on unsecured and unprotected networks. On the other hand, MITB uses malware to infect a web browser. This is done by the malware exploiting vulnerabilities in the browser security which enables them to modify and manipulate the page. Getting Technical, MITB vs. MITM One of the few important differences between these two attacks is that MITM attacks operate at the network layer whereas MITB operate on the application there, in this case on the web browser. Although MITM attacks remain popular attackers prefer MITB as banks may use sessions IDs to identify MITM attacks. Using session IDs banks can determine whether there has been malicious activity during a transaction and notice the fraudulent attempt and consequently cancel it. By giving the customers device a unique ID, the bank can then use algorithms to analyze and link the multiple user sessions from where they typically perform their banking (Eisen, 2012). MITB attacks are a lot more deceitful, they completely take control over the users website and control the browser while the user thinks everything is normal. The attackers in this scenario alter web views and account balance without the users knowledge. Once the user logs in they can also redirect any sensitive traffic to an attackers sy stem, while keeping the original SSL/TLS protections intact (Trusteer, 2013). MITB People are very commonly exposed to the risk of these attacks due to the browser security problems in the case of MITB browser extensions are frequently the malware which allows the attacker to exploit the vulnerability. Browser extensions are frequently portrayed as useful software which enhance user experience but is malicious software or code. This is known as a Trojan. Browser extensions may be plugins, Browser Helper Objects (BHO), JavaScript and add-on features. The functionality of BHOs is usually to provide add functionality to a browser these could be written by the attacker with programming experience. The problem with BHOs is that they can hide from antivrus this makes them undetectable. In a MITMB attack these are used to change a site, add fields, remove fields. They also can add registries to the system and load at booting (Utakrit, 2009). Grease Monkey is a popular add on for chrome which can allow a user to change the appearance of a website or eliminate ads. This JavaScript is not malicious but it uses the same methodology as the malicious JavaScript applets. The danger of add-ons is that they can easily monitor and retrieve the users information at any time. SSL has been thought of as a solution by some security experts for MITB attacks but even this control has been proven to be ineffective. The reason for this is that the attacker injects or gives the user a Trojan which carries out malicious activities directly inside the browser. Therefore, no suspicious activity is detected. MITM MITM are less common as security professionals have learned ways to mitigate the attacks that use this method. It is also widely known as session hijacking. In this case, the attacker usually seeks vulnerable hotspots or networks. The attacker would usually direct the victim to a fake login page of a website (perhaps a phished paged) and then get the credentials as soon as they are authenticated. The attacker could then simply access the account and withdraw money or make transactions. Security measures such as the OTP are not effective as defense against this attack as the attacker could fraudulently capture the temporary password and forward it on the portal in the 30 60 seconds provided. In this attack the main issue is that the user has no way of being sure or verifying who is asking for information. As a result, two step verification is also considered vulnerable. Protective measures. The security triad which is an important principle to security experts evolves around three elements. C- Confidentiality, this means do not allow unauthorized individuals to access or see data or systems. A- Availability, which means ensure the system/data is available when needed. I- Integrity, if data or a system or in this case a transaction it loses its integrity which means it has been manipulated with. In the case of transactions, Integrity is a very important principle. Banks and financial institutions need to always ensure the integrity is maintained. By doing so, we need to implement controls, also known as countermeasures. User Protection Strategies and Controls MITB In order to minimize these attacks the knowledge has to be known on either side of the equation, the users should be aware as well as the bank. Users can take precaution by installing anti virus, although not entirely effective it does depend on the detection capability and reduces the chances. Secondly, use a hardened browser in a USB drive, this will provide moderate protection. Thirdly, only do online banking with banks who are aware of these kinds of threats and implement countermeasure. Ultimately there is risk in every procedure, unless you are will to completely not use online banking there will always be risks and threats. MITM Mitigation for Banks. MITB As previously mentioned, attackers have also learned how to compromise two step authentication as well the same also applies to captcha and others. The malware can simply wait till the user has authenticated himself. It can also intercept and modify response when using SSL or encryption. Moderate protection could be offered by the bank itself providing clients with Hardened Browsers on USBs containing cryptographic smart tokens for authentication. The hardened browsers are harder to infect. Similarly, OTP token with signature would be effective, the user would have to re-enter the transaction details to the OTP device and then it could generate a signature based on that in that way it would not match if the MITB alters the request, this is also rather inconvenient. Fraud detection based on transaction type and amount is also sometimes effective, in the case of an abnormal transactions some banks call the client to check if it is genuine or not. User profiling could also be used. MITM davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-28363452503280135262020-01-18T20:20:00.001-08:002020-01-18T20:20:03.661-08:00Nature and nurture on development EssayIn the study of development, nature refers to the inherited (genetic) characteristics and tendencies that influence development. Some inherited characteristics appear in virtually everyone. For instance, almost all children have the capacity to learn to walk, understand language, imitate others, use simple tools, and draw inferences about how other people view the world. Thus all children have a set of universal human genes that, when coupled with a reasonable environment, permit them to develop as reasonably capable members of the human species. Other kinds of genes create differences among people. Childrenââ¬â¢s stature, eye color, and facial appearance are largely determined by genes. Childrenââ¬â¢s temperamentââ¬âtheir characteristic ways of responding to emotional events, novel stimuli, and their own impulsesââ¬âseems to be in part affected by their individual genetic makeup (Rothbart, Ahadi, & Evans, 2000; D. C. Rowe, Almeida, & Jacobson, 1999). Similarly, being slow or quick to learn from instruction and everyday experiences has some genetic basis (Petrill & Wilkerson, 2000; Plomin, 1989). Inherited characteristics and tendencies are not always evident at birth. Many physical features emerge gradually through the process of maturation, the genetically guided changes that occur over the course of development. Environmental support, such as food, reasonably safe and toxin-free surroundings, and responsive care from others, is necessary for maturation to take place; nature never works alone. Thus natureââ¬â¢s partner is nurture, the environmental conditions that influence development. Childrenââ¬â¢s experiences in the environment affect all aspects of their being, from the health of their bodies to the curiosity of their minds. Nurture affects childrenââ¬â¢s development through multiple channels: physically through nutrition, activity, and stress; intellectually through informal experiences and formal instruction; and socially through adult role models and peer relationships. With good environmental support, children thrive. Unfortunately, the conditions of nurture are not always nurturing. For example, children who grow up in an abusive family must look outside the family for stable, affectionate care. Historically, many theorists saw nature and nurture as separate and rival factors. Some theorists believed that biological factors are ultimately responsible for growth. Other theorists assumed that children become whatever the environment shapes them to be. Increasingly, developmental theorists have come to realize that nature and nurture are both important and that they intermesh dynamically in the lives of children. Consider these principles of how nature and nurture exert separate and combined effects: The relative effects of heredity and environment vary for different areas of development. Some abilities are strongly influenced by genetically controlled systems in the brain. For example, the ability to distinguish among speech sounds develops without training and under a wide range of environmental conditions (Flavell, 1994; Gallistel, Brown, Carey, Gelman, & Keil, 1991). In contrast, abilities in traditional school subject areas (e. g. , reading, geography) and advanced artistic and physical skills (e. g. , playing the piano, playing competitive soccer) rest heavily on instruction and practice (Gardner, Torff, & Hatch, 1996; Olson, 1994; R. Watson, 1996). Inherited tendencies make children more or less responsive to particular environmental influences. Because of their genetic makeup, some children are easily affected by certain conditions in the environment, whereas others are less affected (Rutter, 1997). For example, children who are, by nature, inhibited may be quite shy around other people if they have few social contacts. If their parents and teachers encourage them to make friends, however, they may become more socially outgoing (Arcus, 1991; J. Kagan, 1998). In contrast, children who have more extroverted temperaments may be sociable regardless of the environment in which they grow up: They will persistently search for peers with whom they can talk, laugh, and spend time. Environment may play a greater role in development when environmental conditions are extreme rather than moderate. When youngsters have experiences typical for their culture and age-group, heredity often plays a strong role in their individual characteristics. Thus, when children grow up with adequate nutrition, a warm and stable home environment, and appropriate educational experiences, heredity affects how quickly and thoroughly they acquire new skills. But when they have experiences that are quite unusualââ¬âfor instance, when they experience extreme deprivationââ¬âthe influence of environment outweighs that of heredity (D. C. Rowe, Almeida, & Jacobson, 1999). For example, when children grow up deprived of adequate nutrition and stimulation, they may fail to develop advanced intellectual skills, even though they had the potential for such development when they were born (Plomin & Petrill, 1997; D. C. Rowe, Jacobson, & Van den Oord, 1999). Similarly, when malnourished, children tend to remain short in stature regardless of their genetic potential to be tall (J. S. Kagan, 1969). Timing of environmental exposure matters. When children are changing rapidly in any area, they are especially prone to influence by the environment. For example, early in a motherââ¬â¢s pregnancy, her use of certain drugs may damage the quickly growing organs and limbs of the developing fetus. Just prior to birth, exposure to the same drugs may adversely affect the babyââ¬â¢s brain, which at that point is forming the connections that will permit survival and the ability to learn in the outside world. In a few cases environmental stimulation must occur during a particular period for an emerging ability to become functional (Blakemore, 1976; Hubel & Wiesel, 1965). In such cases there is a critical period for stimulation. For example, at birth, certain areas of the brain are tentatively reserved for processing visual patternsââ¬âlines, shapes, contours, depth, and so forth. In virtually all cases, infants do encounter adequate stimulation to preserve these brain circuits. However, when cataracts are present at birth and not removed for a few years, a childââ¬â¢s vision is obstructed, and areas of the brain that otherwise would be devoted to vision lose some of this capacity (Bruer, 1999). In many and probably most other developmental areas, however, children may be most receptive to a certain type of stimulation at one point in their lives but be able to benefit from it to some degree later as well. Tonya, in the introductory case study, may have encountered only limited exposure to language as a result of her motherââ¬â¢s weakened condition. Immersed later in a rich verbal environment, Tonya would have a second chance to expand her verbal talents. Thus educational experiences at a later time can often make up for experiences missed at an earlier period (Bruer, 1999). Many theorists use the term sensitive period (rather than critical period) when referring to such a long time frame of heightened sensitivity to particular environmental experiences. Childrenââ¬â¢s natural tendencies affect their environment. In addition to being affected by nature and nurture, childrenââ¬â¢s own behaviors influence their growth. Youngsters make many choices, seek out information, and, over time, refine their ideas (Flavell, 1994; Piaget, 1985). For example, children often request information (ââ¬Å"What cooperate mean, Mommy? â⬠) and experiences (ââ¬Å"Uncle Kevin, can I play on your computer? â⬠). Children even help create environments that exacerbate their genetic tendencies. For example, children with irritable dispositions might pick fights and provoke others to lash back at them, creating a more aggressive climate in which to grow. As children get older, they become increasingly able to seek stimulation that suits their tendencies. For example, imagine that Marissa has an inherited talent for verbal skillsââ¬âlearning vocabulary, comprehending stories, and so on. As a baby, she relies on her parents to talk to her. As a toddler, she asks her parents for particular kinds of stimulation (ââ¬Å"Read book, Daddy! â⬠). In elementary school she reads to herself from books supplied by her teachers. As a teenager, she takes the bus to the library and selects her own books. Marissaââ¬â¢s experience would suggest that genetic tendencies become more powerful as children grow olderââ¬âan expectation that is in fact consistent with genetic research (Scarr & McCartney, 1983). davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-5510675352099442462020-01-10T16:44:00.001-08:002020-01-10T16:44:04.990-08:00A Study of Trends in Indian Partition Literature EssayThe Partition of India was the geographical division of colonial India into two bordering nation states of India and Pakistan based on religious demographics.1 It was proposed as an unsavoury but necessary accompaniment to the Independence of India from the British Empire. However, it was not only a diplomatic and administrative exercise but rather had a long-lasting psychological impact on the human population of these areas. Though Bapu2 was firmly against this idea, it was reluctantly accepted by Nehru and Jinnah as the only solution to the growing communal divide between the Muslim and Hindu communities. 3 However, what the political class had never predicted was the unprecedented amount of bloodshed, violence and widespread civil unrest that followed in its wake. Even years after this event, the perpetrators and the victims are still baffled as to the cause of this ââ¬Å"madnessâ⬠4 that gripped civilized society. In the aftermath, historians pretended to ignore it terming it unfortunate but somewhat inevitable while literature tried to come to terms with its bestiality and future implications. The authorial response of the first generation was severely limited however due to a level of emotional attachment and involvement in the subject matter. They lacked perspective and varied in two ways: either they were very brief and lacked empathy or tended to be voyeuristic in nature. The official responses attempted to historicise Partition through statistics, facts and figures while literature, to the contrary attempted to give voice to subaltern perspectives personalising victim narratives. Despite such a movement, it was not until the 70ââ¬â¢s that it was realised that hardly any attention was paid to the experiences of women during Partition. There was a deep reluctance to address the gender atrocities committed during Partition and it manifested itself through the invisibilisation of women voices. Although it had been clear from the start that the worst sufferers of Partition violence had been women5, a stoic silence upon the tragic reality had been maintained. Many of these women had led forgotten lives and their trauma suppressed in an attempt to forget the onslaught upon their bodies and minds. Therefore, renewed efforts began to document and portray the forgotten stories of such women. But it was a complex problem in many ways. Partition had had a multifaceted impact on the women of India and Pakistan that not only defined their coming lives but also impacted the future generations as psycho-somatic memories and construction of familial structures post-Partition.6 Literature took the initiative of this task: there were two major strains of women oriented Partition narratives that emerged in the period thus. One school of thought dealt with Partition as a backdrop to the ââ¬Å"larger narrativeâ⬠. In such stories, the lives of the main characters were highlighted and their lives were allegorised to represent the trauma of the nation itself. The stories of their existence were represented dually: as human beings involved in personal dramas and as social creatures part of a larger mainframe. Their places within the higher superstructure and as creatures dominated by the larger contexts were analysed by writers. A startling example of this was ââ¬Å"The Clear Light Of Dayâ⬠by Anita Desai which never referred to Partition in specific incidents but rather subtle, broken reflections into the people whose day-to-day lives were affected by the growing communal tension and changing socio-political equations. It refers to the ties of family, friendship, kinship and love that were abruptly ruptured by the literal division of the nation. There were novels such as ââ¬Å"Ice-Candy Manâ⬠by Bapsi Sidhwa that looks at Partition from the ââ¬Ëoutsideââ¬â¢. The narrator Lenny is imbued with unique qualities that were highly unconventional for the times. She was a child, hence she had a limited worldview, a Parsee, hence not religiously biased and neither a participant, physically disabled, therefore able to sympathise with the suffering of others and, a girl therefore her narration is unapologetically gender-conscious. What she learns, is all by association. The story is a sharp attack on official discourses that denied the suffering of millions of people. Lennyââ¬â¢s story is not only her own but a mirroring of girl-children everywhere that were faced with questions with identity, sexuality, community and nation as a whole and how they shaped individual lives. A child is brutally honest and spares nobody and nothing. She has no inbuilt prejudices so she can speak for those who cannot speak for themselves. As a result of such experimental tales, women felt ready to finally speak up. But, their attempts were met with more resistance than expected. They were themselves reluctant to speak about they went through; it was too painful but combined with societal pressures, their mouths had been almost sealed shut from fear. For daring to break this unspoken taboo, some of them faced severe consequences and were even disowned by their own families for besmirching the family name. But such actions often took a huge toll on their mental and physical health and though they had survived, they hadnââ¬â¢t healed. As a result of mass migration, women were abruptly uprooted from their homes to move to a strange and unfamiliar place. They had to build their lives and homes anew, sometimes with no support system. Many of these women were so bereaved at losing their home and hearth, that they could never recover from this sense of loss. Women in traditional society had since ancient days been tasked with looking after the home. Since they were not allowed to venture outside their domain7, the home had been almost personified for them. It was a living breathing space. The only place which they could rightfully stake claim to and which was a source of comfort and solace for them. They were so tangibly attached to their land that family was synonymous with home and her identity came to be defined by her place in the home. Hence when forced to migrate, their sense of unsettlement and upheaval was immense. They could never return to their past lives and change was not so easy for these women who had never been given the opportunity to trespass their comfort zones. Some stories that movingly illustrated the dilemmas of such women are ââ¬Å"Jadeinâ⬠by Ismat Chughtai, ââ¬Å"Sikka Badal Gayaâ⬠by Krishna Sobti Sahni and ââ¬Å"The Thirst Of Riversâ⬠by Joginder Paul . These women had to undergo the process of relocating their selves. Many women like Bebe from ââ¬Å"The Thirstâ⬠¦Ã¢â¬ refused to leave their homes assured of its protection from evils outside. However, their families were broken up with some members choosing to stay back and some leaving for a new land. Due to differences in opinion, family members become estranged and refused to talk to each other or had problems meeting each other due to large geographical distances. Often, migrants did not have enough money to travel back and forth and permits were hard to come by. Due to mutual hostilities, communication across borders was sketchy at best. Hence, many a times, a natural void between families occurred. All the while, the matriarch of the family remained a silent witness to events. The family ties that she had spent all her life building up and nurturing were breaking up right before her eyes and she was helpless, unable to act or intervene. Who would listen to her? Partition had served to further communal tension and hardening religious identities than perhaps any event in the history of India or Pakistan. People who had lived together for several millennia with tranquillity were suddenly made conscious of their differences from each other. They who had been friends earlier were suddenly staunch enemies and women bore the brunt of these realizations. In ââ¬Å"Peshawar Expressâ⬠8, one such incident is narrated when at Wazirabad station, where Muslim, Hindu and Sikh communities had celebrated Baisakhi together for ages becomes a site of base humiliation and gruesome celebration; the women of the Hindu and Sikhs communities were paraded around naked as if they were nothing but objects of gratification for the general public. These women had become mere shells, their souls long dead. In Kamleshwarââ¬â¢s ââ¬Å"Kitne Pakistanâ⬠, the author ruminates upon the fruitlessness of Partition and the breaking of bonds of families, love and friendships due to its occurrence. It is the story of a Muslim girl, Bano who falls in love with a Hindu boy, Mangal but is not able to marry him because of religious dogmas. She is told that she will cause communal riots. There is a hidden implication in this viewpoint that seems to say that the cause of every mishappening must be a woman somehow. Rules for men and women in traditional dogmatic societies are different It is ironic that men are not chastised for forcibly marrying a man of the other religion but they will not allow their daughters to choose her spouse on her own and he may never belong to another religion. There is rampant hypocrisy and hollowness in societal mores regarding women. Bano is married off to Muneer who unable to provide for his family with his own hard work resorts to selling his own wifeââ¬â¢s body to earn money. The shamefulness of this situation is beyond imagination. These are not falsifications as advocated by fundamental religious leaders but a retelling of many womenââ¬â¢s lives. Another kind of psychological trauma that many women underwent was the loss of a child. Many women were forced to leave their children by their husband and children during flight. Children became a burden during this time. They had to be cared for especially with crucial funds required by the family going for their supplies. Also, escapees with children were more vulnerable to attacks by rioters since they not only had to look after themselves but look after their child as well. There are real life cases documented by Urvashi Bhutalia in her book, ââ¬Å"The Other Side Of Silenceâ⬠wherein women of Muslim as well as Hindu communities were forced to desert their infants that could raise an alarm in the rioters by making noise. Sikh men told tales of killing their children, asking the author, if they should be saving themselves or their daughters? Clearly, manââ¬â¢s inherent selfishness had come to the fore where no one mattered more than the self. Many children were abducted during the widespread chaos to be sold off as domestic help or prostituted in the streets. Women who lost their children during this time were incessantly plagued by guilt and grief. One such woman was Kulsum from ââ¬Å"Paliâ⬠9 who lost her child and along with him, her mental balance as well. She was blanketed completely by her grief and only the return of her child restored her sanity. But meanwhile, Zenab who had taken care of her son, Dilip when she found him lost had developed a motherly bond with him and cannot bear parting with him. She knows that she has no biological claim over him but what the mind knows, the heart does not. Eventually, she has to reconcile herself with the reality of her situation. But her life will forever be shadowed by this sadness. Women who were forced by circumstances to give up their child were forever haunted by their own actions and decisions. They were always in search of redemption and peace and could not reconcile themselves to the loss of their offspring. One example of this can be seen in ââ¬Å"The Abandoned Childâ⬠10. Infant as well as toddler girls were left by the roadside or killed by their families to avoid making them a target. The life story of one such girl is narrated in ââ¬Å"Where Did She Belongâ⬠by Suraiya Quasim wherein the protagonist Munni is not sure of her religious or national identity. She is pushed into prostitution by her so-called ââ¬Ësaviourââ¬â¢11 , who only wants to use her for economic gain. She is deceived by two of her customers who pretend to love her, but leave her bereft when Partition happens. Nobody asks for her or enquires as to her whereabouts. She is deceived by everyone in her life, ultimately. There were also cases of women who were injured and deceived by members of their own community. People who had been their well-wishers and whom they trusted implicitly, took advantage of their vulnerability and preyed on their bodies. Ayeshaââ¬â¢s12 story is the ultimate tragedy of such a ââ¬Ëladyââ¬â¢13. In guise of protecting her and reuniting Ayesha with her daughter, Nurul takes her with him to Pakistan but betrays her trust by prostituting her instead. She is cursed to a life of assault, on her body and her mind. Her saviour turns out to her destructor. She dies a life of desolation, her own brethren refusing to come to her aid and never seeing her child again. Afroz too in ââ¬Å"I Am Gameâ⬠14 falls weak due to her instincts of providing and caring for daughter. Seeing no option left for herself and her child, she agrees to prostitution. This depicts to us the sad state of affairs during Partition, when uncertainty and insecurity reigned supreme. Man, woman or children, all had to protect themselves on their own and women for the sake of their families were forced into professions of exploitation to earn their keep. Besides these atrocities, women were also subjected to particularly vulgar sexual attacks. Writers like Ashis Nandy, Veena Das, and Mushirul Hasan describe the bizarre and horrific nature of sexual violence afflicted on women. It was pornographic in its varied forms. Their bodies were mutilated, disfigured, slogans15 branded on them like they were animals, their wombs sliced open and their foetuses savagely butchered. Women were reduced to spoils of war who were never allowed to unburden themselves or be free. They were reduced to a part of the multitude, just one of many. Many victims had been traumatised to an extent that they lost themselves to insanity. They could not cope with their reality. Many underwent derealisation16 wherein after the superficial wounds had mended, they started to deny that anything had ever happened to them. It became something of a nightmare, horrific but fantastical. Literature becomes a cathartic medium for many such women, a chance to narrate their tale. Such memoirs also provided a base for Partition scholars to analyse the feminine subject in social and historical contexts of that time period. Partition has often been termed as the dark underbelly17 of Independence but what it really exposed was the base attitudes of patriarchal Indian society, be it any religion. It revealed how women were equated with the community they belonged to. Though the violence was inter-religious in nature, the modes of inflicting violence were one and the same. All ethics were forgotten in the frenzy of religious vendetta. Revenge was used as an excuse to inflict wounds. They were the contested sites between two opposing factions and were devoid of any agency. One example may be an incident in ââ¬Å"The City Of Sorrowâ⬠18 , where a man is forced to strip his sister naked by someone of the other religion. When given a chance to retaliate, he forces his tormentor to strip his own wife naked. Hence, the revenge is complete but ironically, in both cases, the women were the innocent parties who became the medium of exacting justice. They were expected to uphold familial and communal honour and were sacrificed at the altar of ââ¬Å"izzatâ⬠19 if they were in danger of being captured by the enemy. The concept of honour was internalised20 hence any stain on it was beyond tolerance by patriarchal society. Therefore, to insult and hurt communal sentiments, it was natural that in order to debase the enemy and shed him of his honour, women of his community were targeted systematically. There were also women who had been indoctrinated to such an extent by religious propaganda that they committed suicide, misled into thinking that they were fulfilling their duty as women. This tradition dates back to the time of ancient Rajputs whose women committed Johar21 to sustain their honour. Hence, it has been a concept propagated throughout the history of religions, Hinduism especially. Bhishma Sahni in ââ¬Å"Tamasâ⬠and Jyotirmoyee in ââ¬Å"The River Churningâ⬠present such incidents where women of Hindu and Sikh communities drown themselves in wells in order to ââ¬Å"saveâ⬠22 themselves. Women of the family were the most precious possessions and were to be protected at all costs. However, when they presented an obstacle in the escape of their family, they were brutally ââ¬Å"martyredâ⬠23 without compunctions by the family itself. The men of the family did it all in order to save themselves first and to prevent dealing with the hassle of looking after these women. Such people had no conscience in them. This is demonstrated in Shauna Singh Baldwinââ¬â¢s novel ââ¬Å"What The Body Remembersâ⬠where the daughter-in-law of a Sikh family, Kusum is mercilessly killed by her father-in-law and furthermore chopped into pieces to prevent her from being ââ¬Å"contaminatedâ⬠24 by Muslims. Her womb is also removed as a symbolic gesture to signify her being pure25. We can therefore read into the implied fear and repulsion of a child born of an inter-religious union. Hence, Kusum is a victim of her own familyââ¬â¢s moral code. Such incidents are not hyperbolic in nature but rather fictionalized accounts of reality. Women who were misfortunate enough to fall into the hands of the ââ¬Å"otherâ⬠26 and raped by them could never again return to their roots. They were dirtied and treated as untouchable because they had lost their chastity to the enemy. In ââ¬Å"The River Churningâ⬠, the protagonist, Sutara is treated as a lower caste untouchable would be27. Though never raped, even staying in a Muslim household had damned her. She had become polluted like Sita. Like Sita, she became a victim of ââ¬Å"social moralityâ⬠.28 If women had become pregnant somehow, it was even worse for them. They were miscarried forcibly and if the child was born somehow, he or she was never accepted as a part of the family. Women themselves had to come to terms with their reality. They had to learn to let go of their self-loathing which often took root in their minds. They had to live with a child who was a constant reminder of their suffering. Yet, women learned to let go and forgive but their families could not move past this situation. The woman was given the choice of either abandoning her children or her family. Therefore, she was kept trapped in overlapping identities of woman, mother and daughter. There was no time to consider the interests of the self. The children of such women were often physically, mentally and verbally abused all throughout their lives. They were the victims of religious hatred. It left deep scars on their psyche that could never be repaired. They were often castigated for having lived and their mothers looked at with contempt for not having died in order to preserve themselves. Women often started hating their own selves when faced with a constant stream of disgust and repulsion. It is said that ââ¬Å"Rape is the only crime where the victim is held guiltyâ⬠and these women were the prime examples of this adage. They were made to feel guilty, demeaned and dehumanized to such an extent that they often felt that dying would perhaps have been a better option. Women were at the highest risk of being abducted during migration across borders. These women stranded on the wrong side were forcibly converted and married off to their abductors. They were raped repeatedly or sold off as entertainment. Women were objectified as commodities and their bodies became alien to their own selves. They were not their own persons but mere belongings. Anis Kidwai in her novel, ââ¬Å"Azaadi Ki Chaon Meinâ⬠writes starkly about these girls who were nothing but stuff to be shared among the men who were, but slaves of their lust. In his short story, Open It!, Saadat Hasan Manto further elaborates upon the savagery doled out to these women. The main protagonist, Sakina had been ravaged to such an extent that she had lost her personality and her sanity. She was alive only physically, but emotionally and mentally dead. She knew nothing but what she had been forced to go through again and again. Her senses had been so wrecked that she only expects men to want one thing from her i.e. her body. This story presents a horrifying picture to the reader who is compelled to question if Sakina will ever recover from her trauma. Other women were forcibly married off to their abductors and underwent alienation of the self. They were conflicted as to their identities. On one hand, they felt abhorrence for their abductors. On the other hand, such marriages often bore children which caused these women to war with their motherly instincts. Ultimately losing all hope of rescue or restoration, these women had resigned to their life but, again, they were expected to return at the behest of the respective governments of the two countries. Women had become mere tools of diplomatic manoeuvring between the hostile governments who were under immense political pressure to retrieve the population of women that had been left behind or abducted during Partition. One such womanââ¬â¢s tale is narrated in ââ¬Å"Exileâ⬠29 where the woman narrator is forcibly married to her abductor, Gurpal, a man who regards her as nothing more than a maid that he brought to serve his mother (Badi Ma). What is even more poignant is the fact that Badi Ma, a woman herself is not able to empathise with her Bahu30 or show kindness towards her. She is merely there to serve their needs, like a tool. Ironically, Gurpal who is clearly devoted towards his mother evidently has no guilt about ill-treating a woman of another community. We can see here the oppressive influence of patriarchal society that does not allow for women to exercise an opinion of their own. The narrator has never been able to accept Gurpal as her husband. In nine years she has never able to understand why her brother, whom she dearly loves has not come to rescue her. She feels lonely and abandoned by her loved ones. She longs for her home and wants her life to end at last so she can be at peace. When the soldiers arrive to rescue her, she knows that she cannot return since she will not be accepted back as a ââ¬Ëmotherââ¬â¢. And she cannot leave her children. Hence she hides from the soldiers. Her apprehension of the other option can be justified by reading ââ¬Å"Lajwantiâ⬠31 whose tragedy is shrouded by complete silence. She was treated abominably by her husband, Sunderlal who asserts his domination over her body and mind by beating her like an animal. She bore it all as part of her wifely duties clearly adhering to traditional norms of domesticity. But when she is abducted during Partition chaos, her husband, perhaps, feeling remorse for how he had treated her, became a campaigner for the rights of abductee women. He advocates their rehabilitation and reacceptance into society but when his wife, Lajo is restored to him, he distances himself from her and sets her on the pedestal of a goddess. She feels alienated, lonely and longs for her old life where she could at least interact with her husband. In the present, her husband wants her to forget her sufferings and not to speak of them. But can the past really be forgotten as easily as he wanted it to be? Many women who had built new lives for themselves post-Partition often came face to face with their pasts when their lost loved ones returned back to them. In this situation, what was the woman to do? Should she abandon her present life to return to her past happiness? This is obviously a problem to which there is no clear-cut solution. But it was often expected of women to move on from their pasts and not look back but even they are living, breathing human beings with feelings and emotions. These may be unwanted but cannot be so easily banished from the mind. Women end up feeling conflicted all throughout their lives. One text that accurately depicts one such situation is ââ¬Å"A Visitor From Pakistanâ⬠32 where the protagonist Saraswati is trapped between her first husband, Baldev whom she had thought dead; and her husband at present, Sunderdas who had saved her and her parents during the riots. Her own mother chastises her for even talking to Baldev so then who will understand her predicament? She is blamed for something that she is not even responsible for. Partition left a long-lasting impact on the women who witnessed and suffered through it. They passed on the lessons they learned to their daughters hoping for a better future for them. It is an important part of womenââ¬â¢s history and it should be analysed carefully to change the conservative thought processes of Indian society to avoid women from becoming subjects of patriarchal oppression and break the repetitive patterns of history. END NOTES : 1. India and Pakistan were divided along the Radcliffe Line with Muslim majority areas seceded to Pakistan and Hindu-Sikh majority areas to India. 2. Mahatma Gandhi was deemed the ââ¬Å"Father Of The Nationâ⬠and hence affectionately called Bapu by the general populace. 3. J.L. Nehru and M.A. Jinnah were leaders of the Congress party and Muslim League respectively. They were not agreeable to sharing power in the united govt. of sovereign India and hence the only option was to divide the country with both parties ruling over their majority vote areas. 4. The metaphor of madness was used by many Partition writers like Saadat Hasan Manto in ââ¬Å"Toba Tek Singhâ⬠to describe the religious hatred that changed normal people into rioters, rapists and murderers. 5. J.L. Nehru stated this in The International Womenââ¬â¢s Conference in 1947 alluding to the extreme violence perpetrated upon women in North India. 6. Ideas postulated by Carl Jung and supported by Freudian theories. 7. Women were kept under purdah and not allowed to meet with people outside the family. Women lived in separate quarters of the house called the ââ¬Ëantahpurââ¬â¢ which was solely in their control. 8. written by Krishan Chander 9. written by Bhishma Sahni 10. written by Gurmukh Singh Musafir 11. Ironic since Munniââ¬â¢s saviour is herself a victim of circumstances and Munni is just a way to earn more money. 12. ââ¬Å"A Grave Turned Inside Outâ⬠by Ibrahim Jalees 13. Ayesha was the lady of a noble family but debased to the level of a common prostitute. Shows that societal hierarchies were suspended during Partition. 14. written by Sultan Jamil Nasim 15. The slogans Hindustan Zindabad and Pakistan Zindabad were carved onto their bodies as validating gestures of the victimiserââ¬â¢s own national identity. 16. Derealisation is a psychological condition where the subject deludes himself/herself into thinking that their present reality is illusory and unreal and that reality is different. 17. Independence was achieved after a long struggle, so there was jubilation among the people but at the same time, this happiness was marred by the grief of Partition and its aftermath. 18. written by Intizar Hussain 19. Izzat is one of the basic concepts of Hindu womanhood where a womanââ¬â¢s honour is defined by her chastity and any outrage of her modesty stains her honour as well as her familyââ¬â¢s. The familyââ¬â¢s honour is an extension of the womanââ¬â¢s honour. 20. Internalisation is the process of integration of certain values as part of the self-identification. It becomes a part of oneââ¬â¢s self-image. 21. Johar is the ancient Rajput tradition of women jumping into huge fire-pits to save their honour from the enemyââ¬â¢s army if defeat seemed imminent. 22. Women jumped into wells to protect themselves from rape and mutilation. Dying chaste was preferred to living a life of humiliation. Hence, they were saved in the eyes of society. 23. Women who committed suicide were venerated because they were believed to have died for a noble cause. Hence, their deaths received social sanction and appreciation. 24. If women were raped, their bodies no longer remained solely of their religion. And, hence, inter-religious taboos were applied to such women. Hence chopping of the bodies signified that no one of the other side had had sex with her or would be able to. 25. The womb was removed to signify that it did not carry a Muslim bastard child and her ability to do so is removed from her. 26. During conflict, the opposing faction is alienated and presented as someone strange and unfamiliar to the minds of the mob. This requires dehumanization of the people from the other side so that they do not evoke emotions of sympathy. 27. The taboos associated with untouchability are not allowing them to eat and drink from the same vessels and prevent from touching them. 28. Sita was banished from Ayodhya because even though she was pure, the people of Ramââ¬â¢s kingdom did not believe her. Doubts were cast on her character since she had lived in Ravanaââ¬â¢s Lanka for a long time. 29. Written by Jamila Hashmi 30. When a bahu arrives in her marital household, she is bedecked with jewels, dressed in finery and serenaded by shehnai. She is full of happiness and hope. Here, the narrator is exactly opposed to this situation and yet, ironically she has become the bahu of a family. 31. written by Rajinder Singh Bedi 32. written by Ramlal BIBLIOGRAPHY: 1. ââ¬Å"Partition In Fiction: Gendered Perspectivesâ⬠, Isabella Bruschi, New Delhi, Atlantic Publishers & Distributors (P) Ltd.,2010 2. In The Heat Of Fratricide: The Literature Of Indiaââ¬â¢s Partition Burning Freshly (A Review Article)â⬠,Jason Francisco 3. ââ¬Å"Stories About The Partition Of Indiaâ⬠, Vol. 1.,Ed. By Alok Bhalla, Delhi,Harper Collins, 1994 4. Re-Membering Woman: Partition,Gender And Reorientations, ââ¬Å"Narrating Partition:Texts, Interpretations And Ideasâ⬠, Sukrita Paul Kumar, Indialog Publications,2004 davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-38200679806993309322020-01-02T13:08:00.001-08:002020-01-02T13:08:03.121-08:00Holocaust A Diabolical Plan - 1148 Words Eve Atkins Dr. Cooperman November 17, 2015 Holocaust: Nazi Germany and Jews A Diabolical Plan In the movie, The Pianist, a group of SS officers throw an elderly man in a wheelchair off a balcony when he does not follow orders to rise. Later, they yell, ââ¬Å"all out into the yardâ⬠as they escort throngs of Jews into a line. A woman cries, ââ¬Å"where are you taking us?â⬠and is immediately shot. Another woman sits moaning and whimpering because she was forced to smother her baby in order to prevent the police from hearing the cry. Men and women steal food from their own people out of utter desperation and starvation. The Pianist is not an over-dramatized production of the Holocaust but a realistic depiction of life for Polish Jews in the years from 1939 to 1942. During this period, over 400,000 Jews were confined to the Warsaw ghetto alone. The Nazis used the ghettos in Poland as a means of segregating and confining the Jews. They focused on economically, physically and emotionally draining and destroying their victims. With the underlying aim of extinguishing an ââ¬Å"inferior raceâ⬠, the Nazis implemented a ghetto system that ultimately served as a round up center for mass extermination. Jews lived in unimaginable unsanitary conditions, facing starvation and epidemics. Although from the Jewish perspective - at least at first - the ghettos were to serve only as a short time situation until Hitlerââ¬â¢s regime fell, for the Nazis the ghettos were the first step in ââ¬Å"the FinalShow MoreRelatedThe Hbo Movie : Conspiracy1431 Words à |à 6 Pagesguarantees that extermination of the Je ws was not being considered. Soon it became apparent that the meeting was less of a conference to negotiate and plan, than to establish new laws and clear lines of authority with the SS in control. After only two hours of strictly controlled debate the meeting adjourned with a basic plan of operation and a new diabolical means for implementation. Gas chambers would be the tool to help them reach their ultimate goal; the total eradication of every Jewish person inRead MoreAdolf Hitler And The World War II Essay1653 Words à |à 7 Pageswould take more alive and kill more capture and correctness around the orb than any foregone forces. 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This proved key to the success ofRead MoreEssay on Adolf Hitler: Evil Personified3870 Words à |à 16 Pageswithout question, an infamous one. He was a historically significant figure who, as national leader of Germany, staged the perpetration of arguably the most despicable acts of genocide in recorded history. Hitlerââ¬â¢s role as the architect of the Holocaust places him at the top of the list of historyââ¬â¢s villains. By committing atrocities that most of us find beyond comprehension, Hitler has for many people become the definition of evil, an example of absolute malevolence even to those who normally davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-48548083547562999282019-12-25T09:35:00.001-08:002019-12-25T09:35:03.091-08:00Disney Company The World s Multi National Conglomerate The Walt Disney company is considered to be one of the world s multi-national conglomerate in terms of revenue. It was founded in 1923 by Walt and Roy Disney initially named the Disney Brothers Studio. The initial foundation of the company was based on cartoons and animation. The biggest status of success was the establishment of the most recognizable characters in the world Mickey Mouse. Fast forward nearly a century later The Walt Disney company is an empire and leading name in family entertainment along with a diverse amount of other entertainment and media options. This company has significant reach in many markets. Walt Disney s cable networks group owns and operates ESPN, Disney Channels Worldwide, ABC Family and SOAPnet networks. ESPN is a multinational sports entertainment company that runs 8 twenty-four hour TV sports networks. ESPN networks reach customers in 62 countries and territories in four languages. 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By creating an illusory dreaming world among consumers, Disney subtly shapes and influences them into desiring what the company creates for them, and thus successfullyRead MoreExecutive Officer Of The Walt Disney2179 Words à |à 9 Pagesrecreation, Walt Disney is one of the worldââ¬â¢s largest conglomerate in terms of revenue, making $14.28 billion in Quarter Three in 2016. They regularly find different and new innovative ways to promote and sell their brands through various media segments to have a revenue increase and it has helped Disney to successfully complete its mission to position itself as one of the worldââ¬â¢s leader of entertainment. Robert A. Iger is Chairman and Chief Executive Officer of the Walt Disney Company. As Chairman andRead MoreThe Failure of Disney Paris2387 Words à |à 10 PagesIntroduction: Disney, the very word evokes magic in the minds of people young and old. As a brand that has catered to audiences since early 1923, it stands as a symbol of redemption from the mundane existence of daily life for people throughout world. Over the last few decades, the Walt Disney Productions Company has been in the industry of producing cartoons and quickly diversified into an array of operations, riding high on its brand equity. Most famous amongst its flagship projects have beenRead MoreEvil Disney, Research Response to Henry Giroux5383 Words à |à 22 PagesEvil Mickey There are plenty of hotbed issues on how the Disney corporationââ¬â¢s sociological and socio political ideologies are embedded into their products and how they affect children, but very few ask why Disney would place hidden ideologies in their movies/shows. What reasons would Disney have to program children with outdated morals while trying desperately to uphold a model image of innocence? What practices has the disney corporation practiced that some would consider immoral or even illegalRead MoreThe Disney Studios Industry And Competitive Analysis4241 Words à |à 17 PagesINTERNAL BRIEFING DOCUMENT SUBJECT: The Walt Disney Studios Industry Competitive Analysis BACKGROUND The Walt Disney Studios was founded by brothers Walt Disney and Roy O. Disney as Disney Brothers Cartoon Studio on October 16th, 1923. Early production focused on short films and several all-animated cartoon series. Disneyââ¬â¢s first foray into full-length animated features resulted in the seminal 1934 film Snow White and the Seven Dwarfs. Their first fully live-action film, Treasure Island, released davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0tag:blogger.com,1999:blog-3218280995285512623.post-86842348514468539622019-12-17T05:25:00.001-08:002019-12-17T05:25:03.936-08:00Alcoholism A Growing Problem - 1468 Words Alcoholism Alcoholism is a growing problem in today s society. What is alcoholism? Is it a disease? What are the causes of it? What toll does alcohol abuse have on individuals? American society? American economy? What kind of treatments are available to reduce/cure alcoholism? What is alcoholism? Alcoholism is a physical or psychological need for an alcoholic beverage, which is taken for non-medical reasons and produces a noticeable effect on the body (Sheen 93). People develop the need for alcohol for many different reasons. For a lot of people, those reasons are caused by friends/family. Some people think they need alcohol to fit in with their friends. Others think they need it to deal with family problems such as violent or carelessâ⬠¦show more contentâ⬠¦Alcohol abuse and alcohol dependence are not the same thing. â⬠¢ ââ¬Å"With abuse, a person uses alcohol in excess but may not have regular cravings, a need to use daily, or withdrawal symptoms during sudden stoppage. The person may often have heavy alcohol binge episodes separated by periods of not drinking. â⬠¢ If a person is dependent on alcohol, he or she needs to drink regularly or even daily and drink more and more to get the same effects. The person also experiences withdrawal symptoms if he or she stops drinking and wants to quit drinking alcohol but can tâ⬠(http://www.webmd.com/mental-health/addiction/understanding-alcohol-abuse-symptoms). What are symptoms of Alcohol abuse? There are many symptoms of alcohol abuse including: â⬠¢ ââ¬Å"Temporary blackouts or memory loss. â⬠¢ Recurrent arguments or fights with family members or friends as well as irritability, depression, or mood swings. â⬠¢ Continuing use of alcohol to relax, to cheer up, to sleep, to deal with problems, or to feel normal. â⬠¢ Headache, anxiety, insomnia, nausea, or other unpleasant symptoms when you stop drinking. â⬠¢ Flushed skin and broken capillaries on the face; a husky voice; trembling hands; bloody or black/tarry stools or vomiting blood; chronic diarrhea; and drinking alone, in the mornings, or in secret; these symptoms are specifically associated with alcoholism.â⬠(http://www.webmd.com/mental-health/addiction/understanding-alcohol-abuse-symptoms). ââ¬Å"What are davidowens198151http://www.blogger.com/profile/15645215904344472782noreply@blogger.com0