Use Of Personality Pills Essays - Drugs, Pharmaceutical Drug

Use Of Personality Pills As we go farther and farther into the future, scientific discoveries are becoming more and more magnificent. A plethora of pills that can alter one's mind or personality are readily available by prescription, and yearly more pills are being produced. There is a strong moral dilemma over whether these pills should be taken, or accepted as part of normal life. The belief that one should be able to take a pill to change him or herself intellectually and personally is a very controversial subject. By taking a man-made substance to alter our personality, or increase our intelligence, it is literally changing the person who we are, or were meant to be. I believe that only certain types of illnesses should be able to take such medicines, and should only be able to use them for a period of time. Mental disease differs from endearing quirks only in degree. Says Dr. Larry Siever, Mount Sinai School of Medicine, New York. It is very hard to make a judgement on whether someone is suitable to take medicine to alter his or her persona. Often a person may feel that they need a change, when in fact they don't. It would be difficult to choose which patients should take medicine, and which should have to continue to suffer. This is one of the sides of the argument against making these drugs available for the public. No one is truly capable of deciding what degree of severity another person is at, and no one should be able to decide who is normal or abnormal. Right now these drugs are only accessible through prescription, but many believe that they should be obtainable for everyone. I believe that we should not change the system we have right now, for it seems to be working. People who strongly believe they need a drug to get by in life, and people with less need for them take these pills, and it does help. This system should not change, because if we made the medicine more available, many more people would take them just to change, even if they don't need to. If the medicine had more restrictions, more people would be suffering. As aforementioned, I believe that only certain illnesses should be able to take such medicine. Patients with severe depression and diseases that cause strong feelings of pain or hate to them or others should be allowed to take these drugs. This would be to protect the patient, and to try to keep them subdued. Simple things such as stage fright, or mood swings should not be changed, because those are a natural part of oneself that does not cause a serious threat. If everyone took a drug for every little thing that they did not like about themselves, it would not end. There would always be one more thing that we wish we could change, one more drug out of reach. This would make the scientific community very wealthy, but could cause chaos in society. If people are so concerned on being different, and changing themselves in the direction of the norm, they should not be taking a pill to be different. They should try to change themselves naturally, whether it is facing their fears, or however it may be. All through history people have survived without these pills, and we have come along very well without them. Why should we change something that is going perfectly well? Another thing to ponder about is if everyone starts taking these pills, then certain people may not accomplish the things that they could have in life. Many people who have affected the world have been mentally ill, and they have left great impacts on the world. By using these pills, it could inhibit their progress in life, or their progress in the different fields that they were meant to succeed in. If T.S. Eliot had been extroverted, he might have not been such a creative person, for he might have gone out in life and socialized more, rather than sitting alone and focusing on his thoughts. The risks that would be taken to use these drugs are far too high. We are who we are for a reason,

Critical Study of The NHS breast screening programme The WritePass Journal

Critical Study of The NHS breast screening programme Introduction Critical Study of The NHS breast screening programme IntroductionPathway through the Breast servicesConclusionReferencesRelated Introduction The NHS Breast Screening Programme began in 1988 and was set up by the Department of Health in response to the recommendations of a working group, chaired by Professor Sir Patrick Forrest. The report Breast Cancer Screening was published in 1986, and popularly known as The Forrest Report. NHSBSP began inviting women for screening in 1988 and started covering nationally in the mid 1990s. A report by the Department of Health Advisory Committee published in 1991 suggested that the programme would save 1,250 lives each year by 2010(Breast Cancer Screening 1991: Evidence and Experience since the Forrest Report, Department of Health Advisory Committee, NHS Breast Screening Programme 1991).The NHS Breast Screening Programme is an effective part of the UKs efforts to reduce the death toll from breast cancer. In September 2000, research was published which demonstrated that the screening programme had lowered mortality rates from breast cancer in the 55-69 age group. Early detection of breast cancer is an important factor in improving breast cancer survival. Breast screening is an opportunity for early detection of breast cancer. In 2010, research shows that benefits from screening mammography outweigh the harm in over diagnosis. . Between 2 and 2.5 lives are saved for every over diagnosed case. The aim of this essay is to critically analyse and evaluate the pathway through breast services with the relevant departments. Pathway through the Breast services Women registered with the General Practitioner, aged between 50 and 70 years old are routinely invited for breast screening at their local breast screening unit, it could be hospital based or in a mobile trailer. An invitation is sent once every three years.   Women over 70 years old will not receive an invitation but they are encouraged to make their appointment for the breast screening programme. Enclosed in the invitation is a leaflet about the facts about the screening programme.The author finds the leaflet very helpful because it has a lot of facts about the breast screening programme, and its benefits.   The leaflet sent is written in English. There is an available format with this leaflet from large print in English; for women who do not speak English as their first language, the leaflet is also available in other languages such as Arabic, Bengali, Cantonese, Polish, Punjabi and Urdu. It is even available in Braille format and a DVD for British sign language. The Departmen t of Health Cancer Reform strategy announced that effective on 2012 the NHSBSP would be extending the invitation to women aged between 47 and 73 years old. The author visited a mobile breast screening unit, based in the breast screening department car park. There were 55 patients booked on that day.   There were two women who did not attend their appointment.   The author observed that the unit was very relaxing despite the very busy list. Background music was playing while women waited for their mammograms to be performed. Music has been very successful in distracting patient’s attention from pain (Hawthorn and Redmond, 1998). The author strongly agrees with Hawthorn and Redmond that music helps in distracting ones attention from pain. One woman made a comment that music helped her relaxed since it was her first breast screening and the woman was very anxious and a little bit nervous. When a woman arrives for breast screening appointment, the radiographer will then greet the woman. The radiographer will check the woman’s personal details and reviews the questionnaire answered by the woman. In the x-ray room, the radiographer will explain the whole procedure such as the need of compression during the examination. The radiographer will answer all the woman’s questions before carrying out the examination. Giving proper applied compression is very important in producing a good mammography image (Bassett and Hendrick, 1994). Basett and Hendrick (1994) recommended that to give proper compression the radiographer should let women know the importance of compression, and inform when it is about to be initiated, it also should be done slowly and until the skin of the breast is tight without causing pain. After the mammogram, the woman was then given a leaflet for further information about the result of the examination, a contact number for inquiries and more i nformation and it also states that there is a possibility for a recall for assessment. The aim of breast screening assessment is to identify the abnormality found in the screening mammograms. If there is abnormality found, further tests are then needed. Testing for breast cancer should include a clinical examination, breast imaging, fine needle aspiration or core biopsy. These three tests are called triple assessment. Women recalled for further assessment from the breast screening, around one in six to have cancer (NHSBSP Pocket Guide, 2008). The assessment clinics have breast care nurses that help women during assessment or women who are diagnosed to have breast cancer. Breast care nurse gives advice, support and information. According to the Breast Cancer Care and Royal College of Nursing, the key role of the breast care nurse during the treatment pathway is to give information and emotional support. They give information about treatments, options and what to expect during the entire treatment (Breast Cancer Care and Royal College of Nursing December, 2004). The author strongly believes that having a breast care nurse is crucially important to women who are undergoing treatment. It would make their life a bit easier during treatment because someone is there to listen and help them throughout. The author asked a woman on how helpful the breast care nurse during the treatment pathway, and the woman said that her treatment would be totally different without the help of the breast care nurse. The breast care nurse has helpe d the woman from the day she was recalled for further assessments from breast screening. The breast care nurse has given her a lot emotional support and has given her a lot of information during the treatment journey. The woman is extremely glad that someone is there to listen to all her worries during tough times. The author visited an assessment clinic and observed the flow of the clinic that day. The author observed a woman recalled for assessment. The mammograms were read by two consultant radiologist. Double reading has been practiced in the breast screening programme. The opinion of the author is that having two readings is more effective than just having a single reading. Research shows that double reading may boost the number of cancers detected by some 9 to 15 percent (Brown et al, 1996). However, around 13% of the health service costs happen during the breast screening assessment (Clark and Fraser, 1996). The author visited a busy assessment clinic; one the cases observed was that the reporting radiologists have found in the mammogram a calcification in the upper inner quadrant of the left breast that is why the woman was recalled for further tests. Additional views were suggested specifically, left lateral and left magnification views.   After the additional views were done, the wo man went to the examination room and the radiologist explained the suspected abnormality found in the mammograms and further imaging required to confirm or exclude any abnormality. After hearing out the Consultant Radiologist’s explanation regarding examinations needed during the visit, the woman got so anxious and stressed out. The breast care nurse was there to give support in these times. A woman scheduled for breast biopsy procedures suffers anxiety about the result of their diagnostic procedures. The author believes that breast care nurse plays a very important role in the assessment team. Preoperative nurses have special ways in providing quality nursing care for patients waiting for breast biopsy procedures and their definitive diagnosis (Deane, 1997). The woman had a clinical examination; Stereotactic guide biopsy with specimen radiography was performed. The radiologist took five flecks of representative calcification and was sent to the pathology department for analy sis. Result will be ready for the multi-disciplinary team for review in two days. According to the clinical guidelines for breast screening cancer assessment, women who will have further tests should have their results discussed in a multidisciplinary meeting. There are two routine outcomes for assessment; the woman will still be invited for the breast screening programme or the woman will have further treatment (NHSBSP, Publication 49). The author visited a â€Å"one stop breast clinic† at a local breast care unit. Most patients were referred by their GP and there was a patient referred from breast screening assessment. A specialist should see GP referrals or referrals from the breast screening unit within two weeks from referral. Cancer reform strategy 2007 announced that in December 2009, all patients referred to a specialist with breast symptoms even if cancer is not suspected should be seen within two weeks of referral (DOH, 2007). The clinic had a mixture of patients. There were new referrals from the GP, follow up appointments from previous treatment and follow up for results of tests. The clinic had a consultant breast surgeon, registrar, breast care nurses, consultant radiologist, radiographer, and consultant pathologist, consultant oncologist. They are referred as the breast care team.   The Surgical guidelines for the management of breast cancer, Association of Breast Surgery, BASO 2009 states tha t it is now widely accepted that breast care team should be provided by breast specialists in each discipline and that multidisciplinary team form the basis for best practice.   â€Å"One Stop Clinic† is similar to the assessment clinic for women recalled from breast screening. The author observed that triple assessments were done just like women recalled for further assessment from breast screening and these tests are based on clinical examination, breast imaging, fine needle aspiration or core biopsy. Men who have suspected breast cancer will have the same investigations (NICE guidelines, 2009). The author’s opinion, it is important that every woman or man referred to a Consultant Breast Surgeon should have triple assessment, if possible for accurate diagnosis and should be done at the same visit. â€Å"Routine use of triple assessment can increase the speed and accuracy and reduce the cost of diagnosis. When the three tests give consistent results, a definite positive or negative diagnosis can be given 99% of the time. Thus minimises the need for open biopsy, thus preventing unnecessary surgery and reducing anxiety (NICE, 2009).† National Institute for Clinical Excellence suggested that the triple assessment should be available to patients with suspected breast cancer at a single visit (NICE, 2009). The author observed another woman in the outpatient clinic, a woman referred from breast screening that had shown in the mammograms clusters of micro calcification in the right breast. Core biopsy was done during her first visit in the assessment unit and in which turned out to be breast cancer. The woman’s case was reviewed with the Multidisciplinary team and further treatment was recommended. The woman was so anxious, and felt so hopeless but with the help of the breast care nurse to give support and advice, the woman felt a little better. Treatment was discussed during the visit. Another woman referred by the GP complaining on having breast lumps. The Consultant surgeon reviewed the woman’s notes before bringing the woman into the room. After reviewing the notes, the breast care nurse then brought the woman in for clinical examination. The surgeon thoroughly examined the woman’s breast. The surgeon then wrote down an imaging request form with its clinical indications for a Mammogram. The author then accompanied the woman to the Mammography Section of the Breast Unit and was then met by the radiographer.   The radiographer then explained the examination, like how many views to take, and the need to compress both breast and informed the woman might feel a little bit uncomfortable. The author has observed that the radiographer have explained very well about what happens during the whole examination. Good communication between a radiographer and patients is an important factor. The author visited the Pathology department and observed what happens in the department.   NHSBSP uses triple approach, known as triple assessment. Having a fine needle aspiration or breast core biopsy is part of the triple assessment. Fine needle aspiration entails placing a very thin needle inside the mass and extracting cells for microscopic evaluation. The samples are then smeared on a microscope slide and allowed to dry in air and fixed by spraying, or immersed in a liquid. The fixed smears are then stained and examined by a pathologist under the microscope. According to Bateman (2006), fine needle aspiration is the fastest and easiest method of breast biopsy, and the results are rapidly available, fine needle aspiration cannot distinguish between in situ and invasive carcinoma. Core biopsies are samples of cells are taken from the lump or area of abnormality using a needle. It can be performed under local anaesthesia in the outpatient setting. The sample will be sent to the Pathology department. The Consultant Pathologist will evaluate the sample. The accurate diagnosis of breast cancer and the pathological assessment of breast cancer tissue are big responsibilities by pathologists working within the field of breast disease. It is very important to distinguish the pathological changes of benign breast disease from those of early and established breast cancer. Once cancer is confirmed, the pathologist is required to provide an evaluation of the pathological features determining prognosis and the requirement for further treatment (Bateman, 2006). The author has realized that diagnosing a breast cancer relies on the pathological assessment of the breast cancer tissues and that the Consultant pathologist plays a very important role in giving the diagnosis accurately and the pathological assessment of the breast cancer tissue. The consultant pathologist is responsible in establishing the pathological assessment of the breast cancer tissue. The author’s opinion is that excellent histological diagnosis plays a very important p art to breast cancer staging and management. Woman diagnosed with breast cancer picked up from breast screening should be under the care of the Multidisciplinary team. There are some factors that they need to be considered on what treatment is best. The consultants will consider the stage and grade of cancer, health, and whether the woman has been through menopause. Different methods define the stage of cancer; the TNM system of staging describes the tumour size, number of affected lymph nodes, and what extent the cancer has spread (breakthrough).   When treating cancer, the breast consultant will discuss on what treatment is best for the patient. Before an operation is done, the surgeon will talk to the woman concerned about the best surgery that should take place for the woman’s case. According to the BASO surgical guidelines (2009), surgery should only be performed by a specialist who specialize breast diseases and who performs surgery of at least 30 cases per year The NHS Cancer Plan sets a maximum of one month wait from the date of diagnosis. Women diagnosed with breast cancer are given their first treatment within 2 months of an urgent GP referral or women who came from breast screening. Surgery is often the first treatment for breast cancer to remove cancerous tissues, and to find out if the lymph nodes are affected. Surgery is usually the first line of attack against breast cancer.   A range of operations should be available. If the cancer is not too large or diffuse, surgical options include mastectomy and breast conserving surgery. In such cases the choice should be made jointly by the surgeon and the patien t, who should be fully informed of all opinions and their potential risks, benefits and implications for further treatment (NICE, 2002). Before the operation, patient will be seen by a member of the breast surgical team for a pre-admission appointment.   The patient will stay overnight to prepare her for the operation the next day. Surgical considerations are; wide local excision is the removal of the breast tumor and some of the normal tissue that surrounds it. The breast is left intact with less disfigurement. Sentinel lymph node biopsy involves a tiny incision in the axilla and removing one to four lymph nodes, before having this surgery, radioactive tracer is injected two to twenty-four hours prior to surgery. When patient is already under general anaesthesia, blue dye will then be injected around the areola.   Both radioactive tracer and the blue dye will help in identifying the sentinel lymph nodes during the operation, once they are identified the consultant breast surgeon will then remove it and sentinel lymph nodes are sent to the pathology department for analysis.   Axillary clearance takes place if the sentinel lymph nodes are affected by cancer the consultant breast surgeon will remove the entire lymph glands in the axilla. If cancer cells are found in the sentinel lymph nodes patients are given another operation in about two weeks time or after the pathology report is available. The second operation involves the removal of further lymph nodes in the axilla. Research shows th at 20,000 women who will undergo sentinel node biopsy will be spared from unnecessary breast cancer surgery each year ( Goyal and Mansel, 2008).   According to Professor Mansel, ninety two percent of women who had sentinel node biopsy had a quick recovery and they were able to do their normal activities after three months compared to women who had a conventional operation and also they only stayed one night at the hospital compared to four nights. Under the written breast local guidelines, a woman who has had surgery of the breast should be identified on which adjuvant treatment should be given consideration(BASO,2009.). Adjuvant treatment includes radiation therapy, endocrine therapy, hormone therapy and targeted therapy. Radiation therapy is needed to the remaining breast tissues after an operation.   It is often used in combination with other treatments, such as chemotherapy to shrink the size of the tumour before removing it. Radiation therapy to the breast is a localised treatment. The target is directly aimed to the cancer.   It uses high-energy rays to stop cancer cells from spreading and growing. It is often used to destroy remaining breast cancer cells in the breast, chest wall, or axilla. The oncologist may suggest treatment in a specific area; it could be the breast alone, axilla and supraclavicular area. The author visited the Radiation Therapy and observed  Ã‚   what happens in the department.   The author observed that for the patient’s first appointment will be a planning session in the planning CT scanner or in a stimulator. This is not formal consultation. The main purpose of this first visit it to plan and arrange the radiation therapy. The author observed a woman for h er first appointment. The woman’s breast cancer was detected through breast screening. When the woman arrived for her first appointment, the woman was asked for her details and appointment card then she was then told by the receptionist to go to the stimulator. The stimulator is where the planning takes place. This stage helps the consultant oncologist to target the specific area for treatment. Measurements are measured accurately and ink marks are marked on the patient’s skin for the accurate target. This stage helps the consultant oncologist to target the specific area for treatment. After all accurate measurements are recorded the next stage would be treatment. The radiographers are not in the room with the patient although they are equipped with video camera and intercom so they can see and hear the patient in the treatment room at all times.   The Radiation therapy team consist of radiographers, physicist and oncologists.   The author observed that the unit is very busy and not enough staff for a very busy unit. The author asked the radiographer about patient waiting during the visit and the specialist radiographer said that it is quite difficult to judge how long each patient will take and also to get start the radiation therapy process, there is a long wait for appointment for radiation therapy. Patient can get an appointment as long as three months. According to Dr Michael Williams , vice president of the Royal College of Radiologists, in The Telegraph article, he said current waiting times were â€Å"simply not acceptable†.   There are shortage of radiographers and radiation therapy units. The author believes that if the government invests and expands the coverage for radiation therapy units in various places in the United Kingdom then waiting time will be reduced and patient anxiety will lessen. The oncology unit provides a wide range of services such as clinical and support services. The breast care team in this unit includes a consultant oncologist, two breast care nurses, clinical oncology assistant, and nursing team. The breast care team work closely together with the radiology department at the local NHS hospital to ensure that patients are given the multidisciplinary approach. Patients with breast cancer are given a holistic service in their battle with breast cancer.   There is a 24 hour emergency contact number for patients undergoing chemotherapy. The breast care nurses in this unit are always ready to respond to patients needs and concerns during their treatment. After treatment for breast cancer, women should have a care plan with the GP or a Specialist to detect local recurrence or side effects of any treatment the woman has had.   A written care plan should be made for every woman diagnosed with breast cancer. Dates of review for any adjuvant therapy, details of surveillance mammography, and contact details for any urgent referral to a specialist and support services should be in the care plan. Copies are given to the general practitioner and to the woman (NICE, 2009.) Breast care service does not end after having treatment.   After treatment, women are given follow ups and are offered yearly mammography.   Women who are part of the NHSBSP are given yearly screening for five years and will have the routine screening every three years after that. Conclusion The author has learned and gained a lot of knowledge through this essay. Research and visits to various departments that are part of the pathway through breast care services has been extremely educational and helpful in the author’s profession as a radiographer. The pathway through breast services with the relevant departments work really hard as a team. Each individual who is part of the pathway is very dedicated, committed and has the understanding to women undergoing breast screening and to women fighting with breast cancer. The experience that the author had with all the research and visits is very valuable; it made the author become a better radiographer and has gained the motivation to pursue Post Graduate Award in Mammography. It has given the author to put into practice all the experiences learned from Consultants, nurses and patients during the department visits. As a future mammographer, it has instilled in the author’s mind and heart that high quality standar ds should be carried out at all times, it is vital to follow the quality assurance guidelines for radiographers to be able to give a first class service. NHSBSP was established in 1988. In the last 22 yrs since NHSBSP has started its service for breast screening to women in England, between 50 to 70 years old every three years, over 100,000 women had their breast cancer detected in this programme.   The author therefore concludes that the programme is a vital factor in detecting early stage of breast cancer and it definitely does save many lives. The author would like to thank the people behind the NHSBSP for their commitment and effort to make this programme a success, job well done! The author wishes continued success with this programme. From 1988 up to the present, there have been a lot of changes with NHSBSP, like in 2008; the government invested  £100 million in digital mammography equipment throughout the NHS and also the programme will expand its age group between 47- 73 years old in 2012. Therefore, the author concludes that   with these changes, a lot of women will benefit more and will be given the best service and with the latest technology there is to offer in the pathway through breast services. Through the years, breast care awareness has increased rapidly with the help of the NHS Breast Screening Programme. â€Å"Be Breast Aware† leaflets from the NHS Cancer screening programme is available and it gives a lot of information on how to be become aware of the changes of the breasts , what normal breasts feels like, and what changes you need to look out for .A lot of women nowadays even men are breast aware with the help NHSBSP campaign. It is essential to be breast aware before it is too late in the detection of any breast diseases. The author agrees with the facts, research, studies and department visits gathered together, the author concludes that having routine breast screening definitely helps in detecting early stage of breast cancer. The author would like to extend a big heartfelt thank you to the breast care team and to all those individuals who have given their time and effort during the authors’ department visits even with their busy tight schedule. The author is very much thankful to the women who had given their time with the author in sharing their bad and good experiences with their treatment journey. The breast services pathway is continually improving and the author concludes that in order to improve the pathway in breast services, it is important that  Ã‚   consultants, radiographers, breast care nurses, and the rest of the staff who work in the relevant departments in the pathway through the breast services should work hand in hand as a team. Good communication within the team and to the women that belongs in the NHSBSP are key factors to ensure that   Ã‚  good service is maintained for each individual undergoing breast screening or any examination in relation to breast diseases. References Hawthorn,   J.   and Redmond, K (1998). Pain: causes and management. Blackwell   Sciences Ltd., UK. Breast Cancer Care and Royal College of Nursing (2004). Time to care: maintaining access to breast cancer nurses. [Online]. Available from: http://rcn.org.uk/_data/assets/pdf_file/0008/78641/002494.pdf .[Accessed 18 December 2010] Brown, J. et al. (1996). Mammography screening: an incremental cost effectiveness analysis of double versus single reading of mammograms. March, 312 (7034). [Online]. Available from: http://bmj.com/content/312/7034/809.full. Date accessed: 20 December 2010 NHSBSP (2001). NHSBSP Publication No. 49, NHS Cancer Screening Programmes. [Online]. Available from: http://cancerscreening.nhs.uk/breastscreen/publications/nhsbsp49-1st.pdf. [accessed: 2 January 2011]. National Institute for Health and Clinical Excellence Guidelines(2009) Early and Locally Advanced Breast Cancer: Diagnosis and Treatment. The National Collaborating Centre. [Online]. Available from: nice.org.uk/nicemedia/pdf/CG80NICEGuideline.pdf. [Accessed 3 November 2010]. Deane, K A (1997). The Role of the Breast Clinic Nurse. AORN Journal. 66(2): 304-7, pp 304-310. Goyal , A and Mansel, R. (2008). Current opinion in oncology. Recent Advances in Sentinel Lymph Node Biopsy for Breast Cancer. November, 20 (6), pp 621-626. Bassett, L and Hendrick R E. (1994). Quality Determinants of Mammography: Clinical Practice Guidelines. AHCPR Publication. 13. pp 23-24. British Association of Cancer Oncology (2009).Surgical Guidelines for the Management of Breast Cancer. Elsevier Publication. [Online]. Availablefrom: baso.org.uk/Downloads/YEJSO_2782.pdf .[Accessed: 20 January 2011]. NHSBSP, (2008). Breast screening:   a pocket guide. Department of Health Publications.   [Online]. Available from: cancerscreening.nhs.uk/breastscreen/publications/nhsbsp-pocket-guide-2008.pdf . [Accessed 26 October 2010]. Bateman, A C. (2006). Womens health medicine. Pathology of Breast Cancer. January, 3 (1), pp 18-21. [Online]. Available from: http://download.journals.elsevierhealth.com/pdfs/journals/1744-1870/PIIS1744187006001193.pdf . [Accessed   12 January 2011]. Donnelly, L.   (2007). Government pledges to cut radiation therapy wait. The Telegraph. 2 December 2007. [Online]. Available from: telegraph.co.uk/news/uknews/1571199/Government-pledges-to-cut-radiotherapy-wait.html .[Accessed 27 January 2011]. Does breast screening save lives?. [Online]. Available from: cancerscreening.nhs.uk/breastscreen/save-lives.html . [Accessed 29 October 2010]. Going further on cancer waits: the symptomatic breast two week wait standard (2009). [Online]. Available from: http://ncin.org.uk . [Accessed 24 January 2011]. Healthcare services for breast Cancer (2002). Improving Outcomes in Breast Cancer. National Institute for Clinical Excellence. [Online]. Available from: nice.org.uk/nicemedia/live/10887/28766/28766.pdf .[Accessed 3 November 2010]. Breakthrough Breast Cancer. The best treatment. [Online]. Available from: http:// www.breakthrough.org.uk . [Accessed 18 November 2010].

Business Letter Format

Business Letter Format A business letter is a document you send to a reader outside of your organization. A memo is used internally in business. (Memo format.) Here is a standard business letter format model, based on The Business Writer’s Handbook: LETTERHEAD March 22, 201_ (DATE – three lines below the letterhead) Mr. George Vogel (INSIDE ADDRESS – Include the recipient’s name, title, and address, two to six lines below the date, depending on length of letter) Director of Operations New York Transit Authority New York, NY 10010 Dear Mr. Vogel: (SALUTATION – Two lines below Inside address, aligned left margin. Note a business letter salutation uses a colon. A personal letter uses a comma.) Enclosed is our final report evaluating the safety measures for the New York City Transit System. (BODY – Begin two lines below the salutation, justified left.) The report addresses all issues you raised in our last meeting. I believe you will be happy with the issues resolution. However, if you have any further questions, I would be happy to meet with you again. Thank you for your willingness to fully share data, and for your insights as we compiled this report. Your experience was invaluable. Sincerely, (CLOSING – Two spaces below the body. Use Best regards or Best wishes if the recipient is a close colleague.) Marilyn Jones (YOUR SIGNATURE, HANDWRITTEN) Marilyn Jones, Ph. D. (WRITER’S SIGNATURE BLOCK – Your full name four lines below closing. Include business title and individual contact info.) Director of Research mjones@companyname.com MJ/ls (END NOTATIONS AS NEEDED: letter writer initials/typist; enclosures; courtesy copies) Enclosure: Final Safety Report cc: ITS Safety Committee Members Note that all text is fully justified left. It is also acceptable to indent the Inside Address and the Closing, Signature, and Writer’s Signature Block. If you choose this format option, indent them to the center of the page and align all of these elements. CONTINUING PAGES If a letter requires a second page (or, in rare cases, more), always carry at least two lines of the body text over to that page. Use plain (non-letterhead) paper of quality equivalent to that of the letterhead stationery for the second page. It should have a header with the recipient's name, the page number, and the date. Place the header in the upper left-hand corner or across the page.For example:Ms. M.C. MarksPage 2March 16, 2012(we prefer this format)ORMs. M.C. Marks Page 2 March 16, 2012 Letter writing is just one of the skills that we teach in our most popular effective businsess writing course.

Analysis a play Essay Example | Topics and Well Written Essays - 1250 words - 1

Analysis a play - Essay Example The provisions of the law may be great and their intentions may be noble. But if those who implement them are not noble, the society will suffer and a law argued, defended and implemented in a worst manner is calamitous for the society. â€Å"No Crime† by Billy Goda is one of those postmodern plays which chuckles the guilty conscious of its readers, and touches their hearts at the profound depth. The author makes it very clear and his objective is evident and he articulates his viewpoint employing his characters and their mutual relationship. The ending of the play is also on the expected lines, though the author introduces a dramatic element of neutrality in the end of the play. The theme of the play is about the role of the law and its relationship with the society. The implicit purpose of law is to keep members of the society safe collectively and individually. It is the frame on which the society builds itself and it is supposed to keep the members of the society behind the lines of law. The law is supposed to be blind and both arms of the scale of law are equally important. Its main responsibility is to prevent the wrong and see that it does not get stronger and for the weak and support-less to provide the support within the provisions of law. The prime responsibility of the law and the judicial process is to identify the guilty from the innocent. This is the ideal position desired by any society. But the ground realties in almost all the countries leave much to be desired. Societies have never been able to give the true and honest benefit of the provisions of law to the people. The not guilty have been punished and the guilty ones have escaped the noose of law. Those who should have been punished have been acquitted. Though the theme of the play does not offer direct comments on the lacunas in the system of implementation of the legal provisions its hidden agenda and the style of presentation deals with those who are the custodians

PetMeds annotated outline Case Study Example | Topics and Well Written Essays - 500 words

PetMeds annotated outline - Case Study Example The products are also advertised on the internet platform through social media and video advertisements (PetMeds Express, Inc, 2012). Emails are used to persuade new customers. Old customers are reminded to make purchases through the emails, as well (PetMeds Express, Inc, 2012). The website of the company is also an effective means of marketing the products. The products sold by the company are purchased directly from four major manufacturers. However, these manufacturers offer a variety of resources that cater for the needs of all customers (PetMeds Express, Inc, 2012). Customers make orders directly from the company’s website (PetMeds Website). Optionally, a customer can make a toll-free call to the company’s customer representatives to place an order (PetMeds Express, Inc, 2012). The company has a program in which customer care representatives receive training, on a continuous basis, from training officers. These representatives take care of customer complaints and compliments hence evaluation of customer satisfaction is possible (PetMeds Express, Inc, 2012). After making the order, the company’s supply-chain section, based Pompano Beach, processes the order and ships it to customers across the US. Customers can track the progress of their orders through the company website (PetMeds Express, Inc, 2012). This section analyses the market threats of the company and how it has achieved to counter them. The company has experienced stiff competition from veterinarians and other retailers, traditional and online based. In fact, the veterinarians have even engaged in a litigation battle with the company (Fiala, 2012). However, the company commands a greater market share due to the affordability of its products, promptness in delivery and convenience. The company’s net profits have been relatively flat in the past years, and this is attributed to the increased administrative and general expenses. Nevertheless, this is set to improve in the

Posttraumatic Stress Disorder Essay Example for Free

Posttraumatic Stress Disorder Essay Posttraumatic Stress Disorder side effects may take years to show up, they are debilitating to the victims everyday life. A soldier with PTSD may experience emotional outburst, find it hard to communicate with others. Panic attacks, sleeping disorder, and flashbacks are a few of the major side effects. The soldier often will feel guilty which makes it difficult for them to adjust back into civilian life. Not knowing how to reunite with friends and family often lead to sever depression and suicide. An incident that may remind the soldier or their trauma can send them into a sever panic attack which may take days or weeks to recover from. It is said a soldier with PTSD is never truly home, there are always demons around every corner. The military teaches our soldiers how to fight, how to kill and how to survive. But who teaches them how to live with themselves? Soldiers are returning in large volumes with PTSD but are not being treated for their disorder. Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur following the experience or witnessing of a traumatic event. A traumatic event is a life-threatening event such as military combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual assault in adult or childhood. The fight or flight response is what we know happens when one is afraid. Your body is releasing adrenaline, raising you heart rate and releasing glucose to muscles allowing you to respond quickly. Once you are out of the fearful situation you release a hormone known as cortical allowing your body to calm down. In a sever trauma you may not release enough cortical so your body stays under a great deal of stress. Then the victim may produce a high level of catecholamine which is a stimulating hormone. When reminded of the trauma this hormone kicks in. Mason JW, Giller EL, Kosten TR) One out of ten Americans involved in a sever trauma event causes a cascade of psychological and biological changes known as post-traumatic stress disorder. Soldiers returning from wars throughout the years were not able to adapt back in to civilian life. Doctors now understand the severity of this disorder and our addressing to the best of their abilities. To receive the diagnosis the victim must have been in a situation in which they were afraid for their safety, feel horror, or feel helpless. The more terrifying the trauma is, increases the chances of the victim developing PTSD. Victims diagnosed with PTSD can prevent them from working; affect their relationships, and causes great difficulty being a good parent. (Allen IR PTSD) Anxiety is a normal reaction to stress. It helps one deal with a tense situation in the office, study harder for an exam, and keep focused on an important speech. In general, it helps one cope. But when anxiety becomes an excessive, irrational dread of everyday situations, it can become a disabling disorder. Posttraumatic Stress Disorder is not a black and white diagnosis, some the symptoms may be present right away however in others it can manifest years later. For some, the symptoms can be managed with therapy and others the symptoms are disabling. Many traumatic life experiences cause many emotions, such as guilt, anger, and fear. However it normally starts to improve in a short period of time, when these feelings or symptoms do not improve or get worse you may have Posttraumatic Stress Disorder. Reliving the trauma can cause flashbacks and nightmares. Flashbacks are the Soldier or Victim actually mentally transporting back in time to the actual event. They can see, hear, smell, taste, and feel every sensation they experienced during the actual trauma. In their mind they are reliving the event in every shape and form. Nightmares is when the victim is sleeping as their brain slows down and enters into a dream state the trauma comes back to them in a nightmare. Just as in the flashbacks in their mind they are right back in that horrific trauma. Many times they will wake up yelling, swinging their arms, threatening or injuring anyone nearby. PTSD victims also may experience hyper arousal which is a state where a minor act will bring them back to the trauma. It can be as little as a child crying, thunderstorm, or a smell, this can cause a massive reaction from the victim. Men have been known to hi the ground, roll under cars, or even become very violent with a near by person. Another symptom of PTSD is always being on guard, getting startled easily, irritable, and anxious. Victims find it hard to concentrate on their current life they are always ready for that bomb to go off. This will cause lack of sleep which in return causes physical pain, muscle tension, and even heart problems. Many will never talk about their issues; it is too painful to speak out loud what is causing them so much pain on the inside. This causes many family problems and the issues just keep spiraling out of control. For some it may even lead into the thoughts or act of suicide. Many may think that since the increased amount of PTSD victims are returning from war the VA administration would step in and support them. Knowing all of this the support is not there. The VA’s track record nearly to void benefits for the victims, they are not or willing to deal with the large influx of affected Iraq veterans, who are left to deal with their illnesses alone. Judging by its recent actions, VA does not seem interested in changing to fit the needs of the new veterans. The benefits have increased in the recent years from one point seven billion to four point three billion, however the victims that are mostly benefiting from the increase is Vietnam veterans, not Iraqi veterans. (Uhl). Iraq veterans remain widely overlooked, and are coming back in record numbers with severe mental illness. This is a serious problem, since it’s expected that the number of PTSD sufferers from Iraq will exceed the number from Vietnam. Treatment and support are critical to your recovery. Although your memories won’t go away, you can learn how to manage your response to these memories and the feelings they bring up. You can also reduce the frequency and intensity of your reactions. Although it may seem painful to face the trauma you went through, doing so with the help of a mental health professional can help you get better. There are different types of therapy which are necessary to get back on the right track. There is cognitive behavioral therapy, which helps you change the thought patterns that keep you from overcoming your anxiety. Exposure therapy, where one work with a professional, to help confront memories and situations that cause the distress. Cognitive Processing Therapy, which is where you process your emotions about the traumatic event and learn how to challenge your thinking patterns. Another type of therapy is psychodynamic psychotherapy, where you focus on identifying current life situations that set off traumatic memories and worsen PTSD symptoms. (National Center for PTSD).

Technological Diversification of College Students Essay -- Technology

Technological Diversification of College Students Writing takes on many faces, from personal stories to make believe places. College writing however, has a completely different designation. Furthermore, computer intensive college writing looks further into the depths of writing, focusing on technology and the writers behind the computer screens. With the unbound horizons of technology, students are exposed to a vast amount of culture, much more than the traditional pen and paper courses. Computer intensive college writing courses teardown roadblocks, allowing students to become aware of surrounding cultures, therefore diversifying their minds while exposing them to the current technology. Exposure to technology is key not only to succeed in a computer intensive college writing class, but also to succeed in the future. Technology has become more prevalent in today's society. From cell phones in purses, to email stations located all around college campuses. Technology is cropping up in business and industry; those without the skills to be able to interface with technology are pushed aside. As Kathy Camper wrote in her article "A Note from the Future," published in Wired magazine, "How do you think, see a system analysis job and I don't even no enough numbers to punch in and get inside the door" (Camper). This excerpt from Camper's article displays a prime example of a person who is shunned outside because lack of technological skills. Computers are the gateway to diversity, opening the doors to worlds thousands of miles away. These gateways allow students to understand and respect opinions not originally of their own. Maxine Hairston, a professor of rhetoric and composition at the University of Texas, holds views of how... ...hink, to generate ideas, and to present themselves effectively to the university and the community" (Hairston). Not only will the ideas learned by the students help them succeed in other courses, but also it will carry on with them into the future. From advancements in technology to the idea of cultural acceptance, college writing class is the starting point of creating diversified thinking and problem solving. Works Cited Camper, Kathy. "A Note from the Future." Wired. January 1995. http://www.wired.com/wired/archive/3.01/camper.if.html. Calice, Corrine, Marshall Kitchens, and Richard Marback. "An Introduction to Reading, Thinking, and Writing in a Digital World." Writing Cultures in a Digital Age. Boston: Houghton-Mifflin, 2001. Hairston, Maxine. "Diversity, Ideology, and Teaching Writing." College Compostion and Communication. May 1992: 179-195.

Dominican heritage

Angie Cruz’s Soledad is a marvelous story of family and integrity, myth and mysticism, racial identity, culture and chaos and various other themes. The background of the author has deeply influenced the setting of the novel as the story is deeply influenced by her Dominican heritage. Author herself has testified that her cultural upbringing highly impacted the novel. Even though she authored it with keeping ‘community’ in her mind, the novel also turned out to be a story of family, relationships, girlhood, motherhood and extended to several other premises.The main voice in the story is that of an art student Soledad who wants to fly to her sick mother to take care of her. She is about to leave her neighborhood behind as only she can help her mother to recover from the emotional coma. Soledad also has her aunt Gorda, her wild cousin Flaca to tame in her family. As she comes back to her house, she is confronted with a big challenge to negotiate or forget the painful or chaotic past for rebuilding her fellowship with her mother. ‘Family’ and relationships become the centre theme of the story.Soledad had left her contentious family at the age of eighteen as she got fed up with petty fights, struggles and endless tragedies. She joined as an art student at Cooper Union and also had a gallery job (along with a hip East Village walk-up). Soledad was imminently cool, fine, peaceful being infinitely far from her belligerent, superstitious neighborhood where she had her upbringing. Soledad however could not continue for a long time as she got call from Tia Gorda saying that her mother badly needs her as she had slipped into an emotional coma. Soledad's return was the only solution to save her mother.The love that remained for her family made Soledad to return home though she was haunted with the terrible recollections about leering men, open hydrants, and dreadful slick-skinned teen girls with bawdy mouths and snapping gum. Soledad had muc h to face in her home at West 164th Street. She had to adjust with the raucous behavior of her cousin Flaca and had to keep her from falling for Richie, the neighbor. Soledad struggles and she falls into a big challenge. She was also disturbed by the memories and ghosts of her mother’s past and also had to mend their relationship so that she may recover.She had to fight the memories of all painful past experiences to help her love her mother. The story is all about the family burden suffered by young Soledad. Soledad always had strained relationship with the family members, especially her widowed mother Olivia. Much of the novel is about the family of Olivia, her female relatives. Soledad had her aunt Gorda who can better be called a witch. She opt ceremonies and home remedies for treating her sister. Soledad had much to suffer from the fiery adolescent Flaca her cousin. More than all this was the nightmares, terrifying flashbacks and fearful memories.Soledad struggles being ‘caught between two worlds’ for the sake of her family. The bad images of her mother’s Dominican youth, Soledad returns to her family. Soledad’s responsibility for her family and love for her mother constraints her to forgive or forget Olivia's past as a prostitute, her spurious paternity, and the death of her father in the hand of Olivia. She says â€Å"And when I surrender to the warmth of the water, I feel the past, present, and future becomes one. My mother becomes the ocean and the sky, wrapping herself around me†. The family warmth engulfs Soledad as she gets into a spiritual epiphany.Soledad is found to be compelled by guilt and responsibility and a forced loyalty and start to take care of the family that she once left. This forced loyalty or the love remnants make Soledad come back to the place that she longed to leave and meet her family that she wanted to forget. Soledad took herself away from her collapsed family as she wanted to have a d ifferent future than everybody else. She separated from everything, explored new paths and found herself successful in her new world. However the little love residue that remained in her heart made her sacrifice everything for the sake of her family (or her sick mother).She was back to her old neighborhood and finds something that longed for and that she did not expect. She finally recognizes that everything she was yearning for was there in front of her. We can say that the novel Soledad is all about family relationships. The news of her mother’s sickness melted the heart of young Soledad and made her take the crucial decision to leave her happy world and come to her family from which she was fleeing away. Even though Soledad was reluctantly returning to her family, her time with her family becomes too crucial in the novel that it occupies majority of the pages.Soledad’s plight was painful but her family members turned out to be characters that made the whole story in teresting, rather than Soledad. The background of the novel is in the family or cultural background of the author Angie Cruz. Author’s childhood experience in the ethnic barrio of New York City's Washington Heights neighborhood highly influenced the story. The story more or less appears as an autobiography where the family of Soledad represents the entire women folk of the superstitious neighborhood.The bizarre mother, jealous cousin Flaca, her crazy Aunt Gorda, the entire family of Angie Cruz speaks of the predicament of the entire neighborhood. Even though the whole story intended to report the helpless womanhood of the undeveloped neighborhood, the novel turned out to be a tale of family relationships that sprang up from an extremely collapsed background. The family of Soledad, her mother, cousin and her aunt filled the novel making it a tale family story. References Angie (2001) Cruz Soledad, Simon & Schuster Trent Masiki (2001) Soledad – Review – Black Issu es Book Review, Matthews & Associates.

The South American Country Economics Essay

IntroductionThis paper is concerned with the economic consideration of one of the South American states and analyzes the impact of an economic concern on that peculiar South American state that has been chosen and identifies the tendency of the economic concern with in specified part on the footing of informations sets accumulate from the beginning. The south American states has major impact on American economic system and the economic concern of one of an of import state raise our organic structure of cognition sing the economic tendency in that peculiar state and its impact on overall economic system every bit good.South American StateThe economic system of South America consists of 12 states with three districts and comprise of 6 % of population in the universe. I have choose Brazil among other South American states as Brazil is the largest South American state and Brazil is one of the fastest turning economic systems of the universe. It is ranked at 5th topographic point in the universe sing population and geographical part and fifth largest economic system sing GDP in the universe. The economic concern of Brazil is efficaciously contributes to universe economic system and interesting tendency of economic system can be seen. ( Abreu, 2005 ) .Economic ConcernAmong four economic concern including GDP, measures of specific Goods and services gross Domestic Product & A ; Acirc ; ( GDP ) , and unemployment rising prices I have selected rising prices. Inflation is an of import economic concern that will consequence the economic system in great extend and rising prices rate of a state economic system is an of import index for a state growing prospective. Inflation means rise in the general monetary value degree of the state and loss the existent value of money as fewer trade goods will purchase with each extra unit of currency. Inflation straight associate to the economic productiveness and has positive and negative both consequence on economic system as it create economic uncertainness which may deter salvaging and investing. High monetary values of general trade goods and billboard will be its largest disadvantage. In positive sense it may promote not pecuniary investing. But the rising prices rate demands to be control in order to prolong state economic system.Inflation tendency in BrazilThe rising prices rate in Brazil is fluctuating over the old ages. No consistent tendency can be seen in the rising prices rate Acs past twelvemonth informations support this premise. Harmonizing to the informations displayed by ( IPCA ) in 2002 the rising prices rate was 12.53 % that is rather high rate. Then the diminishing tendency of rising prices rate can be seen in Brazil economic system as 9.3 % in 2003, 7.6 % in 2004, 5.69 % in 2005, and 3.14 % in 2006 that is least in this decennary. Then the little increasing t endency can be seen in rate of rising prices. 4.46 % can be seen in 2007 and 5.91 in 2008. The fluctuating tendency can be seen in this scope in coming old ages every bit good. ( Inflation Statistical tabular array )Statistical TableInflation ( IPCA )200212.53 %20039.30 %20047.60 %20055.69 %20063.14 %20074.46 %20085.91 %Past two old ages Inflation TrendPast two old ages monthly rising prices rate tendency can be seen from this graph that shows the monthly frequence of the rising prices rate. The graph bars shows the tendency of rising prices from twelvemonth 2011 that is 6.01 % . The increasing incline can be seen from March, 2011 up to October, 2011. Inflation rate at the month of October is the highest that is 7.31 % . Then the control execution on rising prices increasing tendency can be seen from 7.31 % to the deep low rate at 4.92 % in July, 2012 that is complemented to Brazil economic system. The upward Trent at semi one-year bases can be seen in Brazil economic system. The la st recorded rising prices rate of 6.15 % that is rather high. Brazil authorities mark rising prices rate is 4.5 % with the asset and subtraction tolerance border of 2 % in it. The high rising prices tendency is of import consideration for the authorities as increasing rising prices rate impact the economic system in deep roots and do the investing and salvaging hard. Peoples buying power will be effected that will consequence their criterion of life and indulge the poorness degree in the state as trade goods will be hard to buy with even more money in manus because due to rising prices state will lose its existent money value. ( De Paiva Abreu, 2005 ) .Harmonizing to IBGE study it is recorded from 1980 the Brazil rising prices tendency has gone through assorted fluctuations. Historical information shows norm of 411.8 % Brazil rising prices rate that reached at highest rate of rising prices of 6821.3 % in April 1990 that was the highest rate for all clip. The low rising prices rate o f 1.7 per centum was found in December 1998. The step used to cipher rising prices is consumer monetary value index. Brazil of import part in consumer monetary value index are baccy, nutrient and intoxicant that covers 31 % of entire, 15 per centum by conveyance sector and communicating carries 5 % . . ( Brazil Inflation Rate )Statistical Evidence comparing assorted states rising prices rateInflation Rate of assorted states is demoing the Brazil high rate of rising prices as comparison to other states except India that has the rising prices Rate o f 6.62. An increasing tendency is rather endangering for Brazilian authorities for economic growing and required close consideration to command the rate in hereafter in order to stabilise the economic system. Top Economy Last Previous Highest Lowest Unit of measurement Mention Frequency ChartAustralia2.20 2.00 23.90 -1.30 Percentage Dec/2012 QuarterlyBrazil6.15 5.84 6821.31 1.65 Percentage Jan/2013 MonthlyCanada0.50 0.80 21.60 -17.80 Percentage Jan/2013 MonthlyChina2.00 2.50 28.40 -2.20 Percentage Jan/2013 MonthlyEuro Area2.00 2.20 5.00 -0.70 Percentage Jan/2013 MonthlyFrance1.20 1.30 18.80 -0.70 Percentage Jan/2013 MonthlyGermany1.70 2.00 11.40 -7.63 Percentage Jan/2013 MonthlyIndia6.62 7.18 34.68 -11.31 Percentage Jan/2013 MonthlyDutch east indies4.57 4.30 82.40 -1.17 Percentage Jan/2013 MonthlyItaly2.20 2.31 25.64 -2.44 Percentage Jan/2013 MonthlyJapan-0.10 -0.20 25.00 -2.52 Percentage Dec/2012 MonthlyNew Zealand0.90 0.80 44.00 -15.30 Percentage Dec/2012 QuarterlySoviet union7.10 6.60 2333.30 3.60 Percentage Jan/2013 MonthlySouth Korea1.50 1.40 32.51 0.17 Percentage Jan/2013 MonthlySpain2.68 2.87 28.43 -1.37 Percentage Jan/2013 MonthlySwitzerland-0.30 -0.40 11.92 -1.37 Percentage Jan/2013 MonthlyTurkey7.31 6.16 138.71 -4.01 Percentage Jan/2013 MonthlyUnited Kingdom2.70 2.70 8.50 0.50 Percentage Jan/2013 MonthlyUnited States1.60 1.70 23.70 -15.80 Percentage Jan/2013 MonthlyDecisionThe Inflation rate and economic stableness are closely related to one another and required near concern in order to stabilise the economic system. Brazil increasing tendency provide the threatening for its hereafter concerns and shows that the authorities demand to closely see this government in order to stabilise the economic system and to accomplish the economical growing in the universe.

Blog3 Essays - Economy, E-commerce, Business, Online Music Stores

Blog3 Essays - Economy, E-commerce, Business, Online Music Stores Blog3 The company I choose is Amazon.com Inc., which is an electronic commerce company in America like Alibaba Inc. in china. It is largest Internet retailer in America by selling DVD, furniture, food electronics and so on. The software of amazon most part is sale forecast, predict a customer what and when will order an item by analysis the data from the customer looking for, then pre-shipping to the storage and packed order until customer's order arrives. It can deliver goods to customer quickly. This system is called anticipatory shipping. Not only this system help Amazon create profit in market, amazon also acquire Kiva System in 2012, which is a kind of robot company focus on improving efficient on storage. There is a central computer controlling all robots, make each robot scan the code set on floor and using code to track the goods position. Then, robot will carry the goods to any operator. So Amazon's automated warehouse is reducing time of walking and finding for goods. It make ama zon's warehouse more flexible and create higher profit by saving cost.

Arithmetic Mean and Five-step P-value Approach

A manufacturer of chocolate candies uses machines to package candies as they move along a filling line. Although the packages are labeled as 8 ounces, the company wants the packages to contain a mean of 8. 17 ounces so that virtually none of the packages contain less than 8 ounces. A sample of 50 packages is selected periodically, and the packaging process is stopped if there is evidence that the mean amount packaged is different from 8. 17 ounces. Suppose that in a particular of 50 packages, the mean amount dispensed is 8. 159 ounces, with a sample standard deviation of 0. 051 A. Is there evidence that the population mean amount is different from 8. 17 ounces? (Use a 0. 05 level of significance. ) B. Determine the p-value and interpret its meaning. 9. 27 In New York State, savings banks are permitted to sell a form of life insurance called savings bank life insurance (SLBI). The approval process consists of underwriting, which includes a review of the application, a medical information bureau check, possible requests for additional medical information and medical exams, and a policy complication stage in which the policy pages are generated and sent to the bank for delivery. The ability to deliver approved policies to customers in a timely manner is critical to the profitability of this service. During a period of one month, a random sample of 27 approved policies is selected, and the total processing time, in days, is recorded (and stored in insurance): 73 19 16 28 31 56 45 17 22 18 91 92 50 51 69 A. In the past, the mean processing time was 45 days. At the 0. 05 level of significance, is there evidence that the mean processing time had changed from 45 days? B. What assumption about the population distribution is needed in order to conduct the t test in (a)? C. Construct a boxplot or a normal probability plot to evaluate the assumption made in (b). D. Do you think that the assumption needed in order to conduct the t test in (a) is valid? Explain. 93. 1 One operation of a steel mill is to cut pieces of steel into parts that are used in the same frame for front seats in an automobile. The steel is cut with a diamond saw and requires the resulting parts must be cut within Ð’Â ± 0. 005 inch of the length specified by the automobile company. The file Steel contains a sample of 100 steel parts. The measurement reported is the difference, in inches, between the actual length of the teel part, as measured by a laser measurement device, and the specified length of the steel part. For example, a value of -0. 002 represents a steel part that is 0. 002 inch shorter than the specified length. A. At the 0. 05 level of significance, is there evidence that the mean difference is not equal to 0. 0 inches? B. Construct a 95% confidence interval estimate of the population mean, Interpret this interval. C. Compare the conclusions reached in (a) and (b). D. Because n= 100, do you have to be concerned about the normally assumption needed for the t test and t interval? 9. 45 In recent year, the Federal Communications Commission reported that the mean wait for repairs for ATT customers was 25. 3 hours. In an effort to improve this service, suppose that a new repair service process was developed. This new process, used for a sample of 100 repairs, resulted in a sample mean of 22. 3 hours and a sample standard deviation of 8. 3 hours. A. Is there evidence that the population mean amount is less than 25. 3 hours? (Use a 0. 05 level of significance. ) B. Determine the p- value and interpret its meaning. 9. 47 You are the manager ot a restaurant that delivers pizza to college dormitory rooms. You have Just changed your delivery process in an effort to reduce the mean time between the order and completion of delivery from the current 25 minutes. A sample mean of 22. 4 minutes and a sample standard deviation of 6 minutes. A. Using the six- step critical value approach, at the 0. 05 level of significance, is there evidence that the population mean delivery time value of 25 minutes? B. At the 0. 05 level of significance, use the five-step p-value approach? C. Interpret the meaning of the p- value in (b). D. Compare your conclusions in (a) and (b). 9. 53 The U. S. Department of Education reports that 46% of full-time college students are employed while attending college (data extracted from The Condition of Education 2009, National Center for Education Statistics, nces. ed. gov). A recent survey of 60 full-time students at Miami University found that 29 were employed. A. Use the five- step p-value approach to hypothesis testing and a 0. 05 level of significance to determine whether the proportion of full-time students at Miami University is different that the national norm of 0. 6. B. Assume that the study found that 36 of the 60 full-time students were employed and repeat (a). Are the conclusions the same? 9. 55 One of the issues facing organizations is increasing diversity throughout the organization. One of the ways to evaluate an organizations success at increasing diversity is to compare the percentage of employees in the organization in a particular position with a specific background to the percentage in a position with that specific background in the general workforce. Recently, a large academic medical center determined that 9 of 17 employees in a particular position were female, whereas 55% of the employees for this position in the general workforce were female. At the 0. 05 level of significance, is there evidence that the proportion of females in this position at this medical center is different from what would be expected in the general workforce? 9. 57 One of the biggest issues facing e-retailers is the ability to reduce the proportion of customers who cancel their transaction after they have selected their products. It has been estimated that about half of prospective customers cancel their transactions after they have selected their products (data extracted from B. Tedeschi, E- Commerce, a Cure for Abandoned Shopping Carts: A Web Checkout System That Eliminates the Need for Multiple Screens, The New York Times, February 14, 2005, p. C3). Suppose that a company changed its Web site so that customers could use a single page checkout process rather than multiple pages. A sample of 500 customers who had selected their products were provided with the new checkout system.

Joining and Fastening Processes (Manufacturing Engineering Processes) Term Paper

Joining and Fastening Processes (Manufacturing Engineering Processes) - Term Paper Example These engineering materials in their raw form are extracted from their ores. These raw materials from ores are transformed into molten form through refining and reducing processes. The molten material is process through molds to produce commercial or industrial castings called ingots. These ingots are then processed through rolling to transform these into billets, rods and slabs suitable for marketing. These materials then undergo various manufacturing processes to obtain useful products in diverse range of sizes, shapes and forms desired by end user. According to Singh, these manufacturing processes are classified into six major categories: primary shaping processes, secondary shaping processes, metal forming processes, joining and fastening processes, surface finishing processes and processes to change characteristics and properties of materials (17). In this report, we would be focusing on joining and fastening processes required to assemble or join different parts of a product. T he process where two or more parts of the product are put together to achieve desired shape and function is called assembly, not to be confused with joining and fastening processes. In joining, different parts of the product are joined together to obtained desired function. ... A unique advantage of this process is the focus of heat in welding area ensuring less spread of heat thus reducing welding defect like warping and buckling. In addition, this concentration of heat increases the depth of welding and increases the welding speed of the process. Arc welding process consists of a heat source, shielding and a filler metal. The heat is produced through the electrical arcing between the two metals under contact (Zeilke 4). The power source is referred to as welding machine which may be electrical or mechanical. Shielding gas, fluxes or coatings are used to prevent the welding area from surroundings during the welding process. Generally, arc welding is divided into ten main types called Carbon Arc Welding, Submerged Arc Welding, Stud Arc Welding, Gas Metal Arc Welding, Electro-slag Welding, Plasma Arc Welding, Shielded Metal Arc Welding, Atomic Hydrogen Welding, Gas Tungsten Arc Welding and Electro-gas Welding. In Carbon Arc Welding, a pure graphite rod is us ed as non-consumable electrode to generate arc for producing heat. The welding can be made without or with introduction of filler metal. It can be further classified as single or twin carbon electrode welding. In Shielded Metal Arc Welding, a flux coated electrode is used to produce arc where the flux on the coated electrode fads off due to heat. In Submerged Arc Welding Process, a bare electrode is used as consumable electrode with flux feeder tube. The arc, electrode and molten pool remain submerged under granular flux to achieve homogenous welding across the structure. In Tungsten Arc Welding, a tungsten electrode as non-consumable electrode covered by shielding of an inert gas to prevent these from surroundings is used for welding.