Management Essay Example | Topics and Well Written Essays - 500 words - 29

Management - Essay Example Therefore, it is important for Intel to have a proper understanding and interpretation of its external environment. The external environment comprises of the political, economic, socio-cultural, technological, legal and environment aspects (Penrose 60). The political aspects of the external environment relate to the fact that Intel is a multinational company that operates in different states. In effect, the political stability of the country determines the manner in which the company penetrates the market. Politics tend to have great influence on other aspects of the market such as policy and the economy. The ideology adopted by political players determines the direction in which the economy takes and the manner in which the company operates. Intel took over four years negotiating with the Vietnamese government to be allowed to operate in the country. The economic and technological aspects of the environment go to the financial capacity and competitiveness of the various states. The recent economic down turn greatly affected the company’s profitability and level of investment in innovation and new technology. The legal aspect of the environment affects the manner in which the company operates in the specific environment. Unf riendly policies limit the extent of the company’s operations. The porter’s five forces analysis framework interrogates the environment on five main areas. The competition, the substitutes, consumer bargaining power, supplier bargaining power and the intensity of the competition, are the fundamental aspects of the external environment. The technology market is increasingly expanding, and it allows companies to specialize in particular fields. Intel is one among the largest semiconductor chip makers. The chipset industry has a diverse structure that engages different inventors and producers. The competition is differentiated buy the customer loyalty and the legal boundaries that

Introduction to the Jamaican Legal System Essay Example for Free

Introduction to the Jamaican Legal System Essay Legal Sources -Rules of law are derived from various sources in English Law. These include, The Constitution of Jamaica, legislation, judicial precedents, certain ancient textbooks among others. The Constitution of Jamaica: The Jamaican Constitution is the Supreme Law of the land of Jamaica and all other laws must conform with the Constitution or they will be struck down.1 In 2011 a new Charter of rights was passed by Parliament, known as The Charter of Fundamental Rights and Freedoms (Constitutional Amendment) Act, 2010 This significantly changed Chapter III of the Constitution. â€Å"Traditional human rights protected by our old arrangements, such as the rights to life, liberty, property, freedom of conscience, expression and movement remain protected by the new Charter. Additionally, we now have constitutional rights to equitable and humane treatment by public authorities, not be discriminated against on the grounds of religion, social class or being male or female, to vote in free and fair elections and to be granted a passport. The latter goes hand in hand with the now constitutionally recognized right to leave the island, previously excluded. The Charter provides a number of more modern rights, including the right of every child to public primary education and the right to enjoy a healthy and productive environment free from the threat of injury or damage from environmental abuse and degradation of the ecological heritage. These seemingly ambitious rights are nonetheless enforceable by the Charters express provision for redress, not just against the state but also in citizen versus citizen litigation. Claims may be brought by the person aggrieved or by civic organizations with the permission of the court, where there is an allegation that any of the provisions of the Charter has been, is being or is likely to be contravened.† The Judiciary is the branch of government that is primarily responsible for interpreting the law. The Structure of the Jamaican Court System1 The Courts have been given the duty under the Constitution to examine activities undertaken by the State and determine if acts by the State through its various agents are inconsistent with the Constitution and therefore of no legal effect. Acts of Parliament are also subject to review by the Courts to see if there is any inconsistency with the Constitution. The Constitution of Jamaica provides for the establishment of the Supreme Court as a Court of Origination. Decisions of the Supreme Court upon appeal are heard by the Court of Appeal which is the highest Court physically located in Jamaica, however under the Constitution, the highest Court in the Jamaican Court Structure and the final Court of Appeal from decisions of the Court of Appeal is the Judicial Committee of the Privy Council which is based in England. There are other Courts that are not created by the Constitution and have been created by Acts of Parliament. The Court System is looked at below. Petty Session The Petty Session Court is presided over by three Justices of the Peace. These are not Attorneys-at-Law. They preside over petty matters. These include pickpocketting, common assault and use of indecent language.

Maxis Business Level Strategy

Maxis Business Level Strategy Business model is plan or diagram for how it competes, uses its resources, structures its relationship, interfaces with the customers, and creates value to sustain itself on the basis of the profits its generates. It had included all the activities that define how a firm competes in the marketplace. Core strategy Mission statement Maxis missions are to be simple, trustworthy and creative. Maxis want everything they do is simple for everyone; it must be straightforward and easy to understand by their customers. Maxis believe that trust between customers and it is the key to successful relationship. All good relationships are built on trust which inspires confidence, and, assurance, conviction and reliance. Creativity is important and defines them; this is how Maxis differentiate from their competition. (Maxis is about life enablement, www.maxis.com.my, ND) Product/Market Scope Maxiss market scopes are telecommunication and networking sectors. They are the mobile communications service provider and recently they are also providing wireless broadband services. Their services include prepaid call plans, monthly subscription plans, international roaming, MMS, WAP, Resident Fixed Line services and the recent one Broadband internet plans. Maxis also are offering VSAT services and Blackberry based mobile services for their business customers.(Maxis website, 2010) Basis differentiation The basis differentiation of Maxis are based on the calling plans and pricing structure to appeal to different customer segments. The value-added services in Hotlink Prepaid had make Maxis differentiate from other competitors such as ring-tones, background ring tones, Voice SMS, fb2me, tweet2me, voice portal and etc. (Hotlink easy menu, 2010) Strategic resources Core Competencies What serve as core competencies for Maxis are customer service and their strong brand name. Maxis always emphasize on what can be done best to their customers and provide their best customer services as after the subscription of their plans. To enhance the customer satisfaction, Maxis had announced there are 70 Maxis Authorized service agents outlet are available in customer concentration are in Malaysia opens (Maxis Authorised Service Agents Outlets to Enhance Customer Satisfaction, www.maxis.com.my, 7th July 2001) and continue increasing in the following year. The outlets provide real time services similar to Maxis Centers such as customer registration, payment, IDD and Direct Debit application, and reinstatement of mobile line. With the availability if the shops that strategically located, Maxis clients can look forward to extended service hours, weekend services and easier access. There are more over than RM 500 000 are used for dealers and staff training annually to ensure the best possible service to Maxis customers. This is a part of Maxis core strategies to enhance the value in their existing relationships with key dealers. Maxis had established a strong brand name since 1995 for their wide coverage of signal and reliability. Strategic Assets There are several strategic assets owned by Maxis which let them continue to leading among the mobile service providers. Firstly, Ananda Krishnan, the founder of Maxis communications owned a satellite tv- Astro in Malaysia. It is the ASEAN leading satellite TV that always plays the important role in promoting the plans and services by Maxis. Moreover, Maxis have the huge database of customers information and can be used to make adjustment in their plans, packages and their marketing strategies base on the poll SMS that sent to the subscribers. In addition, one of the most valuable assets Maxis owned is their highly qualified and experienced staffs, such as, the executive director and chief executive officer of Maxis, Sandi Dap. Before he joined Maxis in 2007, he had been served as deputy managing director of Vodafone Essar Limited, one of the largest mobile operators in India since 1994. Jean Pascal is a Chief operating officer, he has 20 years of experience, of which he spent 13 yea rs with France Telecom group in France and Orange in UK. Others like Rossaba Annizah, Mark Dioguardi, Matthew Willsher, Mohamed Fitri and many more (Maxis senior management webpage, 2010). Partnership network Suppliers Maxis main suppliers are consist of SIM card suppliers and broadband wireless thumb drive suppliers. Other partnership network like strategic alliance such as Nokia, Apple and Blackberry are supplying Maxis theirs products to cope with Maxiss various kind of plans and packages. Other Key Relationships Many companies in diverse range of industries such as telecommunications, media and broadcasting, leisure, power generation, property development and management are directly or indirectly controlled or connected with Usaha Tegas, which is owned by Ananda Krishnan. As such, many of these companies and other related parties also subscribe to Maxis Mobiles mobile service and Maxis Broadband s fixed line services due to the relationship with Ananda Krishnan. Customer Interface Target Market Maxis has good customer interface which enable their service reach their customer easily and successfully. Maxis target their market on the telecommunication and networkings consumers market. For the target customer like students maxis come out with Maxis Youth Club. By using this service students can get a lot of benefits. On of them is Point Rewards; under this service students need to collect points as much as they can which enable them to get free talking time. If students top up twice in a week, they will get 100 points which equal anent RM 1.00 of free talking time. Besides that, students also can enjoy free calls to any maxis numbers on their birthdates. Apart from that, maxis also come out with service called subliners for the specific group of people who love to talk with their loved ones or couples everyday for a longer time of period. The subliners need to register their name under the mainliner. By doing this the subliners can enjoy less price. For the specific group of p eople who like to use internet, the maxis come out with broadband services. Maxis has four types of broadband plan which are 1.5GB,3 GB,6 GB and 12 GB. Fulfillment and Support Maxis communication companys service and product reaches it customers. For example, customers of maxis can go to maxis center to get some help like lost the SIM cards, problem of the deduct balance of prepare and postpaid, and the unclear of the new maxis plan package. Besides this, maxis center was build on city to make customers easy to pay the fees of postpaid and internet fees. (Find a Maxis Centre or MEPs, www.maxis .com.my, ND) Pricing structure Maxis are focus on aggressive pricing strategies to compete with other service providers. Apart from that, maxis also has different price depending on their target market. For the students under Youth Club service they can enjoy sending SMS only for 1sen per SMS. They also can enjoy free calls to any maxis numbers from 6pm to 6am.For the target market like line users, the subliners who register their name under main liners only need to pay RM 30 per month compare to RM 80 which is the actual rate for line users. Maxis offer the cheapest broadband services which only need to pay RM48 for 1.5GB. (Wireless Broadband, www.maxis.com.my, ND)

The Effects of Acid Deposition on Humans and the Environment :: Environmental Ecology Essays Pollution Acid Rain

Acid Deposition One of the biggest environmental problems that needs dealing with in society today is acid deposition. It is largely caused by humans, and causes much pollution to the environment and harms people and buildings as well. Although there are minimal positive sides to this issue, the negatives far outweigh it and call people around the world to take action to reduce and even solve this problem. Coming in both wet and dry forms, acid deposition consists of acidic pollutants including nitrogen oxides and sulfur oxides that have been deposited from the atmosphere to the surface of the earth. There are both wet and dry forms of acid deposition, wet forms being referred to as acid precipitation. Acid precipitation is the result of sulfur and nitrogen oxides reacting in the atmosphere with water vapor. This returns to the earth as acid rain or snow. Dry deposition occurs when these oxides react without water and they settle out of the atmosphere onto the earth. Acid deposition can come from a number of different sources such as smokestacks, trucks and cars. More than 90% of the sulfur in the atmosphere comes from humans. Coal burning, the smelting of metal sulfide ores, and automobile exhaust are major human contributions to sulfur dioxide in the atmosphere. Similarly, 95% of the increased nitrogen oxide levels in the atmosphere are a result of the activities of humans. The activity that contributes the most to these elevated levels is the combustion of oil, coal, and gas. Attention was first drawn to acid deposition in the 17th century when the bad effects of industry and acidic pollution on both vegetation and people were noticed. In the 1960s, it became an international problem when fishermen noticed declines in fish numbers and diversity in lakes across North America and Europe. Acid deposition causes many problems such as these worldwide, and is clearly a problem that needs to be properly dealt with. There are different negative affects of acid deposition to different environments on the earth. In soils where a possible buffer of basic material isn’t as great, plant nutrients are often lost, the germination of seeds and the growth of young seedlings are hurt, and plants may become over-fertilized by nitrogen. The plants in this instance often experience reduction in growth rates, flowering ability, and overall yield. This makes the plants more vulnerable to disease, insects, drought, and frost. Trees are also affected by acid deposition.

How to Break Bad Habits and Create Positive Ones Essay

Everyone has one: a bad habit (or habits†¦) we wish we could break. Unfortunately, breaking a bad habit — as anyone who has ever bitten their nails, smoked, or mindlessly snacked in front of the TV knows — is not that simple. Breaking habits is hard, but with a little determination, it is achievable. There is a reason habits are hard to break. The majority of our habits are good for us, allowing our brain to complete certain tasks on autopilot which frees space for decision making, creativity, and quick action. But the brain does not discriminate between good and bad habits; once something becomes a routine, whether it’s helpful or harmful, your brain will perform it automatically, which can make it hard to stop. Step 1: Identify the habit All habits serve a purpose. Brushing your teeth first thing in the morning prevents cavities, stopping at a red light prevents car accidents, and eating cupcakes when you’re feeling low can deliver comfort. To make positive improvements, start by identifying your problem habit and its underlying cause. Step 2: Replace it Once you’ve identified your habit and its trigger, find something positive to take its place. If you eat to wind down after a long day of work, replace food with a walk or yoga. If you bite your nails, try chewing gum. If you smoke to relieve stress, try meditation. Step 3: Keep the commitment Once you’ve decided to break your habit and replace it with something positive, write it down. Keeping a journal of your progress can hold you accountable while serving as a great progress marker. If you’re truly  committed to making your new positive habits stick, complete your new habit daily for 30 days. The more consistent you are, the easier it will be to continue. Step 4: Be prepared for hiccups Through this process, it’s important to remember that habits are habits for a reason — they serve a purpose and our mind is trained to complete them with little to no effort. Be kind to yourself and be patient; all of your attempts to change habits will not be successful immediately. Expect bumps along the way but continue to push through. When in doubt, think positively. If you are at wit’s end and the only thought in your head is â€Å"I can’t do this†¦Ã¢â‚¬ , make it a positive. â€Å"I can’t do this, but it will get easier.†

Indian Society and Social Systems in India

Indian society is multifaceted to an extent perhaps unknown in any other of the world's great civilizations. Virtually no generalization made about Indian society is valid for all of the nation's multifarious groups. Comprehending the complexities of Indian social structure has challenged scholars and other observers over many decades. The ethnic and linguistic diversity of Indian civilization is more like the diversity of an area as variable as Europe than like that of any other single nation-state. Living within the embrace of the Indian nation are vast numbers of different regional, social, and economic groups, each with different cultural practices. Particularly noteworthy are differences between social structures in the north and the south, especially in the realm of kinship systems. Throughout the country, religious differences can be significant, especially between the Hindu majority and the large Muslim minority; and other Indian groups–Buddhists, Christians, Jains, Jews, Parsis, Sikhs, and practitioners of tribal religions–all pride themselves on being unlike members of other faiths. Access to wealth and power varies considerably, and vast differences in socioeconomic status are evident everywhere. The poor and the wealthy live side by side in urban and rural areas. It is common in city life to see a prosperous, well-fed man or woman chauffeured in a fine car pass gaunt street dwellers huddled beneath burlap shelters along the roadway. In many villages, solid cement houses of landowners rise not far from the flimsy thatched shacks of landless laborers. Even when not so obvious, distinctions of class are found in almost every settlement in India. Urban-rural differences can be immense in the Indian Society. Nearly 74 percent of India's population dwells in villages, with agriculture providing support for most of these rural residents. In villages, mud-plastered walls ornamented with traditional designs, dusty lanes, herds of grazing cattle, and the songs of birds at sunset provide typical settings for the social lives of most Indians. In India's great cities, however, millions of people live amidst cacophony–roaring vehicles, surging crowds, jammed apartment buildings, busy commercial establishments, loudspeakers blaring movie tunes–while breathing the poisons of industrial and automotive pollution. Gender distinctions are pronounced. The behavior expected of men and women can be quite different, especially in villages, but also in urban centers. Prescribed ideal gender roles help shape the actions of both sexes as they move between family and the world outside the home. Crosscutting and pervading all of these differences of region, language, wealth, status, religion, urbanity, and gender is the special feature of Indian society that has received most attention from observers: caste. The people of India belong to thousands of castes and castelike groups–hierarchically ordered, named groups into which members are born. Caste members are expected to marry within the group and follow caste rules pertaining to diet, avoidance of ritual pollution, and many other aspects of life. Given the vast diversity of Indian society, any observation must be tempered with the understanding that it cannot apply to all Indians. Still, certain themes or underlying principles of life are widely accepted in India.

The Graduated Driver License essays

The Graduated Driver License essays The Graduated Driver License (GDL) is a law that is aimed to reduce teen driving deaths. This law goes into affect July 1, 2001. The new driving law is made up of 3 main restrictions. These parts are: 1. For the first six months after issuance of an Intermediate Drivers License, the holder of the license may not have any passengers in the car under the age of 20, except for members of the holders immediate family. 2. After the first six months, the holder may not have more than three passengers in the car under the age of 20, except for members of the holders immediate family. 3. The holder of an Intermediate Drivers License may not operate a vehicle between the hours of 1 a.m. and 5 a.m. except when the holder is accompanied by a parent, guardian, or a licensed driver who is at least twenty-five years of age. These restrictions remain on a driver with the Intermediate Drivers License until they are 18 or if after the first 12 months the holder has not been involved in an automobile accident and has not committed or been convicted of traffic offenses or violations of the license restrictions. The Graduated Driver License law is an infringement on civil rights. Our country has a history of refusing the rights of its people. African Americans were not allowed to sit in the front of a public bus, they were not allowed to use restrooms that were reserved for the White population, and they were not allowed to vote. All of these laws and policies were placed on them because it was believed that African Americans were a lesser people, they were considered inferior to the Caucasian race. Our history also teaches that women were once considered to be less then men. They could not own land; if they had inherited land and married, their husband was immediately given ownership of their lands. All the children a woman gave birth to were considered the property of ...

Eating Disorders †A Personal Story

Eating Disorders – A Personal Story Free Online Research Papers Eating Disorders â€Å"I look like a normal, well-adjusted 15-year-old high school sophomore. I like talking to friends on the phone, riding my bike, watching TV, and spending time with my boyfriend. However, about a year ago, my weight dropped to 72 pounds. I lay in a hospital bed with unkempt hair, fragile limbs and a sunken face. I was seriously ill. The villainous disease was not cancer or AIDS. I had anorexia, a condition which afflicts many teens and young adults, especially young women. It all started in late summer. I gradually cut back on what I was eating while being very active as a cheerleader. Soon the pounds began to fall away. At first, no one seemed to notice that I was losing weight. I preferred baggy clothes which hid my condition. Eventually, however, people began to notice my weight loss and soon, it was unmistakable. I became unusually fatigued and irritable and couldnt concentrate. Then my grades fell. People noticed that I didnt eat much, if at all. I was absent from school a lot. The people around me started to realize that I had a problem. When my parents suggested that I had an eating disorder, I denied it. I became defensive when my friends expressed concern. Even after two doctors said I had anorexia, I denied it. I believed the only way to make myself well was to control my diet. My parents became tried forcing me to eat, they tried reasoning with me, and they even had my friends try to make me eat. Finally, they showed me an article about a TV star with anorexia. The actress story moved me. Somehow the article convinced me that what everyone had been saying was right. Before I read the article, I thought I was alone I had never heard of anyone suffering from an eating disorder before. When I finally realized that I wasnt alone it changed my life. For the first time, I realized that I had anorexia. While this realization was my first step to recovery, I still couldnt beat the disease. By December, I weighed 82 pounds. In January, I was down to 72 pounds. The doctors warned me that if my weight dropped be low 70 pounds, I would be at significant risk for major organ failure. My body would simply stop working. I was hospitalized for treatment. Luckily, I made rapid improvement. I voluntarily ate a carefully controlled diet. My weight gradually increased. I went to therapy both alone and with my family. After only a few weeks, I went back to school. I quickly regained all the weight I had lost. Not everyone recovers from anorexia and few recover as quickly as me. I am still in therapy. However, I will always be at risk for a setback but right now it looks like I will remain healthy. None of my teachers helped until after I began to recover. I wish one of my teachers, counselors, or even my cheerleading coach had said something to me about my problem. The words, you may have an eating disorder would have influenced me more coming from one of them rather than from a friend or parent. Maybe if a teacher or someone else had shown me the article about someone with anorexia, I would not have suffered so much. My teachers did help after I began to recover. They made my transition from the hospital to school as easy as they could. I urge teachers to look for students who might have an eating disorder watch for students weight loss, extreme perfectionism, increased absences, poor concentration, and lowered grades. If you think that a student has an eating disorder, observe that student during lunchtime. Does she/he consume a reasonable amount of food? This observation can be very revealing. What you can do to help a student who you think has an eating disorder depends on the kind of relationship you have with the student. If you are relatively close to the student, talk to him or her to show your concern. Telling the student about others who have had an eating disorder can be very helpful. Certainly, you should refer the student to the school counselor. Educating students regarding these phenomena may be the most helpful thing a teacher can do (Holly).† What you see in the story with Holly is only one example of an eating disorder. Eating Disorders are not just unique to young females: Males and females, of all ages, races, and ethnic groups are at risk. There are different kinds of eating disorders that can potentially affect anyone. The different types of eating disorders include anorexia, bulimia, and binge eating disorder. Most people have at least heard of these diseases but are not sure what they are. What you might not know is, these disorders not only affect the physical appearance of a person but also cause extreme emotions, attitudes, and behaviors issues. The root of these problems comes from the individuals surrounding weight and food issues. Anorexia Nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss. Bulimia Nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors s uch as self-induced vomiting designed to undo or compensate for the effects of binge eating. Binge Eating Disorder (BED) is a type of eating disorder not otherwise specified and is characterized by recurrent binge eating without the regular use of measures to counteract the binge eating. Each year millions of people in the United States develop serious eating disorders. More than ninety percent of those people with eating disorders are adolescent and young adult women (Hoffman). Women are more likely to have an eating disorder due to their tendency to go on strict diets to achieve and â€Å"ideal† figure. Lee Hoffman, a staff member of the Office of Scientific Information (OSI), National Institute of Mental Health (NIMH), says that researchers have found that such stringent dieting can play a key role in triggering eating disorders. Around one percent of adolescent girls develop anorexia nervosa; this is a disease in which the girls will literally almost starve to death. Another two to three percent of young women develop bulimia nervosa, a destructive pattern of excessive overeating followed by vomiting (Hoffman). These behaviors can occur in men and older women, but less often. One in ten cases of anorexia nervosa result in death from starvation, cardiac arrest, or suicide. Treatment is the key in helping people cope with an eating disorder. Increasing awareness of the dangers of eating disorders has led many people to seek help. Someone who intentionally starves themselves suffer from anorexia. This disorder usually beings around puberty. Rapid weight loss accompanies this disease, normally at least fifteen percent below the individual’s normal body weight. People who are anorexic deny the fact that they are hungry even if they haven’t eaten all day. They also develop food rituals like eating food in certain orders, excessive chewing, or rearranging food on their plate. Another symptom of anorexia is withdrawal from usual friends and activities. Anorexics have great anxiety about gaining weight or being â€Å"fat.† People with anorexia look very thin but when they look in the mirror they are convinced they are overweight. Many people with anorexia must be hospitalized to prevent starvation. For some with anorexia, they won’t eat even after suffering from terrible hunger pains. People with anorexia continue to think they are overweight even when they are bone-thin. Food and weight become obsessions. Many people with anorexia stick to strict exercise routines to keep off the weight. When a person is anorexic the body is denied the essential nutrients it needs to function normally. â€Å"Loss of monthly menstrual periods is typical in women, and men with anorexia often become impotent,† says Hoffman. The body then slows down all of its processes to conserve energy. Slow heart rate and low blood pressure forces the heart muscles to change. According to Nationaleatingdisorders.com, â€Å"the risk for heart failure rises as the heart rate and blood pressure levels lower.† Osteoporosis is also a common side effect of anorexia due to reduction of bone density. Osteoporosis causes bones to be dry and brittle. Anorexia also causes muscle loss and weakness, severe dehydration, kidney failure, fainting, fatigue, dry hair and skin, and hair loss. As a defense mechanism, the body produces a furry layer of hair called lanugo, all over the body, including the face, to try and keep the body warm. Bulimia nervosa is a disease in which a person eats large amounts of food and then gets rid of the excess calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively (Hoffman). Some people even use a combination of all these forms. This form of eating disorder can often be successfully hide because most people with bulimia binge and purge in secret. Typically around half of those with anorexia develop bulimia. Bulimia, like anorexia, begins normally during adolescence and normally occurs in women. Binge and purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions. Electrolyte imbalances can lead to irregular heartbeats and possibly heart failure and death. An electrolyte imbalance is caused by dehydration and loss of potassium, sodium and chloride from the body. There is also a chance for gastric rupture during periods of bingeing. Also inflammation and possible rupture of the esophagus from frequent vomiting can occur. Another common side effect of bulimia is tooth decay and staining caused by stomach acids that are exposed when vomiting. When abusing laxatives chronic irregular bowel movements and constipation as can result. Bingeing is also a form of an eating disorder. This type varies from bulimia because the person will eat uncontrollably but does not purge the excess food. People who binge lose control of themselves when they are eating. They eat large portions of food and do not stop until they are uncomfortably full. It is extremely hard for someone who binges to lose weight and keep it off. Most people with bingeing are obese and have a history of weight fluctuations. Binge eating disorders are found in around two percent of the general population. Bingeing often results in many of the same health risks as clinical obesity. High blood pressure and high cholesterol levels occur. Heart disease, as a result of elevated triglyceride levels and type II diabetes mellitus are also common side effects of bingeing. There are many causes of eating disorders. Scientists have studied the personalities, genetics, environments, and biochemistry of people with these illnesses (Hoffman). Most people with eating disorders show similar traits, including: low self-esteem, feelings of helplessness, and a fear of becoming fat. People with anorexia, bulimia, and binge eating disorders use eating behaviors to handle stress and anxieties. Researchers say that typically people with anorexia tend to be â€Å"too good to be true.† Anorexics restrict food in order to gain some control over a part of their lives. People who followed the wishes of others have not learned how to handle the problems of adolescence, growing up, and becoming independent. When someone is anorexic they are able to take control of their bodies and gain approval from others. People who develop bulimia and binge eating eat to reduce stress and relieve anxiety (Hoffman). When people binge eat, they acquire guilt and depressio n. Purging brings temporary relieve but it does not last long. Eating disorders appear to run in families and females are most commonly affected. There are many influences that can have and affect on eating disorders, including behavioral and environmental influences. According to Hoffman, â€Å"a recent study found that mothers who are overly concerned about their daughters’ weight and physical attractiveness many put the girls at increased risk of developing an eating disorder.† Most often anorexia and bulimia are found in Caucasians. People pursuing professions or activities that emphasize thinness, like modeling, dancing, gymnastics, and running are more susceptible to the problem. In a study of Division 1 NCAA athletes, over one-third of female athletes reported attitudes and symptoms placing them at risk for anorexia nervosa. Though most athletes with eating disorders are female, male athletes are also at risk. One-third to one-fourth of all people with binge eating disorders are men. Bingeing is equal among races. When it seems like just about everything can trigger an eating disorder, some of us may be asking ourselves â€Å"what can be done to prevent eating disorders?† To prevent something from happening means to attempt to change the circumstances that promote, initiate, sustain, or intensify problems like eating disorders. To do this, the most primary step would be to promote healthy development from an early age. After this, the second step of prevention (sometimes called targeted prevention) refers to programs or efforts that are designed to promote the early identification of an eating disorder, which is to recognize and treat an eating disorder before it spirals out of control. The earlier an eating disorder is discovered and addressed, the better the chance for recovery. Prevention efforts will fail, or worse, inadvertently encourage disordered eating, if they concentrate solely on warning the public about the signs, symptoms, and dangers of eating disorders. Effective prevention programs must also address matters such as our society’s constant obsession with being thin, and helping the development of peoples’ self-esteem and self-respect in all areas in life whether it is at school, in a job, or at home. All of these issues can help trigger eating disorders. Making the general public more aware of what causes eating disorders and being able to identify them is the best way to help them be prevented. Eating disorders are serious and complex problems. We need to be careful to avoid thinking of them in uncomplicated terms, like anorexia is just a plea for attention, or bulimia is just an addiction to food. Eating disorders arise from a variety of physical, emotional, social, and familial issues, all of which need to be addressed for effective prevention and treatment. The most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or counseling, coupled with careful attention to medical and nutritional needs. Ideally, this treatment should be tailored to the individual and will vary according to both the severity of the disorder and the patients individual problems, needs, and strengths (NEDA). Psychological counseling must address the psychological, interpersonal, and cultural forces that contribute to, or maintain the eating disorder. A Psychologist, psychiatrist, social worker, nutritionist, or physician usually cares for people with eati ng disorders. Nutritional counseling is necessary to help change the unhealthy eating habits to healthy ones. Group and family therapy can also be very helpful in treating eating disorders. When an eating disorder leads to physical problems, inpatient care is necessary. This means when the problem is life-threatening, or when an eating disorder has reached a level of severe psychological or behavioral problems (NEDA). The ABCs of Eating Disorders by Lee Hoffman. Eating Disorders. Myra H. Immell, Ed. Contemporary Issues Companion Series. Greenhaven Press, 1999. NIH Publication no. 93-3477, January 1993. Opposing Viewpoints Resource Center. Thomson Gale. 02 May 2006 http://galenet.galegroup.com/servlet/OVRC Health consequences of eating disorders,† National Eating Disorders Association, Seattle, WA. 2002, January 6, 2004. National Eating Disorders Association. 02 May 2006 Hoffman, Lee. EATING DISORDERS: ANOREXIA NERVOSA. 1993: (24-27, 56). Holly. Teacher Talk. Center of Adolescent and Family Studies. 1996. 08/05/06 . Levine and Maine, Michael and Margo. Eating Disorders Can Be Prevented! . National Eating Disorders Association. National Eating Disorders Association . 7 May 2007 . Research Papers on Eating Disorders - A Personal StoryStandardized TestingHip-Hop is ArtThe Fifth HorsemanEffects of Television Violence on Children19 Century Society: A Deeply Divided EraThe Spring and AutumnMarketing of Lifeboy Soap A Unilever ProductGenetic EngineeringQuebec and CanadaLifes What Ifs

What Does It Really Take to Get Into Dartmouth?

Each year, thousands and thousands of hopeful college applicants wait with bated breath to hear back from Dartmouth College, the smallest of the Ivy Leagues. With the number of college applicants on the rise, college admissions have never been so competitive, but the good news is that there are some things that savvy applicants can do to stand out. In this post, we’ll share our top tips for scoring that increasingly rare acceptance to Dartmouth College. Keep reading to unlock our unique insights, gained through our experience with thousands of Ivy League applicants. It should come as no surprise that we’ve written about getting into Dartmouth before. In fact, for a comprehensive overview of all the nitty gritty, including school statistics, requirements, and deadlines, don’t miss our post The Ultimate Guide to Applying to Dartmouth College . In this post, we’ll focus specifically on your application and how you can ensure you’re optimized your chances of getting in. Of course, the first thing you need to do is make sure you meet the basic requirements. This includes getting your application in before the deadline and ensuring that it includes all the required elements. Dartmouth College accepts both early decision (ED) and regular decision (RD) applications. The deadline for ED applications is November 1st. Remember that if you apply early decision, you may only apply to one school and are committed to attending should you be accepted. For more information, don’t miss our post Early Decision versus Early Action versus Restrictive Early Action . The regular decision deadline is January 1st. Dartmouth College accepts the Common Application and the Coalition Application (CAAS). They do not accept the Universal Application. To learn more about the Common Application, don’t miss our post A User’s Guide to the Common App . To complete your application to Dartmouth College, you’ll need to be sure you include: In addition, it is recommended (though not required) that you submit scores from at least two SAT Subject Tests and a recommendation written by a peer. Again, these elements are not required, but they are recommended and you should submit them wherever possible. Dartmouth College is among the most selective colleges in the country. It accepted just 8.7% of its 22,033 applicants to the class of 2022. Applications to Dartmouth have risen 10% over the last year and its most recent admissions cycle was its largest applicant pool in five years. Dartmouth has also increased its yield recently, meaning that it has recently begun to garner a higher percentage of accepted students than in prior years. For this reason, the admissions committee is handing out fewer acceptances than in years past. The yield for the class of 2022 was 61%, the highest in 25 years. Estimating your chance of getting into a college is not easy in today’s competitive environment. Thankfully, with our state-of-the-art software and data, we can analyze your academic and extracurricular profile and estimate your chances. Our profile analysis tool can also help you identify the improvement you need to make to enter your dream school. With such a competitive selection process, Dartmouth College has the ability to be very picky about who it accepts. Ultimately, admissions are offered to students who meet its standards both in terms of academics and achievements outside of the classroom. Dartmouth is of course very selective academically. Students admitted to the class of 2022 achieved a mean SAT score of 1497 or a mean ACT score of 33. 97% of students whose high schools rank students were ranked in the top 10% of their graduating class. Doing well academically is definitely a top priority for students who want to attend Dartmouth, but it is not the only factor considered. Dartmouth values diversity of all kinds. 15% of its admitted students were first-generation college students this year, and 50% are students of color. 11% of the admitted class are foreign citizens and 60% applied for financial aid. Dartmouth also places high value on community, a stance that was reinforced by President Philip J. Hanlon when he welcomed the class of 2022 to campus. â€Å"The search for truth is a team sport, most effectively done when ideas and opinions are exchanged in an open and respectful manner,† he reminded students. To get into Dartmouth, you’ll need to prove that you’re not only a strong student academically, but also that you’re a positive contributor to your community. This is hard for the admissions committee to glean from an application, so you should strive to highlight it through your essays, extracurriculars, and recommendations. Start Early . Don’t rush your college application. You’ll need plenty of time to mull over your essays and short answer questions, and even more time to edit and proofread. If you’ve left your college applications to the last minute, you’ll be at a disadvantage at selective schools like Dartmouth. Highlight Your Value to Your Community. Dartmouth values respectful discourse, cooperative work, and students who work to change the world. You can most easily highlight these skills through your extracurriculars. Try to engage in activities that give back to your community in some way and that show a commitment to civic duty and teamwork.   Ã‚   Consider Early Decision. Of the 1,925, students offered admissions to the class of 2022, 525 were accepted through the Early Decision program. This means that your odds of getting in are significantly increased by applying early. Be Yourself. Admissions committees see a lot of applications over admissions season and they are well trained at recognizing when a student is being true to him or herself. Be authentic and genuine and unapologetically you. If you don’t get in, at least you’ll know if was the real you who didn’t fit, and you can take comfort in knowing the real you will do better elsewhere. Dartmouth is extremely selective and many top students ultimately are rejected. In fact, far more academically qualified students apply to Dartmouth than it is able to accept each year. This means that it routinely turns away students who present top SAT scores and high GPAs. While it can be hard to move past a rejection, try not to dwell on it. Dartmouth does not accept admissions appeals, so don’t waste your time formulating any compelling arguments to change their mind. Dartmouth does accept transfer students, though, and you are allowed to reapply as a freshman another year if you choose to take a gap year. While neither of these should be your knee-jerk reaction after a rejection, they are opportunities to consider if you are well suited to them in other ways too. To learn more about gap years, check out our post What Are the Pros of Taking a Gap Year? and What You Need To Know When Applying to Colleges After a Gap Year . For more about transferring, see our post Transferring Colleges: Opportunity Costs to Consider . Sometimes, the easiest choice after rejection is simply to set your sights elsewhere. While this can initially be a bitter pill to swallow, it’s important to remember that ultimately it’s not where you go to college that matters, but what you do with your time there. For our advice on adjusting to life at a college that wasn’t your first choice, read our post Envisioning a New Future: Preparing for Life at Your Second-Choice (or Third, or Fourth) School .

Friedman and Hayek's neo-liberal political economy Research Paper

Friedman and Hayek's neo-liberal political economy - Research Paper Example If the delivery of mail is a technical monopoly, no one else will be able to succeed in competition with the government. If it is not, there is no reason why the government should be engaged in it. The only way to find out is to leave other people free to enter. (Friedman 1982, p. 29) He therefore disapproves of the idea of the government monopolizing many fields where the private sectors would be able to participate in. Where there is an involvement by the government, because it is necessary, then it should be a legal monopoly, whereby the private sector is prohibited by the law to participate. Hayek Friedrich von Hayek and The neo-liberal political theory Hayek, while continuing with Adam Smith’s liberal traditions, comes to define the concept of minimal state. The most vital contributions include the radical opposition to social justice system which in his opinion disguises the defending of the middle class’ corporate interest. It promotes the complete removal of eco nomic and public social intervention. The idea of the minimal state was just a means of breaking away from middle class’ power which was known to be controlling the democratic processes with an intention of using the public treasury to redistribute wealth. Hayek’s views on neo-political economy as presented in the constitution of liberty (Hayek 1960) and advocates for elimination of ruling, privatization, elimination of housing, fighting of unemployment through the limitation of the number of programs, , reduction of the total social security expenditures, subsidies and rent control and lastly to remove the power of the trade unions. Redistribution cannot be ensured by the state to serve social justice system. Its function is to provide the legal means that... This paper illustrates both Hayek and Milton Friedman defend neo-liberal economy on grounds that it is rational and an inherently free way that people may relate to one another, by removing undue obstacles that the state often imposes on the exchange of goods and services. Neoliberal political economic theory therefore goes beyond identification of the market as a mere place for production of goods and services but as a place that is tangential top the interaction of people. This conception of market economy issues being closely intertwined with socio-moral issues and social relations have equally been raised by the classical liberal theorist. Robins, for instance, stresses the value of inherent morality that underlies ensuring free exchange in the market. He asserts that the ultimate value of liberal political economy is liberty, and not just the market or private ownership. Liberty is very important to the society, in order that every member of the society may be in a position to o ptimize his or her social contribution. When the government gets too much into controlling the private individuals, their optimal contributions will be greatly minimized by the systematic obstacles that the state put in place, such as limitation as to quotas, quantity of exports, price fixing and so on. Such erosion of liberty in the manner an individual deals with one’s products in the market would be a great disincentive to the spirit of enthusiasm, which sustains production.

Top-down model Essay Example | Topics and Well Written Essays - 500 words

Top-down model - Essay Example Each of these layers will be discussed keeping in mind the example of Intertex Corporation and its processes (Turban, McLean, & Wetherbe, 2004). Firstly Business Layer is this level of the top – down approach, Intertex Corporation requires to work on the basic areas of the business which include the strategic business plans, process reengineering, and also the identification of the major business functions, processes and opportunities (Goldman & Rawles, 2004). These basically include the need to focus on areas like the need for the networking within the organization and also implementation of WAN and LAN which helps standardizing the overall processes. Applications Layer: is the second step which involves using the WAN and LAN to pass on all information more simply to all employees within the company and to use this as an excellent opportunity to identify the needs for all information and knowledge within the company (Goldman & Rawles, 2004). Here this can be used to also essential information from the headquarters both locally as well as to the remote locations as well. Data Layer is the third step and this section is also an essential part of the approach. Here factors like the database analysis and design are looked into along with other areas for the organization which include the Data modeling, Data distribution analysis and also aspects of Client/server architecture design (Goldman & Rawles, 2004). In the case of companies for instance Intertex this is an important stage and this forms the major part of the overall top down approach. This stage is essential in the overall determination of requirements for the Top down approach and this area focuses on all data collection and distribution for the business needs and information. Network Layer as explained by Goldman and Rawles 2004 deals with, a) Network analysis and design, b) Logical network design (what), c) Network implementation planning, d) Network

You may choose any comparison-contrast approach related to person, Assignment

You may choose any comparison-contrast approach related to person, place or things - Assignment Example It is apparent that both leaders advocated for non-violent ways of settling their grievances. For instance, Mandela borrowed ideologies and principles from Gandhi who had insisted on negotiation with the black Africans and Indian administrators. Similarly, Mandela and Gandhi were revolutionists who fought for the rights of other citizens (Dalton, 2012). This implies that the two leaders mobilized people to help them fight for changes by pushing the administrators to transform their ruling strategies. It is also evident that Mandela was similar to Gandhi in that they were against social segregation and discrimination across South Africa (Limb, 2008). For instance, as a lawyer in South Africa, Gandhi did not like the way the Indians faced mistreatments from other ethnic groups. Mandela also led the anti-apartheid movement that separated the blacks against the Europeans in the country. This indicates that they had similar approaches of influencing equality and appreciation of separate r aces within the country. However, some differences were also evident between the two prominent leaders. For instance, while Mandela fought for the interests of his people, he emerged as a political leader. He also formed a political party that acquired independence for the black liberators. In contrast, Gandhi later became a religious nationalist in his native country India (Dalton, 2012). Another difference is that Gandhi never had political ambitions and only fought for the liberation of people against the British (Dalton, 2012). Mandela had political ambitions that enabled him to contest in a democratic election where he emerged the victor. It is also different that Gandhi was instrumental in both his country and in South Africa where he led the campaigners for change (Limb, 2008). Contrastingly, Mandela only participated in his home country where he was

Top-down model Essay Example | Topics and Well Written Essays - 500 words

Top-down model - Essay Example Each of these layers will be discussed keeping in mind the example of Intertex Corporation and its processes (Turban, McLean, & Wetherbe, 2004). Firstly Business Layer is this level of the top – down approach, Intertex Corporation requires to work on the basic areas of the business which include the strategic business plans, process reengineering, and also the identification of the major business functions, processes and opportunities (Goldman & Rawles, 2004). These basically include the need to focus on areas like the need for the networking within the organization and also implementation of WAN and LAN which helps standardizing the overall processes. Applications Layer: is the second step which involves using the WAN and LAN to pass on all information more simply to all employees within the company and to use this as an excellent opportunity to identify the needs for all information and knowledge within the company (Goldman & Rawles, 2004). Here this can be used to also essential information from the headquarters both locally as well as to the remote locations as well. Data Layer is the third step and this section is also an essential part of the approach. Here factors like the database analysis and design are looked into along with other areas for the organization which include the Data modeling, Data distribution analysis and also aspects of Client/server architecture design (Goldman & Rawles, 2004). In the case of companies for instance Intertex this is an important stage and this forms the major part of the overall top down approach. This stage is essential in the overall determination of requirements for the Top down approach and this area focuses on all data collection and distribution for the business needs and information. Network Layer as explained by Goldman and Rawles 2004 deals with, a) Network analysis and design, b) Logical network design (what), c) Network implementation planning, d) Network

PR and the Media - Networking and Ethics Essay Example | Topics and Well Written Essays - 1750 words

PR and the Media - Networking and Ethics - Essay Example Introduction Public relations are one of the most important parts of marketing. Public relation is one of the key elements of the promotional mix. Public relations can be defined as a way of communication through which the products or the services offered by one marketer is promoted or evaluated by a third party and hence this helps the marketers to develop an atmosphere of credibility and trust among the customers. Journalists and reporters happen to be one of the most important parts of the modern media. From the perspective of the marketing and public relations, the journalists play an important role as a reference group. The evaluation made by the journalists about an organization or a product can actually influence the buying behavior of the public and hence the marketers usually look to develop strong relationships with the journalists. However, among all these the ethical aspects of the journalism are some that needs to be maintained. The present study has been conducted in or der to analyze the relationship between journalism and PR keeping the ethical aspects of journalism in mind. Also the study looks to understand how the three different businesses can use one media connector to great effect (Belch and Michael, 2005). Part -1 How journalistic ethics affects marketing public relations professionals Journalistic ethics comprises of the principles of the ethics and good practices applicable to the specific challenges faced by the journalists. Presently this subset of the media ethics is mainly known as the code of ethics. Increasing influence of the public relation professional has been quite detrimental to ethical journalism. The role of a journalist in the society is to provide information that serves the best interest of the public. This needs commitment to the relatively less flexible principle of reporting the most balanced and accurate version of the events and stories. On the other hand PR uses persuasive speeches to serve specific interests. Howe ver, the public relations experts are not at all bounded by the ethical code of the journalists. To explain the roles of journalism and public relations in simple terms, it can be said that role of journalism in the business of reporting and public relations is inevitable. But the penalty of such conflicts would lead to the inevitable decay to the overall quality of PR and journalism (Kapferer, 2008). Importance of building relationships with journalists for the marketers The relationship of the marketers with journalists is extremely important and this is also the base of the interaction with the media. If someone is heading a startup company that has not been established yet it would be extremely important for the marketer to read the local publications and get the names of the local journalists and the reporters. Then the marketer may decide to contact appropriate reporter or journalist. It can be assumed that majority of the time the offer made by the marketer would be accepted simply because the journalists are constantly searching for news and happen to be a lot more approachable than what normal people may perceive. However it is also advised that the marketer should not appear as though the marketer is looking for free publicity because at the end of the day it is a win-win situation for both the parties. The same concept applies for established firms also as journalists can act as a credible source of communications as the buyers would

You may choose any comparison-contrast approach related to person, Assignment

You may choose any comparison-contrast approach related to person, place or things - Assignment Example It is apparent that both leaders advocated for non-violent ways of settling their grievances. For instance, Mandela borrowed ideologies and principles from Gandhi who had insisted on negotiation with the black Africans and Indian administrators. Similarly, Mandela and Gandhi were revolutionists who fought for the rights of other citizens (Dalton, 2012). This implies that the two leaders mobilized people to help them fight for changes by pushing the administrators to transform their ruling strategies. It is also evident that Mandela was similar to Gandhi in that they were against social segregation and discrimination across South Africa (Limb, 2008). For instance, as a lawyer in South Africa, Gandhi did not like the way the Indians faced mistreatments from other ethnic groups. Mandela also led the anti-apartheid movement that separated the blacks against the Europeans in the country. This indicates that they had similar approaches of influencing equality and appreciation of separate r aces within the country. However, some differences were also evident between the two prominent leaders. For instance, while Mandela fought for the interests of his people, he emerged as a political leader. He also formed a political party that acquired independence for the black liberators. In contrast, Gandhi later became a religious nationalist in his native country India (Dalton, 2012). Another difference is that Gandhi never had political ambitions and only fought for the liberation of people against the British (Dalton, 2012). Mandela had political ambitions that enabled him to contest in a democratic election where he emerged the victor. It is also different that Gandhi was instrumental in both his country and in South Africa where he led the campaigners for change (Limb, 2008). Contrastingly, Mandela only participated in his home country where he was

PR and the Media - Networking and Ethics Essay Example | Topics and Well Written Essays - 1750 words

PR and the Media - Networking and Ethics - Essay Example Introduction Public relations are one of the most important parts of marketing. Public relation is one of the key elements of the promotional mix. Public relations can be defined as a way of communication through which the products or the services offered by one marketer is promoted or evaluated by a third party and hence this helps the marketers to develop an atmosphere of credibility and trust among the customers. Journalists and reporters happen to be one of the most important parts of the modern media. From the perspective of the marketing and public relations, the journalists play an important role as a reference group. The evaluation made by the journalists about an organization or a product can actually influence the buying behavior of the public and hence the marketers usually look to develop strong relationships with the journalists. However, among all these the ethical aspects of the journalism are some that needs to be maintained. The present study has been conducted in or der to analyze the relationship between journalism and PR keeping the ethical aspects of journalism in mind. Also the study looks to understand how the three different businesses can use one media connector to great effect (Belch and Michael, 2005). Part -1 How journalistic ethics affects marketing public relations professionals Journalistic ethics comprises of the principles of the ethics and good practices applicable to the specific challenges faced by the journalists. Presently this subset of the media ethics is mainly known as the code of ethics. Increasing influence of the public relation professional has been quite detrimental to ethical journalism. The role of a journalist in the society is to provide information that serves the best interest of the public. This needs commitment to the relatively less flexible principle of reporting the most balanced and accurate version of the events and stories. On the other hand PR uses persuasive speeches to serve specific interests. Howe ver, the public relations experts are not at all bounded by the ethical code of the journalists. To explain the roles of journalism and public relations in simple terms, it can be said that role of journalism in the business of reporting and public relations is inevitable. But the penalty of such conflicts would lead to the inevitable decay to the overall quality of PR and journalism (Kapferer, 2008). Importance of building relationships with journalists for the marketers The relationship of the marketers with journalists is extremely important and this is also the base of the interaction with the media. If someone is heading a startup company that has not been established yet it would be extremely important for the marketer to read the local publications and get the names of the local journalists and the reporters. Then the marketer may decide to contact appropriate reporter or journalist. It can be assumed that majority of the time the offer made by the marketer would be accepted simply because the journalists are constantly searching for news and happen to be a lot more approachable than what normal people may perceive. However it is also advised that the marketer should not appear as though the marketer is looking for free publicity because at the end of the day it is a win-win situation for both the parties. The same concept applies for established firms also as journalists can act as a credible source of communications as the buyers would

Journal summary Essay Example for Free

Journal summary Essay Organizational Assessment : Effectiveness vs. Efficiency This journal is being chosen related to the Organizational Theory, Design and Change for chapter 1 about the Organization Effectiveness. i. What was the aim of the study? An organization had its own goals and mission. There were many ways that could be implement in order to make sure that the organization will achieves whether it short or long term goal. The term effectiveness and efficiency was always being the indicator of the organization performance. This study will determine the differentiation, features, proximities or values of the effectiveness and efficiency. There were some people believe that there is no difference between effectiveness and efficiency, but according to Mouzas (2006), each of these terms have their own distinct meanings. ii. Model that being used in this study. As stated in the chapter 1, under â€Å"How Does an Organization Create Value? † there is value creation. Value creation takes places at three stages which are input, conversion and output. To differentiate the meaning of effectiveness and efficiency, the authors of this study has adapted a model from Frey and Widmer (2009) regarding effectiveness and efficiency. Figure 1 Chain of effects Based on Figure 1, we can see that efficiency information provides different data compared to effectiveness. As we can see, under the effectiveness it concern about output, outcome and impact. It measures the on how the organization will achieve their goals or the way outputs interact with the economic and social environment. For the efficiency aspect we can see it concern about the input and output. According to (Low, 2000), the efficiency will measure on how successfully the inputs have been transformed into outputs. iii. What is the result of the study? This study was using the obstructive measure approach where the authors had collected finding from other resources. In order to come out with conclusion, they had gathered many findings related to the effectiveness and efficiency. They highlighted few points such as the meaning, differences, characteristics, and how it will be dependence toward each other. According to the study by Pinprayong and Seingthai (2012), they suggest that return on assets (ROA) is suitable measure of overall company performance, since it reveals how profitable organizations assets are in making revenues. Total assets turnover will measure the ability of a company to use it assets to efficiency generate sales; therefore it can be treated as effectiveness. As conclusion, they had come out with formula of: Organizational performance = effectiveness x efficiency; iv. Limitations In some cases effectiveness concept is being used to reflect overall performance of the organization, since it is a broader concept compared to the efficiency. It gets challenging to explore the efficiency factor if it is included under effectiveness assessment v. Conclusion The characteristics of effectiveness and efficiency Figure 1. 1 shows that the organizations cannot survive without effectiveness policy. Even though the organization is an inefficient but effective, organization still have a chances to survive. Usually, organization that in high effectiveness and high efficiency are well known as high performance entities. Effectiveness is a much broader perspectives, which touch about quality, value, satisfactions, output and environments. Efficiency is on how well the input was transformed into output. Effectiveness and efficiency, they influence each other. In order to achieve all the organizations goals and had an excellence in competitive performance, organizations should find way on increasing the efficiency and effectives evenly. 2. Impact of Employee Adaptability to Change Towards Organizational Competitive Advantage This journal is being chosen related to the Organizational Theory, Design and Change for chapter 4 about the Basic Challenges of Organizational Design i. What was the aim of the study? A change in the most understandable way is the moving process from one point to another. It’s not a must to do things for an organization, but in order to make sure the organization in can compete and achieve the better performance, changes should be made. Although changing is the good things to do, but it have own limitations and it cannot easily made, so that why this study had being conducted. The purpose of this study is to know how the competitive advantages have the significant effect on training and development, empowerment and maintaining in the organization. It is stated in this study, that their aim is to identify and to discuss the reasons why employees didn’t easily adapt the changes than those eager to adapt the change in any case. ii. Model that being used in this study. There were three variables that being used for this study which are training and development, empowerment and culture. These variables will tested in order to know the relationship of the variables towards the employee adaptability to change which is a moderator and competitive advantage being a dependent variable. iii. What is the result of the study? Before come out with a conclusion, data must be collected and analyze. For this study they had distributed 80 questionnaires towards employees within service sector organizations and others. On the basis of the data conducted from the person engage in the executive, supervisors and staff position. Table 2. 1 Descriptive Analysis The findings were analyzed by using descriptive statistics. Based on the result gathered by questionnaires, the authors will use the correlation of the statistical interference in order to identify the hypothesis had being developed this study and relationship between the discussed variables. Above we can conclude that training development is good for the employee to adapt the change and organizations leads it competitive advantage. For the empowerment, they score greater mean that training development which is good to the employee. Lastly, from the table its show that good culture has influence on the organizational competitive advantage. iv. Conclusion In order to make an organization competence, they should a changing process toward the better environments. But, changes are not easily made. They will be some people that against on the changing process. That is why, the adaptability is important. As being stated in this study, employee adaptability is more dependent on the parallel activities that preceded along with the others activities in the organization and these activities helps the employee to perform more enthusiastically and impatient to demeanor any challenge or adapt any change whatever it will be. 3. Organizational Culture and Its Themes This journal is being chosen related to the Organizational Theory, Design and Change for chapter 7 about Creating and Managing Organizational Culture. i. What was the aim of the study? Organizational culture is a about sharing value and norms that will help on controlling organizational members interactions within each other and with people outside the organization. As written in this journal, culture within an organization acts as a critical role in the organizations everyday operations. In order to validate this statement, a study about an organizational culture had being conducted. The purpose of this study is to know in deeper what is an organizational culture, models related, themes and the importance toward an organization. ii. Model that being used in this study. As being stated earlier, organization culture can be described as a set of theory consist of values, beliefs, and understanding that members share in common. It also helps in the ways of thinking that could help while making decision. From the perspective of Andrew Brown (1995, 1998), the organization culture: â€Å"Refers to the patters of beliefs, values and learned ways of coping with experience that have developed during the course of an organization’s history, and which tend to manifested in its material arrangements and in the behaviors of its members†. One of those models that being adapted in this study is the Onion Diagrams, by Hofstede. He was dividing culture into four layers which consist of symbols, heroes, ritual and values. Figure 3. 1 Onion Diagram Based on the Figure 3. 1 above, the core level in the culture level is value; values are intimately connected with moral and ethical codes which determine what people ought to be done. The second level is rituals, which is describing the collective activities that considered essential. The next level is heroes. According to Deal and Kennedy (1982), hero is a great motivator; heroes are also persons who possess characteristic which are highly prized. Symbols are the most overt element of culture and are the gestures, objects, words or acts that signify something different or wider from the others, and which have meaning for individual or group. iii. The importance of this study In order to have a rapid organization development, organization culture can be used as a tool to help the organization reach success. It also can be a management tool, which managers can use some values to control and direct employee behavior. In addition, the importance of the organization culture toward the development of an organization seconded with statement from Campbell and Stonehouse (1999) said: â€Å"Culture can also have influence on; employee motivation; employee morale and ‘good will’; productivity and efficiency; the quality of work; innovation and creativity and the attitude of employees in the workplace†. iv. Conclusion As stated in this study, they highlighted that in order to achieve a successful culture, managers shouldn’t ignore organizational culture and its themes, because culture can be used as a competitive advantage during organizational development, and a strong culture (one in which beliefs and values are widely shared and strongly held) can also offer many advantages, such as cooperation, control, communication or commitment. 4. Re conceptualizing Organizational Role Theory for Contemporary Organizational Contexts i. Aim and introduction of the study. The purpose of this study is to know deeper regarding the organizational role theory and to identify what are the issues related to the organizational theory that will limit it usage. In this study, they were several issue that being listed out regarding organizational theory. Based on Katz and Kahn (1966) state that the assignment of work-roles prescribes the behavior of employees are expected to comply, so that they are able to perform their speci? ed tasks and duties effectively. He also mentions that organizational role theory (ORT) is help to de? ne a â€Å"role-set† for the individual, employee and determine the speci? c role-behaviors the employee. Beside that according to According to Biddle (1986), George (1993), and Smithson and Stokoe (2005), the diminishing usefulness of classical ORT can be traced to three part. There are the limitations in its role-taking, role-consensus and role-con? ict assumptions. The theoretical issues discussed indicate about the development of ORT has failed to keep the change in the organizational context. Data Collections This research consists of two-stage qualitative data gathering process. The ? rst stage included the questionnaire-survey to a sample of employees and the second stage data collection process to collect the data required to answer the second research question. The uses of semi-structured interview allowed the researcher to strengthen the investigation. The respondent reported that charity, education, social are the important impact on their working life. iii. Result Summary To simplify the results for this study it can be divided into two summaries: Research Summary 1 Although the research findings supported the relevance of the â€Å"work-family/work-life balance† literature to ORT, there was evidence that at least four other categories of non-work roles needed to be considered for the effective management of human resources. In terms of work-roles, academics and practitioners must remain aware of the work-roles currently recognized by classical ORT. In terms of work-family roles, they need to recognize the specific impacts of the work-family interface, and become aware of the limitations of â€Å"family-friendly† practices that serve only to enable workers to spend more time at work Research Summary 2 There were two things that will be highlighted in these summaries. First, the recognition that employees (both actual and potential) are multi-faceted is incorporated into the model in three important ways. In the pre-employment phase, the model now requires the employer to attain a level of understanding of the potential employee’s family and non-family roles that they need to enact for their self-validation, self-recognition and overall wellbeing. In the initial employment phase, it requires that employers consider the interaction between the most important non-work-roles (as identified by the employee) and the work-roles to be bestowed on them. iv. Conclusion Finally it can conclude that, this research suggest the employees perceived had a signi? cant impact on their working-life. ORT needs to incorporate for an effective HR policy framework. It also recommends that further investigation into ORT’s role in the workplace and further exploration. 5. Organization Theory and Methodology This is a summary of the article â€Å"Organization Theory and Methodology† by Michael C. Jensen in Harvard Business School. In this research the researcher find the relation between positive and normative theories, the importance to the research effort of the choice of tautologies and definitions, the nature of evidence, and the role of mathematics. The author mentions that, the major reason for the early successes of operations research and its later failure can be traced to the nature of the theories. In addition, According to Alchian (1950), organization need not assume that agents are engaged in purposeful activity for the models to work. Besides that, Hayek (1979) emphasizes most of the complex phenomena that make up human culture were never consciously invented by any individual and much of human culture is still not well understood. Furthermore, there is evidence in Chandler’s (1962), work that the organizational innovations that led to the large, integrated, multi-divisional firms in the early 1900’s were accompanied by substantial innovations in accounting practices. Moreover, the behavior of the organization is the equilibrium behavior which made up of maximizing agents with diverse and conflicting. The Construction of a theory of organizations involves creating a theory that describes the equilibrium behavior of these complex contractual systems where the individual agent is the elementary unit of analysis. On the other hand, the choice of tautologies or definitions has a large impact on the success or failure of research efforts. As a conclusion, the researcher says that the competition in research is an important element for innovation and makes progress at product markets. He also mention that, ideal process described about the important aspects of the environment, monitoring and bonding technology that derive a theory that is consistent with those contracts.

Advanced breast cancer

Advanced breast cancer Background Cancer accounts for 13% of all deaths in 2007, making it the largest cause of mortality worldwide and is the leading cause of premature death in Scotland. 2,22 Out of the staggering figure of 27,500 new cases that were diagnosed on that same year in Scotland, 4044 of them are breast cancer cases, making breast cancer the most commonly diagnosed cancer among Scottish women.3 In the UK, 16-20% of women have advanced breast cancer and approximately 40-50% of those diagnosed with early or localised breast cancer may eventually develop metastatic disease. Breast cancer is usually defined using a staging system known as the Tumour, Node and Metastasis Staging System (TNM) and stage III and IV are known as advanced stages of the disease with stage III being locally advanced and or has spread to regional lymph nodes and stage IV describing the presence of metastases at distant sites such as the bone, brain, or lung.23 In the elderly group of female cancer patients, the prevalence of breast cancer is highest at 4% and these post-menopausal women make up 80% of all breast cancer patients, hence proving that the risk increases with age.1 Apart from age, other factors like family history, uninterrupted oestrogen exposure, early menarche, late menopause, late first pregnancy, hormone replacement therapy, obesity, not breast feeding, taking oral contraceptives and past breast cancer may all attribute to a higher risk of developing breast cancer.9 Over the last decade, mortality rates from breast cancer have dropped by almost 14%, despite having more women diagnosed with the disease. In 2000-2004, the survival rate for breast cancer patients has also bumped up to 84% compared to a mere 64% 20 years earlier.4Improvement in prognosis, screening techniques such as mammography, ultrasound and Magnetic Resonance Imaging(MRI), earlier diagnosis of cancers in women participating in the Scottish Breast Screening Programme, a myriad of new hormonal and chemotherapy treatments, and better organisation and patient care plans has attributed to the substantial increase in incidence and survival rate of breast cancer patients. Women today are also encouraged to perform self breast examinations, hence are familiar with the shape and feel of their breasts, as well as to look out for abnormities like a new discrete lump, nipple discharge, unilateral persistent pain especially in post-menopausal women or pain associated with a lump and skin changes comprising of skin tethering, ulceration, abscess or inflammation.However, there is still a disparity between women from different social classes in terms of combating this disease. Women from more affluent backgrounds are more likely to have their breast cancer diagnosed earlier, have slower disease progression from the time of diagnoses and higher survival rates compared to women from poorer socioeconomic backgrounds. Women from more deprived communities are more likely to be diagnosed with the advanced stage of the disease. Pathogenesis Cancer or malignant neoplasm which literally means new growth is a disease manifested in the form of uncontrolled cell proliferations, dedifferentiation and loss of function, invasiveness and metastasis.6 Breast cancer usually forms from the inner lining of milk ducts or the lobules that supply the ducts with milk. In patients with Breast Cancer, women who inherit a single defective copy of tumour suppressor genes BRCA1 or BRCA 2 have a marked higher risk of developing breast cancer in their lifetime. The presence of a defective BRCA1 or BRCA 2 gene can invoke changes in several cellular systems including the signaling pathways and receptors of growth factors and cell cycle tranducers, the apoptotic machinery which responsible for programmed cell death that normally disposes of abnormal cells, the secretion of telomerase, and local blood vessels which results in tumour-directed angiogenesis to supply nutrients to these tumours both aids the proliferation of cancer cells.7,8 Breast cancer cells are able to invade other tissues like the lymph nodes as they no longer exercise the same restraints as the normal cells and they also secrete enzymes like metalloproteainase to break down the extracellular matrix, conferring them mobility. Metastases are secondary tumours normally found in the advanced stage of breast cancer formed by cells released from the primary tumour and have reached and have established themselves at other sites like the lung brain or the bones which are common sites for metastatic cancers of breast origin through blood vessels and lymphatics. The tissues of lung, brain and bone origin express high levels of CXR4 chemokine receptors produced by the breast cancer cells, facilitating the selective accumulation of the cells at these sites.6 Treatment Options There are three main approaches to treating breast cancer, namely surgical excision, irradiation and a host of systemic disease-modifying therapies or a combination and is chosen based on the stage of breast cancer. However, when caring for patients with advanced breast cancer, the goal of treatment of advanced breast cancer is to palliate symptoms, improve survival and quality of life. There are notably three types of systemic disease-modifying therapies to treat advance breast cancer namely endocrine therapy, chemotherapy and biological therapy. Endocrine Therapy Oestrogen exposure has been instrumental in inducing mutations that can lead to breast cancer as they can stimulate cell growth in most of human breast cancer cell lines expressing Oestrogen Receptor (ER) ÃŽÂ ± .8 Clinical studies have proven that more than half of breast carcinomas are ER ÃŽÂ ± positive and respond fairly well to endocrine therapy. Drugs are aimed either to change the ER signaling pathways or prevent estrogen synthesis.7 Tamoxifen and 3rd generation Aromatase Inhibitors (AI) have been used for advance breast cancer with the former being effective in premenopausal, perimenopausal and post menopausal women. Pre-menopausal and perimenopausal cancer patients with ER positive tumours should be offered Tamoxifen tablets 20 mg daily, an oestrogen -receptor antagonist and ovarian ablation or the administration of LHRH agonists such as Buserelin or Goserelin as first-line treatment.5,12 Both options are just as effective in terms of tumour response and overall surviva l rates. The latter group of drugs, AI, are the preferred choice for post-menopausal women only with no prior history of endocrine therapy or have been previously been treated with Tamoxifen. AI work predominantly by suppressing oestrogen levels in post-menopausal women by blocking the conversion of androgens to oestrogens in the peripheral tissues. However, they do not inhibit ovarian oestrogen synthesis, hence can cause an elevation in oestradiol levels in pre-menopausal women. Anastrozole and Letrozole are non-steroidal AIs are known to be as efficacious as Tamoxifen as first -line treatment of metastatic breast cancer. 14Exemestane is a steroidal AI used as second-line treatment in advanced breast cancer in post-menopausal women in whom anti-oestrogen therapy has failed. Fulvestrant, an oestrogen receptor antagonist also confers short term benefits in the clinical setting for post-menopausal women who was previously prescribed a non-steroidal AI, delaying the need for chemotherapy. 13AI h ave been associated with an increased progression-free survival and 13% decrease risk of mortality and lower incidence of vaginal bleeds and blood clots. However, patients given AI are more prone to hot flushes and gastro-intestinal symptoms. 5 Other endocrine therapies available include older and less popular therapies such as progestogen and androgen for pre-menopausal women and stilboesterol and trilostane for post-menopausal women. 5 Chemotherapy Both ER positive and negative patients with advanced breast cancer would benefit from either a choice of two or three regiments of chemotherapy and classes of drugs commonly prescribed includes antharacyclines, taxanes, capecitabine, vinorelbine, gemcitabine, alkylating agents like cyclophosphamide and platinum based drugs like carboplatin.5 Anthracyclines such as Epirubicin, Mitoxantrone and Doxorubicin are prescribed as first line chemotherapy as they boost modest survival advantage in patients with advanced breast cancer and are superior to non-anthracycline regimens.1,5Doxorubicin is commonly given via injection into a fast running infusion at 21 day intervals as extravastation can cause severe tissue damage. It exerts a cytotoxic effect by interfering with DNA and RNA synthesis by inhibiting DNA toposiomerase II action. The metabolites are excreted through the bile, hence elevated bilirubin levels are indicative of a need to reduce the dosage. 6,12 Higher accumulation of doses may result in cardiopathy precipitating to heart failure, hence cardiac monitoring is deemed important in managing cancer patients taking it and a limit of total cumulative doses is set at 450 mg/m2.Other symptoms of toxicity includes myelodysplasia and neutropenic sepsis. Doxorubicin is also available in liposomal formulations which are safer in terms of reduced incidents of cardiotoxicity and local necrosis but is not recommended by the Scottish Medicines Consortium for treatment of metastatic breast cancer.1,12 Both Epirubicin,an anthracycline derivative, and Mitoxantrone ,an anthracenedione derivative,are structurally related to Doxorubicin, hence similar drug activity could be predicted for all three drugs.12 Mitoxantrone given intravenously is licenced to treat metastatic breast cancer and has been well tolerated by patients.However, side effects like myelosuppression and cardiotoxicity are evident and cardiac examinations are recommended after a cumulative dose of 160 mg/m2.12When both drugs are compared in a clinical trial, Epirubicin boosts higher response rates despite demonstrating a higher percentage of toxicity related side effects.20Clinical trials suggest the efficacy of Epirubicin in treating advanced breast cancer is comparable to Doxorubicin as similar response rates were recorded when equal doses were given. These trials also indicated that patients taking Epirubicin had fewer episodes of congestive heart failure and other complications resulting from cardiotoxicity. Therefo re, it could be surmised that Epirubicin is the drug of choice in this regimen .However,a limit of 0.9-1 g/m2 was still imposed when Epirubicin is given to avoid cardiotoxicity. 1,12 Due to the ineffectiveness of single-agent anthracycline therapies in impeding disease progression, combination therapies are often considered for the treatment of advanced breast cancer after failure of with anthracycline monotherapy, provided that the patient is able to tolerate additional toxicity and have a higher chance of response.5 There are clinical evidence suggesting that a combination of anthracycline and taxanes like Doxorubicin and Docetaxel have resulted in better tumour response, delayed progression time compared and reduce risk of mortality to anthracycline monotherapy. The benefits of this synergistic combination, however, did not include improved survival and side effects experienced were more numerous such as thrombocytopenia, alopecia in 75% of these patients,a 10% increase in peripheral neuropathy and neutropenia in 40 to 68% of these patients.1,5 A combination of Epirubicin and Docetaxel would be a better choice as it is just as potent as the Doxycycline and Pac litaxel combination but deemed free of side effects like cardiotoxicity and fluid retention whereas neutropenia was the dose-limiting toxicity .21 Systemic chemotherapy should be offered to patients whom antrhracyclines are contraindicated in cases of cardiac disease hypertension,the elderly, those who have received myocardial irradiation ,those receiving radiotherapy for breast cancer or had receive prior adjuvant treatment with anthracycline. Docetaxel monotherapy is prescribed as the first-line drug followed by single-agent Vinorelbine or Capecitabine as the second-line treatment. Third-line treatment encompasses the use of either Vinorelbine or Capecitabine of which was not offered previously.5 Docetaxel, a member of the taxane group derived from a naturally occurring compound from the bark of yew trees, is licensed to treat locally advanced or metastatic breast cancer. It acts by stabilizing microtubules in the polymerized state, preventing cell division. Side effects associated with Docetaxel are myelosupression, peripheral neuropathy, cardiac conduction defects with arrhythmias, alopecia, muscle pain, nausea and vomiting . Patients currently on Docetaxel are also susceptible to leg oedema and hypersensitivity reactions, which can be ameliorated by taking Dexamethasone orally.1,6,12 Antimetabolites like Capecitabine is a rationally designed tumour-activated and tumour-selective fluoropyrimidine carbamate thatis metabolized to generate 5-fluorouracil at the tumour site which would then be converted to fluorodeoxyuridine monophosphate (FDUMP), a fraudulent nucleotide and interact and inhibit thymidilate synthetase,preventing the synthesis of 2-deoxythymidilate (DTMP),which is vital for DNA synthesis.17Capecitabine has a role in second-line or third-line treatment of chemotherapy for patients of locally advanced or metastatic breast cancer either in combination with Docetaxel or given orally alone at a dose of 1250 mg/m2 twice daily for a forthnight and subsequent courses are repeated after a 7-day interval. Vinorelbine is a semi-synthetic analogue of vinblastine, a vinca alkaloid derived from Madagascar periwinkle. Unlike taxanes, it is targeted at tubulin of mitotic microtubules to form tubulin dimers which prevents spindle formation in dividing cells leading to mitotic arrest at metaphase resulting in cell death. 6 Besides inhibiting mitosis, its effects are also significant in inhibiting leucocyte phagocytosis, chemotaxis and axonal transport in neurons. Hence, side effects includes neutropenia which was found to be the dose-limiting, peripheral or autonomic neuropathy which manifests as peripheral paraestesia, loss of deep tendon reflexes and motor weakness,constipation and abdominal pain. Neurotoxicity caused by Vinorelbine is considered relatively mild compared to other vinca alkaloids even at maximum tolerated dose as it preferentially binds to mitotic over axonal microtubules. 6,12 Vinorelbine is an option to anthracycline or taxane pre-treated patients with advanced breast canc er as second-line or third-line chemotherapy given via intravenous administration at a dose of 30mg/m2 in 250 ml of normal saline over 1 hour. Alternatively, Vinorelbine can be given orally at a dose of 60 mg/m2 for 3 weeks and can be increased if the patient shows good tolerance to the regime to maximum dose of 160 mg once weekly. A clinical response rates of 16-60% was seen with Vinorelbine as a single agent, 28-77% in combination chemotherapy.5, 16 A study comparing Vinorelbine in intravenous(i.v.) form used in combination with Capecitabine given orally and a combination therapy of Vinorelbine and Capecitabine both in oral formulations was done to observe the efficacy of both combinations in anthracycline and taxane pretreated patients with metastatic breast cancer. Despite showing a marginally higher percentage in control of the disease in the oral group,improved survival rates and lower incidence of neutropenia and thrombocytopenia were associated with the i.v. group.17 This study has also shown that a combination of Vinorelbine with Capecitabine therapy may confer advantages as both have unique mechanisms of action, different proposed mechanism of drug resistance and relatively non-overlapping toxicity profiles. However, this combination has yet to be recommended by the NICE or SIGN guidelines as it has yet to be proven to be cost-effective. The recommendation for systemic chemotherapy by NICE is done following a cost-utility analysis which compares chemotherapy regiments in terms of survival, quality of life and associated costs of 17 different strategies drawn up. From the table below, strategies that gives the best survival rates and quality of life are combinations 3,4,13 and 15.However,combinations 3 and 4 that offer Gemcitabine and Docetaxel as the first line are somewhat more costly by approximately  £ 10 000 in total costs compared to combinations 13 and 15.It is also proven here that offering Docetaxel as a first-line drug is also superior to Paclitaxel as survival rates and quality of life are slightly poorer in combinations 8 and 10. 5 Biological Therapy New agents to specifically target molecular processes have been developed over the last decade like Tratuzumab, Bevacizumab and Lapatinib which are all used to treat advanced breast cancer. Tratuzumab, the sole drug of its kind recommended by NICE for use in the UK, is a recombinant humanized monoclonal antibody which binds to Human Epidermal Growth Factor (HER2) on the cancer cells with HER2 over expression and impedes the growth. Hence, HER2 status should be assessed before commencing this therapy as only a quarter of patients with advanced breast cancer have HER2 positive tumours. Tratuzumab is given intravenously in combination with Paclitaxel, Docetaxel or Vinorelbin has been well tolerated. 5,11However, once disease progression occur outside the central nervous system, Tratuzumab should be discontinued. Bevacizumab is another monoclonal antibody aimed at affecting the growth of tumour blood vessels and Lapatinib affects the metabolic pathways of the HER2 and Epidemal Growth Fac tor Receptor (EGFR). 5,23. Surgery Surgical intervention comprises of conservation surgery which involves the removal of the tumour with a rim of surrounding breast tissue with retention of the breast followed by radiation therapy and mastectomy which is usually followed by breast reconstruction. However, these surgical procedures are limited to patients diagnosed with primary operable breast cancer or as palliative surgery for locally advanced breast cancer as they may not confer much benefits to patients diagnosed with later stages of breast cancer.1,11,19 Some patients may have already underwent surgery which was not very successful in eliminating the disease.1 Treatment Recommendation Hormonal therapies are the recommended first-line therapy for patients with an ER positive tumour, are widely used and are said to be appropriate for 70 % of patients who have hormone receptor -positive advance breast cancer. However, in circumstances whereby the disease is life-threatening or the patient has an ER negative tumour, the hormonal therapy would be of no benefit to these patients. At the time of initial diagnosis, the oestrogen receptor (ER) was accessed and the results came out positive before considering commencing on endocrine therapy. Several factors like previous endocrine therapy including adjuvant therapy, the extent and period of response to the therapy and menopausal status have to be taken into account before prescribing hormonal therapy. 5The patient is 62 years of age and is considered to be post-menopausal, hence would benefit tremendously when given aromatase inhibitors(AI),regardless of whether she is tamoxifen naÃÆ' ¯ve. A choice of non-steroidal AIs o f either Anastrozole 1 mg daily or Letrozole 2.5 daily could be given orally. However, if she has a prior history of non-steroidal AIs and she failed to respond well to it, she should be given either Exemestane 25 mg orally or Fulvestrant 250 mg via intramuscular injection into the gluteal muscle every 4 weeks.5,12 Chemotherapy would be the second choice of treatment following failure to respond to hormonal therapy. If anthracyclines are not contraindicated for this patient, Epirubicin would be a good choice. Initial doses of 75 mg/m 2 of Epirubicin could be given intravenously every three weeks.20The addition of Docetaxel 75 mg/m2in combination with Epirubicin 90 mg/m2 both by intravenous infusions could be given should Epirubicin monotherapy fails. Docetaxel monotherapy could also be given as an intravenous infusion at a dose of100 mg/m2 as a 1-hour intravenous infusion every 3 weeks should anthracyclines be contraindicatedas first-line chemotherapy. Vinorelbine monotherapy could be given intravenously at a dose of 30 mg/m2 for days 1 and 8 of a cycle or whereares Capecitabine monotherapy could be given orally at a dose 1250 mg/m2 twice daily for two weeks. If the patient fails to respond to the entire treatment, the last resort would be to offer support and palliative care to this patient. Pain Management Pain is usually associated with progression of cancer with three quarters of patients with advanced cancer reporting pain during treatment. The principles for treating pain in cancer patients are outlined by the World Health Organisation (WHO) analgesic ladder: Patients are the prime assessor of pain and should have treatment outcomes monitored regularly using visual analogue scales, numerical rating scales. Patients usually start with non-opioids and then progress stepwise to step 2 and step 3. However, critics have debated that the progression to step 2 analgesics was obsolete as inadequate pain control was an issue despite having to endure similar adverse effects when given step 3 analgesics and recommended a immediate step up to step 3. Most patients with advanced breast cancer will be on step 3 for pain control. Oral morphine with an initial dose of 5-20 mg every four hourly, adjusted according to patients response, would be the first-line therapy to treat severe pain in cancer before switching to a modified release preparation once the patient is stabilized on it. Breakthrough pain should be managed while on a modified release preparation by prescribing oral morphine at 1/6th of the total daily dose to be taken when necessary. The use of adjuvants such as antidepressants like Venlafaxine and anticonvulsants like Gaba-pentin are recommended for neuropathic pain. 18 Managing Complications Complications that may arise from treating patients with advance breast cancer includes lymphoedema,cancer-related fatigue,uncontrolled local disease,bone metastases and brain metastases. Lymphoedema may occur due to damage to lymph nodes and vessels following surgery and radiotherapy or as a sign of loco-regional disease progression. This condition can be managed through manual lymphatic drainage, multi-layer lymphoedema bandaging,goos skin care and remedial exercise. Cancer-related fatigue may be well managed by identifying the factors causing lethargy which may be a host of psychological, nutritional and cognitive factors apart from the cancer itself and them treating them accordingly. Patients may also develop local disease characterized by ulceration on the chest wall and axilla, fungating tumours that may bleed and exude discharge, causing pain and giving off repulsive odours. Hence, good wound management should be adopted in relation to preventing dire consequences when wounds are left unattended. Out of the three categories, cancer with distant metastases is the hardest to treat and is considered an incurable disease with palliative care being the sole priority in treatment plans. A diagnosis of metastatic disease could be confirmed with the use of positron emission tomography fused with computed tomography (PET-CT) and bone scintilography.1As bone metastases may be a long-term condition, management involves prevention of skeletal events, pain control with Biphosphonates,radiotherapy and cementoplasty and treating complications such as fractures,immobility and spinal cord compression.5,18 Brain metastases may develop in multiple sites in these patients as most drugs used in chemotherapy cannot penetrate the blood brain barrier, especially in women with HER2-overexpressing tumours. Diagnosis of brain tumours ultimately mean a loss of independence, physical deterioration, communication difficulties,psychological distress and issues regarding body image.Treatment regimens includ es surgery for patients who have solitary metastasis, corticosteroids for symptomatic relief of inflammation and radiotherapy.