Shooting an Elephant Essay

A price is payed to save oneself from humiliation, but, being pressured into doing something that one doesn’t want to do, makes people feel lost and pushed into a big problem. In the story â€Å"Shooting an Elephant† by George Orwell, he himself goes through a struggle in being the one to shoot an Elephant. In the beginning he knew what he had to avoid of being laughed at from the Burmese people that surrounded him, since he is an imperial policeman. Throughout the story, Orwell uses rhetorical tools such as: metaphors, connotation, and irony to give his readers a better perspective in what’s going on in the story. Seeing different forms of writing can help readers see the relationship between these tools and what Orwell is saying about imperialism. First of all, George Orwell uses the rhetorical tool metaphor in story. In the story â€Å"Shooting an Elephant† Orwell wrote that â€Å"They were watching me as they would watch a conjurer to perform a trick. † This metaphor meant that the Burmese who was following behind were waiting for Orwell to shoot the elephant. If Orwell shot the elephant then it would be like he was putting on a show since they were watching him. Another metaphor that he uses in the story is when he wrote that he was â€Å"seemingly the leading actor of the piece; but in reality I was only an absurd puppet pushed to and fro by the will of those yellow faces behind. † This metaphor meant that Orwell was the center of attention because he was being followed by two thousand Burmese people waiting for him to kill the elephant, and he was being controlled by the Burmese when he said he was an â€Å"absurd puppet. † Another metaphor he wrote, â€Å"He wears a mask, and his face grows to fit it†¦ meaning that Orwell pretended that he was strong and powerful, but he really didn’t want to shoot the elephant, he was just being pressured into doing it because if he didn’t then he would pay the price of being humiliated by the Burmese. Another rhetorical tool that George Orwell uses in the story â€Å"Shooting an Elephant† is connotation. In the story he said that â€Å"One day something happened which in a roundabout way was enlightening. † This sentence has a positive connotation because of the word â€Å"enlightening† meaning that Orwell speaking the truth about how he feels about the true nature of imperialism is a good thing. Orwell also wrote that â€Å"I marched down the hill, looking and feeling a fool, with the rifle over my shoulder and an ever-growing army of people jostling at my heels† This has a negative connotation because. Lastly, Orwell uses the rhetorical tool, irony in his story. In the story, Orwell wrote that â€Å"The thought in my mind was that if anything went wrong those two thousands Burmans would see me pursued, caught, trampled on and reduced to a grinning corpse like that Indian up the hill. And that happened it was quite probable that some of them would laugh. That would never do. † The irony that was being employed is that Orwell was more worried about being laughed at then being killed by the elephant. Therefore, Orwell’s writing was convincing because he uses different types of rhetorical tools to prove his point that imperialism is the worst. And Orwell prove this when this little incident happened about the elephant and how he gave him a better glimpse than he had had before about the real of nature of imperialism.

Business Case Study – Cctv

Case Study – Extreme CCTV (all details discussed in this case study have been taken from the Extreme CCTV case study as presented in Cases of entrepreneurship: the venture creation process (Morse & Mitchell, 2005)) Student Name: Katrina BinottoStudent Number: S3172726 Course: BUSM 2367 – Business Enterprise One 1. If you were Jack Gin, what would you do: acquire Derwent Systems, based in Newcastle, UK, to extend its reach into Europe, or focus on the IPO? When assessing if Jack Gin should acquire Derwent Systems or focus on IPO it is would be best suggested to undertake a review of the attractiveness and competitive position of the proposed acquisition. One method of doing this is through the use of the Boston Consulting Group (BCG) Matrix. This matrix assesses the competitive position of the business in its current form, and the aspects of the proposed businesses, against their respective market attractiveness. (Robbins, et al. 2009) The BCG considered businesses in terms of a Cash Cow, Star, Problem Child or Dog. The case study tells us that Extreme CCTV is a growing company with specialized products that produce positive cash flow for the business, which makes it a Cash Cow. Derwent, although they had difficulties with cash flow at the current time, have a specific product base and have a recognized brand name, which sits this business in the Problem Child area of the Matrix. In order to develop a business which could become a star, Derwent would be able to provide the brand and provide recognition, and Extreme is able to provide the business the necessary cash flow to achieve a possible Star business. Therefore I believe that Jack Gin should invest into Derwent Systems as it will allow the acquisition of a recognized product with the ability to sustain positive cash flows assisting in long term sustainability of the business. 2. Briefly outline the risks associated with your recommendation and how the company could manage these risks. There are risks associated both with acquisition and passing the opportunity; Not Acquiring Derwent †¢Will lose access to a high quality high performing product †¢May risk market saturation Ability to provide competitive pricing structure for current product range should competitors produce the same products Acquisition Risks †¢Cash flow – does Extreme have enough cash flow to support Derwent requirements in the short term †¢Change management issues in merging businesses and associated staff cultural issues †¢If competitors are already engaging in the market Extreme is trying to break into – do they have a marke t dominance †¢Geographical issues – managing businesses on two sides of the globe †¢Globalisation and workforce diversity issues 3. List the benefits, and why you believe they outweigh the risks Increased market share †¢Ability to offer the market more products †¢Acquiring the good will of Derwent customers †¢The additional Intellectual property from Derwent research and development †¢Additional staff and their knowledge and experiences †¢Ability to proposed more competitive pricing structures as inputs may be cheaper as business will have greater turn over and thus may be able to purchase components in bulk †¢Economies of scale – not only for tangible inputs but labour inputs †¢Increased borrowing power with the merger of two businesses – increased assets. 4. Analyse Extreme CCTV’s competitive landscape using Porter’s Five Forces Porter’s Five Forces consist of the following; †¢Supplier Power oThis component could be considered as high as with a larger volume of component turnover Derwent could access better trading terms and stronger relationships with suppliers. This would result in more reliable and competitive supply of components and with good relationship management, such as ensuring on time invoice payment, Derwent may be able to become a ‘preferred’ creditor. †¢Consumer Power oQuality would be at the forefront of the consumer’s requirements and thus this component would be considered very high. Without reliable quality products Derwent would allow competitors access to their market, reducing their cash flows and product sales. †¢Substitutes oThere are very few substitutes to CCTV. Any alternative products do not provide the same level of quality or access to the same features provided by Extreme (and Derwent) products, thus this factor is considered low. †¢New Entrants oThe possibility of new entrants into the market is low due to the fact that a number of businesses are already participating in the market, and any new entrants would need a large capital, for research and development and product development. Rivalry oIt is possible that Pelco may merge with other competitors, such as Silent Witness, and their new competitive power would be unknown at this time. Therefore this would be considered a medium risk as neither the new market nor the strategic direction of any competitors is known. 5. Analyse the opportunity using the First Screening Guide INDUSTRY ANALYS IS †¢What is the industry that addresses this market? oCCTV equipment †¢Number of competitors ?Pelco ?Silent Witness †¢Relative size of competitors oNo one competitors having a majority share in the market, which was highly fragmented. Pelco – in Extreme CCTV’s market space, from Southern California oSilent Witness – Canadian public company, worldwide networks with good growths since 1995. MARKET ANALYSIS †¢Is there a need? oIndustry had decided that CCTV use is a vital part of their overall security strategy and have experienced significant benefits oThese benefits in specialized markets, such as government agencies and correctional facilities are not being taken up by the more generalized business and consumer market. †¢Customers? oThere is clear demand for this product in government agencies, correctional facilities, and casinos proven by sales to date. More generalized usage of CCTV over time due to perceived and perhaps real reducti on of crime that has been experienced where CCTV is in use. †¢What value do you add? oThe value added service be provided would be; ?Integrated Day Night Cameras – superb performance ?Product Differentiation – a perceived distinct edge by major distributors †¢Product Life oThe product life expected from this service would be durable, as once the set up was established and trust built with customer they would be very unlikely to ‘try’ a competitor’s product. The security provided and reputation created by Extreme would see more at stake for the consumer and unless motivated by other means, such as additional services or major discounting, they would be reluctant to try another service. †¢What is the current market structure? oThe major competitors in this industry are: ?Pelco, and ?Silent Witness. oFollowing are features of services already provided; ?Pelco – provides similar products to Extreme, but at this time does not have the market reputation nor or they able provide a holistic product range as they are not able to provide an integrated camera. Silent Witness – have a product range that is able to operation in varied operating conditions, but also do not currently provide a product that allows the quality of night vision recording. †¢What is the proposed market size? oThe industry currently serves the following markets: ?Families, ?Singles, and ?Couples of any age group. †¢What is the market’s gr owth potential? oThe potential market available for this service is substantial, although it may be difficult to accurately predict. ?Gin feels that although the market is expanding he is unsure how far it will grow and what may drive this growth. Key drivers for the growth would be the increasing acceptance of CCTV usage and the merge of technologies to strengthen the security features of the products. †¢What would be the proposed cost structure? oExtreme’s proposed product offering would be to provide Derwent products under the Derwent branding, but integrate the results of their research and development which had lead to the development of the even illuminator (UF500) with Extreme’s day/night camera. This would provide a unique product to the market. Pricing for this unique product could be set above the ‘standard’ products and the pricing structure may allow scope to support ongoing research and development investments with a set portion of the pr ofit against these products dedicated to this purpose. Advertising this to the customer may encourage their increased investment in the products Extreme would provide in general. THE NUMBERS †¢Profits after tax? oCurrently Derwent profits after tax have been reducing, from $292,570 in 1998 to $159,111 in 2000. oExtreme has been experiencing good financial growth since its first year of trading in 1997. It could be considered that after Derwent acquisition that profits after tax would still be positive and in fact do have a chance of growth if the market response to the integrated product is strong. †¢Time to break even? oIt Gin purchased Derwent for $2. 6 million is would take approximately 4 years for Extreme to break even against this purchase. This is assuming that their annual profits are approximately $692,000 remains constant and that all other factors such as pay scale and in direct costs remain constant. †¢Time to positive cash? Positive cash flow would take s ome time longer than the estimated 4 years for break even. oWith the development of the desired product and ensuring its marketing and strategic placement would manage it would be possible to achieve positive cash flow very soon after breaking even. †¢ROI Potential? oThe return on investment potential is able to be seen in this business idea, but the level of ROI achievable is not able to be determined at this time as market demand is unreliable at this time. †¢Capital Requirements? oExtreme would require capital investment, through financing, to acquire Derwent. The asset base of Derwent, quoted in 2000 as being $2,353,113 in their financial statements, would provide a significant base for sourcing this finance. When considered as a whole business, i. e. Derwent and Extreme, there would be adequate assets to secure finance to complete the acquisition. The consideration needed by Gin would be the businesses ability to service this size of loan as part of normal operations. †¢Exit Mechanism? oPossible exist strategy would be to sell off the Derwent part of the company should Gin be unable to operate this part of the business. oShould t require a more significant exit from the market then Extreme could sell components and intellectual property to competitors. †¢Value? oStrategic value of the business would be high when established. It would have a solid loyal client base, established branding and market reputation. It would be able to achieve market differentiation needed to provide some assurance of long term sustainability in the market. CAN YOU AFFORD TO PLAY? †¢Production Costs? oProduction costs would differ between operating locations, i. e. Derwent and Extreme factories, as input costs may differ due to the differing localities, i. . Northern America and UK. oEconomies of scale could be achieved in bulk purchase of inputs; however the logistical issues associated with movement of stock between geographic locations may actually inc rease costs should this strategy be employed. This would have to be carefully considered. †¢Marketing Costs? oAs the market in North America currently does not appreciate the Derwent product it would be critical to demonstrate through marketing the benefits that there products, and Extreme’s on trying to enter the market, would have for them. Encouraging distributors and consumers to try the product would be critical in being able to ‘break’ into the market. †¢Distribution Costs? oDistribution costs needed to be considered would be movement of input components, where are the distributors and their clients, and would there be a ‘head office’ hierarchy set up or would the two arms of the Extreme business, i. e. Derwent and Extreme, be seen as equals in the company structure and thus have equal responsibilities and distribution strategies would be determined by each location instead of a ‘one size fits all’ approach. Prices? †¢Pricing structure would need to be competitive with other competitors where product services and capacity is similar, where there are distinct difference between what the competitor can offer and what the new Extreme business could provide the market then the ability to charge inflated prices, limited to the value perceived by the consumer, would be would become available. These potential increase profit margins on specific products could be used either as investment into research and development or to minimise the cost of borrowing. It would be dependent on any marketing strategy that would be linked with the pricing structure. †¢Costs? oBulk buying where possible would represent the best way to minimize costs for this business and achieve any economies of scale. †¢Distribution Channels? oIt would be seen that existing distribution channels to be used to promote and sell the products. As the attractiveness of the product became greater then new distribution channels would open. oAn alternative distribution would be to use the companies own resources. The staff would have the background knowledge on the development of the products and the strategic missions and values of the business and would be able to communicate these as part of their marketing strategy. †¢Barriers to Entry? oEntry into this market at this time is favorable as there are not many competitors and Extreme already holds product differentiation with its current product range. oThe ability to merge research and development from the two businesses would provide a great opportunity to emerging markets globally. †¢Legal/Contractual/Intellectual Property. There are definite intellectual property issues with this merger and then management of research and development results through this business and the proposed merger. oLegal contracts and possible supply and logistic contracts would need to be facilitated to provide opportunity for efficiencies. †¢Contacts and Networks? oContracts and networks already in place for both businesses would be used in the fi rst instance, and then with increase attractiveness of produce new networks and contacts would be developed. It is also evident within the case study that participation at trade shows would provide key opportunities to expand current networks. THE MANAGEMENT TEAM †¢The Extreme structure would remain in its current form. With the proposed retirement of Duffy, Gin would need to find an appropriate management team to continue operations of the Derwent arm of the business. FATAL FLAW/RISK †¢Existence of a Fatal Flaw oThere are possible fatal flaws in this proposal; ?Cost of borrowing required capital to acquire Derwent. ?Ability to establish a suitable management team to continue Derwent operations. ?The need to establish two geographical locations for operations the logistical issues that this may create. Staff culture issues and how Derwent staff would be received and integrate with Extreme employees. †¢Risk? oThere is a risk in this proposal in that the cost of capital required to start up the business may be prohibitive to entering the market, although the use of a merger with a business that has established distribution channels and market would reduce this risk overall. BIBLIOGRAPHY †¢Morse, Eric A, a nd Ronald K Mitchell. Cases in entrepreneurship: the venture creation process. Thousand Oaks: SAGE Publications, 2005. †¢Robbins, S, R Bergman, I Stagg, and M Coulter. Management. 5th . Pearson Australia, 2009.

Paper and Dumas Book Essay

What does Dumas’ decision to take an American name suggest about her feelings toward her adopted country? How does her dual identity enable her to see how Americans â€Å"really† feel about Iran? Dumas’ husband, Franà §ois, experiences life as an American immigrant much differently than does Dumas. What do you think accounts for Americans’ biases in their attitudes toward immigrants from different countries? To what extent are these biases grounded in stereotypes about the immigrants’ native countries? Evaluation: You will be graded on: Organization- Does the paper have an introduction, body, and conclusion? Does the paper have a central argument (thesis) that appears in the introduction and conclusion? Grammar, punctuation, and style- For example, does the writer use the past tense consistently? See â€Å"additional considerations† below. Use of the text- Does the paper successfully incorporate specific examples from the book? Do the examples support the paper’s thesis? Since this is still a relatively short paper, avoid long block quotes. Be succinct. In addition, avoid long summaries of the book. Your paper should be built around examples that support your thesis. You must, however, cite the books to support your claims. In each instance that you draw specific information from the book, you should insert the page number from which the idea or quote originated at the end of the sentence. Plagiarism: See description on syllabus Format: All papers should be double spaced and written in Times New Roman 12 Late Papers: Papers are due in class on the given due date. Computer related problems are not an excuse. Be prepared for a hard drive/ printer disaster. Back up your work often. Papers turned in after class on the due date (unexcused) will be docked 5 points (out of 100). Papers will be docked 3 points for every day they are late with the weekend counting as 1 day. Additional considerations: 1. Use the past tense consistently when discussing historical events. 2. Do not use first or second person in your paper. In other words, don’t use the pronouns: I, me, my, you, your, our, ours, us, etc. So, instead of: â€Å"I think Dumas considered herself to be†¦.† Just write, â€Å"Dumas considered herself to be†¦.† 3. Proof-read carefully. Even if your paper has no misspellings, that does not satisfy your need to proofread. Spell checker will occasionally correct your spelling, but insert a different word than you intended. 4. Do not use contractions. (didn’t should be did not, etc). 5. Your paper should adopt a more formal, authoritative tone. Do not use slang, clichà ©s, or profanity. 6. Use active, not passive voice. 7. Staple the paper 8. Do not use outside sources except lectures from this course (internet, other books etc.).

Comments and questions from classmates on USTA case study questions Assignment

Comments and questions from classmates on USTA case study questions - Assignment Example I build a six step research question in trying to elucidate how USTA approached its management dilemma question to enable the organization come up with a long lasting management decision. Step 2 was to clarify how USTA aimed at expanding itself by persuading more people with divers civilization, masculinity/gender and wealth level to enable the organization acquire vivacious information towards the diversifying multicultural population (Johnson & Clark, 2006). USTA required essential data by involving diverse demographical information to enable the organization design a measurement question of what the household income for male and female who played tennis was in the last 12 months. Thank you for your concern. I used intuition to replace perception as the two words are tantamount, but I came to realize that â€Å"perception† work best than â€Å"intuition†. Thank you for clarification. Your research question hierarchy is impressive. The research USTA undertook was to enable it expand by reaching a more diversified populace hence changing the existed elitist typecast. Therefore, do you support this type of research to be adopted as a universal way of conducting business research? Evidently, nominal data cannot be tabulated in a mathematical way. I would like to pinpoint that USTA used a large sample size, which led to a greater depiction of the population and reduced standard error but at a greater cost. Moreover, the closed questionnaire structure was intentionally meant to reduce inconsistency in the results, and this enabled the company to obtain a less scattered data (Anderson & Whitcomb,  2001). Thanks for your participation. However, I am still not contented with your choice of the measurement scale. From the USTA case study, predominant parameters included social stratification, demographic assessment and people’s participation in tennis. Axiomatically, these factors can best be ascertained by use of nominal scale since the cardinal

Religious persecution in Indonesia ( government of Indonesia is Research Paper

Religious persecution in Indonesia ( government of Indonesia is turning to a blind eye towards it) - Research Paper Example Sukarno, the first president of Indonesia, chaired a meeting with his cabinet and established a constitution law that requires the future president candidates to be a Muslim in order to curb persecution of Christians and other minorities in Indonesia. Having Muslim as a religion will make government officials have a more stable position to this problem. This attracts several people to convert to Muslim and to some extent; they are willing to change their name to Islamic (Aragon 39-41). Religious discrimination is a serious issue in Indonesia and yet the government is not taking any action to solve this issue. They should be more understanding and respect other religions. Although it has subsided recently, discrimination against religion in Indonesia is still visible and vibrant. The religious conflicts have been solely targeting Christians. Indonesia is the world’s largest and fastest growing Muslim country in the world. Being a third world country, Indonesia has unstable political structure and racial and religious discrimination common. Today, discrimination is regarded as an ordinary daily occurrence and sometimes it may have gone too far. In this particular country, discrimination against religion had hurt hundreds and even taken several lives. For instance, to demonstrate the pain the Christians are going through in Indonesia, extreme persecution and violence is the order of the day in that at some point, three Christian school girls were mercilessly b eheaded by masked attackers (AtlasShrug. Com n.d). The girls were attending a Christian school when they were attacked. The Police responded saying that one of the girls head hanged in front of the newly constructed Christian church while others placed outside the police station. The Islamic extremist claims that they are killing Christians in order to instill fears in the hearts of Christians to stop them from spreading Christian messages. Shockingly, the government of Indonesia is turning blind eye to

The Simplified Acquisitions Methods- Contract Administration and Essay

The Simplified Acquisitions Methods- Contract Administration and Management - Essay Example Government official can make and pay for a simplified acquisition using cash, purchase order, government wide purchase order at the convenience of the company (small businesses in this case). To win this acquisition, the company must simply provide contracting officials with a quotation. Simplified acquisition is a flexible method of purchasing as procedures vary by contract value. It also favors small businesses in the following ways: reduces administrative costs, improving opportunities for small firms, small disadvantaged firms and women owned small businesses, promotes efficiency and economically essential in acquisition of contracts and finally to avoid unnecessary burden for agencies and contractors. The public law established special requirements for the acquisition of commercial items intended to more closely resemble those customarily used in the commercial marketplace. The federal government developed a unit that conducted market research as an essential element of building an effective strategy for the acquisition of commercial items and establish the foundation for the agency description of need, the solicitation and resulting contracts (Office of the Federal Register US, 2010). The government also set specific procedures for solicitation, evaluation and award of contracts. Those procedures were to be adhered to by the contractors, thus making business favorable for small businesses. Other laws set by the federal government to monitor contracting include: contract quality assurance, notification of overpayment and determination of price reasonableness (Office of the Federal Register US, 2010). The use of technology has been an enormous advancement in the business sector; it makes transfer of information from one party to the other easily and efficiently. This therefore saves time as far as acquisition of products and contracting is concern. This can be achieved by attachment of quotations on a mail for

A questionnaire for a career choice Term Paper Example | Topics and Well Written Essays - 1000 words

A questionnaire for a career choice - Term Paper Example A questionnaire for a career choice To begin with, she needed a career path and a sound decision towards the same. She seems to possess confusion as regards her interests. She seems to love poker, cooking, gardening and working out. On the other hand, she has been both a player and a coach of tennis and basketball. It is vital to note that she had an earlier fantasy of being a sports’ writer. There are core problems that she seeks to address through counseling and possible solutions. To begin with, the client has a problem of career choice. She seems not to be satisfied of her current job of bier a consultant at a firm that write programs for professionals. In addition to the same, she has psychological problems. Lastly, she possesses a problem that of balancing her career ambitions with that of her children and her husband. It is vital to note that the client possesses psychological and mental problems. The treatment of the same is essential because it affects the career progress of Alaina. In this sense, the c lient is medically proven to be suffering from a mild form of depression. The medical name of this depression is dysthymia. The suicide and eventual death of a cousin might have triggered this depression. As regards this depression, she has been attending counseling sessions for eight months. It is vital to note that she has had counseling sessions over anger management problems. This also relates to previous anger problems at her school sessions. This is the factor that contributed to her career diversion from teaching to consultancy. This was vital for stabilizing her marriage and finding a sound career line. In this sense, she takes medicine in form of depression tablets. However, she still possesses a problem of suppression to feelings of good things in her life. This means she has no feelings of impression for good things in her life. In addition, she possesses anxiety and sleeping problems. Alaina possesses notable strengths and shortcomings. In her career ambitions and passio ns, Alaina seems to have a robust orientation towards writing. This is notable from her course in college. She had a college course of B.A in English and a minor in journalism. It is crucial to note that this was her subject in her schooling days. Her present job entails offering consultancy services for a firm that write career programs. It is notable that her career ambitions entail being an editorial assistant for a publishing firm or technical writing. In addition, she had an earlier fantasy of being a sports’ writer. Besides, Alaina seems to be aware of her interests. In this sense, she has strong decisions of not preferring educational careers. However, Alaina has anger management problems. This attributes to her uncontrolled anger during her teaching days. In this sense, Alaina needs to work on social relation skills. This regards appropriate emotional response to situations. In our working relationship with the client, I will ensure notable ideas for a solid working r elationship. To begin with, my strategy would involve eliminating the professional outlook to the client. This would be appropriate for establishing an intimate relationship with

Do Freshmen Students need RAs at Miami University Term Paper

Do Freshmen Students need RAs at Miami University - Term Paper Example The decision by Miami University to have RAs on campus is very important. A wide range of services provided by RAs help in creating a supportive environment for freshmen, many of whom are away from home for the first time Office of Residence Life ( Office of Residence Life, 2015). The RAs have been helpful in serving the residents as well as granting them a certain level of independence at the same time. It is evident that RAs have been great sources of advice and campus resources to new students that may otherwise be unable to acquire the same resources. RAs serve this purpose most importantly by being friendly and relatable as well as by serving as peer advisors for fellow students. They have organized and transformed halls of residence thereby eliminating confusion and surprise among new students, and instead increased comfort and satisfaction of campus life among residents. The effectiveness of RAs at the University is evident through their ability to deal with conflicting situat ions in halls of residence as well as helping green freshmen to understand university activities. Therefore, the decision of having RAs in halls of residence should be embraced across all higher learning institutions to promote smooth and friendly transition process among freshmen students. The following interviews with two freshmen at the university confirmed the role and importance of RAs in helping freshmen students attain smooth transition process to college life. Kayla: E-mail Address: Lawsonk2@miamioh.edu

The Impact of Westward Expansion during Jefferson's Presidency on Essay

The Impact of Westward Expansion during Jefferson's Presidency on Native Americans, African Americans, and on American - Essay Example The greatest achievement of Jefferson in his first term as president was the purchase of the Louisiana Territory in 1803 from France. The Louisiana Purchase was one of the leading land deals in history. The United States paid approximately $ 15 million dollars in 1803 for over 828, 000 square miles of land2. This act served as the main achievement in the period of Jefferson’s presidency (The Jefferson Monticello 6). The westward expansion of the land had several impacts on the Native Americans, the African Americans and the Americans as a whole. The Louisiana Purchase Thomas Jefferson purchased a large piece land from France that was referred to as the Louisiana Purchase. The land consisted of Missouri, Arkansas, Oklahoma, and Nebraska, some parts of Minnesota to the south of Mississippi River, sections of Montana, Northern Texas, Kansas, Wyoming, and Louisiana on the either sides of River Mississippi as well as the city of New Orleans. There are several areas that are also in cluded in the land Purchase. Before Jefferson purchased the land, United States had only thirteen states. The purchase of this piece of land almost doubled the size of the United States. There are various reasons why President Jefferson purchased land. The main reason was because the New Orleans was the main port for trade. The port was mainly used to store the export items and was also used for importing the goods coming from the other countries. However, the nation was under a constant threat of having the port taken away for trading purposes. For that reason therefore, President Jefferson thought that it would be wise and best for the country if he purchased it3. The plans of President Jefferson depended on the western expansion and access to the markets for the American products, especially the farm products. Due to the expansion, the new American settlements on the west of the Appalachian Mountain mainly depended on river transport in order to get their goods to the market beca use the overland trade to the east was very costly and impractical (The Jefferson Monticello 4). The impacts of westward expansion Baldwin asserts that even though the westward expansion was of vital importance, it also affected the Native Americans, African Americans, and the entire American society differently (41). America did not have New Orleans in 1800 which acted as the major factor to the economy of Mississippi valley as a whole. Most parts of North America were controlled by the European powers, Spain, France, England and Russia4. Another reason why Jefferson agreed with the Napoleon’s offer of selling Louisiana was to ensure that the United States of America dominated power in the northern part of the continent. The expansion had several impacts on the people. For instance, it caused difficulties in transportation, lowered economic level, increased racism and in the process; wars took place leading to destruction of property and loss of life. All individuals includi ng the Native Americans, the African Americans and the American society as a whole experienced the impacts of the expansion. In general, all Americans were affected during the westward expansion. The effects of the westward expansion on Native Americans The Native Americans experienced various impacts due to westward expansion. For instance, social instability as most parents could not control their children because they thought they were big enough to be independent. They therefore left their families

Examining the system and the results Essay Example for Free

Examining the system and the results Essay Specific rules are also taken into accounts which affect the speed of an ambulance vehicle such as number of lanes, number of traffic lights, restricted access, presence of schools, street markets, the width of the road and conditions of the road surface. Each road within the logical network was given a weight according to the different rules mentioned above. This weight is a numerical value that is used along with travel time costs (speed limits and lengths) in order to find weighted travel time costs which consider all the rules that could affect the speed of the vehicles in reality. For example, if a road has one lane, it will be given more weight than the two lanes road. The travel costs of these roads are then re-calculated by multiplying the weight with the travel cost. As a result of this procedure, the calculated travel time (weighted) will be higher in one lane road than two lanes road; i. e. one lane roads will be inadvisable because a vehicle is expected to take much time to travel along these roads than the two lanes and will have an effect on manoeuvre ability of ambulance vehicles along these roads. This procedure is then repeated for all other rules in order to find the travel time costs (table 7). The general rules which considers the day of the week and time of day are then integrated. This is done by adding other weights to the road, dependant on the day and the time, according to that the real travel time cost will be updated Two terms will be used when integrating the expert knowledge to the system, travel time and weighted travel time. Travel time only considers the length and the speed of each road while weighted travel time considers both the travel time and the rules which have already been set from the experts. By assigning various weights (numerical value) to the roads depending on priorities of choosing one route rather than another, it is possible to achieve a more accurate travel time on the streets. This is done by multiplying the weights field to the travel time field to get another field that can be called weighted travel time. Weighted travel times can be then used as the cost field ArcView Network Analyst to find the fastest route between two points. This system was examined by setting up several scenarios based on various times and rules collected from ambulance drivers’ knowledge in order to find the least time cost routes between an incident and a hospital location. As an example it seen that the ambulance drivers usually prefer two lanes roads than one-way lane. This is because it is hard for the drivers to manoeuvre on one-lane roads especially when there is road’s congestion or car accident on the way. Therefore different weights would be assigned to each of these roads in order to find the fastest route that considers the one-lane’s factor. The one lane factor in addition to other factors will be discussed in the scenarios below. Scenarios two, three and four integrates some of the expert knowledge while scenario one is used by norm navigation systems. A comment string field was added to the road network layer to detail the reason of giving such weight or the reason of giving a negative value to the travel cost field as seen in table 8. This scenario calculates the least travel time route (fastest route) in minutes based on using the MINUTES field in the road which is calculated from distance/speed. The speed in here represents the speed limits in km/h. This scenario is used mostly by norm navigation systems such as Dell/Navteq GPS Navigation System in order to find the quickest path between two points. The response time was 3. 25 minutes in this scenario after converting it from hours (figure 4) and related attributes (table 9). Scenario two This scenario assumes that several streets of previous route exist within a school zone of 200 metres. For example, between 1:30-2:30 P. M. this zone is predicted to be congested due the car parking and students crossing the streets. Therefore any street which falls within this zone will be assigned to a weight of 1. 1 while other values are assigned to 1. Then the weight field (weight1) is multiplied by the travel time cost field (MINUTES) to calculate another weighted travel time field (INCHES). As a result of this procedure the travel time will be maximised along these weighted streets as seen in figure 5. The response time was 3.78 minutes as seen in table 10. Scenario three This scenario assumes that a roadwork is in progress, on one side of a local street at the same time as the previous scenario. This temporal data can be collected from the municipality periodically and update the system according to it. Another weight of 1. 1 is assigned to that street which will re-route the current path in order to avoid the expected delay time. In this scenario the response time was 3. 87 as seen in table 11. The re-routed fastest path is shown in figure 6.

The Ethics Of Dark Tourism

The Ethics Of Dark Tourism The Anne Frank Organisation (2006) states that in 2004, 936,000 visitors visited the house that used to be Anne Franks, a Jewish girl who among other Jews were murdered in the time of Hitlers fascism. Among this timeframe, Auschwitz, a concentration camp based in Poland which became a symbol of genocide, annually receives 750,000 visitors (Yuill, 2003) coming close to the annual 900,000 visitors to Dachau (Lippard, 1999). All these sites and many more which are similar, are what are called sites for dark tourism (Lennon and Foley, 2000), also known as Thanatourism (Seaton, 1996 cited in Ryan et al, 2005) and Black Spots (Rojek, 1997). This form of tourism is what Seaton (1999) defines as sites and attractions that are associated with deaths, acts of violence, scenes of death and crimes against humanity. With the popularity of this form of tourism growing within the horror tourism market (Tunbridge and Ashworth, 1996), the ethical issues surrounding it will need to be questioned. With the consumers and providers taking part in this growth of dark tourism, both their potentially contrasting ethical views towards dark tourism may be different. Whereas a providers means of preserving history is to charge people to maintain its upkeep, the consumers may see it as money making scheme in the expense of the deceased lives of the site. Whereas the providers means of letting people know its history is through interpretation of vulgar images, may seem unethically distasteful for consumers. Therefore, using Stone (2006)s shades of darkness spectrum as a tool for measuring different levels of dark tourism sites, these two main issues will be critically examined in depth, and in both the consumers and providers point of views to further understand the ethical dilemma of dark tourism. Dark tourism has often raised ethical debates about the ways in which leisure and pleasure are mixed with tragedy (Kempa and Strange, 2003), as many people think some sites for dark tourism is too sensitive to present it for the world to see. However, although this may be the case, it actually varies depending on the shade the site is supplying. This has been supported by Stone (2006) in which he believes that not all dark tourism sites and its supplies have the same degree of darkness and ethics. Stone (2006) believes that each site and what it supplies has its own degree of darkness, and depending on its criteria; it can be placed on what he refers as a darkest-lightest spectrum. On one side of the spectrum is what he termed lightest side of dark tourism. Sites belonging to this side of the spectrum tend to be fully commercial providers such as the London Dungeon, which Stone (2006) also term Dark Fun Factories, as its main aim may be more financial than educational. Stone (2006) further explains that although sites belonging to this side of the scale will be associated with death and suffering, it is not OF death and suffering. Therefore, sites at this lightest side will most likely be purposeful and entertainment based, with a lower degree of ethics surrounding it. However, on the other end of the spectrum are the darkest side of the spectrum, in which its criterias are completely the opposite of those on the lighter side. Stone (2006) explains that sites on the darkest side will be sites of death and suffering and its orientation will be to educate. Examples of these darker sites are which Wight (2005) class as primary sites, such as holocaust camps to sites of celebrity deaths, as sites on this side of the scale will be seen as authentic and non-purposeful, leading to a higher degree of ethical issues surrounding the sites at this side of the scale. One of these ethical issues is the notion of whether consumers should be charged to enter a site of death and with so much history. In novices and consumers eyes, it could be seen as unethical as they may see it as a means for providers to make profits in the expense of the deceased lives and history. Although this may be the case on sites within the lighter shade of the spectrum as it may be purely commercial, it is not always the case within the darker sites. Sites from the darker shade such as Auschwitz, the Gallipoli Anzac (Slade, 2003) and Robben Island prison (Shackley, 2001) are normally sites which are old and need continuous up keeping and staff. With this continuous maintenance, sites will need money to be able to continue to run its site and its historical contents. However, this also leads to the issue of how much. If a site charges just enough to afford the upkeep, then it may seem fair and ethical to do so. For example, according to Shackley (2001), the prison in Robben Island which Dann (1998) elaborates as a Dungeon of Death attraction, employs local people as tour guides, and their average weekly wage is  £10, which is the same amount as the entrance fees. However, if the entrance fees were to double, it will then be seen as profit making, thus, unethical as it is money making in expense of the past. By charging its consumers, it may also be a means of controlling how many consumers enter the site, as mass consumption of the site may lead to deliberate sanctification and loss of original identity of the site. Strange and Kempa (2003) agrees with this and further states that the commodification of history for mass consumption frequently leads to the trivialization of the site, and in turn causes deliberate sanctification of its history, as well as the loss of original purpose of why the site was built. An example of this happening is shown in the site of Machu Picchu. Johnston (2006) explains how ever since Machu Picchu was named a World Heritage Site in 1983, over 500,000 visitors started visiting the site every year, and to prevent deliberate sanctification, an entrance fee of $20 was put up. This in turn not only did not limit the number of foreign consumers from visiting, but also pushed the local people out of its own heritage site as they could not afford the entrance fees. Johnston (2006) continues to explain that this has contributed to the mass replacement of indigenous people with tourists around the site, causing sanctification and trivialisation of the site, as the original culture of Machu Picchu was gone. Despite all the motives that the providers have for charging its consumers, its clearly shown that it needs to be managed efficiently in order for it to work. Consumers who are consuming the product as experience and integration (Ryan et al, 2005) may agree with the notion of charging as it may feel like they are giving back to the deceased lives and the history of the site. Lippard (1999) explains this as guilt tripping in which consumers of this typologies may feel guilty of what happened in the past and may want to contribute towards the history in order to feed their conscience. Consumers consuming as experience and integration (Ryan et al, 2005) may be more sentimental than consumers that are consuming as play (Ryan et al, 2005), as the typology of play consumers will come from a Psychocentric (Novelli et al, 2005) background in which they may visit frequently to lighter shades of dark tourism sites but rarely to sites of a darker shade. Elaborating from this, it could be possible that consumers consuming as play may not be used to the dark history of the sites and may be shocked of its contents and backgrounds surrounding the darker sites, thus, may welcome the sanctification of the sites but not the notion of charging. Frequent happenings of this emotion tend to happen in what Ryan et al (2005) called Grey tourism supply, in which Ryan et al (2005) explains this theory as consumers with low, or no interest and knowledge in death and tragedy visits an intended dark tourism site. In this situation, a consumer may not be aware of the dark historical contents of the site as they would not have previous knowledge due to its lack of interest, but upon arriving to the intended site and knowing its gore details, they may instantly be repulsed and shocked. However, this is rare as Seaton (1999) believes that dark tourism is consumer demand rather than attraction demand, explaining that if it was not from the high interests and demand from the audience, there will not be the dark sector of tourism. To some extent, Seaton (1999) may be correct and that the main reason for the existence of dark tourism could be from the high demands for dark tourism. However, for this to happen, the presentation of the sites may also be blamed for the high popularity of dark tourism. This is because Walter et al (1995) explains that even when consumers are interested in death and tragedies, for tragedies to be given a real meaning, it needs to have a context by explanation, and sometimes through the personal stories of those people who has been caught up in it. This has been previously mentioned using an example from one of the darker sites of Robben Island. Shackley (2001) states that the prison site in Robben Island located in South Africa, employs ex prisoners that used to be held there. These ex prisoners are now acting as tour guides for its consumers, repeatedly telling each group of consumers their own personal experience of when they were held in the cells. Shackley (2001) continues to ex plain that the emotional welfare of the guides had not been considered and many of the guides felt obliged to continue with its employment due to lack of employment elsewhere. Although Walter et al (1995) did explain that consumers are interested in personal story telling, but ethically, should stories as sensitive as this be told repeatedly and personally from the own mouths of the ex prisoners? This may not only be ethically wrong, but also morally wrong. Blom (2000) agrees with this and states that interpretation as personal as this should be interpreted though technology such as information points within the sites. However, despite this, providers within the darker sites may not see it in the same way. Providers could argue that employees such as ex prisoners are getting paid and that they decide to be employed in this job role voluntarily. Providers could also argue that story telling from the mouths of people who have been caught up within the history of the sites are more rel iable and feasible than technology. This may be because stories that will be told from someone who has actually experienced and been there, may infact reduce the exaggeration of the contents of the history and stories, as well as being less biased than if technology was to tell it. By interpreting using technology, there could be a high chance that the information recorded into the technology is from someone with no relations to the site, thus, gives consumers wrong information. Also, this method of tour guides for interpretation may actually further benefit both the providers and consumers, as if the consumers had to ask a question about the site and its history, it can be answered immediately by the tour guides, delaying the time in which the consumers may form its own answers and judgements about the site. The views of the darker site providers in employing tour guides may also be the same for the views for providers of the lighter shade of dark tourism, as it may be required and expected by consumers to have someone to guide through the lighter sites, e.g. the fun factories (Stone, 2006). However, an implication that can arise from this is that within the lighter shade of dark tourism, the tour guides may exaggerate the actual history and stories behind the site in order to manipulate the consumers attention and encourage repeat business. Manipulation of consumers attention can also be done by the movement of original objects. For lighter shades of tourism sites to do this may be accepted, as previously mentioned before; Stone (2006) explains that sites of a lighter shade tend to promote any materials in order to attract business, thus, attracting profits. However, if a site of a darker shade decides to do this, the circumstances will change and it will become unethically wrong. For example, Wight (2005) states that in Auschwitz, the famous signage that read Work will set you free was moved from its original position to a location near the end of the tour to create a high point for consumers to reach a controversial conclusion to the experience. This can be a form of manipulation as Carnegie (2006) states that some sites do intentionally move objects in order to interpret the displays to contain central, recognisable, emotional and generic truths to the local audiences. This raises an ethical dilemma, as although prov iders may see nothing wrong with this as controversial conclusion may leave its consumers feeling the pain and tragedies of the past, but the ethics of this makes it unfair and unauthentic for its consumers. The main purpose in why consumers visit places of dark tourism in the first place is because they may want to experience the real truth behind the sites first hand, and thus travelled to the site to get this experience. However, when providers moves objects around to help stimulate consumers minds, it is made unreal as it is not how the history says it was, but how the providers want it to be. By moving objects, bits of history gets moved as well, and as time moves on and nobody moves it back to its original place, the origin and bits of history of it are forgotten, hence the deliberate sanctification of some sites and the movement of sites within the shade spectrum. The phenomenon of dark tourism is a difficult and delicate field to understand, but one aspect of it that is most understood is that it is increasingly growing in popularity, with thousands of consumers flocking worldwide to see these sites of tragedy. However, the ethics of visiting sensitive sites such as these are also growing, as questions such as whether to show or not to show, and whether to charge or not to charge are often questioned in both the providers and consumers point of views. To show these sites of tragedies may cause exploitation of local people as well as deliberate sanctification of the sites and its history, but to not to show, our history may be denied to us. By understanding the ethicalities of dark tourism, it will help in preserving its history and sites, so that it can then be better managed and better preserved and presented for the future. This in turn reduces the risk of exploitation of the sites and the way different typologies of consumers think. However, ethical issues do not stop at the grounds of the consumers and its providers, the sensitivity of the tour guides are also needed to be explored. As discussed previously, tour guides such as ex prisoners are sometimes obliged to relive their experience repeatedly in order for consumers to know the history. Although this may be one of the effective methods of telling history, it is important to consider the welfare of these tour guides, as the repetitive telling of their own experience may in turn contribute to further unethical dilemmas. Therefore, maybe to finally conclude on the ethics of dark tourism, it may be possible to state that ethical issues will always continue to exist around dark tourism, as long dark tourism itself exists too. However, the importance of the consideration of the ethicalities of dark tourism cannot be understated, and both consumers and providers may want to work together, if in the future, we still would like to know about our history through the form of tourism instead through textbooks and education.

Unusual Presentation of Ewing’s Sarcoma

Unusual Presentation of Ewing’s Sarcoma D.V.Prasad1, Sanjay Mulay2, Krishna Badgire 3, *Abhinav S.Jadhav4, Deepak Datrange5, Sagar Jawale6, Arun alex7 ABSTRACT: Ewing’s sarcoma is a highly malignant, round cell neoplasm of uncertain origin. It is the sixth most common malignant tumor of bone. It must be distinguished from chronic osteomyelitis and other malignant round cell tumors like lymphoma, metastatic neuroblastoma and small cell osteosarcoma. Most patients are between 10 to 25years old; rarely patients are younger than age 5 years and older than age 40 years. We report a 55 years female who presented with swelling over right shoulder with pain and inability to move right shoulder later diagnosed as Ewing’s sarcoma of proximal part of humerus right side. The earlier diagnosis at this age may help in better management of the condition and prevent further complications and have better prognosis. KEY WORDS: Ewing’s sarcoma, Primitive neuroectodermal tumor (PNET), Ewing family of tumors (EFT), round cell tumor. INTRODUCTION: Ewing’s sarcoma is a highly malignant, round cell neoplasm of uncertain origin. It is the sixth most common malignant tumor of bone [1]. Most patients are between 10 to 25years old; rarely patients are younger than age 5 years and older than age 40 years. The present report is about rare presentation of Ewing’s sarcoma in a 55 years old female who presented with swelling over right shoulder with severe pain and inability to move right shoulder. CASE REPORT: A55 years old female, housewife, was presented with progressive swelling over right shoulder and difficulty in shoulder movements. Swelling was accompanied with severe pain which increased gradually over a period of 6 months. On examination, she was an average built female with swelling over right shoulder and upper part of right arm. Swelling was of 25x20cm size. It was a solitary swelling with local rise of temperature over swelling. Swelling was tender and variable in consistency. It was a non-mobile swelling. Redness and prominent superficial veins were visible over swelling over right shoulder and upper part of arm (Fig.1). Her hemoglobin levels were decreased and she had elevated erythrocyte sedimentation rate (ESR). Her renal function tests and liver function tests were towards lower normal range. X-ray right shoulder with arm shows round lytic lesion in head and upper part of humerus (Fig.2). MRI of right shoulder joint was suggestive of a 8.76.76.5 cm well defined, lobulated, expansile, lytic, lesion involving head and proximal shaft of right humerus, causing thinning and erosion of the cortex with breach at few places and narrow zone of transition, adjacent soft tissue extensions with edema and moderate right shoulder joint effusion. These findings are suggestive of Neoplastic mass involving proximal humerus with pathological fractures (Fig. 3) Histopathology report shows sheets of small round cells with hyperchromatic nuclei, condensed chromatin and scanty eosinophilic cytoplasm with vaculisations with unremarkable bony trabeculae (Fig.4). Immuno-histochemistry is suggestive of Vimentin, CD99, S 100 positive and AE1/AE3 focally positive. Cytology report was suggestive of cytomorphological features positive for malignancy (Fig.5). Fig. 1: Clinical photograph of patient showing right shoulder swelling. Fig.2:X-ray right shoulder showing round lytic area in upper end of humerus. Fig. 3: MRI right shoulder T1W,T2W and STIR images showing expansile, lobulated, lytic lesion involving head and proximal part of humerus. Fig.4: Microscopic picture (40X) showing sheets of small round cells with hyperchromatic nuclei, condensed chromatin and scanty eosinophilic cytoplasm. Fig.5: Cytology report showing cytomorphological features positive for malignancy DISCUSSION: In 1918 Arthur Purdy Stout described a tumor composed of small round cells with rosettes in Ulnar nerve [2], later on it became known as Primitive neuroectodermal tumor (PNET). James Ewing described a tumor of diaphysis of long bones composed of undifferentiated cells and the tumor was radiosensitive [3]. Earlier Ewing’s sarcoma (ES) PNET were described as two separate entities, but in 1975 Angervall and Enzinger described extraskeletal tumor resembling to ES [4]and Jaffe et al. wrote an article on â€Å"the neuroectodermal tumor of bone† in 1984 [5]. Now it is known that ES and PNET show similar translocations and are considered to be ends of histological spectrum of Ewing’s family of tumors (EFT). Analysis of molecular techniques not only provided better understanding of biology but also help in developing better techniques in diagnosis and prospective potential treatment. Epidemology: EFT comprises 5 to 10 % of total bone tumors and is the 2nd most common tumor of childhood [6]. It occurs predominantly in young adults and children and shows a slight predilection for males [7].75% cases are seen between 10 to 25 years age of life. Youngest case reported so far was of 4.5 months old [8] and oldest case reported was 61 years old. Infancy cases are to be differentiated from metastatic neurofibroma. Sites: In 55% long bones it is usually diaphyseal lesion but also metaphyseodiaphyseal lesion can be seen. Flat bone (pelvis and ribs) involvement can also be seen. Less common sites of occurance are skull, vertebra and scapula. Presentation of Ewing’s sarcoma: Pain, Swelling and fever are the presenting symptoms. X-ray shows permeative pattern of bone involvement (boundary between uninvolved bone and area of bone destruction and bone is broad, vague imperceptible). All types of periosteal reactions seen like onion peel, moth eaten, honey combed, fine and reticulated [1]. Biopsy Ideally core biopsy is done, if repeated attempts of core biopsy fails open biopsy is done. FNAC not recommended in case of Ewing’s sarcoma. Frozen section studies opted in selected cases only as freezing of tissue distorts the morphology. Fixation of tissue is done in 10% formalin. Inadequate fixation leads to loss of antigen, so inconclusive results on immunohistochemistry and also causes autolysis and degeneration of DNA thus making molecular analysis difficult. Ratio of specimen to formalin is 1:10. Histology: It is prototype of small round cell tumor growth. It is composed of sheets of small cells with increased nuclear to cytoplasm ratio. Cytoplasm is scanty, eosinophilic, and detected by periodic acid Schiff (PAS), contains glycogen and diastase degradable. Occasional rosette formation are seen and frequently undergoes necrosis and residual viable cells show perithetiomatous or perivascular distribution.EFT tumor cells can be large with irregular nuclear membrane and prominent nucleoli [9]. EFT cells show membrane expression of CD99 /MIC 2 on immunohistochemistry [10]. Antibody against FLI-1 is seen in nucleus of tumor cells which is specific for diagnosis of EFT [11]. Tumor cells may show neuron specific enolase (NSE), synaptophysin and s-100 protein. Family of EFT includes -1)non hodgekin’s lymphoma 2)rhabdomyosarcoma 3)synovial sarcoma 4)messenchymal chondrosarcoma 5)desmoplastic small round cell tumor (DSRCT) 6)retinoblastoma. False positive cd99 screening is seen in other cases as well hence CD99, FLI1 and NSE to be positive for diagnosis of EFT/PNET. Molecular genetics: Translocation t (11:22) (q24:q22) is seen in 85 % cases. Fusion of EWS gene on 22q12 with FLI-1 on 11q24 results in chimeric fusion transcript EWS-FLI1 [12]. EWS-FLI1 induces insulin like growth factor (IGF-1). Phospholipase D2 (PLD2) and Protein tyrosine phosphatase 1 (PTPL1) are expressed in increased levels. Thus tumor cells escape from apoptosin and growth inhibition. Therapeutic targets: EWS-FLI1 fusion is to be targeted and split. Monoclonal antibodies against IGF -1 are being tried as it is associated with EFT growth [13] and PLD 2, PTPL1 are other conceivable candidates as both are highly expressed in EFT [14]. Chemotherapy in ES: There is no universally accepted staging. American joint committee on cancer (AJCC) suggests that primary bone or extra skeletal Ewing’s sarcoma may be included with their respective bone or soft-tissue sarcoma staging (STS) systems [15]. Although AJCC staging includes metastatic disease and tumor size greater or less than 8 cm; nodal status and grade are irrelevant for ES because it rarely spreads by lymph nodes and by definition of ES is high grade tumor [15]. Most of centers use presence or absence of metastasis at the time of diagnosis, as main tool for planning the treatment. Prognostic factors: 1) tumor site and size 2) age and gender 3) serum LDH levels ES in distal extremity has better prognosis than proximal extremity. ES in central location (pelvis) has worst prognosis [16] [17] [18]. Tumor volume 100-200ml- large tumor has bad prognosis. Girls have better prognosis than boys [18]. Increased serum LDH levels at time of diagnosis with large tumor with metastatic disease has worse prognosis. Metastasis in lungs alone has prognosis better than metastasis in extra-pulmonary sites. Patient with minimal tumor or no residual tumor after preoperative chemotherapy incline towards better prognosis. Evolution of chemotherapy: Adjuvant therapy: Vincristine + Actinomycin D + Cyclophosphamide (VAC). Intergroup Ewing’s sarcoma study (IESS): VAC + doxorubicin. IESS trial –II demonstrated that intermittent high doses of VAC + doxorubicin was superior to continuous moderate dose therapy with this agents [19].VAC+ doxorubicin alternating with Ifosfamide and Eloposide (IE) has better prognosis. There is no role of dose intensification. Current trend: Alternating cycles of VAC IE every 3 weeks for 48 weeks with local control at 9-12 weeks [20] is to be administered. There is no role of dose compression (decrease in duration of cycles).There is some role of stem cell in preliminary stage of management. Local therapy: Surgical resection with or without limb salvage followed by Radiotherapy and then chemotherapy is given. Chemotherapy remains back bone of the T/t for Ewing’s sarcoma, local T/t with surgery /or radiotherapy has important role in management of ES. The outcome of management is better in localized ES as compared to elusive outcome in metastatic disease or local recurrence. This case is presented in view of rarity to increase suspicion index for the presence of Ewing’s sarcoma. Early detection of Ewing’s sarcoma as chemotherapy and radiotherapy can limit further damage and progression of the disease can be done. REFERENCES: Joseph M. Mirra, Piero Picci: Ewing’s sarcoma In: Bone tumors- clinical, radiologic, and pathologic correlations, volume two, Lea Febiger, Philadelphia, London1989, pp. 1088-1094. Stout AP. A tumor of the ulnar nerve. Proc NY Pathol Soc 1918; 12:2-12. Ewing J. Diffuse endothelioma of bone. Proc NY Pathol Soc 1921; 21:17-24. Angervall L, Enzinger FM. Extraskeletal neoplasm resembling Ewing’s sarcoma. Cancer 1975; 36:240-51. Jaffe R, Santamaria M, Yunis EJ, Tannery NH, Agostini RM Jr, Medina j, era/. The neuroectodermal tumor of bone. Am j Surg Pathol 1984; 8:885-98. Gurney JG, Swensen AR, Bulterys M. Malignant bone tumors. In: Ries LA, etal, editors. Cancer incidence and survival among children and adolescents: United States SEER Program 1975- 1995. Bethesda, MD: National Cancer institute. SEER Program. NIH Pub. No. 99-4649; 1999. p. 99-110. Zamora P, Garcia de Paredes ML, Gonzalez Baron M, Diaz MA, Escobar Y, Ordonez A, et al. Ewings tumor in brothers. An unusual observation. AmJ Clin Oncol 1986; 9:358-60. Kim, T.E., Ghazi G. Atkinson G. ct al.: Ewings sarcoma of a lower extremity in an infant: A therapeutic dilemma. Cancer, 5c: 187, 1986. Nascimento AG, Unii KK, Pritchard DJ, Cooper KL, Dahlin DC. A clinicopathologic study of 20 cases of large-cell (atypical) Ewings sarcoma of bone. AmJ Surg Pathol 1980; 4:29-36. Khoury JD. Ewing sarcoma family of tumors. Adv Anat Pathol 2005; 12:212-20. Nilsson G, Wang M, Wejde J, Kreicbergs A, Larsson O. Detection of EWS/FL1-1 by immunostaining. An adjunctive tool in diagnosis of Ewing’s sarcoma and primitive neuroectodermal tumour on cytological samples and paraffin-embedded archival material. Sarcoma 1999; 3:25-32. Delattre O, Zucman J, Plougastel B, Desmaze C, MelotT, Peter M, et al. Gene fusion with an ETS DNA-binding domain caused by chromosome translocation in human tumours. Nature 1992; 359:162-5. Ludwig JA. Ewing sarcoma: Historical perspectives, current state-of-the-art, and opportunities for targeted therapy in the future. Curr Opin Oncol 2008; 20:412-8. Abaan OD, Levenson A, Khan O, Furth PA, Uren A, Toretsky JA. PTPL1 is a direct transcriptional target of EWS-FL11 and modulates Ewing’s Sarcoma tumorigenesis. Oncogene 2005; 24:2715-22. Greene FL, Page DL, Fleming ID , A. Fritz, C.M Balch, D.G. Haller et al, eds. AJCC cancer staging Manual. 6th ed. New York, NY: Springer; 2002. Rodriguez –Galindo C, Liu T, Krasin MJ, Wu J, Billups CA, Daw NC, et al. Analysis of prognostic factors in Ewing’s sarcoma family of tumors: review of St. Jude children’s research hospital studies cancer 2007; 1 10:375-84. Cotterill SJ, Ahrens S, Paulussen M, Jurgens HF, Voute PA, Gadner H et al. Prognostic factors in Ewing’s tumor of bone: analysis of 975patient from the European intergroup cooperative Ewing’s sarcoma study group. J clin oncol 2000; 18:3108-14. Bacci G, Longhi A, Ferrari S, Mercuri M, Versari M, Bertoni F. Prognostic factors in non-metastatic Ewing’s sarcoma tumor of bone: An analysis of 579 patients treated at a single at a single institution with adjuvant or neo-adjuvant chemotherapy between 1972 and 1998.Acta oncol 2006; 45:469-75. Burgert EO Jr, Nesbit ME , Garnsey LA , Gehan EA, Herrmann J, Vietti TJ, et al. Multimodal therapy for management of non-pelvic , localized Ewing’s sarcoma of bone :intergroup study IESS-II. J Clin Oncol 1990; 8:1514-24. Granowetter L, Womer R, Devidas M, Karlio M, Wang C, Bernstein M, et al. Dose –intensified compared with standard chemotherapy for non-metastatic Ewing’s sarcoma family of tumors: a children’s oncology group study. J clin oncol 2009; 27:2536-41.

A Comparison of A Midsummer Nights Dream and Romeo and Juliet Essay

Parallel Themes and Characters in A Midsummer Night's Dream and Romeo and Juliet Certain parallels can be drawn between William Shakespeare's plays, "A Midsummer Night's Dream", and "Romeo and Juliet". These parallels concern themes and prototypical Shakespearian character types. Both plays have a distinct pair of 'lovers', Hermia and Lysander, and Romeo and Juliet, respectively. Both plays could have also easily been tragedy or comedy with a few simple changes. A tragic play is a play in which one or more characters has a moral flaw that leads to his/her downfall. A comedic play has at least one humorous character, and a successful or happy ending. Comparing these two plays is useful to find how Shakespeare uses similar character types in a variety of plays, and the versatility of the themes which he uses. In "Romeo and Juliet", Juliet is young, "not yet fourteen", and she is beautiful, and Romeo's reaction after he sees her is, "O, she doth teach the torches to burn bright! It seems she hangs upon the cheek of night As a rich jewel in an Ethiop's ear Beauty to rich for use, for the earth too dear!" Juliet is al... ..., not because one character has a flaw, but both families have a flaw- pride. Prohibited love, romance, controlling families, both plays have it all. With a few simple modifications, "A Midsummer Night's Dream" could have been a tragedy, and "Romeo and Juliet" could have been a comedy. Shakespeare however, uses many of the same character types, young, prudent, rebellous lovers, and controling family members, in both comedies and tragedies. The end results are character molds, along with theme molds that can be easily translated into almost any plot, in any play.

A Midsummer Night’s Dream Essay: Romanticism and Realism :: Midsummer Nights Dream

A Midsummer Night’s Dream: Romanticism and Realism In A Midsummer Night’s Dream, by William Shakespeare, love is viewed in different ways. Bottom proves to be quite accurate characterizing the four main lovers when he states, "O what fools these mortals be† (Act #, Scene #, Line #). While the four main characters believe in romanticism, Theseus is a strong supporter of realism. Demetrius and Lysander both speak in figurative language and both are very handsome. Their love for Helena and Hernia deal mainly with physical attraction and flirtatious acts than love that captures body, mind, and soul. If any of the four characters posses anything of realistic love, it would be Hermia. She was willing to risk death in order to be with Lysander. This act of love goes beyond any other in this play, and demonstrates Hermia’s devotion to Lysander. "My good Lysander, I swear to thee by Cupid’s strongest bow- Tomorrow truly will I meet with thee" (Act 1, Scene 1, Line #). Helena is one of the silliest characters in the play, and at times can be quite irritating. Demetrius shows no love for her, yet she persists in chasing him. "And even for that do I love you the more. I am your spaniel; and, Demetrius, the more you beat me, I will fawn on you" (Act 2, Scene 1, Line #). These characters are a true definition of lovesick. All of them appear to be in love with love, more so than in love with each other. They all frantically run about, each changing partners so often that one is never really sure of who loves whom. Each consumes themselves with what they consider to be real love to the point of losing touch completely with the real world. To them, love is a fairy tale that involves no reason. They all believe that falling in love involves nothing more than romantic speech and desire for each other. Unlike the four main lovers, Theseus, Duke of Athens, believes that men should never be out of touch with the real world. In short, he views the four lovers’ story as nothing but an illusion concocted in their imaginations. The entire idea of being infatuated with one’s lover to the point of losing touch with the real world is ludicrous to him. At first, Theseus’ love for Hippolyta may be viewed as cold, but once one realizes Theseus’ realistic and noble character, it is obvious that he strongly desires his bride.

Insulin and Student Response Sheet

1. In the space below, properly document each of the three sources you found that show how insulin signals a cell to take in glucose from the blood. Under each documented source, write an explanation of why it is a legitimate and reliable source of information about insulin and its effects on cells.R, Bowen. (2009, August). Physiological Effect of Insulin. Colostate. Retrieved from http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/pancreas/insulin_phys.html This source is legitimate because the information is up to date until 2009 and has an author. Also there are very few ads and the sponsor is popular for their knowledge. There is also a contact information, if you have any comments or anything to correct.Insulin and Glucose Regulation (n.d.). In bcs.whfreeman. from http://bcs.whfreeman.com/thelifewire/content/chp50/5002s.swf This source is legitimate because the sponsor is popular for their tutorials. The site is knowledgeable and has no errors, a lot of info, and there†™s also a quiz to see if you learned what you read.Jagoda, Robin. (2011, March). How Does Insulin Signal a Cell to Take in Glucose From the Blood?. Livestrong Foundation. Retrieved from http://www.livestrong.com/article/27924-insulin-signal-cell-glucose-blood/ This source is legitimate because it has an author and also citations on where they got the information from. Very few ads, but no errors and there’s also a comment box, where you can comment the mistakes they made if there was any.2. Take notes on the relationship between insulin and glucose. Draw sketches or diagrams if necessary.Glucose is the main source of energy and insulin is the key to body cells.Both work together to give energy to the body cells. The insulin opens the door of the body cells for the glucose to enter the body. If the body does not produce insulin then the body cells won’t be able to get any glucose and it means that they have type 1 diabetes. If the insulin cannot unlock the body cells door then that means that they have type 2 diabetes and the insulin and glucose will just build up in the blood. When the blood sugar is high, insulin is released to the pancreas and if blood sugar is low then glucagon is released to it.3. Write a summary, either in paragraph form or in a series of steps or bullets, explaining how insulin binds to cells and the mechanism involved in triggering the cells to take in glucose. Write the summary in the space below. After eating your food, glucose from the food is released into the blood. High glucose level is a signal to release insulinThe pancreas then releases the insulin to the cells The insulin acts as a key for glucose to enter the cell The glucose is then used as energy.

Video Game Industry Market Research Reports, Statistics and Analysis

Global Video Games Industry [pic] The world video gaming industry is predicted to record 9% yearly growth through 2013, to exceed $76 billion, according to Business Insights. Mobile and online gaming formats will fuel the market, with customers taking advantage of wider, faster and more mobile internet access. Console gaming, the market’s current segment leader, will see its rate of sales decelerate. Since the first video game was launched on the market around 45 years ago, the video game industry has taken a central place in entertainment culture for children and adults alike. Far from the solitary habit it may have been traditionally, online gaming involves communities and is based on interaction. Key Market Segments †¢ Climbing world demand for Massively Multiplayer Online Games (MMOG) is expected to push the market to over $14 billion by 2015, according to  Global Industry Analysts. Technological developments along with faster, wider-reaching broadband connectivity are driving the market. †¢ The world social gaming market almost hit the $1. 5 billion mark in 2010, reports  Business Insights. The market is expected to reach close to $4 billion by 2015, with the US a leading region generating sales of $1. 2 billion, followed by Japan at $570 million. There are currently 600 million social gamers worldwide, with China representing close to 110 million, followed by the US at 95 million gamers. By 2015, it is predicted there will be close to 275 million gamers in China and 150 million in the US. Leading game companies include Playdom, CrowdStar, Synga, Digital Chocolate and EA. †¢ With consumers connecting to the internet with smartphones, gaming has become increasingly mobile. More than 27% of smartphone subscribers have installed one game or more, with close to 35% having installed at least five on their phones, according to  Visiongain. Mobile game makers, and phone and electronic device makers have been collaborating to capitalize on the trend towards mobile gaming. †¢ The world game console market is expected to reach almost $25 billion by 2014, according to  MarketLine, representing almost 13% growth in five years. The Americas represent almost 45% of the overall market. The three leading companies in the market are Nintendo, Sony and Microsoft. Regional Market Share †¢ India’s gaming market is predicted to grow by 30% by 2014, reports  Netscribes. The market is lead by mobile gaming, which represents close to 60% of the overall market. Gaming competitions, the creation of gaming zones and increasingly popular MMOGs will fuel the market. Service providers are likely to generate higher revenue, and 3D games will become increasingly popular. †¢ China’s games and accessories market is expected to continue recording strong growth. Peripherals and accessories represent a leading market segment, with increasing demand for auxiliary devices to keep up with gaming product innovation. †¢ The online game market in Korea reached a value of over $2 billion in 2011, reports  Pearl Research. Game companies in Korea continue to concentrate on international business, expanding in the US, the EU, China and Japan. Of the $585 million generated by leading game operator Nexon, the largest share came from business outside of Korea. Market Outlook The global gaming industry has seen consumer demand soar thanks to social networking, technological innovation favoring mobile gaming, and the popularity of cyber communities promoting collective online gaming. Marketing and distribution is being facilitated by social networking sites, which do much of the work of attracting an increasing numbers of gamers. As ever, IP protection and piracy remain major issues for the industry, which continues to lose revenues do to illegal downloading. Moving forward, the global gaming industry is likely to represent an ever-present contender for other media, including music and TV. As the cultural trend towards social networking and gaming continues, consumers are as likely to log in to play a leading game (like World of Warcraft) as they are to switch on the TV to watch a film. Leading Industry Associations †¢ American Gaming Association  www. americangaming. org †¢ Entertainment Software Association  www. theesa. com †¢ National Video Game Association  http://nvgaonline. com †¢ Interactive Software Federation of Europe  www. isfe. eu †¢ European Games Developer Federation  www. egdf. eu

Understanding Behaviours and Attitudes Towards Social Networking

The fast development of social networking that has been detected over the last 2-3 years is indicative of its entry into straight life and it’s mixed with our daily lives. In addition to this, there has also been significant media coverage of the development of social networking, its rapid positive results and worries around the approach. For the purpose of this research report I have intentionally put light on the social and communications facets of social networking sites. The SNS also have some drawbacks associated, such as confusion over privacy settings, probable contact with people one doesn’t know and the unintentional penalties of publicly posting delicate individual material. The purpose of this report is therefore to provide evidence-based insights into the social networking phenomenon which can be used to inform current understanding of usage and societal impacts in the UK, and to help identify some of the current and potential future issues around people’s use of social networking sites. Like other communications tools, social networking sites have certain rules, conventions and practices which users have to navigate to make them understood and avoid difficulties. These range from the etiquette of commenting on other peoples profiles to understanding who one should and shouldn’t add as a ‘friend’. Conceptual Framework Engaging with Social Networking Sites The Social networking sites also preferred to as SNS in the document offer people new and diverse ways to communicate via the internet, from PC or mobile phone. According to Dwyer et al (2007), a social network service focuses on building online communities of people who share interests and/or their activities. Today, there are more than 650 social network sites in the world (Stern, 2006), but no one knows exactly the number. Examples include MySpace, Facebook and Bebo. Creator of SNS authorized people to normally create their own online page, construct and show to online contacts called ‘friend’. According to Boyd (2004), reasons for connecting with friends in social network can be varied and doesn’t unavoidably mean friendship in the daily dialect sense. Users can communicate to other user with the help of their profile they have created. Social networking sites are built for users to interact for different purposes like business, general chatting, meeting with friends and colleagues, etc. SNS offer a gloriously direct tool for what Goffman(1972) calls â€Å"impression management†: the profile page. Just as your choice of clothing and hairstyle signals how you think of yourself (and want others to think of you), so does your choice of profile photo. Many users choose to display the most flattering photographs of themselves that they can. It is also helpful in politics, dating, with the interest of getting numerous advantages with the people they meet. Anecdotal evidence suggests that social interaction with political content of interest is important for young adults (e. g. , Steller, 2008). A study by Conners (2005) reported that Democratic Senate candidates were more likely than Republicans to use Meetup, blogs and other interactive online tools in 2004. (ssrn. om)Recently, the use of network sites has increased overtime with the improvement in technology and the use of mobile phone to surf the web and statistics have shown that 90% of people on the internet at one point in time or the other are visiting SNS (Boyd and Ellison, 2007). Attitudes and behaviours towards social networking sites Users of Social networkers fall into different groups Social networkers are different in approaches to SNS and in their behaviour while usin g them. The site users come under five distinct groups. These are as follows: * Leading Socialisers – (a minority) people who are using sites intentionally to encounter new folks, flirt and to be entertained. * Attention Seekers – (some) are those people who need attention and comments from others online, normally by posting photos and edit their profiles. * Followers – (many) are those people who joined SNS to follow what their peers are doing. * Faithful – (many) people who normally use SNS to renew old friendships, sometimes from school or university. Functional – (a minority) those person who wants to be single while using SNS for a specific purpose. * Focussed – (Mostly business users – Recently added user group) Some users of the sites will create the profile to research the market’s response in a specific geography for the predictions of their business in their geography. Also, as this is an easier way to reach a wider and global consumer base, many corporate houses globally a re using these social sites to advertise or endorse their products and promotions. Non-users comes under into different groups Non-users come under three groups; these are the group those who don’t use the SNS: * Concerned about safety – those people who are concerned about safety online, in specific creation personal details accessible online. According to Smith (2007), seven per cent of American sample said they had been contacted ‘by a stranger who made them feel scared or uncomfortable’. * Technically inexperienced – those people who don’t have knowledge for using internet and computer. Intellectual rejecters – people don’t have interest in SNS and think that it’s a waste of time. How people use social networking sites Profile Creation People normally create their profiles on the basis of their knowledge. User Profiles are normally set questioned as per the site, so it is very optional and depends upon the person what he needs to publish on the site. Normally Users enjoy editing their profiles, watch ing video, playing online games, posting photos. Users generally enjoy from the process of creating a social network, creating a list of friends and using friend’s list to browse profiles. Users share individual material with a wide range of ‘friends’. Communicating with their friends is the most famous social networking activity, but most of adults use their profile to communicate with people they do not know. A few users also mention negative aspects of social networking, and these included anger at others using sites for self-importance, parties organised online getting out of hand, and online bullying. Privacy and safety Privacy and safety issues on social networking sites did not emerge as ‘top of mind’ for most users. Information exchange activities operationalized as the activities of interaction among members of a community that acts as a source of information for other members to deepen and expand friendship (Gruen et al. , 2006. 2007). At most of the time Users of the SNS leaves privacy settings as default ‘open’. Generally those who are new, they give out sensitive personal information, photographs and other content about themselves. Sites define some subset of a profile (such as the user’s name and affiliation) visible by default for searching and identification. Most sites also allow users to relax or strengthen their definition of public information. Privacy expectations in social networks are based on relationships. Typical social networks support friends and networks with privileged access. (Felt, Adrienne, and Evans, David. (2008). Research Strategy I will do a qualitative research to examine in depth people’s attitudes to online social networking, their behaviours while using social networking ites, and the reasons why they use these sites. This will contain an analysis of the research based on several distinct user and non-user segments. Also, I will research on the positive aspects of social network in relation to marketing and research and use of SNS for global business empowerment. This qualitative research will find the use of and attitudes towards social networking sites (both for users and non-users) falling into several distinct segments. Although qualitative in nature, these segments provide an interesting insight into how people currently use and view social networking sites. They also help to highlight that site users are not a uniform group in terms of use, attitudes or behaviour. It will also explain the importance of the segments for users and non-users on different bases. User segments will be organised on the basis of how users will behave when using social networking sites and the non-user segments will be focused why they will stop using the basis of non-users’ reasons for not using the sites.

Wound Care

Program Evaluation: Wound Care Center The Methodist Hospital offers a Wound Care & Hyperbaric Medicine Program which works closely with patients and specially trained physicians (2010). The program focuses on monitoring, management, and treatment of chronic and non-healing wounds (TMHS, 2010). Non healing wounds affect a large number of the populace and prevent people from leading an active life. Researchers report new technologies are altering the process in which chronic wounds are treated. More options for wound treatment are available today than previously available. Bio-engineered skin substitutes, specialized dressings and the latest compression wraps are a few of the more recent methods for wound treatment. The Methodist Hospital's Wound Care & Hyperbaric Medicine Program offers state-of-the-art technologies and advanced wound care techniques to effectively care for non-healing wounds. Evidence depicts that a wound that has not healed in over a month should not be overlooked (CDC, 2009). The TMHWC program uses a team approach to promote advanced wound healing. The first step of healing for patients enrolled in the wound care program is a methodical evaluation by a wound care physician. There is a huge need for quality wound centers. Non healing wounds and excessive management cost health care centers a substantial amount of money each year. According to Pompeo (2010) health care organizations want well-organized and precise figures to decide which cost effective wound care services to propose. The difficulty with chronic wounds is that it is very demanding on staff within a hospital’s organization (Shai & Halevy, 2005). The burden of chronic wound management is constant and an evaluation is necessary in an effort to prove the importance of maintaining The Methodist Hospital Wound Center. The purpose of this evaluation is to examine the wound care program at The Methodist Hospital in Houston Texas. This evaluation will provide the history and overview of the root source for chronic wounds and the effectiveness of treatment of those wounds. This evaluation will also comprise a review of the programs patient population, chronic wound diagnoses, primary diseases, treatment devices, as well as costs associated with the health care organization. The assessment will expand the findings of the previously submitted needs analysis for the healthcare organization expansion of services. The components of the proposal are consistent with the organizational mission, values and vision. Background The Methodist Hospital's wound care Treatment Center came to exist from a meeting between several surgeons at a wound care clinic in Southeast Texas. The physicians were discussing a patient who had suffered with wounds for a number of years. The physicians were interested in increasing improving the credentialing and recognition of wound care services. The Wound Care Center was founded and incorporated in 1990 as an extension of The Methodist Hospital. The Methodist Wound Care Center is dedicated to the multidisciplinary team approach in promoting the science of prevention, care, and treatment of acute and chronic wounds. Today the Methodist Wound Center continues to offer treatment and intervention for chronic wounds. The Methodist Wound Center is an independent center staffed and funded by The Methodist Hospital. A chronic wound has an appearance of one or more underlying conditions which become evident on the skin. Chronic wounds are reported to have the following etiologies (Krasner, 2001): pressure, venous, arterial, diabetic, ischemic, cancer, and end-of-life. A chronic wound entails intervention by numerous health care authorities to address the many conditions and co-morbidities that impact future prognosis and healing. Mission The mission of The Methodist Hospital's Wound Care Center is to provide a full range of the highest quality, outcome oriented physical therapy services for a variety of patients with wounds. The Methodist Hospital Wound Care Clinic team of specialists works together for improved healing rates and fewer amputations in chronic wound cases. In the course of treatment, the clinics aim is to prevent prolonged or permanent disability and reduce hospitalizations. Vision Statement Where people want to work, where physicians want to practice, and most important, where registered patients want to go when they need healthcare services. The vision statement sets specific goals in objective terms, and a time frame for the goals to be met (Pelland, 2009). Literature Review Webster's New Riverside University Dictionary (2010) defines an ulcer as an inflammatory, often suppurating lesion on the skin or an internal mucosal surface of the body, as in the duodenum, resulting in necrosis of the tissue. Dorland's Medical Dictionary (2010) describes an ulcer as a local defect or excavation on the surface of an organ or tissue which is produced by sloughing of inflammatory necrotic tissue. Wounds that do not respond within the expected time frame are defined as chronic wounds or ulcers (Wollina, Hansel, Kronert, & Heinig, 2010). Chronic wounds are contributed to primary diagnoses which slow down the healing process and may sometimes result in death (CDC, 2007). The first step in conducting a needs analysis for the Wound Care Center is to identify the services most in need of support. A review of the number of referrals for different services could direct an initial effort. Networking with practices that have already implemented similar services may be of assistance. Performance measures must be in place for monitoring program success. Performance measures should assess for method reimbursement and sustainability, patient and provider satisfaction, treatment outcomes, and areas for improvement (Lockamy & Smith, 2009). Development of standards makes ease of operation with other systems a reality and are necessary for efficient operations (Spivack, 2005). Principles to be considered in selection, implementation, and evaluation are patient satisfaction, strategic alignments, process management, performance measurement, and project management (Lockamy & Smith). Developing community and governing commission liaisons will strengthen the chance of program implementation success (Dick, Manson, Hansen, Huggins, & Trullinger, 2007). The CDC (2009) reported that over 25 billion dollars is spent annually to govern the management of non-healing wounds. Each year seven million Americans are diagnosed with at least one type of chronic wound. The incidence rate of chronic wounds ranges about ten percent annually and is contributed to the current increase in age of the populace. Stages of Wound Healing There are three phases of wound healing (Fishman, 2008). First, there's phase one-the inflammatory phase, which immediately begins and is active for the first five days of injury. The inflammatory phase generates coagulate from vaso-constriction, platelet aggregation, and thromboplastin formation. The proliferative phase is the second stage of wound healing. This phase transpires up to three weeks after injury. Granulation, contraction and epithelialization draw the ulcerated edges together in an effort to reduce the deficiency (Fishman, 2008). Stage three of wound healing is sometimes defined as the remodeling phase. The modification stage last up to two years. Collagen is formed, which increases the overall vigor of the wound (Fishman, 2008). There are three types of cost analyses. They are cost-effective analysis, cost-benefit analysis, cost-utility analysis and cost-utility analysis. They are aimed at reducing the wastage of resources in invalid methods by getting the advantages of use of a particular activity with the value in terms of cost. People with diabetes are more prone to developing ulcers on their feet. Decreased sensation and a lack of circulation lead to this problem. The best way to prevent ulcers from forming is by performing a daily foot inspection. The three are not mutually exclusive in their use and can be used in any one particular situation though in different stages of the pyramid. An example is the use of exercise as a cost-effective means of tackling diabetes. In one of its many advantages, the exercise does not only help manage the diabetes but other conditions are catered for in the primary stage. This includes, stress reduction and hypertension which may be additions to the disease. There are many benefits of using exercise to various diseases like the cardiovascular types. The use of exercise is implemented in the third stage, tertiary stage that will include the treatment or management of the disease. It helps in burning down the excess calories in the body. (Hatziandreu, E. , 2003) Wound Center Protocol Patients undergo an inclusive physical upon admission to the wound care center. The work up plan for wound care consists of physical evaluations, blood work, Xrays and wound assessments. Medical staff meets daily to discuss the best plan of care for the patients. The treatment protocol Centers which practice systematic ways to develop wound treatment provide excellent care, including evidence based treatment protocols which lead to superior clinical outcomes (Fishman, 2008). The Methodist Hospital's Wound Care Center treats and takes care of the wounds at any part of the body including sacral, abdominal and even in the lower extremities. The center treats all types of wounds caused by burns and pressure, diabetes, radiation and vascular diseases. The centers protocol is to treat all chronic wounds until they heal as well as prevents recurrence and preserve limbs. The center’s staff does not only treat but also monitors wounds teaches prevention ways such as eating proper nutrition among other specialties. Program Objectives The American Physiological Society (2010) website indicated the evaluation provides formative feedback that helps guide a program as it is being implemented. It also provides summative data that clearly demonstrates that the program is accomplishing its stated goals and objectives. Without an efficient evaluation, the program personnel may be unsuccessful with regard to documentation of impactful program issues. The Wound Care Center employs five full time registered nurses, certified in wound care. The center also employs three administrative personnel, including the clinic administrator. The wound care center employees several medical staff physicians, including a podiatrist, 2 general surgeons and one plastic and internal medicine. The treatment of chronic wounds and research on the pathogen has been going on for many years now. Despite the effort, a large number of people still face the problem when it comes to wound care. A number of people have named lack of integrative perspective in research methodology as a critical issue facing wound care centers (Singhal, Reis, and Kerstein, 2001). Researchers do not view treatment of wounds holistically but have focused on efficacy and safety of specific therapies. The Methodist Hospital's Wound Care Center objectives are to continue with single treatment investigation in addition to pursuing an integrated approach to the mechanisms of wound healing. Integrated approach deals with the physiological activities that make a wound heal or not heal based on the fundamental activities. Study design This study design is pertinent to an evaluation of the wound care center and the subsequent hospital visits from patients subsequent to discharge. The study design for this research is quantitative and the population will be those patients who required treatment at the Wound Center within the last 24 months. The study will use data from Method admissions data base to calculate the number of patients. The system will also track the number of patients returned to the center. Quantitative designs require a prearranged selection of variables. Quantitative designs clarify the result of an experiment, a correlation testing, and often involve the acceptance or the failure to rejection the null hypothesis (Sproull, 2004) using statistical formulas and hypothesis testing with a significant randomly selected sample that represents the population (Creswell, 2004). Sample Patients who are currently admitted in the wound care center and scheduled for discharge within the next 30 days will be the population for this study. The population will be reviewed and counted from the Method’s computer system. We will aggregate the data of all patients admitted and discharged from the last 24 months. The selection process can be described as systematic sampling. The specificity of the items in the database is controlled by change. The series of items is compiled from the medical record number and is tracked over the last 24 months. The advantage of systematic sampling is that, unlike simple random sampling, a designated number does not need to be assigned to every item. Most patients have been discharged from the program because the wounds have healed or they have transferred to other wound care facilities. Recruitment of Participants. This evaluation will not require an excessive amount of contact with participants. There will be no questions or surveys provided to the participants. An option for this evaluation is to review the data in Method and analyze the discharge and monitoring of each wound care patient. MethoD is the computer admitting database which reports on all admitted patients to any program within the institution. Methods The research study objectives is to identify chronic wound services that need most support, to review the number of referrals and to determine the favorable ways of treating, preventing and controlling chronic wounds. The study uses quantitative data from The Methodist Hospital's Wound Care Center computer records. The study will use a systematic sampling of all the patients that have been treated for wound in the last 24 months. The study will record all the patients who have visited the hospital with wounds, it will determine their age, sex and the type of wound they were treated on. The study will also record how many times the patient has been treated and when the wound healed and if it did not heal the preventive advice given to the patient. The methods of data collection will be observation and investigations of medical records. The prearranged selection of variables includes age, sex, type of the wound and the duration it takes for the wound to heal. The correlation testing will be used to find out if there is a relationship between persons age and time the wound takes to heal or the type of the wound and the sex of a person. The study will apply statistical model of wound healing rates because it predicts the actual healing of the wound. The statistical model does not impose a fixed methodological structure on the healing structure such as time but monitors the progress and actual behavior of the wound (Kumar, 2007). Data Analysis The results obtained from the centers medical records and analyzed by Method’s computer system showed that the center had received quite a number of wounded patients. The computer software showed that 3-4 people out of a hundred people who visited the hospital were wounded. An estimate of 20-30% of the hospital beds were occupied by patients with wounds a big percentage being patients whom had acquired wounds during hospitalization. Pressure ulcers obtained during the period of medication is the major cause of chronic wound affecting an estimate of five inpatients. The results also showed that 5% of patients died after contracting surgical wound infection during the period. The result statistics indicated through tables and graphs drawn using method computer programs showed that chronic wound were caused by a number of factors such as immobility which usually affected patients on hospital bed causing bed sores and pressure ulcers. The other factors included diabetes, trauma, poor circulation and vascular disease (Stillman, 2010). Diabetes was the major cause of developing a chronic would as statistics showed as 20-50% of people with diabetes had the risk of contracting . Wounds can also be caused by other causes namely unhealthy nutrition, ill-fitting shoes, hygiene and lack of exercises. A big number of people obtained wounds after falling. The research study used a new statistical model that combines both the wound’s size wand the time of closure. This was because it was not easy to determine the actual time that most patients would heal after they were released from the hospital. Methodist Wound Care Center just like other hospital and clinical centers released their patients after their wounds closed after giving them advice on proper preventive measures. The model analyzed the wound size against time. A graph drawn should exhibit negative correlation, that is, as time goes the size of the wound reduces in order to indicate healing. Implications Meta-analytic review of wound healing processes showed that the duration a wound took to heal depended on the type of treatment given and the size of the wound. A large number of wounds do not heal completely but only undergo a process called closure. It is therefore not easy to calculate the correlation between the size of the wound and the duration it takes to heal completely. The statistical approach therefore calculated the time of closure as the healing of the wound. Studies have shown that there are four major stages of healing. A normal would heal even before stage IV but a chronic wound that progresses to stage IV may have serious implication that may lead to amputation (Columbia University Medical Center, 2007). Stage IV is usual the wound closure as it involves formation of a new skin and scarring but it does not mean the wound is completely healed. The data analyzed showed there was a negative correlation between the time of closure and the size of the wound. The size of the wound decreased as time the patient undertook treatment increased. This was a measure that healing process was taking place. While 45% of the patients admitted in the hospital for the given period showed a healing trend, some patient’s wounds did not heal regardless of the time frame. In fact some small wounds grew in size as time progressed. The study results did not indicate a linear relationship since some wounds grew in size as time progressed while others became smaller as time increased. The study results showed a non-exponential Gompertz-type model that shows specific differences and variations in individual wound behavior. Monitoring The modified Gompertz-type model was the best for monitoring and evaluating the healing process of the wound as it applied to all types of wound (both the ones that healed and the ones that did not heal). The model has advantage over other models as it could predict the rate of healing based on the treatment and similarity of wound type. Healing involves tissue healing and wound closure. The study model monitored all the patients that had visited the hospital in the last 30 days to determine which stage of healing process they were in. Generally the healing process involved four phases namely inflammatory phase, proliferative phase, remodeling phase and epithelialization(Hess, 2005). All the wounded patients for the last 30 days were monitored and the phase they were in recorded. The wounded patients that had already visited the hospital in last 24 months were expected to be at various phases depending on the size and type of the wound. A table was thereafter recorded and graphs drawn to analyze the data in order to gain conclusive results of the study. A normal wound requires 3-4 days to be at the epithelialization phase where another layer of skin form leading to scarring (Sussman and Bates-Jensen, 2007). Some wounds take more than that depending on the size of the wound. The research study was given 30 days period in which to monitor the phases of patients wound in order to get conclusive results. A table was set up for all the wounded patients, the time they were admitted and the time they underwent all the four phases. At the end of the one month period a time table was prepared that showed the time period and the number of patients at a particular phase.