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The fast food industry

INTRODUCTION In the fast food industry, nothing comes close to McDonalds as this company has stamped its mark as one of the leading fast food chains in its industry. Founded back in 1955 by Ray Kroc, who single handedly opened the first McDonalds in Des Plaines, Illinois. Though Kroc died in the year 1984, his contribution and success still remains thus making him a legend. That was considered as a stepping stone for the restaurant as it has since then grew into one of the largest fast food chains in the world. As of today, McDonalds has over 30000 restaurants world wide in over 100 countries serving up to approximately 47 million customers daily. McDonalds has successful stamp its mark especially in Asian countries like Japan, Thailand, and Malaysia where it has monopolized the fast food industry. Out of all the McDonald restaurants in the world, 70% of them are owned by independent businessman and woman due to its popularity and high demand making it worth while for investment purposes. Since the corporation had make such a big profit out of this fast food chain, it is now heading not just one but a few other restaurants such as Aroma Café, Boston Market, Chipotle Mexican Grill, and Donatos Pizza. Demands for McDonalds are higher in foreign countries outside U.S.A thus causing the corporation to open the restaurant as much as four times more than in the U.S.A. This is due to the fact that foreign countries contributed to more than half of the turnover yearly. MCDONALDS’ INTERNATIONAL MARKETING MIX STRATEGIES Product McDonald’s corporate try to redesign its different of products to adapt to the local needs to achieving economies of scale. McDonalds has studies the difference of culture in whole world. For example India country, beef is not served to the India. Indians are religious sensitive and most of Indians are vegetarian. So, McDonalds are served only chicken or fish and 100 percentage of vegetarian menu. Meat and vegetarian meals are provided in separate areas of the restaurant because this is religious of laws to prepare vegetarians and meat-caters. McDonalds is serving “Chicken Maharaja Mac” and “McVeggie” meal in India. For other instance Malaysia country, Malaysia is a Muslim country, so McDonalds do not served pork. McDonalds are served chicken or fish or beef. Malaysians likes to eat hot and spicy foods as well. So, McDonald is serving “Ayam Goreng McD” and “Spicy Chicken McDeluxe”. Besides that, they are serving beef too. “BigMac” and “Quarter Pounder with Cheese” are popular meal McDonalds’ outlets in Malaysia. Overall, McDonalds in general serves a rather wide variety of food considering the fact that it differs in certain countries for example, the Quarter Pounder Beef Burger is not served in India. This is to help satisfy the needs of everyone with different taste in food, thus attracting more customers to the restaurant. McDonalds also focuses a lot on the happy meals which are meant for children, each happy meal purchased entitles the child to a free toy. This proves vital as it can help in the sales revenue of the restaurant and also attract more family oriented customers to the restaurant. Branding A successful brand building can make its corporate becomes successful and defeated the stronger competitors. David (2001) states that ‘the Profit Impact of Marketing Strategy project shows that return on investment is related to a brand’s share of the market: bigger brands yield higher returns than smaller brands.’ Everyone knew that Coca-Cola is the most famous beverage in the world. McDonalds are severed the global brand’s soft drink, so it is will increase the reputation’s McDonalds. Both of corporations are getting benefits and making profitable. So, brand image may effect on product life cycle. Price Malaysia’s economic is better than India. India is lack of technology and purchasing power status is lower than Malaysia. So, that McDonalds has charged the different price in between Malaysia and India. Stuart et al. (2010) stated that exchange rate is influenced by a range of complex forces in the foreign exchange markets and may not accurately reflect the purchasing power of one country’s currency in another country. Malaysia’s standard living is higher than India. So that Malaysians have higher incomes and purchasing power compare to the Indians. McDonalds think that consumer’s purchasing power is limited and attract more customers affordable to buy their meals, so that McDonalds had charged the different price in different countries. For example, “McChicken” is a general set meal sells in McDonalds every country. McDonalds are selling “McChicken” worth RM 6.10 in Malaysia. Compared in India, McDonalds only sell this meal Rupee 65, convert to Ringgit Malaysia is RM 4.75. Besides that, McDonalds are also attracting its customers with lunch packages at affordable rates, for example in Malaysia, McDonalds lunch package such as “McValue Lunch” is a limited to a time from 12pm to 3pm at a price range from RM 5.95 making it affordable for everyone compared to the usual RM 9.50 price. This lunch package is mainly to attract students and office workers as the lunch hour in Malaysia for office workers are standardize from the time of 12pm to 2pm and students also finish classes at 12pm making it convenient for everyone to drop by and have lunch. Promotion Technology transfers are the most important to the national and international businesses. Advertising can make McDonalds more efficient to the host countries. For example Malaysia country, Most of Malaysians are have own a televisions. So that McDonalds focus the technology infrastructure of the Malaysia to promote its products by TV commercials. McDonalds also promote its product through by magazines, brochures and newspapers. McDonalds are trying to redesign new products many times to satisfy customers’ need and finally provided “Weekday Breakfast Special” and “McValue Lunch”. McDonalds also will provide a special set meal “Prosperity Burger” only for the Chinese New Year festive season in Malaysia. India’s standard living is lower than Malaysia. India country is lack of technology. So, McDonalds to promote its product most of times using by billboards and leaflets. McDonalds are shifted from “McDonald’s mein hai kuch baat” to “To aaj McDonalds ho jaaye”. The reason changed is encouraging Indian customers to visit McDonalds more often with their family and enjoy their time out. It is create awareness to attract more customers visit McDonalds. In general, McDonalds have used promotion as a way of getting customers attention to get what they want or what is being promoted. Customers will then be encouraged to buy the item as actions taken by customers are usually sufficient in terms of purchases. Promotions, usually being advertise on billboards, cinemas and television all have one purpose, which is to obtain awareness from viewers and making sure they remember it. Place Placement, also known as distribution channel is very important for the international marketers. It is affected the product is available to the customer at the right place, at the right time and in the right quantity and price. For example, Malaysia is a technology country. Most of Malaysians are busy working. They have no enough time to have their breakfast and lunch. So McDonalds are located “Drive-Thru” to make easier availability for providing product and services to the customers. It can help Malaysians to save time and money too. For instance, India is a country which lack technology due to low economic status. Most of Indians are having transportation problems. So, Indian can have McDonald’s meals through by “McDelivery” system. It could easy delivery products to the India customers. In Malaysia, McDonald franchises have become a common investment among local businessman and woman as more restaurants have been set up in most towns and major cities. Every McDonald restaurant has been strategically set up in Malaysia as it only takes the corner lot of every shop lot. This allows the restaurant to occupy more space thus attracting more attention from passerby’s. Some franchises also occupy a small building of its own with a private parking bay and drive through accessibility. On the other hand, most McDonald restaurants are also equipped with WIFI services thus allowing customers to enjoy their meals while surfing the internet or working on their assignments. This proves vital as it is an attraction to many customers especially younger generation people. SUGGESTIONS Due to the recent economic crisis and recession, it has affected many companies and organizations, both in the private and public sector. Standardize its food range world wide McDonalds should prepare future market strategies in order to face any unforeseen circumstances that might happen to the company. In my opinion, McDonalds should standardize its food range world wide as this can fulfill customers’ satisfaction, in terms of variety and flavour. For example, the McDonalds franchise in Malaysia and in India both have different range of food. McDonalds in India are served “McVeggie” and served “Ayam Goreng McD” in Malaysia. These prove that meals in India are more vegetable based meals. This can be due to the fact that probably the demand for vegetables are more compared to meat in India. Nevertheless, by standardizing the meals served in both countries. So that, Malaysian can enjoy the “McVeggie” meal and Indian can enjoy “Ayam Goreng McD”. Both of meals are represent both countries’ culture. This will be able to attract more customers as the variety of food has increased in order to fulfill customers’ satisfaction and both of countries’ people can know their cultural each other. Expanding Worldwide Networks McDonalds should be also expanding its network as this will help the company gain profit. McDonald’s franchises are situated in almost every country in the world. The company should expand the franchise to the rural areas such as small towns and suburbs making it easier for the rural people to enjoy its services and foods. This can prove vital in increasing the profit of McDonalds as there are still many small towns and villages which are yet to be developed. Prior to this, the economic and political status of McDonalds in the countries will be strengthened thus gaining popularity among the rural areas. For example of small town have not McDonalds restaurant yet such as Sandakan and Tawau in Sabah areas. Serving the Best Balancing and Healthy Fast Food Many people around the world enjoy consuming fast food and equal amount of people are suffering and dying because of the same reason. The reason is simply because fast food is processed food and has a lot of preservatives such as salt, sugar, spices, and oil. These preservatives if consumed excessively can result in various health problems such as diabetes, and high blood pressure. Various types of food sold in McDonalds for example French fries and nuggets both have excessive oil added in the process which can be very fattening which can lead to obesity which is dangerous to human health. Many consumers especially in the U.S are suffering from obesity and other diseases due to the consumption of too much fast food. This will result in a drop in sales and slower growth rate of the restaurant thus preventing the company from making a profit due to a drop in demand and sales. In order to rectify this problem, and bringing profit to the company, McDonalds should reduce preservatives added in making their food for example, reduction of oil in the process of cooking their food. On the other hand, the restaurant should also have quality control over their food and beverages by making sure that all ingredients are equally added and not excessively. CONCLUSION From the above paragraphs, we can conclude that McDonalds is truly an ambitious corporation in terms of future planning, market strategies and other ideas thus making it one of the leading companies and fast food chain in the world. Based on the qualities the restaurant has, it is no doubt that the restaurant has proven that in order to be successful in the fast food industry, the company should build up good relationships with the franchisor, franchisee, as well as the supplier as this proves to be vital in this line of business as McDonalds can be taken as an example. However, certain points have been listed out as suggestions for the company to improve further in terms of products and services. By using international marketing mix, the restaurant is able to adopt in different countries in terms of politics, economics, social culture, and technology. This can prove vital for McDonalds Corporation as different countries have different backgrounds. Nevertheless, McDonalds still remains on top of the charts in the fast food sector in spite of the recent economic crisis. REFERENCE: Walker, Jr. et al., 1999. Marketing Strategy Planning and Implementation.3rd ed. United States: McGraw-Hill. David, J., 2001. Principles and Practice of Marketing. 3rd ed. United States: McGraw-Hill. Robert, D. and John, F.T., 2009. Business Marketing. 4th ed. United States: McGraw-Hill. Stuart, W. et al., 2010. International Business. 3rd ed. Pearson: Prentice Hall. Ricky, W.G. and Ronald, J.E., 2006. Business. 8th ed. Pearson: Prentice Hall. Uttara, M., 2008. Different Types of Advertising. [Online]. Available from: [cited 01 December 2009] McDonalds’ India. McDelivery. [Online].Available from: [cited 01 December 2009] Vikram, B., 2003. Advertising does help in building brand recall, but advertising alone does not sustain a brand. [Online]. Available from: [cited 02 December 2009] Stephen, O., 2009. The Currency Converter. [Online]. Available from: [cited 02 December 2009] Amit, R., 2008. Case of McDonalds India Launch. [Online].Available from: [cited 03 December 2009] McDonalds’ Malaysia. Menu Items.[Online].Available from: [cited 03 December 2009] · iFranchise Malaysia. McDonald’s Franchise Business Opportunity. [Online].Available from: [cited 04 December 2009] Slinky, C., 2009. Marketing Plan of McDonald’s 7p’s. [Online].Available from: [cited 04 December 2009] Amit, R., 2008. McDonalds India Launch. [Online].Available from: [cited 05 December 2009] Abhishek, B. et al., 2009. Marketing Mix of McDonald’s India. [Online]. Available from: [cited 05 December 2009] McDonalds’ Malaysia. Mission and Vision.[Online].Available from: [cited 06 December 2009]
Assignment Prompt Public policy has a major impact on your practice and your patients. Advocacy is an expectation of the advanced practice nurse. Elected officials care about what their constituents have to say. To make a difference, you need to be informed and engaged. Contacting your legislator and discussing issues is an important attribute of nurse leaders. In your interactions with lawmakers you want to be positive and nonpartisan, personal, persistent, patient, focused on your message, and provide accurate information. Directions Determine the issue or message (e.g., telehealth impact on your practice) you wish to discuss with your legislator(s). Resource: The American Nurses Association Federal Legislative Priorities for 2019. Identify your legislator and contact information from his or her website and/or search here. Choose one method of Advocacy: Face-to-Face or Letter/ Email. Face-to-Face: The student may have to meet with the legislator’s assistant (especially if federal legislator) which is acceptable. Making an appointment might be time consuming (especially if federal legislator), so you will need to begin the appointment process early in course. Students in the same legislative district may go together. Once you have completed the visit, each student will write a summary (one-page) and thank-you note (even when the visit is conducted with other students). Summary may include: Was legislator/assistant: — knowledgeable about APN role and topic or at least willing to become informed? Was he or she willing to express support or opposition? Was he or she cordial or merely civil, helpful or confrontational, or informative about the political process? Post the summary and a copy of your thank you note (letter or email) in the D2L assignment link. Letter or Email: The student must write three (3) letters or emails or a combination of letters/emails to their identified legislators (State and/or Federal). Legislators read correspondence, especially when it is personalized and clearly from a constituent. The following guidelines should be used when writing to your representative: Be brief (one page or less), and use your own words. Begin with the appropriate heading and address. Be specific: State the specific bill number and issue and state your opinion in the first sentence. Relate your experience with the issue. Use personal examples when possible. Your interest and concern about the issue is important. Ask the legislator to specifically commit to supporting or opposing the legislation you are writing about. Ask for specific reasons they are supporting or opposing the proposal. Sign and print your name and include your address and other contact information. If you have pertinent materials and/or editorials from local papers, include them. Avoid form letters/emails if possible. If you are using a sample or form letter, be sure to adapt it, especially in the first sentence and paragraph. Legislators and their aides recognize form letters and are less likely to be influenced by them. Thank him or her for considering your opinion. ***Submit the three letters and/or emails in Word docs in the D2L assignment link along with a separate one-page reflection on your experience.*** ***Use Assembly Bill No. AB-852***:*** ****** Address letters to: 1. Alan Lowenthal – 2. Tom Umberg: 3. Gavin Newsom:

Effects of Cocaine and Crack Cocaine

Share this: Facebook Twitter Reddit LinkedIn WhatsApp Cocaine versus Crack Cocaine Lindsay Janzen Introduction Drugs play a major role on the streets and in the medical field. Some drugs are seen as less serious as others. Stimulants are a wide category of drugs that is an upper. Stimulants generally make you feel happy and energetic. Cocaine and crack cocaine do exactly that. These are two drugs that are very similar, yet very different. Crack cocaine comes from cocaine, but is mixed with baking soda and water to create a lower purity form of free-base cocaine. This creates a hard, brittle unstructured material known as a piece of rock, which is crack cocaine. When it is smoked, it creates a cracking sound, which gives crack cocaine its’ name. Cocaine in its purest form is a white powder, whereas the colour of crack cocaine varies based upon the origin of the cocaine and how the baking soda is added. Crack cocaine can range from white to yellowish to a light brown. Crack cocaine in its purest form is an off-white solid with jagged edges. This paper is going to compare the history, administration, effects, and legal aspects of cocaine and crack cocaine. History Cocaine originated from South America, from coca leaves. Originally, the coca leaves were chewed by workers to decrease fatigue, improve endurance and have a greater resistance to the cold. This was to benefit the workers so they could work longer hours and be more productive. In 1855 the active ingredient in cocaine was isolated from the leaves, and in 1880 it was used as a local anesthetic (Nunes,2006). It was also used in coca cola. In 1855, coca cola was a soda beverage that contained sixty milligrams of cocaine for every eight ounces of the beverage. The idea behind this was to give people energy and a sense of well being (Nunes, 2006). By the late 1880s Sigmund Freud was using cocaine regularly and was even recommending it to others. This only lasted for less than twenty years, until he started discouraging it to others. Then by 1914 cocaine was banned for medical use and in beverages. This caused the use of cocaine and by the 1930s, the use had drastically decreased. It then became popular for recreational use in the 1980s (Nunes, 2006). It was often used and shown in movies such as Scarface, and is famous for the amount of cocaine that Al Pacino uses in one of the final scenes of the movie. Now it is still used recreationally and used by a ‘party crowd’. Although this is the primary category of people who use cocaine, people of all demographics use cocaine recreationally. Cocaine started to be first cut with baking soda in the early 1880s. This was done because of the price drop that drug dealers were facing. They decided to mix it with baking soda and make a hard piece of rock, and sell it in smaller quantities. This made crack cocaine, easily manufactured, cheap which made it highly profitable for drug dealers to develop (Kornbluh, 1997). Crack first started to become largely used in 1984. The worst impact that crack cocaine had was on the Northeastern states of the United States. This was believed to be because the CIA knew about the large amounts of cocaine that was being brought into the United States, to fund some of their operations (Kornbluh, 1997). This was alleged in the Dark Alliances article by a journalist. Today crack cocaine is still used recreationally but by heave drug users and abusers. It is seen as a more serious and more addictive drug than cocaine. Administration Cocaine can be administered in multiple ways, whereas crack cocaine only has one administration method. Cocaine has four main routes of administration. They are orally, injection, intranasal and inhalation. When cocaine is taken orally the person is swallowing the powder or liquid; it then dissolves in the stomach and large intestine and then through passive diffusion it is distributed to get the desired effect. This process takes approximately thirty minutes to enter the blood stream (Volkow, 2013). The next method of administration is injection. There are four different ways that cocaine can be injected into the body. The first method is subcutaneous, which is under the skin. Another method to inject cocaine is intramuscular, which is in the muscle. The third method is intraperitoneal which is in the stomach. Lastly, there is intravenous which is into the veins. Intravenous injection results in intense affects within 30 seconds of the injection (Volkow, 2013). This method is thought to be most common when thinking of heavy drug users because of the fast results. The next route of administration for cocaine is intranasal. This is where cocaine is snorted or sniffed up the nose. This is the most common way that cocaine is administered. Intranasal routes require ten to fifteen minutes for the desired effect of cocaine to begin. The last method is inhalation. This is where cocaine is smoked. The effect of inhaling cocaine is felt almost immediately; however, the effects do not last more than five to fifteen minutes (Volkow, 2013). This method is less likely with cocaine since it is the only way for crack to be administered. Cocaine is readily absorbed after oral and intranasal administration, but the onset of drug action is slower and the peak effect is takes longer period of time to be reached than with other routes of administration. Cocaine is processed rapidly with most of its effects vanishing twenty to eighty minutes after administration (Volkow, 2013). Cocaine and crack cocaine is eliminated through the urine and is detectible up to two to three days after administration. The route of administration is chosen by the user, and is addictive from whichever route is chosen. They become addictive because of the effect cocaine and crack cocaine has on the body. Effects Cocaine is a stimulant drug that has physiological effects that are seen outside of the brain, through how a person acts. Common effects of cocaine that can be detected by others are increased talkativeness, sociability, alertness and insomnia. Cocaine is a stimulant that stimulates the central nervous system. When an individual administers cocaine into body, three neurotransmitters are released into the brain; they are norepinepherine, dopamine and serotonin. These neurotransmitters are normally reabsorbed; however, cocaine works by blocking the reuptake for these neurotransmitters, which allows for these chemicals to build up in the brain (Holman, 1994). Cocaine binds to the transporters that normally remove the excess of these neurotransmitters from the synaptic gap which prevents them from being reabsorbed by the neurons that released them (“Depression: Cocaine,” 2014). This results in a natural effect of dopamine on the post-synaptic neurons, which is amplified and gives the pleasurable effects or feelings of the drug (Holman, 1994). These feelings are happiness, confidence, and energy. Each of these feelings are stimulated from a different neurotransmitter. Happiness comes from excess dopamine, confidence comes from serotonin and energy comes from excess norepinepherine. Along with the pleasurable effects of cocaine, it also has negative effects. Cocaine can cause nasal damage, loss of appetite, hallucinations, strokes, increased blood pressure, and increased pulse and heart rate. Recent studies have found that five to sex percent of people who use cocaine become dependent on it (O’Brien

Screening in Breast and Prostate Cancers

write my term paper Share this: Facebook Twitter Reddit LinkedIn WhatsApp Introduction Currently, people believe that the same level of screening for breast cancer in females should be done for malignancies in males (Razi, 2004, p. 241) since mortality rates are very similar. About 15% of women who die from cancer in the UK are due to breast cancer, which is the second type of cancer that causes more deaths in women [1], while prostate cancer causes about 13% of all cancer deaths in men, being as well the second type of cancer that causes more deaths in males [2]. But whereas in the UK breast screening is performed in women between 50 and 70 years old [3], prostate screening is not a routine to detect this kind of cancer [4]. Breast cancer screening Breast screening is used to detect breast cancers when they cannot even be seen or felt [3], so they are less difficult to treat [5] and there is a good chance of recovery [6]. Sometimes, women younger than 50 years old may be entitled for breast screening if they have high probabilities of suffering this cancer [7]. Then a genetic specialist should evaluate the case. If there is a family history of breast cancer: women should start annual screening mammograms from 40 years old. For those who are too young to undergo a mammogram but have an increased risk of breast cancer, MRI scans can be done each year from their thirties. If they have a gene mutation: MRI scans are performed every year from age 20 in females with a TP53 mutation and from age of 30 in those with a mutation in BRCA1 or BRCA2 [3]. The most common and useful screening test to find breast cancer early and lower the risk of dying from this pathology is the mammogram [5]. The process consists in placing the breast between two plates that flatten it while two X-rays pass through the breast tissue to take an image of it. Then the same procedure is repeated in the other breast. Although it is a brief process, sometimes women can feel uncomfortable. The results will be received within two weeks [7]. But there are other methods used as adjuncts to mammograms, such as Breast Magnetic Resonance Imaging (MRI) technology, which uses magnetic fields and radio frequency signals to take pictures of the breasts in young woman who have a raised probability for getting breast cancer. Although there is no evidence that being examined by a specialist reduces the risk of dying from breast cancer, it may be a complementary method to find early signs of cancer, such as lumps. Also, breast self-awareness [5], which consists in touching breasts to check that everything is normal [8] is recommended as a pre-screening method [5]. Furthermore, new diagnostic techniques can be useful in investigating lesions that are not clear on standard imaging. Also, they may help in decreasing recall rates. But they need to be more developed (Singh et al., 2008 p. 501). Sestamibi scans (Singh et al., 2008, p.501): it is a technique used along with current diagnostic methods, which utilizes a radiopharmaceutical called 99mTc-sestamibi as a tumor imaging agent (Khalkhali et al., 2000, p. 1973). This radioactive material is absorbed by tissues with a high metabolic activity, such as breast cancer tissue, thus allowing the development of scintimammography [9]. This is a new type of mammography that can find cancer signs even in breast implants or dense breast tissue. Moreover, it helps to investigate abnormalities detected in a normal mammography and to determine whether those abnormalities requires biopsy or not, avoiding more invasive procedures [10]. Hence this method has a high specificity for cancer [9]. Optical imaging (Singh et al., 2008, p. 501): a set of techniques that have emerged in recent years as a potential pre-screening tool due to its low cost and non-invasive procedure. They complement clinical breast examination (CBE) and self-breast examination (SBE) since these lead to increased false-positives (Godavarty et al., 2015, p. 193). They can provide detailed information about breast cancer tissue, such molecular, functional and morphologic features by using near infrared (NIR) light (700–1000 nm) and visible light (400–700 nm) (Di Leo et al., 2017, p. 230). Contrast-enhanced digital mammography (CEM) [11]: it provides a better sensitivity since it optimizes the lesion-background contrast. Moreover, this technique allows seeing through the dense breast tissues in younger woman (Singh et al., 2008) (sonography may be useful in these cases as well) (Brooks, 2009, p. 308). Therefore, it is possible to decrease the necessity of repeating scanning, as well as the radiation dose to patients (Singh et al., 2008). Because of that, with this technique is possible to depict cancers that would otherwise be occult on standard unenhanced mammography [11]. Tomosynthesis: is a more developed mammography in which small doses of x-rays are used [12] to get multiple 3D digital X-ray images (Godavarty et al., 2015, p. 197) for the purpose of detecting cancer early [12]. PET/CT (positron emission tomography–computed tomography) (Groves et al., 2012 p. 613): it has a role in detecting tumour recurrence and metastasis in breast cancer patients (Singh et al., 2008, p. 507). With PET imaging, a radiologist injects a small amount of radioactive dye into the patient and then measures the absorption of the dye as it passes through the body [13]. PET discoveries can be localised thanks to the contribution of the CT component (Groves et al., 2012 p. 613). Biomarkers: CA 15-3, carcinoembryonic antigen (CEA), and CA 27 – 29 are serum tumor markers which are used in the clinic for disease surveillance, but they are not useful in detecting early breast cancer, due to their low sensitivity and specificity. Plasma prolactin, circulating insulin-like growth factor (IGF)-1 and IGF binding protein (IGFBP)-3 concentrations are related to a high risk of postmenopausal breast cancer risk in older women, but their use as markers is still being investigated (Brooks, 2009, pp. 309-312). Benefits of breast screening In England, breast screening leads to the diagnosis of 18,000 breast cancers each year. They are usually found at an early stage, when they are easier to treat and need less treatment. Almost all women in this situation will be probably cured and most of them will survive for at least 5 years after the cancer is detected [3]. Randomized controlled trials (RCTs) show that females from 50 to 69 who undergo mammography improved their breast cancer survival [14]. Harms of breast screening False negative result [3]: in 6% to 46% of mammograms there may be invasive cancer that was undetected [14]. This may delay finding a cancer and getting treatment [15]. They are more likely for tumours in dense breasts, frequently in young women [14]. False positive result: the test detects signs of breast cancer in heathy women. Also, about 7% of females that were submitted to screening are called back to be x-rayed again, if the first mammogram is not clear enough. This can lead to more invasive tests, like a biopsy [3], which can be expensive and time-consuming [15]. Overdiagnosis and overtreatment: it happens when cancers that will not ever cause any problems are detected by the test. Currently, it is not possible to distinguish between breast cancers that will develop quickly and those that will disappear on its own. So, the most common procedure is to eliminate it by surgery, and to take other treatments that can be unnecessary. According to a review in 2012, about 4,000 females are overdiagnosed each year in the UK[3]. Exposure to radiation [3]: it is extremely unlikely that radiation doses used in a mammography cause cancer. It would be necessary to receive higher doses to cause radiation-induced mutations [14]. Unnecessary anxiety: when women are called back for more tests (about 1 in 25) they feel very anxious that they might have cancer, but most of them turn out to be fine (just 1 in 5 of those had breast cancer) [16]. The UK breast screening programme The first screening programme aimed to detect breast cancer was performed in 1988 by the NHS. In the year from 2009 to 2010, 1,998,225 females aged 50-70 had breast screening in the UK and 15,517 of these were diagnosed of cancer. A trial put women into two random groups, one of them was screened and the other one not. The Panel found that in the UK, breast screening can avoid the breast cancer death of 1,300 women each year. For every 1,000 women screened, about 5 lives are saved while 17 women are overdiagnosed. The good results yielded in this trial showed that the UK breast screening programme should continue due to its important advantages [16]. Prostate cancer screening Although the incidence of prostate cancer is increasing, the mortality and morbidity rates have remained constant. Moreover, the disease belongs to old ages and if it is not screened, the danger for the patient is less than that of lung, colorectal, and breast carcinoma. It means that the priority is not given to prostate cancer (Razi, 2004, p. 242). The most extended screening test is the PSA test. It involves the measure in the blood of the protein produced by the prostate gland called prostate-specific antigen (PSA). [17]. In men free of disease, who have a normal prostate, a small amount of this protein, leak out into circulation. But the levels of PSA in blood increase significantly when there is a prostate cancer (Stenman et al., 1999, p. 84). However, other non-carcinogenic factors such as the age can also rise the PSA levels in blood [17]. The PSA test has a high fluctuation in specificity and sensitivity (Razi, 2004, p. 243). Although specificity of the test is 60% to 70% (Kim et al., 2015, p. 258) (disease-free cases correctly classified) (Parikh et al., 2008, p. 46) in males with a level of PSA in blood above 4.0 ng/mL, sensitivity is only about 20%. This means that while 20 patients are correctly diagnosed of prostate cancer, 80 patients should be submitted to more invasive procedures such as biopsy, since there will be false negative cases. Therefore, a high number of patients will undergo unnecessary biopsy without detecting prostate cancer (Kim et al., 2015, p. 258). These are some reasons why prostate screening is not performed as a routine in the UK [17]. However, men from 55 to 69 years (Grossman et al., 2018, p. 1901) can access the ‘Prostate cancer risk management’ programme [17], which allows them to have an appointment with the doctor to be informed about advantages and disadvantages of screening according to family history, race/ethnicity and comorbid medical conditions (Grossman et al., 2018, p. 1901). If the result of the screening test shows an amount of PSA in the blood of 3ng/ml or higher, the doctor may suggest further test to find out if it is a prostate cancer. Probably it is a sign of enlarged prostate, prostatitis or urinary infection, which are not cancer [17]. Additionally, Digital Rectal Examination (DRE) test can help in the diagnosis of the palpable form of disease. But its sensitivity changes from 18% to 68%, due to the different sensitivity of examiners’ fingers (Razi, 2004, p. 242). Benefits of prostate screening According to some studies, not executing this test may raise a risk of reducing well-being as well as longevity in men. One of them done in Quebec, in which 80137 men over 50 years old experienced DRE and PSA, shown that the mortality rate from prostate cancer decreased noticeably in screened men in comparison with 38000 controls (5/100000 vs. 48.7/100000) (Razi, 2004, p. 243). If the result of the test does not show any abnormality, men who underwent screening may be relieved [17]. In some cases, it is possible to receive early treatment since it can detect signs of cancer at the beginning of the disease [17]. Men with PSA levels between 4.1 and 10 ng/ml are suggested to perform a biopsy. This will lead to diagnosis of cancer in 25% (Razi, 2004, p. 243). Harms of prostate screening Although it is possible to diagnose the disease in early stages, we are unable to differentiate the non-progressive disease from its fatal form (few cases). Because of that, it is probable that screening test may diagnose a benign form of disease, not requiring treatment. Then the patient will suffer from being aware of his illness and should undergo different stages of investigation and treatment, which might be accompanied by morbidities (i.e. incontinency, impotency, intestinal complications, etc.) (Razi, 2004, pp. 241-242). It is not possible to know if treatments available for prostate cancer, such as radical prostatectomy, radiotherapy and watchful-waiting will alter the natural course of preclinical disease or not. Moreover, these treatments have complications such as urethral stenosis, injury to intestine, incontinency, and impotence (Razi, 2004, p. 242). It is necessary to perform a lot of rectal examinations (289 according to a study) to diagnose one case of clinically significant prostate cancer (Razi, 2004, pp. 242-243). False-positive results: sometimes PSA tests can pick up signs of prostate cancer even if it does not exist. About 75% of males who show a raised PSA level do not have prostate cancer [17], but it is necessary to take second line tests such as transrectal ultrasound (TRUS) or transrectal ultrasound-guided biopsy (TRUS-GB) to confirm that (Razi, 2004, p. 243). In recent years it has become more common to offer an MRI scan before that to help avoid invasive tests [17]. False-negative results: many men are not diagnosed of prostate cancer since about 15% of cases do not have high levels of PSA in blood [17]. Case finding expenses should be equivalent to medical care expenses but in the case of prostate cancer, screening expenditure is much higher than medical care expenses (Razi, 2004, p. 243). The screening test is not all accepted by the community, since many patients are embarrassed with DRE (Razi, 2004, p. 243). There is no agreement that early diagnosis can decrease mortality rate with appropriate treatment. Many studies such as the one from Massachusetts hospital, disagree with the results of the study done in Quebec, which showed a reduced mortality rate from prostate cancer in screened patients (Razi, 2004, p. 243). Because of the large number of disadvantages of PSA test and its controversial use, some prostate cancer biomarkers are being investigated currently. The testing of urine, serum, or prostate tissue for molecular signs of prostate cancer can provide information of diagnosis (Alford et al., 2017, p. 222). Kallikreins: there is a test that measures the plasma levels of four of these proteins which are expressed in the prostate. Human kallikrein-3 (PSA) and human kallikrein-2 (hK2) are the dominant forms and their levels are increased in circulation when the tumor is poorly differentiated. The number of biopsies can be reduced by 49% to 57% among men being screened for the first time with this test (Alford et al., 2017, p. 223). Autoantibodies: the humoral immune response to cancer consists of the production of autoantibodies against several tumor antigens. The blood test Apifiny measures the expression of eight PCa-specific autoantibodies. It is marketed for men with PSA 2.5 ng/mL who are considering initial biopsy (Alford et al., 2017, p. 224). PCA3 (DD3): it is a long noncoding RNA overexpressed in 90% of prostate cancers. The Progensa PCA3 assay is a test that measures the concentration of this molecule. Lower PCA3 levels are associated with a low-grade disease (Alford et al., 2017, p. 224). Screening programs: differences among countries Breast cancer: mammography is the standard screening method in the 26 countries that organize screening programs for woman, according to the National Cancer Institute. Nevertheless, there are some differences depending on the country since there is no agreement for a unique performance of this screening. In general, it is conducted every two years (United States, Sweden), although the United Kingdom recommends screening at three-year interval and Uruguay offers it every year. There are also variations in the onset age of mammography. While most programs are offered to women between 50-70 years old, in China, Japan, Australia, South Korea, Sweden, Uruguay, Iceland, Saudi Arabia, and the United States, patients start to be screened in their forties. Finally, in terms of participation rates, less than 20% women undergo mammography in Japan and Saudi Arabia; around 50% in France, Switzerland and Canada and above 80% in Finland and the Netherlands [18]. Prostate cancer: the controversial use of PSA test as a screening tool means that there is no agreement among all the countries on how to carry it out (Ebell, Thai and Royalty, 2018, pp. 4-5). Most of the countries does not have a national guideline currently. They are limited to recommending an appointment with the doctor (such as Belgium, Luxembourg, Switzerland and Iceland) or do not make any recommendation. Furthermore, according to the United States Preventive Services Task Force (USPSTF), Spain, Sweden, United Kingdom, United States, New Zealand, France, Canada and Australia advise men against prostate cancer screening (Ebell, Thai and Royalty, 2018, pp. 5-8). Regarding US American Cancer Society’s information, men with levels of PSA in blood over 2.5 ng/Ml should be screened every year. However, it should be offered at the age of 40-45 to those men who have a high risk of prostate cancer. This is the age of starting screening ‘regularly’ in Austria (Ebell, Thai and Royalty, 2018, p. 8). Conclusion As we can see, breast cancer screening is a routine in the UK, as well as in many other countries, to decrease effectively deaths due to breast cancer. A large number of studies have confirmed that performing breast screening in women over 40-50 years old has more benefits than harms. However, there is no evidence that a PSA test for prostate cancer screening has the same effect reducing mortality rates caused by this type of cancer. In fact, some experts believe that its disadvantages exceed its advantages, based on the reasons mentioned above. Therefore, PSA test should be used as a screening tool in specific cases but not routinely. Recently, new techniques that can be helpful for the screening and diagnosis of both types of cancer have emerged, however there is still much to investigate and improve. References Alford, A., Brito, J., Yadav, K., Yadav, S., Tewari, A. and Renzulli, J. (2017). The Use of Biomarkers in Prostate Cancer Screening and Treatment. Reviews in Urology, 19(4), pp.221-234. Brooks, M. (2009). Breast Cancer Screening and Biomarkers, in Verma M. (ed.), Cancer Epidemiology. Methods in Molecular Biology, Humana Press, New York, pp 307-321. Ebell, M., Thai, T. and Royalty, K. (2018). Cancer screening recommendations: an international comparison of high income countries. Public Health Reviews, 39(7), pp.1-19. Godavarty, A., Rodriguez, S., Jung, Y. and Gonzalez, S. (2015). Optical imaging for breast cancer prescreening. Breast Cancer: Targets and Therapy, 7, pp.193-209. Grossman, D., Curry, S., Owens, D., Bibbins-Domingo, K., Caughey, A., Davidson, K., Doubeni, C., Ebell, M., Epling, J., Kemper, A., Krist, A., Kubik, M., Landefeld, C., Mangione, C., Silverstein, M., Simon, M., Siu, A. and Tseng, C. (2018). Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement. JAMA, 319(18), pp.1901-1913. Groves, A., Shastry, M., Ben-Haim, S., Kayani, I., Malhotra, A., Davidson, T., Kelleher, T., Whittaker, D., Meagher, M., Holloway, B., Warren, R., Ell, P. and Keshtgar, M. (2012). Defining the Role of PET-CT in Staging Early Breast Cancer. The Oncologist, 17(5), pp.613-619. Khalkhali, I., Villanueva-Meyer, J., Edell, S., Connolly, J., Schnitt, S., Baum, J., Houlihan, M., Jenkins, R. and Haber, S. (2000). Diagnostic Accuracy of 99mTc-Sestamibi Breast Imaging: Multicenter Trial Results. The Journal of Nuclear Medicine, 41(12), pp.1973-1979. Kim, J., Ryu, J., Kim, J., Hwang, E., Jung, S., Kang, T., Kwon, D. and Park, K. (2015). Prostate-Specific Antigen fluctuation: what does it mean in diagnosis of prostate cancer? International Brazilian Journal of Urology: official journal of the Brazilian Society of Urology, 41(2), pp.258-264. Leo, G., Trimboli, R., Sella, T. and Sardanelli, F. (2017). Optical Imaging of the Breast: Basic Principles and Clinical Applications. American Journal of Roentgenology, 209(1), pp.230-238. Parikh, R., Mathai, A., Parikh, S., Chandra Sekhar, G. and Thomas, R. (2008). Understanding and using sensitivity, specificity and predictive values. Indian Journal of Ophthalmology, 56(1), pp.45-50. Razi, A. (2004). Prostate Cancer Screening, Yes or No? The Current Controversy. Urology Journal, 1(4), pp.240-245. Singh, V., Saunders, C., Wylie, L. and Bourke, A. (2008). New diagnostic techniques for breast cancer detection. Future Oncology, 4(4), pp.501-513. Stenman, U., Leinonen, J., Zhang, W. and Finne, P. (1999). Prostate-specific antigen. Seminars in Cancer Biology, 9(2), pp.83-93. Cancer Research UK. (2018). Breast cancer mortality statistics. Retrieved November, 4, 2018, from Cancer Research UK. (2018). Prostate cancer mortality statistics. Retrieved November, 6, 2018, from Cancer Research UK. (2017). Breast screening. Retrieved November, 4, 2018, from National Health Service. (2018). PSA testing. Retrieved November, 7, 2018, from Centers for Disease Control and Prevention. (2018). What Is Breast Cancer Screening? Retrieved November, 4, 2018, from National Health Service. (2018). Overview – Breast cancer screening. Retrieved November, 5, 2018, from National Health Service. (2018). What happens-Breast Cancer Screening. Retrieved November, 5, 2018, from Public Health England (2017). NHS Breast Screening Programme. Breast implants and breast screening. Retrieved November, 4, 2018, from Bell, D., Radswiki, Knipe, H., Power, S., Goel, A. and Jones, J. (2018). Tc-99m sestamibi. Radiopaedia. Retrieved November, 10, 2018, from (2017). Scintimammography. Retrieved November, 10, 2018, from Lewin, J. and Jochelson, M. (2017). Contrast Enhanced Digital Mammography. Society of Breast Imaging. Retrieved November, 11, 2018, from (2018). Breast Tomosynthesis. Retrieved November, 16, 2018, from Halls, S. (2018). Breast Cancer Screening using the PET Scan. Moose and Doc – Breast Cancer. Retrieved November, 5, 2018, from National Cancer Institute (2018). Breast Cancer Screening (PDQ®)–Health Professional Version. Retrieved November, 4, 2018, from Centers for Disease Control and Prevention. (2018). Breast Cancer. What Are the Benefits and Risks of Screening? Retrieved November, 5, 2018, from Cancer Research UK. (2017). 2012 review of the UK breast screening programme. Retrieved November, 10, 2018, from National Health Service. (2018). Should I have a PSA test? Retrieved November, 14, 2018, from Siemens Healthineers. (2018). Breast cancer screening programs around the globe. Retrieved November, 18, 2018, from Share this: Facebook Twitter Reddit LinkedIn WhatsApp

VCU Database Normalization and Related Problems Discussion

VCU Database Normalization and Related Problems Discussion.

I’m working on a databases discussion question and need an explanation to help me study.

1. Normalization and Related Problems: Explain when is it necessary to apply the normalization process to a table.Also, describe the problems that unnormalized tables would have so the database designer should be concerned and fix them.Citation and references are expected. (need explanation from the cite)2. Discuss some of the similarities and differences between virtualization and emulation. Describe a case where you would use either one and why. (for the second question: 5-6 sentences) (citation not required)
VCU Database Normalization and Related Problems Discussion

TCC Healthcare for People Experiencing Homelessness in United States Research Paper

TCC Healthcare for People Experiencing Homelessness in United States Research Paper.

Write a paper exploring the planning, implementation, and evaluation that goes into the program on housing and homelessness as it involves a great amount of planning and needs assessment to get started on such a project. The paper will describe the Program planning and policies process including
the benefits of incorporating components of various approaches to conducting a needs
assessment, selecting the appropriate statistics for analysis of data and the target
audience for the program Your paper must:

be 8–10 ten pages in length

be double-spaced

use 1-inch margins left, right, top, and bottom

use 12 point font
The cover sheet, table of contents, index, pictures, long quotations, or multiple
quotations will count toward the 8–10 pages. APA format is required.
TCC Healthcare for People Experiencing Homelessness in United States Research Paper