You’Re a Contract Painkiller

In You Are a Contract Painkiller (1997, p. 111), author Maureen Littlejohn makes extensive use of personification to describe the functioning of Aspirin in our body, its various properties to fight pain, and its evolution over the years. Littlejohn describes how Aspirin claimed celebrity status as one of the world’s most popular, inexpensive painkillers by relieving headaches, sprains, blows, burns, swelling and fever. Furthermore, she added that Aspirin could also be used to reduce the risk of stroke and heart attack.The author supports the main idea by describing how the aspirin when taken with a modest stream of water or ginger ale, passed to the stomach through the esophagus and undergoes a series of chain reactions to disable the enzyme that converts the acid in cell membranes into prostaglandins (responsible for the pain). In a similar fashion it also helps bring fever down. Moreover, the author gives a brief history about the evolution of the modern day Aspirin from alm ost a thousand years ago when Hippocrates first discovered the property of willow leaves to help relieve pain.The author concludes the essay by highlighting the useful properties of Aspirin and the various ailments it provides relief from. â€Å"You have achieved renown by destroying headaches but you are equally effective in countering sprains, burns, or blows. † (You Are a Contract Painkiller, 1997, p. 112). According to me, this sentence sets the tone for the entire essay. It describes the purpose of using Aspirin and the different ailments that it provides relief from. It basically highlights why and about what the essay is written.It furthermore, sets the stage to write details about the composition and mechanism of Aspirin and also the various ways by which it has meliorated our lives by relieving pain. It puts the entire essay in perspective. â€Å"In the 1800s, two Italian chemists confirmed that willow bark contains one of your main ingredients, the antipyretic (fev er-reducing) salicin. A Swiss pharmacist then found that meadowsweet, a shrub in the spirea family, has ever more of the magic substance than willow bark.In 1893, Felix Hoffmann at the Bayer AG Chemical Works in Germany purified and stabilized you, and that’s when your first claimed celebrity status as one of the world’s most popular, inexpensive pain relievers. † (You Are a Contract Painkiller, 1997, p. 111). The reason I chose this quote is because, it provides a lot of credibility to the essay, by describing how the Aspirin has evolved and also, it gives a perfect example why Aspirin has become so popular all over the world. By describing its formation and development, it gives an overview about what makes Aspirin what it is today.The main idea of this essay revolves around the painkiller called Aspirin. The purpose of this essay is to describe the remarkable properties of Aspirin, to help relieve from different types of pain, and how Aspirin has formed and th e mechanism by which it provides instant relief from the pain. This essay is written for a general audience, to educate them about the useful benefits of aspirin followed by providing detailed information about how an aspirin works to provide relief.This would help people to better understand the pros and cons of aspirin and erase any misconceptions. I really like the way how Littlejohn has written the essay. By using personification method, she has depicted the various aspects of Aspirin in an interesting way rather than just quoting some scientific facts about it. By this, it has really help understand the overall functioning and mechanism of an aspirin in an uncomplicated way.

A Learning Experience: Lost in Translation

Ralph Waldo Emerson, a well-known American literary icon, once said that â€Å"No man should travel until he has learned the language of the country he visits. Otherwise he voluntarily makes himself a great baby – so helpless and so ridiculous.† I came upon this quote while I was looking for some passages or anecdotes that might make for a â€Å"first paragraph with a good hook.†Emerson’s take on the issue of language learning was somehow brutal and unconstructive, instantly attracting my attention since I am an international student acknowledging some limitations in my knowledge and skills in the use of the English language.Although Emerson was, and is still, highly-revered for his ingenuity in literature, I would have to express my disagreement about what he said about the helplessness and ridiculousness of people who visit countries without obtaining knowledge and practical skills on each country’s native language.My experiences in this country h as taught me that being at a disadvantage in terms of one’s lack of knowledge and skills in language and communication do not bring down a person to helplessness and nonsensicality. For I have discovered that being â€Å"lost in translation† is not a hopeless situation but an opportunity to sensibly and realistically learn the language.When arrived here one year ago, my limitations pertaining to the English language has made my life adjustments worse since it was difficult to openly communicate and relate to other people. Being in an unfamiliar place was stressful enough, having to deal with not being able to conveniently visit places, dealing with the changes in the weather, learning the culture, and such.Not being able to communicate well enough made it much worse, since it became a barrier in smoothing the progress of adjustment and adaptation. At first, I was deeply uncomfortable with having to talk to other people who are native speakers of English for fear of bei ng criticized or made of as a joke. However, my everyday experiences has taught me that gradual openness to socialization, interaction, and communication is a opportunity for me to learn not only the language, but the cultural practices and traditions that are unfamiliar to me.I found out how talking to other people often about anything helped in developing my knowledge and skills of the English language. But perhaps the most important skill that I have learned is how to use theEnglish language in practical, everyday conversations in order to avoid or prevent confusion that is rooted from misunderstandings or miscommunications. There was this one time when I was watching the evening news with a friend of mine. The news show televised a case wherein two individuals claiming to be insurance handlers fooled other people into subscribing for insurance plans.They ran away after obtaining the initial payments made by their clients. I remember my friend telling me initially how it was a â €Å"rip off.† I did not understand what he meant by the situation being a rip-off since the act of ripping to me, as I understood it, is the act of tearing or cutting a thing or an object. Out of pure curiosity, I asked him what he meant and he explained to me how the word â€Å"rip-off† means a form of cheating or conning.I especially value learning practical English language through my daily encounters with other people because it has greatly helped in my being able to adjust to my life here in a foreign country.However, I am not disregarding the fact that learning the formal grammar rules of the English language is all too important, my learning of practical English language for everyday use has contributed to my getting used to living in this country as I feel that I understand people more when I talk to them leaving out confusion or awkwardness in misunderstandings or miscommunications.I can relate to my friends when they say they are â€Å"having dibs† on or going â€Å"bonkers† over some girls they see in the campus or on the street, or when they say that we need to â€Å"pull an all-nighter† before the day of the examinations, and such.Learning words or phrases that are commonly used in this country has made it easier for me to understand what other people mean, making it also easy to respond, make judgments, state opinions, and such. Moreover, it has boosted my self-confidence in opening conversations with other people creating more opportunities for me to learn the English language effectively.

Breast Cancer

Some methods used to diagnose breast carcinoma are mammograms, MRI’s, and biopsies (NCI, 2010). A staging system is standardized way for the cancer care team to summarize information about how far a cancer has spread (ACS, 2012). The most common system used to describe the stages of breast cancer is the American Joint Committee on Cancer (AJCC) TNM system (ACS, 2012). Each stage has different prognoses with varying survival rates as well (Marissa, 2011). There are also many ways to prevent breast cancer including maintain a healthy weight, avoiding the alcohol consumption, and by getting an annual mammogram (Reynolds, 2010). A genetic mutation that raises the risk of breast cancer is found in up to 60 percent of U. S. women, making it the first truly common breast cancer susceptibility gene (Metcalf Metcalf, 2008). Other breast diseases besides breast cancer are breast fat necrosis and fibrocystic breast disease (Sacks, 2011; Silverman, 1994). These diseases do not necessarily lead to breast cancer and can be treated (Sacks, 2011; Silverman, 1994). Keywords: – breast cancer, ducts, lobules, tumor, invasive (infiltrating carcinoma), noninvasive (noninfiltrating carcinoma), Ductal Carcinoma In Situ (DCIS), Invasive Lobular Carcinoma (ILC), intraductal carcinoma, nonfunctioning breast tissue, estrogen, lymph nodes, mammogram, MRI (magnetic resonance imaging), core biopsy, somatic mutations, fine needle aspiration biopsy, stereotactic biopsy, FGFR2, BRCA1,  BRCA2,  CDH1,  PTEN,  STK11, AR,  ATM,  BARD1,  BRIP1, CHEK2, DIRAS3,  ERBB2,  NBN,  PALB2,  RAD50, metastasis, fat necrosis, fibrocystic breast disease Breast Cancer Cells are the building blocks of living things and cancer grows out of normal cells in the body (Dugdale, 2010). Cancer is the uncontrolled growth of abnormal cells in the body (Dugdale, 2010). Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors (except in the case of leukemia where cancer doesn’t allow normal blood function by abnormal cell division in the blood stream (Peter, 2011). Normal cells in the body follow an orderly process of growth, division, and death, this is called apoptosis, and when this process breaks down, cancer begins to form (Peter, 2011). Cancer has been around since prehistoric times, and breast cancer is one of the earliest forms to have been mentioned (Eisenpreis, 1999). In the United States, breast cancer death rates are higher than those for any other cancer, besides lung cancer (breastcancer. org, 2012). Today, about 1 in 8 women (12%) will develop breast cancer in her lifetime (Martin, 2012). Breast cancer is a cancer that starts in the tissues of the breast (Yi-Bin David, 2011). In rare cases, breast cancer can start in other areas of the breast (Yi-Bin David, 2011). Breast cancer can be invasive or noninvasive (Yi-Bin David, 2011). Invasive meaning it has spread from the milk duct (lobule) to the other tissues in the breast (Eisenpreis, 1999). Noninvasive means that it has not yet invaded other breast tissue (Yi-Bin David, 2011). Types of Breast Cancer Breast cancer can begin in different areas of the breast – the ducts, the lobules, or sometimes, the tissue in between (breastcancer. org, 2012). There are several different types of breast cancer, including breast cancer in men (breastcancer. org, 2012). Some include Ductal Carcinoma In Situ, Invasive Lobular Carcinoma, and Male Breast Cancer (breastcancer. rg, 2012). Ductal carcinoma in situ (DCIS), or intraductal carcinoma, is a noninvasive breast cancer in the lining of the milk ducts that has not yet invaded nearby tissues of the breast (Yi-Bin David, 2011). It may progress to invasive cancer if it is left untreated (Yi-Bin David, 2011). DCIS is the earliest form of breast cancer and is usually found during a mammogram done as part of breast cancer screening (Mayo Clinic Staff, 2011). Because of the increased use of mammograms, the rate at which DCIS is diagnosed has increased dramatically in recent years (Mayo Clinic Staff, 011). When a woman has DCIS, she is at higher risk for the cancer coming back or also at higher risk for developing a new breast cancer than a person who has never had breast cancer before (breastcancer. org, 2012). Experts believe that 20 to 50% of women with DCIS will later develop an invasive breast cancer within 10 years of the DCIS diagnosis (Hoffman, 2010). The risk of lymph node involvement with ductal carcinoma in situ is only 1% to 2% so the lymph nodes under the arm do not need to be removed, as may be  the case with other types of breast cancer (Hoffman, 2010). In seven out of 10 cases, breast-conserving lumpectomies – instead of mastectomies – were an effective treatment option (Hoffman, 2010). This will depend upon the size of your tumor and the extent of its spread throughout your breast and the surrounding lymph nodes (Hoffman, 2010). While DCIS isn’t life-threatening, it does require treatment to prevent the condition from becoming invasive (Mayo Clinic Staff 2011). Most recurrences happen within 5 to 10 years after the first diagnosis and the chances of that happening are under 30 percent (breastcancer. rg, 2012). Invasive Lobular Carcinoma is an invasive type of breast cancer that begins in the milk-producing glands (lobules) of the breast (Mayo Clinic Staff, 2011). When a person has ILC, this means that the cancer cells have broken out of lobule where they started and they now have the potential to spread to other areas or tissues of the body (Mayo Clinic Staff, 2011). This type of cancer is more difficult to se e on imaging because of the way it grows with spreading branches (Hopkins, 2012). The treatments for invasive lobular carcinoma fall into two broad categories: Local and Systemic Treatment. Local treatments treat the tumor and the areas surrounding it, such as the chest and lymph nodes (breastcancer. org, 2012). Systemic treatments travel throughout the body to destroy any type of cancer cells that may have left the original tumor and traveled to other tissues to reduce the risk of the cancer coming back (breastcancer. org, 2012). ILC cells can proceed to infiltrate fatty tissue and create a web-like mass (Stephan, 2008). This web of cancer cells may feel like a thickened area of breast tissue, and may not cause concern or pain at first (Stephan, 2008). Unfortunately, if it is left undetected, ILC can develop into a mass that is about ? inch ( 2 centimeters) to about 2 inches (5 centimeters) or bigger in size, before causing more noticeable symptoms (Stephan, 2008). Breast cancer in men is a very rare disease (Attebery, Adams ; Weiss, 2011). But the truth is that boys and girls, men and women all have breast tissue (Attebery, Adams ; Weiss, 2011). Men have a small amount of nonfunctioning breasts tissue (breast tissue that cannot produce milk) that is concentrated in the area directly behind the nipple on the wall of the chest (Attebery, Adams ; Weiss, 2011). A type of breast cancer that has spread outside of the duct and into the surrounding tissue is called invasive or infiltrating carcinoma (ASC, 2012). Some symptoms that may occur in males developing breast cancer include lumps, changes to the nipple or breast skin, or discharge of fluid from the nipple (National Cancer Institute, 2011). Men who have an altered gene related to breast cancer have an increased risk of developing breast cancer (National Cancer Institute, 2012). The major problem is that breast cancer in men is more often than not diagnosed later than breast cancer in women because men are less likely to be suspicious of an abnormality in that area (Wax, 2012). Also, their small amount of breast tissue is harder to feel, making it more difficult to catch these cancers early, and allowing tumors to spread more quickly to the surrounding tissues (Wax, 2012). Breast cancer in men is detected the same way as breast cancer is detected in women – through self-examination, clinical examination, or mammography (x-ray of the breast) (ASC, 2012). Methods for Diagnosis Breast cancer is sometimes found after symptoms appear, but many women with early breast cancer have no symptoms (American Cancer Society, 2011). This is why getting the recommended screening tests before any symptoms develop is so important (American Cancer Society, 2011). Three types of methods used for diagnosis are mammograms, MRI’s, and biopsies (NCI, 2010). A mammogram is a low-dose x-ray picture of the breast and can be used to check for breast cancer in women who don’t have any signs or symptoms of the disease. (NCI, 2010) The results are recorded on x-ray film or directly into a computer for a doctor called a radiologist to examine (Webmd, 2010). There are different types of mammograms including Screening mammograms and Diagnositc mammograms (Webmd, 2010). Mammograms detect tiny bits of calcium that develop in dead cancer cells (Hoffman, 2010). As more and more cancer cells age and die, theses calcifications grow nd on the mammogram, they appear as a shadowy area (Hoffman, 2010). Current guidelines from the American College Radiology, the American Cancer Society, and the Society for Breast Imaging recommend that women receive annual mammograms starting at age 40, even if they have no symptoms or family history of breast cancer (ACR, 2010). For every 1,000 women who have screening mammogram: 100 are recalled to get more mammogr aphy or ultrasound images, 20 are recommended for needle biopsy and 5 are diagnosed with breast cancer (ACR, 2010). A mammography unit is a rectangular box that houses the tube in which x-rays are produced (Radiological Society of North America, 2011). Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special digital image recording plate (Radiological Society of North America, 2011). A brief medical history and a history of specific problems related to the breast, such as pain or a palpable lump (one that is felt), is obtained prior to the mammogram (Stoppler, 2011). All jewelry and clothing in the chest and breast area are removed prior to the mammogram (Stoppler, 2011). The patient’s breasts are then placed on a firm flat panel and a gentle, but firm pressure is applied to the breast with another panel, resulting in compression of the breast between the two panels (Stoppler, 2011). The compression of the breast is necessary to obtain quality mammograms and spreads the breast tissue out so that the x-ray image displays the inner breast tissue with good resolution (Stoppler, 2011). Dense bone absorbs much of the radiation while soft tissue, such as muscle, fat and organs, allow more of the x-rays to pass through them (Radiological Society of North America, 2011). As a result, bones appear white on the x-ray, soft tissue shows up in shades of gray and air appears black (Radiological Society of North America, 2011). The results of the mammogram can be given to the patient either by the radiologist at the completion of the mammogram or by the patient’s doctor who ordered the mammogram (Stoppler, 2011). An abnormal mammogram does not mean you have cancer (Stoppler, 2011). In some cases, it may just be an area of thicker or denser breast tissue, a cyst, or a benign lump such as a fibro adenoma (Stoppler, 2011). Unlike mammography which uses low dose x-rays to produce an image of the breast, MRI (Magnetic Resonance Imaging) uses powerful magnetic fields and radio waves to create images of the breast (Imaginis, 2012). The MRI system has the ability to switch magnetic fields and radio waves to achieve views in any plane and from any orientation while x-ray mammography requires re-orientation of the breast and mammography system for each view desired (Imaginis, 2012). MRI is a huge magnet and the woman gets put in the middle of the magnet; the magnetic field is turned on and then turned off again (Eisenpreis, 1999). The way the magnetized cells return to normal gives an image (Eisenpreis, 1999). The MRI finds lumps better than it tells whether or not they are cancerous (Eisenpreis, 1999). However, MRI can be good at showing how big a cancer is, once it has been found on the mammogram (Eisenpreis, 1999). A breast biopsy removes a sample of breast tissue that is looked at under a microscope to check for breast cancer and is usually done to check a lump found during a breast examination or a suspicious area found on a mammogram, ultrasound, or magnetic resonance imaging (MRI) (Marshall, 2009). During a fine-needle aspiration biopsy, the doctor inserts a thin needle into a lump and removes a sample of cells or fluid (Marshall, 2009). Nowadays, doctors might have decided to do something called stereotactic biopsy, where a patient lies on a table, with her breasts hanging down (Eisenpreis, 1999). A mammogram is taken to show where the lump is and a device holding a needle quickly shoots in and removes a few cells from the lesion (Eisenpreis, 1999). There is also something called a core biopsy that uses a larger needle to take out a piece of tissue, instead of just cells (Eisenpreis, 1999). A doctor numbs your skin with a shot of numbing medicine where the biopsy needle will be inserted and once the area is numb, a small cut is made in the skin from where the needle with a special tip is inserted into breast tissue (Marshall, 2009). Three to twelve samples will be taken to acquire the most accurate results (Marshall, 2009). Classifications and Associated Prognoses The stages of breast cancer are usually expressed as a number on a scale of 0 through IV – with stage 0 describing non-invasive cancers that remain within their original location and stage IV describing invasive cancers that have spread outside the breast to other parts of the body (Marisa, 2011). Cancer stage is based on four characteristics; the size of the cancer, hether the cancer is invasive or non-invasive, whether the cancer is in the lymph nodes, whether the cancer has spread to other parts of the body beyond the breast (Marisa, 2011). Sometimes doctors use the term â€Å"locally advanced† or regionally advanced† to refer to large tumors that involve the breast skin, underlying chest structures, changes to the breast’s shape, and lymph node enlargement that is visible or that the doctor can feel during an exam (Marisa , 2011). The three ways that cancer spreads in the body are: Through tissue where cancer invades surrounding normal tissue, through the lymph system where the cancer invades the lymph system and travels through the lymph vessels to other places in the body, and through the blood, where cancer invades the veins and capillaries and travels through the blood to other places in the body (NCI, 2009). When cancer cells break away from the primary (original) tumor and travel through the lymph nodes or blood to other places in the body, another (secondary) tumor may form (NCI, 2009). This process is called metastasis (NCI, 2009). The stage of the breast cancer can help the patient and the doctor understand the prognosis (the most likely outcome of the disease) and make decisions about treatment, along with all the other results in the pathology report (Marisa, 2011). A staging system is standardized way for the cancer care team to summarize information about how far a cancer has spread (ACS, 2012). The most common system used to describe the stages of breast cancer is the American Joint Committee on Cancer (AJCC) TNM system (ACS, 2012). The TNM staging system classifies cancers based on their T, N, and M stages (ACS, 2012). The letter â€Å"T† followed by a number 0 to 4 describes the tumor’s size and spread to the skin or to the chest wall under the breast (ACS, 2012). The letter â€Å"N† followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are affected. The letter â€Å"M† followed by a 0 or 1 indicates whether the cancer has spread to distant organ (ACS, 2012). There are typically five stages (0 to 4) with sub-stages that indicate the prognosis for breast cancer (Lippman, 2005). Stage 0 where the carcinoma is insitu and no lymph nodes are affected had 99 percent 5 year survival rate (ACS, 2012). Stage IA also has a high rate, 92 percent, in which the tumor is equal to 2 centimeters (ACS, 2012). In stage IB, the tumor is 2 centimeters with micro metastases in 1 to 3 axillary lymph nodes but the cancer has not spread to distant sites (ACR, 2012). In stage IIA, the cancer cells have moved to the ipsilateral nodes and the 5 year survival rate lowers to 82 percent (Lippman, 2012). In stage IIB, the cancer cells have spread to movable ipsilateral nodes and the tumor is over 5 centimeters (Lippman, 2012). The 5 year survival rate lowers to 65 percent (ACS, 2012). In stage IIIA, there is no evidence of a primary tumor and no distant spreading (ACS, 2012). The 5 year survival rate lowers to 47 percent (Lippman, 2005). The tumor could be between 2 and 5 centimeters but there is still no distant spreading at this point (ACS, 2012). In stage IIIB the tumor has extended to the chest wall but there is still no distant metastases (Lippman, 2005). The 5 year survival rate lowers again to a 44 percent (Lippman, 2005). In stage IV the cancer can be any size (any T) and may or may not have spread to nearby lymph nodes (any N) (ACS, 2012). It has spread to distant organs or to lymph nodes far from the breast (M1) (ACS, 2012). The most common sites of spread are the bone, liver, brain, or lung (ACS, 2012). The survival rate lowers to 14 percent (Lippman, 2005). Prevention Methods Three ways to prevent breast cancer are by maintaining a healthy weight, avoiding alcohol consumption, and getting an annual mammogram (Reynolds, 2010). Mammogram screening, early diagnosis and better treatments have all contributed to the reduction in breast cancer cases by around 2 percent a year and the improved survival rate in the U. S. (Reynolds, 2010). Experts say now the focus needs to shift on improving personal lifestyle habits to prevent the disease even more (Reynolds, 2010). Early detection of breast cancer with screening mammography means that treatment can be started earlier in the course of the disease, possibly before it has spread (NCI, 2010). A medical team found an 11 percent lower risk of breast cancer in those women consuming the more healthful diet, including more whole grains, fruits and vegetables and less fatty, processed foods (Reynolds, 2010). They also found that those consuming large amounts of alcohol had a 21 percent increased risk (Reynolds, 2010). Drinking alcohol during adolescence has been linked to an increased risk of breast cancer, especially for girls with a family history of the disease (Reynolds, 2010). Exercise also plays a role in the reduction of breast cancer risk (Reynolds, 2010). In one study from the Women’s Health Initiative, as little as 1. 25 to 2. 5 hours per week of brisk walking reduced a woman’s risk by 18 percent (Reynolds, 2010). Walking 10 hours a week reduce the risk more (Reynolds, 2010). Diet and exercise can lead to weight reduction, another positive lifestyle change that can influence breast cancer disease risk (Reynolds, 2010). Many breast cancers are fueled by estrogen, a hormone produced in fat tissue (Reynolds, 2010). Experts suspect that more fat tissue equals more estrogen resulting in more cases of breast cancer that could possibly be avoided (Reynolds, 2010). Genetic ; Hereditary Influence According to researchers, the mutations in the gene, which is called FGFR2, raise the risk of breast cancer by 20 to 60 percent. (Metcalf ; Metcalf, 2008). A genetic mutation that raises the risk of breast cancer is found in up to 60 percent of U. S. omen, making it the first truly common breast cancer susceptibility gene (Metcalf ; Metcalf, 2008). Women with faulty copies of the genes BRCA1 or BRCA2 have 50 percent to 85 percent chance of getting breast cancer in their lifetimes, but they are rare genes and only account for 5 percent to possibly 10 percent of breast cancer cases (Metcalf ; Metcalf, 2008). Only 7% of all breast cancers are hereditary (Hirshaut ; Pressman, 2008). Of these hereditary cancers, 45% is caused by BRCA1 while 35% is caused by BRCA2 (Hirshaut ; Pressman, 2008). (Hirshaut ; Pressman, 2008). Variations of the  BRCA1,  BRCA2,  CDH1,  PTEN,  STK11, and  TP53  genes increase the risk of developing breast cancer (Chen, 2007). The  AR,  ATM,  BARD1,  BRIP1, CHEK2, DIRAS3,  ERBB2,  NBN,  PALB2,  RAD50, and  RAD51  genes are associated with breast cancer (Chen, 2007). Cancers occur when a buildup of genetic mutations in critical genes – those that control cell growth and division or the repair of damaged DNA – allow cells to grow and divide uncontrollably to form a tumor (Honrado, Osorio, Palacios ; Benitez, 2006). These changes, which are called somatic mutations, are not inherited (Honrado, Osorio, Palacios ; Benitez, 2006). Less commonly, gene mutations inherited from a parent increase the risk of developing cancer (Honrado, Osorio, Palacios ; Benitez, 2006). In people with these inherited genetic changes, additional somatic mutations in other genes must occur for cancer to develop (Honrado, Osorio, Palacios ; Benitez, 2006). Additional factors that may influence a person’s risk of developing breast cancer include gender, age, ethnic background, a history of previous breast cancer, certain changes in breast tissue, and hormonal factors (Thompson ; Easton, 2004). A history of breast cancer in closely related family members is also an important risk factor, particularly if the cancer occurred at an early age (Thompson ; Easton, 2004). Women who have inherited certain mutations in these genes have a high risk of developing breast cancer, ovarian cancer, and several other types of cancer during their lifetimes (Thompson ; Easton, 2004). Inherited changes in several other genes, including CDH1, PTEN, STK11, and TP53, have been found to increase the risk of developing breast cancer (Thompson ; Easton, 2004). In hereditary breast cancer, the way that cancer risk is inherited depends on the gene involved (Walsh ; King, 2007). For example, mutations in the BRCA1 and BRCA2 genes are inherited in an autosomal dominant patter, which means one copy of the altered gene in each cell is sufficient to increase a person’s chance of developing cancer (Walsh ; King, 2007). In other cases, the inheritance of breast cancer risk is unclear (Walsh ; King, 2007). It is important to emphasize that people inherit an increased risk of cancer, not the disease itself (Walsh ; King, 2007). Not all people who inherit mutations in these genes will develop cancer (Walsh ; King, 2007). Other Breast Diseases Two other diseases found in the breast other than breast carcinoma are breast fat necrosis and fibrocystic breast disease (Sacks, 2011; Silverman, 1994). Fybrocystic breast disease is a commonly used phrase to describe painful, lumpy breasts (Sacks 2011). Hormones made in the ovaries can make a woman’s breasts feel swollen, lumpy, or painful before during menstruation each month (Sacks 2011). Fibrocysitc changes in the breast with the menstrual cycle affect over half of women (Sacks, 2011). Symptoms are usually worse right before the menstrual period, and then improve after the period starts (Sacks, 2011). Symptoms can include pain in both breasts, breasts that feel swollen and heavy, pain or discomfort under the arms, and thick or lumpy breasts (Sacks, 2011). This disease can be treated with medication like acetaminophen or ibuprofen (Sacks, 2011). Breast Fat necrosis is a benign condition that can occur in your breast (Silverman. 1994). It consists of fatty tissue that has been bruised, injured, or has died (Silverman, 1994). Once fatty tissue has been injured or has died, it can gradually change into scar tissue or may collect as liquid within an oil cyst (Silverman, 1994). Fat necrosis does not lead to the development of breast cancer, but it may sometimes cause breast pain (Silverman, 1994). An area of fat necrosis in your breast may feel like a fairly hard lump, or like a section of thick skin (Silverman, 1994). The person may see some drainage from the nipple that is nearest to the bruised region (Silverman, 1994). The nipple may sometimes even pull inward a little bit or the breast skin may dimple above the lump of fat necrosis (Silverman, 1994). Each case of fat necrosis is unique, so treatments will vary but if the fat necrosis has occurred recently, using warm compresses may help it subside (Silverman, 1994). When fat necrosis causes pain, the person can use ibuprofen and aspirin, but if that doesn’t help, ask your doctor if a prescription medication may be used (Silverman, 1994). About 39,520 women in the U. S. were expected to die in 2011 from breast cancer, though death rates have been decreasing since 1990 — especially in women under 50 (â€Å"Learn about cancer,† 2011). These decreases are thought to be the result of treatment advances, earlier detection through screening, and increased awareness (â€Å"breastcancer. org,† 2012). References Peter, C. (2011, October 20). Medical news today. Retrieved from http://www. medicalnewstoday. com/info/cancer-oncology/ breastcancer. org. (n. d. ). (2012, March 14). Retrieved from http://www. breastcancer. org/symptoms/understand_bc/statistics. jsp Yi-Bin , C. , ; David , Z. (2011, 15 12). A. d. a. m. medical encyclopedia. Retrieved from http://www. ncbi. nlm. nih. gov/pubmedhealth/PMH0001911/ Mayo Clinic Staff. (2011, June 23). Ductal carcinoma in situ (dcis). Retrieved from http://www. mayoclinic. com/health/dcis/DS00983 Avon Foundation Breast Cancer (n. d. ). In http://www. hopkinsmedicine. org/avon_foundation_breast_center/breast_cancers_other_conditions/invasive_lobular_carcinoma. html. Stephan, P. (2008, July 24). Invasive Lobular Carcinoma. Retrieved from about. com website: http://breastcancer. about. com/od/types/p/ilc. html Dugdale, D. (2010, August 14). Pubmed. Retrieved from http://www. ncbi. nlm. nih. gov/pubmedhealth/PMH0002267/ Martin, L. (2012, January 18). Breast cancer facts. WebMD. Retrieved from http://women. webmd. om/guide/breast-cancer-arm-yourself-with-facts National Cancer Insitute. (2012). National cancer institute. Retrieved from http://www. cancer. gov/cancertopics/pdq/treatment/malebreast/Patient/page1 Attebery, L. , Adams, J. H. , ; Weiss, M. (2011, november 22). Male breast cancer. Retrieved from http://www. breastcancer. org/symptoms/types/male_bc/ National Cancer Institute. ( 2011). Male breast cancer. Retrieved from http://www. nlm. nih. gov/medlineplus/malebreastcancer. html Wax, A. (2011). Breast cancer in men: Symptoms, causes, treatments. Retrieved from http://www. webmd. com/breast-cancer/guide/breast-cancer-men American Cancer Society. (2011, September 29). American cancer society. Retrieved from http://www. cancer. org/Cancer/BreastCancer/DetailedGuide/breast-cancer-diagnosis NCI. (2010, September 22). National cancer institute. Retrieved from http://www. cancer. gov/cancertopics/factsheet/detection/mammograms Marshall, S. (2010, November 12). Webmd. Retrieved from http://women. webmd. com/mammogram-16573 Hoffman, M. (2010 February 18). Ductal carcinoma (invasive and in situ. Retrieved from http://www. webmd. com/breast-cancer/ductal-carcinoma-invasive-in-situ ACR. (2012). Mammography facts. Retrieved from http://www. ammographysaveslives. org/facts. aspx Hirshaut, Y. , ; Pressman, P. I. (2008). Breast cancer: The complete guide. (5th ed. ). New York, NY: Bantam Dell. Radiological Society of North America. (2011, June 24). Radiologyinfo. org. Retrieved from http://www. radiologyinfo. org/en/info. cfm? pg=mammo ASCO. (2011, January 26). Breast Cancer- Male Retrieved from http://www. cancer. net/patient/Cancer Types/Breast Cancer – Male/? skid= Stoppler, M. C. (2011). Medicinenet. Retrieved from http://www. medicinenet. com/mammogram/article. html Imaginis. (2012). Breast cancer mri – magnetic resonance imaging. Retrieved from http://www. maginis. com/mri-scan/magnetic-resonance-breast-imaging-mri-mr-3 Eisenpreis, B. (1999). A young woman’s guide to breast cancer prevention. New York: The Rosen Publishing Group. Marshall, S. (2009, April 29). Breast biopsy. Retrieved from http://women. webmd. com/breast-biopsy Metcalf, T. , Metcalf, G. (2008). Perspective on diseases and disorders. (1 ed. ). Michigan: Thomson Gale. Chen, S. ( 2007, April 10). Meta-analysis of BRCA1 and BRCA2 penetrance. Retrieved from http://ghr. nlm. nih. gov/condition/breast-cancer Honrado, E. , Osorio, A. , Palacios, J. , Benitez, J. (2006, September 25). Pathology and gene expression of hereditary breast tumors associated with brca1, brca2 and chek2 gene mutations. Retrieved from http://ghr. nlm. nih. gov/condition/breast-cancer/show/References Thompson, D. , Easton, D. (2004, July 9). The genetic epidemiology of breast cancer genes. Retrieved from http://ghr. nlm. nih. gov/condition/breast-cancer Walsh, T. , King, M. (2007, February 11). Ten genes for inherited breast cancer. Retrieved from http://ghr. nlm. nih. gov/condition/breast-cancer Marisa , W. (2011, August 03). Stages of breast cancer. Retrieved from http://www. breastcancer. org/symptoms/diagnosis/staging. jsp NCI. 2009). Breast cancer treatment (pdq). Retrieved from http://www. cancer. gov/cancertopics/pdq/treatment/breast/Patient/page2 Lippman, M. E. (2005). Cancer monthly. Retrieved from http://www. cancermonthly. com/cancer_basics/breast. asp American Cancer Society. (2012, March 06). Breast cancer. Retrieved from http://www. cancer. org/Cancer/BreastCancer/DetailedG uide/breast-cancer-staging Reynolds, D. (2010, March 26). Emaxhealth. Retrieved from http://www. emaxhealth. com/1506/98/36185/one-third-breast-cancer-cases-avoided-diet-and-exercise. html NCI. (2010, September 22). National cancer institute. Retrieved from http://www. cancer. ov/cancertopics/factsheet/detection/mammograms Sacks, D. N. (2011, November 16). Fibrocystic breast disease. Retrieved from http://www. nlm. nih. gov/medlineplus/ency/article/000912. htm Silverman, P. (1994, July). Breast fat necrosis – symptoms, causes and treatments. Retrieved from http://breastcancer. about. com/od/whenitsnotcancer/tp/Breast-Fat-Necrosis. htm American Cancer Society. U. S. Breast cancer statistics. (2011, September 29). Retrieved from http://www. cancer. org/Cancer/BreastCancer/index Hail, J. (2011, 09). National breast cancer foundation, inc.. Retrieved from http://www. nationalbreastcancer. org/About-Breast-Cancer/ Breast Cancer Breast Cancer Breast Cancer Some methods used to diagnose breast carcinoma are mammograms, MRI’s, and biopsies (NCI, 2010). A staging system is standardized way for the cancer care team to summarize information about how far a cancer has spread (ACS, 2012). The most common system used to describe the stages of breast cancer is the American Joint Committee on Cancer (AJCC) TNM system (ACS, 2012). Each stage has different prognoses with varying survival rates as well (Marissa, 2011). There are also many ways to prevent breast cancer including maintain a healthy weight, avoiding the alcohol consumption, and by getting an annual mammogram (Reynolds, 2010). A genetic mutation that raises the risk of breast cancer is found in up to 60 percent of U. S. women, making it the first truly common breast cancer susceptibility gene (Metcalf Metcalf, 2008). Other breast diseases besides breast cancer are breast fat necrosis and fibrocystic breast disease (Sacks, 2011; Silverman, 1994). These diseases do not necessarily lead to breast cancer and can be treated (Sacks, 2011; Silverman, 1994). Keywords: – breast cancer, ducts, lobules, tumor, invasive (infiltrating carcinoma), noninvasive (noninfiltrating carcinoma), Ductal Carcinoma In Situ (DCIS), Invasive Lobular Carcinoma (ILC), intraductal carcinoma, nonfunctioning breast tissue, estrogen, lymph nodes, mammogram, MRI (magnetic resonance imaging), core biopsy, somatic mutations, fine needle aspiration biopsy, stereotactic biopsy, FGFR2, BRCA1,  BRCA2,  CDH1,  PTEN,  STK11, AR,  ATM,  BARD1,  BRIP1, CHEK2, DIRAS3,  ERBB2,  NBN,  PALB2,  RAD50, metastasis, fat necrosis, fibrocystic breast disease Breast Cancer Cells are the building blocks of living things and cancer grows out of normal cells in the body (Dugdale, 2010). Cancer is the uncontrolled growth of abnormal cells in the body (Dugdale, 2010). Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors (except in the case of leukemia where cancer doesn’t allow normal blood function by abnormal cell division in the blood stream (Peter, 2011). Normal cells in the body follow an orderly process of growth, division, and death, this is called apoptosis, and when this process breaks down, cancer begins to form (Peter, 2011). Cancer has been around since prehistoric times, and breast cancer is one of the earliest forms to have been mentioned (Eisenpreis, 1999). In the United States, breast cancer death rates are higher than those for any other cancer, besides lung cancer (breastcancer. org, 2012). Today, about 1 in 8 women (12%) will develop breast cancer in her lifetime (Martin, 2012). Breast cancer is a cancer that starts in the tissues of the breast (Yi-Bin David, 2011). In rare cases, breast cancer can start in other areas of the breast (Yi-Bin David, 2011). Breast cancer can be invasive or noninvasive (Yi-Bin David, 2011). Invasive meaning it has spread from the milk duct (lobule) to the other tissues in the breast (Eisenpreis, 1999). Noninvasive means that it has not yet invaded other breast tissue (Yi-Bin David, 2011). Types of Breast Cancer Breast cancer can begin in different areas of the breast – the ducts, the lobules, or sometimes, the tissue in between (breastcancer. org, 2012). There are several different types of breast cancer, including breast cancer in men (breastcancer. org, 2012). Some include Ductal Carcinoma In Situ, Invasive Lobular Carcinoma, and Male Breast Cancer (breastcancer. rg, 2012). Ductal carcinoma in situ (DCIS), or intraductal carcinoma, is a noninvasive breast cancer in the lining of the milk ducts that has not yet invaded nearby tissues of the breast (Yi-Bin David, 2011). It may progress to invasive cancer if it is left untreated (Yi-Bin David, 2011). DCIS is the earliest form of breast cancer and is usually found during a mammogram done as part of breast cancer screening (Mayo Clinic Staff, 2011). Because of the increased use of mammograms, the rate at which DCIS is diagnosed has increased dramatically in recent years (Mayo Clinic Staff, 011). When a woman has DCIS, she is at higher risk for the cancer coming back or also at higher risk for developing a new breast cancer than a person who has never had breast cancer before (breastcancer. org, 2012). Experts believe that 20 to 50% of women with DCIS will later develop an invasive breast cancer within 10 years of the DCIS diagnosis (Hoffman, 2010). The risk of lymph node involvement with ductal carcinoma in situ is only 1% to 2% so the lymph nodes under the arm do not need to be removed, as may be  the case with other types of breast cancer (Hoffman, 2010). In seven out of 10 cases, breast-conserving lumpectomies – instead of mastectomies – were an effective treatment option (Hoffman, 2010). This will depend upon the size of your tumor and the extent of its spread throughout your breast and the surrounding lymph nodes (Hoffman, 2010). While DCIS isn’t life-threatening, it does require treatment to prevent the condition from becoming invasive (Mayo Clinic Staff 2011). Most recurrences happen within 5 to 10 years after the first diagnosis and the chances of that happening are under 30 percent (breastcancer. rg, 2012). Invasive Lobular Carcinoma is an invasive type of breast cancer that begins in the milk-producing glands (lobules) of the breast (Mayo Clinic Staff, 2011). When a person has ILC, this means that the cancer cells have broken out of lobule where they started and they now have the potential to spread to other areas or tissues of the body (Mayo Clinic Staff, 2011). This type of cancer is more difficult to se e on imaging because of the way it grows with spreading branches (Hopkins, 2012). The treatments for invasive lobular carcinoma fall into two broad categories: Local and Systemic Treatment. Local treatments treat the tumor and the areas surrounding it, such as the chest and lymph nodes (breastcancer. org, 2012). Systemic treatments travel throughout the body to destroy any type of cancer cells that may have left the original tumor and traveled to other tissues to reduce the risk of the cancer coming back (breastcancer. org, 2012). ILC cells can proceed to infiltrate fatty tissue and create a web-like mass (Stephan, 2008). This web of cancer cells may feel like a thickened area of breast tissue, and may not cause concern or pain at first (Stephan, 2008). Unfortunately, if it is left undetected, ILC can develop into a mass that is about ? inch ( 2 centimeters) to about 2 inches (5 centimeters) or bigger in size, before causing more noticeable symptoms (Stephan, 2008). Breast cancer in men is a very rare disease (Attebery, Adams ; Weiss, 2011). But the truth is that boys and girls, men and women all have breast tissue (Attebery, Adams ; Weiss, 2011). Men have a small amount of nonfunctioning breasts tissue (breast tissue that cannot produce milk) that is concentrated in the area directly behind the nipple on the wall of the chest (Attebery, Adams ; Weiss, 2011). A type of breast cancer that has spread outside of the duct and into the surrounding tissue is called invasive or infiltrating carcinoma (ASC, 2012). Some symptoms that may occur in males developing breast cancer include lumps, changes to the nipple or breast skin, or discharge of fluid from the nipple (National Cancer Institute, 2011). Men who have an altered gene related to breast cancer have an increased risk of developing breast cancer (National Cancer Institute, 2012). The major problem is that breast cancer in men is more often than not diagnosed later than breast cancer in women because men are less likely to be suspicious of an abnormality in that area (Wax, 2012). Also, their small amount of breast tissue is harder to feel, making it more difficult to catch these cancers early, and allowing tumors to spread more quickly to the surrounding tissues (Wax, 2012). Breast cancer in men is detected the same way as breast cancer is detected in women – through self-examination, clinical examination, or mammography (x-ray of the breast) (ASC, 2012). Methods for Diagnosis Breast cancer is sometimes found after symptoms appear, but many women with early breast cancer have no symptoms (American Cancer Society, 2011). This is why getting the recommended screening tests before any symptoms develop is so important (American Cancer Society, 2011). Three types of methods used for diagnosis are mammograms, MRI’s, and biopsies (NCI, 2010). A mammogram is a low-dose x-ray picture of the breast and can be used to check for breast cancer in women who don’t have any signs or symptoms of the disease. (NCI, 2010) The results are recorded on x-ray film or directly into a computer for a doctor called a radiologist to examine (Webmd, 2010). There are different types of mammograms including Screening mammograms and Diagnositc mammograms (Webmd, 2010). Mammograms detect tiny bits of calcium that develop in dead cancer cells (Hoffman, 2010). As more and more cancer cells age and die, theses calcifications grow nd on the mammogram, they appear as a shadowy area (Hoffman, 2010). Current guidelines from the American College Radiology, the American Cancer Society, and the Society for Breast Imaging recommend that women receive annual mammograms starting at age 40, even if they have no symptoms or family history of breast cancer (ACR, 2010). For every 1,000 women who have screening mammogram: 100 are recalled to get more mammogr aphy or ultrasound images, 20 are recommended for needle biopsy and 5 are diagnosed with breast cancer (ACR, 2010). A mammography unit is a rectangular box that houses the tube in which x-rays are produced (Radiological Society of North America, 2011). Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special digital image recording plate (Radiological Society of North America, 2011). A brief medical history and a history of specific problems related to the breast, such as pain or a palpable lump (one that is felt), is obtained prior to the mammogram (Stoppler, 2011). All jewelry and clothing in the chest and breast area are removed prior to the mammogram (Stoppler, 2011). The patient’s breasts are then placed on a firm flat panel and a gentle, but firm pressure is applied to the breast with another panel, resulting in compression of the breast between the two panels (Stoppler, 2011). The compression of the breast is necessary to obtain quality mammograms and spreads the breast tissue out so that the x-ray image displays the inner breast tissue with good resolution (Stoppler, 2011). Dense bone absorbs much of the radiation while soft tissue, such as muscle, fat and organs, allow more of the x-rays to pass through them (Radiological Society of North America, 2011). As a result, bones appear white on the x-ray, soft tissue shows up in shades of gray and air appears black (Radiological Society of North America, 2011). The results of the mammogram can be given to the patient either by the radiologist at the completion of the mammogram or by the patient’s doctor who ordered the mammogram (Stoppler, 2011). An abnormal mammogram does not mean you have cancer (Stoppler, 2011). In some cases, it may just be an area of thicker or denser breast tissue, a cyst, or a benign lump such as a fibro adenoma (Stoppler, 2011). Unlike mammography which uses low dose x-rays to produce an image of the breast, MRI (Magnetic Resonance Imaging) uses powerful magnetic fields and radio waves to create images of the breast (Imaginis, 2012). The MRI system has the ability to switch magnetic fields and radio waves to achieve views in any plane and from any orientation while x-ray mammography requires re-orientation of the breast and mammography system for each view desired (Imaginis, 2012). MRI is a huge magnet and the woman gets put in the middle of the magnet; the magnetic field is turned on and then turned off again (Eisenpreis, 1999). The way the magnetized cells return to normal gives an image (Eisenpreis, 1999). The MRI finds lumps better than it tells whether or not they are cancerous (Eisenpreis, 1999). However, MRI can be good at showing how big a cancer is, once it has been found on the mammogram (Eisenpreis, 1999). A breast biopsy removes a sample of breast tissue that is looked at under a microscope to check for breast cancer and is usually done to check a lump found during a breast examination or a suspicious area found on a mammogram, ultrasound, or magnetic resonance imaging (MRI) (Marshall, 2009). During a fine-needle aspiration biopsy, the doctor inserts a thin needle into a lump and removes a sample of cells or fluid (Marshall, 2009). Nowadays, doctors might have decided to do something called stereotactic biopsy, where a patient lies on a table, with her breasts hanging down (Eisenpreis, 1999). A mammogram is taken to show where the lump is and a device holding a needle quickly shoots in and removes a few cells from the lesion (Eisenpreis, 1999). There is also something called a core biopsy that uses a larger needle to take out a piece of tissue, instead of just cells (Eisenpreis, 1999). A doctor numbs your skin with a shot of numbing medicine where the biopsy needle will be inserted and once the area is numb, a small cut is made in the skin from where the needle with a special tip is inserted into breast tissue (Marshall, 2009). Three to twelve samples will be taken to acquire the most accurate results (Marshall, 2009). Classifications and Associated Prognoses The stages of breast cancer are usually expressed as a number on a scale of 0 through IV – with stage 0 describing non-invasive cancers that remain within their original location and stage IV describing invasive cancers that have spread outside the breast to other parts of the body (Marisa, 2011). Cancer stage is based on four characteristics; the size of the cancer, hether the cancer is invasive or non-invasive, whether the cancer is in the lymph nodes, whether the cancer has spread to other parts of the body beyond the breast (Marisa, 2011). Sometimes doctors use the term â€Å"locally advanced† or regionally advanced† to refer to large tumors that involve the breast skin, underlying chest structures, changes to the breast’s shape, and lymph node enlargement that is visible or that the doctor can feel during an exam (Marisa , 2011). The three ways that cancer spreads in the body are: Through tissue where cancer invades surrounding normal tissue, through the lymph system where the cancer invades the lymph system and travels through the lymph vessels to other places in the body, and through the blood, where cancer invades the veins and capillaries and travels through the blood to other places in the body (NCI, 2009). When cancer cells break away from the primary (original) tumor and travel through the lymph nodes or blood to other places in the body, another (secondary) tumor may form (NCI, 2009). This process is called metastasis (NCI, 2009). The stage of the breast cancer can help the patient and the doctor understand the prognosis (the most likely outcome of the disease) and make decisions about treatment, along with all the other results in the pathology report (Marisa, 2011). A staging system is standardized way for the cancer care team to summarize information about how far a cancer has spread (ACS, 2012). The most common system used to describe the stages of breast cancer is the American Joint Committee on Cancer (AJCC) TNM system (ACS, 2012). The TNM staging system classifies cancers based on their T, N, and M stages (ACS, 2012). The letter â€Å"T† followed by a number 0 to 4 describes the tumor’s size and spread to the skin or to the chest wall under the breast (ACS, 2012). The letter â€Å"N† followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are affected. The letter â€Å"M† followed by a 0 or 1 indicates whether the cancer has spread to distant organ (ACS, 2012). There are typically five stages (0 to 4) with sub-stages that indicate the prognosis for breast cancer (Lippman, 2005). Stage 0 where the carcinoma is insitu and no lymph nodes are affected had 99 percent 5 year survival rate (ACS, 2012). Stage IA also has a high rate, 92 percent, in which the tumor is equal to 2 centimeters (ACS, 2012). In stage IB, the tumor is 2 centimeters with micro metastases in 1 to 3 axillary lymph nodes but the cancer has not spread to distant sites (ACR, 2012). In stage IIA, the cancer cells have moved to the ipsilateral nodes and the 5 year survival rate lowers to 82 percent (Lippman, 2012). In stage IIB, the cancer cells have spread to movable ipsilateral nodes and the tumor is over 5 centimeters (Lippman, 2012). The 5 year survival rate lowers to 65 percent (ACS, 2012). In stage IIIA, there is no evidence of a primary tumor and no distant spreading (ACS, 2012). The 5 year survival rate lowers to 47 percent (Lippman, 2005). The tumor could be between 2 and 5 centimeters but there is still no distant spreading at this point (ACS, 2012). In stage IIIB the tumor has extended to the chest wall but there is still no distant metastases (Lippman, 2005). The 5 year survival rate lowers again to a 44 percent (Lippman, 2005). In stage IV the cancer can be any size (any T) and may or may not have spread to nearby lymph nodes (any N) (ACS, 2012). It has spread to distant organs or to lymph nodes far from the breast (M1) (ACS, 2012). The most common sites of spread are the bone, liver, brain, or lung (ACS, 2012). The survival rate lowers to 14 percent (Lippman, 2005). Prevention Methods Three ways to prevent breast cancer are by maintaining a healthy weight, avoiding alcohol consumption, and getting an annual mammogram (Reynolds, 2010). Mammogram screening, early diagnosis and better treatments have all contributed to the reduction in breast cancer cases by around 2 percent a year and the improved survival rate in the U. S. (Reynolds, 2010). Experts say now the focus needs to shift on improving personal lifestyle habits to prevent the disease even more (Reynolds, 2010). Early detection of breast cancer with screening mammography means that treatment can be started earlier in the course of the disease, possibly before it has spread (NCI, 2010). A medical team found an 11 percent lower risk of breast cancer in those women consuming the more healthful diet, including more whole grains, fruits and vegetables and less fatty, processed foods (Reynolds, 2010). They also found that those consuming large amounts of alcohol had a 21 percent increased risk (Reynolds, 2010). Drinking alcohol during adolescence has been linked to an increased risk of breast cancer, especially for girls with a family history of the disease (Reynolds, 2010). Exercise also plays a role in the reduction of breast cancer risk (Reynolds, 2010). In one study from the Women’s Health Initiative, as little as 1. 25 to 2. 5 hours per week of brisk walking reduced a woman’s risk by 18 percent (Reynolds, 2010). Walking 10 hours a week reduce the risk more (Reynolds, 2010). Diet and exercise can lead to weight reduction, another positive lifestyle change that can influence breast cancer disease risk (Reynolds, 2010). Many breast cancers are fueled by estrogen, a hormone produced in fat tissue (Reynolds, 2010). Experts suspect that more fat tissue equals more estrogen resulting in more cases of breast cancer that could possibly be avoided (Reynolds, 2010). Genetic ; Hereditary Influence According to researchers, the mutations in the gene, which is called FGFR2, raise the risk of breast cancer by 20 to 60 percent. (Metcalf ; Metcalf, 2008). A genetic mutation that raises the risk of breast cancer is found in up to 60 percent of U. S. omen, making it the first truly common breast cancer susceptibility gene (Metcalf ; Metcalf, 2008). Women with faulty copies of the genes BRCA1 or BRCA2 have 50 percent to 85 percent chance of getting breast cancer in their lifetimes, but they are rare genes and only account for 5 percent to possibly 10 percent of breast cancer cases (Metcalf ; Metcalf, 2008). Only 7% of all breast cancers are hereditary (Hirshaut ; Pressman, 2008). Of these hereditary cancers, 45% is caused by BRCA1 while 35% is caused by BRCA2 (Hirshaut ; Pressman, 2008). (Hirshaut ; Pressman, 2008). Variations of the  BRCA1,  BRCA2,  CDH1,  PTEN,  STK11, and  TP53  genes increase the risk of developing breast cancer (Chen, 2007). The  AR,  ATM,  BARD1,  BRIP1, CHEK2, DIRAS3,  ERBB2,  NBN,  PALB2,  RAD50, and  RAD51  genes are associated with breast cancer (Chen, 2007). Cancers occur when a buildup of genetic mutations in critical genes – those that control cell growth and division or the repair of damaged DNA – allow cells to grow and divide uncontrollably to form a tumor (Honrado, Osorio, Palacios ; Benitez, 2006). These changes, which are called somatic mutations, are not inherited (Honrado, Osorio, Palacios ; Benitez, 2006). Less commonly, gene mutations inherited from a parent increase the risk of developing cancer (Honrado, Osorio, Palacios ; Benitez, 2006). In people with these inherited genetic changes, additional somatic mutations in other genes must occur for cancer to develop (Honrado, Osorio, Palacios ; Benitez, 2006). Additional factors that may influence a person’s risk of developing breast cancer include gender, age, ethnic background, a history of previous breast cancer, certain changes in breast tissue, and hormonal factors (Thompson ; Easton, 2004). A history of breast cancer in closely related family members is also an important risk factor, particularly if the cancer occurred at an early age (Thompson ; Easton, 2004). Women who have inherited certain mutations in these genes have a high risk of developing breast cancer, ovarian cancer, and several other types of cancer during their lifetimes (Thompson ; Easton, 2004). Inherited changes in several other genes, including CDH1, PTEN, STK11, and TP53, have been found to increase the risk of developing breast cancer (Thompson ; Easton, 2004). In hereditary breast cancer, the way that cancer risk is inherited depends on the gene involved (Walsh ; King, 2007). For example, mutations in the BRCA1 and BRCA2 genes are inherited in an autosomal dominant patter, which means one copy of the altered gene in each cell is sufficient to increase a person’s chance of developing cancer (Walsh ; King, 2007). In other cases, the inheritance of breast cancer risk is unclear (Walsh ; King, 2007). It is important to emphasize that people inherit an increased risk of cancer, not the disease itself (Walsh ; King, 2007). Not all people who inherit mutations in these genes will develop cancer (Walsh ; King, 2007). Other Breast Diseases Two other diseases found in the breast other than breast carcinoma are breast fat necrosis and fibrocystic breast disease (Sacks, 2011; Silverman, 1994). Fybrocystic breast disease is a commonly used phrase to describe painful, lumpy breasts (Sacks 2011). Hormones made in the ovaries can make a woman’s breasts feel swollen, lumpy, or painful before during menstruation each month (Sacks 2011). Fibrocysitc changes in the breast with the menstrual cycle affect over half of women (Sacks, 2011). Symptoms are usually worse right before the menstrual period, and then improve after the period starts (Sacks, 2011). Symptoms can include pain in both breasts, breasts that feel swollen and heavy, pain or discomfort under the arms, and thick or lumpy breasts (Sacks, 2011). This disease can be treated with medication like acetaminophen or ibuprofen (Sacks, 2011). Breast Fat necrosis is a benign condition that can occur in your breast (Silverman. 1994). It consists of fatty tissue that has been bruised, injured, or has died (Silverman, 1994). Once fatty tissue has been injured or has died, it can gradually change into scar tissue or may collect as liquid within an oil cyst (Silverman, 1994). Fat necrosis does not lead to the development of breast cancer, but it may sometimes cause breast pain (Silverman, 1994). An area of fat necrosis in your breast may feel like a fairly hard lump, or like a section of thick skin (Silverman, 1994). The person may see some drainage from the nipple that is nearest to the bruised region (Silverman, 1994). The nipple may sometimes even pull inward a little bit or the breast skin may dimple above the lump of fat necrosis (Silverman, 1994). Each case of fat necrosis is unique, so treatments will vary but if the fat necrosis has occurred recently, using warm compresses may help it subside (Silverman, 1994). When fat necrosis causes pain, the person can use ibuprofen and aspirin, but if that doesn’t help, ask your doctor if a prescription medication may be used (Silverman, 1994). About 39,520 women in the U. S. were expected to die in 2011 from breast cancer, though death rates have been decreasing since 1990 — especially in women under 50 (â€Å"Learn about cancer,† 2011). These decreases are thought to be the result of treatment advances, earlier detection through screening, and increased awareness (â€Å"breastcancer. org,† 2012). References Peter, C. (2011, October 20). Medical news today. Retrieved from http://www. medicalnewstoday. com/info/cancer-oncology/ breastcancer. org. (n. d. ). (2012, March 14). Retrieved from http://www. breastcancer. org/symptoms/understand_bc/statistics. jsp Yi-Bin , C. , ; David , Z. (2011, 15 12). A. d. a. m. medical encyclopedia. Retrieved from http://www. ncbi. nlm. nih. gov/pubmedhealth/PMH0001911/ Mayo Clinic Staff. (2011, June 23). Ductal carcinoma in situ (dcis). Retrieved from http://www. mayoclinic. com/health/dcis/DS00983 Avon Foundation Breast Cancer (n. d. ). In http://www. hopkinsmedicine. org/avon_foundation_breast_center/breast_cancers_other_conditions/invasive_lobular_carcinoma. html. Stephan, P. (2008, July 24). Invasive Lobular Carcinoma. Retrieved from about. com website: http://breastcancer. about. com/od/types/p/ilc. html Dugdale, D. (2010, August 14). Pubmed. Retrieved from http://www. ncbi. nlm. nih. gov/pubmedhealth/PMH0002267/ Martin, L. (2012, January 18). Breast cancer facts. WebMD. Retrieved from http://women. webmd. om/guide/breast-cancer-arm-yourself-with-facts National Cancer Insitute. (2012). National cancer institute. Retrieved from http://www. cancer. gov/cancertopics/pdq/treatment/malebreast/Patient/page1 Attebery, L. , Adams, J. H. , ; Weiss, M. (2011, november 22). Male breast cancer. Retrieved from http://www. breastcancer. org/symptoms/types/male_bc/ National Cancer Institute. ( 2011). Male breast cancer. Retrieved from http://www. nlm. nih. gov/medlineplus/malebreastcancer. html Wax, A. (2011). Breast cancer in men: Symptoms, causes, treatments. Retrieved from http://www. webmd. com/breast-cancer/guide/breast-cancer-men American Cancer Society. (2011, September 29). American cancer society. Retrieved from http://www. cancer. org/Cancer/BreastCancer/DetailedGuide/breast-cancer-diagnosis NCI. (2010, September 22). National cancer institute. Retrieved from http://www. cancer. gov/cancertopics/factsheet/detection/mammograms Marshall, S. (2010, November 12). Webmd. Retrieved from http://women. webmd. com/mammogram-16573 Hoffman, M. (2010 February 18). Ductal carcinoma (invasive and in situ. Retrieved from http://www. webmd. com/breast-cancer/ductal-carcinoma-invasive-in-situ ACR. (2012). Mammography facts. Retrieved from http://www. ammographysaveslives. org/facts. aspx Hirshaut, Y. , ; Pressman, P. I. (2008). Breast cancer: The complete guide. (5th ed. ). New York, NY: Bantam Dell. Radiological Society of North America. (2011, June 24). Radiologyinfo. org. Retrieved from http://www. radiologyinfo. org/en/info. cfm? pg=mammo ASCO. (2011, January 26). Breast Cancer- Male Retrieved from http://www. cancer. net/patient/Cancer Types/Breast Cancer – Male/? skid= Stoppler, M. C. (2011). Medicinenet. Retrieved from http://www. medicinenet. com/mammogram/article. html Imaginis. (2012). Breast cancer mri – magnetic resonance imaging. Retrieved from http://www. maginis. com/mri-scan/magnetic-resonance-breast-imaging-mri-mr-3 Eisenpreis, B. (1999). A young woman’s guide to breast cancer prevention. New York: The Rosen Publishing Group. Marshall, S. (2009, April 29). Breast biopsy. Retrieved from http://women. webmd. com/breast-biopsy Metcalf, T. , Metcalf, G. (2008). Perspective on diseases and disorders. (1 ed. ). Michigan: Thomson Gale. Chen, S. ( 2007, April 10). Meta-analysis of BRCA1 and BRCA2 penetrance. Retrieved from http://ghr. nlm. nih. gov/condition/breast-cancer Honrado, E. , Osorio, A. , Palacios, J. , Benitez, J. (2006, September 25). Pathology and gene expression of hereditary breast tumors associated with brca1, brca2 and chek2 gene mutations. Retrieved from http://ghr. nlm. nih. gov/condition/breast-cancer/show/References Thompson, D. , Easton, D. (2004, July 9). The genetic epidemiology of breast cancer genes. Retrieved from http://ghr. nlm. nih. gov/condition/breast-cancer Walsh, T. , King, M. (2007, February 11). Ten genes for inherited breast cancer. Retrieved from http://ghr. nlm. nih. gov/condition/breast-cancer Marisa , W. (2011, August 03). Stages of breast cancer. Retrieved from http://www. breastcancer. org/symptoms/diagnosis/staging. jsp NCI. 2009). Breast cancer treatment (pdq). Retrieved from http://www. cancer. gov/cancertopics/pdq/treatment/breast/Patient/page2 Lippman, M. E. (2005). Cancer monthly. Retrieved from http://www. cancermonthly. com/cancer_basics/breast. asp American Cancer Society. (2012, March 06). Breast cancer. Retrieved from http://www. cancer. org/Cancer/BreastCancer/DetailedG uide/breast-cancer-staging Reynolds, D. (2010, March 26). Emaxhealth. Retrieved from http://www. emaxhealth. com/1506/98/36185/one-third-breast-cancer-cases-avoided-diet-and-exercise. html NCI. (2010, September 22). National cancer institute. Retrieved from http://www. cancer. ov/cancertopics/factsheet/detection/mammograms Sacks, D. N. (2011, November 16). Fibrocystic breast disease. Retrieved from http://www. nlm. nih. gov/medlineplus/ency/article/000912. htm Silverman, P. (1994, July). Breast fat necrosis – symptoms, causes and treatments. Retrieved from http://breastcancer. about. com/od/whenitsnotcancer/tp/Breast-Fat-Necrosis. htm American Cancer Society. U. S. Breast cancer statistics. (2011, September 29). Retrieved from http://www. cancer. org/Cancer/BreastCancer/index Hail, J. (2011, 09). National breast cancer foundation, inc.. Retrieved from http://www. nationalbreastcancer. org/About-Breast-Cancer/ Breast Cancer Breast Cancer

The impact on countries & companies of sanctions against Russia Assignment

The impact on countries & companies of sanctions against Russia - Assignment Example The literature suggests that the use of sanctions increases risk in a country. Several studies have indicated that sanctions in most cases fail to bring the desired outcome. Sanctions on Russia were imposed to solve conflicts by using alternative strategies other than military actions. Russia’s economic and political conditions were aggravated with the sanctions. There had been several negative effects which not only affected Russia, but also other countries like the United States and the European Union were affected. Many companies in the United States who had investment plans in Russia had to suffer losses due to restrictions on business activities. The sanctions would be effective only if there is cooperation and collaboration in business activities among the nations. The Russian Government should change its outlook towards the actions taken in Ukraine in the coming five years. The government should emphasis on portfolio diversification in not only the energy sector, but al so other financial sectors. The government should rely on peaceful negotiations with the superpowers like Europe and the United States to sustain growth in the long run. The business environment should be enhanced and trade situations have to be improved. Restrictions on free trade have to be removed so that imports and exports are encouraged. These are the principal steps that the Russian government should seek to achieve in the next five years in order to ensure balanced growth trends in the economical situation.

MicroL20 Essay Example | Topics and Well Written Essays - 1250 words

MicroL20 - Essay Example b. An example of a good with a positive externality is occupied housing. Certainly, the individuals housed benefit from shelter, security, and an ability to organize their lives and families in a way that would not likely be feasible if they were homeless. Owners enjoy rents (implicit if the property is owner-occupied) on the home. These are primarily private benefits. Occupied housing tends to be better maintained, improving neighborhood property values) over the long term and neighborhoods with higher occupancy rates tend to have lower crime rates. Both of these are primarily public benefits. An example of a good with a negative externality is a car with an extremely loud stereo system. While the audiophile-owner may enjoy the experience (a private benefit), those who are forced to experience the sound against their will are faced with a nuisance (a public cost). 2. Monopolies. a. If Bart charges $15, then he sells a meal for a total profit of $10. If he charges $8, he'll sell two meals for a total profit of $6. If he charges $7, he'll sell three meals at a total profit of $6. It's in Bart's best interest to charge $15.00 and sell a single meal. The producer surplus in this case is $10 and there is no consumer surplus. b. Without advanced knowledge of who would be willing to pay which price, it would be difficult for him to price discriminate, but there are some strategies he might pursue. One is to institute â€Å"haggling.† If every transaction is negotiated, it is possible that those willing to pay a higher price might be persuaded to part with more cash for the same meal than a less well-funded customer (though this increases transaction costs). It might also be possible for Bart to create categories of customers, through some sort of discounting mechanism, which would make it more likely that those willing to pay more would spend more. He might create three cosmetically different, though essentially similar, meals (though this pushes the boundarie s of the premise, since the meals would no longer be the same). Ideally, he would be able to sell three meals, one each for $15, $8 and $7. In reality, with imperfect information, he'd likely not do this well. c. Bart would be able to sell three meals, one each for $15, $8 and $7. The producer surplus will be $15 and there will be no consumer surplus. d. If all three meals were purchased by one person, it would be difficult for Brad to price discriminate, except, perhaps, by the use of discount cards or some similar device that needed to be presented upon ordering or paying. Assuming he could not price discriminate and the consumers presented a united, three meals or nothing front, we would expect three meals sold at $7 each. e. If there were another restaurant in town, it would be much more difficult for Bart to price discriminate. He would need to depend on factors such as market friction, customer loyalty or location preference (i.e., Bart's restaurant is easier to get to) or col lusion with his competitor to maintain some degree of monopoly power if he wanted to continue to price discriminate. As the number of competitors increased the situation would increasingly resemble a perfect competition model and Bart would become a price taker. f. It would be very difficult to effectively price discriminate

Human Trafficking Research Paper Example | Topics and Well Written Essays - 500 words - 4

Human Trafficking - Research Paper Example However, the government of the US is combating trafficking in persons both at home and abroad. The clauses, which have been covered in â€Å"the Trafficking Victims Protection Act of 2000 gives new protections to the trafficking victims; the pre-existing penalties â€Å"(Human Trafficking, 2012) have been enhanced. Moreover, certain benefits and services are provided to those who have been severely affected by human trafficking. It was in 1994 that the US started monitoring persons being victimized by trafficking in persons. This was mainly when the issue became prominent in Annual’s Country Reports on Human Rights Practices of the Department (Human Trafficking, 2012). Initially, the women and girls who were trafficked for sexual purposes were kept in the limelight. However, the situation has changed now and men, women and children who are being trafficked in any form of labor force whether it be agriculture, domestic service, construction work, or sweatshops are monitored on a constant basis (Human Trafficking, 2012). The human traffickers commit this act usually when the situation is critical and the police agencies cannot really do anything about it. For instance, when there were crisis in Lebanon, at that time the traffickers took 300000 people in their refuge. These people were mostly from Sri Lanka and Philippines. This was when the important people were busy being evacuated. In such circumstances, the police become handicapped and cannot take any action. The US should focus on having wide-ranging national policies and programs that will assist in preventing human trafficking; hence, the victims will be protected. Moreover, the police agencies should have strong networks so that the exchange of information regarding routes of traffickers as well as their profiles and the profiles of the victims could be easily tracked. Moreover, the police agencies should be a part of UNODC (UNGIFT, 2007). UNODC is contributing in the prevention of

Launching a new product Essay Example | Topics and Well Written Essays - 1000 words

Launching a new product - Essay Example The company currently operates in Singapore, but it is planning to extend its operations in the UK. The UK offers a vital market for the company bracelet due to the high rate of economic growth and high consumer disposable incomes of the population. More than 40 million people in the UK would be willing to buy the product and contribute towards charitable work due to the caring attitudes of the population and feminine culture that is replicated in the bracelet design. The number of wealthy and aged individuals is more than 10 percent of the total UK population (Oxford Business Group 222). The macro-environment is favorable since UK economy is currently experiencing a recovery after the recent financial crisis. UK also enjoys stable political environment and is a member of the EU thus making it easier for the organisation to expand to neighboring European countries. The UK population is highly educated and most of the citizens have access to the internet in their homes. UK citizens ha ve caring attitudes towards the environment and life thus it will be easy for the product to penetrate the market. The existing legal environment enables the citizens to contribute donations towards charitable organisations and adequate e-commerce laws have been enacted in order to facilitate online donations (Oxford Business Group 137). In addition, the level of technology is high thus the organisation can rely on the existing modern communication technologies and high internet penetration in order to reach the potential buyers in the remote villages and smaller towns (Oxford Business Group 189). SWOT Analysis Strengths Midomo bracelet enjoys several strengths that are essential in penetrating the targeted market and sustaining relationships with buyers. The product is made of high quality and wearable jewellery thus appealing to the purchasing behaviour of UK citizens. The product will enjoy high brand recognition and awareness in the market since it has been designed by an award winning designer who has a high reputation of quality and stylish designs. In addition, the bracelet is light in weight thus can be worn by the buyers when travelling thus spreading the word of the mouth on the existence of the charitable product in the market. Accordingly, the bracelet symbolizes abundance and water thus will resonate well with the attitudes of UK citizens towards combating environmental degradation. The product is also lowly priced compared to similar jewellery products in the market. Weaknesses Midomo bracelet suffers from several weaknesses since the designer has not offered a variety in terms of color or raw material. Not all potential buyers would be attracted towards silver products or products that depict a feminine style. Some of the potential donors may not be willing to wear the bracelet due to the stereotypes that associate certain health issues like stiff arms with wearing of bracelets around arms (Yeshin 316). Another challenge that will be involved in clude employment of additional staff to monitor the online transactions and answer to customer complaints (Yeshin 337). Opportunities There are numerous opportunities that Midomo Initiative can exploit in order to attain its mission and objectives in the UK market. The company should provide for a variety in terms of bracelet designs and color in order to appeal to the wider market in the UK. The

Product Strategy Essay Example | Topics and Well Written Essays - 1500 words

Product Strategy - Essay Example Consequently, by incorporating the consumers’ requirements in the designs, quality and composition of its products, an organization is in a position to win over customer loyalty and attract new and potential customers. The customer’s role in the research and development of new products is essential. The significance it plays, as far as profits and sales are concerned is extensive. Many entrepreneurs believe that inventions and innovations normally improve sales. This is opposed to reliance on customers’ needs, where one customer’s demand differs from another customer’s demand. They believe that what can break this barrier are innovations and inventions and that through innovation, a new product is introduced into the market and bridges the different consumer demands, making such opposing needs to converge (Wahab, 2013). Their paradigm is, however, inaccurate because marketing as a strategy concept involves, first knowing the target market, then the needs, wants and demands of the customers. Without knowing consumers’ demands then it is a waste of time selling because a business can be selling an irrelevant product that the target market does not need. Pursuant to that is understanding the products and services on offer since this is what will retain customers’ needs or demands; without consumers then marketing ceases to outlive its usefulness. Last is offering high-quality products and ensuring consumer satisfaction based on how the product is sold (Howard, 2014). Mark Cohen, in his article in the New York Times titled: A Revolutionary Marketing Strategy: Answer Customers’ Question, paints a picture of how the proprietor of Riverpools and Spas, Marcus Sheridon, used his marketing prowess to move the company which was on the brink of collapse back to prosperity. Where Marcus abandoned conventional marketing for content marketing this paid

The History of drag racing Essay Example | Topics and Well Written Essays - 750 words

The History of drag racing - Essay Example I find the title of the documentary movie very descriptive. Slingshot was an ancient weapon used mainly for accelerating an object towards its target. Therefore, the title stick out as the movie tries to unravel how this sporting event started many years ago. Even before opening the movie, the title thus gave me the idea of what I was to expect as far as its content is concerned. I like the idea of how the young men decided to go to the dry riverbeds and desert environment to compete amongst themselves. There were no rules and regulation in the 1930s regulating such dangerous activities. So I find moving away from the general public in Southern California was a great idea for the young men who were not afraid of speed and injuries. I was amused by their choice of the dry lakes of Mojave Desert as their field since it is a pretty dusty environment. After all, I think the sport was a dirty game of trying to outscore each other taken too far. I however find it interesting to discover that even during the domestication of the horse long time ago; young men would challenge each other on matters of speed. I believe any event however entertaining; lack of organisation is a recipe for its failure in the long-run. I was a little bit taken aback that the rowdy youth saw the need for organising their risky activity despite having the most outrageous desire that can cross any mind of a sane person. Two locations that really stands out that helped in the advancement of drag racing is Goleta, north of Santa Barbara and Santa Ana Airport, which came into use in 1949 and 1950 respectively. I like the way their idea of using Goleta as a venue of streamlining drag racing. However, the thought of using an airport to conduct their businesses is a clear indication that the young men were ready to move their love for speed a notch higher establishing codified rules and

How electronic medication administration has prevent medication error Essay

How electronic medication administration has prevent medication error - Essay Example Research reveals that eMAR (electronic medication administration record) minimizes medication administration faults, as well as other adverse occasions that are drug-related. With the help of eMAR bar code technology, physicians are capable of issuing correct medication at the right time to the appropriate patients (Chan, 2010). When nurses adopt this technology, patients’ medication orders appear on their chart electronically after being endorsed by a pharmacist. Nurses are also alerted by this technology in case the medication of a particular patient is overdue. Here, the nurse is supposed to scan the patients’ barcode on their wristband before proceeding to those who are on medication. If the two fail to match the appropriate medication order, one is issued with a warning indicating that the treatment is not right (Richardson, Thomas, & McDowell, 2013). Moreover, CPOE (computerized provider order entry) is an electronic prescribing practice that minimizes errors that are related to wrong transcription or poor handwriting. CPOE systems support drug prescription, alert on unsafe interactions, and allow physicians to make right medication decisions, which minimizes errors further (Ward, Froehle, Hart, Collins, & Lindsell, 2014). Therefore, it is true that electronic medication administration plays a vital role in inhibiting medical faults. Chan, S. (2010). Factors Associated With the Use of Electronic Information Systems for Drug Dispensing and Medication Administration Records in Nursing Homes. Journal of the American Medical Directors Association, 9(6), 414-421. Richardson, S. J., Thomas, S. K., & McDowell, S. K. (2013). Medication self-administration in hospitalised patients: An evaluation using data from an electronic prescribing and medication administration system. Clinical Therapeutics, 36(8), e32-e37. Ward, M. J., Froehle, C. M., Hart, K. W., Collins, S. P., & Lindsell, C. J. (2014). Transient and Sustained Changes in

PEP - netball Essay Example for Free

PEP netball Essay Bike ride: aim to do an hours bike ride around Froyle, Bentley, Binsted etc (suggestions only) and pace yourself to reach the hour. Dont worry about getting up to early because its a Saturday and your next activity is at 14:30; but dont forget lunch!  Afternoon  Go to the park to play football or basketball at the park. This way you can enjoy yourself whilst doing an aerobic activity with some anaerobic working (sprints etc) could also go and find the boat and go rowing down the river and work on your upper body strength so undercuts will be easier to save. Row down to Binsted or further. Could also go cycling. Aim to be working for at least 3 hours. Evening  Nothing: go and play with your friends or just rest!  Wednesday  Morning Afternoon  Paper round: as this is my job I kind of have to do this. The cycling helps to build up the leg muscles and improves the aerobic system. Could do time trials when on the way there and back and try to improve my time each day.  Big Bike ride: get a few friends together, a packed lunch and bikes to go on an 8 hour bike ride (Inc lunch)! Try not to have to many rests but also dont over exert yourself though! Evening  Weights: Firstly do 150 bicep curls, 15 sets of 10 reps as this will help with me stick and glove save. Next do 20 quad thrusts (I think thats what theyre called!) as this will help with my kick in hockey and let me clear the ball further and faster. Afterwards do 50 (5 sets of 10 reps) sit-ups with the 22 lb dumbbells as this will help keep the correct head, knee, tip-toe position throughout the whole match. Lastly do 30 (3 sets of 10 reps) press-ups as this will help with muscles around the arms and the arm muscles. Week 4: Fourth week  Thursday  Morning  Paper round: as this is my job I kind of have to do this. The cycling helps to build up the leg muscles and improves the aerobic system. Could do time trials when on the way there and back and try to improve my time each day.  Afternoon  Go to the sports centre and first do a certain sport like badminton, racket ball or swimming etc as this will work on the aerobic system. After doing this go to the gym and do whichever circuit you have been given by the trainer. Should hopefully work on aerobic/cardiovascular system, muscular strength, muscular endurance and flexibility. Evening  Nothing: go and play with your friends or just rest!  Friday  Morning  Paper round: as this is my job I kind of have to do this. The cycling helps to build up the leg muscles and improves the aerobic system. Could do time trials when on the way there and back and try to improve my time each day.  Bike ride: aim to do 2 hours bike ride around Froyle, Bentley, Binsted etc (suggestions only) and pace yourself to reach the 2 hours. Dont worry about getting up to early because its a Saturday and your next activity is at 14:30; but dont forget lunch! Afternoon  Go to the park to play football or basketball at the park. This way you can enjoy yourself whilst doing an aerobic activity with some anaerobic working (sprints etc) could also go and find the boat and go rowing down the river and work on your upper body strength so undercuts will be easier to save. Row down to Binsted or further. Could also go cycling. Aim to be working for at least 4 hours. Evening  Weights: Firstly do 150 bicep curls, 15 sets of 10 reps as this will help with me stick and glove save. Next do 30 quad thrusts (I think thats what theyre called!) as this will help with my kick in hockey and let me clear the ball further and faster. Afterwards do 70 (7 sets of 10 reps) sit-ups with the 22 lb dumbbells as this will help keep the correct head, knee, tip-toe position throughout the whole match. Lastly do 40 (4 sets of 10 reps) press-ups as this will help with muscles around the arms and the arm muscles. Saturday  Morning  Nothing to do! Stay in bed or get up and do whatever. Afternoon  Go to the sports centre and first do a certain sport like badminton, racket ball or swimming etc as this will work on the aerobic system. After doing this go to the gym and do whichever circuit you have been given by the trainer. Should hopefully work on aerobic/cardiovascular system, muscular strength, muscular endurance and flexibility.  Evening  Nothing: go and play with your friends or just rest! Sunday  Morning  Big Bike ride: get a few friends together, a packed lunch and bikes to go on a 9 hour bike ride (Inc lunch)! Try not to have to many rests but also dont over exert yourself though!  Afternoon  Big Bike ride: get a few friends together, a packed lunch and bikes to go on a 9 hour bike ride (Inc lunch)! Try not to have to many rests but also dont over exert yourself though! Evening  Weights: Firstly do 150 bicep curls, 15 sets of 10 reps as this will help with me stick and glove save. Next do 30 quad thrusts (I think thats what theyre called!) as this will help with my kick in hockey and let me clear the ball further and faster. Afterwards do 70 (7 sets of 10 reps) sit-ups with the 22 lb dumbbells as this will help keep the correct head, knee, tip-toe position throughout the whole match. Lastly do 40 (4 sets of 10 reps) press-ups as this will help with muscles around the arms and the arm muscles.

History of the U.S. Income Tax Essay Example for Free

History of the U.S. Income Tax Essay The income tax of the United States of America, be it federal, state and local, has changed over time. Different circumstances pushed the government to create taxation and to amend the existing taxation laws. During the pre-Revolutionary War era in the 1700s, taxes were not imposed by the colonial government as their need for tax revenue did not exist. The colonies, on the other hand, had greater responsibilities therefore, had greater need for tax revenue. Because of this, different types of taxes were imposed by the colonies. The southern colonies imposed taxes on imports and exports while the middle colonies imposed taxes on property and a poll tax on each adult male. The New England colonies, on the other hand, collected taxes through property taxes, income taxes and excise taxes. When the English Parliament realized the need for money to pay for the French war, it imposed different taxes to the American colonies through the Stamp Act which was enacted in 1765. Later on, this Stamp Act was revised to include taxes for permits, newspapers, legal documents and playing cards. The Townsend Act was later on enacted by the Parliament to include taxes for paint, tea and paper . After a decade of paying taxes, there was much resistance to the tax imposed by the Parliament. During the Boston Tea Party in 1773, colonists, dressed as Native Americans, threw 342 chests of tea from a ship of the British East India Company to the Boston Harbor. In 1775, Isaac Backus during the Massachusetts Assembly said that â€Å"It’s not all America now appealing to Heaven against injustice of being taxed†¦We are persuaded that an entire freedom from being taxed by civil rulers†¦is not mere favor from any men in the world but a right and property granted us by God, who commands us to stand fast in it† . Taxation is considered as one of the factors that led to American War for Independence hence, when America gained its Independence, Article 1, Section 9, Article 4 of the U. S. Constitution in 1787 declared that there be no capitation or any direct taxes imposed on the citizens. The national government had very little responsibilities during these times and relied only on donations given by the States for its revenue. However, in 1789, the Founding Fathers realized that it could not function at its efficiency if it relied only on other governments’ donations hence the Federal Government was granted the authority to impose taxes. The sensitivity to taxation was still existing at this point in time hence the government has to be careful on how it impose taxes so as to minimize resistance from its people. Alexander Hamilton, Secretary of the Treasury in the 1790s, decided that a â€Å"sin tax† was imposed . Through the â€Å"sin tax†, only items which society thinks is deviant or vice were taxed such as distilled spirits, alcohol and whiskey. However, this still led to the armed revolt called Whisky Rebellion by a group of South Pennsylvania farmers. Still during the 1790s, the Federal Government imposed direct taxes to owners of houses, slaves and land. However, when Thomas Jefferson was elected to office in 1802, these direct taxes were removed and for the succeeding 10 years, only excise taxes were imposed. The reason for this was because he realized the inverse relationship of tax rates and tax revenue wherein the higher the taxes imposed on the citizens, the slower the economy grows hence the tax revenue declines. A cut in the rate of tax means that income for the family will become higher, expenditures become higher and hence, the economy experiences growth. During the 1812 War, the need for tax revenue resurfaced again hence taxes on the sales of gold, jewelry, watches and silver were imposed. Treasury notes were also issued to raise money. However, in 1817, the Congress revoked these taxes and for the next 40 years, government revenue was based on high customs duties and sale of government or public land . In 1861, when the Civil War erupted, the Revenue Act of 1861 was enacted. This Act restored the previous taxes on personal income. This tax was similar to the modern income tax because it was based on a gradual taxation of withholding tax from its source. A person earning $600 to $10,000 a year paid 3% tax. Persons with income higher than $10,000 paid a higher rate of tax. In 1862, the debt created by the war was rising at a rate of $2 million per day hence there was another need for the government to increase its revenue. Because of this, the Congress passed another tax imposition on items such gunpowder, playing cards, telegrams, iron, pianos, yatchs, drugs, among others. After the Civil War, the need for revenue declined and hence the income tax was abolished and only the excise taxes remained from 1868 to 1913. The War Revenue Act in 1899 was enacted to raise funds for the Spanish-American War. Government revenues, thru this Act, was raised through sales of bonds, tax imposition on recreational facilities, beer and tobacco. However, the Supreme Court realized that the people of America were becoming aware that the high tarrifs and excise taxes were not good to the economic welfare of the nation and that these taxes were usually paid by the less affluent citizens. Hence, there was an agreement that business income instead was imposed tax. By 1913, Congress enacted a new income tax law which imposes 1% to 7% for persons with income above $500,000. These people earning above $500,000 was only 1% of the total United States population . During World War I, the United States needed to increase its revenue again to fund the war. The 1916 Act raised the tax imposition from 1% to 2% and could go as high as 15% for those with income of more than $1. 5 million. By 1917, the government still needs further government revenue to pay for the war, hence the War Revenue Act of 1917 was enacted. Through this Act, exemptions were lowered and tax rates increased that those who earn $40,000 needs to pay 16% tax rate. In 1918, the tax rates were further increased. Those citizens paying 1% had to pay 6%. The highest rate in 1917 was 15% but during 1918, this was increased to 77%. Due to this increase in tax rates, government revenue increased from $761 million during 1916 to $3. 6 billion in 1918. After the war, the government revenue rose and the government decided to cut taxes to 1% bottom rate and 25% top rate . The Great Depression during the late 1920s and early 1930s pushed the government to once again increase the tax rates. The Tax Act of 1932 was enacted and by 1936, the bottom tax rate was at 4% and the top tax rate reached 79%. When the World War II came, another price hike came into place which altered the tax rates. Those with taxable income of less than $500 paid a bottom rate of 23% taxes while those earning taxable income of over a million dollars paid about 94% of taxes . The tax structure in the United States was also heavily altered in that the number of taxpayers increased from 4 million during 1939 to roughly 43 million during the World War II. Throughout all these years of implementing taxation, the government learned a very important lesson which until now is being valued by government officials and economists and has affected the tax laws enacted in the country – the marginal dollar is far more important to the economy compared to the tax rate being used. The Economic Recovery Tax Act of 1981 was implemented with this important lesson in mind. Unlike the previous taxation laws, this Act was intended to focus on marginal tax rates and it also included consumption taxes. However, due to the deep recession experienced by the country in 1982, the government was once again faced with the need to increase tax rates to overcome budget deficits. Following the 1982 recession was an economic boom which lead the country to believe that marginal tax rates are very important for a strong economy. During the Reagan administration, tax rates were further reduced and had a broader base through the Tax Reform Act of 1986. This reduced tax rate from 50% to 28% while business taxes were reduced from 50% to 35% . In 1997, the Taxpayer Relief Actof 1997 was enacted. The significant party of this Act was the Per Child Tax credit which benefited the lower-income families. During the Bush administration in 2001, the government experienced a budget surplus of about $281 billion hence a tax cut was once again conducted . This tax cut included raising the Per Child Tax Credit from $500 to $1,000 per child, as well as increased the Dependent Child Tax Credit. Until now, this tax law is being implemented and is expected to boost economic growth for the country.