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Title A Tale Of Two Cities. This Is Significant Because

Title: A Tale of Two Cities. This is significant because A Tale of Two Cities tells the story of two cities - London and Paris. Author’s Name: Charles Dickens Life and Country of Origin: Charles Dickens was born on February 7, 1812, in Portsmouth, England. He grew up quite poor, despite his families best efforts, and it had a great impact on him. Which is quite similar to the oppression the French felt during the French Revolution. (biography.com) Setting: The story takes place in the cities of London and Paris from 1775-1792. Paris is portrayed as a city where the corruption of the upper class leads revolutionaries to rise up against them, but the violence that replaces that corruption is not much better. London is portrayed as somewhat†¦show more content†¦Unlike her husband, she proves to be truly evil because her desire for blood-shed knows no bounds. Monsieur Defarge - Monsieur Defarge was a wine shop owner and a intelligent and committed revolutionary. He used to be servant for Doctor Manette. Even though Monsieur Defarge wants a â€Å"better France† he is not as bloodthirsty as his wife. Jarvis Lorry - A old business man who works for Telson’s bank. He is a trustworthy person and a loyal friend to the Manette’s. Miss Pross - The servant who raised Lucie. She is very loyal to Lucie. Because of this she provides a foil to Madame Defarge, who symbolizes violent chaos that is associated with the revolution. Marquis Evremonde - A French aristocrat and Charles Darnay’s uncle. He shows absolutely no regard for human life and wishes that the world be free of peasants. He is cruel, and during the story will not help an old widow pay for her husband’s grave marker. He also runs over a child and feel’s no remorse. He is killed in his sleep because of these acts of cruelness. Mr. Stryver - A very ambitious lawyer, who â€Å"stryves† to climb the social ladder. He is a contrast to Sydney Carton. Themes and Ideas: The necessity of sacrifice - A theme in a tale of two cities is that sacrifice is necessary in order to be happy.We see this theme on both a personal level with Sydney Carton, and a national level with the French Revolution. Example: In order for Carton to transform into aShow MoreRelatedA Tale of Two Cities, by Charles Dickens1381 Words   |  6 PagesOf the extraordinary amount of literary devices available to authors, Charles Dickens uses quite a few in his novel A Tale of Two Cities, which is set during the French Revolution. One of his more distinctive devices is character foils. The five sets of foils are Carton and Darnay, Carton and Stryver, Darnay and the Marquis de Evremonde, Madame Defarge, and Mr. Lorry and Jerry Cruncher. 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Lipid Profiles In Postmenopausal Women Health And Social Care Essay Free Essays

string(158) " Writers concluded that Letrozole modestly decreases TC at 3 months ; nevertheless, the consequence is non sustained throughout the intervention clip period\." Aim: Aromatase inhibitors are presently used in accessory to the former gold criterion Tamoxifen or as first line hormone therapy in postmenopausal adult females with chest malignant neoplastic disease. Suppressing the aromatase mechanism of action impedes the synthesis of estrogen, forestalling estrogen protection on lipid profiles. This literature reappraisal examines, discusses, and analyzes peer-reviewed published clinical tests analyzing the effects of anastrozole, exemestane, and letrozole, on lipid profiles in postmenopausal adult females with estrogen dependent chest malignant neoplastic disease. We will write a custom essay sample on Lipid Profiles In Postmenopausal Women Health And Social Care Essay or any similar topic only for you Order Now Decisions: Overall, there are minimum, if any, unfavourable effects of aromatase inhibitors on lipid profiles. However, restrictions of little population sizes, fluctuations in design methods, and old Tamoxifen usage, make it hard to accurately assess hazard. Long term prospective surveies utilizing big sample sizes and patients with no exposure to any other hormone intervention besides aromatase inhibitors, are needed to accurately measure if inauspicious effects on lipid profiles exist from the utilizing aromatase inhibitors. Healthcare professionals should go on to supervise lipoids in postmenopausal adult females with chest malignant neoplastic disease and develop individualized intervention programs utilizing current recommendations. Cardinal Wordss: aromatase inhibitor, chest malignant neoplastic disease, post-maturity, lipid, Anastrozole, Letrozole, Exemestane, cholesterin, and lipid metamorphosis. Aromatase Inhibitors Risk of Adverse Effects on Lipid Profiles in Postmenopausal Women with Breast Cancer: A Literature Review Introduction Breast malignant neoplastic disease pestilences about 2.5 million adult females in the United States, 1 doing it one of most prevailing signifiers of tumor that healthcare practicians dainty today. The hazard of developing chest malignant neoplastic disease increases with age, with one in 13 postmenopausal adult females developing the disease.2 Nearly 70 per centum of those postmenopausal adult females will hold a endocrine dependant ( estrogen positive ( ER+ ) , progesterone positive ( PR+ ) ) signifier of chest malignant neoplastic disease that utilizes estrogen as its chief alimentary beginning for the proliferation of the tumour. 2, 3, 4 In postmenopausal adult females, estrogen is chiefly synthesized in the peripheral tissues, chest, musculus, adipose, tegument by the enzyme aromatase.4,5 Aromatase converts adrenal androgens into estrogen via the CYP450 enzyme pathway.4, 5, 6, Suppressing aromatase and hindering this transition limits the sum of estrogen available for use by tum our cells, later forestalling growing and spread. Through this mechanism of action, steroidal ( Exemestane ) and non-steroidal ( anastrozole and letrozole ) aromatase inhibitors have shown to be extremely efficacious in the intervention of ER+/PR+ chest malignant neoplastic disease in postmenopausal adult females compared to that of Tamoxifen.5 Multiple landmark surveies ( MA.17, 2 ATAC, 7 BIG 1-98, 8 and EORTC9 ) , suggest that Tamoxifen is no longer a gilded criterion, and now recommend utilizing AIs as first line hormone therapy in these patients.5 With the spread outing usage of AIs by practicians in the intervention of endocrine dependent chest malignant neoplastic disease and the subsequent betterment in disease free endurance rates, more postmenopausal adult females are populating long plenty to see other comorbidities, such as cardiovascular disease ( CVD ) .4 Since CVD is the primary cause of mortality in postmenopausal adult females, 10 understanding the associated inauspicious effects AIs pose on cardiovascular hazard factors is pertinent. Lipid biomarkers are often assessed clinically to find a patients hazard of developing CVD. Previous epidemiologic surveies have shown that estrogen is protective and good to some cardiovascular hazard factors, specifically lipid profiles, via its direct effects on the endothelial cells found in blood vessels.6,11 Estrogen alters concentrations of lipoids in the blood ; diminishing serum concentrations of entire cholesterin ( TC ) , low-density lipoprotein ( LDL ) , and triglycerides ( TRG ) , while increasing serum concentrations of high-density lipoprotein ( HDL ) .11, 12 Therefore, it is thought that postmenopausal adult females taking AIs are deprived of this cardioprotective consequence of estrogen since its synthesis is being prevented by suppressing the aromatase transition mechanism. Therefore, the inquiry can be proposed: Make aromatase inhibitors adversely affect lipid profiles and later present an increased hazard of developing cardiovascular disease in postmenopausal adult females with ER+/PR+ chest malignant neoplastic disease? This literature reappraisal of current clinical test informations examines and assesses the usage of AIs, Exemestane ( Aromasin ) , Anastrozole ( Arimidex ) , and Letrozole ( Femara ) , on the inauspicious effects of the lipid profiles of postmenopausal adult females with ER+/PR+ chest malignant neoplastic disease. Search footings included cardiovascular, aromatase inhibitor, chest malignant neoplastic disease, post-maturity, lipid, Anastrozole, Letrozole, Exemestane, plasma lipoid, cholesterin, and lipid metamorphosis. MEDLINE in Pubmed, MEDLINE ( on EBSCO ) , and OVID were used to seek for peer-reviewed diary articles published between the old ages 2005 to 2010. Recent grounds showing the effects AIs render on the lipid profiles of postmenopausal adult females with estrogen dependent chest malignant neoplastic disease is discussed, analyzed, and reviewed in the undermentioned subdivisions. AROMATASE INHIBITORS EFFECT ON LIPID PARAMETERS Depriving chest malignant neoplastic disease stricken postmenopausal adult females of the benefit of estrogen via the AI mechanism is thought to hold damaging effects on CVD hazard factors. Several clinical tests utilizing assorted design methods have been conducted and show variable effects of AIs on the different cholesterin parametric quantities and lipoproteins. Table 1 summarizes the effects of AIs on assorted lipid biomarkers in the postmenopausal adult female with ER+/PR+ chest malignant neoplastic disease, and all surveies in the tabular array are discussed in the following subdivisions. Placebo Controlled Tests Two surveies have evaluated the consequence of AIs versus placebo on lipid biomarkers. As a secondary end point, Cigler et al13 studied the effects of Letrozole versus placebo on serum lipid parametric quantities ( TC, HDL, LDL, TRG ) in 60 seven postmenopausal adult females utilizing a random, placebo-controlled design. Lipids were measured at baseline and during the 3rd, 6th, 12th, and 24th months, and the per centum alteration from baseline was calculated for each month. Researchers noted a statistically important lessening in the TC at month 3 ( P value=0.052 ) in the Letrozole arm of the survey. The other parametric quantities ( TRG, LDL, and HDL ) measured were non significantly changed from baseline in either the Letrozole or the placebo weaponries. Writers concluded that Letrozole modestly decreases TC at 3 months ; nevertheless, the consequence is non sustained throughout the intervention clip period. You read "Lipid Profiles In Postmenopausal Women Health And Social Care Es say" in category "Essay examples"13 The cogency of consequences in the lipid part of this survey are questionable because of the imbalanced figure of participants in each intervention group, and the little population size that remained at the terminal of the 24 months ( Letrozole: 26 patients, and placebo: 16 patients ) . It is hard to measure accurate tendencies in informations with little population sizes, and consequences should be verified utilizing similar survey methods with larger population sample sizes. A confusing variable in this survey was the old usage of Tamoxifen in some patients and non others. Tamoxifen has shown to hold good effects on lipoids ; 14, 15 therefore, the consequences from patients that had antecedently taken Tamoxifen may non be a true representation of the effects of the AI entirely on lipid profiles. Another placebo controlled test utilizing different design methods was conducted by Lonning et al16 and contrasting consequences were found. The effects of Exemestane versus that of placebo on plasma lipoids in postmenopausal adult females with resectable chest malignant neoplastic disease was studied by Lonning et al.16 In a dual blind manner, one hundred 40 seven patients were indiscriminately assigned to an Exemestane intervention group or a placebo intervention group. Measurements of lipid biomarkers ( TC, HDL, LDL, TRG, ApoLipoprotein A1, lipoprotein A, ApoLipoprotein B, homocysteine ) were taken at baseline, and at the 3rd, 6th, 12th, and 24th month. Results revealed that the Exemestane intervention group had a statistically important ( P value A ; lt ; 0.001 ) lessening in HDL versus that of the placebo intervention group. Besides, a statistically important ( p=0.004 ) lessening in Apolipoprotein A1 occurred in the Exemestane intervention group versus that of the placebo intervention group. Writers concluded that the steroidal AI, exemestane has modest effects on HDL lipid biomarkers and those hazard factors for C VD should be followed overtime.16 This survey included more participants than Ciglers study ; hence, the consequences seen here may hold more cogency. Besides, a different AI was used in each test, and this variable could account for the disagreement in consequences between the two surveies. No old Tamoxifen usage was denoted in the survey by Lonning et Al ; 16 therefore, the consequences are a better representation of the effects of the AI on lipoids without confusing influences of Tamoxifen. More placebo controlled tests are necessary to to the full understand the effects of AI on lipoids in postmenopausal adult females with endocrine dependent chest malignant neoplastic disease, and to denote if a true lessening in HDL exists. The following subdivision discusses tests in which AIs were compared with Tamoxifen alternatively of a placebo as the intercession intervention groups to be assessed. Tamoxifen Comparative Tests Surveies have been conducted utilizing Tamoxifen as a comparative intervention group to that of Exemestane, and their several inauspicious effects on lipid profile alterations are discussed. The TEAM Greek bomber study17 randomized postmenopausal adult females with early chest malignant neoplastic disease into an Exemestane arm ( 77 patients ) or into a Tamoxifen arm ( 65 patients ) , and evaluated HDL, LDL, TRG, and TC at baseline, and at 12, 18, and 24 months. Results indicate that TC decreased overtime in both intervention groups ; nevertheless, those in the Tamoxifen arm had a crisp diminution at month 18 and 24, doing the difference between groups at that clip period statistically important with P value=0.020 and P value=0.0087, severally. Both interventions had a statistically important lessening in HDL ; nevertheless, the Tamoxifen group maintained higher degrees of HDL, leting for a more favourable consequence than exemestane, with a statistically important average difference ( P=0.011 ) between the intervention groups. The Tamoxifen intervention group had a important consequence on the LDL parametric quantity doing a steep lessening in values overtime. exemestane had failed to demo any important alteration on LDL. The TRG parametric quantity revealed no noticeable tendencies for either intervention regimen. Research workers concluded that Tamoxifen has a favourable consequence on TC and LDL, while Exemestane has a more indistinct consequence on lipid biomarkers.17 The lessening in HDL in this survey is in harmony with that of Lonning et al.16 One restriction is that all four lipid parametric quantities were non accounted for in all patients in each intervention group ; hence, tendencies seen in each parametric quantity may non stand for the true tendency that would be present if all values were recorded for all patients at all measurement clip periods. This survey reiterates the idea that Tamoxifen has good effects on lipoids ; accordingly, it is hard to accurately measure the hazard of AI when the comparative intervention group is Tamoxifen. 14 Though some restrictions were present in this survey, comparative consequences were seen by Francini et al14 in another test utilizing different methods than the TEAM Greek bomber survey. Francini et al14 conducted a survey in which 55 postmenopausal adult females who had antecedently been treated with no less than 2 old ages of Tamoxifen were randomized into two intervention groups: either continue Tamoxifen or exchange from Tamoxifen to Exemestane. Lipid parametric quantities were measured at baseline and at 6 and 12 months. Consequences yielded were statistically important in the Exemestane arm of the survey entirely demoing a lessening in HDL overtime ( p value A ; lt ; 0.05 ) , an addition in LDL overtime ( p value A ; lt ; 0.01 ) , and a lessening in TRG overtime ( P value A ; lt ; 0.01 ) . The differences between the Tamoxifen and Exemestane intervention group were non important except for the LDL biomarker ( p value A ; lt ; 0.05 ) . Writers concluded that the addition in LDL of the Exemestane group may be due in portion to participants being antecedently treated with Tamoxifen, which is known to hold good effects on LDL.14 Francinis survey and the TEAM Gr eek bomber study17 indicate that there was a lessening in the HDL parametric quantity in the Exemestane intervention group versus that of the Tamoxifen intervention group, proposing that AIs may hold an inauspicious consequence on HDL degrees. This lessening in HDL was besides noted in the ATENA trial18 in which Tamoxifen had been antecedently used for 5-7 old ages before the patients were assigned to have either Exemestane or no intervention, merely observation. The addition in LDL found in the survey by Francini14 was besides seen in the ATENA test ; 18 nevertheless, the TEAM Greek bomber study17 did non back up this determination. It must be kept in head that patients in the survey by Francini14 and the ATENA trial18 had antecedently been treated with Tamoxifen before get downing intervention with AIs, while patients in the TEAM Greek bomber study17 were non. Hence, the design differences could account for the fluctuation of consequences between surveies on the LDL, TRG, and TC p arametric quantities. A likewise designed survey by Montagnani et al15 exposed comparable consequences to the survey by Francini. Montagnani et al15 investigated the effects of Exemestane after anterior intervention with Tamoxifen, and indiscriminately assigned 60 eight postmenopausal adult females to go on taking Tamoxifen ( 20 milligrams daily ) or exchange to the aromatase inhibitor, Exemestane ( 25 milligrams daily ) for 2 old ages. Parameters ( TC, HDL, LDL, TRG ) were measured at baseline and at 12 and 24 months. Consequences showed that the Exemestane intercession had a important lessening in HDL, while the Tamoxifen group showed no significance in alteration from baseline. Therefore, a important difference between the intercession groups ( p value A ; lt ; 0.05 ) was noted. Besides in the Exemestane group, LDL was increased from baseline ; nevertheless, no alteration was seen in the Tamoxifen group. The between group differences were besides statistically important with a P value A ; lt ; 0.05. The Exemestane group besides had a statistically important lessening in TRG doing the between group differen ces important with a p value of A ; lt ; 0.05. The consequences found in this survey showed some similarities with those discovered by Francini et al.14 Montagnani revealed important differences between groups for HDL, LDL, and TRG parametric quantities, while Francinis survey merely showed important differences between groups for LDL. In both surveies, the aromatase inhibitor was compared with go oning Tamoxifen after the patients had already used Tamoxifen, hence some of the consequences may hold occurred from taking the good effects of Tamoxifen instead than uncovering damaging effects of the AI. Both Francini and Montagnani revealed lessenings in TRG in the Exemestane arm. This would be considered a favourable consequence of utilizing AI, but since Tamoxifen negatively affects TRG and Tamoxifen was antecedently used by the Exemestane patients, the simple remotion of the unfavourable consequence of Tamoxifen could account for the consequence. To increase the respectability of th ese findings, comparable consequences should be confirmed in likewise designed surveies utilizing larger sample population sizes without old exposure to Tamoxifen. Banerjee et al19 designed yet another survey comparing a different AI, Anastrozole, to Tamoxifen, and to a combination of Anastrozole with Tamoxifen. The IMPACT trial19 compares the effects of utilizing Anastrozole, Tamoxifen, or a combination of Anastrozole/Tamoxifen on the lipid profiles of postmenopausal adult females with chest malignant neoplastic disease. In a stage III, randomized, double-blind multicentre trial,19 three hundred 30 patients were assigned to have either Anastrozole ( 1 milligrams daily ) + Tamoxifen placebo, Tamoxifen ( 20 milligrams daily ) + Anastrozole placebo, or a combination of both ( Tamoxifen 20 mg day-to-day + Anastrozole 1mg daily ) for a period of 12 hebdomads. Measurements for TC and HDL were taken at baseline and three months. Results revealed that the Tamoxifen merely intervention group had a statistically important lessening in the TC lipid parametric quantity ( p value A ; lt ; 0.05 ) , while the Anastrozole merely intervention group had an addition in TC lipid parametric quantity that was non statistically important ; nevertheless, the difference between the two groups was important. The co mbination group consequences showed a important lessening in TC ( P value A ; lt ; 0.05 ) , nevertheless the between groups differences were non important. A statistically important addition in HDL from baseline was noted overtime in all intervention groups ( P A ; lt ; 0.05 ) , nevertheless the difference between the groups was non important. Writers suggest that, although there was a little addition in TC in the Anastrozole merely group, this negative consequence was counterbalanced with the positive consequence of the addition of HDL in the Anastrozole group, and that there is no damaging consequence on the lipid profile when utilizing the AI, Anastrozole.19 Measurements were merely taken over a 3 month clip period, therefore consequences are limited and the effects seen may non prolong through longer intervention tests. This addition in HDL in the AI intervention group is contrary to the consequences seen in antecedently discussed surveies. Different AIs were used in each test and this unsimilarity in methods could account for the differences. Studies reexamining the disparities between AIs are necessary to find their several effects on lipid profiles and to measure if an AI is more good or damaging than the others. Comparison between Aromatase Inhibitors It is of import to understand the differences between each aromatase inhibitors several effects on lipid profiles to assist healthcare practicians choose the appropriate drug regimen for each single patient. In a multi-centre, unfastened, randomized survey, McCloskey et al5 compared the effects of Anastrozole, Letrozole, and Exemestane on lipid profiles in one hundred and two postmenopausal adult females, and randomized them into one of three intervention groups: Anastrozole ( 1 milligrams daily ) , Letrozole ( 2.5 milligrams daily ) , or Exemestane ( 25 milligrams daily ) , for 24 hebdomads with a 12 hebdomad follow up period. Measurements of lipid biomarkers ( TC, TRG, LDL, HDL, LDL/HDL ratio, Apolipoprotein B/Apolipoprotein A-1 ratio ) were taken at baseline and at the 12th, 24th, and 36th hebdomad. Consequences revealed that Exemestane had a important lessening from baseline in TC, nevertheless the differences between the three intervention groups were non statistically important ( p value=0.535 ) . The LDL/HDL ratio parametric quantity was significantly different for all three groups at the 12th and 24th hebdomad measuring, with Exemestane giving the greatest alteration ( p=0.007 ) compared to Letrozole ( p=0.025 ) and Anastrozole ( p=0.045 ) . This increased ratio in the Exemestane intervention group was due to the statistically important lessening in HDL ( p value A ; lt ; 0.001 ) . The TRG measuring for all groups showed much variableness, with Letrozole demoing a statistical important addition at 12 hebdomads ( p=0.011 ) versus the other AIs. This alteration from baseline did non last through the 24 hebdomad measurement period. No other alterations were noted between the three intervention groups. Writers suggested that those treated with Exemestane have an addition in hazard of inauspicious effects on the ratios finding atherogenesis.5 The lessening in the HDL parametric quantity in patients utilizing Exemestane is in understanding with the anteceden tly mentioned surveies that used Exemestane as an AI comparator of pick. Since Tamoxifen was non a confounding factor here, the suggestion that Exemestane perchance adversely effects HDL, now becomes a more significant and valid statement because the consequence is still seen without Tamoxifen act uponing the consequence. However, it must be considered that this survey used healthy postmenopausal adult females, non breast malignant neoplastic disease patients, as the sample population evaluated, and the consequences can non be imposed as the same consequences that might hold occurred if the population had used a sample of postmenopausal adult females with chest malignant neoplastic disease. Long clinical surveies utilizing the right population sample and sample size should be conducted to further understand the impact of each AI on the postmenopausal chest malignant neoplastic disease patient. This is one of the lone surveies available measuring the inauspicious effects of each part icular AI compared to one another. More surveies are necessary to corroborate the consequence that Exemestane offers more inauspicious hazard compared to Letrozole and Anastrozole. Decision Tamoxifen has been in usage for more than 30 old ages, and was considered the gilded criterion hormone therapy for handling postmenopausal adult females with endocrine dependent chest cancer.15, 20 Large epidemiologic surveies have shown that AIs are more efficacious than Tamoxifen in overall and disease free endurance rates, and hence are now recommended as first line accessory hormone therapy for postmenopausal adult females with chest cancer.3,15 With their known mechanism of action of striping postmenopausal adult females of serum estrogens, therefore taking estrogens protective effects on these cardiovascular hazard factors,6, 11 there is concern that AIs may hold inauspicious effects on lipid profiles. Most writers concluded that aromatase inhibitors have minimum effects or no inauspicious effects on lipid profiles in postmenopausal adult females with chest malignant neoplastic disease. However, it is hard to measure the true consequence of AIs on lipid profiles with Tamoxifen as the comparator since it has proved benefit on some lipid parameters,14 and because of the many different design methods used. Small sample sizes were restrictions in a few surveies ; therefore, the tendencies yielded in those tests may non be genuinely declarative of postmenopausal adult females with chest malignant neoplastic disease. Long term prospective surveies utilizing big sample sizes and patients with no exposure to any other hormone intervention besides AI, are needed to accurately measure if inauspicious effects on lipid profiles exist from the usage of AIs. From the current available information, though minimally, HDL is the parametric quantity most adversely affected by the usage of AI. This may be a cause of concern for some practicians since lessenings in go arounding sums of HDL are linked with additions in cardiovascular disease.15 Since HDL is considered good cholesterin and a positive hazard factor, diminishing the sum available in blood could perchance hold damaging effects on CVD. Healthcare practicians should be cognizant of this possible hazard of diminishing HDL with AI usage so that proper monitoring in their patients may be performed. Given that a current intervention option still includes the usage of Tamoxifen followed by exchanging to an AI, it is particularly of import to supervise lip id profiles since some studies14, 15, 17 have shown unfavourable effects on lipid profiles when doing this switch. To find if an existent hurt on CVD hazard factors occurs in adult females taking the non steroidal and steroidal aromatase inhibitors, more long term clinical tests should be conducted. In decision, aromatase inhibitors are being used more and more as first line accessory intervention in postmenopausal adult females with chest malignant neoplastic disease. Though it depletes estrogen beginnings, surveies show no well damaging effects on lipid profiles, with most merely demoing minimum, if any, inauspicious consequence. Placebo controlled surveies utilizing equal patient populations and sample sizes for appropriate sums of clip, are necessary to accurately depict the hazards of AIs on cardiovascular hazard factors. Healthcare practicians should go on to supervise lipid profiles in postmenopausal adult females with chest malignant neoplastic disease and develop individualized intervention programs utilizing current recommendations. Specific safety steps for patients utilizing AIs are non necessary,16 and the effects seen in the surveies mentioned in this reappraisal suggest that long term monitoring of all lipid parametric quantities should be a portion of the postmen opausal adult female with chest malignant neoplastic diseases intervention program. Surveillance of hazard factors overtime in these adult females with should assist forestall unfavourable cardiac events. How to cite Lipid Profiles In Postmenopausal Women Health And Social Care Essay, Essay examples

Cumberland Metal Industries free essay sample

The table below breaks down the economic value in use of the CMI pads according to both the Colerick and Fazio tests. I used the data from each case to derive the number of hours of driving required to complete the job with both the asbestos and CMI pads. The difference in time to complete the job multiplied by the cost per real hours was one part of the economic value in use. The economic value that is created by use of the CMI pads is different in total dollars between the Colerick and Fazio tests. However, when you divide those values by the number of feet driven in each test you derive the same economic value in use of $0. 46/ft. When you examine the breakdown of savings associated with a decrease in project time between the 2 tests you find that the Colerick test had a saving of $. 0/ft, and Fazio $. In the current state the pads are a commodity product manufactured by several small firms. The fragmentation of the distribution channel combined with the commodity nature of the product has put most of the channel power in the hands of the equipment distributors who despite carrying the products mostly as a matter of necessity are still enjoying a 30-40% gross margin on the sale of the pads. CMI is in the situation where they can circumvent the channel and provide their product direct to the market. CMI is able to offer their product direct to the market because they have a very specific consumer target engineering/construction contractors, and independent pile-driving contractors. It would be easier to create awareness among these consumers by direct sales than trying to have the various outlets that exist in the conventional channel do so. This also allows CMI to avoid the situation of having their distribution limited by the number of outlets that they can get to carry their product. If CMI is able to gain a monopoly in the market then they can approach distribution through the conventional outlets because they will have a strong brand and will be able to put pressure on distributors to accept a lower price. The nature of the CMI pads makes them much longer lasting than the asbestos pads. Thus one assumes that CMI would be looking for a high EBIT on this product rather than ATR. By circumventing the distributors they are able to capture more of the Total Channel Margin and increase their EBIT. Segmentation of the market can be done by applying the variables of willingness to pay, benefit, and the heavy half or 80 / 20 rule. Willingness to pay is appropriate but needs to be approached in an abstract way. There are many contractors in the pile driving business that are looking to maximize their take, of these some are not sophisticated enough, or their business is not large enough to realize substantial gains on the time savings through use of the new pads. They are going to be your smaller independent construction contractors and pile driving operations. They will typically see the lower price of the asbestos pads and choose them. You can also look at willingness to pay in another way the more sophisticated outfits will realize that by paying more for the CMI pads they will realize savings on time and cost on their projects over all. The players in this segment are likely to be the larger international construction contractors like Conmaco and Raymond International, as well as larger independent pile driving firms. The market can be segmented by benefit because there are those consumers or purchase influencers who look at the impact the pads can have from an engineering standpoint. Because CMI pads transfer the energy from the pile more efficiently they were less likely to result in damage to the pile that may affect the integrity of the foundation. The players that would be in this segment would be the architectural and consulting groups, as well as the more sophisticated of the larger engineering/construction contractors. There is a second benefit segment that you can identify as well. This group would be defined by there need or want for a safer work environment. The use of asbestos pads would be undesirable to this segment, and would be more likely to choose the CMI pads. This segment would be harder to identify because they would be spread out amongst the different size firms. It is likely that at the time of the case larger firms were not yet concerned about the major litigation issues surrounding the use of asbestos. Since it is most likely site workers that would be identified in this segment’ it is likely that smaller firms were the principle is on site at the projects would be the major part of the segment. The last segment would be the heavy half. This is appropriate b/c there is likely to be a small number of larger firms that handle multiple pile driving project at a time, as well as the larger ones. It is then logical to ssume they are going to consume a majority of the pads in the market. This segment is likely to consist of a few of the larger engineering/construction firms. When looking to price the CMI pads they would first need to look at the equivalent cost of the asbestos pads. Using the total number of sets used between both tests (70) and the total number of feet driven (27000) you get and average of 386 ft per set. Given the conse rvative estimate of the CMI set of pads having a durable life of 10,000 we can calculate that you would use 26 sets of asbestos pads over the durable life of one set of CMI pads. Multiplying that figure by and average price of $45/set you get $1170, providing a good base. But this would put them at 24% margin per pad if using current equipment and 55% after retooling(retooling adds $16. 7/pad to total manufacturing cost), without adding extra capacity over 250 pads per month. If they choose not to retool they would have increase their price, they have room to do so because they are creating project cost savings at an average of $. 35/ft or $3,500 per set of pads. If they increased their price to $1800/set or $300/pad they would be realizing 50% margins per pad without retooling, and 71% after retooling. They would also be providing about $2,900 in project cost savings to the consumer. CMI should distribute these directly to the consumer for the reasons mentioned earlier in this analysis. There key segment should be the heavy half users consisting of the larger engineering and construction firms. They should also focus on the benefit segment of Architectural/Consulting engineers who can drive demand for the new pads. Key to gaining this segment would be a favorable review by Dr. McCormack. The NATRU listed bellow estimates the volume of pads that should be produced in each of the first five years. I used a rough estimate on the number of pile hammers existing in the market of 22,750. This number was then decreased in each of the five years by the number of trial from the previous year. This assumes that the market is not growing and that non repeat customers will not trial the product again. The steady state volumes of repeat customers are captured in the total of each year. Because there is a lot of uncertainty about how to gain awareness of the new product in the market I kept awareness very low at 15% in the first year increasing of the next five to 55%. Much of the growth in awareness would be contributed to extended time in the market of and active sales force and word of mouth amongst market players. I assumed a moderate amount of trial given the evidence available about the superiority of the pads. This rate would increase over time as well because there would be more evidence based information available to the market. Because the pads are somewhat of an experience good, and all evidence points ot a favorable experience I weighted the repeat rate heavily at 80%.