Motivation to Help Essay Example for Free

Motivation to Help Essay This paper discusses the social psychological perspective on helping. It tackles the factors that lead people to help other people and the theoretical basis on such actions. It also includes a reflection on the altruistic property in helping. Motivation to Help The murder of Kitty Genovese in 1964 as one of the most disturbing cases where almost 40 people were witnesses but none of them called the police in time to rescue her. This baffled social psychologists as to how this was possible. The result of their investigation was the formation of the concept of the Genovese Syndrome. This condition is theorized to exist on certain emergency situations where people encounter a diffusion of responsibility. This was because of the notion that there will be someone who will carry out the responsibility (Alex, 2008). On a personal account, an example of this behavior was observed in the sidewalk near a well-known shopping center. A lady, approximately aged 50 years was walking on the nearly crowded pavement when two men riding a motorcycle snatched her bag. It was not easily taken from her since she tried to defend herself and her belongings. The struggle made the two men shoot the lady until she was down on the sidewalk. The initial reaction of the people there was to run away from the scene. When the two men quickly left, the people slowly went towards the lady. Nobody helped until the lady screamed in pain. There are a number of factors that have resulted to the lack of responsiveness of the people on the victim. One of which is the bystander effect. Since there are more people in the area, the responsibility of helping the victim is divided among them. Each of these people had two choices of whether they should act or wait for someone to do it. Thus, the more people there are in the area means that people feel less obligated (â€Å"The Bystander Effect†, n. d. ). Also, the scream of the lady may have somehow alarmed the people around her, which may have motivated the some people to finally help her. Basically, there are five steps to helping or prosocial behavior. First of all, in order to help, there must be a realization that something is happening. It must also be interpreted as an emergency. The person who is to help must also feel the responsibility towards the situation. He must also know how he is going to help. Finally, the costs of helping are also assessed (Stocker, n. d. ). In this particular scenario, the five steps were evident. Although the initial reaction was to run because of the gun shot, people did realize that it was an emergency situation. However, because there were a lot of people, they did not have much responsibility for the situation because of the assumption that someone will act. When the lady screamed and the two men left, it was the time when someone helped, knowing that the costs are already low and it was no longer dangerous. There are many theories which explain why people are motivated to help. However, the most widely accepted theory on the subject is the theory of Victor Vroom, known as the expectancy theory. This simply states that people are motivated to help because they are expecting something in return such as a reward, or a good performance appraisal (Shah, n. d. ). Based on this theory, the act of helping may not be truly altruistic because of the tendency to expect for something in return. If the one helping does not want anything as a reward, it may be because of other outside factors such as his social image, religion, or the dictate of the society. Nevertheless, additional helped could have been offered in the situation, knowing the there were a lot of people in the situation. If all of them felt responsible for the incident, it is most likely that the crime would have been prevented. References Alex. (2008, February 13). The Genovese Syndrome: When Nobody Helps. Retrieved July 14, 2010, from Neatorama: http://www. neatorama. com/2008/02/13/the-genovese-syndrome-when-nobody-helps/ Shah, K. , Shah, P. (n. d. ). Theories of Motivation. Retrieved July 14, 2010, from Laynetworks: http://www. laynetworks. com/Theories-of-Motivation. html# Stocker, S. (n. d. ). Social Psychology. Retrieved July 14, 2010, from http://webcache. googleusercontent. com/search? q=cache:P4aNe4_DzhsJ:www. spsp. org/student/intro/ppt/myers15. ppt+five+steps+to+prosocial+behaviorcd=4hl=enct=clnkgl=ph The Bystander Effect. (n. d. ). Retrieved July 14, 2010, from Changing Minds: http://changingminds. org/explanations/theories/bystander_effect. htm

Treatments for Patients with Prostate Cancer

Treatments for Patients with Prostate Cancer EFFECTIVE TREATMENT FOR PATIENTS WITH PROSTATE CANCER TO ACHIEVE A BIOCHEMICAL RECURRENCE FREE SURVIVAL Mariam O. Akinwale MEDICAL UNIVERSITY OF THE AMERICAS Mentor: Dr. Akintola Odutola Manuscript word count: 4205 HYPOTHESIS: In the treatment of aggressive and metastatic prostate cancer, patients who undergo radical prostatectomy with additional radiation therapy and/or hormonal therapy have less recurrence rate in comparison to those who receive radical prostatectomy alone due to its additive curative effect. ABSTRACT (word count: 275) Hypothesis: In the treatment of aggressive and metastatic prostate cancer, patients who undergo radical prostatectomy with additional radiation therapy and/or hormonal therapy have less recurrence rate in comparison to those who receive radical prostatectomy alone due to its additive curative effect. Method: The articles reviewed in this studies were obtained from PubMed. The database search combined terms from three themes: men above the age of 50, radical prostatectomy, radiation therapy or hormonal therapy and prostate cancer remission. This search yielded 72 articles after inclusion criteria were considered. A total of 32 articles were used for final review after excluding 40 articles that did not compare management options for treatment of prostate cancer. Result: Better life-expectancy have been indicated in patient treated with radiotherapy with hormonal therapy compared to patient treated with radical prostatectomy only. However, radical prostatectomy and radiotherapy with hormonal therapy are far more efficient compared to radiotherapy with hormonal therapy. The use of hormonal therapy for treatment of prostate cancer has always been frowned at because of its life-threating side effects but its patient-survival rate supersedes that of radical prostatectomy as a monotherapy. Conclusion: Combination therapy of radical prostatectomy with radiotherapy and hormonal therapy for treatment of patients with either benign or metastatic prostate cancer have a longer life-expectancy than radiotherapy with hormonal therapy, while patients treated with radiotherapy and hormonal therapy have a longer life-expectancy than those with radical prostatectomy with radiotherapy even after considering the side effects of hormonal therapy. Screening tests may help with early detection of biochemical recurrence and also prevent overtreatment with radiotherapy and/or hormonal therapy after radical prostatectomy. Keywords: radical prostatectomy, adjuvant radiation therapy, hormonal therapy, biochemical recurrence, prostates cancer INTRODUCTION Prostate cancer (PCa) is the second commonest cancer in males above age 60. African- Americans have the highest prevalence in the US. Risk factors include diets high in beef and milk. Two hundred and thirty-three thousand new cases are diagnosed yearly with 29,480 mortality reported in 2014. (American Cancer Society, 2014) Given these statistics, it is very important to diagnose and treat PC early in order to reduce the risk of high mortality. Several treatments options are available in the management of PCa. Low- risk prostate cancer is managed by active surveillance in order to prevent unnecessary exposure to radiation or surgery. Intermediate or high- risk non-metastatic prostate cancer is treated with prostatectomy or radiation therapy (Zietman et al., 2010). Aggressive and metastatic prostate cancers are treated with variable combinations of radical prostatectomy (RP), radiation therapy (RT), chemotherapy, cryosurgery, hormonal therapy (HT) and bisphosphates. These combination therapeutic options address the tendency of aggressive PCa to metastasize to neighbouring structures/organs. This study is designed to evaluate a specific combination of treatment option in the management of aggressive and metastatic PCa. It is hypothesized that patients with aggressive PCa who undergo radical prostatectomy and adjuvant radiotherapy have less recurrence rate compared to those who receive radical prostatectomy alone due to its additive curative effect (Thompson et al., 2013). This study is significant because evidence suggests that different combination treatments of aggressive PCa are associated with different recurrence rate. The identification of the combination therapy with the lowest recurrence rate and longer life-expectancy is essential in this study. I chose this topic because it is important for family practice physicians to have accurate information to give to their patients regarding best treatment options for aggressive metastatic PCa. METHOD The articles reviewed in this studies were obtained from PubMed. The database search combined terms from four themes: specific population (older men OR men above 50 OR prostate cancer patient OR post prostatectomy patient OR recurrent prostate cancer patient), intervention (prostate cancer adjuvant therapy OR prostate cancer adjuvant radiotherapy OR prostate cancer adjuvant chemotherapy), comparison (radical prostatectomy) and possible outcomes (prostate cancer recurrence OR prostate cancer remission OR prostate cancer curative OR prostate cancer life span OR prostate cancer prognosis OR prostate cancer quality of life). Boolean operators used were OR and AND. OR was used to capture each term within a theme and AND was used to link each theme within parentheses. Filters used were: article types (randomized controlled trial), text availability (free full text), publication dates (5 years), and limited to human. Inclusion criteria Articles that were included in the systematic review of this study had to meet the following criteria: used randomised clinical trials, cohort studies and meta-analysis; prostate cancer population; radical prostatectomy with adjuvant radiotherapy and hormonal therapy as intervention; radical prostatectomy only as comparison; and prostate cancer recurrence, prostate cancer remission, prostate cancer curative, prostate cancer life span, prostate cancer prognosis, prostate cancer quality of life as outcome. Localized and high risk prostate cancer management were included in the study. Exclusion criteria Population of women and men below the age of 50 were excluded. Articles published prior to 2011 and were not written in English language were excluded. Articles that were not free full text were excluded. Articles that did not compare RP+RT+HT with radical prostatectomy only were excluded. RESULTS This search yielded 72 articles after inclusion criteria were considered. A total of 27 articles were used for final review after excluding articles that did not compare management options for treatment of prostate cancer. Treatment of Prostate Cancer with Radical Retropubic Prostatectomy (RRP) And Pelvic Lymph Node Dissection (PLND) Before we can lay emphasises on other possible treatments to prevent biochemical recurrence (BCR) after RP, we have to talk about RRP and PLND. According to one of the studies cited in this systematic review, ten of 11 patients with histologically confirmed lymph node metastasis (LNM) showed a PSA response (Winter et al., 2015). Three of 10 patients with single LNM had a complete biochemical remission (median follow-up 72months, range 31.0-83) (Winter et al., 2015). In five cases with single LNM PSA decreased et al., 2015). All of the additionally removed 30 LNs were completely negative (Winter et al., 2015). Treatment of Prostate Cancer with Radical Prostatectomy (RP), PLND and Hormonal Therapy (HT) The above combination therapies have been reported to be commonly used for the treatment of metastatic PCa to lymph nodes and other neighboring tissues than localized PCa due to its higher efficacy and potency for the treatment of metastatic PCa. The first article I will be talking about under this subtopic had a mean follow-up of 5.3 years and LNM occurred in 140 patients. An average of 10.9 lymph nodes was dissected from patient with pN1 through a method known as extended sentinel lymph node dissection (eSLND) (Muck et al., 2015). After the surgery, 121 patients with pN1 patients received adjuvant ADT for a sort period of time (Muck et al., 2015). Average survival year for; recurrence-free survival (RFS), RFS after secondary treatment, case-specific survival (CSS), and overall survival (OS) were 4.7, 7.0, 8.8, and 8.1 years, respectively (Muck et al., 2015). RFS, CSS, and OS were significantly correlated with tumor staging (Muck et al., 2015). The second article focuses on the 67 Chinese patients with lymph node metastasis (LNM) after RP and extended PLND, and these patients received continuous adjuvant ADT. The median follow-up of this study was 46.7 months and two patients were lost to follow-up. BCR-free survival was recorded annually indicating 52%, 40%, 22% for the first 3 years respectively and a more significant survival was observed in patients with 5-year BCR free-survival which shows a 93% free-local recurrence, 83% free-systemic metastasis and 96% cancer death-free (Qin et al,2015). Postoperative BCR-free survival was 27.5 months (Qin et al.,2015). Even though a lot of articles support the positive effect of HT as a treatment for PCa, we also have to consider the adverse effect of HT including depression. According to Lee et al, 2015, patients who are treated with ADT have shown to a significant prolonged depressive state (pet al.,2016). The depressive state in correlation to ADT is confirmed when compared to a control by indicating a p value less than 0.001 (Lee et al.,2016) Apart from the adverse effect associated with HT, metastasis have been reported after adjuvant ADT has been used for treatment of both localized and high-risk PCAa (Taguchi et al., 2014). Taguchi et al. reported 9 (4.6%) patients developed metastasis and 6 (3.0%) died from PCa. Eight of nine metastatic patients had a GS greater than 9 and developed a metastasis to the bone, while the remaining one had a GS greater than 7 and developed lymphatic spread (Taguchi et al.,2014). Based on the findings above, optimal timing of salvage ADT for BCR after RP is crucial. According to a study by Taguchi et al., biochemical recurrence was seen in one patients (2.0%) in the ultra-early group and seen in 12 patients (17.1%) in the early salvage ADT group (Taguchi et al.,2014). Only one patient in the early salvage ADT group developed metastasis to a left supraclavicular lymph node, and no patient died from PCa during follow-up (Taguchi et al.,2014). Treatment of prostate cancer with Radical Prostatectomy (RP) and Radiation Therapy (RT) In order to examine the effect of RT after RP, an article which compared outcome of patients treated with radiotherapy after radical prostatectomy and patients who were under active surveillance after radical prostatectomy (Petruzzeillo et al., 2014). Patients who were under surveillance had a longer follow-up but higher recurrence rate and short life-expectancy (Petruzzeillo et al.,2014). Another article was able to back-up this finding, indicating significant longer life-expectancy and lower risk of recurrence (Gandaglia et al.,2014). However, the earlier administration of radiotherapy after RP is very essential. Studies had if indicated that patients who had ultra-early radiotherapy after RP had lower recurrence and longer life-expectancy (Azelie et al.,2012). A number of reports have associated early RT after RP to decrease risk of BCR and longer overall survival (OS). According to Gandaglia et al, patients with high risk score benefitted more from early radiotherapy compared to patients with lower risk scores (Gandaglia et al.,2014). The risk scores were determined based on its association to increasing 5- to 10- year prostates cancer mortality rates with a p value less than 0.001 (Gandaglia et al.,2014). the risk score was associated with increasing 5- and 10-year cancer-specià ¯Ã‚ ¬Ã‚ c mortality rates (P et al., 2014). However, adjuvant RT after RP have shown to present with gastrointestinal and genitourinary toxicities. A study indicating the use of real-time tumor-tracking intensity-modulate radiation therapy (RT-IMRT) as a much preferable RT for treatment of PCa with less adverse effects (Shinohara et al.,2013). In patient treated with RT-IMRT have shown to have better quality of life with little or no risk of urinary and sexual dysfunction (Shinohara et al., 2013). No patients treated with RT-IMRT after RP have gastrointestinal discomfort (Azelie et al.,2012). An article has indicated that earlier RT can lower the risk of adverse effect such as gastrointestinal and urinary dysfunction (Hegarty et al.,2015). Another concern is excessive treatment of PCa with RP+RT using standardized guideline. Patients who underwent RT after RP using this standard guideline 27 patients out of 163 patients had recurrence and 3 out 87 with PSAet al.,2014). Hence the other patients were over treated and therefore exposing them to preventable adverse effects. Treatment of Prostate Cancer with Radical Prostatectomy(RP), Radiation Therapy(RT) and Hormonal Therapy (HT) For the treatment of high-risk prostate cancer (PCa) different evidence-based therapies exist such as (RT+HT), (RP+RT), and (RP+RT+HT). RT + HT resulted in a longer life-expectancy which is always greater than 1 compared to RP+RT (Parikh et al.,2012). However, RP+RT+HT combination have a greater than 0.5 longer life-expectancy compared to RT+HT after considering their side effects (Parikh et al.,2012). Treatment of Prostate Cancer with Radical Prostatectomy (RP), Radiation Therapy (RT), Hormonal Therapy (HT) and Neoadjuvant Chemotherapy (NCHT). Patients with local and metastatic PCa are prone to recurrence after RP. Hence adjuvant therapies are required to reduce biochemical failure and also prolong life-expectancy. Therefore, it is important to study the adverse effect of these combination therapies (RP+RT+HT+NCHT). The major adverse effect associated with these combinations are gastrointestinal and urinary dysfunction while leucopenia and neutropenia mainly for NCHT (Guttilla et al.,2014) and (Thalgotti et al.,2014). Gastrointestinal and urinary dysfunction are seen in low grade pathologically (Guttilla et al.,2014). Thalgotti et al.,2014 reviewed the percentile of blood toxicity after patients have been administered the combination therapies; 90% had neutropenia and 53.8% leucopenia in the studied patients (Thalgotti et al.,2014). Effective Screening Test to Aid Prevention of Biochemical Recurrence (BCR) Eighty-eight miRNAs were identified to be significantly (p36months) (Bell et al.,2015). Nine miRNAs were identified to be significantly (pet al.,2015). Based on the efficacy of the above result a new prognostic stick has been created, composed of miRNA-4516 and miRNA-601, Gleason score and lymph node status (Bell et al.,2015). A study was done to assess which patients would benefit the most from RT after RP using 11C-choline PET/CT. In order to identify which patients would benefit the most from restaging 11C-choline PET/CT before RT, 11C-choline PET/CT was positive in 28.4% of patients (172/605) (Castellucci et al, 2016). Castellucci et al.,2016 categorized these patients based on staging: Eighty-three of 605 patients were positive locally, 72 of 605 patients had systemic metastasis, and 17 of 605 patients had both local recurrence and systemic metastasis (Catellucci et al., 2016). At multi-analysis; PSA, PSA doubling time (PSAdt), and ADT were signià ¯Ã‚ ¬Ã‚ cant predictors for positive scan results, whereas PSA and PSAdt were signià ¯Ã‚ ¬Ã‚ cantly related to distant recurrence detection (Pet al.,2016). Genomic classifier (GC) used to predict biochemical recurrence and distant metastasis in men receiving radiotherapy (RT) after radical prostatectomy (RP). Illustrating Den et al.,2015, the measurement of GC was used to predict recurrence of PCA at 5 years after receiving RT (Den et al.,2015). A multi-analysis was done which no correlation between GC and PSA before RP. However, patients with low GC had no significance recurrence at 5 years after RT while patients with high GC had recurrence at 5 years after RT (Den et al.,2015). DISCUSSION This reviews attempted to answer the question: Can adjuvant therapy be used in patients that have undergone radical prostatectomy to prevent local recurrences? The general collective consensus of articles included in this review supported the hypothesis that in the treatment of aggressive and metastatic prostate cancer, patients who undergo radical prostatectomy and adjuvant radiotherapy with hormonal therapy have less recurrence rate in comparison to those who receive radical prostatectomy alone due to its additive curative effect (Parikh et al.,2012; Kyrdalen et al.,2012; Hayachi et al., 2012; Shinohara et al.,2013; Kaplan et al.,2013; Linder et al.,2013; Azelie et al.,2012; Miyake et al.,2014; Taguchi et al.,2014; Muck et al.,2014; Gandaglia et al,2015; Den et al.,2014; Castellucci et al.,2014; Lee M. et al., 2015; Kang et al.,2014; Thalgotti et al.,2014; Sato et al.,2014; Gutilla et al.,2014; Kim et al.,2016; Rosenkrantz et al.,2015; Petruzzeillo et al.,2014;Den et al.,2014; Lee J. et al.,2015; Qin et al.,2015; Mizowaki et al,2015; Winter et al.,2015; Bell et al,2015; Hegarty et al.,2015; Den et al., 2015; Taguchi et al.,2014). Only one article concluded that patient with High Gleason score (GS) carry a risk of bone metastasis and cancer specific-death after RP with ADT (Taguchi et al.,2014). Seven articles laid more emphasise on the combination therapys adverse effects such as gastrointestinal, genitourinary toxicities and sexual dysfunction (Shinohara et al.,2013) and specifically; diabetes mellitus, heart disease, osteoporosis (Parikh et al.,2012) and depression for HT (Lee M. et al.,2015). However, few articles addressed these adverse effects by recommending ultra-early RT after RP (Azelia et al.,2012 and Hegarty et al.,2015) and early HT after RP (Taguchi et al.,2014 and Sato et al., 2014). However, early RT after RP does not only reduce gastrointestinal and gastrourinary toxicities but it also prolongs quality-adjusted life expectancy (QALE) and lowers biochemical recurrence (BCR) (Azelie et al.,2012, Sato et al.,2014 and Gandgalia et al.,2014). Radiotherapy such as Real-time tumor-tracking intensity-modulated RT (RT-IMRT) may be a better treatment for localized PCa even though it has a similar effect as RP because of the adverse effects associated with RP such as urinary incontinence and erectile dysfunction (Azelie et al.,2012). Hence, better quality of life with RT compared to RP (Shinohara et al.,2013). An article compared RT after RP with observation alone (OA) after RP which reviewed 87.1% to 30% biochemical progression-free survival, respectively (Petruzzeillo et al.,2014). This result lays further emphasises on the efficacy of RT after RP. Despite all the articles emphasizing the efficacy of adjuvant RT and androgen deprivation therapy (ADT) after RP, there is concern for excessive treatment of PCa using AUA/ASTRO guideline on adjuvant RT. A particular article stretched on the concern by concluding that patients treated with RT who met the AUA/ASTRO guideline should be carefully considered to prevent excessive treatment (Kang et al., 2014). This is because in the article, among 163 patients with high risk BCR according to AUA/ASTRO guideline, only 27 patients developed BCR and treated with RT (Kang et al., 2014). In addition, in 87 patients with pre-operative PSAet al., 2014). Some articles (Gutilla et al,2014; Gutilla et al,2014 and Thalgott et al.,2014) considered the effectiveness of screening test on predicting biochemical failure in order to prevent BCR after RP. Several screening test were considered and tested. Specific miRNA (miR-4516 and miR-601), 11C-Choline PET/CT, Genomic Classifier (GC) and whole-lesion histogram apparent diffusion coefficient (ADC) metric have sensitivity and specificity for BCR after RP (Bell et al.,2015; Castellucci et al.,2015; Den et al.,2015; Den et al.,2014 and Rosenkrantz et al.,2015). These screenings can help to identify specific treatment for BCR, for example, patients with low GC scores are best treated with RT only, whereas those with high GC scores beneà ¯Ã‚ ¬Ã‚ t from additional therapies (Den et al., 2014). Some studies verified that the trimodality therapy (RP+RT+HT) has shown an increase in quality of life expectancy (QALE) (Parikh et al.,2012; Guttilla et al.,2014; Kyradalen et al.,2012 and Den et al.,2014). Limitations of the search strategy include searching only one database (PubMed), only one source of information is used (database), only published data is included, only data from the last 5 years is included, only articles published in the English language are included, and only one reviewer is reviewing the abstracts. The major limitation of this systematic review is use of more retrospective cohort than clinical trials and use of only free-full articles and also broad question covering several treatment options such as different types of adjuvant radiation therapies, hormonal therapies and inclusion of some chemotherapies. Future research may consider comparing multiple interventions in a single randomized clinical trial with several approaches to allow for better comparison across clinical outcome measures. Further research may consider more screening test to prevent overtreatment. APPENDICES First Author Date of Publication Study Design Level of Evidence Study Population Therapy Outcome Azelie C. 2012 Randomized Clinical trial 1b 178 patients were referred for daily exclusive image guided IMRT (IG-IMRT) and 69 patients were the control group IG-IMRT vs RP+IMRT Patients with low risk PCa treated with IG-IMRT had a more significant outcome compared to the control group (patient treated with RP + IMRT) Bell E. March, 2015 Prospective Cohort Study without controls 4 43 patients who undergone RT after RP miRNAs miRNA signatures (Notably, two novel miRNAs: miR-4516 and miR-601) can be used as a diagnostic tool to determine patients who will benefit from additional therapy after RP. Castellucci P. Nov., 2015 Case series 4 605 patients treated with RT after RP. RT+RP vs ADT at the time of 11C-choline PET/CT At the early stage of BCr after RP 11C-choline PET/CT should be suggested before ADT is administered. Den R. March, 2015 Randomized Clinical Trials 1b 188 patients with positive margin of PCa at Thomas Jefferson University and Mayo Clinic between 1990 and 2009 were considered. Neoadjuvant HT, IMRT, salvage RT, ART In patients treated with RT after RP,genomic classifier (GC) was a good prognostic tool for determining metastasis. Den R. August, 2014 Randomized Clinical trial 1b 139 patients who underwent RT after RP that were identified with pT3 or positive prostate margin. Using genetic classifier to predict biochemical failure after RP+RT The genetic classifier (GC) predicted biochemical failure and metastasis after RP +RT. Patients with lower GC may benefit from delayed RT, as opposed to those with higher GC. Gandaglia G. August, 2014 Randomized Clinical trial 1b 7616 prostate cancer patients treated with RP. Early treatment with RT after RP vs not receiving early RT after RP Patients with two or more adverse pathological characteristics at RP might beneà ¯Ã‚ ¬Ã‚ t the most from adjuvant RT in terms of reduced cancer specific mortality. Guttilla A. 2014 Randomized Clinical Trial 1b 35 patients with newly diagnosed high-risk localized prostate cancer IMRT, RP, ADT, docetaxel-based chemotherapy This treatment phase for high-risk PCa indicated an acceptable oncological outcome. Hayashi S. July, 2012 Retrospective Cohort Study without controls 4 41 patients were treated with external beam RT as salvage RT because of increasing PSA levels following RP. RT after radical prostatectomy Lymphatic invasion is reported after RT+RP Vascular invasion is not associated with biochemical failure in PCa treatment. Hegarty S. February, 2015 Prospective Cohort Study without controls 4 Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we identified 6,137 prostate cancer patients diagnosed during 1995-2007 who had one or more adverse pathological features after prostatectomy. RT after RP RT after RP is associated with adverse effects such as gastrointestinal and genitourinary toxicities while early treatment with RT is not associated with these adverse effects. Kaplan J. 2013 Retrospective Cohort Study without controls 4 577 men with LN metastases discovered during RP and 177 men underwent ART with no distant metastases Adjuvant RT, RP ART after RP in men with LN-positive prostate cancer was associated recurrence free-survival. Kang J. 2014 Retrospective Cohort Study without controls 3b 163 men who had pT2-3 with undetectable PSA level after RP who had metastasis. Adjuvant RT (ART) after RP ART in patient who met the ASTRO/AUA criteria should be applied more selectively to avoid overtreatment. Kyrdalen A. 2012 Randomized Clinical Trial 1b 771 compliers were divided into four groups (i) no treatment, (ii) RP, (iii)RT without HT and (iv) RT+HT No treatment vs RP vs RT vs RT+HT No treatment group: had the highest level of moderate/severe bladder outlet-obstruction. RP group: reported more urinary incontinent compared to other treatment groups and also the highest prevalence of poor erectile functions. RT group: reported highest gastrointestinal dysfunction and fecal leakage compared to RP and no treatment group. Bladder outlet obstruction and poor sexual drive were significantly associated with low quality of life. Lee J. July, 2015 Prospective Cohort Study without controls 4 307 patients who underwent RP at Seoul National University Hospital between January,2006 and July,2007. RP According to this finding, SHBG may be useful in selection of candidate for adjuvant treatment following RP. Lee. M 2015 Observational studies with controls 3b 61 men with prostate cancer and their match control group (n=61) without cancer ADT This article indicates an association with PCa patient developing depression after receiving ADT. Linder B. 2013 Retrospective Cohort Study without controls 4 419 patients who received additional HT Adjuvant HT after RP Adjuvant HT after RP with high-risk PCa does not increase non-prostate cancer (such as cardiovascular disease) mortality, even in patient with multiple comorbidities. Mizowaki T. April, 2015 Observational Study with controls 3b Patients with localized PCa from the Japanese Radiation Oncology Study (JROSG) who were treated with RP before 2005 and those who received RT in 2007.. HT, RT Hormonal therapy was combined with radiotherapy which resulted in a longer life- expectancy. Muck A. March, 2014 Retrospective Cohort Study without controls 4 819 patients with localized prostate cancer (PCa) Extended sentinel lymph node dissection (eSLND) and RP. The use of ESLND and RP in patients with low risk can serve serve as complete cure for BCR. Parikh R. Jan., 2012

SWOT analysis of paint manufacturer Dulux

SWOT analysis of paint manufacturer Dulux ICI Dulux paints is the worlds largest manufacturer of paints and industrial coating.ICI Dulux trade paints is one of the leading paint manufacturers in Britain and has about 130 outlets in the UK. With the increase in demand for broken colour decorative paints effect, dulux trade paints have launched three new products i.e. Duette, sonata, and acrylic scumble glaze in order to meet the demand and customer preferences. These newly launched are targeted at trade customers in the UK. In this case study we will be discussing various stages of marketing. It consists of three crucial stages, SWOT analysis, Market Segmentation and Branding. TASK 1: The marketing audit is the process of taking stock of an organisations internal and external factors. The marketing audit is a fundamental part of the marketing process. The marketing audit is a major exercise which ranges over all the internal and external factors. There are number of tools which can be used such as PEST, Five Forces Analyses and SWOT Analysis. The first two focuses on external environment and SWOT Analysis is used for both internal and external environment. (Brassington and. Pettitt, 2006a) SWOT analysis is one of the best tools in marketing audit. It involves both internal and external environment. It is the overall evaluation of companys strengths, weaknesses, opportunities and threats. The strengths and weaknesses are internal factors and opportunities and threats are external factors. SWOT Analysis enable a business to focus into those areas that present the greatest opportunities and those competencies in which it is strongest. (Pinson, 2001) SITUATIONAL ANALYSIS: SWOT Analysis of Dulux Trade Paints: STRENGTHS: It is an internally controlled factor. It enhances the performance of the company. Some of the strengths are as follows: It has a strong brand name and positive reputation in the minds of customers so far them its a great strength of the company ICI Dulux Trade Paints has well established infrastructure. It has a wide range of distribution (merchants and retailers) It has 130 outlets in the UK, the largest of any trade supplier. It provides vide range of colours (52 two-tone colourways). All products are uniquely water-based. WEAKNESSES: It is also an internally controlled factor. It minimizes the performance of the company. Some of the weaknesses are as follows: The major weakness of Dulux Paints is that they dont have their own distribution channels. They have dealers which sell their products in different cities. The public awareness about Dulux paints is not high, mainly because of lack of advertisements and promotions. OPPORTUNITIES: It is an externally controlled factor. Some of the opportunities are as follows: One of the greatest opportunities for Dulux Paints is to increase awareness among the customers regarding high quality paints and newly launched products. Advertisements and promotions can play an important role in achieving it. THREATS: It is also externally controlled factor. Some of the threats are as follows: The biggest threat of Dulux Trade Paints is the increased number of competitors. They are other companies producing the same products; they have captured the market share. So it is a great threat for Dulux Trade Paints. (Kotler. and Keller 2009 ) TASK 2: MARKET SEGMENTATION Market segmentation is defined as the process of identifying different groups of users within a market who could possibly be targeted with separate products or marketing programmes. It can also be defined as dividing the market into groups of potential customers with similar needs and purchase behavior. The idea of dividing market into various segments and targeting each segment with a distinct product is the heart of marketing theory. (Croft 1994.) The main objective of market segmentation is to analyse market fully, finding opportunities and to improve companys competitor position and serve the needs of customers. Management must segment the market according to benefit sought. In this case we will apply business to business segmentation. In B2B segmentation we can focus on organisation as well as on individual buyers within it. B2B market segmentation can involve two stages: Macro segments: are those in which we have to identify subgroups within whole market and Micro segments: are those in which we have to select target segments based on specific buying characteristics. In this case we will define few market segments which are most important in this type of industry and upon which Dulux Trade Paints should consider and target. Size of organisation: The size of an organisation is important in any organisation. As far as Dulux Trade Paint is concerned it must fully focus on large organisation because they consume large percentage of goods as compared to small organisations. Dulux is a brand name, they always come up with innovative ideas and new products like Duette, Sonata and Acrylic Scumble glaze so it will be easier to target large organisations like real estate companies, big organisations, hotels, hospitals etc as large organisations need new products time to time in order to be in competition. Dulux has 52 two tone colour ways available which they can offer to company. Dulux paints need to come up with exciting new offers and promotions so as to attract large organisations like free samples, credit facilities, better quality, discounts etc Purchase Organisations: It can be defined as those organisations which purchase goods and services either for themselves or for other purposes. This is an important segment on which Dulux paints must work. These may include Contractors, Interior designers, Architectures. Contractors: A contractor is an individual or group of people that constructs or renovates a building, road etc. Dulux paints must target contractors for supply of paints required for construction purposes. It covers a large area of market. As these newly launched products are very popular so these products must be in demand for contractor also. Dulux must target contractors depending upon nature size and type of contractors. They should come up with new schemes, promotions, discounts and delivery of goods on time so as to ensure demand and supply. Interior Designers: They are professionals who decorate and organise the interior of any house, building etc. nowadays paints are important part of interiors, Dulux paints come up with decorative paints like Duette which is the latest trend in paint industry. So they must target interior designers to use their products in their projects which will increase the popularity of Duette, sonata and acrylic and helps in creating brand name. Trade Outlets: They are important in any organisation. Dulux trade paints have 130 retail outlets in the UK known as Dulux decorator centres, largest number of outlets of any trade supplier. These outlets should be managed properly. Newly launched products such as Duette, Sonata and Acrylic must be available in those outlets so that they will be easily available as there demand is increasing day by day. Their must be proper contact between company and outlets, moreover there must be proper balance between demand and supply. Customers should be provided with proper guidance regarding colour schemes and good product knowledge. If these outlets are properly targeted and maintained it will be the strength of company and also a great threat for competitors. Hence if all those segments are properly targeted and achieved then the company will reach ahead of its goals and will be a huge success. ( Brassington and. Pettitt,2006b) TASK 3: BRANDING AND POSITIONING Once target market segmentation is selected, we have to promote the organisational offerings to its target markets in a better way. This process is called branding and positioning strategy. The organisation must have an offering that differentiates it from the competitors. It should give a clear identity in the mind of the consumers. Branding: A brand is a name, symbol, design or term, or a combination of them used by manufacturers to identify its products from those of competitors. Today, a brand is the result of a synaptic process in the brain. A brand differentiates a product form those of competitors. It can simply be defined as customers perception about your business. (Bed bury and fenichell, 2002) Dulux is a market leader in the paint industry. The consumer is aware about the Dulux brand name It is much easier for Dulux to market its newly launched products like Duette, sonata and Acrylic. However there are some fundamental principles of branding are as follows: Flexibility: Dulux trade paints are flexible with the changing demands and supply. As the demand for broken colours rise they launched new products in the market. It helped the company in achieving good brand name. The customers are aware about the Dulux brand name Quality: The qualities of the products are fair enough as these products are manufactured by other manufacturers. This helps in maintaining good brand name and increase in sales. Product differentiation: The products differ in price, quality and design as compared to competitors. As Duette comes in 52 two-tone colour ways. These products offer all the benefits of traditional glaze. Consistent: Dulux maintain brand promise and brand standard. These products leave a good effect on consumers. The customer is aware about the quality standards. (Kumar and Mittal, 2002) Positioning: The act of designing the organisations image and offer so that it occupies a distinct place in the target customers. It is about the position a brand occupies in the minds of consumers. It starts with the choosing of a segment in which to compete. (Adock, Bradfield and Ross, 1995) Every product needs a positioning strategy so that it gives a clear position about a specific product in the minds of consumers. In this case there are some strategies which can be targeted. Positioning Against or Associating with another product: Dulux trade paints has to position itself as the ultimate solution for achieving the luxury look with great quality. Its main customers are contractors, large organisations, retailers etc. It has to differentiate itself from other paint companies in order to achieve good name and high volume of sales. Benefits/ Needs: Dulux paints have to provide better benefits to the purchaser so that he will stick to the companys products like huge profit margins discounts etc. Quality/Price: They have to provide better quality and low price as compared to their competitors in order to gain orders from large organisations. Product Features: They have to position it as, the presenting classics. They have to identify product features and differentiate it from other products. (Kotler and Scheff, 1997) Hence if position strategy is constructed on those bases then it will prove fruitful to the company. It will help in achieving good brand name and taking the company ahead of its competitors. REFRENCES: Adock, D. Bradfield, R. and Ross, C. (1995) Marketing Principles and Practice (2nd edn.), p 126-129. London, Pitman Publishing Bedbury, S. (2002) A New Brand World: 8 principles for Achieving Brand Leadership in the 21st century, p11-12. USA, Penguin Group. Croft, M.J. (1994) Market Segmentation. London, Solidus Limited. Kumar, N. and Mittal, R. (2002) Advertising Management. India, Anmol Publications Ltd. Kotler, P. and Scheff, J. (1997) Standing Room Only, p115-118. USA, Harvard Business School. Kotler, P and Keller, K.L. (2009) Marketing Management (13th edn.). USA, Pearson International. Pinson, L. (2001) Anatomy of a Business Plan (5th edn.). USA, Dearborn Trade. Pettit, S. and Brassington, F. (2006) Principles of Marketing (4th edn.). London, Prentice Hall.

American Industrialization Essay -- essays research papers

Had it not been for the American industrialization, we would not enjoy the technology we have in the year 2002. The reason we have this technology is that between those years a great change in the world’s history was made. People started to discover faster methods of producing goods, which increased their economy. However, this industrialization had no effects on society. Society then was still very poor in some areas, but later on in the future the United States becomes the richest and most powerful country in the world. What do these industries depend on? Yes they depend on good transportation systems to bring raw materials to factories and to distribute finished goods. Thus they started building canals between mines and factories, then a road surface, and finally the rail road industry was developed. George Stephenson developed the Rocket; the first steam powered locomotive. Also the American Engineer Robert Fulton developed a way to use steam power for ships. The postal system was also introduced by the British but this time inexpensively. And last we should remember the telegraph that sent messages by electrical impulses not only in Europe but also between America and Britain. So after all the years we wonder why Britain lead the industrial revolution, well the reason is that they enjoyed many advantages that helped them take the lead in the revolution. As I have wrote the agricultural revolution increased food production, which freed many laborers to work in indust...

The Good Earth :: Essays Papers

The Good Earth I was in a complete daze after reading Pearl S. Buck’s remarkable novel, The Good Earth. It was somewhat hard not to stop what I was doing afterwards and try to put myself in the characters’ shoes and visualize everything that happened in the book. I was so taken by the plot that I remember not wanting to put down the book till I knew what happened next in one of the conflicts in the story. Considering my reaction to it when I first got the book and my reaction to it now, you would really think it’s ironic. First of all I wasn’t quite happy when I found out about the reading we had to do and obviously not looking forward to reading having to squeeze it in my hectic after school schedule. I remember when I was at the bookstore and saw how thick of a book it was I thought to myself, â€Å"Great...here’s another long boring book.† But after reading it I eventually proved myself wrong and found out it was well worth reading it all the way thro ugh the last page. Pearl S. Buck did an outstanding job on the book’s vivid description of the characters, emphasizing the importance of Wang Lung’s land, and its sense of dramatic reality. The way the characters are described in the book you can really picture in your mind who they are. It’s very important to be able to visualize them because it helps you get to know them better as characters and have a better understanding of the book. One vivid description is O-lan’s, Wang Lung’s wife. â€Å"Wang Lung turned to the woman and looked at her for the first time. She had a square, honest face, a short, broad nose with large black nostrils, and her mouth was wide as a gash in her face. Her eyes were small and of a dull black color, and were filled with some sadness that was not clearly expressed. It was a face that seemed habitually silent and unspeaking, as though it could not speak if it would.† (p.19) As I was reading this I got the impression that O-lan would be a faithful wife to Wang Lung and it turned out I was right. The fact that she wasn’t beautiful didn’t matter at all. She served her family well. Another meaningful desc ription is Lotus’, Wang Lung’s first mistress, which has an irony to it if you compare it to O-lan’s.

Adjusting to College Life :: essays research papers

When students are still in high school, college looms in the distance like an ominous cloud. Frankly, all of the students are scared about going to college. When students go to college they feel like going to the great unknown – to go to a place where they don’t know anyone. But after all college is not that bad. First of all, the adjustment to college isn't that rough. The staff and students are trained to make the adjustment as easy as possible, and the other students they meet are just as nervous as they are. Their new fellow classmates are just as anxious as you to meet people, so as long as you make the effort, you'll be surprised as to how many people you meet. Meeting people will not be that hard, since most colleges offer a bazillion a lot social events at the beginning of the year. And the friends that students do meet in college you will be surprised as to how close students become to each other. This is mostly due to the fact that they live about twenty feet from them or even closer. Just think how much closer students would be to their friends in school if, to visit them, you just had to walk down the hall at midnight about three doors and walk into their friends bedroom. And you can never hide anything, because the student bedroom could end up becoming the floor social lounge and your bed could end up being the common couch. Basically, college classes are not much more difficult than high school classes. The only major difference is that much of the work for classes is done out of the classroom. In college, classes are usually twelve hours per week and dispersed over three or four days of the week. If you keep up with your work, then students should have no problem getting a B or an A. Many students worry about financial aid. Do not apply to a school because you don't think that you can't afford it. The people at college are trying to help you, and financial aid is one way that they do that. If you don't get enough money from a school, call them and tell them your situation. In most cases things can be worked out. College is also great because it lets you be ourselves. To be perfectly honest, people at college can be a bit odd, and the diversity of

Great Gatsby and Elizabeth Barrett Browning Essay

The Great Gatsby by F. Scott Fitzgerald written in the Jazz age of 1920s America, and Sonnet from the Portuguese written by Elizabeth Barrett Browning composed in the wake of Romanticism, although the two texts were composed in two distinct time period both texts are influenced by their varying contexts in their portrayal of the enduring human concerns. Both authors explore the universal human concerns of love, hope and mortality through the use of various language features such as metaphors, use of irony and the subversion of the established values of their time. Elizabeth Barrett Browning employs the Petrarchan form and male linguistics to challenge the tradition of courtly love whereas Fitzgerald critiques the hedonistic lifestyle, and the fall of the American dream to illustrate the illusion of love and hope. During the Victorian Era people were still very religious and EBB was no different and is reflected in her poetry. She implies that love, if it more than merely attraction and desire, must have a spiritual element. It also further reflects the value of Victorian ideology in its religious affirmations and patriarchal attribution of masculine power. This is especially shown In Sonnet 43 when she writes â€Å"as men strive for Right.. as they turn from Praise. † She also writes how their love will continue after their deaths into the afterlife, â€Å"I shall but love thee better after death. † This suggests her deep passion for her love, and how it will carry on. Even in Sonnet 32 where she is very doubtful, the sonnet still shows spiritual, soul-bonding power of ideal love as the poem ends with the musical and spiritual analogy that, together, they create ‘perfect strains’ and their ‘great souls, at one stroke, may do and coat. As a person like EBB who experienced melancholy, love was very unexpected for her and thus created a lot of doubt, but nonetheless accepts the power of transformation that love brings. In Sonnet 32 she has feelings of inadequacy shown by the extended simile as herself as an ‘out-of-tune Worn viol. ’ EBB makes a magnitude of musical references while also deeming herself unworthy for her lover such as â€Å"To spoil his song†¦ in haste, is land down at the first ill sounding note. † This is saying how she does not want to ruin the song. She also references the male dominance of the Victorian Era showing how the male which is the active, powerful agent which appears to be playing instrument, and is being referenced to Robert. She also appears to express her doubt about the relationship in Sonnet 13, specifically with the imagery of the torch between both the lovers. However the repeated ellipses suggest an inarticulate awkwardness in expressing her feelings and thus drops the torch. Although in the sestet she recognises the great power of love to cause transformation in life. SHe mentions her love is â€Å"rendering the garment of my life. † Realising that she cannot deny love, and the enormous power it has. While Browning sonnet’s explore deeply felt love in Victorian Era England, F Scott Fitzgerald explores the elements of love throughout his character of Gatsby and how his obsessional desire for love was futile and destructive, ultimately reflecting the values and perspectives of the 1920s Jazz Age of America. Gatsby’s pursuit of Daisy involved the accumulation of vast wealth used to host massive lavish parties. The green light on Daisy’s dock repeated 3 times throughout the book symbolises the dream being at the tip of your fingers, yet being unachievable. This was the obsessive, unreasonable longing found expression in the lavish parties at his mansion, as Jordan Baker later explained â€Å"so that Daisy would be just across the bay. † Nick expresses the intensity of Gatsby’s devotion in the metaphor â€Å"He waited 5 years and bought a mansion where he dispensed starlight to casual moths. † Gatsby wins Daisy but is revealed to be illusory. The Degree to which Gatsby’s desire is based on a false premise and unworthy object is shown when he finally achieves his goal and takes Daisy and Nick to his house. Fitzgerald uses the repeated motif of ‘wonder’ to express Gatsby’s ‘inconceivable pitch of intensity. ’ However Gatsby is soon left defeated as Daisy fails to please Gatsby when she fails to say to Tom â€Å"I never loved you†. The fallacy of Gatsbys idealised love is evident in his total defeat: dismissed by TOm as â€Å"Mr Nobody from Nowhere. † However Nick still admires Gatsby for that. Fitzgerald later reveals there meeting before Gatsby went to war was also illusory and superficial, reinforcing the fact that the values of that time appeared to be based more on materialistic wealth. Finally the failures of Gatsby’s pursuit can be linked to the failures of the American Dream and the loss of spiritual values. The book raises questions whether genuine love is possible in the society and culture of the 1920s where it seems to suggest the impossibility of real love when selfishness, greed and infidelity predominate. It also depicts how Hedonistic materialism precludes spiritual values and the idealism of the American Dream. The dilapidated billboard â€Å" the eyes of Dr T J Eckleburg† represents the pervasive consumerism and materialism have taken place of spiritual values. . Dr T J Eckleburg appears later in the book as a motif for the absence of God in the world as when Wilsons remembers confronting Myrtle about infidelity, he said â€Å" You may see me†¦ God sees everything. † In Conclusion the two texts offer differing viewpoints in regards to love, this can be linked to both their author’s values and perspectives during their particular time.