The effects of Performance on Audience

Music soothes and relaxes the mind of audiences. It is one way of showcasing talent and at the same time give entertainment. An exquisite performance can eventually bring audiences to a moment of joy or sorrow. It depends upon the performer’s capability and musical knowledge. One can easily transform a beautiful mood into something bad when the performance is atrocious. On the other hand a pleasant performance can negate the sadness and anger of an audience. A good performance is not only the ability to convey the music’s notated structure but also the emotional metadata of the piece. Overall performance is assessed by how the audience goes out of the performance hall. If they go out wearing a smile, it means that the performance was a success. On the contrary, crumpled faces of the audiences will mean failure of the performance. It is vital for performers to know who their target audiences are. This way the chances of having negative outcome will be prevented. The performance will also determine if the quality of music and the message that the performer wanted to imply is grasp wholeheartedly by the audience. The goal of every performance is to catch the audience attention and at the same time absorb the theme or message as a whole. Although there are performance for a cause, the main point of having a performance is to keep the crowd alive and in union with the performer. A boring performance will eventually lead to audience walk out. It is also important for the performance to be adaptive to the audience. This way the listener’s musical interest is kept intact. The effects of performing on audience also boost the confidence and moral of the performer. A performer who stands in front of a crowd lively and intelligently assures that the flow of the performance is best. More audiences may trigger the performer’s nervousness and stage fright but this is the usual feeling of performers. After having performed many times, the performer will get use with the feeling and sees himself/herself not afraid anymore. Performing on audience also helps in looking for positive and negative traits of the performer. It will be based on the feed backs after the show which is given by jurors if it is a competition or by critics if it is just a program, concert r performance. Over all the effect of performing on audience is to know what makes the performer stand out and what needs to be improved. A performer’s attitude is also seen when performing before audiences. This is on how he/she relates with the kind of crowd. There are instances that the performance is held on a strange place and it is for the performer to adjust to the environment and continue the show without getting distracted and keeping his/her focus. Regardless of who your audiences are, you are compelled to perform with the best of your abilities. Performers often finds themselves having goose bumps and cold feelings upon seeing audiences but then it will also make them more motivated to perform. Performing also inhibits positivism on the performance and the perception of musical expression by the performer.

Compound Crusher with Substantial Efficiency Satisfies

China's economic climate and continuous exploitation of mineral assets, compound crusher has acquired far better improvement. SUB Mining Machinery Co. , Ltd. Is often a incredibly strong enterprise, our artificial sand making machine, excellent traits and cost-performance stands out in fierce industry competition, and that is broadly recognized through the industry. The elements influencing manufacturing efficiency of compound crusher are a variety of, of which one of the most vital elements are hardness, humidity, viscosity ND ingredient.Elements with higher harness have bigger abrasion of tools, which also lower crushing means and crushing velocity of gear at the same time. Meanwhile, production efficiency of products with wonderful humidity, viscosity and more fine powder articles is lower. Moreover, the larger necessities of fineness of crushed materials are, the reduced the crushing efficiency is. Reliable excellent, excellent overall performance, state-of-the-art engineering, r easonable structure and good wear-resistance are also the important thing aspects affecting production efficiency of compound crusher.Market place competitors Is Increasingly fierce, so, the compound crusher ought to continuously strengthen Itself to satisfy production demands. One of the most outstanding traits of compound crusher are sensible framework, reduced operational cost, high crushing efficiency, power conservation, dual perform of coarse and fine crushing, low noise and so forth. It might crush elements with higher hardness, to not mention elements with small hardness. Crushing and screening equipment application Is comparatively affordable and scientific.When applying compound crusher, take note of adjustment and mastering of crushing force. You'd better decide on a proper crushing force for each kind of supplies. , consequently realizing selective crushing. Along with Improvement and Improvement of science and technologies, financial construction puts forward higher nec essities on automation degree of mining equipment. Hence, mining enterprises must constantly Inject new technologies, accelerate upgrading of products and make Improvements to core competitiveness. Grinding media balls priceAt current, SUB compound crusher Is playing Increasingly more vital part In Infrastructure building. So that you can much better satisfy demand of Infrastructure projects and Industrial manufacturing, compound crusher need to constantly make Improvements to ablest of Independent Investigation and Innovation. Crusher enterprises should generate more crushing machines with valiantly conservation, environmental production and higher efficiency so as to create dilation contributions to environmental safety undertakings. Http:// Compound Crusher with Substantial Efficiency Satisfies Production DemandBy Livingston Market place competitors is increasingly fierce, so, the compound crusher ought to continuously strengthen itself to satisfy production demands. One of the m ost application is comparatively affordable and scientific. When applying compound decide on a proper crushing force for each kind of supplies. , consequently realizing selective crushing. Along with improvement and improvement of science and degree of mining equipment. Hence, mining enterprises must constantly inject new technologies, accelerate upgrading of products and make improvements to coreAt current, SUB compound crusher is playing increasingly more vital part in infrastructure building. So that you can much better satisfy demand of infrastructure projects and industrial manufacturing, compound crusher need to constantly make improvements to abilities of independent investigation and innovation. Crusher enterprises should generate more crushing machines with vitality conservation, environmental production and higher efficiency so as to create additional www. Heterogeneous. Com/pro]etc/artificial-sand-making-machine. HTML

The Negative Impact of Tourism Due to Increased Globalization Essay

The Negative Impact of Tourism Due to Increased Globalization - Essay Example It is essential and even necessary to communicate and reach out to the rest of the world as an isolated country can never flourish and keep pace with the rapidly moving world. Japan is an evident example of this case as it had kept itself apart from the rest of the world for many years, not even allowing trade and business with other nations. Japan's isolation policy was fully implemented by Tokugawa Iemitsu, the grandson of Ievasu and Shogun from 1623 to 1641. For over a hundred years, it retained its secluded position, cut off from the rest of the world, but then, after the Tokugawa government fell, it realized the importance of interconnectivity and globalization (Richie and Reischauer 1994). Now Japan is the home of technology; it is a pioneer in various novelties, most of them related to the information technology and better ways of communication and connectivity. Through globalization the economies of all countries are being rapidly integrated. One method of achieving globaliza tion is through tourism. It especially helps in the cultural interaction of one nation to another as well as a source of revenue generation. Tourism is the commercial organization of traveling for recreation and the sum of relationships resulting from the interaction between the tourists, local government, business suppliers, host communities etc. Tourism plays a vital role in the strengthening of a country's economy as it generates an immense amount of revenue for the government of the county. Local businesses also thrive due to tourism and the tourism industry offers various jobs, which ultimately results in high rates of employment. These are a few positive aspects of tourism but where it is earning net national benefits, it is also responsible for its negative impact on the country's image and economy. Tourism is the world's number one export earner, but with its advantages come the negative aspects and disadvantages. Underdeveloped and developed countries want to promote touris m because it is a good industry for revenue generation, but more than often these are not as beneficial or promising as they sound. The major reason for this is the large transfer of money from the host country and the exclusion of local businesses and products. The tourism industry results in inbound country expenses, as the tourists that come to visit the local community or the host country bring foreign exchange revenues with them mostly in the form of liquid cash, taxes, expanses etc. from their home country. These inbound expenses are usually in the form of destination specific expenses as the tourist require lodging and food facilities on their vacation trips. The foreign revenue which is supposed to help the host country economically results in having unfavorable effects on the host community because of certain hidden costs. These hidden costs are more applicable in developing and underdeveloped countries as most of the foreign revenues which come in the host country through tourists leave through leakages. Even though the revenues are retained by destination specific expenses, estimates show that nearly 80% of them are leaked back to the home country of the tourists, the inbound country expenses are basically the destination specific expenses which the tourists spend on their vacation residence and culinary expenses along with the

Cause & Effect Analysis Essay on Rapper Fifty Cent

Cause & Effect Analysis on Rapper Fifty Cent - Essay Example It was when 50 Cent was sent to live with his grandmother that he claimed to start adjusting to the street life. When he was only twelve, 50 Cent began selling drugs and bringing guns with him on his school campus. Even after he was caught by the metal detectors at his school, he still continued doing what he did. When 50 Cent was sixteen years old, he was arrested for selling cocaine to an undercover police officer. After being released, he was arrested not too long after once police discover cocaine, heroine, and a gun in his household. Though he was given three to nine years in prison, he only served six months in a shock incarceration boot camp where he earned his GED. It was during that time that he adopted the name â€Å"50 Cent,† using it as a metaphor for â€Å"change,† which was 50 Cent’s goal for life. All that he had put himself through was due to the influences of his mother’s life and the goings-on in the neighborhood that he lived in. As 50 Cent got older, he began to experiment with music, discovering his talents of rapping. He continued this until his career officially took off after meeting the famous rapper Eminem. Unfortunately, the life he grew up with was one that he kept with him during his music career, often using his experiences and situations as the foundations for the majority of his songs. However, things did change for him after the birth of his son in 1997, when 50 Cent became determined to give his son the life that he was deprived of when he grew up. The way someone behaves in life or responds to situations usually goes hand-in-hand with how they were raised, or the situation in which they were raised, such as the environment of both the family and the neighborhood. 50 Cent, despite the birth of his son and his want to better his life because of his son, was still brought up in a way that would have an effect on who he

Managing Diversity and Equal Opportunity Essay Example | Topics and Well Written Essays - 3000 words

Managing Diversity and Equal Opportunity - Essay Example Moreover, the discussion of this report would also reflect on identifying the amount of workers who meet obstacles in relation to developing their career that have been labelled ‘glass ceiling’ and ‘glass cliff’ within the United Kingdom (UK) business organisations. In order to provide relevant examples relating to the present demographic trends, the report would also render instances of real cases of the UK companies regarding their practice of managing diversity and equal opportunity within the organisation. Part 1: Ways in Which Current Demographic Trends Influence to Increase Workforce Diversity The incessant growth and development of demographic trends has been identified to enforce numerous challenges for the global organisations to manage diversity along with promoting equal opportunities. According to the concept of demographic trends, the notion has been identified to increase since the period of 1950s within the UK population. In this regard, the m ajor ways in relation to the current global demographic trends which augment workforce diversity can be characterised into different categories (Department for Business Innovation and Skills, 2013). A few of the major ways of demographic trends have been briefly highlighted in the following discussion. Internationalisation The rising pace of internationalisation has been viewed as one of the major factors, which influences the development of the current demographic trends within the UK. In relation to the present globalisation driven era, the rising internationalisation trends rapidly influence the organisations to focus on managing diversity and rendering equal opportunity to the workforce. The incessant development of the global business organisations has resulted in... The incessant growth and development of demographic trends has been identified to enforce numerous challenges for the global organisations to manage diversity along with promoting equal opportunities. According to the concept of demographic trends, the notion has been identified to increase since the period of 1950s within the UK population. In this regard, the major ways in relation to the current global demographic trends which augment workforce diversity can be characterised into different categories. A few of the major ways of demographic trends have been briefly highlighted in the following discussion. The rising pace of internationalisation has been viewed as one of the major factors, which influences the development of the current demographic trends within the UK. In relation to the present globalisation driven era, the rising internationalisation trends rapidly influence the organisations to focus on managing diversity and rendering equal opportunity to the workforce. The inc essant development of the global business organisations has resulted in compelling these corporations to extend business locations across the geographical boundaries (CIPD, 2013). Therefore, the organisations are not fully aware of the potential advantages and at times overlook the required competencies and knowledge to successfully obtain the foreign opportunities. In this regard, the diverse culture, language and racial differences often discourage the UK companies from accomplishing their overseas opportunities.

Effective Leadership Essay Example | Topics and Well Written Essays - 1750 words

Effective Leadership - Essay Example 74-78, 2001). This paper is attempt to look at different types of leadership and the recent developments in the field of leadership by briefly looking at the literature available on Fred Fielder’s Situational Leadership Model, Level 5 Leadership, 360-degree leadership and Charismatic leadership. Discussion Fred Fielder’s Situational Leadership Model Fred Fielder is considered as one of the most notable gurus of leadership. During the mid of the 20th century, when most of the leadership experts were occupied by the discussion that whether leaders are born with certain characteristics which distinguish them from others or whether people can acquire these skills to become leaders. Fielder took the liberty of providing an entirely different perspective to the management and organizational behavior experts by giving his situational leadership theory (Kellerman, pp. 234-238, 2010). He divided the leadership styles into two groups namely relationship motivated and task motivat ed. Relationship motivated leaders are the ones who would place their emotional bonds with their people over the tasks and jobs. These leaders are more concerned about their image, respect, and perception amongst their followers. However, task motivated leaders are the ones who are more interested in numbers, targets, figures and objectives, and in the pursuit of the same, they are ready to sacrifice their image and bonding with their employees (Robbins & Judge, pp. 223-228, 2010). Furthermore, fielder proposed three elements, which have the ability to determine the situational control of the person. These are leader member relations, task structure and position power. Leader member relations refer to the degree to which the leader enjoys the backing, support, and loyalty of his sub ordinates. Second, task structure is high when the job descriptions are clear, structured, and well defined. Third, position power refers to the degree to which the leader enjoys the formal power to hire , recruit, select, reward, punish, or obtain compliance from the employees (Fulmer & Goldsmith, pp. 74-78, 2001). Furthermore, Fielder suggests that when the above-mentioned factors are high, the situational control is high and vice versa. A task-motivated style remains the most favourable option when the situational control is either extremely high or extremely low. Nevertheless, when the situational control is moderate, the leader should opt for a relationship motivated leadership style (Kellerman, pp. 41-49, 1999). 360 Degree Leadership Maxwell (2006) gave one of the most modern and influential concepts in leadership known as the â€Å"360 degree leadership† (pp. 15). Maxwell focuses on the most basic and simplest definitions of leadership, which says, â€Å"Leadership is nothing but the art of influencing people towards the achievement of shared goals† (Maxwell, pp. 84-86, 2008). Quite understandably, one cannot only influence the people who are underneath the indi vidual in the organizational hierarchy but also who lie at the same line or even who are over him in the organizational hierarchy. This means that one cannot only lead his subordinates but also his peers, colleagues, friends, bosses, bosses’ peers, and others. Many leaders fail to view the concept of leadership in a board way of leading down, leading across and leading up but they fall into the trap of leading down

Start up of Replacement Ink Assignment Example | Topics and Well Written Essays - 2000 words

Start up of Replacement Ink - Assignment Example The concept of CRM is very closely related to the relationship marketing. It suggests that maintaining and fostering personalised relationships, in the context of business to consumer sales, can definitely lead to profit if it is combined by a mutual exchange of benefits and fulfilment of promises on the part of both the parties i.e., buyers and sellers. CRM therefore involves managing customer information in a way that can lead the organisation to satisfy its customers in a better manner. A new business of replacement inkjet cartridges, in the same vein, needs to employ effective customer relationship management programs such as customer surveys, service evaluations, pre-sale and after sale inquiries on a database driven system so as to foster the relationship with its customers and stimulate customer loyalty. Loyalty is regarded as an important aspect of relationship management. Crosby (2002, p273) expounds that, â€Å"loyalty refers to a strong emotional attachment to a firm that is manifest in customer behaviours like staying with the company, recommending it, buying additional products and services and so forth†. At the crux of customer relationship management is the concept of customer loyalty. CRM programs are basically designed to keep the customers loyal to the organisation. The customers display their loyalty mainly by coming to the company every time the same product is needed or recommending the product to the others. However, this report focuses on the criticism of relationship.... A new business of replacement inkjet cartridges, in the same vein, needs to employ effective customer relationship management programs such as customer surveys, service evaluations, pre-sale and after sale inquiries on a database driven system so as to foster the relationship with its customers and stimulate customer loyalty. Loyalty is regarded as an important aspect of relationship management. Crosby (2002, p273) expounds that, "loyalty refers to a strong emotional attachment to a firm that is manifest in customer behaviours like staying with the company, recommending it, buying additional products and services and so forth". At the crux of customer relationship management is the concept of customer loyalty. CRM programs are basically designed to keep the customers loyal to the organisation. The customers display their loyalty mainly by coming to the company every time the same product is needed or recommending the product to the others. CRM programs can be initiated to enhance relationships at both ends i.e., the suppliers as well as the customers. However, this report focuses on the criticism of relationship building in case of business to consumer sales. Criticism Of Customer Relationship Management In The Context Of Business to Consumer Sales: Despite the fact that there happen to be several benefits attributable to the implementation of customer relationship management, several criticisms have been levied against this concept in the context of business-to-consumer sales. In a consumer market scenario, the customer relationship management is not considered to result into enhanced customer relationship. A study of literature [for example, Mishra et al. (1998), Gronroos (1994), Bagozzi (1995), Tax et al.

The Use of the GAP Model Approach Measuring Client Satisfaction Essay

The Use of the GAP Model Approach Measuring Client Satisfaction - Essay Example According to the research findings, it can, therefore, be said that customer satisfaction is an area that the management of different institutions takes a keen interest in. Quality service provision is a critical aspect that determines whether a company maintains relevance in the market or diminishes. At times, clients meet and talk concerning service provision in a particular institution. In their discussion, there are bound to arise certain issues about expectations towards service provision. In the event that their expectations fall below the expected level, a gap is then created. Breast cancer is one of the single most phenomena that have provided a new whole level of challenges in this modern dispensation. The dire consequences of this problem have made health practitioners get back to the drawing board and establish new ways and means of providing better services to the customers. This is relevant in so far as breast cancer is concerned. North County Breast Screening Unit provi des the services of screening the breast to ensure that no patient dies of the cancer disease. In the recent past, the number of people seeking services at the screening unit has increased significantly. The unit offers services to almost half a million people and in with an uptake of services from 70% to 77%. This is above the national quality grid of 75%. In a recent research done on the screen, its unit, the results told it is all about quality of service provision at the unit. A number of patients were interviewed a number of patients together with a selected number of employees. The results revealed some unique aspects that only need to be put into perspective for proper analysis. From the survey done at the North County Breast Screening Unit, some critical issues can be understood about service provision.

Productivity within Allstate Insurance Corp Research Proposal

Productivity within Allstate Insurance Corp - Research Proposal Example That was one conclusion drawn from a study carried out recently by Benjamin Waber and Sandy Pentland of the Massachusetts Institute of Technology.† (2) Although the methods for achieving the same or better outcomes with fewer resources may vary, improved productivity will not occur unless it is pursued actively. Ineffective searches and wasting time looking for information is a cost of a company. Many service economy jobs could enjoy substantial productivity growth through better application of information technology. For example, every time you check in at the airport, you wait several minutes as the agent frantically taps away at a hidden computer. Most of this time is wasted due to airline softwares horrendous usability. With a better user interface, agents could process passengers much faster, which would immediately increase their productivity and save time for customers. The answer, according to Nick Bloom, Raffaella Sadun and John Van Reenen, researchers at the Center for Economic Performance at the London School of Economics, is that American companies make much more effective use of information technology than European companies.† (4) The importance of incentives to employees on the productivity is well known fact. Even socialism has admitted it. As Gerard Roland says â€Å"Prior to the privatization, It was China that went the farthest in trying to give managers better profit incentives. Data on 769 Chinese enterprises between 1980 and 1989 in four provinces (Sichuan, Jiangsu, Jilin, and Shanxi) analyzed by Groves and colleagues (1994) showed that increased autonomy to managers led them to give more incentives to workers by increasing the shares of bonuses in total wages payments and the share of contract workers relative to permanent workers. Increased incentives also had a positive effect on productivity.† (5) Companies can increase productivity in a variety of ways. The most obvious methods involve automation and

Scholarly Paper on Adult Learning Theory Research

Scholarly on Adult Learning Theory - Research Paper Example It contrasts to this, it is being further noted that with the growing age people are likely to face problems associated with neuroscientific perspective. In addition, this particular perspective also affects the behavior of the adults and is further associated with functioning of the brain. This in turn also signifies a similar kind of fact that reveals the existence of difference in learning at different stage of adulthood respectively. From this study, the major problem identified is that the difference in culture is another vital factor that is likely to influence the learning environment as well as behaviour of the adults (Knowles, 2012; Vygotsky, n.d.). In this regard, the primary purpose of the paper is to evaluate the theories associated with adult learning and further analyze the impact of the cultural factor on the learning environment of the adults.DiscussionThe key points highlighted in the introduction section respectively are associated with the adult learning theory and environment. The theory proposed by Malcolm Knowles states different assumption related to adult learning. From the concerned theory, it has been evaluated that learning environment within the classroom is the most vital factor that is likely to influence the behavior of the adults in a particular stage respectively. In addition, it is worth mentioning that the interest, as well as needs of the adult learners, is another crucial factor that is likely to influence the overall learning process respectively. Â  

Danielle Steels novel Fine Things Essay Example for Free

Danielle Steels novel Fine Things Essay Novel Title: Fine ThingsAuthor: Danielle SteelSummaryBernard Fine is a successful bachelor managing of the biggest stores in California. Bernie (nickname) runs into a little girl who is very lost and decides to help her out while. Her mother Liz comes to pick up her seven year old daughter Jane Calloway. The two newly met became friends (Bernie and Liz) and eventually fell in love and got married (much to the liking of Jane). Everything goes well and shortly after their marriage Liz gives birth to a son but the doctors decided that Liz has to stay in the hospital for a while and when Bernie asks why, they said that she must be tested for something but they never mentioned anything else to the overly concerned husband. A week later Liz is out of the hospital and with Bernie she finds out that shes a victim of the deadly disease cancer. Liz soon grows so weak that she looses her life and the long and painful journey for the young step-father Bernie has finally hit the saddest dead end. He tried to put up with his lost of his wife with the help of his parents. Bernie has no trouble at all raising Alexander and Jane all by himself then one day he met Janes biological father, Carter, and Bernie believes that custody should be his because Carter abandoned his wife and daughter long before. Carter defends himself while Bernie doesnt believe him but somehow the man gains custody of his daughter then all of a sudden Bernie hears from his agent that Jane is the middle of a drug smuggling havoc in Mexico. He begs to the police that he should go with them to rescue Jane. Bernie drives down to the motel waited for a while until the agent finally has Jane out of the motel and back in her fathers arms. Bernie begins to move on emotionally, and becomes involved with a beautiful doctor, but Jane is still loyal to her mother and cant accept this new woman but later on realized that his step father deserves to be happy and knew that her late mother would let him to be happy with someone new. Reaction:The story of the novel is not far from happening in real life. To keep a happy and complete family is always a challenge. In this novel, Bernie Fine struggles with the lost of his wife from the early stage of their marriage, leaving him the responsibility of raising their children and the longing of having someone special again. It showed the vulnerability of a man when it comes to losing a very important person forever. Reference: Fine Things by Danielle Steel

Survey of Satisfaction with College Facilities

Survey of Satisfaction with College Facilities Assignment 1 1. Plan for collection of Primary data and secondary data Primary data is the data which is collected directly from the field, i.e., it is first hand data and the secondary data is collected from some other source, i.e. second hand data. In this given problem primary data can be collected through interview to the Students and Staffs of the college. A Questionnaire will be prepared which will be filled up on the response of these individuals. Based on the information provided by them the database will be prepared and thus the primary data will be collected. In case of secondary data, the data could be collected from any organization / department which collects the school/college data or from any journal or from any Researcher. 2. Present the survey methodology and sampling frame used There are different areas in the college which are simultaneously used both by the Students of the college as well as the Staffs of the college. Considering those area alongwith few other he questionnaire is prepared. The survey will be then conducted on the basis of that and a selected sample will be chosen randomly from the students and from the staffs. Here since one has to plan a survey methodology, first thing which has to be done is to identify the sample members. For this purpose a total number of 50 individuals may be selected form70 students and 30 staffs taking 50% from each group (that is 35+15=50). Now, the Interview method will be used here for collection of data. Data on satisfaction level of each individual will be collected on different variables. Once the sampling units is finalized, sampling frame needed to be done. Sampling frame is basically the area/ space from where the sampling is to be done. Here one has to see whether all the units in the population are avail able in the sample. List of students and staffs must be representative of all classes and segments of the college. The level of satisfaction will be coded as 5= very good, 4= good, 3= average, 2= bad, 1= very bad, in five categories, following Likert scaling. 3. Design a questionnaire to know the opinion of students and staff on the matter Gender†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ Origin †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. Age†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. Very good Good Average Bad Very Bad How much satisfied are you on the overall infrastructure of the college? How much satisfied will you be if Laundry facilities are available? How much satisfied are you with the Hostel facilities of the college? How much satisfied are you with the gym? How much satisfied are you with the parking facility of the college? How much satisfied are you on the toilet facilities? How much satisfied are you on the structure of labs in the college? 4. Information for decision making by summarizing data using representative values The data collected from the after the survey is recoded as per Likert scaling and is as below: How much satisfied are you on the overall infrastructure of the college? How much satisfied will you be if Laundry facilities are available? How much satisfied are you with the Hostel facilities of the college? How much satisfied are you with the gym? How much satisfied are you with the parking facility of the college? How much satisfied are you on the toilet facilities? How much satisfied are you on the structure of labs in the college? 1 4 2 2 5 2 2 4 2 5 4 4 2 3 4 2 3 3 2 2 4 2 2 4 4 5 1 1 2 4 3 4 5 4 2 2 1 2 5 4 6 1 4 2 2 1 2 4 7 2 2 4 4 2 4 2 8 5 3 2 2 4 5 5 9 3 5 1 3 2 2 4 10 4 2 2 5 3 2 2 11 4 4 4 4 5 4 4 12 5 5 2 5 2 4 2 13 2 2 3 4 4 1 4 14 4 2 2 2 2 2 4 15 5 4 4 4 4 3 4 16 3 4 2 4 2 2 4 17 2 1 1 4 1 1 2 18 4 2 2 5 2 2 5 19 5 3 4 4 4 3 4 20 1 2 2 2 2 2 2 21 4 1 3 4 3 1 2 22 5 2 5 4 5 2 2 23 2 3 2 4 2 3 4 24 5 2 4 4 4 4 2 25 4 1 2 2 5 4 3 26 5 2 4 5 2 4 5 27 4 3 2 4 4 2 2 28 3 4 1 2 2 3 4 29 5 4 2 1 1 5 5 30 4 4 4 2 2 2 2 31 3 4 2 4 5 4 2 32 4 2 3 2 2 2 4 33 5 3 5 3 4 4 4 34 3 2 2 2 2 2 1 35 5 4 4 4 1 1 2 36 4 3 5 2 2 2 3 37 3 2 2 1 4 4 2 38 4 4 2 2 2 2 1 39 5 4 4 4 3 3 2 40 3 2 4 2 5 5 3 41 5 5 1 3 4 2 2 42 4 4 2 5 5 2 1 43 5 2 3 4 4 1 2 44 3 4 2 2 2 2 3 45 5 4 1 4 4 2 4 46 4 4 2 4 4 1 2 47 5 4 3 4 4 2 4 48 3 2 2 4 4 4 2 49 5 5 4 2 3 2 3 50 4 4 3 5 3 3 5 5. For Analytical; purpose the variables are denoting as below: How much satisfied are you on the overall infrastructure of the college? How much satisfied will you be if Laundry facilities are available? How much satisfied are you with the Hostel facilities of the college? How much satisfied are you with the gym? How much satisfied are you with the parking facility of the college? How much satisfied are you on the toilet facilities? How much satisfied are you on the structure of labs in the college? overall infrastructure Laundry facilities Hostel facilities gym parking facility toilet facilities structure of labs Mean overall infrastructure 3.88 Laundry facilities 3 Hostel facilities 2.66 gym 3.26 parking facility 3 toilet facilities 2.7 structure of labs 3.06 The average of the Overall infrastructure is 3.88 which indicated that on average people are recognizing the overall infrastructure as almost â€Å"GOOD†. When it was asked â€Å"How much satisfied will you be if Laundry facilities are available?†, the mean response is 3 which is Average. This is quite sensible because this facility is yet to be there in the college. Regarding â€Å"Hostel facilities†, the average response is below averages which indicate that there is some urgent need to repair this sector. Gym facility is slightly more than the â€Å"Average†. The condition is better than â€Å"Average† but less than â€Å"Good† In case of â€Å"parking facility† the satisfaction level is exactly â€Å"Average† which indicates that there is scope to improve the sector. Satisfaction level on â€Å"Toilet facilities† is below average which also requires urgent attention of the college authority. Structure of Labs also requires some kind of attention. 6. Drawing valid conclusions based on information derived from the survey Laundry The above diagram shows that 36% are saying good to Laundry facility and also 36% is recognizing it as Bad. Only 8% is saying it â€Å"very Good† and 8% is saying very Bad. Some kind of symmetrical situation is observed here. It seems that the service provider is paying good attention to selected individuals. Hostel facilities In case of Hostel 46% saying it â€Å"Bad† and this is a matter of concern. While discussing with Average values, the data indicates the same urgency. But at the same time it can be observed that 24% , which is in 2nd position as far as percentages in concern, is saying is good. It may indicate that some portion of the Hostel is having better situation than the rest. Also 6% feeling their accommodation as â€Å"Very Good†. Gym While discussing about Gym, which is yet to be established, 48% is in favour of this, out of which 42% saying it as a Good facility and 6% as â€Å"Very Good† facility. Parking The above diagram shows that 38% are saying â€Å"Bad† to Parking facility and also 30% is recognizing it as â€Å"Good†. Only 8% is saying it â€Å"very Bad† and 12% is saying â€Å"Very Good†. Toilet In case of Toilet 44% saying it â€Å"Bad† and this is also a matter of concern. While discussing with Average values, the data indicates the same urgency. But at the same time it can be observed that 22% is saying is good. It may indicate that there is also some better situation. Also 8% feeling as â€Å"Very Good†. Lab In case of Lab, which is more related to education, 46% is in favour of this, out of which 36% saying it as a Good facility and 10% as â€Å"Very Good† facility. 7. Trend lines Now as per the given question, the trend lines have to be created in the spreadsheet graph. For this purpose , here the intercept is considered as zero(0) and then the equation is shown alongwith the scatter plot and the trend line. Here the first variable â€Å"Overall infrastructure† is considered as the Dependent Variable and there are other six independent variable. Taking each Independent variables separately, the trend line along with the graph will be created. Case 1. Overall infrastructure and Satisfaction on Laundry: As shown in the graph, the required equation is Y=.732x Case 2. Overall infrastructure and Satisfaction on Hostel: The required equation is Y= .659X Case 3. Overall infrastructure and Satisfaction on Gym : The required equation is Y= .787X Case 4. Overall infrastructure and Satisfaction on Parking facility : The equation here is Y= .740X. Case 5. Overall infrastructure and Satisfaction on Toilet facility : Here the equation is Y=.656x Case 5.Overall infrastructure and Satisfaction on Toilet facility : Here the equation is Y= .735x 9.Business Report All the equations are formed considering the variables separately. In each equation, if value of x is given, the estimated value of Y will be obtained by solving the equation with simple calculation. The dependent variable is considered as â€Å"Overall infrastructure:† which actually says whether there is really any need of ‘refurbishing the whole college† or not. This dependent variable depends on several other issues/ factors as considered as Independent variable. So, taking care or giving attention on those areas actually help the project to take decision whether or not this could be done. The above analysis tells which area needs utmost attention and which area is somehow okay up to this. Based on the analysis, one could say that the two issues .i.e. Toilet and Hostel need to be addressed seriously. Assignment 2 Question No.1 X = scores of a market survey regarding the acceptability of a new product launch by a company Frequency Table with a class interval of 5 Class interval 5-10 10-15 15-20 20-25 25-30 30-35 35-40 40-45 45-50 frequency 2 0 1 1 6 2 10 8 2 Mean, variance and standard deviation. Mean () = ,where N = and Variance = ÏÆ'2= 2 Standard Deviation = Square root of variance. And Xi here will be the mid value of the class interval. The following table is being constructed for the required calculations. Class interval mid value(xi) frequency 5-10 7.5 2 10-15 12.5 0 15-20 17.5 1 20-25 22.5 1 25-30 27.5 6 30-35 32.5 2 35-40 37.5 10 40-45 42.5 8 45-50 47.5 2 247.5 = 32 Here mid value(xi) frequency 7.5 2 56.25 15 112.5 12.5 0 156.25 0 0 17.5 1 306.25 17.5 306.25 22.5 1 506.25 22.5 506.25 27.5 6 756.25 165 4537.5 32.5 2 1056.25 65 2112.5 37.5 10 1406.25 375 14062.5 42.5 8 1806.25 340 14450 47.5 2 2256.25 95 4512.5 247.5 = 32 = 8306.25 = 1095 = 40600 Mean = = 1095/32 = 34.22 Variance = ÏÆ'2= (40600/32) – (34.22)2 = 97.83 Standard Deviation = Square root of variance =9.90 Score corresponding to 50% percentile. 50% percentile is also the median. Here the data set has to be written in increasing order 8 8 18 25 26 26 27 27 29 30 32 35 36 37 38 39 39 39 40 40 40 40 41 41 42 43 44 44 45 45 48 49 There are 32 observations in all => There will be two middle values. The average of those two middle values will be the value corresponding to 50% percentile or the Median. Now since both are 39 implies the average is also 39. So, it could be said that the score 39 corresponds to 50% percentile. Calculate the location of third quartile. Rewriting the data set in increasing order: 8 8 18 25 26 26 27

Management of Melanoma Brain Metastases (MBM)

Management of Melanoma Brain Metastases (MBM) Abstract: Melanoma is the third most common cause of brain metastases, after lung and breast cancer. Common clinical manifestations include headache, neurologic deficits, cognitive impairment and seizures. The management of melanoma brain metastases (MBM) can be broadly divided into symptom control and therapeutic strategies. Supportive treatment includes corticosteroids to reduce peritumoral edema, antiepileptics for seizure control and medications to preserve cognitive function. Until recently the therapeutic strategies focused on local treatment including surgery, whole brain radiation therapy (WBRT), and stereotactic radiation (SRS). Historically, systemic therapy has had limited utility. Immunotherapeutic drugs like anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and anti-programmed cell death protein 1 (PD1) and agents targeting BRAF- MEK pathway have revolutionized the systemic treatment of MBM. Recent clinical trials with these agents have shown activity against MBM and incre asingly being used in clinical practice. In this article, we will discuss epidemiology, biology of MBM and the role of surgery, WBRT, SRS in this patient population. An overview of the currently available systemic therapeutic agents that includes immunotherapy and targeted tyrosine kinase inhibitors (TKIs) and a practical multidisciplinary management algorithm to guide the practicing oncologist will be outlined. Introduction: Recent advances in the management of advanced melanoma have resulted in improved 5-year survival rates, however, MBM remain a significant cause of morbidity and mortality. Approximately 20% of metastatic melanoma patients have brain metastases at diagnosis.   Overall about 50% of stage IV melanoma patients will develop symptomatic brain metastases (1-3). Cerebral hemispheres are the site of 80% of brain lesions from melanoma followed by the cerebellum (15%) and brainstem (5%)(4).Common clinical manifestations include headache, neurologic deficits, cognitive impairment and seizures. Until recently, patients with MBM had a dismal prognosis with a median overall survival (OS) of 6 months (5). The management of MBM can be broadly divided into supportive management and therapeutic strategies. Supportive treatment includes steroids to reduce peritumoral edema, antiepileptics for seizure control and medications to preserve cognitive function. Traditionally, therapeutic strategies focused on local treatment including surgery, WBRT, and SRS. Historically, systemic therapy has had limited utility in the management of MBM. However, the treatment paradigm has changed considerably with the advent of targeted therapy and immunotherapy. Approximately 50% of advanced melanoma patients harbor a BRAF mutation and a number of targeted agents for this mutation and downstream pathway have shown promise in the management of metastatic melanoma. Immunotherapeutic agents like anti- CTLA-4 and anti- PD-1 have shown clinical efficacy in MBM and now constitute first line treatment options for metastatic melanoma. Biology of brain metastases: Until recently MBM were believed to have the highest mutational discordance compared to the primary site (6).   However, Chen et al. reported molecular profiling that included hot spot mutations, global mRNA expression patterns, quantitative analysis of protein expression and activation by reverse protein array (RPPA) analysis of 16 patients (7). In this study, authors reported complete concordance in mutational profile between intracranial and extracranial sites. Despite these similarities crucial differences in the expression of PI3K/AKT pathway were noted by RPPA. Another study compared the expression of BRAF mutation in different sites of metastases in advanced melanoma and showed greater mutational concordance (16/20 patients) in brain compared to other visceral/subcutaneous metastases (8). These studies provide an initial understanding of the molecular characteristics of MBM. With the advent of immunotherapy, tumor microenvironment and immune infiltration has been a focus of intense research. Brain has been traditionally thought of as an immune privileged organ but recent studies have established the existence of a neuro-immune axis and questioned this belief(9). Our understanding of this unique interplay between the immune system and central nervous system has dramatically evolved over time. Berghoff et al. investigated the expression of PD-1, PD-L1, CD3, CD8, CD45RO, forkhead box protein 3 (FoxP3), CD20, and BRAF V600E by immunohistochemistry in MBM samples (10). Varying degrees of tumor infiltrating lymphocytes (TILs) were reported in this study, 33 out of 43 specimens stained positive for CD3(+) T-lymphocytes, 39 for CD8(+) T-lymphocytes, 32 for CD45RO (+)memory T-lymphocytes, 27 for PD-1(+), 21 for FoxP3(+) T regulatory lymphocytes, and 19 for CD20(+) lymphocytes.   Significant tumoral PD-L1 expression (>5%) was observed in 9 specimens while 22 sam ples stained positive for PD-L1 suggesting role of immunotherapeutic agents in MBM. Prognostic indices Although the median OS of MBM is dismal, approximately 5% patients are long term survivors(2). Hence prognostic factors that predict outcomes and can guide the treatment decisions and enrollment in clinical trials are of value. Several large single center series have examined various primary tumor, brain metastases, and patient characteristics predictive of survival (2, 11, 12). Age, performance status, number of brain metastases, extra-cranial metastases, time from primary tumor diagnosis, presence of neurologic symptoms and elevated LDH are factors that determine survival. (13). Sperduto et al proposed a new disease basedscoring index based on 483 newly diagnosed MBM patients from 8 different centers (14). On multivariate analysis, performance status and number of BMs were prognostic for survival in MBM. The outcomes of ds-GPA MBM varied from GPA class I with survival of 3.4 months to GPA class IV with survival of 13.2 months. These prognostic indices have inherent limitations. All of them were evaluated retrospectively, had only overall survival as the end point, did not include molecular and genetic profile of the primary malignancy, and did not take systemic therapy into consideration (15). A large single institutional experience of 366 patients treated to 1,336 brain metastases has also shed some light on the interplay of important prognostic variables in patients with MBM. In this series, characteristics associated with survival included younger age, lack of extracranial metastases, performance status, and treatment with BRAF inhibitors or immunotherapies. This work specifically highlights the importance of modern out outcomes in patients who are eligible for and receive newer targeted therapies. For example, the 12-month survival estimate for patients treated with BRAF inhibitors was 37% compared to 23% for those patients who did not receive these therapies (p=0.01). Moreover, the 12-month survival e stimate for patients treated with immunotherapies was 47% compared to 22% for those patients who did not receive these therapies (p=0.04). Clearly, further work is needed to define the impact of mutation, targeted drugs and immunotherapy in the current era. Diagnosis: The neurologic symptoms associated with brain metastases include headaches, seizures, cranial nerve deficits to motor or sensory deficits. All melanoma patients with neurologic symptoms worrisome for MBM should undergo a gadolinium enhanced magnetic resonance imaging (MRI) of the brain, if no contraindications exist. Guidelines recommend routine MRI of brain with and without gadolinium contrast for patients with stage IV melanoma due to the high prevalence of asymptomatic brain metastases(16). Computed tomography of brain with and without contrast can be used as an alternate imaging. Management: The options available for management of brain metastases include surgery, WBRT, SRS, systemic therapy and symptom management. The management plan to treat these patients should take into account the overall prognosis, performance status and morbidity associated with the treatment. 5.1 Management of symptoms: Supportive care for patients with brain metastases is typically to control the cerebral edema with steroids. Due to minimalmineralocorticoid effect and long half-life, dexamethasone is the steroid of choice, however, other steroids at an equivalent dose can be used and tapered gradually over a two week period(17). A randomized trial in 1990s compared different doses of dexamethasone ranging from 4 mg/day to 16 mg/day and concluded that 4-8 mg/day would provide same degree of clinical improvement in 1 week (18). Routine use of prophylactic anti-epileptics in patients with brain metastases is not recommended(19). When patients have seizures several anti-epileptics are available including phenytoin, carbamazepine, valproic acid and levetiracetam. Non-enzyme inducing agents like levetiracetam are preferred to avoid interactions with systemic agents. 5.2 Neurosurgical Options: Surgery has traditionally been used for management of solitary brain metastases, or large symptomatic brain lesions. Multiple retrospective studies have reported improved survival with surgery compared to best supportive care(13, 20-22). Younger patients with good performance status, fairly well-controlled extracranial disease, solitary brain metastasis, lesions in accessible locations and of small size generally have better outcomes with surgery (21, 23). Surgery is usually followed by radiation boost to the surgical bed by either WBRT or SRS, with an intention of sterilizing the surrounding tissues and preventing local recurrence. Two randomized trials comparing adjuvant WBRT to surgery alone have shown improvement in outcomes(24, 25). Patchell et al. evaluated the role of WBRT post-resection of a single brain metastasis compared to surgery alone(25). Postoperative WBRT resulted in a significant reduction in local and distant intracranial failure. However, no difference in the over all survival or time duration of functional independence was noted. Similar results were seen in the EORTC 22952-26001 study with decreased 2-year intracranial and resection site recurrence without significant survival benefit. Multiple retrospective reports of post-operative SRS have shown improved patient outcomes however prospective data is awaited (26, 27). Bindal et al. showed benefit of resection in select group with multiple metastases in a retrospective review of 56 patients(28).   In practice, surgery plays an important role in debulking or removal of life-threatening lesions. Surgery also provides immediate relief from intracranial hypertension by eliminating the mass effect, and symptomatic hydrocephalus by reestablishing the flow of cerebrospinal fluid (CSF). 5.3 Whole brain radiation therapy: Melanoma brain metastases lesions are generally considered radio-resistant compared to other histologies (29). Randomized trials with WBRT have reported survival in the range of 2.4 to 4.8 months.(30) The ideal dose and number of fractions, balancing the intracranial control and cognitive decline, has been subject to intense debate.   WBRT fraction sizes of ≠¤ 3 Gy do not lead to significant neuro-cognitive decline. A retrospective study compared higher dose of radiation, 40 Gy in 20 fractions with 30 Gy in 10 fractions(31). The 40 Gy group had overall survival of 5.6 months compared to 3.1 months. However most of these trials were not melanoma specific and included patients with all tumor types. Patients who are symptomatic with change in mentation, headaches and seizures but are deemed unfit for surgery or SRS due to large number of metastases, poor performance and uncontrolled extracranial metastases are generally treated with WBRT(32). 5.4 Stereotactic radiation therapy: Stereotactic radiation has been increasingly used in the management of MBM in the last two decades. SRS in MBM results in local control rates of 50-75% at 1 year(33-35). SRS is generally limited to lesions smaller than 4 cm in diameter (36).   In a retrospective review of 333 patients treated with SRS showed a sustained tumor control rate of 73%(35). The 12-month cumulative incidence of local failure was 14% in another single institution experience of 191 patients treated to 793 MBM.   Number of brain metastases that can be treated with SRS has been intensely investigated. SRS for solitary brain metastasis was compared to surgery plus WBRT in a phase III trial that closed prematurely due to poor accrual. The overall survival, freedom from local recurrence and neurological death rates were similar in both groups(37).   Several studies have evaluated the role of SRS in patients with 1-3 brain metastases (38, 39). Aoyama et al. compared SRS alone with SRS followed by WBRT in patie nts with 1-4 brain metastases(38). No difference in neurocognitive function and survival was observed. SRS-alone arm had increased local and distant intracranial failure. A phase III trial compared WBRT followed by SRS to WBRT alone, in 333 patients with 1-3 brain metastases from different histologies that included only 13 MBM patents (40). Performance status at six months improved significantly with addition of SRS to WBRT. SRS for patients with 5-10 brain lesions was evaluated in a multi-institution prospective observational Japanese study of 1194 patients(41). The overall survival, neuro-cognitive function and post SRS complications did not differ for patients with 5-10 brain lesions compared to 2-4 brain lesions(42). 5.5 Systemic therapy: Traditional systemic therapy had a limited role in MBM due to challenges of drug delivery in the brain from blood brain barrier (BBB) with its tight junctions and efflux pumps (P-gp and MRP transport proteins) (43). The concept of localized disruption of BBB at the site of brain metastases has been proposed, as demonstrated on MRI by contrast enhancement (44). Chemotherapy: Chemotherapy agents have not shown good activity in MBM. Dacarbazine which is the approved chemotherapy for metastatic melanoma does not cross the BBB(45). A number of studies evaluated the role of alkylating agents with good BBB penetration such as temozolomide (TMZ), lomustine and fotemustine in MBM patients. In a phase II trial Agarwala et al. enrolled 151 MBM patients with no local radiation therapy for BM to receive TMZ (46). TMZ use showed a modest intracranial response of 6%, median PFS of 4.3-5.2 weeks and median OS of 3.2 months. Two phase II trials of WBRT with TMZ(47, 48); or thalidomide, WBRT with TMZ (49) failed to improve the response rates significantly. Lomustine in combination with TMZ showed modest efficacy in a phase I/II study(50).   Intracranial activity of fotemustine was first reported in a phase III trial of fotemustine versus dacarbazine for metastatic melanoma (51). This led to a randomized phase III trial that compared fotemustine plus WBRT to fotemustine alone in MBM (52). The response rates were 7.4% for fotemustine alone and 10% for fotemustine plus WBRT. Fotemustine is not currently approved by FDA for use in MBM due to delayed thrombocytopenia and leukopenia(53). Targeted therapy: BRAF, NRAS and KIT are three common, mutually exclusive driver mutations seen in metastatic melanoma (54, 55). Of these three, BRAF mutation is the most common mutation seen in approximately 40-50% of patients with advanced melanoma. The presence of BRAF, NRAS increases the risk of CNS metastases seen in patients with   advanced melanoma. Prior studies have reported 24% CNS metastases rate in BRAF and 23% CNS metastases incidence in NRAS mutant melanoma compared to 12% rate in those who lack these mutations(56). Dabrafenib and vemurafenib target BRAF V600 mutation and FDA approved for metastatic melanoma. A phase I trial of dabrafenib in ten patients with untreated asymptomatic brain metastases, intracranial response was seen in 8 patients (four CR, four PR) (57). This impressive 80% response rate prompted the phase II trial of dabrafenib in BRAF mutant melanoma brain metastases (BREAK-MB) (58). This multicenter open label study accrued 172 patients asymptomatic brain metastases with BRAFV600E or BRAFV600K mutation and one measurable lesion (defined as atleast 1 cm in diameter). Cohort A consisted of 89 patients who were radiation naive and cohort B consisted of 83 patients who had failed prior radiation therapy for BM. BRAFV600E patients had an intracranial response rate (IRR) of 39% (29/74) in cohort A and 31% (20/65) in cohort B, PFS of 16.1 weeks in cohort A and 16.6 weeks in cohort B with OS of 33.1 weeks in cohort A and 31.4 weeks in cohort B. BRAFV600K patients had a lower IRR of 7%(1/15) in cohort A and 22% (4/18) in cohort B. This trial supports the efficacy of dabrafenib in BRAF mutant MBM patients, especially those with BRAFV600E mutations with acceptable toxicity. In an open label study of 24 non-resectable, untreated MBM patients harboring BRAFV600 mutation, treatment with vemurafenib resulted in tumor regression of more than 30% (7/19)and partial response was seen in 3 patients. Median PFS and OS was 3.9 and 5.3 months respectively in this study. In a phase II study, 146 BRAF mutant MBM patients were treated with vemurafenib(59). The first cohort included 90 patients with untreated BM, the second cohort comprised of 56 patients with previously treated BM.   Complete response was noted in 2 patients, with 14 PRs, and a best objective response rate of 18%. In previously untreated MBM, the median intracranial PFS and OS were 3.7 months and 8.9 months respectively. Previously treated MBM had similar PFS and OS of 4.0 months and 9.6 months respectively. There is no prospective data of safety and efficacy of combination of BRAF inhibitors and radiation therapy. Most reports are retrospective in nature with increased incidence of dermatitis seen in extracranial skin associated with concurrent use of BRAF inhibitors and radiation (60). Rompoti et al. reported five patients with MBM treated with combined radiation and BRAF inhibitor(61). Two patients underwent SRS and three received WBRT. Patients treated with SRS did not experience any skin adverse effects while all three patients treated with WBRT noted grade1/2 dermatitis. A retrospective analysis evaluated effectiveness of vemurafenib and radiation in BRAFV600 MBM (62). All of them received vemurafenib, six patients underwent SRS, two received WBRT, one received SRS and WBRT and three underwent surgery and radiation. Thirty-six of the 48 index lesions responded with 23 (48%) CRs and 13(27%) PRs. Major limitations were the retrospective nature of the study, small number, and pretreat ed patients with radiation and systemic therapy including ipilimumab. Several small retrospective case series have reported outcomes of MBM treated with targeted agents and SRS/WBRT (Table-1). A recent study of 19 patients with BRAF mutations undergoing SRS and concurrent BRAF directed therapies has shown impressively few local failures (12-month cumulative incidence of 1%). Additional studies of combination therapy are clearly warranted. Immunotherapy: Melanoma is an immunogenic malignancy (63) with a high mutational burden that results in high number of neo-antigen(64). It has been proposed that the relatively high neo-antigen burden makes this malignancy more susceptible to immunotherapy. However, the brain has traditionally been considered an immunologically privileged site due to the presence of the BBB. Recent studies on the intracranial tumor microenvironment as elucidated above have suggested otherwise, showing CD8 T-cells, CD 20+ cells, T-regulator cells and PD-L1 expression within intracranial tumor(10). The intracranial activity of interleukin-2 (IL-2, one of the first immune modulatory agents) was reported in two retrospective reviews(65, 66).   A response rate of 5.6% was seen in 37 patients with untreated brain metastases within a larger group of 1069 metastatic melanoma and renal cell carcinoma patients treated with high dose IL-2(65). In a second report, two of the 15 brain metastases patients treated with high dose IL-2 showed CR (66). No prospective trials were initiated with high dose IL-2 due to concerns for cerebral edema and neurotoxicity. Two pathways that have revolutionized the management of advanced melanoma are those involving CTLA-4 and PD-1/PD-L1.   The CTLA-4 receptor is expressed exclusively on T-cells and downregulates the interaction between antigen presenting cells and T-cells. Ipilimumab is a fully human monoclonal antibody against the cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4)(67). The pivotal phase III trial that compared ipilimumab with or without gp 100 peptide vaccine to gp 100 vaccine as a single agent allowed enrollment of patients with asymptomatic and/or previously treated MBM (68). A non-significant trend towards better survival in the MBM subgroup was noted among the patients treated with either ipilimumab alone or ipilimumab plus gp 100 compared to gp 100 alone(69). In an expanded access program (EAP) in Italy, 146 MBM patients received ipilimumab and a global response rate of 12% was seen (70). An American EAP reported a 1-year overall survival rate of 20% among 165 MBM patients tr eated with ipilimumab (71). Margolin et al. conducted an open label phase II clinical trial of ipilimumab for MBM (72). The trial enrolled 72 patients 51 patients in cohort A (those who were not on steroids for cerebral edema) and cohort B of 21 patients (on treatment with steroids). According to the WHO criteria, the response rate was 18% (9/51) in cohort A compared to 5% (1/21) in cohort B, and by immune-related response criteria the response rate was 25% (12/51) in cohort A and 10% (2/21) in cohort B. The median OS was 7.0 months and 3.7 months in cohort A and cohort B respectively. The study concluded that ipilimumab can be used safely in MBM patients. An Italian phase II trial tested a combination of ipilimumab and fotemustine in patients with advanced melanoma including asymptomatic MBM patients (73). A total of 20 patients (out of 83 patients) had asymptomatic MBM, and among these patients the study reported a PFS of 3.0 months and 3-year OS rate of 27.8% (74). A randomized, 3 arm, phase III trial of fotemustine, versus fotemustine plus ipilimumab, versus ipilimumab plus nivolumab (NIBIT-M2) is currently recruiting patients (75). Several retrospective studies have evaluated the safety of combining ipilimumab and radiation therapy (SRS or WBRT), and prospective trial data is forthcoming (76-78). PD-1 receptors are expressed on several cells including T-cells and antigen presenting cells. Their interaction with PD-L1 ligands on tumor cells leads to T-cell exhaustion and downregulation of tumor-specific immune response(79). Nivolumab and pembrolizumab are two anti-PD-1 antibodies that are currently approved for the management of advanced melanoma, and several others are under evaluation. An open label, single-center, phase II clinical trial is currently enrolling patients with untreated brain metastases from melanoma or non-small cell lung cancer (80). In a published early analysis, a response rate of 22% (4 patients) was reported in a total of 18 MBM patients and the responses were durable. Authors noted a high concordance between systemic and brain metastasis responses. Additionally, 11% (2 patients) had stable disease. Intriguingly all responders lacked a BRAF mutation. Relatedly, 4 patients were not evaluable either due to rapid progression necessitating BRAF-targeted ther apy (3 patients), or intralesional hemorrhage (1 patient). Toxicities in the MBM cohort included grade 3 transaminitis (1 patient), as well as grade 1-2 seizures (3 patients) and grade 3 cognitive dysfunction (1 patient) from peritumoral edema. Leptomeningeal disease in melanoma   Leptomeningeal disease (LMD) is a subset of metastatic with extraordinarily poor prognosis and median survival of 8 weeks(81, 82). About 5% of malignant LMD originates from melanoma (Kesari) and up to 23% of melanoma cases develop LMD(1, 83). Primary leptomeningeal melanoma also exists as a separate clinical entity and should be a consideration in the context of a person with multiple congenital melanocytic nevi(84). Diagnosis of LMD is usually made based on the combination of neurologic symptoms along with corresponding leptomeningeal enhancement on MRI. While cytology from cerebrospinal fluid (CSF) is considered to be the gold standard for LMD diagnosis, sensitivity of this testing ranges from 50% to 80%, depending on number of lumbar punctures performed (85). Like with MBM, treatment of LMD with chemotherapy has low response rates(86). The clinical course of LMD is more treacherous in melanoma in other malignancies given the propensity for melanoma LMD to hemorrhage(87). Molec ular characterization of melanoma LMD suggests a higher percentage of BRAF mutations in comparison to the general melanoma population (68% v 45%), based on a single center melanoma LMD cohort of 60 patients(76). Several case reports have been published highlighting complete and partial responses as well as prolonged ongoing survival beyond 15-18 months with BRAF inhibitors (86). Immunotherapy approaches, including intrathecal IL-2, adoptive cell therapies with tumor infiltrating lymphocytes (TILs) and cytotoxic T-lymphocytes (CTLs), and immune checkpoint inhibitors, have also reported prolonged survival in comparison to historic medians (86). A single center study of 38 patients with melanoma LMD who were treated with intrathecal IL-2 reported a median survival of 9.1 months, and the best 15% of patients reached a median survival over 24 months(88). Ongoing survival over 18 months in a melanoma LMD case was reported with WBRT followed by ipilimumab, an immune checkpoint CTLA-4 inhib itor; in this case, treatment with ipililumab resulted in complete radiologic response(89). A phase II trial of combination immunotherapy with ipilimumab and nivolumab, a PD-1 inhibitor, in melanoma LMD has recently opened to accrual(90). In summary, these early data suggest that both targeted therapy and immunotherapy have efficacy in melanoma LMD and can result in durable responses well over a year. Upcoming trials addressing melanoma LMD with newer therapies will likely yield significantly improved survival data over the next decade. Conclusion: Despite significant recent improvement in the outcomes of patients with melanoma, brain metastases remain a major determinant of mortality and morbidity in melanoma patients, and patients with MBM remain in the worst prognostic category. The vast majority of clinical trials with newer agents exclude patients with MBM, thus data on the effectiveness of new drugs in the context of MBM is still lacking. Understanding the biology of MBM and its clinical response to newer agent and particularly combinations of agents and strategies is crucial to increasing the longevity of the poorest-risk melanoma. Appropriate care of MBM begins with diagnosis. In melanoma, the brain is a common site of metastatic spread, both early and late. It is crucial to begin screening patients for MBM at diagnosis, and NCCN guidelines have recently been updated to reflect this changing diagnostic paradigm. The frequency at which to repeat imaging is still not known. Several therapeutic options now exist for the treatment of MBM (A proposed algorithm is provided in Figure-1). Surgical resection, radiation therapy, targeted therapy and immunotherapy all show some degree of efficacy with MBM.   Even in cases of LMD, perhaps the worst subset of MBM in terms of survival, treatment with targeted therapy and immunotherapy can induce prolonged survivals from historic means. Initial reports involving combinations of these therapies, such as radiotherapy with either targeted therapy or immunotherapy, appear promising, but will need to be systematically studied in cohorts with larger numbers. Equally important will be the parallel investigation of predictive markers in MBM with these therapies and combinations. Thus, whenever possible, patients with a new diagnosis of brain metastases should be enrolled in appropriate clinical trials. If an appropriate clinical trial is unavailable, treatment decisions should be made with input from a multidisciplinary t eam including radiation oncologists, neurosurgeons, and medical oncologists.

Anne Finchs Poems :: Anne Finch Poetry Poem Essays

Anne Finch's Poems While other writers use their poetry to decipher the meaning of life, Anne Finch, Countess of Winchilsea was busy writing about how to live it. Five of her poems, â€Å"Jupiter and the Farmer,† â€Å"The Tree,† â€Å"The Shepherd Piping to the Fishes,† â€Å"Love, Death, and Reputation,† and â€Å"There’s No To-Morrow,† convey strong messages to the reader about how to live their lives. In her poetry, Anne Finch uses anecdotes to help illustrate the validity of her statements, thereby providing the reader with a strong, meaningful, and important message about how life should be lived. â€Å"Jupiter and the Farmer† tells the story of a farmer who took it upon himself to control the weather in favor of his crops: â€Å"The Frost to kill the Worm, the brooding Snow, / The filling Rains may come, and Phoebus glow† (14 – 15). In doing this, the farmer plays god himself rather than let the real god, Jupiter, control things. The farmer ends up choosing what he wanted in such a bad fashion, he ruins his crops and is â€Å"with Famine pinch’d† (24). Upon the realization of his mistake, the farmer calls upon Jupiter and promises he will no longer take fate into his own hands. He resolves to let Jupiter lead the way while he â€Å"live[s] to Reap† (30). Through this poem, Finch stresses how important fate is in everyday lives. Like the farmer, we may have a desire to try and take the reigns from destiny, but it will never end well. Finch says we should just leave our lives to fate, and everything will work out alright. In â€Å"The Tree,† the speaker talks to a tree and express thanks for its â€Å"delightful shade† (1). The speaker goes on to talk of the others who benefited from the existence of the tree and gave it something back in return, such as the birds singing, travelers praising it’s welcome shade, and nymphs making crowns from its blooms. The speaker wonders what she can do to repay the shade given her by the tree. She decides to wish something for the tree’s future. She wishes, â€Å"To future ages may’st thou stand / Untouch’d by the rash workman’s hand† (19 – 20). Ultimately, she wishes something such as â€Å"some bright hearth† (32) be made from the tree at its death.

8th Fire: Indigenous in the City Analysis: One Step Forward, One Step B

8th Fire: Indigenous in the City, is part of a documentary series that describes the challenges that aboriginal people face when moving to the large cities from reservations. The documentary begins by describing the stereotypes that English Canadians as well as other visible minority groups perceive aboriginal people to be. They show how damaging the stereotypes are to the First Nations, especially in the area of education. The documentary concludes by offering a few some solutions of how to change and improve the relationship between the aboriginal community and the rest of Canada. The two main aspects of the film that I will focus my analysis on is the education system from past to present and the negative impacts it has had on the First Nation’s people as well as aboriginal stereotyping. These two themes were the most prominent topics brought up throughout the film, and while one topic was well argued and framed, the other I will argue was more damaging than educationa l. I should mention that due to my ethnicity being of aboriginal decent, Mà ©tis in particular, I was extremely critical of the film because though these issues need to be addressed publicly, if they are presented in the wrong light, it can cause more negative implications than positives. Though the film mentioned the impact that residential schools had and still has on the aboriginal people, I felt that this issue needed to be stressed further because the legacy of the schools is still extremely prominent in aboriginal communities today. The film refers to the fact that residential schools harmed the aboriginal people because they were not able to learn their culture, which has resulted in the formation of internalized oppression within in the group. â€Å"The... ...t Kids Docs Radio TV. Web. 1 Apr. 2012. . Fleras, Augie. â€Å"Aboriginal Peoples in Canada: Repairing the Relationship.† Chapter 7 of Unequal Relations: An Introduction to Race, Ethnic and Aboriginal Dynamics in Canada. 6th ed. Toronto: Pearson, 2010. 162-210. Print. King, Thomas. â€Å"Let Me Entertain You. The Truth About Stories: A Native Narrative. Minneapolis: University of Minnesota Press, 2005. 61-89. Print. Ruth, Seà ¡n. â€Å"Theories of Internalized Oppression.† Leadership and Liberation: A Psychological Approach. London: Routledge, 2006. 155-173. Print. Schissel, Bernard, and Terry Wotherspoon. â€Å"The Legacy of Residential Schools.† Inequality in Canada: A Reader on the Intersections of Gender, Race, and Class. 2nd ed. Ed. Valerie Zawilski. Don Mills: Oxford University Press, 2010. 102-121. Print.

Peter in da Vincis Last Supper Essays -- Leonardo da Vinci Last Supp

Leonardo's The Last Supper depicts the sequence of events before Jesus's betrayal and crucifixion. Rather than merely a snapshot in time, The Last Supper seems to be a continuous sequence of events, and a foreshadow of events to come. Two interpretations of the subject of the painting come to mind: the betrayal announcement and the first communion. Observing the impulsive Simon Peter's interactions with Judas and John, Jesus and Thomas, it is clear that The Last Supper represents a conjoint presence of both the betrayal announcement and the institution of the Eucharist. The main theme behind The Last Supper is Jesus's death. Jesus came to earth to be crucified as the sacrifice for the sins of mankind. Man cannot become righteous by his own works and are thus condemned to hell. But Jesus comes as a sacrifice to pay for those sins and thus all who trust in him and give their lives to God will be forgiven of their sins. This is what the Eucharist represents. The bread is Jesus's body broken for man, and it symbolizes Jesus's sacrifice on the cross. From a secular viewpoint, the Eucharist means nothing, so the main theme is obviously Jesus's announcement of the betrayal. Jesus already knows that Judas will betray him and accepts it because the betrayal is but one part of God's plan. The reactions of the apostles as seen in the painting seem to differ, as some react to the betrayal while others appear to be receiving communion. Peter's placement on the left side of the painting and his placement between John and Judas reflects his character. The painting is divided with six apostles on either side of Jesus. The ones on the right are beside a lighted wall, whereas the ones on the left sink into the shadows. Peter is on the darke... ...himself claims: "Your tongue will be paralyzed... before you predict with words what the painter shows in a moment" (Steinberg, p. 53). Yet The Last Supper has become a masterpiece that has sparked many debates. Does it depict the first Holy Communion, or the prediction of the betrayal? Many have argued either way, and there are valid arguments for both. By examining the interactions of Peter with John, Judas, Jesus and Thomas, we see that indeed both events are represented. Instead of choosing to capture a single moment, Da Vinci's masterpiece covers past, present and future events and both the institution of the Eucharist and the betrayal announcement. The Last Supper is truly complete work of art in every way. Works Cited Holy Bible. Wheaton: Tyndale House Publishers Inc., 1996. Steinberg, Leo. Leonardo's Incessant Last Supper. New York: Zone Books, 2001.

Historical Overview of Montessori Method

ALPNA KUMAR Section 1, Part 1, Lesson 1 August 8, 2012 Lesson 1: Historical Overview of Montessori Method Write a chronological overview (time line) of Maria Montessori’s life and work. Indicate the life events you feel were most significant in her development of the Montessori Method of education. Describe how Montessori developed her approach. Include the factors occurring at that time in the world that contributed to the method’s popular acceptance.Education being a necessary part of our lives, there has been several ways to teach a child and thus creating a teacher dominant learning. But, it was about a century ago when a revolutionary thought â€Å"teacher within† came to existence. It was the one woman who changed the world with her new innovative method of teaching and would break the stereotype in teaching method. This was Maria Montessori who developed Montessori Method of teaching with a firm belief in the motto â€Å"Within the child lies the fate of future†.Montessori Method focuses on the idea that children learn best when they are placed in an environment full of learning activities and given the freedom to work on their own. Montessori model believed that children at liberty to choose and act freely within an environment prepared accordingly would act spontaneously for optimal development. Montessori education is characterized by an emphasis on independence, freedom within limits, and respect for a child’s natural  psychological  development, as well as technological advancements in society.Although a range of practices exists under the name â€Å"Montessori†, the Association Montessori Internationale (AMI) and the American Montessori Society (AMS) cite these elements as essential [1, 2]: Mixed age classrooms, with classrooms for children aged 3 to 6 years old by far the most common, student choice of activity from within a prescribed range of options, a  Ã¢â‚¬Å"constructivism†Ã‚  or â€Å"di scovery† model, where students learn concepts from working with materials, rather than by direct instruction and specialized educational materials developed by Montessori and her collaborators.To understand Montessori Method it would be necessary to know how it came to existence and what the underlying principles behind this method are. Maria Tecla Artemesia Montessori was born on August 31, 1870, in Chiaravalle, Italy. Her father, Alessandro Montessori, 33 years old at the time, was an official of the Ministry of Finance working in the local state-run tobacco factory. Her mother, Renilde Stoppani, 25 years old, was well educated for the times and was probably related to Italian geologist and paleontologist  Antonio Stoppani.Her father did not believe that women should receive higher education. However, her mother, fully supported Maria in all her endeavors. Montessori's was educated as a doctor, but went on to start her own preschool. She believed children should not be tre ated as receptors of knowledge from the teacher, but instead should be leaders of their own learning. Her philosophy has been embraced in schools around the world [3]. Maria Montessori was always a little ahead of her time. At age thirteen, against the wishes of her father but with the support of her mother, she began to attend a boys' technical school.At that time schools had very few teaching supplies, like books and writing supplies. Children had to learn everything by memorization. Girls were taught skills like sewing or knitting, while only boys were encouraged to study math, science, and other technical subjects. Maria fought for her right to study math and science. She was supported whole-heartedly by her mother to continue studying these subjects, and her father grudgingly permitted her to do so. Maria originally intended to become an engineer, but her interests soon shifted to the field of medicine.Her desire to become a doctor was unprecedented for a woman in Italy at the time. Maria was allowed to attend medical school only after the intervention of the Pope. Because her attendance of classes with men in the presence of a naked body was deemed inappropriate, she was required to perform her dissections of cadavers alone. In addition to the isolation, she found she had another problem. She was repelled by the smell of the anatomy hall. When this became too complicated she tried smoking herself. Due to all these challenges, her interests turned to pediatrics and psychiatry.This would be the beginning of her lifelong work with children [4]. After graduating from the University of Rome in 1896, Montessori continued with her research at the University's psychiatric clinic, and in 1897 she was accepted as a voluntary assistant there. Maria opened her own medical clinic to treat children. In 1897, she became an assistant doctor at the psychiatric clinic of the University of Rome. She began visiting asylums for mentally challenged and handicapped children. M aria observed that the living conditions for these children were miserable.The patients were kept like prisoners in dark, bare rooms with nothing to stimulate them. She observed that it was not the medical problem but rather pedagogical one. It was this time when she came across the work of two French doctors Edward Seguin and Jean Itard’s experiments to educate defective children. Maria observed these children picking up crumbs off of the floor and playing with them. She realized that the children were using the crumbs as toys. Maria realized that these children needed a special school that would meet their needs.While working at the asylum, Maria was introduced to the methods and materials developed by Jean Itard and Edward Seguin, who had trained defective children years before. Later she would use a similar approach to work with normal children. Keeping a busy schedule, Maria had little outside social life. She became close friends with her colleague, Giuseppe Montesano w ith whom she had an illegitimate child. They never married, and in 1898 she gave birth to her son Mario. Fearing that news of her child would ruin her reputation and career, she felt forced to send him to the countryside and could not visit him very often.Deprived of being with her son, her desire to work with children increased. She designed new teaching materials like shapes to hold, laces to tie, beads to thread, and letters to feel. She believed that they learned better through their five senses first. Maria noticed that the children were interested in the letters, which they thought of as new toys. These children began to write letters with chalk on a board. She began to wonder if the teaching methods she used would work with typically developing kids [5]. In 1907 Maria started her own school, Casa dei Bambini, in the slums of the San Lorenzo district of Rome.A few bankers who were building cheap housing for the poor and homeless granted her a single room where she had to teach 50 impoverished children from the slums. Maria was asked to keep an eye on these children while their parents were. Maria kept observing and experimenting with these kids. She brought in light, child-sized furniture and tools for these children and taught them grace and hygiene. She had low open shelves and cabinets made for this classroom so that the children could choose and reach materials by themselves.Children were even given responsibilities like preparing and serving their own snacks and tidying up the classroom. Maria prided herself on the independence of her students. She wrote, â€Å"The greatest sign of success for a teacher is to be able to say, ‘The children are now working as if I did not exist. ’† Using the three-dimensional letters, the 4 and 5-year-old children from the slums were teaching themselves how to read and write. This was considered a miracle, because until that time, children were never taught to read or write before the age of six.Ma ny people began to flock to the Casa dei Bambini to witness the â€Å"miracle†. They could not believe that children from the slums had such grace and good manners, and were reading and writing at such an early age. These underprivileged children showed that they had the potential to become respectable citizens of Italy instead of thieves and criminals. Many people saw the children working and learning in harmony and realized that the Montessori Method of education had the ability to cure the social ills of society.Due to the success and popularity of the Montessori Method in Europe, other countries like China, Australia, Canada, Switzerland, and the United States by 1911 applied the Montessori Method eagerly to their educational systems. Montessori’s books were translated into 23 languages to meet the overwhelming international demand for her teaching method. Unfortunately, Maria Montessori was forced to leave Italy because she refused to support the Fascist regime of Mussolini. Upon the invitation of Mahatma Gandhi, Montessori travelled to India with her son in 1939 to train teachers.She stayed there for seven years. For her lifetime of commitment to the education of children, Maria was nominated for the Noble peace Prize in 1949, 1950 and 1951. After dedicating her life to the education of children, Maria Montessori died in Holland in 1952. Maria Montessori passed away over 50 years ago, but her legacy lives on to this day. Montessori’s revolutionary ideas about children and their instinctive desire to learn have transcended time. Montessori schools operate worldwide now, and even schools that do not label themselves â€Å"Montessori† are using some of her methods to teach children.If her methods are used correctly, every child can reach their potential to the fullest. As Montessori herself once said, â€Å"Free the child’s potential, and you will transform him into the world†. Bibliography†¦.. [1]†AMI Sc hool Standards†. Association Montessori Internationale-USA (AMI-USA). [2]†Introduction to Montessori†. American Montessori Society (AMS). [3]http://www. biography. com/people/maria-montessori-9412528. [4]Kramer, R. – Maria Montessori: A Biography – New York: Putnam, 1976. [5]Barbara O'Connor, Sara Campitelli – Mammolina: A Story about Maria Montessori – Carolrhoda Books, 1993.

Keeping the Drinking Age at 21

Listening to the news on television, hearing other students talk about it, is it really true, or are they going to lower the drinking age to 18? This is not just a rumor but nowhere have they actually lowered the age. The debate has been talked about for the last few years. The nation has always tried different things to solve the irresponsible drinking problems. In order to try and prevent this problem America has tried a national prohibition in the 1920’s and state prohibitions in the 1850’s. Many believe that rising the drinking age has saved lives of many young adults. There has been evidence that the drinking age of 21 has decreased the amount of tragic car accidents related to alcohol between young adults. Since 1987 the decrease of drinking and driving problems have gone down. If they did lower the drinking age to 18 or 19 the more health related problems the young adults would deal with once they get older. On the other hand the current law of the minimum drinking age at 21 leads to problems behind the scenes. The amount of students at colleges under the age 21 are more likely to be binge drinkers, which means they have more than five drinks in a row. This can be very dangerous to the body. Many also argue that if a person is old enough to fight for the country they should be old enough to have a beer. Also if a people are expected to be able responsible and live on their own at eighteen they should be able to be responsible enough to drink on their own. There are many pros and cons to lowering the drinking age, but the most important reason not to lower the drinking age is to protect the lives of young adults. A survey found that out of 1,881 surveyed college students 88 percent of males and 86 percent of females said they were drinkers (Gonzalez 2). Many adults have noticed the problem of underage drinking and want to fix the problem. If the states were to lower the drinking age we would be putting many lives at risk. Many studies have shown that the minimum drinking age of 21 has saved many lives when it turns to drinking and driving. In the article College-age Drinking Problems states â€Å"the age limit at 21 has saved 16,500 lives in traffic crashes alone since 1975† (Hingson 1). Traffic crashes are one of the leading causes of deaths in America for people under the age 25. 10,431 people between ages 15 and 24 died in 1996 from fatal traffic crashes and 45% of them were related to alcohol (1). By leaving the drinking age to 21 it will continue to save many lives from traffic crashes. The amount of alcohol related accidents doubles if a person has a . 02 percent increase in blood alcohol level. For people under 21 drinking and driving increases the risk of being involved in a fetal traffic crash with each alcoholic dri nk they have. As Hingson says â€Å" For young drivers, drinking is like throwing gasoline on a fire† (1). It is illegal for anyone under 21 to drive with blood alcohol level more than . 0 percent. With this law alcohol related traffic deaths has dropped 57 percent from 5380 in 1982 to 2315 in 1996 with people ages 15 to 20 (2). Lowering the legal limit for the amount allowed of blood alcohol content (BAC) for drivers will continue to save lives. The lowering of BAC has shown a 5 to 8 percent decrease in alcohol related traffic crashes (Wagenaar 6). Drivers under 21 who are intoxicated are more likely to get involved in traffic crashes, because they have less experience on the road. Communities have noticed the problem with underage drinking and driving and started The Saving Lives Project, which was designed to reduce alcohol impaired driving and related problems (Holder 2). This project uses media and education to get the word out about the risk of drinking. The communities that are apart of this project have shown a 40 percent reduction in alcohol related fatal crashes (Holder 2). The project has been shown that older teens ages sixteen to nineteen are now less likely to drink and drive after learning about the risks in alcohol related classes. Colleges that have set a week to focus on education and prevention of alcohol have shown a five-fold increase (Gonzalez 4). Not only does alcohol affect a person once they drink a beverage but it also affects them in their future. If people start drinking at a younger age the more problems they will encounter in their future. Over the life of many people it has been proven that most people drink the most in their late teens and early twenties (Chen 1). Drinking in young adults is turning to be a serious concern with public health. By exceeding the daily drinking limit is about four or more drinks in a single day, and college teens shown that hey binge drink. Binge drinking is when a person consumes more than five drinks in one setting (Hingson 1). People who binge drinks are more likely to do things they regret, fall back in schoolwork and become hurt or injured. Alcohol can cause risky behaviors and immediate and long-term problems with health. Becoming stricter on under age drinkin g laws can prevent this. If the cops gave more MIP’s out to parties with underage drinking teens would be less likely to drink. Even though many would agree to keep the drinking age at 21, many would also have many reasons why to lower the drinking age to 18. One main argument is if a person is old enough to fight for the country, vote or live on their own they should be old enough to drink (Johnson 1). If a man and women is old enough to go to war and put their life at risk they should be able to drink on their own. People would argue if they are old enough to vote for the person who runs the country, then what’s the difference in choosing the responsibility of drinking. Colleges have also debated the fact of lowering the drinking age. College president McCardell say’s â€Å"it does not reduce drinking. It simply puts young adults at greater risks. (2) Many agree with McCardell and say that the drinking age of 21 does not prevent college students from drinking. It just causes them to drink under ground. If young adults do drink under ground they are more likely to binge drink and put their life at risk. â€Å"85 percent of 20 year old Americans reported that they have used alcohol, and two out of five said they have binge drank† (2). Johnson believes that if they lowering the drinking age young adults would learn to drink responsibly and stop binge drinking. Even though they are great arguments, raising the drink to 21 has proof with statistics that it has saved lives of many each year. It is more important to save the lives of people than it is to let them drink. Educating young adults about the risks of drinking can also prevent binge drinking. If the community worked together to have alcohol awareness days more people would be aware of the problem of underage drinking. The more people know about the problem the more people will work together to stop the problem. It can also stop underage drinking by creating more laws towards the people who sell to minors. If more people got in trouble for selling to minors the less people would sell to minors. The communities who have taken the step up in stopping underage drinking problems have noticed a huge change in the amount of deaths related to alcohol. By keeping the age at 21, it will continually save lives of accidents related to alcohol. If there was not a problem with the drinking age at 21 they would have never raised the age to 21, the law was set in place for a reason and it has been shown that it is a good law. As a parent many are worried about their children and want to make sure they will not ruin their life with alcohol related problems.

What should be done with our solid waste

The amount of solid waste in the world's economically developed countries has been increasing dramatically during the 20th century. This is due to increasing economic affluence like increased consumption of ebergy and raw materials, the increased manufacture and transport sale. Also free constant demand for the products that does not last for long like toys. There is an increase in the amount the world, which requires considerable packaging. Also use of a wide range of variety of products cause the production of more waste. Many things have been done to solve this problem. But we have not managed to solve the hole problem, but there are some particular methods how to reduce the waste. The three methods i am going to include in this essay are the landfill method, the incieration and recycling.Landfills are facilities that serve as long-term disposal sites for community solid wastes. They are designed and operated to protect both the community and the environment from contamination. When properly operated, landfill sites can ensure clean groundwater and clean air in the community and environment. Proper landfill design will enhance the environmental protection provided by locating the landfill correctly. When selecting a landfill location it is preferable to have a site located in an environment that provides natural protection. Similarly, a site where landfill generated contaminants are naturally reduced to acceptable concentrations or are naturally contained is preferable. This is known as a site with abilities of natural self attenuation. Where self attenuation is not possible, it is necessary to construct a landfill facility in a designated area. Advantages A properly sited and engineered landfill offers much better control of the environmental and health hazards associated with waste disposal than a garbage dump or burning pit. After a landfill has been closed, the site is landscaped and can be converted into a park, tobogganing hills, golf courses, etc. A new landfill can also serve as an incentive for increased environmental awareness in the community. In communities currently using a garbage dump or burning pit, the regular collection of community solid waste and its disposal in a landfill encourages the separation and safe disposal of hazardous waste and can even serve as a starting point for a recycling program. A well-run landfill can become a source of pride to a First Nations community, allowing the community to serve as a model of environmentally responsible community solid waste management. Disadvantages A key disadvantage of the community solid waste landfill relates more to public perception than with a flaw in the solid waste management method itself. Many people, usually confusing the landfill with the uncontrolled garbage dump, react negatively and strongly to the idea of building a new community solid waste landfill in their community. One operational disadvantage is the difficulty in applying cover materials in winter months. To ensure the coverage of wastes in winter conditions, heavy equipment may be needed which may not be available in small communities. Secondly, a landfill also produces what is commonly termed â€Å"landfill gas.† This gas, which consists primarily of methane, forms because of the decomposition of organic wastes in the landfill. If allowed to accumulate in a confined space, landfill gas can pose a danger as an explosive. Because of the small scale of a typical First Nations community landfill, the low level of landfill gas produced, does not usually pose serious hazards to the community and to the environment. Also, depending on community size, landfills require a large land base to meet the community's current and future needs. Hauling waste off-reserve to a nearby municipal or regional landfill would better preserve a community's land base. Finally, constructing and operating a community solid waste landfill may require more financial resources than hauling waste off-reserve.