Energy Society Essay Example for Free

Energy Society Essay The Kyoto Protocol The official name of the Protocol is The Kyoto Protocol to the United Nations Framework Convention on Climate Change. It is an agreement by 165 countries for mandatory targets for the reduction of the world’s greenhouse gas emissions. These gases—carbon dioxide, methane, nitrous oxide, and several fluorinated gases are believed to contribute significantly to global warming. The targets of the Protocol are primarily industrialized countries, which are expected to reduce their combined emissions to 95% of 1990 emission levels between 2008 and 2012. The Protocol was agreed on in 1997, although it only took effect in 2005. Between the years 1990 and 2000, the overall emissions of industrialized countries have been reduced by 3%, but largely because of the drastic reduction of emissions from former Soviet countries because of their failing economies. Other industrialized countries overall had an increase of 8% emissions. It is estmated that emissions from industrialized countries will be 10% above 1990 emission levels by the year 2010. For industrialized countries, the emission reduction target of the Kyoto Protocol is only around 5%, and many climate scientists are concerned that this is not enough to curb the effects of global warming. They believe that in order for the agreement to actually help solve the problem, the emission rates would be cut down by 60%. This has led to the opinion that the agreement lacks real value, more so without US backing. However, advocates believe that the Protocol lays out the groundwork for future negotiations. Emission reduction laws were already signed in many countries and would continue to take effect even when the Protocol itself has ceased to exist. â€Å"Happy Kyoto Day† – http://www.worldchanging.com/archives/002119.html This site has an unusual approach to the problem of determining the Kyoto protocol’s merit. According to the author, â€Å"In and of itself, the Kyoto treaty wont solve global warming or avert disastrous climate disruption.† The author states that the protocol is essentially a catalyst. It will put the world in an environmentally aware mindset—even if the Kyoto protocol fails, it will force the world to come up with something better. It will also encourage economic changes that strive towards greater efficiency and sustainability. Lastly, the protocol â€Å"is a symbol, a conscious step in the right direction for the planet. â€Å"Kyoto global warming: good stuff or part of a dark conspiracy to dominate the world?† – http://uspolitics.tribe.net/thread/e4978f31-0439-4b70-bbf3-f0ce93a09a42 According to this site, â€Å"global warming alarmism† is indeed the â€Å"mother of all environmental scares.† The author states that it is definitely not settled whether human activity has had any significant effect on global warming; global warming is a theory, not a fact. Some effects of the Kyoto protocol would include â€Å"impoverishing the USA and creating intense disaffection within the ranks of the working classes.† Basic necessities would become very expensive. â€Å"Electricity would double in cost, fuel would skyrocket.† Lastly, the author claims that the Kyoto protocol is a political â€Å"device to lead the Social Communists closer to world dominion.† One of the worst effects that global warming could have would be the rise of sea levels, due to the melting of ice caps and to thermal expansion of the world’s waters. A hundred years from now, if the worst global warming predictions come true, millions of people will be displaced from their homes, which will be submerged. This will have drastic economic and cultural impacts. The effects of the mass displacement on the economy could reach far into the future. The loss of farmland, of business districts, etc. may spawn another (much worse) Great Depression in many areas. Forced cultural dispersion will be commonplace, making the ubiquitous problem of the generation gap much more considerable. Many people who would call themselves environmentalists would not necessarily have good knowledge of environmental issues. They may pay lip service to the environmentalist cause without inconveniencing themselves in any respect to protect it. But I would venture to say that a majority of those who call themselves environmentalists would be willing to go out of their way to ‘serve’ the world. However, it is certain that, as in other controversial issues, there would be much hypocrisy. If by ‘environmentalists’ we mean those who are—or claim to be—‘concerned’ about the environment, then certainly most of them would just be claiming belief in the cause, but be too lazy. In them would be an awareness of an ideal—the preservation of the environment—but a lack of initiative, probably because of the lack of any immediate incentives. References    Kyoto Protocol, 2006, Department of the Environment and Heritage, Australian Greenhouse Office, Available at: http://www.greenhouse.gov.au/international/kyoto/index.html The Kyoto Protocol, New Zealand Ministry for the Environment, Available at: http://www. climatechange.govt.nz/about/kyoto.html Cascio, Jamais, 2006, Happy Kyoto Day, Available at: http://www.worldchanging.com/archives/002119.html Kyoto global warming: good stuff or part of a dark conspiracy to dominate the world?, 2006, Available at: http://uspolitics.tribe.net/thread/e4978f31-0439-4b70-bbf3-f0ce93a09a42 QA: The Kyoto Protocol, 2005, BBC News, Available at: http://news.bbc.co.uk/1/hi/sci/tech/ 4269921.stm The Kyoto Protocol A brief summary, 2006, European Union, Available at: http://ec.europa.eu/ environment/climat/kyoto.htm Kyoto Protocol, 2006, Wikipedia, Wikimedia Foundation, Inc., Available at: http://en.wikipedia. org/w/index.php?title=Kyoto_Protocololdid=80236719 Kyoto Protocol comes into force, 2005, BBC News, Available at: http://news.bbc.co.uk/2/hi/ science/nature/4267245.stm

Automatic Quantification of the Myocardial Extracellular

Automatic Quantification of the Myocardial Extracellular Automatic Quantification of the Myocardial Extracellular Volume by  Cardiac Computed Tomography: Synthetic ECV by CCT Thomas A Treibel, MBBS1,2, Marianna Fontana, PhD,1,2, Jennifer A Steeden PhD2,3, Arthur Nasis, MD1, Jason Yeung, MBBS4, Steven K White, BSc, MBChB1,2, Sri Sivarajan4, Shonit Punwani, PhD4, Francesca Pugliese, PhD1, Stuart A Taylor, MD4, James C Moon, MD1,2, Steve Bandula, PhD4 1Barts Heart Centre, St Bartholomews Hospital, London, UK. 2Institute of Cardiovascular Science, University College London, London, UK. 3UCL Centre for Medical Image Computing, Department of Medical Physics, London, UK. 4Centre for Medical Imaging, University College London, London, UK. Manuscript Type: Original Manuscript Manuscript: 3924 words (all including) No conflict of interest declared. Funding: TAT and SB are supported by Doctoral Research Fellowships from the NIHR, UK (NIHR ­DRF ­ 2013-06-102 / NIHR ­DRF ­ 2011 ­04 ­008). MF and SKW are supported by Clinical Research Training Fellowships from the British Heart Foundation (grants FS/12/ 56/29723 and FS/10/72/28568). JCM is directly and indirectly supported by the University College London Hospitals NIHR Biomedical Research Centre and Biomedical Research Unit at Barts Hospital, respectively. FP: this work form part of the translational portfolio of the Cardiovascular Biomedical Research Unit at Barts, which is supported and funded by the NIHR. SAT is an NIHR senior investigator. This work was undertaken at University College London Hospital, which received a proportion of funding from the UK Department of Health National Institute for Health Research Biomedical Research Centres funding scheme. ABSTRACT [TT1] Background: The quantification of myocardial extracellular volume fraction (ECV) by Cardiac Computed Tomography (CCT) can identify changes in the extracellular space due to fibrosis or infiltration. Current methodologies require laboratory blood hematocrit (Hct) measurement which complicates the technique.   The attenuation of blood (HUblood) is known to change with anemia. We hypothesized that the relationship between Hct and HUblood could be calibrated to rapidly generate a synthetic ECV without the need to formally measure Hct. Methods: This retrospective study received institutional review board approval. The association between Hct and HUblood was derived from forty non-contrast thoracic CT scans using regression analysis. Synthetic Hct was then used to calculate synthetic ECV, and in turn compared with ECV using blood Hct in a validation cohort with mild interstitial expansion due to fibrosis (aortic stenosis, n=28, ECVCT = 28 ±4%) and severe interstitial expansion due to amyloidosis (n=27; ECVCT = 54 ±11%, psynthetic ECV was correlated with collagen volume fraction (CVF) in a separate cohort with aortic stenosis (n=18). All CT scans were performed at 120kV and 160 mAs. Results: HUblood was a good predictor of Hct (R2=0.47; p), with the regression model (Hct = [0.51 * HUblood] + 17.4) describing the association. Synthetic ECV correlated well with conventional ECV (R2=0.96; p with minimal bias and 2SD difference of 5.7%. Synthetic ECV correlated as well as conventional ECV with histological CVF (both R2=0.50, p). Finally, we implemented an automatic ECV plug-in for offline analysis. Conclusion: Synthetic ECV by CCT provides instantaneous quantification of the myocardial extracellular space without the need for blood sampling. KEYWORDS: Computed tomography; Myocardial tissue characterization; Extracellular matrix; Myocardial extracellular volume fraction; Myocardial fibrosis; cardiac amyloidosis. LIST OF ABBREVIATIONS AL amyloidosis = Immunoglobulin light-chain amyloidosis AS = Aortic stenosis CCT = Cardiac computed tomography CMR = Cardiovascular magnetic resonance CVF = Collagen volume fraction ECV = Extracellular volume fraction HU = Hounsfield units INTRODUCTION Extracellular volume fraction (ECV) quantification by cardiac computed tomography (CCT) 1-5 and cardiovascular magnetic resonance (CMR) 6, 7 is a promising new imaging biomarker for interstitial expansion due to myocardial fibrosis and cardiac amyloid deposition. Emerging data suggests ECV predicts outcome as well as left ventricular ejection fraction 8, 9 and there is increasing interest in targeting the interstitium during the development of heart failure therapy.10 Current methodologies for ECV quantification require blood hematocrit (Hct) measurement, which adds a layer of complexity and is potentially a barrier to easy clinical implementation. Alternatively, for CMR, Treibel et al. recently proposed a synthetic ECV technique, removing the need for Hct measurement by utilizing the relationship between relaxivity of blood and lab measured Hct.11 It is unknown if a similar approach can be used for CCT, although a relationship between anemia and unenhanced blood attenuation has been observed.12-17 For example the aortic ring sign and dense intra-ventricular septum on unenhanced thoracic CTs suggest underlying anemia.17-19 We hypothesized that the relationship between Hct and unenhanced blood attenuation (HUblood) could be used to estimate a synthetic Hct, permitting immediate synthetic ECV calculation without blood sampling. We used existing patient cohorts1, 4 to investigate how synthetic ECV (a) compares to conventional ECV, and (b) correlates with the reference standard collagen volume fraction. We also tested implementation of an automated synthetic ECV measurement plug-in within the open-source DICOM viewer OsiriX.20 MATERIAL AND METHODS This study is a retrospective analysis of prospectively acquired data, received local ethical approval and conformed to the principles of the Helsinki Declaration. The study received no industry support.   All participants provided informed and written consent. Exclusion criteria were uncontrolled arrhythmia or impaired renal function (estimated glomerular filtration rate ECV CCT Protocols. The CCT protocol consisted of three steps: first, a low dose non-contrast scan to obtain baseline attenuations; second, contrast administration with a contrast-enhanced 1-minute acquisition and a 5 minute delay to allow blood to myocardial contrast equilibration; third, a repeat scan to re-measure blood and myocardial attenuations. CCT examinations were performed on a 64-detector row CT scanner (Somatom Sensation 64; Siemens Medical Solutions, Germany).1, 4 A topogram was used to plan CT volumes from the level of the aortic valve to the inferior aspect of the heart, typically a 10 cm slab. Cardiac scans (tube voltage, 120 kV; tube current-time product, 160 mAs; section collimation, 64 detector rows, 1.2-mm section thickness; gantry rotation time, 330 msec) were acquired with prospective gating (65%-75% of R-R interval), and reconstructed into 3-mm-thick axial sections with a B20f kernel. All pre- and post contrast acquisitions were performed and reconstructed with the same parameters and matched the level of the pre-contrast scan. The iodinated contrast material used was iohexol (Omnipaque 300; Nycomed Amersham, Oslo, Norway; 300 mg of iodine per milliliter) at a standard dose of 1mL/kg and injection rate of 3ml/sec without a saline chaser. Image Analysis. CCT image analysis was performed using a free and open-source Digital Imaging and Communications in Medicine viewer (OsiriX v4.1.2; Pixmeo, Bernex, Switzerland) independently by two experienced readers blinded to all other study data. For Hct estimation, regions of interest (ROIs) were placed in in a single axial slice in the center of the right atrium. The mean area of these ROIs were 4.8 ±1.2cm2. ROIs were drawn in the myocardial left ventricular septum and blood pool in the contrast-enhanced 1-minute acquisition in axial sections and propagated to the pre-contrast and post contrast acquisitions. Myocardial and blood attenuation values (pre-and post contrast only) were used to calculate the ECV fraction from the ratio of the change in blood and myocardial attenuation (ΆHU) corrected by the blood volume of distribution (1 Hematocrit): ECV   =   (1 Hematocrit) x (ΆHUtissue / ΆHUblood) Synthetic Hematocrit and ECV Methodology 1. Derivation of synthetic Hematocrit To derive a regression model predicting hematocrit from pre-contrast HUblood, clinical unenhanced CT scans of the thorax were retrospectively analyzed (120 kV; reconstructed at 5mm slice thickness and B70F soft tissue kernel). These were consecutive clinical CT scans of the thorax for investigation of malignancy, fibrosis or infection. Datasets were included if the patients had a contemporaneous paired laboratory measured Hct (within 20 days, median 8 days). HUblood was analyzed in a single axial slice through the center of the right atrium. This was chosen to minimize beam-hardening artifact from the spine (compared to aortic blood pool) and partial voluming of papillary muscles in the left or right ventricular blood pool. Synthetic Hct was obtained from the equation describing the linear regression line between laboratory HUblood and Hct. 2. Creation of a synthetic ECV Equation Blood hematocrit was substituted by the derived synthetic Hct to derive a synthetic ECV: Synthetic ECV   =   (1 synthetic Hct) x (ΆHUtissue / ΆHUblood) 3. Validation of synthetic ECV For validation, we used existing patient cohorts to investigate how synthetic ECV (a) compares to conventional ECV with laboratory blood hematocrit,4 and (b) correlates with the reference standard collagen volume fraction.1 3a. Clinical Validation Cohort In order to test synthetic ECV across a range of ECV values, the cohort used by our group to validate ECV by CT in amyloidosis was chosen; this comprised of two sub-groups with differing degrees of extracellular volume expansion: I. patients with cardiac amyloidosis (typically high ECV), comprising of 26 patients with systemic amyloidosis (21 males, age 55 ±10 years; 18 with transthyretin amyloidosis; 8 with systemic AL amyloidosis) with varying degrees of cardiac involvement; II. A comparator group of 27 age- and sex-matched patients with severe aortic stenosis (19 male, age 68 ±8 years) who typically exhibit only mild ECV elevation. Scans were performed between January and December 2013. In the clinical cohort, contrast administration was performed using a bolus only approach with a 1 mL/kg bolus of iohexol and post-contrast imaging at 1 minute (for segmentation) and 5 minutes (for post contrast analysis), as validated by our group previously.4 3b. Histological Validation Cohort For histological validation, the performance of synthetic ECV against a histological measure of fibrosis, the collagen volume fraction (CVF), was tested in a second smaller cohort of patients with severe AS, who underwent intra-operative biopsy (no overlap with clinical cohort). This cohort had been used by our group to validate ECV by CT again histology:1 Consenting severe AS patients (n = 17, median age 71 ±10 years, 76% male) underwent CCT between July 2010 and February 2012. Biopsies were obtained and stained with picrosirius red for histological measurement of collagen volume fraction (CVF) as previously described.21 In the histology cohort, contrast administration followed primed iodinated contrast material infusion (bolus plus maintenance infusion) with a 1 mL/kg bolus of iohexol followed by a maintenance infusion of at a rate of 1.88 mL/kg per hour for 25 minutes, when the post contrast imaging was performed.1 4. OsiriX Plugin To facilitate offline analysis and to exemplify future inline automation by scanner manufacturers, an automatic synthetic ECV plug-in was developed for OsiriX. Statistical analysis Analyses were performed using SPSS (Chicago, IL, USA, version 22). All data are presented as mean  ± SD. Normal distribution was assessed by using the Kolmogorov-Smirnov test. Differences were assessed using unpaired, two-sided student t-tests (significance level p). Agreement between conventional and synthetic ECV was analyzed using the Bland-Altman method. The significance of the difference between two correlation coefficients was tested using the Fisher r-to-z transformation. RESULTS[TT2] Step 1. Derivation cohort 40 thoracic CT scans with contemporaneous Hct samples within 20 days (mean 8 ±7 days) of the scan were included (n=40, 53% male, age 60 ±20 years) with a broad range of Hct (mean 38.2 ±6.0%; range 24.7-50.7%) and HUblood (mean 40 ±8; range 20-55). The linear regression equation was:   (sHct = [0.51 * HUblood] + 17.4) with R2=0.47 p (Figure 1). Step 2. Creation of the synthetic ECV Equation Blood hematocrit was substituted by the derived synthetic Hct to derive a synthetic ECV: Synthetic ECV   =   (1 ([0.51 * HUblood] + 17.4)x (ΆHUtissue / ΆHUblood) Step 3. Validation Step 3a. Clinical cohort Baseline characteristics of twenty-six systemic amyloidosis and twenty-seven AS patients are shown in Table 1.In this cohort, Hct were mean 41.4 ±3.8% (range 29.3-47.4%) and HUblood mean 40.2 ±3.9 (range 29.3-50.1). Synthetic ECV, calculated using the regression model to derive HCT,and conventional ECV were highly correlated (R2=0.96; p) with a 5.7% SD of differences and minimal bias (2.4%) on Bland-Altman analysis (Figure 2). ECVCT was significantly higher in amyloid patients with definitive cardiac involvement than aortic stenosis (54 ±11% versus 28 ±4%, p Step 3b. Histology cohort Baseline characteristics of the histology cohort are described in Table 2.The mean histological CVF of the 17 biopsies was 18  ± 8% (range 5% to 40%), Hct were 40.2 ±4.6% (range 29.4-46.4%) and HUblood 37.7 ±4.2 (range 29.5-45.1). Synthetic and conventional ECV both correlated well with collagen volume fraction (R2 = 0.50, p vs. R2 = 0.50, p ; Figure 3) and did not differ statistically on Fisher r-to-z transformation (p = 0.8). Step 4. Automatic synthetic ECV plug-in in OsiriX Example output of the OsiriX plugin are shown in Figure 4, and the code is provided in the supplementary data. This plugin involves three simple steps: I. Manual segmentation of the blood pool in the pre- and post-contrast images; II. The plug-in automatically estimates blood hematocrit using the attenuation relationship defined above; III. The plug-in produces a three-dimensional myocardial ECV volume, where each image voxel represents an ECV value. Reproducibility Inter- and intra-observer agreement was excellent for myocardial (ICC = 0.92 and ICC = 0.94, respectively) and blood pool (ICC = 0.96 and ICC = 0.99, respectively) attenuation measurements. Similarly for ECV, excellent agreement was found (ICC = 0.95 and ICC = 0.98, respectively). Repeat sampling variability was tested in 44 patients who underwent two samples a median of 4 hours apart. Test:retest variability of laboratory hematocrit was higher than expected (n=44, variability 10% with hct:hct R2=0.86.11 DISCUSSION Identifying interstitial heart disease is important for diagnosis and prognosis,10 and myocardial extracellular volume fraction (ECV) can be measured non-invasively by CCT.1-4 However, its measurement is complicated by the necessity for venous blood sampling, image analysis and then offline ECV calculation. This process is cumbersome and a major obstacle for implementing this technique into routine clinical practice. In this manuscript, we simplify the technique by calculating ECV without blood hematocrit. This development arose out of a need to simplify ECV measurement to make it more clinically applicable. We utilize the relationship between hematocrit and blood attenuation (the attenuation of blood decreases with anemia)12-14, 17-19 to derive a synthetic hematocrit for immediate synthetic ECV calculation without blood sampling. We show that synthetic ECV was highly correlated to conventional ECV, and had a similar association to the histologic reference standard of CVF. The implementation of an offline automated processing tool provides a significant aid to workflow, allowing for ECV measurement in routine clinical practice.   Automated synthetic ECV can be implemented inline on CT scanners with test performances approaching that of conventional ECV measurement. ECV quantification by CT, despite it lower signal to noise ratio, has key advantage over CMR: The CT approach is cheaper and widely available, can be completed in 5 minutes, and the scanner design can accommodate patients with obesity and claustrophobia (CMR is not suitable in around 10% of patients due to claustrophobia or many cardiac pacemakers).22 Furthermore, ECV by CCT can provide high-resolution 3D ECV volumes with whole heart acquisition and limited cardiac motion. Finally, the concentration of iodine has a linear relationship with th e CT attenuation value, which is not affected by fast exchange mechanism like CMR T1 mapping (depending on cell size and contrast dose, fast transcytolemmal water-exchange may reach its limits), which do not apply to CT.23, 24 ECV (by CMR or CT) allows quantification of a key pathophysiological pathway in heart failure: interstitial expansion due to diffuse myocardial fibrosis (or in rare cases by deposition of amyloid fibrils).1-4 As the CMR field is showing, ECV is diagnostic in certain diseases, tracks myocardial remodelling and predicts outcome.25, 26 Interstitial expansion can be global (hypertension, aortic stenosis) or focal (hypertrophic or dilated cardiomyopathy), therefore high spatial resolution and whole heart coverage is important. Due to the aforementioned advantages of CT over CMR, ECV by CT will undoubtedly receive greater attention as part of comprehensive assessment of the heart by CT coronary angiography, perfusion and myocardial tissue characterization. Limitations[TT3] The study has limitations. In the derivation cohort, the mean interval between Hct samples and CT 8 days. Normal within-subject variation in Hct between 1 day and 1-2 months in a healthy adult is actually very low (3%), but together with an analytical variation (3%) this may explain a relative change of >10% between two successive Hct values.27 The control cohort used in this study comprised of patients with AS rather then healthy volunteers, but, given the exposure to ionizing radiation and contrast, patients with AS were deemed as adequate control cohort, avoiding exposure of healthy volunteers. For the same reasons, variability of repeat synthetic ECV was not tested. Development and validation were performed using a single scanner platform, therefore this regression model is only valid for 120 kV and an X-ray tube used in a specific CT vendor. Spectrum of the X-rays emitted by a CT X-ray tube substantially varies among CT vendors. In addition, low KV scans are increasingly used to reduce radiation exposure to the patients. Consequently, multiple regression models for different KV settings as well as for different CT vendors should be carefully prepared for synthetic ECV by CCT. Other factors that may affect the attenuation of blood such as temperature28 and other blood constituents such as macromolecules, fat and iron require further investigation. The 64-slice-CT-system employed here reflects commonly available systems, but did not offer iterative reconstruction algorithms, dual energy acquisition and larger detector arrays that allow acquisition of whole heart, isotropic volumes of in one heart beat and at low radiation dose. In single-source 64 detector rows CT, myocardial CT attenuation is not homogenous due to artifacts, especially in the inferior wall and lateral wall. In the current study, we only included data from ROIs in the left ventricular septum. The accuracy of synthetic ECV should be validated in other segments in LV myocardium, if synthetic ECV by CT is more widely available and used in patients. Furthermore, 3D image registration and processing, reduces the errors of whole heart ECV maps.29 CONCLUSION Synthetic hematocrit derived from the relationship between blood hematocrit and blood attenuation allows quantification of the myocardial extracellular volume fraction by cardiac computed tomography without the need for blood sampling. ECV shows great potential, allowing myocardial tissue characterization with negligible effect on workflow and radiation dose. However wider adoption requires simplification and automation of the established technique synthetic ECV offers this. REFERENCES 1.Bandula S, White SK, Flett AS, et al. Measurement of myocardial extracellular volume fraction by using equilibrium contrast-enhanced CT: validation against histologic findings. Radiology. 2013;269:396-403. 2.Nacif MS, Kawel N, Lee JJ, et al. Interstitial myocardial fibrosis assessed as extracellular volume fraction with low-radiation-dose cardiac CT. Radiology. 2012;264:876-883. 3.Nacif MS, Liu Y, Yao J, et al. 3D left ventricular extracellular volume fraction by low-radiation dose cardiac CT: assessment of interstitial myocardial fibrosis. J Cardiovasc Comput Tomogr. 2013;7:51-57. 4.Treibel TA, Bandula S, Fontana M, et al. Extracellular volume quantification by dynamic equilibrium cardiac computed tomography in cardiac amyloidosis. J Cardiovasc Comput Tomogr. 2015. 5.Kurita Y, Kitagawa K, Kurobe Y, et al. Estimation of myocardial extracellular volume fraction with cardiac CT in subjects without clinical coronary artery disease: A feasibility study. J Cardiovasc Comput Tomogr. 2016;10:237-241. 6.Ugander M, Oki AJ, Hsu LY, et al. Extracellular volume imaging by magnetic resonance imaging provides insights into overt and sub-clinical myocardial pathology. Eur Heart J. 2012;33:1268-1278. 7.Banypersad SM, Fontana M, Maestrini V, et al. T1 mapping and survival in systemic light-chain amyloidosis. Eur Heart J. 2015;36:244-251. 8.Wong TC, Piehler K, Meier CG, et al. Association Between Extracellular Matrix Expansion Quantified by Cardiovascular Magnetic Resonance and Short-Term Mortality. Circulation. 2012;126:1206-1216. 9.Wong TC, Piehler KM, Kang IA, et al. Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in diabetes and associated with mortality and incident heart failure admission. Eur Heart J. 2014;35:657-664. 10.Schelbert EB, Fonarow GC, Bonow RO, Butler J, Gheorghiade M. Therapeutic targets in heart failure: refocusing on the myocardial interstitium. J Am Coll Cardiol. 2014;63:2188-2198. 11.Moon JC, Treibel TA, Schelbert EB. T1 mapping for diffuse myocardial fibrosis: a key biomarker in cardiac disease? Journal of the American College of Cardiology. 2013;62:1288-1289. 12.New PF, Aronow S. Attenuation measurements of whole blood and blood fractions in computed tomography. Radiology. 1976;121:635-640. 13.Black DF, Rad AE, Gray LA, Campeau NG, Kallmes DF. Cerebral venous sinus density on noncontrast CT correlates with hematocrit. AJNR. American journal of neuroradiology. 2011;32:1354-1357. 14.Collins AJ, Gillespie S, Kelly BE. Can computed tomography identify patients with anaemia? The Ulster medical journal. 2001;70:116-118. 15.Lan H, Nishihara S, Nishitani H. Accuracy of computed tomography attenuation measurements for diagnosing anemia. Jpn J Radiol. 2010;28:53-57. 16.Jung C, Groth M, Bley TA, et al. Assessment of anemia during CT pulmonary angiography. Eur J Radiol. 2012;81:4196-4202. 17.Kamel EM, Rizzo E, Duchosal MA, et al. Radiological profile of anemia on unenhanced MDCT of the thorax. Eur Radiol. 2008;18:1863-1868. 18.Wojtowicz J, Rzymski K, Czarnecki R. Severe anaemia: its CT findings in the cardiovascular system. Eur J Radiol. 1983;3:108-111. 19.Doppman JL, Rienmuller R, Lissner J. The visualized interventricular septum on cardiac computed tomography: a clue to the presence of severe anemia. Journal of computer assisted tomography. 1981;5:157-160. 20.Jalbert F, Paoli JR. [Osirix: free and open-source software for medical imagery]. Revue de stomatologie et de chirurgie maxillo-faciale. 2008;109:53-55. 21.Flett AS, Flett AS, Hayward MP, et al. Equilibrium contrast cardiovascular magnetic resonance for the measurement of diffuse myocardial fibrosis: preliminary validation in humans. Circulation. 2010;122:138-144. 22.Rosmini S, Treibel TA, Bandula S, et al. Cardiac computed tomography for the detection of cardiac amyloidosis. J Cardiovasc Comput Tomogr. 2016. 23.Moon JC, Messroghli DR, Kellman P, et al. Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement. J Cardiovasc Magn Reson. 2013;15:92. 24.Coelho-Filho OR, Holland DJ, Mongeon FP, et al. Role of Transcytolemmal Water-Exchange in Magnetic Resonance Measurements of Diffuse Myocardial Fibrosis in Hypertensive Heart Disease. Circulation. Cardiovascular imaging. 2013;6:134-141. 25.Banypersad SM, Banypersad SM, Sado DM, et al. Quantification of Myocardial Extracellular Volume Fraction in Systemic AL Amyloidosis: An Equilibrium Contrast Cardiovascular Magnetic Resonance Study. Circulation. Cardiovascular imaging. 2013;6:34-39. 26.Wong TC, Wong TC, Piehler KM, et al. Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in diabetes and associated with mortality and incident heart failure admission. European Heart Journal. 2013. 27.Thirup P. Haematocrit: within-subject and seasonal variation. Sports Med. 2003;33:231-243. 28.Bydder GM, Kreel L. The temperature dependence of computed tomography attenuation values. Journal of computer assisted tomography. 1979;3:506-510. 29.Nacif MS, Liu Y, Yao J, et al. 3D left ventricular extracellular volume fraction by low-radiation dose cardiac CT: assessment of interstitial myocardial fibrosis. J Cardiovasc Comput Tomogr. 2013;7:51-57. FIGURES Figure 1: Derivation of synthetic hematocrit from the attenuation of blood Thoracic CT scans (n=40, 53% male, age 60 ±20 years) with contemporaneous hematocrit samples (mean interval 8.8 ±7.3 days) of the scan were used to create a regression line between hematocrit (Hct; 38.2 ±6.0%; range 24.7-50.7%) and blood attenuation (HUblood; 40.7 ±8.0; range 19.5-55.2). The regression line between Hct and HUblood was linear (R2=0.47 p) with a regression equation for synthetic Hct = [0.51 * HUblood] + 17.4). Figure 2: Validation of synthetic ECV vs conventional ECV in AS and Amyloid Synthetic ECV, calculated using the regression model,and conventional ECV were highly correlated (R2=0.96; p) with a 5.7% SD of differences and minimal bias (2.4%) on Bland-Altman analysis (right image). Figure 3: Histological Validation of Synthetic ECV Synthetic and conventional ECV both correlated well with collagen volume fraction (R2 = 0.50, p vs. R2 = 0.50, p ) and did not differ statistically. Figure 4: OsiriX Plugin workflow To facilitate offline analysis and allow future inline automation, an automatic synthetic ECV plug-in was developed for Osirix. Following manual segmentation of the blood pool in the pre- and post-contrast images, the plug-in automatically estimates blood hematocrit using the attenuation relationship defined above, and produces a three-dimensional myocardial ECV volume from pre- and post-contrast CCT data.

McDonalds Employee Relations

McDonalds Employee Relations Q.a. What may McDonalds have considered in order to establish their approaches to collective bargaining in both Germany and the UK? To answer the above question we first need to know about basics of collective bargaining where Collective Bargaining is defined as the process of turning disagreements into agreements in an orderly fashion. Collective bargaining is the process followed to establish a mutually agreed set of rules and decisions between unions and employers for matters relating to employment. This is a regulating process dealing with the regulation of management and conditions of employment. Collective bargaining is used as the negotiation process between employees and employers with unions acting as the representatives of employees. The entire process depends on the bargaining powers of the concerned parties. In line with the above definition McDonalds may have considered the approach and settings of collective bargains as an important issue of employee relations. The German setting and approach McDonalds may have considered establishing their approaches to collective bargaining in Germany: The traditional collective approach to Employee Relations (ER) in German companies is deeply rooted in the particular configuration of the German Industrial Relations (IR) system. This is characterized by a high degree of regulation and a dense, encompassing institutional infrastructure that imposes a uniform set of institutional constraints on companies, but at the same time provides incentives for employers to accept institutional constraints. McDonalds, to establish its approaches to collective bargaining this ER and IR framework may have been considered in first instance. In addition, the institutional structure is highly integrated with strong linkages, not only within the IR system, but also to the wider German businesses system. Key elements of the German model, to which the majority of German companies subscribe, are the centrally co-ordinated sector based collective bargaining system and employee representation at domestic level via the works council system equipped with sta tutory participation and consultation rights. Food industry in Germany is not beyond this mechanism where McDonalds considerations regarding collective bargaining approach must have encompassed with statutory participation and employee consultation and codetermination rights. Indeed, German employers have to negotiate a densely structured institutional framework inside and outside the company level. The German approach to collective bargaining is also underwritten by strong labor market legislation and an elaborate welfare system. Despite growing interest in individual bargaining style direct employee involvement mechanisms, their uptake has so far been comparably modest in German companies (Sperling, 1997). Because of the wide ranging rights of information, consultation and co-determination in the German food industry, the use of individual voice mechanisms is relatively unimportant in the German setting where collective bargaining still has the paramount influence. Therefore, in the international context, McDonalds may have considered a propensity to support a collective approach to ER in their international operations by recognizing trade unions, engaging in collective bargaining and establishing strong workplace level employee representation systems. The UK Setting and the UK Approach to Employee Relations In contrast to Germany, the contemporary British system of collective bargaining is characterized by a weak regulatory framework and a thin, fragmented institutional infrastructure, which imposes relatively few barriers and constraints on labour relations practices. The fragmentation of the institutional structure goes hand in hand with weak linkages both within the IR system and in connection to the wider national business system which obviously includes food industry in the UK. Because of the relative permissiveness of the contemporary IR context, the UK seems to be a particularly suitable country for McDonalds, as subsidiary, to explore the country of origin effect in international operations, since home country approaches to ER can be transferred relatively unconstrained by host country institutional arrangements. However, to uncover the existence of possible ownership effects it is necessary to establish the differential space between the home and the host country ER approaches. Contrary to the German experience, no distinct stereotypical UK ER approach can be identified. Traditionally the cornerstone of labor relations was the pluralist workplace industrial relations system, which subsequently collapsed in the 1980s in the wake of the neo-liberal labor market policies under the Thatcher government. These reforms are most important issue to be considered in establishing collective bargaining approaches in the UK which have encouraged employers to dispense with collective labour relations and to individualise ER along the lines of US style HRM by end of the 1990s a collective approach to ER is no longer representative of the economy as a whole, but is increasingly confined to the public sector and a dwindling minority of private sector companies. In the private sector, trade union recognition collapsed throughout the 1980s and 1990s and with it the incidence of workplace level trade union representatives. The institution of collective bargaining dramaticall y declined. By 1998, two-thirds of private sector employees had their pay fixed by management decision without any union involvement. Here, employees are neither represented by collective voice mechanisms, nor do they enjoy a comprehensive individual voice mechanism. In case of establishing McDonalds may have considered those conditions and changing mechanisms to establish their approaches to collective bargaining efficiently. Factors May have been considered by McDonalds National Legislation: National legislation must have been considered by the McDonalds in establishing their approached towards collective bargaining within the industry both in UK and Germany. In the UK legislation there is no specific preference regarding the mode of employee or industrial relationship for MNEs like McDonalds. So McDonalds is well known as anti-union giant in the UK and their approach towards collective bargaining is strictly negative. In Germany on the other hand, has a highly regulated industrial relations system which, in theory at least, provides considerable constraints on the employee relations practices of MNEs. As a result McDonald had to thing the statutory bindings and regulations constraints regarding approaches to collective bargaining. Codetermination and collective bargaining rights The McDonalds in case of both Germany and UK has considered these rights as a different approach. German workers enjoy a dual system of representation, collective bargaining rights and co-determination rights through the institution of the works council and the supervisory board. Together with codetermination and collective bargaining rights, these legally enforceable and constituted rights appear to provide German employees with significant power resources compared to UK employees. So McDonalds must have considered the issues of the both rights of the employees before establishing their bargaining approach. Size of Franchise: The McDonalds corporation established itself in the UK in 1974, in Germany in 1971. The corporation currently has well over 800 stores in Germany amongst approximately 65% outlets are franchisee where in there are a similar number of stores in the UK with some 20% franchisee with approximately 45,000 employees in each country. In this case being a fast-food market leader in both countries McDonalds have considered the size of franchise. The franchise aspect influence collective bargaining issues through local entity and regulations involvement. So size of franchise is also a factor that may have been considered. Unioin Membership: McDonald also may have considered Union membership. German unions are arguably better organized and have retained a position of relative strength compared to those in the UK. Union membership at McDonalds in Germany and in the German fast-food industry is very small at around 5 per cent. However, these low percentages are still higher than the percentage of union membership at McDonalds and the fast-food industry in the UK. So this issue is an important consideration in establishing Macdonalds collective bargaining approach. The increasingly anti-union climate: The increasingly anti-union climate in the 80s and early 90s has encouraged Macdonalds in the UK to withhold or withdraw union recognition, and discouraged employees from joining unions and posed difficulties for recruitment. In Germany, union membership remains at around 5 per cent at McDonalds. The findings suggest that it is only where a works council has been established where still there is better union practice than the UK. So this consideration may have been involved in planning McDonalds approach towards collective bargaining. Characteristics of Workforce and Nature of the industry: McDonalds have considered both the factors in case of both countries to design its approach towards collective bargaining. Redundancy and employee apathy: Redundancy and employee apathy amongst part-time, temporary, foreign or young workers undoubtedly play an important role in the low or non-existent levels of union membership. So this factor may have been considered in both UK and Germany. Strong corporate culture: Strong corporate cultures are seen as instilling appropriate behaviors and. This is essentially what is argued here with regard to the non-union approach of McDonalds in both the countries. McDonalds Anti-union belief: McDonalds is basically a non-union company and intends to stay that way. About unionization in the UK once McDonalds stated thatà ¢Ã¢â€š ¬Ã‚ ¦.. unionization has risen its ugly head over the years, but you know, we feel that we offer a good deal to people, all kinds of ways in which we can communicate, so that if there was a problem they can bring it to management, we feel that we dont need unions. But in Germany McDonalds never been outspoken like in UK about union. Public image Macdonalds has a big public image and brand reputation which may have been considered both in the UK and Germany to establish collective bargaining approaches. Employer Associations Employer associations in Germany are stronger than UK. So the MsDonaldS approach in the UK is different from that of Germany. Q.b. How may McDonalds have considered individual bargaining as an alternative or additional approach in both Germany and the UK? What benefits and/or problems may this have brought in both countries? Individual bargaining: Individual bargaining is the process by which an employer and an employee negotiate an individual contract of employment, regulating the terms and conditions of employment. Individual Bargaining: Advantages The main advantage of individual bargaining is it is a single voice and thus there is no conflict in matters Another advantage of individual bargaining is that it expresses the views and opinions of one person and thus there is no compromising Individual Bargaining: Disadvantages The main disadvantage of individual bargaining is that the manager will not take a lot of notice of just one persons views or opinions and therefore nothing will happen Thus there is not a lot of chance that individual bargaining will have an influence on company decisions and policies. Collective Bargaining: Advantages The main advantage of collective bargaining is that the manager will not take a great deal of time in deciding on what action to take on an individual level. The employees have greater influence in the final decision the manager will take. There is also a chance of the employees getting what they demand. Collective Bargaining: Disadvantages The main disadvantage of collective bargaining is that it is seen as depriving the individual worker of their individual liberty and voice. The major changes in the industrial relations in UK i.e. a shift away from collective bargaining towards individual argaining were in the favour of McDonalds own strategy. The turn down in the union membership in both UK and Germany also helps McDonalds to practice the individual bargaining in their organization. Benefits: Improvement in the relationship of management and workers within the organization as it is evident from the statement of John cooke McDonalds US Labour relations chief as: We feel that we offer a good deal to people, all kinds of ways in which we can communicate, so that if there was a problem they can bring it to management. As employees are generally unaware of their rights they can take advantage of the situation to save their costs. As example is given cleaning of uniforms. And also regarding pay, performance related pay, probation and notice for redundancy, paid leave. Individual workers can never be a threat for McDonalds where there may have a chance in the existence of trade union. Disadvantages: Loss of public image in Germany that subsequently decrease their sale growth in German market. Large compensation need to provide for violating employees rights in different work place. Q. c. How may the approach to collective bargaining in Germany and the UK influence employee relations for McDonalds internationally? McDonalds opposition to trade unions is now well-documented; however, the extent to which it can operate without unions or can avoid or undermine collective bargaining with unions and/or statutory works councils varies considerably in different countries and over time. Consequently the ability of national unions and their GUFs to improve pay levels and conditions of work has been limited, variable and by no means static. This is nicely illustrated by McDonalds operations in New Zealand where the corporation responded pragmatically to changes in government and labour legislation, excluding unions from and then returning to collective bargaining ahead of law reforms aimed at strengthening unions in 2000, but continued to keep unions out of its restaurants wherever possible. Attempts to regulate McDonalds employment conditions are therefore an ongoing struggle in which without pro-union labour law, unions have little chance of organising workers and even less chance of establishing collective agreements. This may come as no surprise in countries such as the and Ireland where unions have had either no success or short-lived successes in gaining union recognition only to be denied before collective agreements can be established or enforced. However, even unions located in countries with more stringent labour legislation (e.g. Denmark, the Netherlands, France, Italy, Germany, Sweden and Norway) have had varying success in achieving some improvements in employee representation, pay and conditions of work and even where improvements have been achieved they are often under threat. Union attempts to increase the number of union-backed works councils and establish a company-level works council (Gesamtbetriebsrat) have completely failed, resulting from a number of sophisticated union-busting practices. Furthermore, despite some success in persuading McDonalds to accept collective bargaining in Germany in the late 1980s, McDonalds withdrew from collective bargaining in 2002 and has threatened to deal exclusively with a yellow union. In Denmark, where average union membership is much higher than Germany and labour law is equally stringent, McDonalds only agreed to bargain collectively after a year of conflict and boycotts involving other Danish unions and support from Finnish and Swedish unions in the late 1980s. McDonalds has tried to roll-back the basic terms of such agreements ever since. Nevertheless, in Sweden, Norway and Denmark, McDonalds workers do enjoy better conditions of work and higher pay than in other European countries and the USA itself. However, even in those countries it is very difficult to establish union representatives in the outlets, something which experience shows is essential if such collective agreements are to be properly enforced in. Despite these difficulties European unions have undoubtedly had some success in bringing McDonalds to the bargaining table, especially where sector-level bargaining is in effect compulsory and where labour law is more stringent and supportive of union rights and collective bargaining. Q.d. What additional or alternative methods could support good employee relations for McDonalds? Consider the role an HR function could take? The HRM approach to employee relations can be described in terms of several prescriptions that McDonalds can use for good employee relationship. An HRM model for employee relations focuses on a drive for commitment meaning that the focus of the organization should be to win the trust, motivation and commitment to the organization, participating in its development opportunities. Emphasis is on mutuality, meaning that employees share common goals, the vision and mission of the organization. Communication within the organization follows an established set of procedures that are agreed formally or informally and may include briefings, meetings with representatives, etc. HRM emphasizes the shift from collective bargaining to individual contracts. Employee involvement in McDonalds may be fostered and a number of techniques and approaches are followed to support their involvement. Total quality management aims at continuous improvement of quality. Another initiative for McDonalds is flexible working arrangements and focus on the life-work balance through harmonization of conditions for all employees. Finally the support of employee communities of practice and team spirit are of high priority. Employee relations describe as in-terms employee communication, employee involvement, employee rights and employee discipline. Armstrong has identified the elements of employee relations as follows may have been considered in designing the employee relationship: Formal and informal policies and practices of the organisation. The development, negotiation and application of formal systems, rules and procedures for collective bargaining, handling disputes and regulating employment. Policies and practices for employee communications . Informal and formal process regulating the interactions between managers and employees. Policies of the government, management and trade unions. A number of parties including state, management, organisations, trade unions, employees, etc. The legal framework. Institutions (e.g. ACAS) and the employment tribunals. The bargaining structures, recognition and procedural agreements enabling the formal system to operate. Employee relations processes Figure Reconciliation of interests between employers and employees According to the Industrial Relations Services there are four approaches to employee relations that can contribute in better relationship between McDonalds and its employees are: Adversarial meaning that employees are expected to follow the targets identified by the Organization. Traditional meaning that employees react on management proposals and directives. Partnership meaning that employees are involved in assisting the organisation and consensus is reached in decision making related to policies. Power sharing employees are involved also in daily management apart from policy making. Employee relations policies act to disseminate its preferred approach with respect to the relationship it wants to have with its employees and the empowerment of employees for certain activities. Employee relation policies cover several areas McDonalds may have used in improving employee relations including: Trade union recognition meaning decisions with respect to the recognition or derecognition of certain unions and preferences of the unions the organisation prefers to deal with. Collective bargaining meaning the identification of those areas that should be covered from such a negotiation. Employee relations procedures meaning procedures such as redundancy, grievance handling and disciplinary actions. Participation and involvement meaning the extent to which the organization shares power and control with its employees. Partnership meaning the extent to which a partnership with employees is desirable. The employment relationship meaning the extent to which employment terms and conditions are controlled by collective agreements or individual contracts. Harmonization meaning the harmonization of terms and conditions of employment arrangements. Working arrangements meaning the extent to which unions are involved in the determination of working arrangements. Employee involvement is central to employee relations as Bratton and Gold discuss. Employee involvement can be described in terms of the form of involvement (whether it is formal or informal), the level of involvement in the organizational hierarchy and the degree of involvement. Across these three employee involvement dimensions several types of involvement can be rated from the lower ones in terms of empowerment, involvement and organizational level to the higher ones. Through wide range of employee involvement McDonalds can start good employee relations process which never been in this organization. The following situations are ranked in an ascending order in terms of all three dimensions of employee involvement McDonalds should take into consideration: Communication -> Financial Involvement -> Problem solving groups -> Quality circles -> Cross functional teams -> Self directed teams -> Collective bargaining -> Worker directors -> Works councils. Employee involvement in McDonalds can be described as an involvement-commitment cycle, a communication cycle that builds an internal culture encouraging initiative, learning and creativity. The cycle consists of the following stages: Managers perceive the need for involving employees in decision making Introduce new forms, employee involvement and open communication mechanisms Greater autonomy and input into decision making Increased employee job satisfaction, motivation and commitment Improved individual and organisational performance. Q.e. Conclude by taking the key elements of your observations in steps a-d regarding McDonalds approach to employee relations in order to make a short recommendation for similar countries or organisations with regard to developing and/or improving their employee relations Findings recommendations: The process of collective bargaining is to settles down any conflicts regarding the conditions of employment such as wages, working hours and conditions, overtime payments, holidays, vacations, benefits, insurance benefits etc. and management regulations. In most areas, McDonalds German employees appear to enjoy better conditions than their UK counterpart. This is particularly so with regard to holiday entitlement but again this is still lower than for most German firms. The recent UK pay increase has brought pay levels close to those in Germany. In Germany the NGG are satisfied that by and large they have been able to improve pay and conditions for most employees, however, there remain two main problems. The above discussion suggests that there is an obvious need to scrutinise the powers of MNEs and it raises questions about the adequacy of labour legislation. Conditions of work and employment appear to be increasingly threatened, regardless of particular institutional arrangements. Weak or ambiguous legislation and continuing employer demands for flexibility, decentralisation and deregulation may increasingly allow MNEs to choose employee relations policies with interference from external labour market institutions. This may be too pessimistic, clearly more comparative work is needed in the area and it will need to concentrate on the common themes or tensions in all countries and examine how they are affecting the choices of micro-level actors and institutional arrangements in different societies. Individual bargaining can be used as both of alternative to collective or in parallel. But my recommendation for Macdonalds to use individual bargaining as an alternative approach specially in Europe and American territory whereas in Australia and New Zealand it could be used in addition. Due to decline in collective bargaining in all over the world it is now strongly recommended that McDonalds should prepare to adapt with a change in the bargaining structure which is becoming more decentralised in Sweden, Australia, the former West Germany, Italy, the United Kingdom, and the United States, although in somewhat different degrees and ways from country to country. We have also come to understand that bargaining structure both influences and is influenced by the distribution of bargaining power. Yet, data that allow clear tests of the effects of changes in bargaining structure on bargaining outcomes generally have not been available. The difficulty of assessing the effects of bargaining structure arises in part from the fact that there is no simple measure of the degree of bargaining structure centralisation, because the location of collective bargaining often differs depending on the subject of bargaining. In many countries, wages are negotiated in company or sectoral agreements, and work rules are set at a lower level, often in plant agreements. Furthermore, worker participation in decision making often occurs at still another bargaining level, or through informal mechanisms (works councils or shop floor discussions, for example) rather than through collective bargaining agreements. McDonalds is now a biggest brand in the food industry world-wide. So it has its own responsibility to look into public image and good employee relations which are widely correlated. So McDonalds should keep very efficient employee relation practice through an efficient Human Resource Strategy and functioning properly on HR roles. Web Resorce: www.rdi.couk http://www.wales.ac.uk/en/account/login.aspx References: Royle,T (1999) The reluctant bargainers? McDonalds, unions and pay determination in Germany and the UK, Industrial Relations Journal,30(2), p135-150 A, Arthur and et al. (2001),Strategic Management: Concepts and Cases, 12thedition, McGraw-Hill Irwin ACCA, 2005-2006, Paper 3.5 Strategic Business Planning and Development, 5th Edition, June 2005, for exams in December 2006 and June 2006 Study Text, BPP Professional Education BBC.com (2003). Court dismisses McDonalds obesity case. BBC. 22 January http://www.bbc.com/issues_06/030807EC.html. (Accessed: 2 November 2007). Bized.co.uk.(2006). McDonalds Company Facts. Bized.co.uk. [Online]. Available at: www.bized.co.uk/compfact/mcdonalds/mcindex.htm. Botterill, J. and Kline, S. (2007). Re-branding: the McDonalds Strategy. Emerald management First. Brassington F., (2005). Essentials of Marketing (Vol. 2). USA, St. James Press. CNNMoney.com (2007). Fortune 500 index. CNN.com. [Online]. money.cnn.com/magazines/fortune/fortune500/2007/index.html. Data Monitor. (2007) McDonalds Corporation Profile Reference Code:067DBDCC-E9DC-4CAC-80AD-164A6748F392 [Athens], http:/ www.datamonitor.com, Eisenberg, D. (2002). Can McDonalds ShapeUp? . Times.com. 25 September. http:/ www.time.com/time/business/ article/0,8599,354778,00.html Erlichman, J. (1994). Leaflet A Threatto McDonalds. The Guardian.29 June. http://www.guardian.co.uk/uk_news/story/0,3604,1299121,00.html. External and Internal Factors Affecting McDonalds- Management Theory. External and Internal Factors Affecting McDonalds Management Theory Paper Forrest, W. (2006). McDonalds Applies SRM Strategy to Global Technology. Reed Business information. 7 September. http:/ www.purchasing.com/article/CA6368285.html. Goggoi P.. (2006). Why McDonalds Isnt Free of Trans Fat Business Week Online 00077135 [EBCSCO], http://web.ebscohost.com/ehost/detail?vid=2HYPERLINK http://web.ebscohost.com/ehost/detail?vid=2hid=117sid=17122dbb-79eb-4b1f- [emailprotected]HYPERLINK http://web.ebscohost.com/ehost/detail?vid=2hid=117sid=17122dbb-79eb-4b1f- [emailprotected]hid=117HYPERLINK http://web.ebscohost.com/ehost/detail?vid=2hid=117sid=17122dbb-79eb-4b1f- [emailprotected]HYPERLINK http://web.ebscohost.com/ehost/detail?vid=2hid=117sid=17122dbb-79eb-4b1f- [emailprotected]sid=17122dbb-79eb-4b1f- b879-472028dbb304%40sessionmgr109 HealthActive (2007) Active After-school Communities http://www.healthyactive.gov.au/internet/healthyactive/publishing.nsf/Content/active_after_school_communities.pdf/$File/active_after_school_communities.pdf Henry Assael, 1998, Consumer Behavior and marketing action, 6th Ed., South-Western College Publishing IASO International Association for the study of Obesity. (2007). Making schools and young people responsible: a critical analysis of Irelands obesity strategy. http://www.blackwell-synergy.com/doi/full/10.1111/j.1365- 2524.2008.00763.x#Education,%20schools%20and%20obesity, Jagger, S. (2007). As Americans tighten their belts, fast-food operators let it all hangout. In The Times, 21 July 2007, 62.

Free Scarlet Letter Essay: Secrets :: Scarlet Letter essays

The Secrets of The Scarlet Letter Nathaniel Hawthorne's The Scarlet Letter is considered by many to be the greatest accomplishment of an author hailed as the master of the American short story. It is set in Salem, Massachusetts. In this strictly controlled Puritan town the inhabitants live by harsh laws and fierce prejudices. Hester Prynne, a young wife whose husband is presumed dead, is being publicly humiliated for the sin of adultery. The proof of her sin is her baby girl Pearl. She conceals the identity of Pearl's father to protect him from the harsh judgement of Puritan law. She however is doomed to spend the rest of her life marked as an adulterer by wearing a scarlet "A" on her chest. Hester's husband meanwhile has arrived in the colony and taken up practice as a doctor. He makes Hester promise that she won't reveal his identity to anyone. The book covers a seven year period during which the identity of the father becomes known. It is the Reverend Arthur Dimmesdale, who is renowned as an especially holy and pi ous man. Wracked by guilt he starts to show outward signs of serious illness. Hester's husband under the assumed name Roger Chillingworth moves in and begins taking care of Dimmesdale. Chillingworth soon discovers that the Reverend is Pearl's father. Dimmesdale however thinks that Chillingworth is simply a doctor. Chillingworth uses his influence to multiply the feelings of guilt in the minister while trying to keep him in physical health, as a form of emotional torture. At the climax of the story, Dimmesdale confesses and dies. Hester and Pearl leave the colony. Chillingworth whose whole purpose was to get revenge from Dimmesdale suddenly finds his life without purpose and dies within a year. Hawthorne used the settings in the book, not only to develop the story, but to make a statement about Puritan Society through the use of allegory. The Puritans were a people dedicated to perfecting themselves according to a certain set of values that were uniquely Puritan. On the individual level a Puritan would try to reach perfection by living out this series of values. If they did not succeed, as in Hester or Arthur Dimmesdale's cases, their punishment would be in the fact that they did not live up to the perfection they strived for. The prison, in The Scarlet Letter is proof that Salem is a society striving for self perfection, not only individuals dedicated to perfecting themselves.

Types of Cancer and the Impact Upon the Patient and Family Members Essa

Abstract This paper is about cancer and the devastating impact it has on, not only the patient but the family members as well. How it forms, takes shape, what the symptoms are, how to diagnose the illness, and how to treat it as well as live and everyday life with this form of disease. Also how you can prevent it. What steps you can take to make sure you don’t get it. I will also explain on how to look for signs of what types of cancers you might get. Tell you, how often you should get screenings. I will also tell you who is at risk for getting cancer. Just how many people have cancer right now, how many are expected to get it? I will also tell you how many people are expected to die from this disease. I will discuss how there are many different types of cancer. I will also tell you about the stages, symptoms and if it can be cured or be fatal. Finally I have to tell you about the costs of fighting cancer, plus how much of a toll it takes not only on the patient but the family members as well. With cancer it can take not only a physical but emotional toll on everyone involved. Not to mention, all the money and time that is involved in fighting to win the battle. (Ahmedin, 2009). Most people do not discover they have cancer till it is too late. One can hope and pray that they will never contract this disease. Some of it is hereditary and runs in the family. Cancer sometimes is passed down through the generations. Cancer can also skip a generation. Cancer can lay dormant in your body for years and never show signs it is there. The best way to avoid cancer is to eat healthy, exercise, don’t smoke. (Ahmedin, 2009). Cancer and the Devastating Affects On Family Members & Types Cancer is a group of growths and abnormal c... ...on and Cancer; The Currant Epidemiological Evidence. Electronic Journal Center. (Vol.96, Issue S1, 42-45). Khatcheressian, J.L. (2006). American Society Of Clinical Oncology. Breast Cancer Follow Up. (Nov. 2006, (31), 5091-5097). Kristal, Alan R. (2004). Vitamin A, Retinoid and Caroteniods as Chemopreventive Agents For Prostate Cancer. The Journal Of Urology. (Vol.171, Issue 2, Supplement 554-558). Mysliwiec, P.A. (2006). Malignancies Following Cancer of the Colon. Malignancies Among Cancer Survivors. (NIH Publ. No. 05-5302). Schairer, Catherine. (2006). Family History of Breast Cancer as a Risk Factor for Ovarian Cancer in prospective Study. Breast Cancer. Electronic Journal. (Vol. 107, Issue 5, 1075- 1083). Siegfried, Jill M. (2001). Woman and Lung Cancer. Does Estrogen Play a Role. Lancet Oncology, Electronic Journal Center. (Vol. 2, Issue 8, 506-513).

Terrorism Essay: Metaphors for Terror :: September 11 Terrorism Essays

Metaphors for Terror The administration's framings and reframings and its search for metaphors should be noted. The initial framing was as a "crime" with "victims" and "perpetrators" to be "brought to justice" and "punished." The crime frame entails law, courts, lawyers, trials, sentencing, appeals, and so on. It was hours before "crime" changed to "war" with "casualties," "enemies," "military action," "war powers," and so on. Donald Rumsfeld and other administration officials have pointed out that this situation does not fit our understanding of a "war." There are "enemies" and "casualties" all right, but no enemy army, no regiments, no tanks, no ships, no air force, no battlefields, no strategic targets, and no clear "victory." The war frame just doesn't fit. Colin Powell had always argued that no troops should be committed without specific objectives, a clear and achievable definition of victory, a clear exit strategy-and no open-ended commitments. But he has pointed out that none of these is present in this "war." Because the concept of "war "doesn't fit, there is a frantic search for metaphors. First, Bush called the terrorists "cowards"-but this didn't seem to work too well for martyrs who willing sacrificed their lives for their moral and religious ideals. More recently he has spoken of "smoking them out of their holes" as if they were rodents, and Rumsfeld has spoken of "drying up the swamp they live in" as if they were snakes or lowly swamp creatures. The conceptual metaphors here are Moral Is Up; Immoral Is Down (they are lowly) and Immoral People Are Animals (that live close to the ground). The use of the word "evil" in the administration's discourse works in the following way. In conservative, strict father morality (see Moral Politics, Chapter 5) evil is a palpable thing, a force in the world. To stand up to evil you have to be morally strong. If you're weak, you let evil triumph, so that weakness is a form of evil in itself, as is promoting weakness. Evil is inherent, an essential trait, that determines how you will act in the world. Evil people do evil things. No further explanation is necessary. There can be no social causes of evil, no religious rationale for evil, no reasons or arguments for evil. The enemy of evil is good. If our enemy is evil, we are inherently good. Good is our essential nature and what we do in the battle against evil is good.

Procurement Essay

1. A buyer who communicates expectations clearly. The number one quality of a good customer is that they are able to express what they want and need. This ability is vital for a supplier to deliver the right product or service. A supplier can’t deliver what wasn’t asked for. As with pretty much every project of any sort that involves more than one person communication is the biggest factor in success. Poor communication will without a doubt cripple your project and it most often comes in one of two different forms. First there is slow communication. When clients take weeks to get back to you on simple updates projects drag and you don’t get paid. Additionally your motivation for the project will probably drop significantly causing you to take shortcuts when you finally do hear back on changes or approval or make assumptions when you don’t hear back. While your mindset may be that you just want to get this project out the door it could result in sub par work and a poor reflection of your capabilities. Second there is miscommunication. While your client may get back to you in a timely manner there is just something off between the two parties. This road can go both ways, as a designer working with clients its up to you to find out what their comfort level may be when communicating ‘techy’ things. Some clients are plenty familiar with the technology and best practices that go into web design while others will need to be walked through the process more. The positive side of this problem is that it is very avoidable. Communication issues are often glaringly obvious before a project ever gets under way. If you are looking for a project and not a headache you will likely be better off passing on projects that appear to be ridden with communication issues from the get go. 2. Allows a reasonable amount of time for the work. The business world is filled with customers who want it â€Å"yesterday.† Often, what these customers actually get is a rushed job full of mistakes and needing a lot of rework. A good customer, however, understands that quality service from the supplier takes time and plans accordingly. 3. Available for questions. While most suppliers can and do work independently, there’s nothing more frustrating for a supplier than being surprised by an obstacle and being unable to reach the customer for questions and clarifications. Smart customers therefore know that it’s cheaper to get it right the first time than to fix it later. They make themselves available. 4. Pays a fair amount for work required. A bargain is a bargain, except when it’s not. Often paying less than market rate for work results in getting work of less than average quality. That’s because a supplier who works on the cheap often must take on more work than they can really do well just to make ends meet. 5. Pays in a timely fashion. This is a buyer who discusses their payment terms with the supplier before the project begins and then honor those terms. If you say that you will pay within x days of the project’s completion, be sure to pay that amount within that timeframe. Don’t make the supplier beg you for their payment. You could ruin your professional reputation and even your credit history. 6. Has high integrity. Honesty is at the core of every successful business relationship. Suppliers like to deal with customers who conduct all of their business in an honest and transparent fashion. Not only is this a great way to conduct oneself in general, it will also enhance the buyer’s business reputation. 7. A buyer who allows the supplier to do their job. Once the buyer has hired the right person, then they the supplier possess the talent and skill to do the job well. The buyer therefore keeps an open mind about what their supplier proposes. They don’t be constantly second-guessing their supplier’s abilities. 8. A buyer who seeks an ongoing relationship. The best customers understand the value of an ongoing relationship. They don’t want to have to â€Å"break-in† a new supplier with each new project that they have. This will encourage loyalty from both parties which is very essential in any business undertaking. 9. A buyer who gives credit where credit is due. While it’s not always possible to give a supplier authorship credit for a product or service, a discerning customer notices when a supplier puts in extra effort or goes the extra mile in a project. 10. Committed to quality. Most suppliers take pride in their work and want to produce high quality work. They dislike it when a customer asks them to take shortcuts. 11. Project Attachment: Look for clients who are attached to the project at hand. If a project has a high personal or financial value to a client it can help solve a lot of the problems on this list. Working for a client who doesn’t care about the project at hand can be a demoralizing experience. While it might be counter-intuitive try to avoid clients that ‘need’ to have a project done. 12. Additional Work: It’s a little bit of a bonus but also one of the best characteristics about any client. A client that refers their friends to you or has multiple projects to tackle is a huge value to any designer. Be sure to reward your loyal customers with discounts and your best work. After all these clients are saving you a huge amount of time and the effort of finding additional work, time that would otherwise go unpaid. If you like a client that you work with and had a project that went well don’t hesitate to ask them for a testimonial and suggest that they share your contact information with anyone they know who needs a web site as well. 13. Save a large deposit (or buy with cash!) A large deposit shows a level of commitment to the property, as that money is non-refundable when you exchange contracts. The only thing that trumps a massive deposit is, of course, a cash buyer. Assuming the buyer has the funds in place and can prove it, the sale is much more likely to go through quickly without business owners being involved. 14. Flexible buyer: Sellers absolutely love flexible buyers because it means they can do things in the way they want, at the pace they want. This is one reason they like chain-free buyers because they tend to be able to move very quickly if necessary. But the opposite is also true. Perhaps your seller has been unable to find a suitable property themselves so they may want to agree a price with a buyer who is prepared to wait for them. If you are happy to proceed quickly, or slowly, and you make this clear to the seller, it could work in your favor.