Women's Sexuality and Violence linked through Feminism Writing Skills Essay

Women's Sexuality and Violence linked through Feminism Writing Skills - Essay Example Women's Sexuality and Violence linked through Feminism Writing Skills The main objective of this paper is to conduct a research study of the alternate feminist treatments of traditional, patriarchal Western fairy tales and popular myths in the works of Angela Carter, with a special reference to her revolutionary work- The Bloody Chamber (1979), which is a collection of re-told  fairy tales. The work captures the author’s powerful and passionate delineation of  the links between myth, sexuality and violence in constructing female subjectivity. The Bloody Chamber revels in the power of female aspiration to re-imagine and reconstruct the world. The history of violence against women is tough to track, yet it is claimed that violence against women has been accepted, excused and legally sanctioned until the late 19th-century. The practice of violence against women was tangled to the notion of women being viewed as property and the historically unequal power relations between men and women. (UN, 1993) Even today, violence against women is an existi ng reality and "there is no region of the world, no country and no culture in which women’s freedom from violence has been secured." (UN, 2013) Specific forms of violence are more prevalent in specific parts of the world. For example, incidents of dowry violence, acid throwing and bride burning are common in countries such as India, Pakistan, Bangladesh, Sri Lanka, Cambodia and Nepal; honour killings in the Middle East and South Asia; trafficking and forced marriage in some parts of Sub-Saharan Africa and Oceania. (UN, 2013) It is unfortunate that women are targets of unwanted sexual attention even in the modern era of violence-prevention. Women nowadays face sexual harassment on a daily basis even in schools, colleges and workplaces, and this takes a toll on their health, work and studies. Morgan and Gruber provide an extensive coverage on the current state of prevention methods and research studies on violence against women in their book â€Å"Sexual Harassment: Violence a gainst women at work and in schools† The authors Morgan and Gruber have summarised the results of research that say schools where sexual harassment is usually considered as rare occurrence are in reality the ones where girls face high rates of severe harassment. It also reveals the astonishing fact that the men whom women love and trust the most are the ones who violate the very essence of womanhood. (Morgan & Gruber, 2011) Women often succumb to poor health and non-fatal injuries subsequent to incidents of sexual violence. What is even more shocking is that most of these women lack access to treatment, owing to various social and cultural factors. Men are usually reluctant to acquire help from social service organizations, but usually permit women and children to seek medical or psychological help. Hence the need of the hour is that the health care practitioners should focus more and more on the victimised women, in order to increase access to treatment. Susan Staggs and Step hanie Riger, in their journal article â€Å"Effects of Intimate Partner Violence on Low-Income Women’s Health and Employment†, summarise the results of a survey conducted on women of the low-income group, which shows that intimate partner violence and low health is high among these women. (Staggs & Riger, 2005) Research has suggested various theories on why men exert violence on women and has identified the associated risk factors of men. Many thinkers believe that relational factors

Fashion Taste and Ethics Essay Example | Topics and Well Written Essays - 2500 words

Fashion Taste and Ethics - Essay Example The essay "Fashion Taste and Ethics" discovers the taste in fashion. If the word can be taken within this context, ways in which the word culture is used seems to be fine. However, there arguably seem to be a different view concerning the term culture ought to be viewed. Perhaps this can enlist some reaction. With a view to help people appreciate the wholesome significance of a culture for the better understanding of humanity it is it certain that there is meaningless distinction between low cultures and high cultures. This thus implies that it is impossible for a certain group of people to be said to be more cultured or otherwise have more cultures than others. It goes without saying that the term culture from the anthropological point of view has a different distinctive meaning away from what it is known. This paper, therefore, investigates the word culture with a view to provide a fairly precise definition. In this paper, other terms that encompass the term culture shall be discus sed. The paper shall cover some pertinent elements of culture, as well as elaborate how essential culture is as far as human species is concerned. The paper shall sum up with explaining the modern anthropological view concerning how physical or biological differences and cultural differences between the human populations are closely related. The most widely celebrated technological developments are those pertaining to culture. These technologies are widely celebrated because they have broken physical barriers, transforming the world. into a village. The eventuality is that the current era is characterized by increased interaction of people across all cultures in the world. Therefore, it cannot be disputed that, as far as intercultural interactions are concerned, communications remains a pertinent subject. Indeed, communication barriers are not uncommon in communication, especially in communications involving low context and high context cultures. What may make the subject further cr itical is when nonverbal communication is involved. Eye-contact non-verbal communication is one of the critical areas of concern in high-context and low-context intercultural communication. Eye contact is not only an important form of verbal communication, buts also a human form for communication; animals are often disturbed by eye contact (Salas, 1992). A substantial focus has been directed to understanding intercultural eye-contact communication, in order to foster cultural competence and minimize cultural conflict. However, few studies have focused on assessing the implications of eye-contact on instruction adherence, especially in the multi-cultural learning environment. In the early phases of human revolutions, most human activities were limited to organized groups, that is, societies. As time went by, the interaction among these societies opened up, extending across regions, cultures, and languages. Undoubtedly, trends in business activities followed the same trend. Even intri guing is the fact that the world has evolved to the extent that globalizations has made human activities subject to cultural interactions. The world is now a global village, where people across diverse culture and all regions of the world interact more frequently than ever. To this extent, it cannot be overemphasized that human beings, as well as

Licensing and Professional Organizations Research Paper

Licensing and Professional Organizations - Research Paper Example I decided to work in the Family Practice Clinic, as it will suit my passion of serving all from the young to the elderly who may have different difficulties due to their ages. Family nursing practitioner roles requires nurses to be registered nurses in order to serve as primary and as specialty health care providers. FNPs work with patients throughout their lives, conducting exams, diagnosing illnesses, prescribing medication and therapy, conduct routine checkups, and assisting in minor surgical procedures. Working in family nursing organization requires one to dedicate his profession in serving the patients as their sole care provider while also running own private practices. Offering of these requires the nurses to be well structured, multifaceted, independent, and to have a patient facing mentality (Mason, Leavitt & Chaffee, 2013). In family nursing organization, advocacy is the cornerstone of the complete nursing procedures. Nurses usually advocate causes, patients, and the profession itself. The main advocacy in the organization, motivated by the moral and ethical principles will be seeking to influence different policies in the primary health care sector. The influence would be through arguing or pleading within the economic, political, and social systems in an effort to promote the nursing fraternity in offering family nursing services. The aim of the organization is to coordinate care on a large scale among families adhering to the organizational scope of delivering high quality care to the patients. In this case, communication will be the main governing tool. The organization aims at offering patient-centered care, in that the patients would be in active involvement with their care providers in making health decisions. The organization aims at being all round although the roles, medical treatments, medical duties, and pharmacological abilities in the nursing profession depend on state of licensure. The main roles of the nurses in the Family

MRI as a Breast Cancer Screening Tool

MRI as a Breast Cancer Screening Tool Chapter 1 Introduction In the United States, one in eight women will be diagnosed with breast cancer, accounting for 26% of all cancer cases in women (Jiao, 2014). The standard of care for women over the age of 40 is mammography. It has been shown to increase life expectancy by detecting breast cancer through a quick and easy x-ray. Magnetic resonance imaging, which is more sensitive to breast cancer is costlier and produces more false-positive results, therefore it is not used as often. When mammography is the only test being done, breast cancer is more likely to go undetected in patients with dense breasts and those with small lesions. In high-risk women, MRI has been shown to detect breast cancer in earlier stages than mammography. MRI screening is successfully reported between 77% and 91% (Jiao, 2014). Most detections from MRI are located within axillary lymph nodes during stage 1 breast cancer. A patient may simply refuse yearly mammograms, when she goes five years later breast cancer may be in the fi nal stage whereas MRI could’ve detected it years earlier. Women are recalled more often for additional diagnostic testing when screened less frequently and recalled less often when screened more frequently (Orel, 2005). The American Cancer Society recommends MRI testing for women with the BCRA1 & BCRA 2 genes or a lifetime risk of 20% or greater for breast cancer (Saslow, 2007). Women who inherit the BRCA1 or BRCA2 gene have a 45% to 65% chance of developing breast cancer (Plevritis, 2006). BRCA 1 gene carriers are at a greater risk for developing breast cancer at an aggressive pace. Tumors in women screened with mammography alone are larger and more likely to have metastasized to axillary nodes (Taneja, 2009). MRI is approximately ten times more expensive than mammography making its cost effectiveness a critical consideration (Jiao, 2014). Due to its lower specificity than mammography increased costs are related to biopsies and additional exams. Estimated lifetime costs for 10,000 women would be higher by $10.6 million with MRI in combination with mammography than with mammography alone. In 2009, the costs billed to Medicare for a bilateral mammography was $49.76 while a bilateral MRI was $965.57 (Jiao, 2014). The price per quality adjusted life year would be $310,616 when MRI was performed with mammography (Fieg, 2009). MRI screening is most cost effective if the cost of MRI decreased or the cost of mammography decreased, when the risk of breast cancer increases, when mammography performance worsens, and if greater quality of life is accomplished (Orel, 2005). MRI becomes cost effective when patients with high-risk profiles are treated. If cancer was detected early enough, chemotherapy can be reduced. MRI is also needed for surveillance when breast conserving therapy results in recurrences. MRI would yield an additional 106 years of life per 10,000 women (Fieg, 2009). Women with BRCA1 and BRCA2 start mammograms at the age of 25 which makes MRI more cost effective and would decrease their radiation dose. Given the aggressive nature of breast cancer, screening with MRI whether alone or with mammography is cost effective and will prolong life expectancy (Berg, 2012). Contrast enhanced MRI is proven to detect breast cancer in the earliest stages compared to ultrasound and mammography. Statement of the Problem and Professional Significance Is MRI effective as screening tool for breast cancer? Which modality is the most effective study for diagnosing breast cancer? Are imaging modalities other than MRI a waste of time and money for patients? Mammography is seen as the first step in preventing breast cancer when a patient turns 40. For some patients, it might already be too late. Mammography is quick and low cost but does not detect breast cancer in patients with dense breasts or small lesions. MRI is considered the gold standard in imaging but is used with fewer women. As the population grows and rates of cancer increase, patients are demanding precise diagnosis and early detection for cancer. What factors should stand out to differentiate who receives MRI vs. mammography? By gathering medical history and diagnosis from several women receiving breast MRI’s, data will be examined to determine whether or not breast MRI’s were needed for proper diagnosis and if testing detected further malignancies. Research Hypothesis 1. It is hypothesized that MRI will be more effective in detecting breast abnormalities than Ultrasound or Mammography. This can be tested by comparing the results of their MRI with results of previous tests.    2. It is hypothesized that at least 50% of patients will feel more confident regarding their diagnosis following a MRI scan. This can be tested by having patients rank how they felt before and after having the test and talking with a radiologist on staff (using a scale of 1-10). 3. It is hypothesized that patients will not have had a mastectomy or received radiation until an MRI is performed. By surveying patients to determine who was and wasn’t diagnosed prior to MRI and what measures they took to prevent the malignancy from spreading I can determine these results.    4. It is hypothesized that patients positive for breast cancer will have at least one lesion undetected on mammography or ultrasound because of its small size or position in the axillary region.   This can be tested by comparing MRI test results with other imaging modalities. 5. It is hypothesized that 10% of participants will have had inconclusive results. This can be determined by whether the radiologist recommends a breast biopsy. MRI can produce false-positives, which cause the radiologist to compare results with past imaging. 6. It is hypothesized that at least 50% of the participants were recommended to have an MRI after inconclusive testing in other modalities. This information will be obtained through obtaining previous medical history in the survey. Definitions Breast cancer Uncontrolled growth of breast cells resulting in a malignant tumor (Medical Dictionary Online, 2018). Malignant Cancerous tumor that can spread to other parts of the body. Benign Tumor that is not dangerous to health. Quality adjusted life year Used to assess the value for money of medical intervention. One QALY = one year of perfect health (Science Direct Online, 2018). Probabilistic sensitivity analysis Technique used in economic modeling that allows the modellar to quantify the level of confidence in the output of the analysis (Science Direct Online, 2018). National comprehensive cancer network Not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. BRCA 1 breast cancer type 1 susceptibility protein- Identified in 1990 and is on chromosome 17, increases likelihood of cervical, uterine, and colon cancer (National Cancer Institute, 2018). BRCA 2 breast cancer type 2 susceptibility protein- Identified in 1994 and is on chromosome 13-, increases likelihood of stomach cancer, gallbladder cancer, and melanoma (National Cancer Institute, 2018). Ultrasound Imaging test using high frequency sound waves. MRI Imaging test that used magnets to generate a detailed picture. Mammography Images produced from low dose radiation. Gadolinium Chemical element of atomic number 64, injected into patients as contrast during MRI. Ductal carcinoma in situ (DCIS) Presence of abnormal cells inside a milk duct in the breast (Medical Dictionary Online, 2018). Mastectomy Surgical operation to remove a breast. Stereotactic biopsy Procedure that uses mammography to precisely identify and sample an abnormality within the breast. Limitations and Delimitations This study will survey twenty women (all ages) who are scheduled for breast MRI’s at Geisinger Community Medical Center during September-November 2018. I will conduct surveys with the patient prior to their MRI. Breast MRI’s will be conducted on a 1.5T, Siemens machine. All patients will be scanned using the same protocol for imaging regardless of medical history. External limitations are obtaining a medical history, incompletion of the patient’s MRI, lack of intravenous access for contrast, claustrophobia, and no show appointments. I will rely on patients to give me a detailed, accurate medical history. Assumptions During a typical work day in MRI at Geisinger Hospital a breast MRI is completed once. Within a typical month at least 20 scans are completed. This should allow me to survey enough patients over a six-week period. Permission for this study will come from patients who allow me to ask questions regarding their medical history and diagnosis. In accordance with HIPAA, I will keep all patient names and identifying information anonymous. Chapter 2 Introduction The purpose of this research project is to determine if MRI is effective as an imaging tool for diagnosing breast cancer. By surveying women, who have been diagnosed or are currently being diagnosed, collecting medical history, and analyzing data, imaging modalities will be examined to determine the most reliable, accurate, and timely way to diagnose breast cancer. If MRI is more efficient than mammography and ultrasound, time and money spent on those modalities could be eliminated. Women can be treated faster, and cancer could be diagnosed earlier when proper testing is ordered. Breast cancer during stage one is treatable, thousands of lives could be changed when it is diagnosed in a timely manner. Cancer is the overall most common cause of death in America with breast cancer being the most common type (Jiao, 2014). One in eight women will be diagnosed with breast cancer during their lifetime making it a very costly disease. Standard protocols for screening are determined by the American Cancer Society. Screening mammography is recommended for women with a 25-30% lifetime risk of breast cancer (National Cancer Institute, 2018). This includes women treated for Hodgkin disease and those with a family history of breast or ovarian cancer. Screening mammography typically starts at age 40 unless preexisting conditions are present, screening begins at age 25. The Gail, Claus, and Tyrer-Cusick models are used to estimate breast cancer based on family history. Breast cancer genes 1 and 2 (BRCA) are found in 1/500-1/1,000 women. Women of Jewish ethnicity have a 1/50 risk (National Cancer Institute, 2018). Those who test positive have a 65% chance of breast cancer by 70 years old (Saslow, 2007). What are American Cancer Society Guidelines? Recommendations for women at average risk of breast cancer are women between 40 and 44  have the option to start screening with a mammogram every year. Women ages 45 to 54  should get mammograms every year. Women 55 and older  can continue with mammograms every year or switch to having mammograms every other year (American Cancer Society, 2018). Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer. Not all types of breast cancer cause a lump in the breast. Many breast cancers are found on screening mammograms which can detect cancers at an earlier stage, before the mass can be felt, and before symptoms develop. Women who are at high risk for breast cancer based on certain factors should get and MRI and a mammogram every year, starting at age 30 (American Cancer Society, 2018). This includes women who have a lifetime risk of breast cancer of about 20% to 25% or greater, have a known BRCA1 or BRCA2 gene mutation, have a first-degree relative (parent, brother, sister, or child) with a  BRCA1 or BRCA2 gene mutation, had radiation therapy to the chest when they were between the ages of 10 and 30 years, or have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes. (American Cancer Society, 2018). The American Cancer Society recommends against MRI screening for women whose lifetime risk of breast cancer is less than 15%. MRI in this case would be less cost-effective and timelier for patients to get done. How does MRI detect breast cancer? There are three imaging modalities that can effectively detect breast cancer. MRI, mammography, and ultrasound are commonly used in different combinations. MRI uses magnetic fields to produce cross-sectional images of breast tissue. Hydrogen atoms in fat and water contribute to the signal that is produced (Pilewskie, 2014). Gadolinium, IV based contrast, is administered to detect lesions and cancer. Subtraction images are obtained to differentiate fat from enhancing lesions. MRI produces high quality imaging from signal to noise ratio and high spatial resolution (Pilewskie, 2014). MRI is safe for all women (unless contraindicated by pregnancy) and doesn’t use radiation. A drawback to MRI is false positives that are produced and additional testing that this creates. On the other hand, additional testing leads to a higher number of cancer detected. The more women who are being closely watched and recommended for further tests, the greater their likelihood of being diagnosed earl y. In a study in the UK involving high risk populations, 4% found MRI â€Å"extremely distressing† and 47% reported having disturbing thoughts about it six weeks after (Saslow, 2007). Due to the psychological distress of MRI, other testing needs to be considered. Imaging Limitations Unlike other imaging tests, MRI candidates need to be screened for metal before considering the test. Pacemakers, aneurysm clips, specific stents and filters, and neuro-stimulators are not allowed in the machine. Body habitus and claustrophobia are also factors to consider. A small, loud environment can cause emotional distress and anxiety for a patient, some patients will refuse MRI testing. Breast MRI testing should be completed with and without contrast. Gadolinium, MRI contrast, can only be injected in patients with a glomerular filtration rate of >60. Patients on dialysis, with impaired kidney function, diabetes, high blood pressure, or certain allergies may not be able to receive contrast, making the test inconclusive. MRI results can also be misleading. False-negatives and false-positives occur from technical limitations, patient characteristics, quality assurance failures, human error, and heightened medical concern. A false negative exam looks normal even though the patient has breast cancer. They are more likely to occur in younger patients with dense breasts. MRI is commonly used for dense tissue to differentiate benign and malignant lumps. A false positive test looks abnormal even though the patient doesn’t have cancer. False positives occur in half of women getting mammograms over a ten-year period (Gillman, 2014). MRI’s and MRI guided biopsies are usually recommended for more accurate diagnosis. A patient’s need for definitive findings may increase testing ordered. According to the American Medical Association, 7% of women are biopsied only because of MRI findings. The call back and biopsy rates of MRI are higher than mammography in high risk populations due to the increased sensitivity of MRI (Gillman, 2014). MRI is also able to obtain images for women with breast implants. 3D and 2D images are acquired in all planes, whereas mammography could miss an area of interest and compromise the breast implant.    Economic Impact   Cancer treatment can be impacted by lack of insurance, proximity to health care facilities, and availability of services. According to  Cancer Facts & Figures 2018, â€Å"Uninsured patients and those from many ethnic minority groups are substantially more likely to be diagnosed with cancer at a later stage, when treatment can be more extensive, costlier, and less successful.† (American Cancer Society 2018). Without routine mammograms, breast cancer can go undiagnosed and impose much higher costs when it’s found in a later stage. Early detection can potentially eliminate radiation, chemotherapy, mastectomy, and breast reconstruction. In 2009, the average Medicare reimbursement for a bilateral mammogram was $49.76, a bilateral MRI $965.57, and mastectomy $13,590.03 (Moore, 2009). These procedures drastically differ in costs therefore insurance companies use cost effectiveness and quantity adjusted life years as means in determining which patient will benefit from costlier studies. MRI screening becomes more cost effective as the cost of MRI decreases or the cost of mammography increases. It is also more cost effective for patients with higher risk profiles such as BRCA1 & BRCA2 genes. MRI combined with mammography would produce 106 years of life per 10,000 women compared with mammography alone (Taneja, 2009). The drawback is that MRI in addition to mammography would increase lifetime health care costs for those 10,000 women by $10,600,000 (Taneja, 2009). What does insurance cover? Breast cancer is the costliest cancer to treat. In 2010, it cost $16.5 billion in the United States to treat breast cancer. A major concern when ordering breast MRI’s is that insurance will deny it or charge a high co-pay. MRI’s cost more due to radiologist, facility, contrast, and technology fees. According to a survey by the American Cancer Society, many patients are cutting prescriptions, not going to their doctor, and not getting preventive services due to the high costs. Yearly mammograms are covered by insurance companies. The average cost of a breast MRI in the United States is $1,325 with prices ranging from $375 to $2,850. Patients with health insurance are responsible for paying their deductible, copay, and coinsurance amounts. The amount of each of these costs depends on their health plan. Patients without health insurance are responsible for 100% of mammogram and MRI costs. Case Study In a study published by the New England Journal of Medicine, titled MRI evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer, 969 women with a diagnosis of unilateral breast cancer and no abnormalities on mammography went for a breast MRI. MRI detected clinically occult breast cancer in the contralateral breast tissue in 30 women (Lehman, 2007). Biopsies were performed on 121 of the 969 women whose MRI showed breast cancer (Lehman, 2007). Of those 121, 30 were tested positive. MRI was able to detect cancer that was missed by mammography and clinical exam. Within the 969 women, 33 tumors were diagnosed with 30 being from MRI. The three others were diagnosed from a mastectomy specimen before a biopsy could be performed. Those three samples contained ductal carcinomas in situ and measured 1, 3, and 4 mm in diameter. The most common types of invasive cancer found on MRI was ducal carcinoma (67%), invasive lobular carcinoma (22%), and tubular carcinoma (Le hman, 2007). 96.7% of cancer found was stage 0 or 1. The overall high accuracy of MRI is due to technology and interpretation of results. Contrast enhanced MRI aids in distinguishing benign from malignant patterns. This study also showed that screening MRI can improve on mammography by detecting cancer in women at high risk especially those with aggressive cancers. When ordering MRI, cost effectiveness continues to be a major concern. In the article, American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography, benefits of MRI’s sensitivity in detecting lesions is noted but without data on the recurrence and survival rates, MRI is not recommended as a screening exam. The article compares study results from six published studies, sensitivity for MRI is consistently higher than mammogram and ultrasound while specificity was lower than mammogram and ultrasound. High sensitivity means MRI correctly identifies a patient with cancer. Low specificity means MRI is not able to correctly reject a patient without cancer as accurately as other modalities. MRI has higher error but in calling back more patients and performing more biopsies, it diagnoses cancer more accurately. With this being said, the article does not recommend MRI as a screening tool unless women are at an increased risk of breast cancer, have a fami ly history, or carry the BRCA gene (Stephens, 2011). Conclusion Women who present with signs and symptoms of breast cancer or have a family history should be screened with MRI in addition to mammography. It is not acceptable to deny patients imaging studies that can prolong their life. Breast cancer is 100% treatable when caught early. Due to advances in technology and a growing healthcare system, facilities are more readily available to treat women. Patients no longer need to wait months for tests or results. Steps should be taken to reduce anxiety associated with MRI cancer screening and wait time. Patients should be informed about the likelihood of false-negative and false-positive findings. Whether or not patients need to go through additional imaging, the chance of early detection outweighs the stress of additional testing. MRI is a very useful imaging test that can save lives if performed. Patients who want to be proactive in their treatment should be encouraged to get routine imaging tests done and educate themselves on different stages of breast cancer, so they understand the process they are going through. By creating high resolution imaging, MRI proves to be the most effective study for diagnosing breast cancer. MRI is able to detect smaller masses and abnormalities than other imaging tests miss. Utilization of MRI is crucial for early detection, with its results breast cancer can be highly treatable and late stages along with metastases can be stopped. MRI used in screening for women with high risk factors proves more cost effective than mammography and ultrasound because it detects cancer in earlier stages which reduces the need for more invasive, long term care. MRI is also able to cover a larger area including axillary lymph nodes where cancer is commonly missed on mammograms. References: Jiao, X., & Hay, J. (2014). Cost-Effectiveness Of Breast Mri And Mammography For Screening High Risk Population.  Value in Health,17(3). doi:10.1016/j.jval.2014.03.780 Orel, S. (2005). 1–10 Efficacy of MRI and Mammography for Breast-Cancer Screening in   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Women With a Familial or Genetic Predisposition.  Breast Diseases: A Year Book Quarterly,16(1), 37-38. doi:10.1016/s1043-321x(05)80023-2 Saslow, D., Boetes, C., Burke, W., Harms, S., Leach, M. O., Lehman, C. D., . . . Russell, C. A.   Ã‚   (2007). American Cancer Society Guidelines for Breast Screening with MRI as an   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Adjunct to Mammography.  CA: A Cancer Journal for Clinicians,57(2), 75-89.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   doi:10.3322/canjclin.57.2.75 Feig, S. (2009). Cost Effectiveness of Breast Cancer Screening With Contrast-Enhanced MRI in High-Risk Women.  Breast Diseases: A Year Book Quarterly,20(4), 383-385. doi:10.1016/s1043-321x(09)79390-7 Berg WA, Zhang Z, Lehrer D, et al. Detection of Breast Cancer With Addition of Annual   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Screening Ultrasound or a Single Screening MRI to Mammography in Women With Elevated Breast Cancer Risk.  JAMA.2012;307(13):1394–1404. doi:10.1001/jama.2012.388 National Cancer Institute. (2018). Retrieved August 31,2018, from National Cancer Institute   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet#q1 Medical Dictionary Online. (2018). Retrieved August 31,2018, from Medical Dictionary Online:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   https://medical-dictionary.thefreedictionary.com/breast+cancer Medical Dictionary Online. (2018). Retrieved August 31,2018, from Medical Dictionary Online: https://medical-dictionary.thefreedictionary.com/carcinoma Elsevier Online. (2018). Retrieved August 31,2018, from Science Direct Online:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   https://www.sciencedirect.com/search?qs=QALY&show=25&sortBy=relevance Elsevier Online. (2018). Retrieved August 31,2018, from Science Direct Online:  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   https://www.sciencedirect.com/science/article/pii/0010480986900200 National Comprehensive Cancer Network: Practice Guidelines in Oncology – Genetic/Familial   Ã‚   High-Risk Assessment: Breast and Ovarian. 2005, National Comprehensive Cancer   Ã‚   Network, Inc, 1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ: Cancer Statistics, 2008. CA Cancer J Clin. 2008, 58: 71-96. 10.3322/CA.2007.0010. Information and Resources about for Cancer: Breast, Colon, Lung, Prostate, Skin. (n.d.). Retrieved September 18, 2018, from https://www.cancer.org/ Ali, K., & Vinnicombe, S. (2018). Accuracy of contrast enhanced breast tomosynthesis in patients suspected of having breast cancer: Comparison with digital mammography and breast MRI.  Http://isrctn.com/. doi:10.1186/isrctn12691785 Gillman, J., Toth, H. K., & Moy, L. (2014). The Role of Dynamic Contrast-Enhanced Screening Breast MRI in Populations at Increased Risk for Breast Cancer.  Womens Health,10(6), 609-622. doi:10.2217/whe.14.61 Pilewskie, M., & King, T. A. (2014). Magnetic resonance imaging in patients with newly diagnosed breast cancer: A review of the literature.  Cancer,120(14), 2080-2089. doi:10.1002/cncr.28700 Heil, J., Czink, E., Schipp, A., Sohn, C., Junkermann, H., & Golatta, M. (2012). Detected, yet not Diagnosed Breast Cancer Screening with MRI Mammography in High-Risk Women.  Breast Care,7(3), 236-239. doi:10.1159/000339688 Lehman, C. D. (2007, March 29). MRI Evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer. Retrieved September 19, 2018, from http://www.nejm.org/ Stephens, T. (2011). Breast Cancer Screening With Imaging: Recommendations From the Society of Breast Imaging and the ACR on the Use of Mammography, Breast MRI, Breast Ultrasound, and Other Technologies for the Detection of Clinically Occult Breast Cancer.  Yearbook of Diagnostic Radiology, 2011, 46-47. doi:10.1016/s0098-1672(10)79236-5 Plevritis, S. K., Kurian, A. W., Sigal, B. M., Daniel, B. L., Ikeda, D. M., Stockdale, F. E., & Garber, A. M. (2006). Cost-effectiveness of Screening BRCA1/2 Mutation Carriers With Breast Magnetic Resonance Imaging.  Jama,295(20), 2374.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   doi:10.1001/jama.295.20.2374 Taneja, C., Edelsberg, J., Weycker, D., Guo, A., Oster, G., & Weinreb, J. (2009). Cost Effectiveness of Breast Cancer Screening With Contrast-Enhanced MRI in High-Risk Women.  Journal of the American College of Radiology,6(3), 171-179. doi:10.1016/j.jacr.2008.10.003 Moore, S. G., Shenoy, P. J., Fanucchi, L., Tumeh, J. W., & Flowers, C. R. (2009). Cost-  Ã‚   effectiveness of MRI compared to mammography for breast cancer screening in a high risk population.  BMC Health Services Research,9(1). doi:10.1186/1472-6963-9-9

Essays --

Abortion itself is not an easy process to go through. Having a simple fetus removed medically might seem easy, but the woman herself might go through many difficult situations before, during, and after the process of abortion emotionally and physically. Making the right choice of having an abortion might be regretful to some woman and their family. The choices are either having the baby and later finding out they can’t take care of the baby or having an abortion and finding out later that you cannot have a child in the future. There can physical effects on woman that have abortion. Abortion can result in miscarriages, ectopic pregnancies, and a slight chance of breast cancer. Many miscarriages happen when an abortion is used on the previous pregnancy because it can be dangerous to the future reproductive systems of woman. After an abortion, there can be severe case where bleeding and infection can occur. A woman might have five times the chance of ectopic pregnancy because the woman who had their first pregnancy was terminated. An ectopic pregnancy happens when the embryo is implante...

TTTC Essay

Vietnam in the form of stories that change the reader's outlook on a variety of topics. One Of O'Brien chapters, â€Å"How to Tell a True War Story† truly exemplifies his role as a storyteller in the unique way he retells each of his stories. O'Brien alters his style with each recount to emphasize the different ways a story can affect a reader. Through his specific style of storytelling, O'Brien is able to describe his different experiences of Vietnam while explaining his perspective of the human situation.O'Brien alternation between narrating a story and commenting on its exceptive effects explicitly expresses his role as a storyteller in this chapter. In doing this, he is also able to point out the influence it had on his view of human disposition and the true nature of war. He explains the traits of a true war story while giving examples of his own. His strategy of retelling a war story with multiple different approaches emphasizes the power of his storyteller position.He c laims that ‘A true war story is never to depict his recount of the incident in a specific way, thus characterizing one of his many experiences . Just like most soldiers after war find a way to cope with their sufferings, O Brine relays his own experiences by stating that â€Å"In any war story, but especially a true one, it's difficult to separate what happened from what seemed to happen†(63). This chapter is unique in the sense that it takes the minutiae of a certain war memory, twists it to invoke certain emotions, and stimulates a reaction in the reader.Throughout the chapter he illustrates how incredibly the meaning and the effect of a story can change with the smallest adjustment to details . The different ways that O'Brien tells a story help us realize the power of his practice. O'Brien analyses of true war stories, followed by his real life account strike the reader in the heart and change their view of the war as a whole. Brine's storytelling is a powerful mediu m through which he expresses his thoughts on the war.Aside from relaying the incidents during the war, O'Brien also aims to point out his observations Of human nature relating to war. Whether we realize it or not, war has a large influence in all of our lives – O'Brien aims to bring out hose realizations through his storytelling. During this chapter O'Brien repeatedly shares the many characteristics of a true war story. He describes many different traits such as: a true war story â€Å"never seems to or â€Å"a true war story cannot be believed â€Å"(64). Then O'Brien gives an example of how that certain trait rings true in a story of his own.The effect produced is eye opening and causes the reader to adapt the same mindset that O'Brien takes towards his revelations. With his continued explanations of why war stories are so complex, O'Brien moves into the realm of legacies. His vivid description of Curt Lemon's Death is a poignant reminder of the gruesome and tragic, yet sudden end to a great man's life. Even though Lemon perished in the snap of a finger, O'Brien urges us to realize that his creative style of storytelling keeps Curt Lemon alive.Just like Ted Lavender and Kiowa, Curt Lemon left behind a legacy that lived among the memories of the soldiers. This is how O'Brien is able to keep him alive along with all of the others who he does not want to let go of. This novel can be viewed as simply a novel that describes a war experience room the point of a soldier; however, the way it's portrayed makes it much more. Not only does O'Brien express what it was like to be in the Vietnam war, but also he gives us a deep analysis of our race in relation to common struggles among us.Often when a soldier has a hard time coping with their return, it is because he or she does not feel like they belong. It's as if no one believes what they say is true because of how terrible it sounds. O'Brien explains that if â€Å"somebody tells a story, let's say, and afte rward you ask, ‘Is is true? ‘ [then] if the answer matters, you've got your There are any people who are ignorant to the lengths that soldiers go to for protecting this country, and when those people fail to appreciate those actions, it is heartbreaking.When O'Brien says that â€Å"if the answer matters, you've got your answer he is emphasizing the point that all war stories can be true even if they never actually happened. The experience Of war as a whole is so unbelievable that any story is true in some sense if it helps the reader understand what the narrator went through. His depiction of war is gruesome to say the least, but it explains to us how war impacts a man. He also expresses the importance off legacy like those of Curt lemon's, Kiosk's, and Ted Lavender's.O'Brien has the potential to be scarred for life from these death incidents; however, he uses the power of his stories as a coping mechanism, and in turn is able to keep the souls of his comrades alive. He does this with Timmy preserve his innocence, and in the same way, he does this to his friends to aid the hurt the war has caused him. All in all, O'Brien strategy of storytelling achieves the multiple goals intended: to portray his tragic war experiences, to explain the human notation in relation to the war, and to portray the strength of a legacy preserved in a Story.

Morality and Babyhood Essay

Characteristics of babyhood: (From 2 weeks to 2 years) i) Babyhood is the true foundation age. At this time, many behavior patterns, attitudes and emotional expressions are established. It is a critical period in setting the pattern for personal and emotional adjustments. ii) Babyhood is an age of rapid growth and development. Babies grow rapidly both physically and psychologically. Changes are rapid in appearance (height and weight) and capacities. The limbs develop in better proportion to the large head. Intellectual growth and change are parallel to physical growth and change. iii) Ability grows to recognize and respond to people and objects in the environment. The baby is able to understand many things and communicate its needs and wants. iv) The babyhood is an age of decreasing dependency. The baby begins to do things to itself. With decrease of dependency, a rebellion against being treated as baby. A protest takes protest comes in the form of angry outbursts and crying when independence is denied. v) It is an age of high individuality which can be realized in appearance and in patterns of behavior. vi) Babyhood is the beginning of Creativity, sex role and socialization for adjustment in future life. vii) Babyhood is a hazardous period. The physical hazards are illness, accidents, disabilities and death. Psychological hazards are disinterests and negative attitude. Havighurst’s Developmental Tasks During The babyhood Learning to take solid food Learning to walk. Learning to talk. Learning to control the elimination of body wastes. Learning sex differences and sex modesty. Getting ready to read. Learning to distinguish right & wrong and beginning to develop a conscience. Babyhood skills Hand skills – self-feeding , self dressing,and play skills Leg skills-Jumping, climbing stairs, running without falling speech development in babyhood Talking is one of the biggest milestones there is, and the latest research suggests there’s a lot you can do to help your child become a master chatter. Months before my daughter Ella spat out her first official word (â€Å"bath! â€Å"), she was a Chatty Cathy in terms of sheer noise–exercising her pipes by howling for a feeding, squealing at a sock puppet, or babbling â€Å"ba ba ba† at the top of her lungs. And it turns out there’s a reason behind the racket. For babies, it’s a kind of linguistic cross-training–a way they prep for the main event of real speech, otherwise known as one of the coolest milestones ever. The average age at which kids utter a bona fide first word is 12 months, and they’re able to manage two-word â€Å"sentences† by the time they’re 2. But (reality check! ) as any pediatrician will attest, babies hit language milestones at a wide range of ages. A child who seems behind can all of a sudden make a giant leap ahead of her peers, verbally. And a kid who starts talking early may get stuck on the same few words for months before adding more to her repertoire. So no comparing or panicking! Sure, you can hardly wait to hear that first word or â€Å"wuv you. † But like all Big Moments in your baby’s life–sleeping through the night, sitting up, first steps–it will happen when she’s ready. There are, however, proven ways you can nudge language development along, experts say. Check out our stage-by-stage (and completely anxiety-free! ) guide to baby talk for the scoop on what you’ll hear, when to expect it, and how best to keep up your end of the conversation. 1 Month Waaah. Crying may not sound conversational, but it’s your newborn’s primary way to communicate, meaning she uses it for everything from â€Å"I’m tired† and â€Å"I need food† to â€Å"It’s a little too bright in here. † Wailing also primes your baby for genuine language by strengthening the same neural pathways in the brain that are used for speech–and by giving her larynx, the organ in the throat responsible for sound production, a good workout. What to say back: Something that will soothe the fussing and squalling. While a good cry may exercise your baby’s vocal cords, the sooner you can comfort her, the more confident she’ll be that you’re really listening to her–and the more willing she’ll be to keep trying to â€Å"tell† you what she’s feeling. 2 to 5 months Ooh? aah. Those supercute coos are airy sounds that come straight from the larynx–making them easy to say for tiny babies still figuring out how to use their lips and tongues. They’re also fun. â€Å"Kids tend to focus on particular sounds: squeals, vowels, or growls, as we call them,† says D. Kimbrough Oller, Ph. D. , a professor of audiology and speech-language pathology at the University of Memphis. These will help your little one learn to control vocal tone and volume–something she’ll need to form her first word. What to say back: Anything in â€Å"parentese,† that singsongy voice that sounds like it came off a children’s CD–only it’s you repeating â€Å"Hiiiii! † Research shows the high pitch makes your infant really take notice of–and want to imitate–what you say. 5 to 7 months Ah? goo. When your baby begins to add in consonants, it means she’s now able to produce a full repertoire of sounds–a major linguistic milestone. â€Å"It’s harder to produce consonants because they require interaction between the tongue and the lips,† says Roberta Golinkoff, Ph. D. , director of the University of Delaware Infant Language Project in Newark. â€Å"It’s a big deal. † What to say back: Narrate the sights you see on your drive or your daily plans (â€Å"We’re going to the store for some milk, and then Daddy’s taking you to the park! â€Å"). Talking to a non-talker may feel bizarre, but research has found that infants actually understand far more than we realize. In one study, 6-month-olds who heard the word â€Å"mommy† responded by looking at a picture of their mom. 7 to 9 months Ma-ma-ma. Was that a first word? Hmm? Though your baby is probably still simply parroting sounds, once she starts babbling in distinct syllables, her â€Å"conversation† can sound so much like language that it’s hard to tell. Consider this her final dress rehearsal for putting those syllables together in a way that has real meaning. What to say back: Talk about the things around her so she’ll connect objects with words. Just don’t assume â€Å"bo-bo† means â€Å"ball† if she says it while reaching for her shoe. â€Å"Notice where your child is looking before you label an object. It’s very adaptive for babies–and a lot of parents do it naturally,† says Jenny Saffran, Ph. D. , director of the Infant Learning Lab at the University of Wisconsin-Madison. 9 to 12 months Nee-nigh. Getting out just the right sounds takes practice, so for now, your baby’s making up combos that indicate real objects–a halfway point between babbling and true speech. She may say â€Å"nee-nigh† for â€Å"bottle,† or â€Å"sho-sho† for â€Å"yogurt,† for example. What to say back: As long as you know what your baby’s trying to say, don’t quibble over correct pronunciation. Swapping in weird names for regular words is normal for new talkers–so your best move is to respond in a way that shows you understand: She says â€Å"banktee,† you produce her blanket. It’s cute to hear (and say) her made-up words, and experts say it’s fine if â€Å"banktee† becomes de rigueur in your household. Eventually, you’ll phase it out for the real thing. 12 to 15 months Dog. Whatever recognizable word your child produces first, it’s bound to be something she’s fascinated by and something she can easily say–which is why the single-syllable â€Å"Da,† â€Å"Ma,† â€Å"ball,† and, yes, â€Å"dog† are fairly common first words. â€Å"Kitten† and â€Å"television†? Not so much. What to say back: â€Å"Hurrah! † Cheering on her speaking attempts will motivate her to master new words. Plus, Golinkoff notes that the rule for babies learning to talk is â€Å"the more language in, the more language out. † So keep chatting! By doing so, you’re supplying the words for interesting objects and emotions. Add that to praising her for using the ones she already knows and you’ll soon have a total motor mouth on your hands. 15 to 18 months Go. After your toddler has spit out that first word, she’ll learn what she needs to do to make others–including different parts of speech, like verbs and adjectives. By 15 months, most kids are able to say 20 or more words, and the lexicon expands as weeks go by. What to say back: Cuddle up with a good story for a no-brainer vocab booster. Perfect at this age: board books filled with short-and-sweet words, like Where Is Baby’s Belly Button? by Karen Katz, or Dear Zoo, by Rod Campbell. â€Å"Talk about what’s in the pictures, as well,† suggests Julie Masterson, coauthor of Beyond Baby Talk: From Sounds to Sentences, A Parent’s Complete Guide to Language Development. â€Å"It’s fun for kids to hear you say ‘See the dog? It says ‘woof. ‘† 18 to 22 months Da-me-fo-bee. You know your toddler is saying something amazing–if only you could understand it. In their second year, kids become masters of nonsensical speech, producing strings of elegant gibberish that sound like a faux version of adult conversation (often complete with inflection and hand gestures). She’ll also be saying around 30 or so real words-but even those may not be crystal clear. What to say back: Ask questions that get your kid talking. If she says â€Å"boo-bee-lala† while building a block tower, ask â€Å"What do you like about the blocks? † One recent study in the journal Pediatrics showed that back-and-forth conversations between adults and little ones are the best way to improve their verbal skills. 22 to 24 months. More milk. By the time she turns 2, your toddler will likely be able to string two or three words together to make mini-sentences. A favorite to throw into the mix of the dozens of words in her growing vocabulary: â€Å"more. † It’s a sign that your kid is figuring out the ability of language to make things happen. What to say back: Give her what she asks for! (Within reason, of course. ) Being able to tell you what she wants is a major milestone for her, but it’s a happy day for you, too. Just think: fewer meltdowns over misunderstood requests! And by responding, you show her just how powerful and rewarding talking really can be. Prespeech forms of communication Four prespeech forms of communication are there Crying- Hurlock considers it to be the very first piece of human behaviour that has social value. It gradually becomes differentiated as the newborn reaches the third or fourth week of life. Cooing and Babbling-As the baby’s vocal mechanisms develop,he becomes capable of producing explosive sounds which develop into babbling or lallation. Babbling begins during the second or third month of life. Gesturing –This develops and is used by the baby not to supplement,but to substitute for his speech. Emotional expressions- This is most effective forms of preseech. Baby communicates with others by using some gestures and emotional expressions emotional development in babyhood month 1 Makes eye contact Cries for help Responds to parents’ smiles and voices Month 2 Begins to develop a social smile Enjoys playing with other people and may cry when play stops Prefers looking at people rather than objects Studies faces Gurgles and coos in response to sounds around her First begins to express anger Month 3 Starts a â€Å"conversation† by smiling at you and gurgling to get your attention Smiles back when you smile at him. The big smile involves his whole body — hands open wide, arms lift up, legs move Can imitate some movements and facial expressions Month 4 Is intrigued by children. Will turn toward children’s voices in person or on TV Laughs when tickled and when interacting with others Cries if play is disrupted Month 5 Becomes increasingly assertive Can differentiate between family members (parents and siblings) and strangers Likes to play during meals Month 6 May quickly tire of a toy but will never tire of your attention Temperament becomes increasingly apparent. You’ll see whether she tends to be easygoing or easily upset; gentle or active Recognizes his own name Coos for pleasure and cries with displeasure Can make noises like grunts and squeals; clicks his tongue Month 7 Starts to understand the meaning of â€Å"no† Enjoys social interaction Expresses anger more strongly Tries to mimic adult sounds Month 8 Can differentiate between familiar and unfamiliar May become shy or anxious with strangers Cries in frustration when he can’t reach a toy or do something he wants to do Month 9 Imitates gestures that other people make Looks at correct picture when an image is named. Smiles and kisses own image in the mirror Likes to play near parent (i. e. , in kitchen while Mom is cooking) May be more sensitive to the presence of other children Month 10 Separation anxiety may begin Self-esteem begins to develop Responds to positive recognition such as clapping Becomes cautious of heights Shows moods such as sad, happy, and angry Month 11 Tries to gain approval and avoid disapproval Can be uncooperative Month 12 May have temper tantrums Can fluctuate between being cooperative and uncooperative Shows a developing sense of humor May cling to parents or one parent in particular Development of understanding. As the babies grow the criteria of understanding increases. It depends largely on two factors : their level of intelligence and their previous experiences. Most important concepts that are related are Space Weight Time Self Sex-role Social Beauty The comic Functions and vertues od play: 1 it aids growth 2 it is a voluntary activity 3 language can be developed through it 4 it offers opportunities for matery of physical self PLAY PATTERNS OF BABYHOOD: sensorimotor play exploratory play imitative play make -believe play games and amusements Moral development in babyhood: Babies have no scale of values and no conscience. They are therefore neither moral nor immoral but nonmoral in the sense that their behavior is not guided by moral standards. Eventually they will learn moral codes from their parents, and later from their teachers and playmates etc. Learning to behave in a morally approved manner is a long, slow process. However, foundations are laid in babyhood and on these foundations children build moral codes which guide their behavior as they grow older. Because of their limited intelligence, babies judge the rightness or wrongness of an act in terms of the pleasures or pain it brings them rather than in terms of its good and harmful effects on others. They therefore perceive an act as wrong only when it has some harmful defect in themselves. They have no sense of guilt because they lack definite standards of right and wrong. They so not feel guilty when they take things that belong to others because they have no concept of personal property rights. Baby is in a stage of moral development which Piaget has called morality by constraint- the first of three stages in development. This stage lasts until the age of seven or eight years and is characterized by automatic obedience to rules without reasoning or judgment.