Chronic Disease Essay Example for Free

Chronic Disease Essay Chronic disease is an illness. It can be regulated but not cured. It is in most cases a long-lasting medical condition that can have a long-term variation in the body (Prakash, Porwal, Saxena, 2012). There are many cases of chronic disease around the world but in the United States it is the foremost cause of death. Seven out of 10 deaths amid Americans every year are from chronic diseases. One disease that can be severe, depending on the stage is colon cancer. It is also known as colorectal cancer. It grows in the digestive tract, which ultimately can change into a cancerous polyp. A polyp is a benign growth on the body that sometimes becomes malignant (Prakash, Porwal, Saxena, 2012). This means it can spread throughout the body. The colon is complete with three parts, the ascending, transverse, and descending also known as the sigmoid colon. It lies within the large intestine and is directly above the rectum. The sigmoid is to help digest, process, and eliminate food. If someone were to get colon cancer it would start in the sigmoid and if it is not treated early, it can result in losing his or her colon (Prakash, Porwal, Saxena, 2012). There are quite a few risk factors with this disease; the people who have the highest risk to develop colon cancer are 50 or older, the chances increase with age. Gender also plays a big role; they say men have a higher risk than women because they tend to have more occurrences with adenomas or benign tumors in tissue glands. There are also two types of medical conditions that increase chances of acquiring colon cancer; they are ulcerative colitis and Crohn’s. Another name for them is Inflammatory Bowel Disease. They are set off by long-term inflammation. My boyfriend has ulcerative colitis and a friend has crohn’s disease, they have to get regular checkups every six weeks and an infusion. Otherwise they would be sick and probably develop colon cancer. They also get colonoscopies every so often seeing how much of a risk they have. According to Emedicinehealth (2012), â€Å"A colonoscopy is a procedure through which a physician inserts a viewing tube (endoscope) into the rectum for the purpose of inspecting the colon. During a colonoscopy, polyps can be removed, bleeding can be cauterized, and a biopsy can be performed if abnormal areas of the colon are seen† (para.27). To do this procedure they, use an endoscope. It is a medical tool made up of a long tube inserted into the body. It may sound scary to have done or painful, but it could save a life. Some ways to decrease modifiable risk factors for colon cancer are by doing what is best for the body, just like with any other types of disease but there are a few differences. One important thing to do is screening, which is a test for a disease (2002). That way if one does have any polyps it can get removed before becoming cancerous. Another important thing to do is diet, especially if they are obese because obesity is a high risk factor. Fats, alcohol, and too much red meat can also lead to a higher risk. Eating more vegetables, exercising, and maintaining a healthy weight, these are good lifestyle choices, and everyone should keep them in mind. (Davies, Batehup, Thomas, 2011). One thing that lowers the risk of most cancers is staying away from smoking; it is a bad habit for anyone, whether they are sick or not (Daniela, Simona, Imola, 2011). So if one starts to have symptoms such as rectal bleeding, dark stools called melena which is began by bleeding into the bowel, passing of solid waste, gas discomfort, backache, and liquid discharge from the rectum, they should go immediately to see a doctor because those are signs of a tumor in the colon and can lead to severe colon cancer. If someone needs help or support when dealing with colon cancer there are quite a few sources of help that he or she may reach out to. The American Cancer Society, the American Psychosocial Oncology Society (APOS), and Fight Colorectal Cancer.org. These organizations care about people and their needs. Colon cancer is a very serious disease and can be life threatening. So if you or someone you love has cancer make sure to eat healthy, exercise, avoid unhealthy habits, such as smoking and get daily screenings to protect yourselves. Acquiring a polyp or strange bleeding from your rectum can be life threatening, so a screening and a colonoscopy is crucial. ‘Works Cited Continue colonoscopy screening in stable patients, regardless of age. (2002). Geriatrics, 57(1),23.http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=7cc2eb43-5583-4161-b181 f6ccc2c74387%40sessionmgr112vid=3hid=102 Daniela, C., Simona, B., Imola, T., Melania, M., Silvia, S. (2011). Smoking and the

Kudler Fine Foods Problem Statement Essay Example for Free

Kudler Fine Foods Problem Statement Essay The following is a problem statement explaining what is currently wrong with Kudlers plans on expansion, and how they can improve these plans. Introduction After reviewing the strategic plan for Kudlers Fine Foods it is obvious there are several issues that will stunt the growth and success of the organization. The company is suffering from a lack of management and poor organization planning. The issues that will be discussed are the poorly developed expansion and growth plans, and the lack of risk management in preparation of a competitor entering the market. Problem Statement The management at Kudler Fine Foods is planning on opening a new location when all of the current locations are not successful, and the company has not done a proper analysis of the need for their services in the area. Also Kudler is not prepared for factors that may decrease the profitability of the company, or factors that can contribute to the failure of a new location. Solution With the Del Mar location not producing profit as expected this is the location management should use to create a market research and analysis plan. By using this location they will be able to determine the factors that are hindering the success of this location and then develop ways to counteract those factors. The benefit is they will improve the business done at that location before opening a new location. By looking at factors like population, socio-economic status in locations surrounding area and health factors in the area can determine what the need are for the community. Management should also look to see where people are purchasing food in the community and what types of food and products are selling at the local grocery. If there are gourmet products selling out of the supermarket than that is a factor that needs to be accounted for. Once the market research is done Kudlers management can the focus on a risk management plan. Before a risk management plan can be established they must know what risk are out there and the market analysis and research will help the company determine what risk and challenges they face. Risk management is a part of a basic business plan, I see where threats are outlined in the strategic plan but there are no alternative plans to minimize each threat nor are there any plans for how to be competitive should a competitor arise. Kudler only considers other gourmet shops as competition they should also consider, grocery stores that sell gourmet foods a competitor. Then they should focus on how to maintain their existing book of business. If Kudler developed their website so customers could place orders online that would give them a way to expand while working on the risk management plans and the online based business would also help with the market research. A high concentration of orders coming from a specific location may be an indicator used to determine where to open a new store. Desired Resolution Kudler Fine Foods will be able to expand all facets of the business and have a risk management plan in place to counter act competition entering the market. Kudler will expand in to locations where they will be successful. Kudler will also have an effective and efficient model for future expansion and growth. Conclusion The goal of Kudler Fine Foods is expansion and growth while increasing profit and the current book of business. By doing the extra research and implementing a risk management program before opening a new location will increase the success of all three current locations and ensure the success of any future locations. It will also help Kudler organize and develop other facets of the business like the website. A little extra work goes along way and with the risk management plan in place and a new location market analysis model being used Kudler Fine Foods should be able to grow and meet all the organizations goals.

MGMT Methylation Status and Glioblastoma Multiforme Outcome

MGMT Methylation Status and Glioblastoma Multiforme Outcome ABSTRACT Background: O6 – methylguanine-methyltransferase (MGMT) promoter methylation has been associated with increased survival among patients with glioblastoma multiforme (GBM) who were treated with various alkylating agents. We examined the relationship between MGMT methylation status and clinical outcome in newly diagnosed GBM patients treated with BCNU wafers (Gliadel ®). Methods: MGMT promoter methylation in DNA from 122 newly diagnosed GBM patients treated with Gliadel was determined by a Quantitative methylation-specific polymerase chain reaction assay (QMSP) and correlated with overall survival (OS) and recurrence-free survival (RFS). Results: The MGMT promoter was methylated in 40 (32.7%) of 122 patients. Overall median survival was 13.5 months (95%CI: 11.0-14.5) and recurrence-free survival (RFS) was 9.4 months (95%CI: 7.8-10.2). After adjusting for age, KPS, extent of resection, temozolomide (TMZ) and radiation therapy (RT), newly diagnosed GBM patients with MGMT methylation who were treated with Gliadel had a 15% reduction in hazard of death compared to patients with unmethylated MGMT (Hazard ratio: 0.85, 95%CI: 0.56-1.31). Patients aged over 70 with MGMT methylation and treated with Gliadel had a significantly longer median survival of 13.5 months compared to 7.6 months in patients with unmethylated MGMT (p=0.027). A similar significant difference was also found in older patients with a median recurrence-free survival of 13.1 versus 7.6 months (p=0.01) for MGMT methylated and unmethylated, respectively. Conclusions: Methylation of the MGMT promoter in newly diagnosed GBM patients who were treated with Gliadel followed by RT and TMZ, was associated with significantly improved survival compared to the non-methylated patient population with similar treatment. For the elderly population, methylation of the MGMT promoter was associated with significantly better OS and RFS. INTRODUCTION Glioblastome multiforme (GBM) is the most common primary brain tumor, with a median survival of less than two years [1]. To date, only two different alkylating agents have been shown to be consistently associated with prolonged survival – temozolomide (TMZ) and the locally delivered BCNU wafers (Gliadel) [1-3]. Gliadel wafers (Eisai Inc. for Arbor Pharmaceuticals, LLC) are implanted and locally deliver Carmustine (also known as (1,3-bis(2-chloroethyl)-1- nitrosourea (BCNU)) at the site of tumor resection, allowing for a higher concentration of local chemotherapeutic doses while minimizing systemic adverse effects [2-4]. These wafers provide a controlled- release form of local chemotherapy for approximately 3 weeks [4, 5]. Methylation of the MGMT promoter in gliomas was found to be an important predictor of the tumor responsiveness after several cytotoxic regimens [6], including BCNU treatment [7]. It was found that expression of the DNA repair protein, O6 – methylguanine-methyltransferase (MGMT), results in GBM resistance to alkylating agents. Alkylating agents cause cell death by binding to DNA, most commonly to the O6 position of guanine, and forms cross-links between adjacent DNA strands. This cross-linking of double strand DNA is inhibited by the cellular DNA-repair protein MGMT. In this study, through a unique analysis of 122 patients with newly diagnosed GBM who were treated with Gliadel, we retrospectively examined the association between MGMT promoter methylation status and survival. METHODS Patients and Tumor Specimens We retrospectively reviewed 185 patients with newly diagnosed GBM who received Gliadel after tumor resection, at Johns Hopkins Hospital in Baltimore, USA, between July 1997 and December 2006. Of these patients, only 122 patients had stored samples that were available for MGMT analysis. The clinical, radiological and hospital course of these patients were retrospectively reviewed. Age and gender were recorded, as well as Karnofsky performance score (KPS) at time of diagnosis, tumor location, time to recurrence and dates of death were recorded. Overall survival (OS) was calculated from the time of surgery to death, and recurrence free survival (RFS) was calculated from the time of surgery to time of recurrence or censored at the last time of follow-up. GBM was histologically confirmed in all cases. Extent of surgical resection was determined based on a postoperative MRI performed Treatment Algorithm Gliadel wafers were typically not implanted in patients after tumor resection when the tumor largely extended into the ventricles or was multifocal. DNA Extraction After initial patient de-identification, all original histologic slides from the GBM specimens were reviewed to reconfirm the diagnosis of GBM by a senior neuropathologist (PB). A representative block with tumor was retrieved for DNA extraction. Histologic slides from the formalin-fixed, paraffin-embedded tissue were obtained. One representative slide was stained with HE and the tumor was marked by the senior neuropathologist (PB). An additional five correlating unstained 10 micron slides were also obtained. The tumor cells in the unstained slides were microdissected according to the marked HE stained reference slide. DNA was extracted from paraffin embedded tissue after xylene deparaffinization. The microdissected tissue was digested with 1% sodium dodecyl sulfate (SDS) and 200ug/mL proteinase K (Roche, Nutley, NJ) at 48 °C for 48 hours, followed by phenol/chloroform extraction and ethanol precipitation of DNA. Extracted DNA was dissolved in either LoTE (2.5 mM EDTA, 10 mM Trisâ⠂¬â€œHCl [pH 8]) or distilled water. Bisulfite Treatment Extracted DNA was subjected to bisulfite treatment, to convert unmethylated cytosine residues to uracil residues. Briefly, 2  µg genomic DNA from each sample was treated with bisulfite using the EpiTect Bisulfite kit (Qiagen, Valencia, CA) according to the manufacturer’s instructions. Converted DNA was stored at -80oC. Methylation Analysis Bisulfite-modified DNA was used as a template for fluorescence-based real-time PCR. Amplification reactions were carried out in triplicate in a final volume of 20  µL that contained 3  µL bisulfite-modified DNA; 600 nmol/L concentrations of forward and reverse primers; 200 nmol/L probe; 0.6 units platinum Taq polymerase (Invitrogen); 200  µmol/L concentrations each of dATP, dCTP, dGTP, and dTTP; and 6.7 mmol/L MgCl2. Primers and probes were designed to specifically amplify the promoter of MGMT and the promoter of a reference gene, ACTIN B; primer and probe sequences and annealing temperatures are provided in Table 1. Amplifications were carried out using the following profile: 95 °C for 3 min followed by 50 cycles at 95 °C for 15 s and 60 °C for 1 min. Amplification reactions were carried out in 384-well plates in a 7900 sequence detector (Perkin-Elmer Applied Biosystems) and analyzed by a sequence detector system (SDS 2.2.1; Applied Biosystems). Each plate included patie nt DNA samples, positive controls (Bisulfite-converted Universal Methylated Human DNAStandards (Zymo Research) in serial dilutions 20ng to 2pg) and molecular grade water was used as a non-template control. The ÃŽ ²-actin gene was used to normalize and act as an internal loading control. The methylation ratio was the ratio of values for the gene-specific PCR products to those of the ACTIN B and then multiplied by 1,000 for more efficient tabulation. Statistical Methods The overall survival (OS) time was defined from the date of initial diagnosis of the disease (surgery) to the time of death or censored at the time last known alive. The recurrence-free survival (RFS) was counted from the date of initial diagnosis of the disease to the time of disease recurrence or censored at the time last known alive and recurrence-free. Probabilities of OS and RFS were estimated using the Kaplan-Meier (KM) method [15] and compared using Log-rank test. Confidence intervals were calculated using the method of Brookmeyer and Crowley[14]. Cox proportional hazards model [16] was used to estimate the association between OS or RFS and MGMT methylation status, treatments and well known prognostic factors. Schoenfeld residuals were used to test the proportionality of factors in Cox proportional hazards models. Radiation status was treated as a stratification factor in the Cox regression model. TMZ has FDA approval for newly diagnosed GBM patients aged between 18-70. Subgro up analyses were performed for patients who were aged over 70. All p values were two-sided. All analyses were performed using the Statistical Analysis System, version 9.2. MGMT was considered as promoter methylated if the methylation ratio was higher than 8, and unmethylated if below 8. RESULTS Patient Population Six hundred patients with newly diagnosed GBM underwent craniotomy between 1997 and 2006, at the Johns Hopkins Hospital. One hundred eighty five patients received Gliadel (30.8%) after tumor resection. Methylation specific PCR was performed in 122 of the 185 patients (66%) because 63 patients did not have sufficient paraffin embedded tumor tissue for MGMT analysis. The characteristics of the patients and type of treatments are shown in Table 2. The clinical course of forty patients who had methylation of MGMT promoter was compared to 82 patients without promoter methylation of MGMT. The similarity of distributions among patients characteristics, and treatments between MGMT methylated and unmethylated is also shown in Table 2. There was a slightly male predominance in both groups. The median age of the MGMT methylated group was 65.5 years compared to 60.5 years in the non-MGMT methylated group (p=0.59). Most of the patients in both groups had KPS score of ≠¤ 80 (p=0.67). Most of the patients in both groups underwent gross total resection (GTR) (85% vs. 74% in the methylated and non-MGMT methylated group, respectively), (p=0.19). Most of the patients in the MGMT methylated and non-MGMT methylated groups received post-operative radiation therapy (RT) (80% and 72% respectively). However, there were 31 patients (25%) without radiation treatment recorded in their medical chart. Only 33% and 29% of MGMT methylated and non-MGMT patients, respectively, were treated with TMZ due to majority of patients was treated prior to 2005 when RT+ TMZ became the stadnadrd of care for the newly diagnosed GBM patients. Overall Survival The Kaplan-Meier estimate of the median OS for the122 patients with newly diagnosed GBM was 13.5 months (95% CI: 11.0, 14.5). Median OS for those with MGMT methylation was 13.9 months (95%CI: 9.5, 17.1) compared to 12.9 months (95%CI: 10.9, 14.5) (p= 0.86) in patients non methylated. Univariate and multivariate association of survival with treatment factor, baseline prognostic factors, and MGMT methylation status are shown in Table 3. There was a 15% reduction in hazard of death (Hazard ratio: 0.85, 95%CI: 0.56-1.31) for patients with MGMT methylated tumor compared to those with MGMT unmethylated tumor after adjusting for age, KPS, extent of resection, TMZ and RT. A subgroup analysis was performed among 35 patients who were 18-70 years old and treated with Gliadel, RT and TMZ ( Gliadel+ Stupp’s regimen) [1]. The median OS was 19.8 months (95% CI, 14.5, 22.2) in this subset of patients. There was no statistically significant difference in OS among these 35 patients with MGMT pr omoter methylation (median OS:20 months,95% CI: 9.2, 37.0), compared to patients without MGMT promoter methylation (median OS: 18.9 months, 95% CI: 11.9, 22.2), (Table 4). Only two out of 30 elderly patients aged above 70 years were treated with TMZ, one was MGMT methylated and another was not. Among these elderly patients, those with MGMT promoter methylation showed a significantly longer median survival of 13.5 months (95% CI, 0.49, 17.1) compared to 7.6 months (95% CI, 2.9, 9.4) when the MGMT promoter was non-methylated (p=0.027). A similar significant difference in median recurrence-free survival was also found in elderly patients where the median survival was 13.1 versus 7.6 months (p=0.01) for MGMT methylated and unmethylated, respectively. The overall median recurrence-free survival was 9.4 months (95%CI: 7.8-10.2) for all patients. There was no difference in RFS between patients 18-70 years old with and without MGMT methylation. DISCUSSION In this study we investigated the significance of MGMT methylation status in a series of 122 patients with newly diagnosed GBM who underwent surgical resection and implantation of Gliadel wafers. The results of our series show a reduction in hazard of death for patients who were MGMT methylated compared to non-methylated. Interestingly, this effect was much more profound in the elderly group of 35 patients who were older than 70 years old when they were diagnosed with GBM. Elderly patients who were MGMT methylated had significantly better OS, compared to non-methylated (13.5 vs. 7.6 months respectively, p=0.027). The methylation of the MGMT promoter region leads to a reduced ability to repair DNA damage induced by alkylating chemotherapeutic agents [7]. Methylation of the MGMT promoter was found to be associated with responsiveness to alkylating chemotherapeutic agents such as temozolomide [6] and BCNU [7], and an increase in OS and progression free survival. The median survival of patients who received the combination of Gliadel, temozolomide and radiation therapy in our cohort ranged between 18.9 to 20 months, six months greater than that for the radiation therapy and temozolomide historic cohort [1] (Figure1). For patients younger than 70 years old, the median survival of the MGMT methylated sub-group was slightly greater that MGMT non-methylated. KPS in a known prognostic factor for patients with brain tumors [8]. Most of the patients in our study cohort had poor KPS of less than 80. Still, our results were in line with the report of Lechapt-Zalcman et al. [9] who assessed the prognostic impact of MGMT promoter methylation in patients with newly diagnosed GBM that received Gliadel in addition to radiation therapy and temozolomide. The OS of their study cohort was 17.5 months. Patients with MGMT methylation had a significantly longer OS of 21.7 months compared with patients without MGMT methylation who had OS of 15.1 months. Two recent phase III clinical trials in the elderly age of patients with malignant astrocytoma, the NOA-08 [10] and Nordic trials [11], demonstrated that temozolomide therapy alone was not inferior to radiotherapy alone, and methylation of the MGMT gene promoter was associated with a benefit from temozolomide. However, there is a concern that combination therapy of radiation therapy and temozolomide may be less active and less well tolerated in the elderly population [12]. European Organization for Research and Treatment of Cancer (EORTC)-26981/National Cancer Institute of Canada (NCIC) CE3 trial have suggested that with increasing age, the relative benefit of addition of temozolomide to radiotherapy decreases and the patients suffer from increased chemotherapy-associated side effect such as neutropenia, lymphocytopenia, thrombocytopenia , raised liver-enzyme concentrations infections and thromboembolic events. As opposed to systemic chemotherapy with its limitations, local delivery of Gliadel wafers may be promising in this subset of patients. Chaichana et al. compared 45 elderly patients who were treated with Gliadel to 88 elderly patients who did not receive Gliadel [13]. The survival for older patients who received Gliadel was significantly longer than for patients who did not receive Gliadel (8.7 months vs. 5.5 months respectively, p=0.007). The median survival of MGMT methylated in elderly patients in the current cohort was doubled. These results may support the use of Gliadel in this sub-population. Limitations There are several limitations to this study. Its retrospective nature carries a potential bias. Moreover, the time period of this study ended in 2006, only one year after temozolomide became the standard of care in the treatment of GBM, thus most of the patients were not treated with the combination of temozolomide and radiation therapy. Furthermore, because this is a tertiary referral center, there is a bulk of patients who were operated in this center, but received further neuro-oncology treatments elsewhere, near their home, and therefore, their complementary oncology treatment is not available. Still, this large and unique cohort of patients with newly diagnosed GBM who were operated in one tertiary center provide novel data that may assist in optimizing and personalizing the treatment for GBM patients.

There Are Jews in My House Essay -- Literary Analysis, Lara Vapnyar

There Are Jews in My House Lara Vapnyar, in There Are Jews in My House, ingeniously shows her wisdom about life by exploring humanity and human frailty. Remarkably adept at portraying characters, Vapnyar, a recent Russian immigrant herself, vividly depicts the struggles and adventures, dilemmas and unexpected turns in small people's world, with delicate humor and incredible emotional honesty. It is her deft and vivid portraits of different main characters in each of the six stories that successfully develop her main theme: human beings should always stay on their way of pursuing spiritual sustenance, regardless of the adversity they face. In the title story, "There Are Jews in My House," Vapnyar reveals that morals and faith are two important forms of spiritual sustenance. The emotional transition of the only three-dimensional character, Galina, towards her Jewish friend, Raya, is the main thread of this story. At first, Galina decides to save Raya and Leeza although she somehow knows the danger inherent in harboring Jews. "But the thought of the danger [does not] dampen Galina's ardor; on the contrary, it [makes] her all the more enthusiastic" (28). However, the external conflicts, which arise under the law against Jews, cause the internal conflicts in Galina's mind. Ambivalence comes up inevitably and her hypocrisy slowly outweighs her generosity. Holding two lives in her hand while risking her own life, Galina "desperately [wants] to back out" and to tell Raya, "'No, no, you can't stay here. It's not for me. I am the wrong type of person. I am not prepared'" (30). Furthermore, Galina's negative attitudes towards Raya, deeply buried in her mind, are unearthed and magnified. On the one hand, Galina still hides Raya in her ... ... lessons anymore" (138). At the end of the story, her confession about her ignorance in front of her students finally releases her from solving the burdens of sex as well as of exile. â€Å"'I don't know!'† she says, â€Å"I enjoyed saying these words so much that it made me light-headed. I felt like hopping on one foot around the classroom singing, ‘I don't know! I don't know! I don't know!’† (149). By creating all these characters, Vapnyar successfully conveys to people the importance of adhering to their morals and opening their hearts, facing the present and relinquishing the past, experiencing the need for confirmation and feeling the desire for shared hesitancy, maintaining their faith and pursuing true love, or admitting their ignorance and confronting their fears. Only when people begin to seek these objectives, can they finally achieve their spiritual sustenance.

Comparing Christianity, Judaism, and Islam Essays -- Compare Contrast

Similarities and Differences between Christianity, Judaism and Islam There are many similarities and differences between Judaism, Christianity and Islam. There are also many differences that separate the three major religions of the world. This paper will delve into all three of them. The major similarities that all three religions share are that they are all monotheistic. This all means that they believe in one god and that he is the supreme ruler of all things. They also believe that all things are created equal under one god. They all have books of what they believe to be God's word. The Jews have their book known as the Torah. The Christian's have their book known as the Bible. Lastly the Islamic people have their book known as the Qu'ran. All three of these books have scriptures. These three major religions also share a belief that there is one major area that they claim as their Holy Land. The Jews and the Christians claim Jerusalem, Israel as there Holy Land while the Islamic people claim Mecca, Saudi Arabia. These places are where the people believe that ...

The Role of Dreams in Genesis, Song of Songs, and The Oresteia Essay

The Role of Dreams in Genesis, Song of Songs, and The Oresteia When describing the role of dreams in ancient texts, Freud wrote, â€Å"They took it for granted that dreams were related to the world of the supernatural beings in whom they believed, and that they brought inspirations from the gods and demons.   Moreover, it appeared to them that dreams must serve a special purpose in respect of the dreamer; that, as a rule, they predicted the future.†Ã‚  Ã‚   He goes on to explain the findings of a fellow psychiatrist, Gruppe, who believed that there are two classes of dreams in ancient texts.   The first class is influenced only by the present or past and does not play a largely significant role in these texts.   The second class, however, is determinative of the future and is quite important to the understanding of the texts in which they appear.   This class contains dreams that are direct prophecies and directly show the future, dreams that are foretelling of the future and indirectly hint at what the future will be, and dreams that are symbolic and require interpretation to fully understand their explanation of the future.  Ã‚   The gods use all these types of dreams to play a direct role in the lives of men in Genesis, Song of Songs, and The Oresteia.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The use of dreams in Genesis is most obvious through the story of Joseph.   Dreams play an important role in determining the course of Joseph’s life, and are used to reveal the mind of God to the people.   The first dreams he encounters are those of the sheaves of his brothers bowing down to his sheaf, and the sun and moon and eleven stars bowing down to him.   These dreams best fit into Gruppe’s description of symbolic dreams.   While their explanation is fairly evident as showing tha... ...re very important in ancient texts because they present to mankind a world that they cannot see.   Without dreaming, there would be almost no connection to the gods, to those beings who impact and design life on earth.   As Freud states, there is significance in every dream; they each have a special meaning for the person who experiences them.   They are important because the gods can directly shape the course of a life through them, because they can be a form of communication with the gods, and because they can show what is going on behind the secret â€Å"god curtain† that humans cannot see through.   Without dreams, man would be stranded, left on earth by himself with no understanding of the meaning behind things.   For this reason, dreams are used as a major literary device, because they create a supernatural connection that everyone can experience and wonder about.   

Research Proposal Essay

Overview This dissertation aids in identifying the fundamental, extrinsic aspects influencing the dynamics of employee turnover and how it affects the surrounding atmosphere including internal and external behaviour of an organization. Employee turnover is one of the much talked challenges faced by employers which hinders an organization’s sustainable growth and generates negative synergy among other employees. This review can assist in analyzing strategy for retention and reduction of employee turnover in both public and private sector organizations. Organizations invest immensely in recruiting and developing their employees as it relates to continuous success of the organisation. Hence employee turnover is a potential loss for any firm. HR managers try to prevent the employee turnover by implementing effective retention strategies. Employee turnover is a common issue in Indian IT sector, though the trend has been reduced for the interim due to the recession. This dissertation helps in suggesting productive retention strategy in the organizations; and make recommendations to management of the organizations on how to effectively retain employees and reduce turnover. This review focuses on labor cost being a quintessential factor in the employee turnover process. In order to minimize the costs associated with the turnover, firms are implementing various strategies. Considering the fluctuation in direct and indirect costs of labour turnover, therefore, management does incessant studies to recognize the reasons why people leave organizations so that appropriate action can be undertaken by the management. Providing competitive salaries and other benefits, empowerment, providing stock options, flexible work hours are few of such strategies adopted by the firms to retain their staff. But how significant are these strategies to the employees? (James and Mathew: 2012. 79,page 1) Bussin (2002) asserts that constant training and development of emplo yees’ skills can actually aids employee early turnover rather than strengthening their retention. Providing employees with the latest training and development opportunities enhances the employee skills leading to escalating their chances of mobility. (Samuel and Chipunza; 2009) Our discussion proceeds in following steps. First, we investigate the aspect of money being the main motivator of employee turnover or could there be other motives. Next we identify the role of management to achieve a self- actualised employee and understand the factors that lead to this phenomenon.The final section of this dissertation discusses the results of the study and the conclusion. One of the main challenges to Emiratisation in the private sector is related to adapting the legal framework to accommodate national jobseekers’ needs. While they are well protected and privileged in the public sector, Emiratis find themselves vulnerable in private sector jobs. This is mainly due to a stricter legal framework that is mainly designed for the transient expatriate workforce in the private sector. A simple comparison between the contents of the Labour Law No. 8 of 1980 (and its amendments), which governs the employment relationship in the private sector and the employment legislations in the government sector reveal vast differences in favour of citizens who work in the public sector, as opposed to those working in the private sector. In general, employment legislation in the government sector stipulates in detail various rights and obligations of workers, while much of the employment relationship in the private sector is left to be determined through contractual agreements between employers and employees. Also, residence permits tend to tie expatriates to one specific employer, tipping the balance in labour turnover unfavourably against citizens, who are not tied in this way (Mellahi and Wood, 2002). A study by Abdalla et al. (2010) examining the determinants of employment and wage levels in the UAE found evidence to support the notion of a dual labour market that is segmented by sectors (public versus private) and nationality of workers (citizens versus expatriates). The experience of UAE citizens, who until recently had easy access to public sector jobs with wages inconsistent with the market value of their human capital, makes their expectations regarding wages and working conditions unrealistically high. This makes them unattractive to profit-oriented employers in the private sector. As a result, GCC citizens often prefer to wait for a government job rather than take a private sector job, even if they are aware that the wait might last many years (Shaban et al., 1995) Another 23 per cent of the respondents indicated they would take a private sector job as a temporary measure to earn a salary until finding employment in the public sector. In total, half of the interviewees indicated that they see no future career for themselves in the private sector at all. These answers were consistent across all three groups of interviewees. Respondents were very clear about the factors that make them prefer one sector over the other. For those who prefer the public sector, the main factors were job security (39.5 per cent), salary levels (31.5 per cent), and advancement opportunities (30 per cent). Other significant, but less frequently cited reasons to prefer the public sector, were more vacations (10 per cent) and relatively less working hours (8.3 per cent). When asked what a private sector organisation would need to do to make her apply for a job, a female graduate in our sample answered: â€Å"I don’t want to sign my death paper. The salary, the wor king hours and the contractual conditions I would sign would equal that.† It is interesting to note that while a small number of respondents (15 per cent) indicated that they would prefer to work in the private sector, many (38 per cent) said that good career opportunities exist in the private sector. Those who prefer the private over the public sector cited advancement opportunities (44 per cent) and finding a job consistent with one’s specialisation (33 per cent) as the reason for their preference. However, these attributes were not sufficient to attract many Emiratis to pursue employment in the private sector due to several structural barriers reflected in inferior salary levels and employment conditions in the private sector compared to the public sector. In addition to the basic preference for public sector employment, it was also clear that this preference is supported by a strong sense of entitlement to such jobs and the salary levels coming with it, as one male student puts it: â€Å"We are a rich country – Thank God – and the government pays well because it can afford to do so. It is our right as nationals to have jobs that pay well.† This sense of entitlement (Al Gergawi, 2008) is deeply rooted in the existing social contract, changes to which Forstenlechner and Rutledge (2010) argue need to be communicated urgently if citizens are no longer able to be employed in the public sector at current levels. When asked about factors affecting their decision to accept a job offer from an employer, respondents gave the highest rating to employee rights (48.3 per cent) and job security (45 per cent). These were followed by working conditions and availability of advancement opportunities. Table I further shows that Emiratis in general are unwilling to take risks with regard to their job and career choices. Job security and protection of employee rights are their top priority, followed by working hours and advancement opportunities. Despite the importance of salary and benefits, these were not on the top of the list as shown in Table I. Salary: Salary expectations Our findings support the contention that one of the major barriers to Emiratisation in the private sector is the high reservation wage required by Emirati job seekers. When asked what minimum monthly net salary they would work for, 38 per cent indicated that they would accept 6,000-10,000 dirhams[1]. However, 32 per cent had a reservation wage of 10,000-15,000 and a further 12 per cent said they require 15,000-20,000. The remaining 18 per cent said their required salary would be above 20,000. However, when asked what they think they should get paid, respondents’ answers were higher than their individual reservation wage. In this case only one female respondent said she considered a monthly salary of 6,000-10,000 fair. 37 per cent of respondents said they should get 10,000-15,000, 20 per cent indicated that they should get 15,000-20,000 and 8 per cent said fair pay would be 20,000-25,000 monthly. The remaining 30 per cent, however, considered a fair wage to be upwards of 25,000 monthly, with 10 per cent actually expecting a monthly net salary between 35,000 and 50,000[2]. These expectations are clearly driven by public sector (welfare) wages, as one male student explained: Salary expectations Our findings indicate that young Emirati jobseekers on average have a higher expected salary than their – already relatively high – individual reservation wage. This points to several somewhat troubling conclusions: . The average reservation wage for young Emirati job seekers is high compared to the expatriates they are competing against in both sectors, confirming previous research (Bremmer, 2004; Godwin, 2006; Mellahi, 2007). . The perceived fair pay for young Emirati job seekers is higher than their reservation wage, which means they are likely to experience pay dissatisfaction even when they accept job offers in the generally lower paying private sector. . The perceived fair pay and the reservation wage required by the majority of Emirati job seekers interviewed in this study is comparable to the going rates in the public sector for national employees of similar calibre. This clearly indicates the need to consider the potential impact of pay policies in the public sector on Emiratisation efforts and policies, as they effectively hinder private sector employment. We see the roots of such expectations in the structure of the labour market, where public and private sector are governed by different considerations and different rules and regulations. Therefore, one of the key hindrances remains the salary difference between the public and the private sector. As it is unrealistic that public sector pay will be lowered, as recommended by the IMF (2004), and just as unrealistic to expect the private sector to match public sector salaries and benefits in the context of the UAE, we therefore support a recommendation made by Abdalla et al. (2010) to revise the wage-setting mechanism in the public sector. They suggest to separate the total public sector wage into two parts: pay related to market considerations and productivity of workers (efficiency wage); and (2) a portion motivated by the desire to improve the standards of living and wealth distribution for citizens (welfare). They assume that, in the UAE, only part of the wage paid to national workers in the public sector is related to the value of their human capital or their work performance, while the other part is a transfer payment to raise the standards of living for citizens. Separating the two components has two advantages: (1) it sends the right signal to national workers about the realistic value of their human capital; and (2) it helps to remove the distortion of labour market mechanisms in setting wages according to market forces. Mechanisms to extend the welfare component of pay to those citizens working in the private sector will need to be implemented. Subsidizing wages of citizens in the private sector to bridge the gap between the efficiency and welfare components of pay might be a reasonable alternative. Funding of these subsidies can be secured through fees imposed on employers who recruit foreign workers. Selective application of such fees on employers depending on number of foreigners recruited and affordability to pay might be needed to ensure fairness and avoid excessive burdens on certain employers. As mentioned previously, salary is, of course, not the only aspect where expectations are driven by the public sector. The same is true for days off work, as one male student puts it: â€Å"All I am asking for is normal vacations†, with â€Å"normal† in this case meaning those vacations the public sector offers. Recommendations for further research Further research is needed to clarify the perspective of private sector employers on localisation, for example the perceived threshold of tolerable legislative changes and their perception and intention of compliance. Also, research is needed to analyse the potential effects of employment laws and regulations on the effectiveness of workforce localisation policy and the legislative changes that might be needed to enhance its outcomes. Further quantitative, large-scale testing of some of the conclusions regarding the attitude of jobseekers would also be beneficial to further investigate the perceptions of jobseekers, possibly by delivering a survey to a large number of students enrolled in the higher education system. Understanding the process of employee turnover has been interpreted differently by various researchers depending on the controlling factors of the socio-cultural environment. This is because different factors have been found useful when it comes to interpreting employee turnover, and these have been used to model turnover in a range of different organizational and occupational settings. They include: job satisfaction (Hom and Kinicki, 2001); labour market variables (Kirschenbaum and Mano-Negrin, 1999); various forms of commitment (see Meyer, 2001 for a review); equity (Aquino et al., 1997); psychological contract (Morrison and Robinson, 1997); and many others (see Morrell et al. (2001a) for a review). S. Wren (1980) also suggested that to reduce employee turnover the company should keep employees informed on company matters, encourage employee innovation and setting clear communication channels between top management and lower employees. Also Inge, Peter , Arnold and Jan (2003), sugg ested that work motivation is related to emotional exhaustion which in turn induces employee turnover rate in their longitudinal study. Considering the prolonging economic downturn, the primary stimulating factor impacting employee turnover has been money, as consequently it affects both employees and their respective organizations. However, organizations try to implement other strategies to keep employee turnover to a minimum level by rewarding their employees with better incentives and bonuses. Research has portrayed that even when people’s main motivation for work is not money, if they are offered a higher salary by other organizations, they would not be hesitant to leave their current job, thus leading to high employee turnover. In response, researchers have recently turned their attention towards employee work motivation as predictors for employee turnover (Richer et al., 2002), as motivational sources have been found to influence employee turnover beyond job satisfaction and organizational commitment (e.g. Mitchell et al., 2001). In fact, some authors proclaim that the primary aim of incentives is to enhance better motivation by satisfying an individual employee’s needs indirectly through means of pay and bonuses (Anthony and Govindarajan, 2007; Kunz and Pfaff, 2002). Some UAE scholars pointed out that â€Å"Motivation is an important subject area for researchers and practitioners all over the world. ( Abubakr M and Nawal , p 86)† It is an ongoing universal argument if money is the main motivation causing high employee turnover within an organization. Therefore, this literature review is based on theory testing evidenced by past studies on staff turnover and retention, not supported by theory building. All these theories consolidated as one forecasts potential costs of organizations in diversifying pay, mainly through two kinds of de-motivating factors: first, individuals that don’t earn as much as they feel their work deserves may perceive that they are less-well valued than their higher-paid counterparts; and second, higher-paid individuals may perceive that they are more valuable than they actually are (Kohn, 1998; Carr, 2004). In reference to (Abdulla j., Djebarni R. and Mellahi K, 2011, p138) employees in the UAE put a strong emphasis on salary and incentives especially for non-UAE nationals because of their impact on living standards and importance in providing a sense of security where perceived job security is very low. Furthermore, the high importance of salaries and incentives could be due to the high cost of living in Dubai compared to other Middle Eastern emirates. Having reviewing the EU countries such as Greece, extrinsic rewards such as pay give better outcome in the organizations and their governments actually want to convince private sectors on the importance of intrinsic rewards where workers are motivated to work without expecting a reward and love what they do. (Manolopoulos D., 2008) Crucial factors like employee involvement and the process of performance rewarding impacts the degree to which employees are included in decision-making processes. Are they occasionally asked for input or feedback? Or are they authorized and challenged to make a difference? Obviously, the greater an employee’s level of involvement in the decision-making process, the greater the sense of ownership for the outcomes of such decisions, which, in turn, assures employees that he/she is a part of the organization as a whole. (Dell’Agnese, 2001; Mintzberg, 1994a,b,c, 2001a,b; Pfeffer, 2001a,b; Piggott, 1997). One of the effective ways of reducing staff turnover is making more effective use of existing staff resources and in attempting to put together a pay package which attracts and retains staff, through rewarding them fairly for their performance (A. Baines, (1991) pp. 8 – 10). According to one source (Curtis S. and Dennis W. 2001, p.59), the cost of replacing an employee is higher than recruiting a new staff. This is because of accumulated cost of the loss of skills, knowledge, experience and the investment in training. There is also the disruption to the work and staff, when a new employee is recruited, there are barriers like new challenges of adopting to the culture of the organization, personality conflicts, time taken to familiarize with the job description etc. Also, many other administrative cost associate with the employee turnover process like agency fees for recruitment firms, wasted time in exit interview process and administrative process of recruitment being time consuming and expensive etc. As further discussed by (Curtis S. and Dennis W., 2001, p.61-62), to get employees committed quickly, they should feel emotionally attached to the organization and feel that resigning would be a personal sacrifice for them where they would have an obligation and responsibility to stay. One of the interesting fast track employee commitment mentioned is offering flexible hours. Organizations should have improved retention schemes through flexible working options implementing other family-friendly policies like baby-sitting facilities, special consideration for new mothers and expecting mothers etc. Other initiatives might include workshops aimed at achieving a better work-life balance, access to a range of domestic services, extended maternity leaves, paid vacation breaks and extended parental leave. Since, the UAE is a family oriented culture, majority of employees would appreciate having easygoing strategies in their work place which allows them to have a work-life balanced with fami ly life. A worker lacking motivation is a problem waiting to happen. That’s why companies need to be able to ensure that their workers are fully motivated to do their jobs. If this isn’t the case then all that knowledge that they may possess isn’t fully utilized as a result of them not putting in 100percent (Maria C. Osteraker, 1999, pp. 73 – 77). Money as the sole motivation for work or production isn’t exactly the right solution. As portrayed within the proposal it is an important aspect, but should not be classified as highly crucial, since it is evident that other factors are arising. Taking into consideration that employees may transfer to other companies for a higher rise in money, however the effect is only temporary as behavioral aspects is also taken into account. Therefore it’s a balance of both. As Carolyn Wiley put it, Motivation is not a fixed trait; it is a combination of various aspects. (Wiley C., 1997, pp. 263 – 280). Going by this article (Industrial and Commercial Training, 1975, pp. 508 – 508). It details that it was Herzberg in the 1960’s who determined that money was not the sole motivator. It also goes on to state how the issue of money could be mixed. Both negative and positive, a worker will not accept a job that pays less simply because the all-round package was better. However he/she may accept a similar paying job if other aspects were improved. In other words they are looking for the right balance between the two. The dissertation is crucial because it shows the organizations the reasons behind employee turnover; it explains why it is happening in an organization. The main purpose of this dissertation was examining the impact of the retention on employee turnover; high employee turnover leads to collision on the competence and continuation within the organization. It is seen that many organizations features these kinds of issues with the labor turnover because it can lead to loss of the organizations, time consuming of the management and stress in the workforce plans. The study portrays that; pay can be one of the main motives for staff turnovers, also culture of the organizations and the job satisfactions. These three factors lead to labor turnover within the organization. Employee would stay in the organization if retention strategies are available like training sessions, good work timings, and employee’s proposal. Welfare benefits can be assigned as one of the main motives; as penetration after employee retirement and insurances. And other factors like personal and job satisfaction. (Employee Retention Strategies: IT Industry, Leena James and Lissy Mathew, July-Sept2011), (the impact of career motivation and polychronicity on job satisfaction and turnover intention among hotel industry employees, Jichul Jang, B.S, August 2008) This paper can be applied to the UAE. This is because almost half of the UAE population made up of expatriates. As a result the workplace is incredibly varied. So the question is why these people come from far and wide just to seek employment. Is it money or just a better work environment? Judging by the influx of new foreigners each year it is most likely a combination of the two. 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