Reflection on a change management and leadership

Reflection on a change management and leadership In 1947, MIT Professor Harold E. Edgerton and his several students were established EG G and which were involved in management of nuclear weapons to government and also in a wide range of similar activities. Perkin-Elmer was an older company then EG G and was established in 1930. Perkin and Elmer introduced it in a partnership and its operation was divided into two major divisions which was Analytical Instruments Applied Bio system. In 1999, there was an acquisition of Perkin-Elmer and EG G. Perkin-Elmer sold its name and Analytical Instruments division to EG G and EG G also sold its technical services business to Carlyle group investment firm .Then they would drop the EG G name and take the name of the acquired co. by disappearing the hyphen between Perkin Elmer and after the approval of its shareholders then after EG G was known as PerkinElmer. But there was one problematic element in the future of EG G its Perkin-Elmer operations was a good leadership. A good leadership was required in EG G to change a company rapidly and radically. Thats why for the fulfillment of the above requirement. In 1998, GREGORY L SUMME brought in company. He was with the experienced a lot as a partner at Mc Kinsey Co. , at General Motors he was general manager of commercial motors, at AlliedSignals Aerospace Engines and at General Aviation Avionics he was a president and recently at the Automotive products Group at AlliedSignal he was president of it. And because of his this track record at making technology companies competitive and profitable the Co. brought him to turn around the business as in recent years the company had been faltering. Now, PerkinElmer divided its business in two segments Human health and Environmental health. In Human health they are dealing with the companies of Bio-discovery, Genetic Screening Medical Imaging operating units. Environmental health segments are dealing with the laboratory services, Analytical sciences and detection Illumination units. DISCUSSION OF CHANGE MANAGEMENT AND LEADERSHIP THEORIES Change management: Change management  is a structured advent to developing  individuals,  teams, and  organizations  from a current status to a desired future status. It is aimed at empowering the employees to secure and changes of the grip in their current business environment within the organizational process. In Change management, project changes are formally introduced and approved. Models of Change Management McKinsey 7S Model The McKinsey 7S model involves seven interdependent factors which are categorized as either hard or soft elements as. I personally feel that 7s model can be related to this assignment as the changes were distributed in 7 elements which are as above and which are explain below as per the related company STRATEGY: after the acquisition, the leader implemented new strategies in the company. STRUCTURE: there was a structural change because of acquisition. SYSTEMS: New systems were implemented by the new leader in a company. SHARED VALUES: there were some ethics and new systems of work made by new leader which was shared as a core value of company. STYLE: the style of leadership adopted by the new leader to sort out all the complicated issues of the company. STAFF: the employees were distributed according to their capabilities and mostly new staff was recruited. SKILLS: Training programs were given to every individual from top to lower level management. Leadership  is the process of  social esteem  in which one person can influences others to attain an objective and directs the organization with a group of people to achieve a common goal through change. Leader: An individual who has granted authority, usually based on hierarchal position, in an organization. Leaders carry out this process by applying their leadership knowledge and skills make it more cohesive and coherent. Leadership is ultimately about creating a way for people to contribute to making something extraordinary happen . According to this assignment I concluded that the contingency theories are applied as this theory focus on individuals related to the environment that can be determined which particular style of leadership is best satisfied with the situation. The organization was structured in a way that who reports to whom rule was adopted. All the implementations were covered by the leader Gregory L. Summe. He distributed the whole problems in his effective leadership style that he focused on identifying the situational variables to fit the particular circumstances. COMPLICATED ISSUES IN EG G They had problem like inconsistent operating performances, a week reputation with investors, a highly fragmented organization as a company was holding of 31 diverse businesses with 31 different cultures brands and many businesses with uncertain prospects, no strategic coherence while there was lot of good technology in the business, experienced executives were there in company management but some of them had a lack of the right skills, the Pace Priorities were incompatible with the direction of the co. want to go as many of them came from the govt. services business and also other managers skills were under-developed and too narrow. So, they worked in one role in one business of EG G for a long time. CHANGES ADOPTED TO OVERCOME Firstly, the company focuses on improving their ability to gain consistent earnings. So that, they had good financial record and also regain trust of financial markets. And for this they established a new culture which was with more ambitious about performing goals and with clearer accountability. Secondly, it consolidated its 31 businesses into five strategic business units. Five strategic business units Thirdly, they offset the charges involved in this restructuring from the sale of several businesses including two mechanical businesses Sealol and Rotron. Fourthly, they sold all the government services business as it operated in a low margin, consolidating, declining market. Fifthly, they changed their name to signal to their customers, investors and employee that this was a new company. Sixthly, as they started with nine different businesses and brands but then they quickly narrowed their focus on just three segments: specialty illumination, digital imaging and telecommunication as dealing in more selective and for healthier their portfolio. Seventhly, they made seven key acquisitions and this is designed to quickly provide them complementary products, technologies and geographic coverage. Seven key acquisitions are divided as follows: One in optoelectronics, One in fluid sciences, Two in instruments, and Three in life sciences. Eighthly, they shifted power away from corporate center to each of the business units. Last but not least, for all employees of PerkinElmers they place a broad range of training programs to teach leadership skills, business fundamentals and best practices and it consists of four programs aimed to develop each individual at various levels of the organization and they were Advanced Leadership Institute, Emerging Leaders Program, Driving World-class Performance Program and Skills based Training Programs. SUSTAINING CHANGE Companys operating margin which was less than 6% in 1997 exceeds to 11%. After focus on three segments, the market leaders in both specialty illumination and imaging segments, which together accounts for 80% of the divisions revenues. In telecommunications segment, they achieve an annual revenue growth rate of more than 100%.The seven acquisitions made them number one in world in explosives detection systems and one of the top three in analytical instruments. They also have good terms with their investors as they understand and support their strategy to upgrade the portfolio. They reduce their corporate staff from 140 people to 65 people after taking the decision of shifting power away from the corporate center to each of the business units. CONCLUSION It can be concluded that if you have the right person leading the charges, good thing always happen but the Important decision is to choose right person and also in this company they choose a right man at right time which no doubt benefitted the company a lot. In contrast of a company, the Gregory L Summe was taking almost all right decision to turn around the business as per the requirement of the company and it also gained a success by restricting it. As its operating margin was increased , its revenues was increased , the co. had a tag of no. one in world in explosives , detection systems and one of the top three in analytical instrument and in present in current year its revenue was gone up to 498.3 million. The major change was to change of the name of company i.e. from EG G to PerkinElmer. The change of the name was just the part of acquisition however it was also to attract the new group of investors in the company. The profit has been raised in current year and it has been concluded that 2010 may be a brighter year for the company. PerkinElmer is delivering world drive productivity, quality and accuracy. Although forward looking statements such as believes, plans, project intends are leased on managements current assumption and expectation. However, these should be assured that their expectation and assumption are proved to be accurate and profitable.

Public Health Policy in Australia

Public Health Policy in Australia Section 1 Healthy public policy is an denotative pertain for equity of health in all field of policy and for the benefit to impact in health. The importance of public health policy is to make a positive environment to enable people to lead healthy lives. Healthy public policy create a healthy choices possible for the citizens’ concerns. Public policy creates a physical and social environment of healthy lifestyle. As government sector pursuit of healthy public policy concerned with trade, education, agriculture, industry and communication require to take into account for the healthy consequences of their decisions in policy and these sectors should be answerable for the health consequences of their decisions in policy. The government should play an important role in healthy public policy for the economic consideration (1†¦.). According to the Catherine Althaus policies are theory about the world, some flourish while other shrivel up, the better designed the theory, the more tested its assumption’s, the greater the chance of success.(4..) The healthiness amends Quality of life, Productivity of workforce, Learning capacity, Strengthens of family and community. The government are responsible for making policy and allocate resources for the implemented policies, basically public policy can be defined as a system of law, course of action, regulatory measures and funding priorities regarding a given promulgated topic by a governmental representatives or entity.(3..) What is Health in All Policies (HiAP)? According to the definition of World Health Organization Health in All Policies (HiAp) is an approach path to public policies across sectors that consistently takes into account that the health decisions implications, synergies searches and destructive health impacts, avoidance in order to improve health and health equity of population. It also related to rights and obligations and improves accountability of impact in health policymakers at all levels of policymaking. The HiAP include a vehemence on the consequences of public policies on health systems, healthy wellbeing, and health determinants and contributes to sustainability of developments (2..). The HiAP approach are as follows; It ameliorates the public policy maker’s accountability for health impacts at all stages of policy making. It admits an emphasis on the effects of public policies on health systems, determinants of health and well-being. It contributes to sustainable development. Social determinants of health (SDH)is the core concept of HiAP in which health and wellbeing of the population is shaped. According to the definition of world health Organisation SDH is a conditions in which people are born, grow, work, live and age and theses circumstances are shaped by the distribution of money, power and resources at global, local and national levels(5†¦). For example transport, housing, education and the environment are some of the factors which affect health and wellbeing which lies outside of the main function of health systems and these are some of the broad changing areas in which most significant improvement in health and life expectancy over the 150 years and are not directly attributed to improvement in health care (6†¦). Health in all policy is a way of government working across to achieve better public policy results and simultaneously improve health of population and wellbeing consequences. A healthy population has positive impacts on economy, sustainability and productivity in which it benefit all sectors and society as a whole (6†¦.). How public policy are formed in Australia? In Australia the public policy is formulated not only by the influence of politicians but by contribution of many public servants and thousands of men and women who file the petition to parliament and ministers who join interest group, by media comment, union, corporation and community movements. The entire community is effected by public policy(4†¦.). The policy procedure are generally follow a logical system and that system seeks to structure the way problems are empathized and introduced, so that the decision makers can hear about the issues, understand options, learn of informed opinion, make choices, test their decision and evaluate their actions.(4..). Section 2 Issues are multi –sectorial and involve a range of interesting group Yes, according to the Food Security Policy it is clearly states about the multi sectorial issues which mostly affects Low income households such as sole parent, students English low proficiency peoples mainly newly migrants and refugees Aboriginal and Torres Strait Islander Northern suburbs householders People with mental illness or weak older adults who needed support for daily activities People with stress or who were homeless. HPP involves commerce, industry, voluntary, Organisation, community and government Yes, the Food Security Policy has been implemented with local government food security policy project which is funded by Victorian Department of Health. The main goal of this policy is to achieve to reduce the prevalence and impact of food insecurity. HPP involves the representation of: †¢ Northern Area Mental Health Service †¢ Neami Darebin †¢ Austin Health †¢ Northern Division of General Practice †¢ Spectrum Migrant Resource Centre †¢ Department of Health †¢ North East Primary Care Partnership †¢ Planning for a Healthier North †¢ Women’s Health in the North †¢ Mental Illness Fellowship of Victoria Darebin Community Health Darebin Council Community Health and Safety Officers **Table is created according to the information of â€Å"The Food Security Policy† data. Health risks are global and not confined to regional boundaries Yes, the Food security is a global issue which will affect the future food security due to the climate change and increasing the demand if food production resource were reduced worldwide. According to the 2014 repot around 805 million people that is one in nine of the world’s population were chronically undernourished. The vast majority of this issues in developing country. (7†¦)According to the city food security policy. Current global climate change will affect the global food insecurity and that will continue to grow the capacity to produce and distribute food undernourishment due to the changes in water scarcity, food producing land for production of bio fuels, degradation of lands and land lose due to urbanization due to these above factors will increase the demand for food as the grows of population. Simultaneously will impact the community and household level with increased food price, increased transportation price and utilities price as well. The above factors al so will influence the food that will be available with increased local product, more depends on seasonal products and low processed product such as meat, dairy and imported food items. Thus will mostly effect the average community household to manage due to its affordability and vulnerable to food insecurity(8†¦.). HPP aims should be educational and not persuasive This is a limited rational because the report only explains about the food security policy should focus to educate the following issues such as Daily intake of vegetable and fruit particularly for disadvantaged groups. Lack of knowledge and skills related to healthy cooking and eating habits. Lack of knowledge about the Australian food products and how to use and this effect mostly newly migrants who don’t speak English. Lack of motivation and cooking healthy meals on a daily basis. Action for HPP takes many forms lobby groups, local community action. Limited because according to the report the local government capacity is limited to address the determinants of food security which are complex and influenced by global environmental, economic and social factors that are related to skill and production of food. The state and federal leadership on this issue of food security has been minimal and slow issue. The local government are showing their leadership in the food security area slowly because of need in their local community. The HPP of the Food Security Policy has been designed to reflect areas of action where local government can play a role in addressing local food security issues through both broad systemic response and social welfare around local land use planning, environmental sustainability and transport. HPP is intrinsically a political activity. No, the HPP of City Food Security Policy is not a political activity. The policy of food security is formed due to the city council’s community planning, partnership and performance of department are carry importance for the co-ordination of Food Security Policy. The council are responsible for the implementation of particular aspects of the policy making. Policy Summery The main benefit of developing such food security policy is to recognize the local government limited capacity to explain the determinants of food security which are complex and determined by global environmental changes, social factors and economic that related to production and acquisition of food. The HPP of Darebin also admitted that local government carry an important role play for responding to undernourishment of food insecurity to their municipal setting and how they can improve by implementing such HPP in which HPP contributing for making local and regional food supplies for accessibility in the future. Section 3 Health is multiphase and no more defined in terms of disease and illness or according to the WHO definition of health Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity†(†¦..), rather it is enlaced with social prevailing, economic, political and condition of environment where more food sustainability or access for land. According to Kaplan the major reason of disease and population suffering are rooted firmly in the social, behavioral and psychological world in which people grow, live and die are embedded in multiple factors of geographical, environmental, institutional and economic circumstances (9). The most responsibility for health inequities is due to the social determinates of health. When viewed through social health lens, the health inequities and public health opportunity which enables community health, planning and community priority circumstance is inconsistently used (10†¦). Health inequities is due to the social determinants of health within countries are influenced by political power, economically and socially unacceptable which is avoidable and unfair. The Health public policies made in all sectors can have profound effect on health of a population and health equity. The health of world is shaped by the demographic changes, climate change, globalization and urbanization. Some of the diseases disappear due to the living conditions improvement and in developing countries many poverty diseases is still present, this all factors will improve by implementing health public policy for the benefit of community and future development. In order to improve the population health and social determinants of health, Health in All policies is relevant method of public policy approach that accounts systematically into account, the decision implication in health and avoid harmful health impacts (11†¦). What are the major different between Health public policy and Health in All policy? Health public policy(HPP) Health in All Policy (HiAP) The redistribution of public policy income through : Pension provisions unemployment insurance child care (12†¦) giving opportunity to people to adopt healthy lifestyle; preventing people to adopt unhealthy lifestyle; and Creating healthy physical and social environments.(13..) The HiAP reflects the principles of legitimacy, accountability, Transparency (2..) Health implications of decisions, seeks synergies, Avoids harmful health impacts Improve population health and health equity. It access to information, participation, sustainability, and collaboration across sectors and levels of government (2..) *** Table is created according to the reference data given above. The benefit of Implication of Health policy is to plan, action and decision that are beneficial to achieve target society health care goals. Health policy outlines priorities and the expected roles of different groups and builds consensus and informs people (14..).For example the Food Security Policy distinguishes that local government is limited in its capacity to address all of the determinants of food security by implication of policy will improve the ongoing supply of nutritious and sustainable food available, and improving access to the available food supply, particularly for those who are most vulnerable to food insecurity (15..).The target group of this policy is Low income households ( sole person, sole parent and student ) English low proficiency people( new migrants and refugees ) Aboriginal and Torres Strait Islander Northern suburbs Households People with a mental illness or disability (15†¦) The new public health approach will brings changes in environment and preventive measures with appropriate therapeutic interventions, especially to old age community and disabled persons. However the new public health will recognizes the health lifestyle problems and Underlying health lifestyle problems are concrete issues of local and national public policy and require to address issues by variety of Health Public Policies and the policies in all sectors will support the Health promotion. (16..)

APC Hypermethylation as a Prostate Cancer Indicator

APC Hypermethylation as a Prostate Cancer Indicator Evaluation of APC Hypermethylation From Serum Samples as an Indicator for Presence of Prostate Cancer and Higher Gleason Score Abstract Purpose In this prospective study it is aimed to identify role of hypermethlation analysis of APC gene from serum samples on detection of prostate cancer in patients with PSA level 2,5-10 ng/ml and its correlation with GS of the patients Materials and Methods Data from 142 patients underwent prostate biopsy with PSA level of 2,5-10 ng/ml was analyzed. Hypermethlation analysis of promoter region of APC gene from serum samples was done via methlation specific PCR. Patients were grouped as positive or negative depending on results of methylation analysis and compared for presence of prostate cancer and GS distrubution. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of methylation analysis were calculated. P value of 0.05 is used for statistical significance. Results There were 48 patients (33.8%) in methylation (+) group and 94 patients (66,2%) in methylation (-) group. Prostate cancer was detected in 43 of 142 (30,2%) patients after the first biopsy and 32 of these patients were in methylation (+) group. sensitivity and specificity of methylation analysis were 74,4% and 83,8%. PPV and NPV were 66.6% and 88.30 %. When GS distrubutions of the two groups analyzed patients in methylation (+) group were more likely to have higher GS compared to methylation (-) group(p=0,03). Conclusions Hypermethlation analysis APC gene from serum samples have shown promising results with its correlation with prostate cancer and higher GS. Further studies on prediciton of survival with long term follow up are needed to verify its value on prediction of survival Introduction Prostate Cancer (PCa) is one of the most important medical problems of the male population as it is the most common solid neoplasm in Europe having the highest incidence of 202,100 cases in 2004 (1). It is not only common but also a dangerous disease that it is the second most common cause of cancer death in men (2). These findings prove the importance of detection of PCa. However identifiying patients with clinically significant disease is an important issue, that is to treat patients that really need treatment while sparing ones that have silent disease. The European Randomized Study of Screening for Prostate Cancer (ERSPC) trial concluded that 1,410 men would need to be screened and 48 additional cases of PCa would need to be treated to prevent one death from PCa (ERSPC-3). These findings point out that current diagnostic tools are inadequate for screening and detection of clinically significant PCa (3). Epigenetic studies evolved in the era of urooncology in the last decade and DNA methylation is widely studied for certain urological malignancies especialy for PCa (4). Hypermethylation of promoter regions of tumor supresor genes results in gene silencing. This epigenetic change in APC gene promoter regions has been shown in cancerous and precancerous prostate tissues,serum, and urine of PCa patients and sensitivity and specificity rates of 27-100% and 50-100% have been reported (5,6). However the current literature lacks studies that investigate corrolation of results of methylation analysis from serum samples and clinicopathologic properties (grade and stage of disease) of patients. This point should be verified to identify applicability of this method in clinical practice. In this prospective study it is aimed to identify role of hypermethlation analysis of promoter region of APC gene from serum samples on detection of prostate cancer in a population of patients with PSA level 2,5-10 ng/ml and its correlation with Gleason score (GS) of the patients. Patients and Methods. This study was approved by ethical committe of Turkish Ministry of Health. All patients signed informed consent. The patients admitted to urology outpatient clinics of Ankara University Schol of Medicine with PSA level of 2,5-10 ng/ml and who were decided to undergo prostate biopsy were involved in the study. Serum samples were obtained from all patients prior to biopsy and 12 cores transrectal ultrasound guided prostate biopsy was performed by a single radiologist. Age, serum PSA level, prostate biopsy results were recorded and patients were followed regardless of the results of methylation analysis. Rebiopsy was suggested to patients with benign histology and persistant elevated PSA levels 6 months after the first biopsy. Patients with biopsy results of PCa were evaluted for staging and treated based on their stage. GS of the patients were evaluated in 3 groups GS:6 , GS: 7 and GS:8-10. The patients were grouped as positive (methylation +) and negative (methylation -) based on methylation analysis results and compared with results of prostate biopsy. The primary outcome measures were sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of methylation analysis. As a secondary outcome measure the results were also compared with the GS groups. Genetic analysis DNA extraction Genomic DNA was extracted from peripheral blood samples using a PureLink â„ ¢ Genomic DNA Mini Kit (Invitrogen â„ ¢, catalog No. K1820-02) according to the manufacturer’s instructions and were stored at -20 °C until modification and MSPCR amplification. DNA integrity and quantity was assessed with agarose gel electrophoresis and spectrophotometry, respectively. For this purpose, 1% agarose gel was used and 260 nm and 280 nm optical density ratio values (OD260/OD280) were determined. Bisulfite Modification and Methylation-Specific PCR of APC and GSTPI promoters The genomic DNA was modified by sodium bisulfite treatment using the CpGenomeTM DNA Modification Kit (S7820, Chemicon, Temecula, CA). The DNA promoter methylation status of APC and GSTPI genes were investigated by MSPCR using the specific primers to methylated and unmethylated promoters. The methylated and unmethylated control DNA were also subjected to bisulfite DNA modification and PCR analysis, and serves as positive controls for methylated and unmethylated DNA respectively. H2O was used as negative control for the PCR reaction. The PCR reaction was started with denaturation at 95 °C for 13 min, followed by 40 cycles at 95 °C for 30 s, 56 °C for 30 s, 72 °C for 30 s; and 72 °C for 5 min. Statistical analysis Continuous variables were compared using the t –test. Categorical variables were compared by the chi-square test..Sensitivity, specificity, PPV and NPV were calculated. Results Prostate biopsy was performed in 142 patients. The mean age of the patients were 68,3  ± 8,2 and mean ages of the methylated and unmethylated groups were not significantly different (67,8 vs 68,6 , p=0,47). There were 48 patients (33.8%) in group 1 and 94 patients (66,2%) in group 2. Prostate cancer was detected in 43 of 142 (30,2%) patients after the first biopsy and 32 of these patients were in methylation (+) group and 11 of them were in methylation (-) group. Based on these results, sensitivity and specificity of methylation analysis were 74,4% (95% CI: 58.83 % 86.46 %) and 83,8% (95% CI: 75.08 % to 90.47 %). PPV and NPV were 66.6% (95% CI: 51.59 % to 79.59 %) and 88.30 % (95% CI: 80.02 % to 94.00 %). When GS distrubutions of the two groups analyzed patients in methylation (+) group were more likely to have higher GS compared to methylation (-) group (p=0,041) and results are summarized in table 1. Second biopsy was performed in 12 (6 patients in each group) patients totally. At these second biopsies, PCa was observed in 4 patients, and all of them were in methylation (+) group. Based on the total results of first and second biopsies, sensitivity and specificity , PPV and NPV were reevaluated. Sensitivity and specificity of methylation analysis were 76.6 % (95% CI: 61.97 % to 87.68 %) and 87.3 % (95% CI: 78.97 % to 93.29 %). PPV and NPV were 75.0 % (95% CI: 60.4 % to 86.3 %) and 88.30 % (95% CI: 80.02 % to 94.00 %). Discussion Epigenetic alterations, such as hypermethylation of prompter regions of tumor supressor genes are associated with many human tumor types and this type of alteration have also emerged as markers for cancer risk assessment, cancer diagnosis, and therapy monitoring in several different types of cancer (7-10). APC is a well-characterized tumor suppressor gene and it downregulates Wnt signaling by targeting the transcriptional coactivator beta-catenin for proteasomal degradation and this prevents its association with the nuclear transcription factor Tcell factor/lymphoid enhancer factor (11). The activation of Wnt pathway leads to deregulation of cell proliferation and differentiation and is a common feature of many human cancers including prostate cancer (12-14). Detection of clinically significant PCa at an early stage is still a great challenge and current imaging modalities are often not able to detect a tumor and biopsies may miss the tumor focus. Role of gene promoter hypermethylation in prostate carcinogenesis, has been studied recently and promising results to improve PCa diagnosis has been established (5-7). In this study methylation analysis of promoter region of APC gene is performed prior to prostate biopsy in serum samples in order to evaluate the the role of this analysis on prostate cancer detection. Serum samples were obtained from all patients prior to biopsy and PCa was detected in siginificantly higher rates in patients with positive methylation analysis. In their study Yoon et al. showed that APC methylation levels were significantly higher in PCa patients than in benign prostate hyperplasia patients. Moreover, APC hypermethylation was not only associated with the increased incidence of PCa but was also positively correlated with increased GS (15). This has also been shown in other studies indicating APC hypermethylation as a reliable predictor of PCa and of its aggressive feature (12,13). Similarly, in our study, methylation positive patients were found to have higher GS and GS>7 was not observed in any patient with negative methylation analysis. Sensitivity and specificity of APC hypermethylation has been studied on prostate tissue samples and high sensitivity (89.3%) and specificity (98.1%) rates have been reported (15). In our study, sensitivity of 74,4% and specificity of 83,8% was found. These results are slightly lower compared to results of Yoon et al. and this may be due to source of DNA, that is higher rates might be reached when analysis is made through prostate tissue samples compared to serum samples. Additionally the results may be effected from the detection method, including the primer design, reagents, detectors, equipment, and protocols, all of which potentially influence the sensitivity and specificity. The important point of our study is making the analysis from serum samples to evaluate its role in clinical practice. The lack of such studies has been emphasized in previous trials conducted on tissue samples (15). Repat biopsies is an important issue in PCa diagnosis in the study of Trock et al. (16) APC methylation provided a very high NPV with a low percentage of false negatives, in a clinical cohort of men undergoing repeat biopsy.In our study, repeat biopsy was performed in 12 patients (6 patients in each group) and all of the 4 patients with PCa detected in second biopsy were in the methylation positive group. Our study involves low number of repeat biopsies therefore further studies with higher number of patients evaluating role of hypermethylation analysis from body fluids should be conducted on the topic of repeat biopsies. Conclusion Prediction of clinical significance of PCa is of clinicial importance and hypermethlation analysis of promoter region of APC gene from serum samples have shown promising results with its correlation with prostate cancer and higher GS. Further studies on prediciton of survival with long term follow up are needed to verify its value on prediction of survival. Conflict of interest: None of the authors have any conflict of interest Ethical standarts: The study was approwed by ethical committe of Turkish Ministry of Health. References 1. Boyle P, Ferlay J. Cancer incidence and mortality in Europe 2004. Ann Oncol 2005 Mar;16(3):481-8. 2. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin 2008 Mar-Apr;58(2):71-96. 3. Schrà ¶der FH, Hugosson J, Roobol MJ, et al.Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009 Mar 26;360(13):1320-8. 4. Veeck J, Esteller M J Mammary Gland Biol Neoplasia. Breast cancer epigenetics: from DNA methylation to microRNAs. J Mammary Gland Biol Neoplasia. 2010 Mar;15(1):5-17. 5. Kang GH, Lee S, Lee HJ, et al. Aberrant CpG island hypermethylation of multiple genes in prostate cancer and prostatic intraepithelial neoplasia. J Pathol 2004; 202: 233–40 6. Yegnasubramanian S, Kowalski J, Gonzalgo ML et al. Hypermethylation of CpG islands in primary and metastatic human prostate cancer. Cancer Res 2004; 64: 1975–86 7. Moritz R, Ellinger J, Nuhn P, Haese A, Muller SC, Graefen M, Schlomm T, Bastian PJ. DNA hypermethylation as a predictor of PSA recurrence in patients with low- and intermediate-grade prostate cancer. Anticancer Res 2013 Dec;33(12):5249-54. 8. Kim WJ, Kim YJ. Epigenetic biomarkers in urothelial bladder cancer. Expert Rev Mol Diagn 2009;9:259-69. 9. Hoque MO. DNA methylation changes in prostate cancer: current developments and future clinical implementation. Expert Rev Mol Diagn 2009;9:243-57. 10. Ushijima T. Detection and interpretation of altered methylation patterns in cancer cells. Nat Rev Cancer 2005;5:223-31. 11. Rai K, Sarkar S, Broadbent TJ, et al. DNA demethylase activity maintains intestinal cells in an undifferentiated state following loss of APC. Cell 2010;142: 930-42. 12. Jeronimo C, Henrique R, Hoque MO, et al. A quantitative promoter methylation profile of prostate cancer. Clin Cancer Res 2004;10:8472-8. 13. Bastian PJ, Ellinger J, Wellmann A, et al. Diagnostic and prognostic information in prostate cancer with the help of a small set of hypermethylated gene loci. Clin Cancer Res 2005;11:4097-106. 14. Gavert N, Ben-Zeev A. beta-Catenin signaling in biological control and cancer. J Cell Biochem 2007;102:820-8. 15. Hyung-Yoon Yoon, Young-Won Kim, Ho Won Kang, et al. Pyrosequencing Analysis of APC Methylation Level in Human Prostate Tissues: A Molecular Marker for Prostate Cancer. Korean J Urol. 2013 Mar;54(3):194-198. 16. Trock BJ, Brotzman MJ, Mangold LA, et al. Evaluation of GSTP1 and APC methylation as indicators for repeat biopsy in a high-risk cohort of men with negative initial prostate biopsies. BJU Int. 2012 Jul;110(1):56-62 Table 1. GS distrubutions of the two groups

The Big Sleep Movie and Novel :: Movie Film comparison compare contrast

The Big Sleep Movie and Novel On first inspection of Raymond Chandler's novel, The Big Sleep, the reader discovers that the story unravels quickly through the narrative voice of Philip Marlowe, the detective hired by the Sternwood family of Los Angeles to solve a mystery for them. The mystery concerns the General Sternwood's young daughter, and a one Mr. A. G. Geiger. Upon digging for the answer to this puzzle placed before Marlowe for a mere fee of $25 dollars a day plus expenses, Marlowe soon finds layers upon layers of mystifying events tangled in the already mysterious web of lies and deception concerning the Sternwood family, especially the two young daughters. When reading the novel, it is hard to imagine the story without a narrator at all. It certainly seems essential for the story's make-up to have this witty, sarcastic voice present to describe the sequence of events. Yet, there is a version of Chandler's novel that does not have an audible storyteller, and that version is the 1946 movie directed by Howard Hawks. Hawks' version of The Big Sleep is known to be one of the best examples of the film genre-film noir. "Film noir (literally 'black film,' from French critics who noticed how dark and black the looks and themes were of these films) is a style of American films which evolved in the 1940s." (The Internet Movie Database LTD). Film noir typically contains melancholy, and not so moral themes. Another characteristic of film noir is just because the main character has the title hero, that does not mean that he will always be alive at the end of the book, or that the hero is always "good." Marlowe in The Big Sleep is a prime example of this concept. In the novel it is questionable how lawfully moral he actually is, concerning the situation of turning Carmen into the police for killing Sean Regan. This aspect of Marlowe's character added yet another difficult task of formatting The Big Sleep to the big screen-the question of how the audience (media) might react to such a personality trait was now placed before the writing staff (IE production codes). The Big Sleep Movie and Novel :: Movie Film comparison compare contrast The Big Sleep Movie and Novel On first inspection of Raymond Chandler's novel, The Big Sleep, the reader discovers that the story unravels quickly through the narrative voice of Philip Marlowe, the detective hired by the Sternwood family of Los Angeles to solve a mystery for them. The mystery concerns the General Sternwood's young daughter, and a one Mr. A. G. Geiger. Upon digging for the answer to this puzzle placed before Marlowe for a mere fee of $25 dollars a day plus expenses, Marlowe soon finds layers upon layers of mystifying events tangled in the already mysterious web of lies and deception concerning the Sternwood family, especially the two young daughters. When reading the novel, it is hard to imagine the story without a narrator at all. It certainly seems essential for the story's make-up to have this witty, sarcastic voice present to describe the sequence of events. Yet, there is a version of Chandler's novel that does not have an audible storyteller, and that version is the 1946 movie directed by Howard Hawks. Hawks' version of The Big Sleep is known to be one of the best examples of the film genre-film noir. "Film noir (literally 'black film,' from French critics who noticed how dark and black the looks and themes were of these films) is a style of American films which evolved in the 1940s." (The Internet Movie Database LTD). Film noir typically contains melancholy, and not so moral themes. Another characteristic of film noir is just because the main character has the title hero, that does not mean that he will always be alive at the end of the book, or that the hero is always "good." Marlowe in The Big Sleep is a prime example of this concept. In the novel it is questionable how lawfully moral he actually is, concerning the situation of turning Carmen into the police for killing Sean Regan. This aspect of Marlowe's character added yet another difficult task of formatting The Big Sleep to the big screen-the question of how the audience (media) might react to such a personality trait was now placed before the writing staff (IE production codes).

Essay --

Jonathan Swift was a famous author who combined humor and politics to create many prominent works. He was born in Dublin, Ireland on November 30, 1667. Swift was born prematurely and with Menierà ©Ã¢â‚¬â„¢s Disease, a condition in the inner ear that causes nausea and hearing problems. Because his birth mother couldn’t provide for him, she gave him over to a relative named Godwin Swift. As a child, Jonathan Swift went to Kilkenny Grammar School, which was the best school in Ireland. During elementary and middle school, Jonathan was friends with William Congreve, a future poet and playwright. At the age of fourteen, Swift entered Trinity College in Dublin. Because he didn’t have financial support, he had to drop out after four years, but he still received a bachelor’s degree. After college, Swift moved to his mother’s home in Leicester, England, and it was there where he received his first job. He became Secretary to a retired diplomat, Sir William Temple, staying with him at his home in Moor Park. This was an important event for Swift where he gained some power as a politician. He only obtained this job because he had many family connections, and his relatives had good reputations. At his job at Moor Park, he met Esther â€Å"Stella† Johnson who was 8 years old at the time. They had a long-lasting friendship, and he became a tutor, mentor, and a great friend to her. Soon, Jonathan Swift sought a new occupation, and in 1694, he worked for an Anglican priest. After he worked with the church for about a year, Swift returned to Moor Park and had his old job back. When Sir William Temple grew old, Jonathan Swift was instructed to publish William’s work after his death. Soon, Sir William passed away, and he left Swift  £100 and his unpublished books th... ...s. Gulliver is able to sail to Japan, and from there, he travels back to England. On his fourth and final journey, Gulliver becomes a victim of mutiny and lands in a mysterious land populated by Houyhnhnms, rational-thinking horses who rule the Yahoos, savage humanlike creatures. He becomes great friends with the Houyhnhnms, but when they realize that he physically resembles a Yahoo, they banish him from the island. Jonathan Swift was an Irish satirist, essayist, poet, and cleric who turned political writing into something more riveting and humorous. Although his works were aimed towards the political audience, his writings impacted everyone in Europe in many ways. His combination of genres created a new theme that was admired by many groups of people. Though his work may not be remembered forever, he will remain a distinguished author in all of his reader’s hearts.

Gettysburg :: essays research papers

There is a lot to say about the Battle of Gettysburg. Many people wonder why this battle out of all others during the war was so great. Many questions were asked. Such as, what did they do for supplies? How did they live? What was the typical military strategy? I will also answer many other questions to in this essay. It’s really hard to believe the things I saw during the movie. It just makes wonder how stupid the government was to even think about starting a Civil War. Millions and millions of men died in this war. For what? Honor? I certainly think they did not die honorably, but just went out there and got slaughtered. Although many people say that the Union and Confederate armies fought because of the importance of Gettysburg; the thing is that it was just a small town back then. Gettysburg was chosen because it was â€Å"good ground†. The Confederate army was passing through to go further north and invade the Union territory. The Union army was having the same idea about the south. Good ground was high terrain surrounded by trees. The role geography played in the war was that the army who was placed on the good ground would have a better position on the opposing forces. The officers and soldiers had different lifestyles during the war. The generals would be in cabins or log houses with plenty of supplies. The rest of the army had lived in tents with supplies, but not as much as the generals. So basically the higher your rank, the better you r living conditions were. Although living conditions were different, the strategy was similar. Many times the Union army had to play defensively. The development of trench warfare began. If supplies or ammo got too low, sometimes they would charge and attack the Southerners, like Colonel Chamberlain did when he was defending the line. The Confederate army under the command of General Lee would march all the way to the gate and try to capture it. When in combat, both sides had the same kind of artillery. Soldiers used muskets and small handguns and generals on the other hand would ride on horseback with a sword and pistol. Another type of weaponry that was used were cannons. Even though cannons were much more powerful, muskets were easier due to the fact that they were portable and fired rounds quicker.

Jewish ROles in Medieval Europe Essay -- essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  There are many disputes as to when exactly the Jewish people and their roles in medieval civilization became apparent to the Christian and Islam peoples of the time. Various time periods are claimed by various different authors, however in this particular case I have utilized the historical writings of Louis Finkelstein. In one of his many books, we find that his perception of Jews in this time are from about 1000 AD to 1603AD. These dates seem to encompass the entire Middle Ages much better than some of the other speculations made by various other Jewish authors.   Ã‚  Ã‚  Ã‚  Ã‚  Many events were taking shape towards the end of the first century, and this is where Finkelstein finds it necessary to mark the start of the Jewish people in the so-called Dark Ages. In the year 1000, Jews were spread across the world in large and small communities from Spain and North Africa, all the way to the Byzantine Empire, which is now in modern day Turkey. Finkelstein particularly chooses this date to being with however, because of the establishing of the courts in this time period. Furthermore, this is where we now see Jews being forced to convert to Christianity or be killed. We see a great upsurge in the so-called need to reform all other religions until they are under Christianity, and Jews were the focus of much of this persecution.   Ã‚  Ã‚  Ã‚  Ã‚  It is not right to say that all Jewish people of this time were being persecuted...