A study on Fraud prevention and Detection

A study on Fraud prevention and Detection The aim of this writing is to present how fraud is defined today, why fraud prevention and detection is global concern and introduce main means of detecting and preventing fraud. It can be seen that fraud can range from small employee theft, fruitless behaviour, embezzlement of company`s assets and fraudulent financial reporting. This kind of actions can have strong adverse effect on company`s market value, reputation and it reduces company`s power to achieve its strategic objectives, etc. Lately, numerous cases that found themselves in limelight of public attention, such as Enron and WorldCom, sensitized everyones awareness about the effect of fraudulent and deceptive reporting. Therefore, large number of companies started to be more proactive in taking serious measures to prevent and detect its occurrence. The jeopardy of fraud can be minimized through effective combination of prevention, deterrence and detection measures. As it will be described in more detail in the rest of this paper, fraud can be very hard to detect. As means of detection are becoming more sophisticated, so do the ways of committing fraud. For this very reason every company should strongly emphasise fraud prevention, which can definitely reduce chances for fraud to take place, and fraud detection, which can create atmosphere at work that fraud will be detected and committers will be punished. Moreover, costs for fraud prevention are less expensive than the time and money needed for fraud detection and investigation. Definition Defining fraud can be harder than it seems. It is a term that can be heard very often in everyday life. Though, what is meant by fraud in business world can be somewhat different. Finding consistent meaning and precise definition of fraud is crucial for understanding it. For this reason a few legal definitions of what is considered by fraud will be presented. In UK fraud is defined in Fraud Act form 2006. In explanatory notes to Fraud Act 2006, Chapter 35 it can be seen that there are several ways fraud can be committed, such as: by false representation (person must make dishonest and false representation with clear intention to gain or cause loss to other party), by failing to disclose information (failing to disclose an important information to another person to which you have legal duty to disclose it, is considered as fraud), by abuse of position (abusing privileged position, where by virtue of this position a person is expected to protect another`s financial interest and do not act against those intersperses), by gaining or losing property dishonestly (whether material or intellectual), possession of items for use in fraud, making or supplying articles for use in fraud (for example manufacturing machines for false money making), by participating in fraudulent business carried out on by sole trader (fraudulent trading for under the companies legislation), by taking part in fraudulent business carried on by a company, obtaining service dishonestly (for example by avoiding payment) and liability of company officers for offences by company (if a person has specific corporate role for which is responsible, it usually applies to directors, managers, etc). In USA there are numerous state and federal laws which are regulating fraud in number of areas, such as consumer fraud, insurance fraud, corporate fraud, etc. Summary of what is generally perceived as fraud leads one to conclude that there are some similarities with fraud definition in UK by Fraud Act 2006. In both cases there must be purposive misinterpretation of facts made by one, fully aware party in order to cause injury or damage (material, intellectual, etc.) to other party. Fraud of failing to disclose information in U.S. is interpreted as omission or `purposive failure to state material facts, which nondisclosure makes other statement misleading` (www.uslegal.com) Moreover, in Canada fraud is classified as criminal offence. In Canada`s Criminal Code, Article 380 (1) and 380 (2) it is stated clearly that fraud is considered to be any fraudulent behaviour designed to manipulate other party, so as this party will give something of value to him/her by means of lying purposively misleading the second party although fully aware of falseness of that act hiding a fact from the other part which may have prevented the party to suffer any kind of loss or damage. Additionally, `every one who, by deceit, falsehood or other fraudulent means, whether or not it is a false pretence within the meaning of this Act, defrauds the public or any person, whether ascertained or not, of any property, money or valuable security or any service (or) with intent to defraud, affects the public market price of stocks, shares, merchandise or anything that is offered for sale to the public` Canada`s Criminal Code, Article 380 (1). Contemporary researchers (Weirich and Reinstein, 2000; Albrecht et al., 1994, 1995) define fraud as intentional deception, stealing and cheating investors, creditors, public, government bodies, etc. Statement on Auditing Standards (SAS) No. 82 identifies two separate fraud types: Fraudulent financial reporting or management fraud (managers try to report inflated profit, overstates assets and revenues or understate expenses and liabilities with intention to modify financial statements) and Misappropriation of assets or employee fraud (employees steal money or other companies belongings). This statement also points out different fraud schemes such as employee embezzlement, management fraud, investment scams, vendor fraud, customer fraud, and miscellaneous fraud. However, it can be concluded that though these countries have similar definitions of what fraudulent activities are considered to be, there are substantial differences. Businesses operating in different countries, especially multinational companies, must be aware of these differences, acts and statements as they are the one in greatest danger suffering from not thoroughly knowing them. Causes associated with individuals committing fraud Fraud Triangle Before explaining main methods and bodies within company responsible for prevention and detection of fraud, psychological factors that might influence the behaviour of fraud committers must be mentioned. It is suggested (Moyes and Hasan, 1996; Hernan, 2008) that the best way of fraud prevention is understanding what main drivers of fraud are. The three following drivers are most commonly known as fraud triangle. Need there are numerous types of financial pressure, gambling habits or maybe unreasonably high expectations of high returns that create enough pressure for management to commit financial statement fraud. Some warning signs of pressure in organization and among employees could be discovered by internal control questionnaires, interview with managers, surveys or communication with employees. Opportunity people often see opportunity to commit fraud when internal control system in organization is weak. Internal auditors and managers should from time to time test the effectiveness of various types of control in order to reduce opportunities for fraud. Justification the third component of fraud triangle is rationalization for fraudulent activity. There are a lot of different explanations and justifications of fraudulent activity. Some fraudsters concludes that they did not get a deserved promotion and want to make things right on their own. Others did not get deserved bonuses at the yearend or they rationalize their act as just borrowing from the company. The risk is higher in companies with poor management structure and unclear bonus system. Hernan (2008) suggests evaluation of management competences, objectivity and transparency in order to identify and spot on time fraud risks. If management, internal control or any other entity in a company, which duty is fraud prevention and detection, is aware of these factors, then that entity will certainly be more effective in developing mechanisms of fraud detection and punishment The Cost of Fraud Before any prevention and detection method or entity within a company is discussed the cost of fraud must be explained as only then when we realise how big damage fraud can cause, we are able to truly understand significance of internal controls, audit committee, management, internal auditors, independent auditors and certified fraud examiners. Fraud is a global problem affecting organizations of all types and sizes. According to the Association of Certified fraud examiners (ACFE) estimates that US companies loose approximately 5% of their annual revenues to fraud. Majority of frauds are detected by tips or accidently. The most frequently type of fraud are: asset misappropriation (91,5% of reported frauds), corruption accounts for 30,8% and financial statements fraud accounts for 10,6% ,with median loss estimated at 2 million dollars. Most recent large fraudulent schemes were Enron (63 billion dollars in assets) and WorldCom (107 billion dollars in assets) were investors lose billions of dollars. According to Adams et al. (2006), the greatest financial impact of fraud is in small firms and businesses. The loss of 7% of revenues (estimated by ACFE) is also significant for large companies but small companies will probably be out of business because of it. On the other hand, when fraud occurs companies could suffer from damage of brand and reputation. Stakeholders could see that as an early warning sign. Big bills caused by fraud are almost never paid by committers, but unfortunately, by innocent parties such as consumers, insurance companies etc. This just amplifies opening statement how important job of bodies in charge of fraud detection and prevention is. Fraud prevention and detection Many authors (Mclnnes and Stevenson 1997, Adams et al 2006, Hernan 2008, Grambling et al 2009) suggests that prevention of fraud is the most cost-effective way to deal with possible financial and reputation loss. For all of the reasons mentioned in previous sections of this work it is crucial for every company to develop mechanism for effective detection and prevention of fraud. Statement on Auditing Standards No. 99 by AICPA (2002) suggest that there should be a body within a company with appropriate overight function. Oversight function can take many forms such as audit committee, board of directors etc. Measures this entities can implement are divided into three categories: create atmosphere of honesty and high ethics; evaluate the risks of fraud and implement adequate processes, procedures, and controls necessary to reduce the risks and the opportunities for fraud develop an appropriate oversight process The pivotal role in the process has the companies CEO. Although the management is responsible for implementing these activities, without CEOs support, this process is likely to be successful. In the oversight process specific companys entity has specific role in preventing and detecting fraud. The most important entities will now be discussed and their role will be explained. Culture of honesty and high ethics Every organization should posses a set of core values and nurture culture of honesty and high ethics. This set of values is often involved in companys code of conduct which has aim to guide employees in everyday activities (often include topics like ethics, confidentiality, conflicts of interests etc.). Management must show to employees through their actions that dishonest or unethical behaviour will not be tolerated. It is also important for management to create: a positive workplace environment. For example, if employees work in bad work environment, the chances of committing fraud against a company are greater To hire and promote appropriate employees Provide training to new employees and introduce them with code of conduct Require from employees to annually sign code of conduct and to write about possible breaking of code of conduct If fraud occurs in organization, the appropriate steps should be taken to examine all aspects of fraud and to improve existing internal controls Implement and Monitor Appropriate Internal Controls As mentioned before in work, people often see opportunity to commit fraud when internal control system in organization is weak. That is the main reason why organization should be put more effort to minimize fraud opportunities. According to AICPA (2002) some risks are inherent within the environment of the company, but large number of them can be most can be discovered with a proper internal control system. One process for assessment of fraud risk takes place; the company can recognize controls, processes and other procedures that are crucial for reducing identified risks. Committee of Sponsoring Organizations (COSO) report of the Treadway Commission states that effective internal control should include: a well-developed control environment an effective and secure information system, appropriate control and monitoring activities. Information technology plays pivotal role in operations and transactions over information generated by computers. For this reason management need to implement and sustain proper controls (automated or manual). Especially, management is obliged to assess whether internal controls have been implemented in those areas where high risk of fraud exists and in entities where financial reports are processed. Reporting of fraudulent activities can be going on temporary basis, hence management should evaluate internal controls responsible for short term financial reporting. The institute for fraud prevention in 2007 mentioned that upper level management is usually involved in fraudulent financial reporting by overriding internal controls involved in controlling the process that fraudulent financial reporting by upper-level management typically involves override of internal controls within the financial reporting process. Because management has the ability to override controls the need for a strong value system and a culture of ethical financial reporting becomes more important. This helps create an environment in which other employees will decline to participate in committing a fraud and will use established communication procedures to report any requests to commit wrongdoing. The potential for management override also increases the need for appropriate oversight measures by the board of directors or audit committee which will be discussed in the following section. Fraudulent financial reporting by lower levels of management and employees may be detected by appropriate monitoring controls, such as having higher-level managers review and evaluate the financial results reported by individual operating units or subsidiaries. Unusual fluctuations in results or the lack of expected fluctuations may indicate potential manipulation by some department managers or employees. DEVELOP AN APPROPRIATE OVERSIGHT PROCESS After implementation of code of conduct, core values and internal control process into organization, management should also develop an appropriate oversight process to overlook internal controls and reduce as much as possible risk of fraud. The oversight process contains management, internal auditors, audit committee, independent auditors and certified fraud examiners. Audit Committee or Board of Directors Gramling et al. (2009) in his work argue that audit committee is critical element of internal controls and have important stewardship responsibility to shareholders. Also he cited former SEC chairman Arthur Levitt who described audit committee as one of the most reliable guardians of the public interest ( Gramling et al.,2009,p.24). According to research taken by Cohen et al.(2009), audit committee effectiveness has been improved since Sarbanes-Oxley act of 2002. From auditors perspective, audit committee has enough expertise to identify main risks and oversee internal controls. It is crucial that audit committee members be independent of management to provide oversight and comply with regulations. This could be a problem especially in smaller companies. Also smaller companies facing with another problem- How to find and recruit quality and qualified members for audit committee. AICPA(2005) suggested to audit committee to consider periodical meetings with representatives from each of the above mentioned groups (internal auditors,external auditors etc.) to discuss any matter could affect the financial reporting process and increase the risk of fraud. The main duties of audit committee should be to: evaluate managements identification of fraud risks and implementation of antifraud measures. Audit committee can by active oversight support management in implementation of appropriate fraud prevention measures. The final aim is better protection of all stakeholders. The Report of the NACD Blue Ribbon Commission on the Audit Committee (2000) emphasized the importance of role which audit committee plays in helping the board of directors in oversight duties, with regard to companys financial reporting processes and internal control systems. When taking the oversight responsibility, the audit committee must take care not to override managements control responsibilities. Therefore, they should have a good communication with internal and external auditors and may consider to review from time to time firm`s reported information with forecasted ones and industry averages as well. In addition to this SAS 60 in AICPA (2002) argues that communication with external auditors could improve strength of the firms internal control and give higher potential to deal with fraudulent financial reporting 10 See Statement on Auditing Standards No. 60, Communication of Internal Control Related Matters Noted in an Audit (AICPA, Professional Standards, vol. 1, AU sec. 325), and SAS No. 61, Communications With Audit Committees (AICPA, Professional Standards, vol. 1, AU sec. 380), as amended. Audit committee, as part of their oversight duties, should try to motivate management to encourage all employees to report everything that looks like unethical behaviour, fraud, or any violations of the code of conduct. The committee should then receive periodic reports from management and employees, describing the nature of any possible unethical behaviour. Report of the NACD Best Practices Council (1998) suggests that if senior management is involved in fraud (according to Deloitte survey 2008, which is the case in 68 per cent of all financial statement fraud), next management level is very likely to be cognizant of it. Hence, it would be recommended that audit committee has an open communication with one or two levels of management under senior executives. In this way they could take part in fraud identification at the top positions of the organization. Usually, the audit committee has the power to investigate all suspicious activities that catch their attention and within the realm of their responsibilities. They could also benefit from assistance of accounting and professional advisors. All committee members must be educated about finances and have at least one expert in that field. Management Mclnnes and Stevenson (1997) argue that according to statements in SAS 110 management is responsible for the prevention and detection of fraud. Also Cadbury committee (1992) requires from directors to report on effectiveness of a companys internal control system. On the other hand, Kranacher and Stern- Cpa journal argue that despite the responsibility for preventing fraud lies on management of company, auditors should be also prepared to detect fraud. Authors underpin their statement with presentation of SAS 99-Consideration of fraud in financial statements, which set new fraud standards for auditors. It requires from auditors to discuss with management about possible frauds in organization and to be aware of risk that fraud may occur and be material for financial statements. The main concerns about fraud prevention could be data presented from The institute for fraud prevention in 2007 that executive directors (CEO and CFO) could deceive auditors and audit committee by providing false information. Their analysis further indicates that in 21% of the financial statements fraud cases, external auditors were named as participants. Also in 40% of companies where fraud took place, board members were participants. This can be significant obstacle in effective fraud detection. Similar evidences could be seen from Deloittes survey taken in 2008 about financial statement fraud. CEO, CFO and controller of the company were involved in 68% of individuals who committed financial statement fraud. Other members of management were involved in 24% of all financial statement fraud. That survey can give us a lot of interesting data about financial statement fraud. For example, most common fraud schemes are revenue recognition (38%, especially recording of fictitious revenue), manipulation of expenses (12%) , improper disclosures (12%) and manipulation of liabilities and assets etc. The financial fraud schemes are most common in industries like telecommunications, technology, media and entertainment. The average duration of fraud schemes has been seven years in 2008 and has increasing trend. Responsibility of management is to supervise the employees` activities. They typically do that by implementing and montiroing all control means previously mentioned. Management is also able to commence, take part in, or direct means against fraudulent acts. Audit committee is responsible (if there is no audit committee the board of directors is in charge) to supervise activities of senior managers and think about risks that fraudulent financial reporting brings. Mclnnes and Stevenson (1997) in their work conclude that although general public perceive external auditors as strongest defensive against corporate fraud that is not their primary objective. Board of directors have a duty to safeguard the assets of their companies and to report on the effectiveness of their companies internal control system (section 404 of SOX). The most effective way of implementation of measure for reducing wrongdoing is to establish them on a range of core values that could be embraced by the company. These values consist of important key principles that have the potential to guide all employees` actions. Then this values could be taken a step further and a platform for detailed code of conduct could be forms. Companys code should entail specific descriptions about what is permitted and what is prohibited. At the end management must be clear in stating that all employee`s will be hold accountable in the company`s code of conduct. Also Mclnnes and Stevenson (1997) argue that board of directors are responsible for prevention and detection of fraudulent activities by others in the company, but on the other hand it is not clear who has a legal responsibility for preventing and detecting fraudulent activities by directors. Internal Auditors Organized audit team can very effectively be involved in many aspects of oversight control. Their familiarity with how entity operates can help them identify indicators of fraud. The Standards for the Professional Practice of Internal Auditing (IIA Standards), issued by the Institute of Internal Auditors, state The internal auditor should have sufficient knowledge to identify the indicators of fraud but is not expected to have the expertise of a person whose primary responsibility is detecting and investigating fraud. Internal auditors are in position to asses fraud risks and control, and suggest actions for risk minimization and control improvement. Some standards, such as IIA Standards, even require from internal auditors to perform assessment of possible company`s risk. These assessments of risk then provide starting point for audit plans and internal control tests are based on them. Additionally, the same standard demands that all audit plans are presented and permitted by the audit company (where audit committee does not exist this should be presented to board of directors). Furthermore, audit plans provide guarantee for affirmation of management`s control. Internal audit can have two roles detection and deterrence. Internal auditors are included in fraud deterrence by analysing and evaluating the appropriateness and efficiency of internal control systems, though Hillison et al (1999) states that it is responsibility of management. In executing this responsibility, internal auditors should: evaluate the control environment identify control weaknesses have strong communication with management Hillison et al (1999) argue that internal auditors should pay attention on cash transactions as well as on other non-balance sheet assets. The following steps should be taken: increased use of analytical review (because ratio analysis and trend analysis sometimes could show us unusual relations with other accounts, especially when we have several years data to analyse and compare Cohen et al.(2009) stated that reliance on internal auditors has increased in the post-SOX period, mainly because of section 404. Internal auditors could use a lot of techniques (analythical or other procedures) to prevent and detect fraudulent behaviour in organization. They could search for particular types of fraud or they could check high-risk accounts for frauds. Every suspicion of fraud or management involment should be directly reported to the audit committee. Independent Auditors and existing audit approach to prevent fraud External auditors have a significant role in oversight process. They should provide information to management and audit committee about possible risks. In order to have full benefit from external auditors, management should have open communication with them. Glover and Aono (1995) in their work presented basic audit-risk model which consists of three elements: inherent risk, control risk and detection risk. They stressed that auditors should understand clients internal control system because they should determine how much they can rely on accounting information generated from clients financial reporting system. On the other hand, McKee and Norway (2006) argue that auditors become too predictable in their audits and that fraudsters could anticipate their actions. Moreover, the public and stakeholders expects from auditors to do better job at fraud prevention (that is the main reason of existence of audit expectation gap). Audit plans should incorporate an element of unpredictability according to SAS 99 and ISA 240 in order to decrease fraud risk. The main benefits of unpredictable auditors approach according to authors would be increasing chances of fraud discovery (more effective audit), deterrence of fraud will be also increased (because of reduced opportunity to commit fraud) and audit will become more enjoyable. On the other hand, this will have impact on costs associated with unpredictable audit approach: extra planning time, extra time to perform necessary procedures and additional training time. Also, authors suggested a following procedures for unpredictable audit approach: random sampling, unannounced inventory observation, changing techniques from prior years, test some small and low risk accounts etc. Certified Fraud Examiners Certified fraud examiners as professionals could have the important role in oversight process. They have a lot of knowledge and experience in fraud detection and prevention and could use their knowledge to assist the audit committee and internal auditors. As professionals from outside the company they can give more objective opinion about internal control system. Also, they can evaluate possible risks of fraud ( especially fraud committed by top management) and implement appropriate measures in order to minimize it. fraud.5 5 Association of Certified Fraud Examiners, 2006 Report to the Nation on Occupational Fraud and Abuse (Austin, TX: ACFE, 2004), p. 18 Ernst Young International Fraud Group, Fraud: the Unmanaged Risk: An International Survey of the Effects of Fraud on Business (London, UK: Ernst Young, 1998), p. 2. To conclude, despite management have responsibility to conduct adequate fraud risk assessment, audit committee should overlook quality of the financial reporting process. According to Silver et al. (2008), audit committee should not only apply traditional fraud risk assessment (like segregation of duties), but to consider and incorporate proactive approach. In order to be good in their stewardship role they should improve their accounting and fraud knowledge , search for collusive fraud and obtain feedback. Conclusion Some organizations have significantly lower levels of misappropriation of assets and are less susceptible to fraudulent financial reporting than other organizations because these organizations take proactive steps to prevent or deter fraud. It is only those organizations that seriously consider fraud risks and take proactive steps to create the right kind of climate to reduce its occurrence that have success in preventing fraud. It was also found that organisations with strong internal controls, internal auditors and audit committees were better equipped to deal with fraud in any form according to Alleyne and Howard(2005)

Emotional Intelligence in Leadership Essay -- Leadership

The premise of emotional intelligence in leadership is that emotional intelligence should be the premise of leadership. Before tasks, followers, goals and styles can be defined or critiqued, the leader’s emotional intelligence must first be assessed (Goleman, Boyatzis & McKee, 2002, pg 5). Emotional intelligence then becomes the predictor of how effectively the leader will be able to lead in any given situation, set of tasks or followers. In this paper, the author will compare this premise of emotional intelligence with the Leader-member exchange (LMX) theory and the situational approach to leadership (Northouse, 2010). Also, the author will evaluate, in terms of resonance and dissonance, how appropriately an emotional intelligence model would function in a higher education environment. Emotional intelligence operates under four theoretical domains and their respective competencies that are essentially classified under two divisions: personal competence and social competence (Goleman, et al, 2002, pg. 39). These broader competencies do not describe leadership talents, but learned abilities that describe how effectively the leader manages intrapersonal and interpersonal relationships (Goleman, et al, 2002). The assumption is that if the leader is thoroughly competent in an intrapersonal sense---meaning, among other factors, he or she is appropriately self-aware, transparent and adaptable---the leader will have better interpersonal insight into his or her subordinates (Goleman, et al, 2002). This social competence delineates more specific qualities including a strong sense of empathy, service, influence, and collaboration (Goleman, et al, 2002). In terms of leadership effectiveness, these competencies are not only ideal,... ...the author believes that the comparison of the Leader-member exchange, the situational approach to leadership, and the premise of emotional intelligence has uncovered important leadership truths that may not be mutually exclusive. Surely the enigma of leadership is that it contains many truths, with the only universal truth being that none are universal, but empirically sound to aid the leader in guiding followers and the institutions they comprise. References Bolman, L. G. & Deal, T. E. (2008). Reframing organizations: Artistry, choice, and leadership, 4th Ed. San Francisco: Jossey-Bass Goleman, D., Boyatzis, R., McKee, A. (2002). Primal leadership: Realizing the power of emotional intelligence. Boston: Harvard Business School Publishing. Northouse, P.G. (2010). Leadership theory and practice. 5th Ed. Thousand Oaks: Sage Publications.

Ferm Life Cycle Essays -- essays research papers

Ferm Life Cycle Introduction:   Ã‚  Ã‚  Ã‚  Ã‚  This essay will discuss the fern life cycle as taught in biology lab. The essay will cover the basic process which we used to grow a fern. I will discuss the methods and the results of the lab exercise. Finally, I will discuss the evidence of the methods and results that were obtained . Methods and Results:   Ã‚  Ã‚  Ã‚  Ã‚  To begin our experiment we obtained a petri dish from our lab instructor which contained fern spores and the food they needed to survive. We then look at the spores through the micro scope. It was to soon to see anything but little green dots. We then put our petri dishes under a light until next week.   Ã‚  Ã‚  Ã‚  Ã‚   When we came in next week we observed our fern spores through the dissecting microscope. We looked to see if we could find anything germinating. We quickly noticed something that appeared like an air bubble squirting out something green. This was our fern spore which was germinating. Next, we removed a few of the germinating spores from the petri dish and put them under a compound microscope scope. We found the spore wall and observed how the developing gametophyte had broken through the wall, as instructed by our lab manuals. One could also identify the chloroplasts with in the cell. We then put up our dishes for another week.   Ã‚  Ã‚  Ã‚  Ã‚  The third week of our fern lab we identified the difference between male and female gametophyt...

Par, Inc.

Here is the report about Par, Inc. , is a major manufacturer of golf equipment test whether the new ball drive longer distance than the current model. To compare the driving distances for the two balls, 40 simple tests both of new and current models were subjected to distance tests. According to the data, we got the information we need for a hypothesis test as follow: | Current| New| Means| 269. 42| 266. 67| Count | 40| 40| Standard Deviation| 8. 09| 9. 79| Confidence Level(95. 0%)| 2. 59| 3. 13| | | The 40 simple of both current and new model golf balls show that the average distance of the new ball drive is less than the current model, but the standard deviation of new ball is 9. 79 which is larger than the current one and It imply the new ball is not stable as the current one, it has more chance drive longer or shorter than the current model. But at present, we can’t get the conclusion which ball drive longer distance, So we need a hypothesis test the difference of this two ball models.The hypothesis test suggested follows: H0:Â µ 1-Â µ 2? 0 Ha:Â µ 1-Â µ 2>0 We use this formula for a hypothesis test to compare the driving distance of the current and new golf balls. After analyses, we get the conclusion that we can’t reject the null hypothesis. Because this is a hypothesis test about two different populations, standard deviation of population is unknown and we use t-test and the p-value we got equals 0. 09 which is much bigger than the confidence level of 0. 05. So it is Type? error and we do not reject the null hypothesis.And we recommend the company to use the new model, that there is more chance to drive longer distance. The confidence interval we got for each model and or the difference between the means of the two populations are given below: Current: 266. 83~272. 00 New:263. 54~269. 80 The difference between two populations: -1. 26~6. 74 As the interval show above, at the level of 95% confidence, the distance current ball can drive is between 266. 83 and 272. 00 and the new one can drive between 263. 54 and 269. 80.And the new ball can drive longer distance till 6. 74 than the current one, but it is possible that the new ball drive shorter distance than the current till 1. 26. I think simple sizes for this test is not enough. Because the population of ball is very big and there are only 40 simples testing. We make assumption that the population of the ball is 1000 the simple size now is 5 and the proportion is 40/1000 and NP equals 1. 6, N (1-P) equals 38. 4. The NP is smaller than 5 so. We need more simple sizes to make the test much exactly.

Herbal Market

MALAYSIA HERBAL MARKET Currently, the value of global herbal market for nutraceuticals is at USD 70 billion and USD 20 billion for phytomedicines with an average growth rate between 15 to 20 percent annually. While the Malaysia herbal market is valued at RM 4. 55 billion 0f which 90 percent of the raw material used was imported. It is with this potential in mind that Malaysia’s herbal industry can be one of the agriculture Entry Point Projects under the National Key Economic Areas in the Economic Transformation Programme.According to the Agriculture and Agro-Based Industry Minister Datuk Seri Noh Omar, Malaysia's fast growing herbal industry is expected to contribute about RM2. 2 billion to Gross National Product (GNP) by 2020. While the world market for herbal products is expected to exceed RM2 trillion by 2020 from RM777 billion in 2009, the local herbal market was likely to grow 15 percent annually from RM7 billion in 2010 to about RM29 billion by 2020. Moreover, Malaysia h as been listed as the 12th most biodiversity nation in the world and ranks fourth in Asia.We have over 15,000 flowering plants and over 3000 species of medicinal plants in our rich biodiversity tropical rainforest. Of these about 200 are being used as herbal remedies and approximately 50 species are commonly used in traditional medicine preparation. Furthermore, Malaysians quite familiar for the uses of herbal products as our multi-ethnic communities have been practicing traditional medicine with herbal plants for centuries. In rural area, some of them still use poultices, myriad brews and pastes derived from herbal plants or used it for the purpose of physical ailments and beauty treatments.Therefore, upon realize the significance of herb, our government had given financial support to research work related to herbs in term of Intensified Research in Priority Areas (IRPA) grants, the focus areas by the National Biotechnology Directorate, as well as other grant schemes. For example, RM25 million had been allocated by the government for a local company to conduct clinical research on Tongkat Ali in order to securing approval from the US Food and Drug Administration (USFDA).Our government also support the effort that try to make halal pharmaceutical products being proved by the Halal standard for the pharmaceutical industry in order to protect the interests of Muslim consumers and all consumers in general the world over. Not only these, certain implementations also have been taken in view of turning Malaysia into a global herbal producer. World Health Organization (WHO) consistently reported that 80% of the world’s population depends on herbal medicine. There also a growing trend of people moving from synthetic allopathic drugs to herbal cures.This is because consumers realize the importance of health versus diseases, the changes in lifestyle, the growing of synthetic medical cost, and the growing knowledge of consumers about traditional medicines. Many co nsumers have known that the effective of herbal cures are the results of thousands years of herbal healing framework development through practise and error, observation, analysis and study. Moreover, there have been some high profile natural based cures such as Taxol plant for breast cancer and the Bintangor plant for AIDS.In order to achieve the goal stated in the previous paragraph, the highest standard of manufacturing should be included to be able to compete in terms of quality, safety, efficacy, pricing, and branding of products, as well as efficient distribution network and meeting international health certification standards. We also need to increase the domestic consumption by strengthen the domestic demand for Malaysian health foods and medicine besides reduce reliance on imported medicine, according to the speech by TAN SRI NOR MOHAMED YAKCOP.The ministry of health also has been diligently monitoring the herbal products in the market as well as conducted random sampling of herbal products to ensure that the standards of these products remain the same as the specified standards registered by the manufacturers. Notable markets for Malaysians herbal producer are USA, Europe, China, Japan and the Middle-east countries. This is important to ensure that our herbal product to penetrate the global export market.

Knowledge, Attitude and Breast Cancer Screening Practices in Ghana Essay

INTRODUCTION   Ã‚   Breast cancer in its simplest definition is the cancer of breast tissue. It is the most common nonskin cancer that affects women in the United States and the highest fatality rates of cancer deaths among women in low-resource countries (Anderson et al 2006). Severity of breast cancer differs based on its level of tissue invasion. Ductal carcinoma in situ is the most common noninvasive breast cancer while infiltrating or invasive ductal carcinoma is the most common breast cancer that accounts for about 80% of invasive breast cancer. Breast lumps presentation is the commonest form of presentation regardless of the breast cancer type (ACS 2005). Epidemiologic factors are attributed to dietary and environmental risk factors, although association of diet and breast cancer had varied results. Environmental risk factors involve the exposure to several toxic elements which accounts for the increased incidence of breast cancer in Western countries. Alcohol intake is also considered to effect in the increase of the number of cases in the US population. Age is also considered as cancer risk factor and can be attributed to hormonal change. Genetic variation and ethnicity are not out of scope for the investigation of breast cancer risk factors (Barton 2005). Diagnosis and Pathology of Breast Cancer: In 2002, Breast Health Global Initiative (BHGI) together with panel of breast cancer experts and patient advocates develop a consensus of recommendations for the diagnosis of breast cancer in limited-resource countries (Shyyan 2006). Histopathologic diagnosis included fine-needle aspiration biopsy which was recognized as the least expensive, core needle biopsy and surgical biopsy and had a consensus of choosing the method based on the availability of tools and expertise. They gave emphasis on the correlation of histopathology, clinical and imaging findings. They agreed on the need of histopathologic diagnosis before breast cancer treatment. In 2005, BHGI panel recommended an additional strategy of breast cancer management. They stratify diagnostic procedure and histopathology methods into – â€Å"basic, limited, enhanced, and maximal—from lowest to highest resources†. Basic level includes medical history of the patient, clinical breast examination, tissue diagnosis and medical record keeping. Limited level includes the increasing resources that enable diagnostic imaging utilization such as ultrasound with or without mammography, tests that can evaluate metastasis, use of image-guided sampling and hormone receptor sampling. Enhanced level includes diagnostic mammography, bone scanning and an onsite cytologist. Maximal level includes mass screening mammography (Shyyan 2006). Treatment of Breast Cancer: Treatment includes surgery, radiotherapy or chemotherapy or combinations of these three treatment modalities. According to American Cancer Society (2005), treatment can be local or systemic. Local treatment of the tumor is done without affecting the rest of the body. Surgery and radiation are examples of this treatment. On the other hand, systemic treatment which includes chemotherapy, hormone therapy and immunotherapy, is given into the bloodstream or by mouth to reach the cancer cells that may have spread the beyond the breast.    Radiotherapy is a treatment of breast cancer with high-energy rays to help shrink the cancer cells. It can be given outside of the body (external radiation) or can be placed directly into the tumor as radioactive materials (ACS 2005). It may be given external to the body.   Radiotherapy requires safe and effective application requiring appropriate facilities, staff and equipment. Radiotherapy should be applied without delay, should be accessible to all but without prolongation of the overall treatment time exposure. It is part of an integral part of breast-conserving treatment. It is required in almost all women with the breast cancer, and therefore should be available (Bese 2006).   Ã‚  Chemotherapy is the use of anticancer drugs that are administered through injection in the vein or taken orally as a pill. It may be given before breast cancer surgery to reduce the size of the tumor or may be given after the surgery to reduce the chance of   recurrence (ACS 2005). This treatment is done in cycle the most common of which is 3-6 months. Most common side effects of these drugs usually stop   once the treatment is over such as in hair falling. Some of   drugs used as chemotherapy     are tamoxifen, cyclophosphamide, methotrexate, 5-fluorouracil doxorubicin, epirubicin, taxane and aromatase . These are usually prescribed in combination, and treatment is done with adjuvant therapy such as radiotherapy and pre- and post operation ( Eniu 2006).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Surgical management in breast cancer is very common. This is done to remove as much as the cancer as possible and to find out whether the cancer has spread to the lymph nodes under the arm. Surgery can also restore the appearance of the breast and relieve the symptoms of advanced cancer. ACS (2005) released some of the common surgical procedures in breast cancer. These are lumpectomy, partial or segmental mastectomy, simple or total mastectomy, modified radical mastectomy and radical mastectomy. RESULTS    Breast cancer patients in Ghana. The present study which included women with mean age population of 48 years   revealed an almost consistent perception with regards to breast cancer.  Ã‚   They were aware that breast cancer is highly increasing in their place but not informed of the cause of disease. All of the responders were not aware of family breast cancer history except one. Information about breast cancer was acquired through television and radio programs. Only after   consultation with doctors due to lumps or   pains in their breast and some due to liquid coming out of their breast, that they were informed that they have breast cancer. Most of them underwent breast tissue exam for confirmation of the disease. Afterwards, they were advised to undergo surgery with medical treatment. The responders were ignorant of the breast cancer screening and prevention. In fact, out of 10 responders, only 2 (20%) of them were aware of breast self examination and clinical breast examination and admitted that they occasionally practice BSE. None of the responders knew about mammogram except for one (10%) of them who has heard of it but never had tried one. The feeling towards the knowledge of acquiring the disease was also the same; the feeling of being a burden in the family was common. They were afraid to face the reality but have realized that they have to fight the disease through the encouragement and support of family members and   help of medical professionals. The sample population was aware of the herbalist and faith healers but they did not submit themselves into that kind of treatment because herbalist have not   proven cure for breast cancer.   The most common complaint of the responders was the high cost of therapies, hospitalization and doctor fees. The treatment cost ranged to    ¢250,000- ¢24 million except to one of them who received a free treatment for being enrolled to a clinical trial. Sentiments of the participants were the same. Delay of treatment was attributed to their distant place from the health clinics; some facilities like x-ray were not available in the clinics and   high cost of treatment. These people asked for the betterment of breast cancer management through education dissemination to the community by health care providers and a help from the government to provide financial support to those who cannot afford to submit themselves for treatment. Patients in breast cancer clinic. In this part of the study, women with mean age of 42 years who were in breast cancer clinic were included. Most common medical complaint was lump and pain in the breast while others submit themselves for screening because they have just heard it from the radio/TV.   The study revealed that women who were attending the clinic were not actually informed of the cause breast cancer but aware of its increasing rate of mortality. Misconception about the cause of breast cancer such as exposure to coins was not common but did not exclude the form of trauma due to manipulation of the breast. Others correlate breast cancer with smoking and taking alcoholic beverages. They were not aware of their family history of breast cancer.   Information regarding breast cancer was acquired through television and radio programs and others were through their friends and family members. Most of the respondents believed that early detection and prompt treatment of the disease can prevent the unfavorable outcome of breast cancer such as removal of their breast or the worst would be cancer death. Only one out of   10 participants (10%) actually practice breast self examination (BSE). Most of them were informed of BSE but not actually practicing it. They were also aware of healers and herbalist but they did not believe that they can cure breast cancer but did not disagree of the possibility that herbalist and healers could treat other diseases or illnesses like hypertension. The participants suggested that it would be better if the government would provide or establish more health care clinics for breast cancer screening and provide free screening programs especially to those who cannot afford to   pay for high cost of treatment of the disease and for an open-easy access to all especially to those in rural areas. One of the participants suggested   that doctors should study further about the treatment of breast cancer instead of resorting to breast surgery. Healers involved in breast cancer management. Many of the population of Ghana are still patronizing healers and herbalist as a resort   of treatment. Two healers from Ghana were interviewed regarding their management of breast cancer. The healers have been into this practice for about 20-50 years. According to them, breast cancer is very common in Ghana and they are aware of the increasing incidence of   the disease. They described breast cancer as an â€Å"obosam† disease and the other was a supernatural disease. Healers believed that their ability to cure   the disease inherited from their forefathers who taught them how to prepare herbs and provide them with dwarfs. They believed that doctors have no right treatment towards breast cancer because according to them they just remove the breasts of women   and subsequently die. According to the healers they do not promote breast   examinations to their patients because these are useless and cannot stop women from getting the disease. Despite the big machines available in the hospitals, women with breast cancer still die, according to them. Healers charge their patients with as much as  ¢200,000- ¢1( £15-60) million depending on the patients’ condition. The healers admitted that there were cases of recurrence of the disease due to lost to follow up and missed spiritual sessions. Healers do not refer patients to hospitals rather, they encourage hospital doctors to refer their patients to healers because they are more capable of treating breast cancer. Breast cancer consultants.   Medical health professionals play a significant role in the awareness of breast cancer. They have the power to influence their patients toward right management of the disease. In the present study, surgeon/breast cancer consultants were interviewed. Consultants as expected were aware of the increasing incidence of breast cancer but they cannot give an exact figure due to absence of cancer registry in the place however they were able to attend to 200-300 new cases of breast cancer annually with age range starting from 20 years and above. They revealed that women in Ghana associate breast cancer to death because after undergoing breast caner surgery they usually die. People in Ghana link medical intervention and death which made the women in this place afraid of   the disease and lead them to negative attitude towards the disease. Consultants believed that there were several misconceptions about the disease. They were also aware that healers and herbalist delay the   presentation of patients to   hospital which accounted for the late stage of diagnosis. National Screening Program would benefit the people in Ghana for early detection of breast cancer and prompt treatment, however, they did not deny the fact it would be difficult to establish such program due to lack of funds by the government at present time. Consultants were aware of the limited resources of the needed for the implementation of the program. They believe that it is much easier and feasible to educate the women on simple screening methods such as regular breast self examination and encourage practitioners to take advantage of examining the breasts of their patients. There are also NGOs who are engaged in some activities like providing health care assistance. Consultants revealed that they receive referrals from district regions and from private practitioners. All patients with breast cancer are candidates for surgery. There are just some procedures that lead to untoward incident which cause the people to blame the doctors. According to consultants, one big problem that they encounter is the delay of the result of tissue exam from the pathologists which sometimes lead them to acquire the high cost of private laboratory. According to consultants the 5-year survival rate in Ghan is 25% which is disappointing. According to radiology consultant, patients present themselves to treatment once they are already in advanced stage, most at stage 3 and 4. They revealed the common factors that influence the delay of treatment among Ghana women. Most of the patients were scared of the procedure of   breast cancer treatment like in breast surgery which have many social and marriage implications. The high cost of the procedure hinders the patient to go to the doctors. Consultants revealed that surgical procedure may cost    ¢2-3million   ( £ 150-200), radiotherapy is about    ¢3-4 million (  £ 200-300) and chemotherapy is around  ¢6 million ( £400). Although surgical treatment cost is covered in National Health Insurance, the cost of radiotherapy and chemotherapy are excluded. Mammography which is an effective tool in breast cancer screening costs  ¢400,000 ( £30) in private health institution and around  ¢250,000 ( £20). DISCUSSION WITH REVIEW OF RELATED LITERATURES   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The present study aimed to increase the awareness of the women in Ghana to breast cancer and the benefits that can be gained from breast cancer screening. The knowledge, attitude, behavior and practices of the women regarding early detection of breast cancer were analyzed. The ultimate aim of the study was to reduce the mortality rate of   breast cancer.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The study revealed that there were still misconceptions about breast cancer despite the information gathered from televisions and radio programs. Attendance of Ghanaian women in breast clinic did not mean that they were informed of the nature of their disease. Only few of them were also aware of preventive procedure in detecting breast cancer. Local healers and spiritualists also delayed the presentation of the patients to the hospital which contributed to the late diagnosis of the disease. Difference in the disease management of health professionals can be attributed to the location of practice and availability of resources. Several factors   thought to affect the breast cancer screening program were the poor education of the Ghanaian towards prevention awareness against breast cancer; lack of initiative of the people to spread the knowledge of   breast cancer screening such as simple breast self examination and clinical breast examination; the inaccessibility of the of primary health care and the organizers; the unavailability of the appropriate screening tools like x-ray and mammography in the community and its high cost   and the lack of support from the government.   The following   review of related literatures will help in the understanding of breast cancer and breast cancer screening. Because of the continuous increasing prevalence of breast cancer and high cost of treatment, breast cancer screening remains the most cost effective way of cancer management (Parkin and Fernandez 2006).   Most of the world faces resource constraints that hinder the capacity to improve early detection, prompt diagnosis and sufficient treatment of the breast cancer. Every country finds its way to develop evidenced based, economically feasible and culturally appropriate guidelines that can be utilized by countries of limited health care resources to improve breast cancer outcomes (Anderson 2006). Adaptive strategies should be applied to ease the growing burden of breast cancer. In 2005, according to Smith and his colleagues (2006), the Breast Health Global Initiative (BHGI) held its second summit in Bethesda, MD with the intention of reaffirming the principle of requiring all women of all resource levels to support in seeking health care and assuring the access to affordable and appropriate diagnostic tests and treatment intervention against breast cancer. They recommended breast health awareness to all women including the basic resources. They enhanced the basic facilities for effective training of relevant staff in clinical breast examination (CBE) or breast self examination and even the feasibility of mammography. MRI: Magnetic resonance imaging is one of the breast cancer screening procedures. It has been increasingly used as tool for early diagnosis of breast cancer. This screening tool has shown to detect cancers even they are small and potentially proven to be more curable than mammography alone. However, MRI is more costly than mammography and can lead to unnecessary breast biopsies, thus causing anxiety and discomfort to patient. On the other hand, a research study about the cost-effectiveness of breast MRI screening by cancer risk where they included the cancer detection ability of MRI, characteristics of women with dense breast tissue and women with high inherited breast cancer risk, revealed mortality reduction and cost effectiveness of breast MRI screening added to mammography in BRCA1 and BRCA2 mutation carriers (Kurian 2006).    The hallmark of morality and morbidity of breast cancer can be attributed to the late presentation of the patients at an advanced stage of breast cancer. It is when there is no or little benefit that can be derived from any treatment modality. In a study conducted by Okobia and colleagues (2006), the knowledge, attitude and practice of community dwellers of Nigeria towards breast cancer were analyzed. They recruited urban-dwelling women with conducted an interviewer-administered questionnaires to elicit sociodemographic information regarding knowledge, attitude and practice towards breast cancer. It was found out that the participants had poor knowledge of breast cancer. Only 214 out of 1000 participants knew that breast cancer is presented initially with breast lumps. Breast cancer examination practices were low. Only 432 participants were able carry out breast self examination while only 91 participants had clinical breast examination. This study revealed that participants with higher level of education were significantly more knowledgeable about breast cancer. Ethnicity or race-related culture and beliefs are factors that affect the increase in prevalence of breast cancer mortality. Paterniti (2006) investigated how ethnically diverse women who are eligible for tamoxifen prophylaxis because of their breast cancer risk decide about tamoxifen use for risk reduction. Prior to the study, there was discussion of the benefits and risks of tamoxifen as prophylaxis. The study which included African-American, White, and Latina women, of 61–78 years, revealed that fear of breast cancer was not prominent and they were not inclined to take tamoxifen as preventive therapy after receiving the information. Participants showed limited unwillingness to take the medication with potential adverse effects. This study revealed that women felt that they had other options other than taking the risk of tamoxifen to reduce their risk of breast cancer, including early detection, diet, faith and other alternative therapies.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Graham (2002) conducted a research about   the relationship between beliefs and practice of breast self examination (BSE in a black women population of 20-49 years of age. It was found out that health beliefs were much stronger in determining BSE performance for a given individual than were demographic characteristics. Breast self examination was related to increased perceived seriousness of breast cancer, benefit of the procedure and health motivation and was noted to have inverse relationship with perceived barriers. A related study was reported by Mitchell and colleagues (2002), about the effects of religious beliefs with other variables on breast cancer screening and the intended presentation of self-discovered breast lump. This study included women aging 40 years and above and were interviewed in their homes. Most of the interviewees believed that doctors cure breast cancer with God’s intervention which was labeled as â€Å"religious intervention with treatment†. This dimension was found out to be correlated with self-reported mammography but no clinical breast examination or intention to delay presentation of self-discovered breast lump. Minority of them believed treatment of breast cancer was unnecessary because only God could cure the disease which was labeled as â€Å"religious intervention in place of treatment†, and was significantly more common among African-American women who   are less educated and older. This was correlated with the strong intention of delaying the presentation of self-discovered breast lump. It was concluded that   religious intervention in place of treatment contributes significantly the delay presentation of breast cancer among African-American that contribute largely to the advanced-stage cancer diagnosis. The cause of breast cancer is still unclear. Adjei (2006) who grew up in Ghan and had some work about breast cancer. In his letter, he revealed his sentiments about the genetic differences in breast cancer. He had been aware of the incidence of breast cancer in Ghana since 1974 to 1999. He noted that the peak incidence of breast cancer in Ghana is in younger women with age range of 40-45 years while in United States and Caucasians, the peak incidence is in older age groups. Adjei (2006) pointed out that women of different places and environments, with different diets have similar epidemiology of breast cancer. In an argument which revealed number of breast cancer in African-Americans but rare in native African has been used to suggest that ethnicity is one factor of acquiring the disease, however, according to Adjei (2006), this information is leading because cancer has not been well-studied in Africa. Researchers are still finding their ways to fully disclose the correlation of genetic signature in breast tumors that are presently noted   to be a powerful predictor of cancer spread and cancer death. In a limited study conducted by Kolata (2002), she included few patients who are relatively. As she stated in her report, scientists said that the activity of a collection of 70 genes appear to predict cancer mortality   better than traditional measures like tumor size, cancer stage or lymph node spread to the axilla of women. She revealed in her study that 5.5% of women with good genetic signature died within the next decade while 45% of women are those of with bad genetic signatures. Adherence to the treatment regimen of breast cancer plays a big role in the improvement of disease outcome. There are no much literature about the factors associated to the behavior that influence the patient to delay or cause an incomplete adherence to the recommended follow up in patients with breast cancer. In a study conducted by Kaplan (2006), race/ethnicity, country of birth, financial issues fear of pain and difficulty of communicating with the healthcare providers are the barriers to seek follow up consultation Breast Cancer Screening: There was decline in breast cancer mortality rate of 0.9% in African American women while 2.1% was the decline in breast cancer mortality rate in non-Hispanic White women (Stewart et al 2004 as stated by Settersten , Dopp, and Tjoe, (2005).    On the contrary, De Koning (2000), questioned in his study the cost effectiveness of breast cancer screening. His idea came out when he analyzed his expectations of the reduction of breast cancer mortality after breast cancer screening. He stated in his study that the Dutch program of 2-yearly screening for women aged 50-70 would produce a 16% reduction in the total population. As stated in his research paper, the actual benefit that can be achieved from breast cancer screening programs is overstated. According to him breast cancer screening need to be carefully balanced against the burden to women and health care system. De Koning (2000) stated that â€Å"effects of breast cancer screening program depend on many factors such as epidemiology of the disease, the health care system, costs of health care, quality of the screening program and the attendance rate†. Groot, M. T. et al (2006) estimated the costs and health effects of breast cancer interventions in epidemiologically different regions of Africa, North America and Asia. They developed a mathematical simulation model of breast cancer using the different stages of cancer, its distribution and case fatality rates in the absence and presence of treatment as predictors of survival. The study resulted to a conclusion that untreated patients were the most sensitive to case fatality rates. This study suggest that treating breast cancer at stage 1 and introduction of an extensive breast cancer program are the most cost effective breast cancer interventions.   Ã‚   This study is supported by the research done by Aylin and colleagues (2005). They recruited women at the mammography clinic to evaluate the knowledge about breast cancer and mammography as breast cancer screening procedure. The striking result of this study is that most of the participants (95.3% of the total participants) were aware that women should have mammography screening periodically. They were informed of the fact that breast cancer screening such as mammography could help in the early detection of breast cancer. However, less than 50% of them admitted that they had never had mammography screening. Majority of the respondents (71.1%) were practicing breast self-examination. Another related study was conducted by Dundar and colleagues (2006), since breast cancer is the second leading cause of cancer deaths in Turkey , they determined the t the knowledge and attitudes of women in a rural area in western Turkey about breast self examination and mammography. They recruited women with age ranging from 20-64 years. Although majority of the participants have heard or read about breast cancer only 56.1% of them had sufficient knowledge about breast cancer and some admitted that they acquired the information from their health care professionals. Those with information of beast cancer were also those who practice breast self examination. This study revealed that health care professionals play a big role in information dissemination about breast cancer. Table 1. Recommendations for routine mammographic screening in North American women aged 40 years or older who are at average risk for breast cancer* Group (date of recommendations) Frequency of screening (yr) Included ages (yr)       40-49 50-69 >70 Government-sponsored and private groups US Preventive Services Task Force (2002)** 1-2 Yes Yes Yes*** Canadian Task Force on Preventive Health Care (1998, 1999, 2001) 1-2 No Yes No National Institutes of Health consensus conference (1997)    No+ — — American Cancer Society (1997) 1 Yes Yes Yes National Cancer Institute (2002) 1-2 Yes Yes Yes Medical societies American College of Obstetricians and Gynecologists (2000) 1-2 if aged 40-49 yr 1 if aged >50 yr Yes Yes Yes American Medical Association (1999) 1 Yes Yes Yes American College of Radiology (1998) 1 Yes Yes Yes American College of Preventive Medicine (1996) 1-2 No|| Yes Yes American Academy of Family Physicians (2001) 1-2 No+|| Yes No American Geriatrics Society (1999) 1-2 — — Yes*** Advocacy groups National Breast Cancer Coalition (2000)    No –+ No National Alliance of Breast Cancer Organizations (2002) 1 Yes Yes Yes Susan B. Komen Foundation (2002) 1 Yes Yes Yes The above table   was taken from the study conducted by Barton (2005) There are several ways presented and studied for breast cancer screening. Its concern is to reduce the prevalence of cancer mortality and to improve the quality of life as a result of early detection, however, there are still people that are not aware of breast cancer screening In response to increase the worldwide awareness of breast cancer, breast cancer advocacy movement has been analyzing the common experiences of women with breast cancer around the world especially those with limited resources. They found out that although there are language barriers, sentiments were consistent across cultures; cancer survivors have the same experiences and fears. The beliefs and taboos about breast cancer hinder the awareness programs and treatment. There are also limited resources for public education and awareness. Difficulty in understanding and translating the concept of the disease into English also hinders them in the public awareness of breast cancer (Errico and Rowden 2006). In accordance with this, sociological review of the barriers experienced by the women from different traditional cultures is essential not just to understand patterns of late breast cancer diagnosis but also the importance of interventions and programs. This is necessary for them to understand the preventive health care, specifically in breast cancer. This is because many are still ignorant of the breast cancer. According to Remennick (2006), health care providers and policymakers should try to understand and influence women especially those who are cancer risk to be aware of the disease to detect and treat breast cancer early. There are many structural barriers that hinder women especially those living in rural areas. Socioeconomic factors include poor health insurance, distance to medical facilities and inability to take time off work. Organizational barriers include difficulty in navigating complex health care systems and interacting with medical staff. Psychological and sociocultural barriers are poor health motivation, denial of personal risk, fatalism mistrust of cancer treatments and fear of becoming a burden on the family members. Still in other cultural behavior, especially in Muslims, women are strongly controlled by men and therefore may prohibit women in breast cancer screening. Remennick (2006) includes in his study the different approaches that lower the mentioned barriers, including implementation of uplifting the educational programs that would enlighten people regarding cancer myths and fallacies. He suggests that health care professional must outreach to their co ethnics. Primary health care providers play a critical role in   determining the compliance with treatment and preventive practices through direct recommendations to their patients. Family physicians and general internists showed that 70% of women who received a provider referral completed a screening mammography within one year versus only 18% of self-referred women (Grady   et al 1997 as stated by Santora 2003). However, Over 90% of rural women report that a doctor’s recommendation to have breast cancer screening is â€Å"important† (Sparks et al 1996 as stated by Santora 2003). It should be noted that clinician compliance is contributed by several factors such as relation with provider, guideline of the treatment, patient’s behavior and environmental factors. Several studies have been conducted to report the   differences of health services in rural, urban and suburban areas with regards to their   health care services in the family practice clinics. It has been pointed out that lower utilization has been a significant factor. Those rural health practitioners have less access to health care services.   In a study done by   Pol and his colleagues (2001), suggested that rural health services do not lag for patients with access after revealing that 9 out of 16 services examined were as high or higher in rural areas. Another   study to examine the variations in breast cancer screening among primary care clinicians by geographic location of   clinical practice was done by Santora (2003). Physicians, nurse practitioners and physician assistants were included in the study and were classified into urban, rural and suburban categories based upon practice location. The study revealed that although there was no significant difference in the practice location, there was evident variation in the practice of   breast screening. It was reported that urban and suburban health practitioners were less compliant with the use of breast cancer guidelines as compared to clinicians in rural areas.   Primary care clinicians, including physicians, nurse practitioners and physician’s assistants lack a consistent. This study revealed   that geographical location is not the main factor of inconsistent medical approach to breast cancer screening. Although the difference in the approaches to the procedure is uncertain in this study. A related study about General Practitioners’ (GP’s) knowledge, beliefs and attitudes toward breast screening, and their association with practice based-organizations of breast cancer screening, was conducted by Bekker, Morrisona and Marteau (1999). This study revealed that women’s attendance for breast cancer screening may be increased due to raising GP’s perceptions of the   threat of breast cancer. 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Managing Time And People Commerce Essay

Planning is indispensable in making a new venture. This undertaking remains chiefly on the enterpriser get downing the concern. A good enterpriser demands to hold a assortment of accomplishments in order to be successful. SimVenture which is a concern simulation game, is a good manner of rehearsing these accomplishments. Indeed, learning entrepreneurial and concern accomplishments is one of the chief intents of SimVenture, by leting the users to make and run their ain practical company. SimVenture besides gives the chance to larn how to do efficient determinations in all the different sectors of a concern including selling, human resources, operations, finance, and more. As a concern disposal pupil and possibly future enterpriser, it is cardinal to understand how to successfully run a company and to pattern and trade with diverse accomplishments. I have learned many lessons by utilizing that simulation and many of these will decidedly be utile in my future life and heighten my cognition and personal development. Three of the chief that I have learned are how to pull off clip and people, how to develop a concern theoretical account, and how to research and analyse the market.Pull offing clip and peopleFirst, managing clip and people has been a important lesson that I have learned utilizing SimVenture. An enterpriser ‘s most of import and most hard occupation is to pull off these two constituents. The first constituent of the concern that has to be good managed is people. Get downing a concern is non merely a one individual trade, in the reverse, good developed and directed squads are behind most of the most successful concern start-up. Indeed, developing strong entrepreneurial squads are cardinal to a good functioning venture. It is the enterpriser ‘s undertaking to happen persons that can offer cognition, experience, accomplishments, and, therefore, add up a to the societal capital of their company. Furthermore, one time the good 1s are chosen, employees have to be motivated, leaded, inspired, and encouraged in order to be efficient and to increase their committedness to the company. With SimVenture, I have learned that this procedure is important for a concern, because taking inefficient or unsuitable employees can increase unusually its costs. Besides, the simulation taught me that non merely taking the best campaigner is of import, but particularly giving them the o ccupation place in harmony with what they are the best in. The 2nd constituent of the venture that has to be greatly managed is clip. Effectiveness, productiveness, and efficiency, are facets that can be overly increased if clip is managed right. Particularly during the concern start-up procedure, at every measure of it, clip should be spent on elements that are truly relevant for the creative activity of the company. SimVenture clearly showed that clip can truly be an issue in a company as clip direction was one on the chief jobs that my squad and I had while utilizing the simulation. Sometimes employees were passing clip idle, and some other times, they were non able to complete their undertaking due to miss of clip. In the hereafter, I will cognize that clip is the constituent of a concern that is likely the most indispensable to be good managed in order to be successful.Developing a concern theoretical accountSecond, making a concern theoretical account has been an indispensable lesson that I have learned with SimVenture. Constructing a concern theoretical account can be a really long and hard procedure, because it is a complex, precise, and specific undertaking. However, it is indispensable for a new venture to develop an effectual 1 because it is the bosom of a company. â€Å" Management author Joan Magretta defined a concern theoretical account as â€Å" the narrative that explains how an endeavor plant † † ( Casadesus-Masanell and RicartAA , 2011 ) . Bing portion of a concern scheme, a concern theoretical account is used to stand for nucleus facets of a venture. A concern theoretical account can be separated in five chief characteristics. The first subdivision is understanding the clients and their purchase determination. A client in a purchase determination procedure will go through through some phases before purchasing a merchandise or service. He will research information, seek value, measure alternate, and assess value before doing any determination. Using the simulation, I learned that understanding the clients that are in the mark market can greatly profit the company in doing merchandises in harmony with their demands. Besides, through SimVenture, I realized that clients are the wheels of the concern and that it is aboriginal to do determinations in relation to them. The 2nd characteristic of a concern theoretical account is the value proposition, or the benefits that clients gain. It is really of import for a company to understand and be cognizant of what their clients derive and profit from their merchandises or services. Developing a value proposition relies on analyzing qualitative and quantitative facets and happening a manner to be different from rivals by cognizing who they are and what they do. The value proposition is used to pull clients and guarantee the company ‘s fiscal good health. The 3rd portion of a concern theoretical account is the architecture of the concern. That characteristic describes the construction and the administration of the company. It besides defines how the venture creates and distributes its merchandises and services. The concern architecture discusses whether there is a market or non for what the company is selling, by analyzing the external environment such as geographics. All these different constituents are put together to make value for the clients. Using SimVenture, it was a challenge to do efficient determinations because all the characteristics of the concern and the mark market were to be taken in history. The 4th subdivision is the gross theoretical account of the concern. Its end is for the company to happen a profitable manner to present great value to their clients and fulfilling their demands. In other words, by making better than its rivals, the venture has to pull off its costs and disbursals in order to increase its return on investings. Pricing is besides an of import facet of that phase, so the monetary value should be fixed so that it is high plenty to do net income but non excessively high for the gross revenues to diminish. Furthermore, the company has to make up one's mind which gross mechanism will be adopted and how the benefits will be delivered to their clients. SimVenture taught me that it is indispensable to hold a great cognition of our costs and disbursals in order to repair the monetary value of the merchandise at a profitable degree. The 5th characteristic of the concern theoretical account is the strategic way. The strategic way is how the organisation scheme will be achieve and which actions will be in topographic point to make so. It demonstrate the place that the venture is be aftering to take over its rivals in a long term position. It is besides a projection of where the concern wants to be in a certain sum of old ages. Using SimVenture, I have learned that the strategic program of the concern is ever to be kept in head if you want the long term aims to be achieved. In the simulation, I would hold made different determinations than my squad. In my sentiment, we were believing excessively much about the present month and non plenty of the hereafter of the venture.Researching and analyzing the marketThird, researching and analyzing the market has been a important lesson that I have learned with SimVenture. The market analysis is indispensable to be done at the get downing point of every new venture. It allows the enterpriser to cognize more about the planetary environment of its concern. The market analysis is highly of import because it â€Å" helps specify the nature of the concern and the balance of the program. [ †¦ ] Similarly, the more a start-up understands the demands of its mark market, the more it can fit its merchandise attributes to those demands † ( Barringer, 2009 ) . Indeed, the venture will hold to section the market and choose a mark market. The â€Å" market cleavage is the procedure of spliting a market into distinguishable subsets ( or sections ) that behave in the same manner or have similar demands † ( Barringer, 2009 ) . As the market cleavage was already done in SimVenture, nil was learned from that subdivision. Before choosing a mark market, the company should research and analyze the size and the tendencies of the different market sections. This is critical because a good choice will let the concern to be successful in footings of net income and gross revenues growing. With SimVenture, I have learned that choosing the best market section is one of the most of import things, because if you do n't do a good choice, maintaining a financially healthy company can be debatable in the hereafter. I had trouble choosing the appropriate mark market for the concern. Therefore, what I have learned from that for the hereafter is that a deeper research and analysis of the market and of the sections should be done in order to do the best determination possible.DecisionTo conclude, through SimVenture, I have learned many of import lessons including managing clip and people, making a concern theoretical account, and researching and analyzing the market. The simulation made me cognizant that a concern can c onfront many troubles and that the enterpriser needs the cognition and the ability to do the best determination harmonizing to any state of affairss that can happen. Runing my ain concern for a few hebdomads has decidedly helped me in my personal development, because I would now experience more confident and experient if, in the hereafter, I would make up one's mind to get down my ain company.