Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
A. CLEMENTS, bsc, senior research nurse, Cancer Research UK Primary Care Education Research Group,
University of Oxford, Department of Primary Health Care, Oxford, B.J. HENDERSON, phd, research psycholo-
gist, Institute of Medical & Social Care Research, Ardudwy, Normal Site, University of Wales, Bangor, Gwynedd,
S. TYNDEL, ba, research officer, Cancer Research UK Primary Care Education Research Group, University of
Oxford, Department of Primary Health Care, Oxford, G. EVANS, md frcp, consultant in medical genetics,
Department of Clinical Genetics, St Mary’s Hospital, Manchester, K. BRAIN, phd, senior research fellow,
Institute of Medical Genetics, University of Wales College of Medicine, Heath Park, Cardiff, J. AUSTOKER, phd,
director, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of
Primary Health Care, Oxford, & E. WATSON, phd, deputy director, Cancer Research UK Primary Care Educa-
tion Research Group, University of Oxford, Department of Primary Health Care, Oxford, UK for the PIMMS Study
Management Group*
CLEMENTS A., HENDERSON B.J., TYNDEL S., EVANS G., BRAIN K., AUSTOKER J. & WATSON E. FOR
THE PIMMS STUDY MANAGEMENT GROUP (2008) European Journal of Cancer Care 17, 245–252
Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study
Mammographic screening is offered to many women under 50 in the UK who are at moderate or high risk of
developing breast cancer because of their family history of the disease. Little is understood about the impact
of screening on the emotional well-being of women with a family history of breast cancer. This qualitative
study explores the value that women at increased risk placed on screening, both pre- and post-cancer diagnosis
and the impact of the diagnosis. In-depth interviews were undertaken with 12 women, aged 35–50, diagnosed
with breast cancer while on an annual mammographic screening programme. Women described the strong
sense of reassurance gained from screening prior to diagnosis. This faith in screening was reinforced by early
detection of their cancer. Reactions to diagnosis ranged from devastation to relief at having finally developed
a long-expected condition. Despite their positive attitudes about screening, not all women wanted to continue
with surveillance. For some, prophylactic mastectomy was preferable, to reduce future cancer risk and to
alleviate anxieties about the detection of another cancer at each subsequent screen. This study illustrates the
positive yet diverse attitudes towards mammographic screening in this group of women with a family history
of breast cancer.
Keywords: breast cancer, early screening programme, family history, qualitative.
Correspondence address: Alison Clements, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of Pr.
Assignment 2 Final Project Part III Designing a StudyYou are t.docxrock73
Assignment 2: Final Project Part III: Designing a Study
You are the hospital administrator in a medium-sized, urban, for-profit hospital that caters to middle-income groups. You wonder if patients' satisfaction with the hospital stay will increase significantly if they are given better and more flexible meal options. You decide to conduct a research study to find the answer. The first step is to design the study.
Design a descriptive study to investigate if better meal options will increase patient satisfaction. Include the following elements of design:
1. Develop a research question or purpose of the study
2. Selection of subjects for study (what is the sample)
3. Assignment of subjects to experimental or control groups
4. Study time period
5. Type of data to be gathered
6. Measures of meal options and of patient satisfaction
7. Method of data collection
8. Guidelines for data interpretation
After you complete building the study design, list three design elements you considered in your study that were not readily obvious in the one you read last week “Diagnosed with Breast Cancer While on a Family History Screening Programme: An Exploratory Qualitative Study.”
By Tuesday, February 21, 2017, submit your study design and list of three identified design elements in a Word document to the W3: Assignment 2 Dropbox.
Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
A. CLEMENTS, bsc, senior research nurse, Cancer Research UK Primary Care Education Research Group,
University of Oxford, Department of Primary Health Care, Oxford, B.J. HENDERSON, phd, research psycholo-
gist, Institute of Medical & Social Care Research, Ardudwy, Normal Site, University of Wales, Bangor, Gwynedd,
S. TYNDEL, ba, research officer, Cancer Research UK Primary Care Education Research Group, University of
Oxford, Department of Primary Health Care, Oxford, G. EVANS, md frcp, consultant in medical genetics,
Department of Clinical Genetics, St Mary’s Hospital, Manchester, K. BRAIN, phd, senior research fellow,
Institute of Medical Genetics, University of Wales College of Medicine, Heath Park, Cardiff, J. AUSTOKER, phd,
director, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of
Primary Health Care, Oxford, & E. WATSON, phd, deputy director, Cancer Research UK Primary Care Educa-
tion Research Group, University of Oxford, Department of Primary Health Care, Oxford, UK for the PIMMS Study
Management Group*
CLEMENTS A., HENDERSON B.J., TYNDEL S., EVANS G., BRAIN K., AUSTOKER J. & WATSON E. FOR
THE PIMMS STUDY MANAGEMENT GROUP (2008) European Journal of Cancer Care 17, 245–252
Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study
Mammographic screening is offered to many women under 50 in the UK who are at moderate or high risk of
developing breast cancer because of their family history of the disease. Little is understoo ...
SUO_HCM4004_W2_A2_Estevez_Maria.docxby Maria Estevez.docxpicklesvalery
SUO_HCM4004_W2_A2_Esteve
z_Maria.docx
by Maria Estevez
FILE
T IME SUBMIT T ED 24 - JUL- 2017 10:22PM
SUBMISSION ID 83293157 1
WORD COUNT 631
CHARACT ER COUNT 3626
SUO_HCM4 004 _W2_A2_EST EVEZ _MARIA.DOCX (26.86K)
%55
SIMILARIT Y INDEX
%11
INT ERNET SOURCES
%45
PUBLICAT IONS
%48
ST UDENT PAPERS
1 %33
2 %14
3 %3
4 %3
5 %2
EXCLUDE QUOT ES ON
EXCLUDE
BIBLIOGRAPHY
ON
EXCLUDE MAT CHES OFF
SUO_HCM4004_W2_A2_Estevez_Maria.docx
ORIGINALITY REPORT
PRIMARY SOURCES
Submitted to EDMC
St udent Paper
A. Clements. "Diagnosed with breast cancer
while on a f amily history screening programme:
an exploratory qualitative study.", European
Journal of Cancer Care/09615423, 20080501
Publicat ion
Submitted to Walden University
St udent Paper
P Hopwood. "Surviving breast cancer: can
women expect to 'get back to normal'?", Breast
Cancer Research, 2008
Publicat ion
orca.cf .ac.uk
Int ernet Source
SUO_HCM4004_W2_A2_Estevez_Maria.docxby Maria EstevezSUO_HCM4004_W2_A2_Estevez_Maria.docxORIGINALITY REPORTPRIMARY SOURCES
Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
A. CLEMENTS, bsc, senior research nurse, Cancer Research UK Primary Care Education Research Group,
University of Oxford, Department of Primary Health Care, Oxford, B.J. HENDERSON, phd, research psycholo-
gist, Institute of Medical & Social Care Research, Ardudwy, Normal Site, University of Wales, Bangor, Gwynedd,
S. TYNDEL, ba, research officer, Cancer Research UK Primary Care Education Research Group, University of
Oxford, Department of Primary Health Care, Oxford, G. EVANS, md frcp, consultant in medical genetics,
Department of Clinical Genetics, St Mary’s Hospital, Manchester, K. BRAIN, phd, senior research fellow,
Institute of Medical Genetics, University of Wales College of Medicine, Heath Park, Cardiff, J. AUSTOKER, phd,
director, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of
Primary Health Care, Oxford, & E. WATSON, phd, deputy director, Cancer Research UK Primary Care Educa-
tion Research Group, University of Oxford, Department of Primary Health Care, Oxford, UK for the PIMMS Study
Management Group*
CLEMENTS A., HENDERSON B.J., TYNDEL S., EVANS G., BRAIN K., AUSTOKER J. & WATSON E. FOR
THE PIMMS STUDY MANAGEMENT GROUP (2008) European Journal of Cancer Care 17, 245–252
Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study
Mammographic screening is offered to many women under 50 in the UK who are at moderate or high risk of
developing breast cancer because of their family history of the disease. Little is understood about the impact
of screening on the emotional well-being of women with a family history of breast cancer. This qualitative
study explores the value that women at increased risk placed on screening, both pre- and post-cancer diagnosis
and the impact of the diagnosis. In-depth inte ...
The LANCET Oncology is the world-leading clinical oncology research journal globally (2021 Journal Citation Reports®, Clarivate 2022) With an Impact Factor of 54·433.
Publisher: Elsevier's Oncology Journal Network
Total Indexing – 11
Some Indexing sites are – Scopus , MEDLINE ,PubMed , Chemical Abstracts , Essential Science Indicators ,etc .
Editor :David Collingridge, Editor-in-Chief , gained a PhD in Tumour Biology from the Gray Cancer Institute/University College London (UK) and held research posts in the Department of Therapeutic Radiology, Yale University (USA) and in the PET Oncology Group, Imperial College School of Medicine, Hammersmith Hospital (UK)
Assignment 2 Final Project Part III Designing a StudyYou are t.docxrock73
Assignment 2: Final Project Part III: Designing a Study
You are the hospital administrator in a medium-sized, urban, for-profit hospital that caters to middle-income groups. You wonder if patients' satisfaction with the hospital stay will increase significantly if they are given better and more flexible meal options. You decide to conduct a research study to find the answer. The first step is to design the study.
Design a descriptive study to investigate if better meal options will increase patient satisfaction. Include the following elements of design:
1. Develop a research question or purpose of the study
2. Selection of subjects for study (what is the sample)
3. Assignment of subjects to experimental or control groups
4. Study time period
5. Type of data to be gathered
6. Measures of meal options and of patient satisfaction
7. Method of data collection
8. Guidelines for data interpretation
After you complete building the study design, list three design elements you considered in your study that were not readily obvious in the one you read last week “Diagnosed with Breast Cancer While on a Family History Screening Programme: An Exploratory Qualitative Study.”
By Tuesday, February 21, 2017, submit your study design and list of three identified design elements in a Word document to the W3: Assignment 2 Dropbox.
Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
A. CLEMENTS, bsc, senior research nurse, Cancer Research UK Primary Care Education Research Group,
University of Oxford, Department of Primary Health Care, Oxford, B.J. HENDERSON, phd, research psycholo-
gist, Institute of Medical & Social Care Research, Ardudwy, Normal Site, University of Wales, Bangor, Gwynedd,
S. TYNDEL, ba, research officer, Cancer Research UK Primary Care Education Research Group, University of
Oxford, Department of Primary Health Care, Oxford, G. EVANS, md frcp, consultant in medical genetics,
Department of Clinical Genetics, St Mary’s Hospital, Manchester, K. BRAIN, phd, senior research fellow,
Institute of Medical Genetics, University of Wales College of Medicine, Heath Park, Cardiff, J. AUSTOKER, phd,
director, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of
Primary Health Care, Oxford, & E. WATSON, phd, deputy director, Cancer Research UK Primary Care Educa-
tion Research Group, University of Oxford, Department of Primary Health Care, Oxford, UK for the PIMMS Study
Management Group*
CLEMENTS A., HENDERSON B.J., TYNDEL S., EVANS G., BRAIN K., AUSTOKER J. & WATSON E. FOR
THE PIMMS STUDY MANAGEMENT GROUP (2008) European Journal of Cancer Care 17, 245–252
Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study
Mammographic screening is offered to many women under 50 in the UK who are at moderate or high risk of
developing breast cancer because of their family history of the disease. Little is understoo ...
SUO_HCM4004_W2_A2_Estevez_Maria.docxby Maria Estevez.docxpicklesvalery
SUO_HCM4004_W2_A2_Esteve
z_Maria.docx
by Maria Estevez
FILE
T IME SUBMIT T ED 24 - JUL- 2017 10:22PM
SUBMISSION ID 83293157 1
WORD COUNT 631
CHARACT ER COUNT 3626
SUO_HCM4 004 _W2_A2_EST EVEZ _MARIA.DOCX (26.86K)
%55
SIMILARIT Y INDEX
%11
INT ERNET SOURCES
%45
PUBLICAT IONS
%48
ST UDENT PAPERS
1 %33
2 %14
3 %3
4 %3
5 %2
EXCLUDE QUOT ES ON
EXCLUDE
BIBLIOGRAPHY
ON
EXCLUDE MAT CHES OFF
SUO_HCM4004_W2_A2_Estevez_Maria.docx
ORIGINALITY REPORT
PRIMARY SOURCES
Submitted to EDMC
St udent Paper
A. Clements. "Diagnosed with breast cancer
while on a f amily history screening programme:
an exploratory qualitative study.", European
Journal of Cancer Care/09615423, 20080501
Publicat ion
Submitted to Walden University
St udent Paper
P Hopwood. "Surviving breast cancer: can
women expect to 'get back to normal'?", Breast
Cancer Research, 2008
Publicat ion
orca.cf .ac.uk
Int ernet Source
SUO_HCM4004_W2_A2_Estevez_Maria.docxby Maria EstevezSUO_HCM4004_W2_A2_Estevez_Maria.docxORIGINALITY REPORTPRIMARY SOURCES
Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
A. CLEMENTS, bsc, senior research nurse, Cancer Research UK Primary Care Education Research Group,
University of Oxford, Department of Primary Health Care, Oxford, B.J. HENDERSON, phd, research psycholo-
gist, Institute of Medical & Social Care Research, Ardudwy, Normal Site, University of Wales, Bangor, Gwynedd,
S. TYNDEL, ba, research officer, Cancer Research UK Primary Care Education Research Group, University of
Oxford, Department of Primary Health Care, Oxford, G. EVANS, md frcp, consultant in medical genetics,
Department of Clinical Genetics, St Mary’s Hospital, Manchester, K. BRAIN, phd, senior research fellow,
Institute of Medical Genetics, University of Wales College of Medicine, Heath Park, Cardiff, J. AUSTOKER, phd,
director, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of
Primary Health Care, Oxford, & E. WATSON, phd, deputy director, Cancer Research UK Primary Care Educa-
tion Research Group, University of Oxford, Department of Primary Health Care, Oxford, UK for the PIMMS Study
Management Group*
CLEMENTS A., HENDERSON B.J., TYNDEL S., EVANS G., BRAIN K., AUSTOKER J. & WATSON E. FOR
THE PIMMS STUDY MANAGEMENT GROUP (2008) European Journal of Cancer Care 17, 245–252
Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study
Mammographic screening is offered to many women under 50 in the UK who are at moderate or high risk of
developing breast cancer because of their family history of the disease. Little is understood about the impact
of screening on the emotional well-being of women with a family history of breast cancer. This qualitative
study explores the value that women at increased risk placed on screening, both pre- and post-cancer diagnosis
and the impact of the diagnosis. In-depth inte ...
The LANCET Oncology is the world-leading clinical oncology research journal globally (2021 Journal Citation Reports®, Clarivate 2022) With an Impact Factor of 54·433.
Publisher: Elsevier's Oncology Journal Network
Total Indexing – 11
Some Indexing sites are – Scopus , MEDLINE ,PubMed , Chemical Abstracts , Essential Science Indicators ,etc .
Editor :David Collingridge, Editor-in-Chief , gained a PhD in Tumour Biology from the Gray Cancer Institute/University College London (UK) and held research posts in the Department of Therapeutic Radiology, Yale University (USA) and in the PET Oncology Group, Imperial College School of Medicine, Hammersmith Hospital (UK)
Survival Analysis of Determinants of Breast Cancer Patients at Hossana Queen ...Premier Publishers
Breast cancer is one of the most severe diseases in the world and become the public’s ever day’s agenda in both developed and developing countries. The primary goal of this study was to identify the determinants of survival time of breast cancer patients at Hossana hospital, south Ethiopia. Kaplan-Meier estimation method and a new two-parameter probability distribution called hypertabastic are introduced to model the survival time of the data. A simulation study was carried out to evaluate the performance of the hypertabastic distribution in comparison with popular distribution with the help of R and SAS statistical software Packages. One-fourth (25%) of the total patients survived for only 2 days. 31(35.2%) were censored, and 55(62.5%) were died. Hypertabastic survival model was found to be best fitting to the breast cancer data and age, level of education, family history, breast problem before, High fat diet, child late age, early menarche, late menopause were significant risk factors for the death of breast cancer patients. Awareness has to be given for the society on causes of breast cancer and screening test and early detection policies for most risky groups has to be established.
A prospective study of breast lump andclinicopathologicalanalysis in relation...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Twenty five year follow up for breast cancer incidence 12-feb2014Miguel Pizzanelli
Twenty five year follow-up for breast cancer incidence
and mortality of the Canadian National Breast
Screening Study: randomised screening trial
OPEN ACCESS
Anthony B Miller professor emeritus, Claus Wall data manager, Cornelia J Baines professor
emerita, Ping Sun statistician , Teresa To senior scientist , Steven A Narod professor Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5T 3M7, Canada; 2Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario M5G 1N8, Canada; 3Child Health Evaluative Services, The Hospital for Sick Children, Toronto, Ontario, Canada
Assignment User FrustrationThe quality of the user experience i.docxlynettearnold46882
Assignment: User Frustration
The quality of the user experience is very important to the success of an application. In the early days of computing, users often experienced long delays since computing power was poor and networks had comparatively slow throughput. Modern systems have largely eliminated these delays due to increased network and computing power, yet users still report a high level of frustration.
Write a four to five (4-5) page paper in which you:
Describe three (3) reasons users are still frustrated with modern applications.
Suggest one (1) method for reducing the frustrations for each of the reasons you supplied in Question one (1).
Describe methods for determining if user frustration is caused by poor system design or from the natural frustration associated with learning a new software product.
Suggest at least three (3) methods to reduce the frustrations among the disabled population and how this population can be better served.
Use at least three (3) quality resources in this assignment. Note: Wikipedia and similar Websites do not qualify as quality resources.
The specific course learning outcomes associated with this assignment are:
Describe the inherent design issues across HCI environments.
Explain the use of interaction devices.
Use technology and information resources to research issues in human-computer interaction.
Write clearly and concisely about HCI topics using proper writing mechanics and technical style conventions.
.
Assignment Upstream Approaches to Canadian Population HealthAlt.docxlynettearnold46882
Assignment: Upstream Approaches to Canadian Population Health
Although Canada is contiguous to the United States and has some cultural and historical similarities, Canada’s population enjoys a vastly superior health status. Reasons are many, can be traced historically, and are related to a different view of the role of government. The experience of Canada demonstrates that neither a heterogeneous population, nor a health system that has waiting lines for services, are reasons for poor health. By looking critically at what produces good health in Canada, much can be learned about steps the U.S. might need to take if population health is its goal.
The Canadian Best Practices Portal challenges Canadian public health practitioners and researchers to create upstream interventions aimed at the source of a population health problem or benefit. What is being done to address the influences on population health in Canada?
To prepare
for this Assignment, review your Learning Resources. Search the Internet and scholarly research for examples of Canadian “upstream interventions” that can be put forth as examples of either effective or ineffective efforts to improve population health.
The Assignment (2–4 pages):
Provide a description of an existing intervention in Canada, intended to improve health inequities. Include an explanation of the inequity and how the intervention targets upstream determinants of health.
Describe the organizations involved and/or social policies enacted in the implementation of the intervention.
Explain whether or not the intervention was/is successful and what lessons public health practitioners can learn from that experience that might improve population health in the United States.
Expand on your insights utilizing the Learning Resources.
Use APA formatting for your Assignment and to cite your resources.
.
More Related Content
Similar to Diagnosed with breast cancer while on a family historyscreen.docx
Survival Analysis of Determinants of Breast Cancer Patients at Hossana Queen ...Premier Publishers
Breast cancer is one of the most severe diseases in the world and become the public’s ever day’s agenda in both developed and developing countries. The primary goal of this study was to identify the determinants of survival time of breast cancer patients at Hossana hospital, south Ethiopia. Kaplan-Meier estimation method and a new two-parameter probability distribution called hypertabastic are introduced to model the survival time of the data. A simulation study was carried out to evaluate the performance of the hypertabastic distribution in comparison with popular distribution with the help of R and SAS statistical software Packages. One-fourth (25%) of the total patients survived for only 2 days. 31(35.2%) were censored, and 55(62.5%) were died. Hypertabastic survival model was found to be best fitting to the breast cancer data and age, level of education, family history, breast problem before, High fat diet, child late age, early menarche, late menopause were significant risk factors for the death of breast cancer patients. Awareness has to be given for the society on causes of breast cancer and screening test and early detection policies for most risky groups has to be established.
A prospective study of breast lump andclinicopathologicalanalysis in relation...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Twenty five year follow up for breast cancer incidence 12-feb2014Miguel Pizzanelli
Twenty five year follow-up for breast cancer incidence
and mortality of the Canadian National Breast
Screening Study: randomised screening trial
OPEN ACCESS
Anthony B Miller professor emeritus, Claus Wall data manager, Cornelia J Baines professor
emerita, Ping Sun statistician , Teresa To senior scientist , Steven A Narod professor Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5T 3M7, Canada; 2Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario M5G 1N8, Canada; 3Child Health Evaluative Services, The Hospital for Sick Children, Toronto, Ontario, Canada
Assignment User FrustrationThe quality of the user experience i.docxlynettearnold46882
Assignment: User Frustration
The quality of the user experience is very important to the success of an application. In the early days of computing, users often experienced long delays since computing power was poor and networks had comparatively slow throughput. Modern systems have largely eliminated these delays due to increased network and computing power, yet users still report a high level of frustration.
Write a four to five (4-5) page paper in which you:
Describe three (3) reasons users are still frustrated with modern applications.
Suggest one (1) method for reducing the frustrations for each of the reasons you supplied in Question one (1).
Describe methods for determining if user frustration is caused by poor system design or from the natural frustration associated with learning a new software product.
Suggest at least three (3) methods to reduce the frustrations among the disabled population and how this population can be better served.
Use at least three (3) quality resources in this assignment. Note: Wikipedia and similar Websites do not qualify as quality resources.
The specific course learning outcomes associated with this assignment are:
Describe the inherent design issues across HCI environments.
Explain the use of interaction devices.
Use technology and information resources to research issues in human-computer interaction.
Write clearly and concisely about HCI topics using proper writing mechanics and technical style conventions.
.
Assignment Upstream Approaches to Canadian Population HealthAlt.docxlynettearnold46882
Assignment: Upstream Approaches to Canadian Population Health
Although Canada is contiguous to the United States and has some cultural and historical similarities, Canada’s population enjoys a vastly superior health status. Reasons are many, can be traced historically, and are related to a different view of the role of government. The experience of Canada demonstrates that neither a heterogeneous population, nor a health system that has waiting lines for services, are reasons for poor health. By looking critically at what produces good health in Canada, much can be learned about steps the U.S. might need to take if population health is its goal.
The Canadian Best Practices Portal challenges Canadian public health practitioners and researchers to create upstream interventions aimed at the source of a population health problem or benefit. What is being done to address the influences on population health in Canada?
To prepare
for this Assignment, review your Learning Resources. Search the Internet and scholarly research for examples of Canadian “upstream interventions” that can be put forth as examples of either effective or ineffective efforts to improve population health.
The Assignment (2–4 pages):
Provide a description of an existing intervention in Canada, intended to improve health inequities. Include an explanation of the inequity and how the intervention targets upstream determinants of health.
Describe the organizations involved and/or social policies enacted in the implementation of the intervention.
Explain whether or not the intervention was/is successful and what lessons public health practitioners can learn from that experience that might improve population health in the United States.
Expand on your insights utilizing the Learning Resources.
Use APA formatting for your Assignment and to cite your resources.
.
Assignment Type up an essay on one of two prompts and submit the .docxlynettearnold46882
Assignment:
Type up an essay on one of two prompts and submit the final draft online.
Choose
only
one
topic:
1.
Symbols are important in Fahrenheit 451. Identify 3 symbols and analyze their references and meanings throughout the novel.
2.
Illustrate how each of Montag's three mentors - a new mentor for each part of the novel - help to spur Montag's ideological progression.
This is the final draft of your individual research paper essay.
1.
Essay must be 7-8 pages typed, not including the works cited page.
2.
Essay must follow MLA format.
3.
Research must include a minimum of 8 sources, 4 of which must be from Library Databases: Proquest, CQ Researcher, Infotrac, Opposing Viewpoints, etc.
4.
Essay must have a complete Works Cited page that cross references correctly to all in-text citations.
Note:
Please submit your document with YOUR last name first. (Example:
Schilf-Research-Paper-Final-Draft.pdf
)
Format:
Follow the BASIC OUTLINE TEMPLATE ( i have already done this part and attached pictures)
A.
Introduction
: Type up an Introduction with an opening strategy (OS) that grabs the readers attention using a story based example (PE, OPE, HYPO, CS, or HYPO/COMBO) that also supports your chosen topic. End the Intro with the Thesis Statement. (Limit 1 to 2 paragraphs)
B.
Body
: Present the analysis position through 3 topic points. Type up the topic sentence and bullet point the evidence (in this case, only quotes from the primary source material). A minimum of 3 quotes for support are needed for each topic point. Ideally, you provide 4 or 5 supporting quotes
C.
Quoting
: Avoid long quotes. Instead, be concise with quoting. You want quotes that are short, dynamic, and memorable. You will still need to set up quotes with a signal phrase that sets up the context of the quote.
D.
Analysis
: Never assume that the quote itself is self-explanatory. You must respond to each quote with your Original Voice (ROV) to illustrate, explain, compare, contrast, identify, analyze, etc. Do not simply restate the quote in your own words. Your response needs to go deeper.
F.
Conclusion
: Type up a Conclusion that revisits the opening strategy story based example. (Limit to 1 paragraph)
G.
Format
: Essay must follow MLA format with a Works Cited page that cross references correctly to all in-text citations.
H.
Length
: Essay should be 3 to 4 pages typed.
Note:
Please submit your document with YOUR last name first. (Example:
Schilf-Fahrenheit-451-Final-Essay.pdf
)
.
Assignment Type:
Individual Project
Deliverable Length:
8–10 slides
Points Possible:
150
Management utilities can be vendor-specific or vendor-neutral. There are many utilities that are
available to provide a proactive approach to monitoring each node of the cluster.
Submit a PowerPoint presentation of 8–10 slides that includes the following:
• Identify 1 vendor-specific server-monitoring utility.
• Identify 1 vendor-neutral monitoring utility.
• In your presentation, list advantages and disadvantages of using one or the other.
Your answer should clearly identify what notification and management interfaces each utility has
available (i.e., e-mail enabled, management console, Web-based)
.
Assignment Type Individual discussion Board; 450 – 550 word.docxlynettearnold46882
Assignment Type
: Individual d
iscussion Board;
450 – 550 words
Leadership varies widely by culture and personality. An international organization with locations in several countries must balance the local customs and cultures with those of the primary culture of the organizations’ headquarters. Using the USA as the headquarters, pick two other countries that might be part of a international internet retail organization and research and discuss the differences that leaders would have to navigate in approach and adapting to different standards of behavior and culture within the countries.
Grading criteria: students are graded on the quality and originality of their posts and responses, not the quantity. Responses should indicate the dilemma that leaders will face in working in cultures where values and leadership styles vary widely from those of the US. Examples may include the use of payments for access, the difficulty that women might experience in dealing with a patriarchal country or other theoretically sound differences in leadership
.
Assignment Two UNIT 2Student Name _______________________.docxlynettearnold46882
Assignment Two UNIT 2
Student Name: ______________________________________________
(Your NAME must be exactly as it is on the roll in e campus and in WEBCOM2)
Your Section Number _____________ (you must enter your section number)
The Unit 2 Assignment 2: Unit Two in the Textbook. ONLINE HUMA 1315send this to professor through WEBCOM 2
DIRECTIONS: The assignment is in WORD. Save the document to your computer and write your answers in the spaces given. You may change the spacing as needed. You are also asked to just write what your thoughts are and what you think such as your own opinion for some answers for some questions.
NOTE: Turn in assignments using WEBCOM2 Internal Messages found under MENU in the top left corner of the site. You may either attach your Word file or copy and paste your entire submission in the message box. Be thorough in your answers. You should use the Textbook, Essential Humanitiesthird edition and/or the Study Guide. The Study Guide is not mandatory; however, it is there for your enrichment. The Study Guide is in WEBCOM 2 in the tab labeled Student Resources. You may also want to use additional information for any assignments from the Internet. If you do, please remember to cite your source at the end of your answer. If you add additional information from the Internet, this is great, but you must cite sources. This applies to photos as well. (Remember that SLO and ULO are for evaluator and for this course to be certified and you do not have to do anything with them. However, they show that the assignments are aligned with the text, WEBCOM 2 and with the test questions.)
When completing your assignment questions, you should use the text for your answers. You may also want to look at the WEBCOM 2 website and the PowerPoints related to the great artists and individuals mentioned in Unit II, and the colored timeline. The timeline shows historical periods. These are available in the Student Resources’ tab. Do not worry about timeline dates being exact. Different sources give different dates depending upon who wrote the timeline. Dates also overlap with time periods, so dates are sometimes given as “approximate dates”. Subject in a question means what it is about. Answer all the following questions:
1. Explain what makes Giotto an important artist and why many historians consider him important in history?
Why is Giotto considered a “transitional” artist? (SLO2: ULO 2.3)
(EXPLAIN WHAT MAKES HIS WORK SIGNIFICANT IN YOUR TWO ANSWERS FOR #1)
2. Distinguish what subject matter the artist, Johannes Vermeer painted during the Baroque Period in Holland? Refer to textbook appendix for visuals.(SLO 1: ULO 1:3; SLO 2, ULO 2.2) You should also write about what you think about his paintings.
EXPLAIN WHAT HIS PAINTING WERE ABOUT SUCH AS WHAT WAS IN HIS PAINTINGS?
3. Pieter Brueghel’s work is unique for his time. Examine the cultural heritage of the people in his paintings. Refer to textbook appendix for visual.
Assignment Two Select a college or university and provide th.docxlynettearnold46882
Assignment Two
Select a college or university and provide the information listed below for the university.
History of the Institution
Mission Statement
Accreditation Status of the Institution
Institutions Goals and Objectives
.
Assignment Two
Objectives
• Understand how the AVL tree works
• Give you further practice with C and data structures
Admin
Marks 10 marks, excluding bonus marks. Marking is based on the correctness and
efficiency of your code. Your code must be well commented.
Group? This assignment is completed individually.
Due Time 23:59:59 pm on Sunday 31 March 2019. 23:59:59 pm on Wed 3 April 2019
Late Submissions Late submissions will not be accepted!
In this assignment, you will implement AVL tree and a set of functions associated with AVL
tree. For simplicity, we make the following assumptions:
1. Each item of an AVL tree contains an integer key and an integer value.
2. No AVL tree contains duplicate items. Two items (k1, v1) and (k2, v2) are duplicates
iff k1=k2 and v1=v2 hold.
3. An AVL tree may contains multiple items with the same key and the number of
duplicate keys is a constant.
A template file named MyAVLTree.c is provided. MyAVLTree.c contains the type definitions of
AVL tree and AVL tree node as well as some basic functions. You can add your own helper
functions and auxiliary data structures for better performance in terms of time complexity.
You need to implement the following functions:
1. AVLTree *CreateAVLTree(const char *filename). This function creates an AVL tree by
reading all the items from a text file or from the standard input (keyboard)
depending on the argument filename. If filename is “stdin”, this function will read all
the items from the standard input. Otherwise, it will read all the items from a text
file with filename as its full path name. (2 marks)
An input text file contains zero or more items where each item is of the form (key,
value). Any characters such as white space between two adjacent items are ignored.
For example, the following sample file contains 10 items:
(2, 50) (4, 30) (9, 30) (10, 400) (-5, -40)
(7, 20) (19, 200) (20, 50) (-18, -200) (-2, 29)
Similarly, when reading from the standard input, each input line may have zero or
more items, separated by one or more white space characters. An empty line
indicates the end of input.
In case of an error in the input, this function will print the error and your program
terminates.
You may assume that the input does not contain duplicate items and thus this
function does not need to check for duplicate items.
The time complexity of this function cannot be higher than O(n logn), where n is the
size of the resulting AVL tree. If your time complexity is higher, you will get 0 mark
for this function. You may assume that each call to a C built-in function takes O(1)
time.
2. AVLTree *CloneAVLTree(AVLTree *T). This function creates an identical copy (clone)
of the input AVL tree T, and returns a pointer to the clone tree. (1 mark)
The time complexity of this function cannot be higher than O(n), where n is the size
of T. If your time complexity is high.
Assignment Topic Exploration and Analysis (Proposal)In Week 6 o.docxlynettearnold46882
Assignment: Topic Exploration and Analysis (Proposal)
In Week 6 of this course, you will submit an 8-page research paper (Final Project) in which you are required to:
Analyze an important social change movement of the
pre-modern era
(pre-1945).
Analyze an important social change movement of the
modern era
(post 1945).
Compare and contrast both movements.
Analyze and explain the leadership structure of both movements. Who led these social change efforts? Was it an individual or a collective effort? What prompted individuals to become leaders of the movements?
Analyze how the movements parallel or complement each other.
Evaluate the success of these movements in promoting social change.
This week, as part of the Final Project writing process, you will complete a Topic Exploration and Analysis (Proposal). In this proposal, you will select your research topics (the two social change movements), create a beginning outline of what you plan to cover in the Final Project, provide a short summary of your initial research findings, and provide an initial bibliography.
In preparation:
Review the Final Project Guidelines document, located in this week’s Learning Resources.
Select and begin to research a social change movement pertinent to the
pre-modern era
(pre-1945). For ideas, look at content contained in Weeks 1–3 of this course. Pay particular attention to the selection of readings in the course text for each of these weeks.
Select and begin to research one of the following social change movements pertinent to the
modern era
(post 1945):
African American civil rights movement
Chicano movement
American Indian or ”Red Power” movement
Women’s rights movement
LGBTQ (lesbian, gay, bisexual, transgender, and queer) rights movement
Disability rights movement
Maintain a listing of scholarly resources that you locate and are using. The Walden Library provides a rich selection of material. Keep in mind that websites are generally not considered sources of scholarly material.
Note:
In your initial research this week, look at the historical background of each issue, the leadership structure in each movement, examples of specific changes that resulted related to each movement, and challenges the movement faced or is still facing. Consider the impact, successes, and failures of each movement.
The Assignment
Write a 1- to 2-page essay that includes:
Identification of the two social movements you will address in your Final Project
A brief outline of what you plan to cover in the paper
A short summary of your initial research findings
A bibliography of resources you used
.
Assignment To consider three sources about the Fall of Rome and w.docxlynettearnold46882
Assignment:
To consider three sources about the Fall of Rome and write an analytical essay.
Purpose:
To demonstrate proficiency in integrating historical sources and producing a well-informed analytical essay.
Part 1:
Research
Examine three sources:
1.
The textbook explanation concerning the decline and fall of Rome (chapter 7).
2.
The class presentation lecture on the Roman Empire.
3.
An article on the subject (“Friends, Romans, Countrymen” – see the Reading & Study link).
Write a 1,000–1,300-word essay concerning the decline and fall of the Roman Empire.
The paper should have a clear thesis statement, located at the end of the introduction.
The paper should cover the following:
1.
The various viewpoints given in the three sources (focus on the viewpoints you agree with)
2.
The variables involved (social, economic, military, etc.).
3.
Lessons the United States (our people and our government) can learn from Rome’s decline and fall.
4.
Similarities between the actions and attitudes of ancient Rome in their decline and fall and our American society today
Be careful that you use only the three sources provided. Use of other sources will be penalized.Textbook:
Perry, M., Chase, M., Jacob, J. R., Jacob, M. C., & Von Laue, T. H. (2013).
Western civilization: Ideas, politics, and society
(10th ed.). Boston: Wadsworth, Cengage Learning. ISBN: 9781111831707.
Williams, S., & Friell, G. (1994). Friends, romans or countrymen? barbarians in the empire.
History Today,
44
(7), 34.
http://bb7.liberty.edu/bbcswebdav/pid-22815357-dt-content-rid-159718173_1/xid-159718173_1
.
Assignment topic Rapid Influenza Testing in Children and Adult.docxlynettearnold46882
Assignment topic : Rapid Influenza Testing in Children and Adults.
When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to accurately interpret the results.
Not only do these diagnostic tests affect adults, body measurements can provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture—among other factors—are also relevant. That said, gathering and communicating this information can be a delicate process.
For this Assignment, you will consider the
validity
and
reliability
of different assessment tools and diagnostic tests. You will explore issues such as
sensitivity,
specificity,
and
positive
and
negative predictive values
. You will also consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.
To Prepare
· Review this week’s Learning Resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. You also will review examples of pediatric patients and their families as it relates to BMI.
· Search the Library and credible sources for resources explaining the tool or test you were assigned. What is its purpose, how is it conducted, and what information does it gather?
· Also, as you search the library and credible sources, consider what the literature discusses regarding the validity, reliability, sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool.
Assignment
(3–4 pages, not including title and reference pages)
:
For the Adult Assessment Tools or Diagnostic Tests:
Include the following:
· A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.
o What is its purpose?
o How is it conducted?
o What information does it gather?
· Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.
For the Child :
Include the following:
· An explanation of the health issues and risks that are relevant to the child you were assigned.
· Describe additional information you would need in order to further assess his or her weight-related health.
· Identify and describe any risks and consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this infor.
Assignment Topic 1Choose a contemporary painting, sculpture, o.docxlynettearnold46882
Assignment Topic 1
Choose a contemporary painting, sculpture, or piece of art that captures your interest. This should be a piece created between the end of World War II (about 1945) and today. You may choose one of the illustrations or color inserts in the textbook, or try a virtual museum (check the links in this week's My Humanities Kit).
Before you begin writing your post, view the “Closer Look” art critiques from the unit My Humanities Kit resources. Consider what features are discussed in the piece you select. Aim for an evaluation that notes small details in a work, considers the purpose of various elements, and perhaps investigates the artist’s life.
In the post, begin by introducing the piece of contemporary art created between 1945 and present. What is the title? Who created it and when? What is the style? How would you describe it to someone who had not seen it? Finally, explain why viewing this work is a valuable experience. Connect the Unit 5 reading material in your response; include APA formatting.
Student 1
Hello Class and Professor,
For my piece of Art I have chosen Andy Warhol’s painting “Diamond Dust Shoes 1980”. I not only love the colors that are presented in the piece but the meaning to me signifies how many shoes women fill in our daily lives such as a mother, a friend, a lover, a daughter and etc. I fell a since of gratitude when I look at this colorful piece.
Andy Warhol was born in 1928; he left a huge legacy behind when he passed away in 1987 (Janaro & Altshuler, 2012, p. 142). From drawings, paintings and prints to videography, publishing and performance, he produced more than art -- he was essentially his own brand. From haunting black and white self-portraits to Polaroid snapshots of celebrities, many of the photos in the collection later became the inspiration for Warhol's most well-known Pop Art pieces (Janaro & Altshuler, 2012, p. 142).
Warhol's focus on consumer goods and pop-culture icons, as well as his own taste for money and fame, suggest a life in celebration of the very aspects of American culture that his work criticized (A & E Television Networks, 1996-2013). When looking at this piece of work you have a sense of what life is everyday!
Please look at the link provided below to take a look at this peice of Art. (The last reference below)
Margaret
A & E Television Networks, L. (1996-2013). bio.true story. Retrieved from Andy Warhol Biography: http://www.biography.com/people/andy-warhol-9523875?page=2
Student 2
Hello Class and Professor,
For some reason many of the illustrations in our text I cannot view. So I decided to search for contemporary art photos. There were quite a few interesting images but I found a sculpture or performance piece by Rook Floro that really caught my eye. Oddly, there is no title; at least I have not been able to locate one. Parts of this three-dimensional art look like it has some kind of wiry texture. The piece seems to be an imitation of human emotion. .
Assignment TitleAssessment Item 03 Case Study Analysis – Engagi.docxlynettearnold46882
Assignment Title
Assessment Item 03: Case Study Analysis – Engaging and Motivating staff
Length
3000-3500 wordsLearning outcomes
1. Knowledge - Describe and critically discuss key principles and theories of Human Resource Management.
2. Problem Solving Skills - Critically evaluate and synthesize relevant information to solve real world issues associated with Human Resource Management.
3. Change Management - Analyse the role of Human Resource Management in implementing change within a global context.
4. Global Environment - Identify and critically discuss local, global and international workforce trends and assess the implications for human resource managementLecturer Discretion
Lecturers may, at their discretion, ask students to verbally present their assignment submission or rewrite some selected part/s of their answer in a controlled setting.Task Details
Engaging and motivating employees is at the centre of Strategic Human Resource Management (SHRM) practices. It is therefore important to identify the organisational practices that can be used to foster the cognitive, emotional and behavioural qualities that will positively impact on employees and enhance their motivation.
To understand what motivates people to work is essential to this assignment. The focus of the assignment is to identify the motivational theories, the characteristics of a positive work environment and the HR practices that positively influence affective processes (e.g. motivation, commitment, job satisfaction, wellbeing) and behavioural processes (e.g. effort, reduced turnover and absenteeism).
To complete this assignment successfully students at a minimum should:
· Identify the key motivational theories and discuss which of the theories strongly influences employees’ affective processes and behavioural processes.
· Describe the characteristics of a positive work environment and discuss how HR designs jobs to motivate employees.
· Discuss the synthesis of Hackman and Oldham’s (1976) job characteristics and employees’ psychological states in relation to work outcomes, such as intrinsic work motivation, job satisfaction, and high quality work performance.
International Human Resource Management
· Discuss the possible relationship between Maslow’s general components and job characteristics in view of engaging and motivating employees in organisations.
Your assignment must be formatted with heading.
Harvard referencing style must be used.
References
Gallup Consulting 2010, The state of the global workplace: A worldwide study of employee engagement and wellbeing, viewed 20 February 2015
<http://www.gallup.com/services/176300/state-global-workplace.aspx>
Jackson, S & Schuler, R 1995, Understanding Human Resource Management in the context of organisations and their environments, Annual Review of Psychology, vol. 46, pp. 237-264.
Pfeffer, J & Veiga, F 1999, Putting people first for organisational success, Academy of
Management Executive, vol. 13, no. 2, pp.37-48.
Runni.
Assignment Title Knowledge management cycle process in or.docxlynettearnold46882
Assignment Title:
Knowledge management cycle process in organizations and significance communities of practice
Note:
Each question/concept/ topic must be supported with peer reviewed journal references.
Assignment Structure:
Part A.
1.
Provide brief description about knowledge management processes in organizations. (
1 Mark
)
2. Explain the concept of organizational learning and describe the link between individual and organizational leaning. (
2 Marks
)
3. Describe role of organizational culture in knowledge management. (
2 Marks
)
Part B.
1. Describe the concept of community. Describe its key components. (
1 Mark
)
2. Discuss how communities can be linked to organizational memory in order to foster organizational learning and innovation. (
2 Marks
)
3. Highlight some of the key steps you would need to carry out in order to conduct social network analysis of an organization. What sort of questions could the social network analysis answer? (
2 Marks
)
NO plagiarism/ 700 WORDS
.
Assignment Three Technical Descriptions Due March 2 (1155 PM .docxlynettearnold46882
Assignment Three: Technical Descriptions
Due: March 2 (11:55 PM on Moodle)Peer:Feb 29
For this assignment you will either be creating a technical description or an extended technical definition. Officially, an extended technical definition is a microgenre of a technical description, but there are some differences worth noting. Technical descriptions are “longer explanation[s] . . . of the physical or operational features of an object, mechanism, or process”(Markel 534). While technical descriptions include technical definitions, an extended technical definition is slightly different.
An extended definition includes the three parts of a basic sentence definition, “[1] the term being defined, [2] the category in which the term belongs, and [3] the distinguishing features that differentiate it from its category” (Johnson Sheehan 155). It also expands the definition by adding more details of an object, process, or idea (Markel 534). It is divided by adding some (all) of the following: examples, partition, principle of operation, analogy, negation, and etymology (Markel 538 – 541).
Technical descriptions need a title/indication of the nature/scope of what the description will accomplish; an introduction that answers the questions in table 20.1 on page 545; a body with appropriate detail that discusses each step or section with detail, creativity, and clarity; and a conclusion that usually explains how the steps work together or summarizes the main steps. Look at the guidelines on page 547 for writing tips and additional help.
What you choose to do this on is up to you. You are free to choose any object, place, or process (and the definition of these can be pretty loose—think about my spider example). If you want to choose something that interests you, something you currently work with, something from your future workplace, or something else entirely—go for it. If you want to do something out of the ordinary you can always ask me if it’s okay.
Requirements
· The description/definition should be between 600 to 1000 words.
· It should be typed in a serif font.
· It must focus on clear writing that uses creative and technical writing techniques.
· It should be written for an audience similar to Wikipedia.
· It should follow checklist on page 571 – 572.
Green Hospitality: Green Hospitality:
Saving the EnvironmentSaving the Environment
A student Webzine from the International Council
on Hotel, Restaurant, and Institutional Education
for Future Hospitality & Tourism Professionals
Vol. 17 No. 1 • ISSN: 1095-7898 Spring 2008
HOSTEUR
INTERNATIONAL
CHRIE
The Hospitality &
Tourism Educators
Volume 17, No. 1 | Spring/Summer 2008 Issue2 HOSTEURTM
Sustainability Standards for the Hotel Industry............5
by Andrew Moreo
Destination “Green”land - a Look at the Sustainable
Efforts of the Air Travel Industry......................9
by Katie Fontaine
Green Hotels..................................................
Assignment ThreeUNIT 3 – ON LINE CLASSStudent Name __________.docxlynettearnold46882
Assignment Three
UNIT 3 – ON LINE CLASS
Student Name: ______________________________________________
(Name must be exactly as it is on the e campus roll and the same in WEBCOM 2) Turn in assignment through WEBCOM 2 to Professor on time
Your Section Number _____________ (you must enter your section number)
The Unit 3 Assignment 3: Unit Three in the Textbook.
DIRECTIONS: The assignment is in WORD. Save the document to your computer and write your answers in the spaces given. You may change the spacing as needed.
NOTE: Turn in assignments to me through WEBCOM 2 see the place where you send me the assignment. You may either attach your Word file or copy and paste your entire submission. Be thorough in your answers. You should use the Textbook, Essential Humanitiesthird edition and/or the Study Guide. The Study Guide is not mandatory; however, it is there for your enrichment and it is helpful. The Study Guide is in WEBCOM 2 in the tab labeled Student Resources. You may also want to use additional information for any assignments from the Internet. If you do, please remember to cite your source at the end of your answer. If you add additional information from the Internet, this is great, but then be sure to cite your source at the end of your paragraph. You must cite sources. This applies to photos as well.
DIRECTIONS FOR FULL CREDIT: You will need to show how the architectural structure is significant (importance in history and explain its legacy). You should explain how it fits into the historical period and what it reflects about its time and place. Include names of important individuals connected to the construction and especially the name of the architect, if known. Mention the materials used in the construction and include information about how it was built. Also include location. Use full sentences in your answers and be sure to site your answers if you use photos and the internet if you use google. Do not just write in your site that you used google. You must place exact address. Google is too broad of a site for a reference. Thank you
1. List the major time periods in sequential order. The first period is Prehistoric. Then comes Mesopotamia, and then Egypt etc. Under each period, list the minimum of 3 major accomplishments or achievements of that period. See the WEBCOM 2 Resources tab that has the heading timeline and the Textbook Index in front of the textbook for Unit III which lists the periods of time in order
1. Discuss in written statements at least 2 major differences between the Paleolithic Era (Old Stone Age) and the Neolithic Era (New Stone) found during the Prehistoric Period? (Unit 3, Chapter 3). (SLO 3: ULO 3.4).
EXPLAIN ANSWER FULLY USING THE CHART THAT YOU WILL SEE ON A PAGE IN YOUR TEXT
1. Explain how the Sumerian marble statuettes, sculptures, and Queen Puabi’s Harp that were excavated in modern times help us understand how the Sumerian people’s lived and what their beliefs were during the anc.
Assignment title An Evaluation of the Business Strategy at Mc D.docxlynettearnold46882
Assignment title: An Evaluation of the Business Strategy at Mc Donald’s.
Word count: 4242
Student name: Shane Sunil Mohan
Student number: A001753898
Subject name: 9050PROJ
AQF Level: 9
Discipline: Strategic Management
Theme: Critical Evaluation of a Business Strategy
EXECUTIVE SUMMARY
This paper was fundamentally about conducting a research and analyzing the findings on an evaluation of the business strategy at Mc Donald’s. Mc Donald’s establishment is a centralized, international organization which competes in the fast food industry by supplying hamburgers, french fries, and other consumable items using standardization. Substantial expansion and branding as the main driving force. As mentioned previously, operating in an open market in the food chain sector, one of Mc Donald’s major competition would be Wendy’s. These two establishments offer the exact same service which tends to make it difficult for Mc Donald’s to gain market share. With this being said, this report outlines different strategic strategies in which Mc Donald’s can gain competitive advantage against Wendy’s by providing substantial evidence on Mc Donald’s weaknesses and how it can be improved by using the case study method to help assist presenting its findings.
Table of Contents
1.0 Introduction 4
2.0 Literature Review: 5
2.1 Application of the literature to Mc Donald’s 6
2.2 Analysis with respect to Neoclassical microeconomics: 7
2.3 Analysis with respect to Evolutionary economics: 8
3.0 Research Methodology: 9
3.1 Case study method: 9
3.2 Data Collection: 10
3.3 Presentation of findings: 10
3.4 Analyzing the data: 11
4.0 Data Analysis and Reflections 11
4.1 Presentation of data 11
4.2 Reflection on findings and implications: 12
5.0 Conclusion and Recommendations: 14
5.1 Addressing social changes with differentiation strategy: 15
5.2 Recommendation: Improved Promotional Strategy: 16
5.3 Conclusion 16
References 18
1.0 Introduction
With the increase in the trend of globalization and the increasing competition in global markets, companies work day and night to come with effective strategies. Some of the multinational companies are known for the strategies they use and practice. In this paper, two of the companies operating in the United States of America will be discussed and compared along with the suggestion of a competitive strategy for McDonald’s. One of the companies that was researched in this paper name is McDonald's. This company operates internationally while the opposition organization which is Wendy’s also known as a fast food restaurant operates in the United States of America. As far as McDonald's is concerned, McDonald's was established in the year 1940 by Richard and Maurice McDonald, in San Bernardino, California, United States. The organization's business structure depends on three basic axes: representatives, franchisees, and suppliers. This business structure made by the founder of the organization, Ray Kroc, is known as "the three-legged sto.
ASSIGNMENT The student will submit a research project that compares.docxlynettearnold46882
ASSIGNMENT: The student will submit a research project that compares and contrasts two organizations in the same sector (Career Education Corporation and the Apollo Group Inc. or any other that you prefer), including analysis of the following criteria: legal, social, and economic environments; management structure; operational and financial issues; and impact of potential change factors.
1) Student should analyze the basic legal, social, and economic environments of the organization
2) Student should analyze the managerial, operational and financial issues of the organization
3) Student will analyze the impact of potential change factors as they related to the organization.
4) Student should apply appropriate college level writing standard.
the submission should be in APA Format. LENGTH of Paper: 5 Body Pages
.
Assignment Three Case study report – mixed mediaValue 40 .docxlynettearnold46882
Assignment Three: Case study report – mixed media
Value: 40% of the total marks for the unit
Length: 2000 words, or 5-6 minute video, or audio-narrated powerpoint of 10-15 slides, or photo essay supported with 500 words
Due: Week 12
Task description
Attend the event nominated in Assignment 2.
Briefly describe the event – name, date, location and venue, and attendance numbers and demographics.
Describe and critically analyse the positive and negative impacts of the event utilising the principles of sustainability and the triple bottom line approach.
Describe and discuss how the event’s program elements related to the aims and objectives identified in Assignment Two.
Describe and discuss the marketing of the event and how the promoted experience related to the actualisation and attainment of its aims and objectives (include actual audience details – numbers, demographic composition).
Provide recommendations for future activities which clearly identify issues relevant to event management.
The task is a report on the event nominated in Assignment Two that uses the triple bottom line approach to identify and critically analyse - the attainment of the events aims and objectives; the positive and negative economic, environmental, sociocultural impacts of the event; and recommendations which clearly identify issues relevant to the event management.
The evaluation report should use creativity in the approach to the task style.
The assignment may be presented as a 2000 word essay, or a 5-6 minute video, or an audio-narrated powerpoint of 10-15 slides, or a photo essay supported with 500 words. The process for submission of this assessment will depend upon the format chosen and prior negotiation with the tutor is required.
.
Assignment The Nurse Leader as Knowledge WorkerThe term kn.docxlynettearnold46882
Assignment: The Nurse Leader as Knowledge Worker
The term “knowledge worker” was first coined by management consultant and author Peter Drucker in his book,
The Landmarks of Tomorrow
(1959). Drucker defined knowledge workers as high-level workers who apply theoretical and analytical knowledge, acquired through formal training, to develop products and services. Does this sound familiar?
Nurses are very much knowledge workers. What has changed since Drucker’s time are the ways that knowledge can be acquired. The volume of data that can now be generated and the tools used to access this data have evolved significantly in recent years and helped healthcare professionals (among many others) to assume the role of knowledge worker in new and powerful ways.
In this Assignment, you will consider the evolving role of the nurse leader and how this evolution has led nurse leaders to assume the role of knowledge worker. You will prepare a PowerPoint presentation with an infographic (graphic that visually represents information, data, or knowledge. Infographics are intended to present information quickly and clearly.) to educate others on the role of nurse as knowledge worker.
Reference: Drucker, P. (1959).
The landmarks of tomorrow. New York, NY: HarperCollins Publishers.
To Prepare:
Review the concepts of informatics as presented in the Resources.
Reflect on the role of a nurse leader as a knowledge worker.
Consider how knowledge may be informed by data that is collected/accessed.
The Assignment:
Explain the concept of a knowledge worker.
Define and explain nursing informatics and highlight the role of a nurse leader as a knowledge worker.
Develop a simple infographic to help explain these concepts.
Your PowerPoint should Include the hypothetical scenario you originally shared in the Discussion Forum. Include your examination of the data that you could use, how the data might be accessed/collected, and what knowledge might be derived from that data. Be sure to incorporate feedback received from your colleagues’ responses.
.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Diagnosed with breast cancer while on a family historyscreen.docx
1. Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
A. CLEMENTS, bsc, senior research nurse, Cancer Research
UK Primary Care Education Research Group,
University of Oxford, Department of Primary Health Care,
Oxford, B.J. HENDERSON, phd, research psycholo-
gist, Institute of Medical & Social Care Research, Ardudwy,
Normal Site, University of Wales, Bangor, Gwynedd,
S. TYNDEL, ba, research officer, Cancer Research UK Primary
Care Education Research Group, University of
Oxford, Department of Primary Health Care, Oxford, G.
EVANS, md frcp, consultant in medical genetics,
Department of Clinical Genetics, St Mary’s Hospital,
Manchester, K. BRAIN, phd, senior research fellow,
Institute of Medical Genetics, University of Wales College of
Medicine, Heath Park, Cardiff, J. AUSTOKER, phd,
director, Cancer Research UK Primary Care Education Research
Group, University of Oxford, Department of
Primary Health Care, Oxford, & E. WATSON, phd, deputy
director, Cancer Research UK Primary Care Educa-
tion Research Group, University of Oxford, Department of
Primary Health Care, Oxford, UK for the PIMMS Study
Management Group*
CLEMENTS A., HENDERSON B.J., TYNDEL S., EVANS G.,
BRAIN K., AUSTOKER J. & WATSON E. FOR
THE PIMMS STUDY MANAGEMENT GROUP (2008)
European Journal of Cancer Care 17, 245–252
Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
2. Mammographic screening is offered to many women under 50 in
the UK who are at moderate or high risk of
developing breast cancer because of their family history of the
disease. Little is understood about the impact
of screening on the emotional well-being of women with a
family history of breast cancer. This qualitative
study explores the value that women at increased risk placed on
screening, both pre- and post-cancer diagnosis
and the impact of the diagnosis. In-depth interviews were
undertaken with 12 women, aged 35–50, diagnosed
with breast cancer while on an annual mammographic screening
programme. Women described the strong
sense of reassurance gained from screening prior to diagnosis.
This faith in screening was reinforced by early
detection of their cancer. Reactions to diagnosis ranged from
devastation to relief at having finally developed
a long-expected condition. Despite their positive attitudes about
screening, not all women wanted to continue
with surveillance. For some, prophylactic mastectomy was
preferable, to reduce future cancer risk and to
alleviate anxieties about the detection of another cancer at each
subsequent screen. This study illustrates the
positive yet diverse attitudes towards mammographic screening
in this group of women with a family history
of breast cancer.
Keywords: breast cancer, early screening programme, family
history, qualitative.
Correspondence address: Alison Clements, Cancer Research UK
Primary Care Education Research Group, University of Oxford,
Department of Primary
Health Care, Rosemary Rue Building, Old Road Campus, Old
Road, Headington, Oxford, OX3 7LF, UK (e-mail:
[email protected]).
4. method recommended for women from the age of 40
whose family history places them at a lifetime risk of
developing breast cancer of 1:6 or greater (NICE 2004).
Surveillance from the age of 35 can be carried out as part
of a research programme.
Mammographic screening aims to detect tumours at an
early stage when the prognosis is enhanced. While the
potential clinical benefits of screening younger women at
increased risk have not been established, evidence is
emerging to suggest that screening younger women with a
family history leads to increased survival (Maurice et al.
2006), and preliminary retrospective data suggest it is pos-
sible to identify impalpable breast cancer with regular
mammography (Gui et al. 2006). Strong evidence of effec-
tiveness in reducing mortality is important to establish if
a national programme of early screening for all women at
increased risk is to be introduced. The findings from a
large prospective study evaluating the potential clinical
benefits of mammographic surveillance in women aged
40–49 with a family history of breast cancer are expected
in 2010 (The FH01 Management Committee, Steering
Committee and Collaborators 2006).
It is equally important to understand the psychological
impact of mammographic surveillance for women with a
family history of breast cancer, particularly as a number of
studies have reported increased levels of breast cancer
worry and anxiety in this group of women (Lloyd et al.
1996; Zakowski et al. 1997; McCaul et al. 1998). The
majority of women who attend screening receive an initial
all-clear/normal screening result, and a small proportion
will be recalled for further tests prior to their all-clear
result. To date, research has focused on comparing the
psychological impact of screening on women in these two
screening result groups (Watson et al. 2004, 2005). The
5. focus of the present paper, however, is on women who
received a screen-detected cancer diagnosis while on a
screening programme. It is estimated that of those with a
family history who are screened every year, four women
per thousand will receive a diagnosis of breast cancer (The
FH01 Management Committee, Steering Committee and
Collaborators 2006). To our knowledge, no studies have
looked at how women react to a diagnosis of breast cancer
while on a surveillance programme because of their family
history, or how they feel about the breast screening pro-
gramme that has detected their breast cancer. This paper
presents the first qualitative data on the emotional impact
of being diagnosed with breast cancer while on a screening
programme in the UK.
P A R T I C I P A N T S A N D M E T H O D S
A qualitative study was undertaken involving interviews
with 12 women aged 35–50, diagnosed with screen-
detected breast cancer while on a mammographic surveil-
lance programme. Participants were identified from two
sources: (1) a sample of 2321 women, at moderate or high
risk of developing a familial breast cancer, who had been
recruited by 21 centres in the UK to participate in a ques-
tionnaire survey (12 women) (Henderson et al. 2007); (2)
two of the clinics identified women outside the survey
who fulfilled the eligibility criteria (7 women). All women
were approached with the consent of their clinical team.
Six women were interviewed from each of the sources.
Reasons for non-participation were (1) non-response from
the women (four women) or (2) clinicians not agreeing to
the women being contacted (three women). See Table 1 for
biographies of the participating women.
Data were collected using in-depth, semi-structured
7. fied both across interviews and within each interview.
The coding framework, categories and themes were dis-
cussed between the three analysts to ensure the credibility
and trustworthiness of the interpretation and analysis
(Mays & Pope 1995). A qualitative software package
(ATLAS-ti 2007) was used to help in the management of
the data, in particular in the comparison of issues and
experiences between participants.
F I N D I N G S
The findings we describe below relate to the women’s
reactions to participating in an enhanced breast screening
programme, and the emotional impact of their cancer
diagnosis. The themes presented occurred across the range
of participants and the quotations represent the full range
of the responses given. The bracketed number is the iden-
tifier from Table 1.
Reasons for being on the early screening programme
The reason given by most women for wanting to be on the
programme of regular mammography related to early diag-
nosis: the sooner a cancer is detected, the greater they
perceived the chance of survival to be.
. . . that’s the crucial time to catch it isn’t it, is in the
early stages, which is what I was very keen on, think-
ing well you know if I’m going to get it I want to know
as soon as it’s there . . . I was highly unlikely to be
able to detect it myself, so I wanted someone else or
some other method of being able to detect it, which
was the mammograms. [2]
As can be seen from the previous quote, related to early
8. detection was the greater faith most women had in mam-
mograms and clinical breast examinations than in self-
examination. With the exception of one woman, there was
Table 1. Biographies of women diagnosed with breast cancer at
an annual mammographic screen
Participant
Age at
diagnosis Risk*
Time between
interview and
diagnosis Treatment
Type of cancer as
described by
the women
Number of
previous screens
1 46 High 8 months Lumpectomy
Radiotherapy
‘Small – caught early
second lumpectomy to
remove precancerous
cells’
None
2 37 High 17 months Mastectomy
Chemotherapy
Waiting for PM
9. ‘Very small – no lymph
nodes, not palpable’
2
3 45 Moderate 5 months Mastectomy
Receiving chemotherapy
Waiting for PM
‘Grade 3 aggressive
cancer, many lymph
nodes involved’
11
4 40 High 8 months Lumpectomy
Radiotherapy
‘Area of precancerous
cells, no lymph nodes’
5
5 48 High 4 months Lumpectomy
Radiotherapy
‘Very small – no lymph
nodes’
3
6 43 High 10 months PM
Chemotherapy
Waiting for
reconstruction
10. ‘Aggressive’ 4
7 46 Moderate 12 months Lumpectomy
Radiotherapy and
chemotherapy
Waiting for PO
‘Small grade 3 –
aggressive’
4
8 47 High 5 months Receiving radiotherapy ‘Very small – no
lymph
nodes’
8
9 47 High 49 months Lumpectomy
Radiotherapy
‘Very small – no lymph
nodes’
None
10 40 High 37 months Mastectomy ‘Very mild’ None
11 37 High 27 months PM
Reconstruction
‘Preinvasive cancer’ (both
breasts)
12. checking regularly? No because it just made me feel
sick doing it. In case there was . . . and I know it’s
stupid, but in case there was anything there. [3]
What early screening gave the women – feelings before
the cancer diagnosis
The value that the women placed on being in the early
screening programme was striking. There was variety in
the understanding that women had about the effectiveness
of screening – some women felt that if a cancer was there,
it would be detected; others knew that not all cancers could
be picked up and that screening for women under 50 years
old was generally less effective than for older women.
There was, however, no difference in the reassurance
described by the women in terms of the reassurance that
screening offered. ‘Relief’, ‘peace of mind’, ‘safety net’ were
very common descriptions of the women’s feelings about
what screening meant to them. One woman reflects this in
her description that mammography gave her:
. . . the confidence and reassurance that I could just
forget about it (fear of developing breast cancer) now
until the following year. [6]
The security offered by mammography was also described
in the following way:
I don’t think the mammography so much was the
anxiety, it was the fact that you sit down in front of
the doctor and who goes through your genetic tree and
says your risk is, and that’s the frightening bit. and
the mammography was the safety aspect to it. [3]
For one woman, having regular and early screening took
away the worry of developing cancer. She felt that if
13. cancer was detected, the outcome would be far more posi-
tive than it had been for her relative.
We always thought if any of us had breast cancer,
because we were part of the screening programme, we
would never be in the same situation that our sister
was in, we were never going to be that bad. She was
one side and we were the other. I: In terms of the
potential outcome, do you mean? Yes, the severity
of the disease would be nothing like my sister had.
It was very aggressive. It was a very aggressive
cancer . . . I: Do you know what it was that made you
feel it would be very different for you . . . ‘Early
detection. If you’re having them every year they
would be detected at a much earlier stage’. [12]
Reaction to diagnosis
There was a marked difference in women’s reactions to
their cancer diagnosis. For several women, the diagnosis
brought with it a sense of relief. A relief that finally the
cancer had been diagnosed. As the following two quotes
show, this reaction can be understood in the context of
having for years lived with the fear of developing breast
cancer.
. . . it was like an expected, something we were
expecting, so once it had turned up it was like okay
we can deal with it now, whereas like before we were
thinking oh when’s it going to be and you know is it
going to turn up, isn’t it going to turn up, and you’re
almost living – not living on the edge but . . . you have
that, so it probably sounds really weird doesn’t it,
saying it was almost like a relief . . . [2]
15. . . . no, I certainly wouldn’t have liked to have
thought right I want to have it just so that then I can
move on. No, not at all . . . when you were younger
and . . . more at risk? No. No. My anxieties were
please don’t let me get it, not right just give it to me
and I can move on. No not at all. Yeah. You’re not
shock, shocked when you get the phone call, because
you know you’re at risk, but you are instead shocked
that well this is it, it’s happened now . . . [3]
Feelings about mammography after the detection
of cancer
Perhaps not surprisingly, all the women were overwhelm-
ingly positive in their attitudes to having had a mammo-
gram. Their diagnosis had come early enough for
treatment to be beneficial. This was most noticeable for
women whose cancers could not be felt even when seen
on the mammogram, although women whose cancers
were at a more advanced stage still felt mammography had
given them the opportunity for curative treatment.
I: How do you feel about accepting the offer that they
made of being on the screening programme? Elated!
(laughs) Because as I say the way I look at it, if I hadn’t
been on that screening I’d be dead, because it being a
grade three, I wouldn’t have found that lump possibly
for a couple of years, by which time it would be too
late for treatment basically because by that time, with
it being a grade three, it would have gone through my
body and it would have been elsewhere and that
would have been a horrible prognosis I think, defi-
nitely. So I’m eternally grateful for being on it. [7]
Anticipated reactions to future screening
16. Despite the overwhelmingly positive reaction to mam-
mography, there were differences between the women’s
reactions to the ongoing management of their cancer risk.
Not all women wanted to continue with surveillance by
yearly mammography. Some described wanting to rid
themselves of the anxiety that they felt regular screening
would provoke, and in preference selected bilateral mas-
tectomy as their treatment of choice.
I don’t want to have any more screening done,
because you’re looking for something again aren’t
you, you know. So if I’ve had my breasts removed
there’s nothing left for anybody to screen . . . I just
want to get rid of the anxiety now, of having to go
back for regular . . . it was like a reassurance before,
whereas like now I’m thinking I don’t want you to
look, just remove whatever you need to remove . . . [2]
. . . if I hadn’t have had my other breast off, I think I
would have had fear then, every time I had a mam-
mogram I would have been more fearful . . . So I had
bilateral mastectomy which, I had no difficulty
making that decision at all. I just didn’t want to live
under the cloud every year of having mammograms
on the other breast. [12]
Another woman who no longer wanted to continue
with screening also selected bilateral mastectomy as
her treatment of choice, as she wanted a minimal
chance of the cancer returning. Her mother had
experienced two recurrences following her initial
breast cancer, and she herself had suffered a very
powerful emotional reaction to her chemotherapy
regime. [6]
17. Those who felt that they would carry on with screening
described an anticipation of feeling more anxious at the
time of the next mammogram, fearful that a second diag-
nosis might be made. Despite this, the first diagnosis was
translated into a positive reason to maintain screening. If
a further cancer did develop, the women had faith that it
would again be detected by mammography.
I think if I got called up again, and they found another
one I’d be fed-up obviously, you know if they said
“Sorry Mrs xxx we’ve found another one in here”, I’d
just say ‘Right well take it out.’ You know what else
can you do? [5]
Women had not always anticipated their reactions to
future management. One woman, who had felt a strong
sense of relief at the point of diagnosis, had initially
decided to undergo bilateral mastectomy. This was based
on her feeling ‘. . . how much of my life do I want to spend
thinking I’m going to get cancer?’. She subsequently
changed her mind about treatment and decided to con-
tinue with screening, having become aware that her
worries about dealing with cancer were now less than they
had been prior to her diagnosis.
I hope I’m right in thinking this, but in another year
or two if they tell me they’ve found something else I
do feel as though I’ll probably be a lot more sort of oh
okay, right what happens next? I think I’ll deal with it
better than I thought I would in the first place you
know. As I say I’ve dealt with it all right actually this
time . . . much better than I thought I would . . . [8]
D I S C U S S I O N
This study has highlighted both commonalities and diver-
19. mammography in the general population (Nekhlyudov
et al. 2003). In both this and our study, all women had
positive attitudes towards screening mammography; the
perceived risks of mammograms were seen to be minimal,
and the women’s feelings did not reflect the current con-
troversy about the value of screening in women under 50
(Moss 2004).
While repeated regular self-examination is not currently
advocated, breast awareness involves being responsive to
potential changes, which may be seen or felt (‘Be Breast
Aware’ leaflet 2006). A number of women in our study
voiced concerns about examining their own breasts, a
finding which has also been reported in other qualitative
studies (Salazar & Carter 1994; Persson et al. 1997). Some
questioned how reliable self-examination is as a means of
detecting breast symptoms, and also described being
inhibited from touching their breasts through fear of
detecting a symptom. It may be that these apprehensions
increased the trust placed in early screening. This finding
is slightly at odds with a study of adherence to self-
examination in women with a family history of breast
cancer (Brain et al. 1999) in which an association between
increased general anxiety and cancer worries, and hyper-
vigilant self-examination was seen. It may be beneficial
for women to have detailed discussions with their care
teams to ensure that any concerns they have are under-
stood, and where possible barriers to maintaining breast
awareness are diminished.
One of the unexpected findings from this study was the
positive reaction by some women to their cancer diagnosis,
describing feelings of relief, while other women seemed
accepting of their situation, and only one woman described
the emotional devastation the cancer diagnosis had
brought to her. One suggestion for these findings is the
20. reduction of uncertainty in the threatening situation of
being at risk of developing breast cancer. Individuals vary
in their need for certainty (Frenkel-Brunswick 1949;
Kruglanski 1989), and this has been shown to be related to
motivations to undergo genetic testing (Croyle et al. 1995;
Henderson et al. 2006). It could be that the women who
describe feeling relieved at their diagnosis prefer the cer-
tainty of the situation compared to the ambiguous one of
being at risk. A further potential explanation is that the
years during which the women have been at risk have
enabled them to prepare psychologically for their diagnosis
of breast cancer. The diagnosis is therefore not as shocking
or devastating as it may be for women without a family
history because their expectations have been confirmed.
The highly positive views that women held of mam-
mography after their diagnosis of cancer are comparable to
those of other women diagnosed with screen-detected
cancers (Farmer 2000; Miles et al. 2003), who seem to
have lower levels of psychological morbidity compared
with women with symptomatically detected cancer.
Farmer demonstrated that women with screen-detected
breast cancer received more reassurance by doctors that
their cancer had been caught at an early stage, which in
turn led to a minimization of the significance of screen-
detected cancer.
While all women described their full appreciation of the
screening programme, prior to and following the detection
of their cancer, not all wanted to continue with annual
mammography, with some preferring bilateral mastec-
tomy as their management choice. It is possible that the
surveillance and care offered by the programme conferred a
high level of psychological protection as long as no cancer
was detected. For some women, once the diagnosis was
made, and regardless of their reaction to it, surveillance
22. stage. It may be useful in future work to attempt to deter-
mine specific reasons for non-participation, to estimate
how far the findings from this study can be translated to
other women in the same situation.
Several clinical implications arise from this study. Not
all women diagnosed with breast cancer while on a family
history screening programme will have a pronounced
negative reaction to their diagnosis; indeed a number may
feel relieved that they have finally developed the condi-
tion that has been long expected. The period while they
are under threat of developing the condition may be a time
of psychological preparation for the women, which helps
them adjust more readily to their diagnosis. We have also
identified that women may select bilateral mastectomy as
their treatment of choice, although clinically, their cancer
may warrant a less radical approach. Surgeons need to be
aware that women may have a need to reduce, as far as is
possible, the risk of a future cancer, or alleviate totally the
fears associated with future screening. Although women
place significant emphasis on the early detection of
cancer, self-examination, as part of maintaining breast
awareness between annual mammograms, is often not
practised. It may help to identify women who may be
averse to self-examination, to see if the reasons for avoid-
ance can be overcome. We have shown that being diag-
nosed with cancer for the women in this study has not
been solely a negative experience. It may therefore benefit
asymptomatic women, who are particularly distressed
about their likelihood of developing breast cancer, to be
involved in a mentoring system with those who have
experienced the process of diagnosis and treatment in
order to improve their perceptions of their ability to cope
with a potential diagnosis of cancer.
Extending this work with a larger number of women
23. could enable an exploration for patterns within psycho-
logical reactions to screening and diagnosis, and pragmatic
reactions to risk management. Future work also needs to
explore the experiences of women who have put their
faith in a screening programme but whose cancers have
not been detected by an annual mammogram, or whose
cancers are at a much more advanced stage at the point of
diagnosis.
A C K N O W L E D G E M E N T S
We would like to thank those at the following centres who
helped in the recruitment of patients to this study: Breast
Test Wales – North, South East and South West Wales;
Royal Cornwall Hospital; Withington Hospital, Manches-
ter; Nottingham City Hospital and in particular Dinah
Winstone and Sue Thomas who facilitated this process.
We are indebted to the women who gave their time and
shared their experiences.
This work was supported by Cancer Research UK, grant
number C73/A2916.
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One strong direction will be to bring in an outside and
contemporary artwork or works that would make a great
comparative study and help to progress your narrative and
connections between the past and the present.
Or, you could further discuss the elements and principles of art
focusing on a particular element or principle.
Or, possibly talk about the iconography more extensively.
Deliverables:
· 2 Page commentary focused on one work of art in proper MLA
forma by February 18.
My chosen artwork is The Louvre Museum in comparison to
pyramids, particularly to the Great Pyramid of Giza.
Research Evaluation Checklist
Complete the checklist below for the study/article you are to
evaluate.
Define topic and need.
· What phenomenon does the study investigate?
29. · Is the phenomenon a problem, an opportunity, or a dilemma?
· What symptoms (easily observable signs) indicate that it is a
problem, opportunity or a dilemma?
· How do people who know this organization explain these
symptoms? What do administrators want to know about the
phenomenon?
· How can it be expressed in manageable terms?
Assess relevant knowledge.
· How much is already known?
· Is additional background information necessary? Should this
research be conducted?
· Is the topic a special case of a broader, more fundamental and
important problem?
Identify variables and measures, and research questions and
hypotheses.
· What variables associated with the phenomenon are
investigated? How are the variables measured?
· What are the research questions?
· What specific hypotheses are formulated?
Identify and analyze the research design.
· What is the research design—exploratory, descriptive, or
causal research? Is this non-experimental, quasi-experimental,
or experimental research? What is the nature of data—primary
30. or secondary?
· What is the source of data—interviews, questionnaires,
existing databases? Are answers obtained through interviews
and questionnaires objective?
Analyze the sample.
· What is the population from which the respondents have been
selected? How large is the sample?
· Is it random, stratified, or other sample?
Gather data.
· How are data gathered?
· Does the procedure of gathering data ensure objectivity?
Analyze data.
· Are the data words (qualitative data) or numbers
(quantitative)? How are qualitative data analyzed?
· How are quantitative data recorded and checked for accuracy?
What statistical methods are used to analyze data?
Assess results.
· What are the answers to research questions? Are hypotheses
supported?
· What evidence did the study produce that helps answer
research questions or support/refute hypotheses?
Evaluate recommendations.
31. What recommendations can be made on the basis of results?
What recommendations are made that cannot be supported with
results?
Evaluate the study.
· What limitations does the study have?
· What improvements in research design can be recommended?
Page 1 of 3
Research Methods in Health Administration
Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
A. CLEMENTS, bsc, senior research nurse, Cancer Research
UK Primary Care Education Research Group,
University of Oxford, Department of Primary Health Care,
Oxford, B.J. HENDERSON, phd, research psycholo-
gist, Institute of Medical & Social Care Research, Ardudwy,
Normal Site, University of Wales, Bangor, Gwynedd,
S. TYNDEL, ba, research officer, Cancer Research UK Primary
Care Education Research Group, University of
Oxford, Department of Primary Health Care, Oxford, G.
EVANS, md frcp, consultant in medical genetics,
Department of Clinical Genetics, St Mary’s Hospital,
Manchester, K. BRAIN, phd, senior research fellow,
32. Institute of Medical Genetics, University of Wales College of
Medicine, Heath Park, Cardiff, J. AUSTOKER, phd,
director, Cancer Research UK Primary Care Education Research
Group, University of Oxford, Department of
Primary Health Care, Oxford, & E. WATSON, phd, deputy
director, Cancer Research UK Primary Care Educa-
tion Research Group, University of Oxford, Department of
Primary Health Care, Oxford, UK for the PIMMS Study
Management Group*
CLEMENTS A., HENDERSON B.J., TYNDEL S., EVANS G.,
BRAIN K., AUSTOKER J. & WATSON E. FOR
THE PIMMS STUDY MANAGEMENT GROUP (2008)
European Journal of Cancer Care 17, 245–252
Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
Mammographic screening is offered to many women under 50 in
the UK who are at moderate or high risk of
developing breast cancer because of their family history of the
disease. Little is understood about the impact
of screening on the emotional well-being of women with a
family history of breast cancer. This qualitative
study explores the value that women at increased risk placed on
screening, both pre- and post-cancer diagnosis
and the impact of the diagnosis. In-depth interviews were
undertaken with 12 women, aged 35–50, diagnosed
with breast cancer while on an annual mammographic screening
programme. Women described the strong
sense of reassurance gained from screening prior to diagnosis.
This faith in screening was reinforced by early
detection of their cancer. Reactions to diagnosis ranged from
devastation to relief at having finally developed
a long-expected condition. Despite their positive attitudes about
screening, not all women wanted to continue
with surveillance. For some, prophylactic mastectomy was
33. preferable, to reduce future cancer risk and to
alleviate anxieties about the detection of another cancer at each
subsequent screen. This study illustrates the
positive yet diverse attitudes towards mammographic screening
in this group of women with a family history
of breast cancer.
Keywords: breast cancer, early screening programme, family
history, qualitative.
Correspondence address: Alison Clements, Cancer Research UK
Primary Care Education Research Group, University of Oxford,
Department of Primary
Health Care, Rosemary Rue Building, Old Road Campus, Old
Road, Headington, Oxford, OX3 7LF, UK (e-mail:
[email protected]).
Ethical approval: London Multi-Centre Research Ethics
Committee (MREC) 02/2/97.
*Other members of the A Psychosocial Evaluation of the Impact
of Mammographic Surveillance Services on Women under 50 at
moderate or high risk of
inherited breast cancer (PIMMS) Study Management Group:
Stephen Duffy, Cancer Research UK Department of Statistics,
London; Hilary Fielder, Screening
Services, Velindre National Health Service (NHS) Trust;
Jonathon Gray, Institute of Medical Genetics, University
Hospital of Wales; Douglas Macmillan,
Professorial Unit of Surgery, University of Nottingham; James
MacKay, North East Thames Regional Genetics Service.
Accepted 19 June 2007
DOI: 10.1111/j.1365-2354.2007.00837.x
European Journal of Cancer Care, 2008, 17, 245–252
35. benefits of mammographic surveillance in women aged
40–49 with a family history of breast cancer are expected
in 2010 (The FH01 Management Committee, Steering
Committee and Collaborators 2006).
It is equally important to understand the psychological
impact of mammographic surveillance for women with a
family history of breast cancer, particularly as a number of
studies have reported increased levels of breast cancer
worry and anxiety in this group of women (Lloyd et al.
1996; Zakowski et al. 1997; McCaul et al. 1998). The
majority of women who attend screening receive an initial
all-clear/normal screening result, and a small proportion
will be recalled for further tests prior to their all-clear
result. To date, research has focused on comparing the
psychological impact of screening on women in these two
screening result groups (Watson et al. 2004, 2005). The
focus of the present paper, however, is on women who
received a screen-detected cancer diagnosis while on a
screening programme. It is estimated that of those with a
family history who are screened every year, four women
per thousand will receive a diagnosis of breast cancer (The
FH01 Management Committee, Steering Committee and
Collaborators 2006). To our knowledge, no studies have
looked at how women react to a diagnosis of breast cancer
while on a surveillance programme because of their family
history, or how they feel about the breast screening pro-
gramme that has detected their breast cancer. This paper
presents the first qualitative data on the emotional impact
of being diagnosed with breast cancer while on a screening
programme in the UK.
P A R T I C I P A N T S A N D M E T H O D S
A qualitative study was undertaken involving interviews
36. with 12 women aged 35–50, diagnosed with screen-
detected breast cancer while on a mammographic surveil-
lance programme. Participants were identified from two
sources: (1) a sample of 2321 women, at moderate or high
risk of developing a familial breast cancer, who had been
recruited by 21 centres in the UK to participate in a ques-
tionnaire survey (12 women) (Henderson et al. 2007); (2)
two of the clinics identified women outside the survey
who fulfilled the eligibility criteria (7 women). All women
were approached with the consent of their clinical team.
Six women were interviewed from each of the sources.
Reasons for non-participation were (1) non-response from
the women (four women) or (2) clinicians not agreeing to
the women being contacted (three women). See Table 1 for
biographies of the participating women.
Data were collected using in-depth, semi-structured
interviews. Interviews were carried out by AC; all women
chose to be interviewed in their own homes, and inter-
views lasted between 90 and 150 min. A flexible topic
guide was used to allow exploration of issues introduced
by the participants and incorporation of additional issues
that arose from the data analysis. The broad topic areas
included experiences of breast cancer within the family,
feelings of likelihood of developing breast cancer, own
screening and cancer diagnosis experiences, views of
mammography, of overall participation in the programme
and future management of cancer risk. Each interview was
audiotaped, transcribed verbatim by a specialist transcrip-
tion service, checked for accuracy and anonymized.
Analysis was undertaken by AC, BH and ST using the
framework approach (Ritchie & Spencer 1993). Analysis
began as soon as the first interview had been undertaken,
and continued concurrently with the data collection to
allow emerging findings to be included in subsequent
38. Reasons for being on the early screening programme
The reason given by most women for wanting to be on the
programme of regular mammography related to early diag-
nosis: the sooner a cancer is detected, the greater they
perceived the chance of survival to be.
. . . that’s the crucial time to catch it isn’t it, is in the
early stages, which is what I was very keen on, think-
ing well you know if I’m going to get it I want to know
as soon as it’s there . . . I was highly unlikely to be
able to detect it myself, so I wanted someone else or
some other method of being able to detect it, which
was the mammograms. [2]
As can be seen from the previous quote, related to early
detection was the greater faith most women had in mam-
mograms and clinical breast examinations than in self-
examination. With the exception of one woman, there was
Table 1. Biographies of women diagnosed with breast cancer at
an annual mammographic screen
Participant
Age at
diagnosis Risk*
Time between
interview and
diagnosis Treatment
Type of cancer as
described by
the women
39. Number of
previous screens
1 46 High 8 months Lumpectomy
Radiotherapy
‘Small – caught early
second lumpectomy to
remove precancerous
cells’
None
2 37 High 17 months Mastectomy
Chemotherapy
Waiting for PM
‘Very small – no lymph
nodes, not palpable’
2
3 45 Moderate 5 months Mastectomy
Receiving chemotherapy
Waiting for PM
‘Grade 3 aggressive
cancer, many lymph
nodes involved’
11
4 40 High 8 months Lumpectomy
Radiotherapy
‘Area of precancerous
40. cells, no lymph nodes’
5
5 48 High 4 months Lumpectomy
Radiotherapy
‘Very small – no lymph
nodes’
3
6 43 High 10 months PM
Chemotherapy
Waiting for
reconstruction
‘Aggressive’ 4
7 46 Moderate 12 months Lumpectomy
Radiotherapy and
chemotherapy
Waiting for PO
‘Small grade 3 –
aggressive’
4
8 47 High 5 months Receiving radiotherapy ‘Very small – no
lymph
nodes’
8
41. 9 47 High 49 months Lumpectomy
Radiotherapy
‘Very small – no lymph
nodes’
None
10 40 High 37 months Mastectomy ‘Very mild’ None
11 37 High 27 months PM
Reconstruction
‘Preinvasive cancer’ (both
breasts)
20
12 50 Moderate 30 months PM
Chemotherapy
Reconstruction
‘Very small – early stage
1 lymph node
involved’
8
*Family history risk as provided by the screening clinic.
PM, prophylactic bilateral mastectomy; PO, prophylactic
oophorectomy.
Familial breast cancer diagnosis at an annual mammographic
screen
43. her description that mammography gave her:
. . . the confidence and reassurance that I could just
forget about it (fear of developing breast cancer) now
until the following year. [6]
The security offered by mammography was also described
in the following way:
I don’t think the mammography so much was the
anxiety, it was the fact that you sit down in front of
the doctor and who goes through your genetic tree and
says your risk is, and that’s the frightening bit. and
the mammography was the safety aspect to it. [3]
For one woman, having regular and early screening took
away the worry of developing cancer. She felt that if
cancer was detected, the outcome would be far more posi-
tive than it had been for her relative.
We always thought if any of us had breast cancer,
because we were part of the screening programme, we
would never be in the same situation that our sister
was in, we were never going to be that bad. She was
one side and we were the other. I: In terms of the
potential outcome, do you mean? Yes, the severity
of the disease would be nothing like my sister had.
It was very aggressive. It was a very aggressive
cancer . . . I: Do you know what it was that made you
feel it would be very different for you . . . ‘Early
detection. If you’re having them every year they
would be detected at a much earlier stage’. [12]
Reaction to diagnosis
44. There was a marked difference in women’s reactions to
their cancer diagnosis. For several women, the diagnosis
brought with it a sense of relief. A relief that finally the
cancer had been diagnosed. As the following two quotes
show, this reaction can be understood in the context of
having for years lived with the fear of developing breast
cancer.
. . . it was like an expected, something we were
expecting, so once it had turned up it was like okay
we can deal with it now, whereas like before we were
thinking oh when’s it going to be and you know is it
going to turn up, isn’t it going to turn up, and you’re
almost living – not living on the edge but . . . you have
that, so it probably sounds really weird doesn’t it,
saying it was almost like a relief . . . [2]
Initially it was quite a shock. I felt quite shocked by it.
and I have to say, it was a really strange feeling, and it
probably sounds horrible, but I was almost relieved
when I was diagnosed. Because I thought this dark
cloud, that I’ve always been waiting for, is finally here.
I don’t have to wait for it any longer. I can deal with it
now and get it over and done with. I know it sounds
really strange but there was almost a feeling of relief. I
mean obviously initially not, I was shocked. [11]
For some, there was nothing positive about the diagnosis.
One woman described herself as being absolutely devas-
tated when she developed breast cancer; for her, the diag-
nosis was completely traumatic. Having been told she had
a one-in-four chance of developing breast cancer, she had
interpreted this as:
. . . my stakes were pretty high really on not getting it,
and it never really affected my life . . . I managed to
46. on the mammogram, although women whose cancers
were at a more advanced stage still felt mammography had
given them the opportunity for curative treatment.
I: How do you feel about accepting the offer that they
made of being on the screening programme? Elated!
(laughs) Because as I say the way I look at it, if I hadn’t
been on that screening I’d be dead, because it being a
grade three, I wouldn’t have found that lump possibly
for a couple of years, by which time it would be too
late for treatment basically because by that time, with
it being a grade three, it would have gone through my
body and it would have been elsewhere and that
would have been a horrible prognosis I think, defi-
nitely. So I’m eternally grateful for being on it. [7]
Anticipated reactions to future screening
Despite the overwhelmingly positive reaction to mam-
mography, there were differences between the women’s
reactions to the ongoing management of their cancer risk.
Not all women wanted to continue with surveillance by
yearly mammography. Some described wanting to rid
themselves of the anxiety that they felt regular screening
would provoke, and in preference selected bilateral mas-
tectomy as their treatment of choice.
I don’t want to have any more screening done,
because you’re looking for something again aren’t
you, you know. So if I’ve had my breasts removed
there’s nothing left for anybody to screen . . . I just
want to get rid of the anxiety now, of having to go
back for regular . . . it was like a reassurance before,
whereas like now I’m thinking I don’t want you to
look, just remove whatever you need to remove . . . [2]
47. . . . if I hadn’t have had my other breast off, I think I
would have had fear then, every time I had a mam-
mogram I would have been more fearful . . . So I had
bilateral mastectomy which, I had no difficulty
making that decision at all. I just didn’t want to live
under the cloud every year of having mammograms
on the other breast. [12]
Another woman who no longer wanted to continue
with screening also selected bilateral mastectomy as
her treatment of choice, as she wanted a minimal
chance of the cancer returning. Her mother had
experienced two recurrences following her initial
breast cancer, and she herself had suffered a very
powerful emotional reaction to her chemotherapy
regime. [6]
Those who felt that they would carry on with screening
described an anticipation of feeling more anxious at the
time of the next mammogram, fearful that a second diag-
nosis might be made. Despite this, the first diagnosis was
translated into a positive reason to maintain screening. If
a further cancer did develop, the women had faith that it
would again be detected by mammography.
I think if I got called up again, and they found another
one I’d be fed-up obviously, you know if they said
“Sorry Mrs xxx we’ve found another one in here”, I’d
just say ‘Right well take it out.’ You know what else
can you do? [5]
Women had not always anticipated their reactions to
future management. One woman, who had felt a strong
sense of relief at the point of diagnosis, had initially
decided to undergo bilateral mastectomy. This was based
on her feeling ‘. . . how much of my life do I want to spend
49. was over, to intense shock. Despite the positive attitudes
towards mammography, both pre- and post-diagnosis, not
all women wanted to continue mammographic screening,
preferring bilateral mastectomy both to reduce risk and to
alleviate continuing concerns.
When asked to reflect back on their feelings about the
screening programme before their diagnosis of breast
cancer, most women described the security afforded by
the screening programme and their belief that any cancers
would be detected at an early stage. While some women
highlighted issues to do with effectiveness of screening for
younger women, this seemed not to influence the relief
they obtained from receiving an all-clear result. The faith
in mammography held by women has been highlighted in
another qualitative study exploring beliefs and expecta-
tions of women under 50 years old regarding screening
mammography in the general population (Nekhlyudov
et al. 2003). In both this and our study, all women had
positive attitudes towards screening mammography; the
perceived risks of mammograms were seen to be minimal,
and the women’s feelings did not reflect the current con-
troversy about the value of screening in women under 50
(Moss 2004).
While repeated regular self-examination is not currently
advocated, breast awareness involves being responsive to
potential changes, which may be seen or felt (‘Be Breast
Aware’ leaflet 2006). A number of women in our study
voiced concerns about examining their own breasts, a
finding which has also been reported in other qualitative
studies (Salazar & Carter 1994; Persson et al. 1997). Some
questioned how reliable self-examination is as a means of
detecting breast symptoms, and also described being
inhibited from touching their breasts through fear of
detecting a symptom. It may be that these apprehensions
50. increased the trust placed in early screening. This finding
is slightly at odds with a study of adherence to self-
examination in women with a family history of breast
cancer (Brain et al. 1999) in which an association between
increased general anxiety and cancer worries, and hyper-
vigilant self-examination was seen. It may be beneficial
for women to have detailed discussions with their care
teams to ensure that any concerns they have are under-
stood, and where possible barriers to maintaining breast
awareness are diminished.
One of the unexpected findings from this study was the
positive reaction by some women to their cancer diagnosis,
describing feelings of relief, while other women seemed
accepting of their situation, and only one woman described
the emotional devastation the cancer diagnosis had
brought to her. One suggestion for these findings is the
reduction of uncertainty in the threatening situation of
being at risk of developing breast cancer. Individuals vary
in their need for certainty (Frenkel-Brunswick 1949;
Kruglanski 1989), and this has been shown to be related to
motivations to undergo genetic testing (Croyle et al. 1995;
Henderson et al. 2006). It could be that the women who
describe feeling relieved at their diagnosis prefer the cer-
tainty of the situation compared to the ambiguous one of
being at risk. A further potential explanation is that the
years during which the women have been at risk have
enabled them to prepare psychologically for their diagnosis
of breast cancer. The diagnosis is therefore not as shocking
or devastating as it may be for women without a family
history because their expectations have been confirmed.
The highly positive views that women held of mam-
mography after their diagnosis of cancer are comparable to
those of other women diagnosed with screen-detected
cancers (Farmer 2000; Miles et al. 2003), who seem to
52. The value of qualitative research lies in the depth of
understanding gained from detailed descriptions of spe-
cific experiences. For this reason, the number of partici-
pants in a qualitative study is necessarily small. Although
it was the restricted number of women available to us,
rather than data saturation that determined our sample
size, the views of the 12 women included in this study are
a valuable addition to the scarcity of literature regarding
women who are diagnosed with breast cancer while on a
family history screening programme. One limitation to
the study is that the views of the women who declined, or
were not approached to participate, may have added even
more to our understanding, particularly as they may have
been more adversely affected by their diagnosis and their
cancers may have been diagnosed at a more advanced
stage. It may be useful in future work to attempt to deter-
mine specific reasons for non-participation, to estimate
how far the findings from this study can be translated to
other women in the same situation.
Several clinical implications arise from this study. Not
all women diagnosed with breast cancer while on a family
history screening programme will have a pronounced
negative reaction to their diagnosis; indeed a number may
feel relieved that they have finally developed the condi-
tion that has been long expected. The period while they
are under threat of developing the condition may be a time
of psychological preparation for the women, which helps
them adjust more readily to their diagnosis. We have also
identified that women may select bilateral mastectomy as
their treatment of choice, although clinically, their cancer
may warrant a less radical approach. Surgeons need to be
aware that women may have a need to reduce, as far as is
possible, the risk of a future cancer, or alleviate totally the
53. fears associated with future screening. Although women
place significant emphasis on the early detection of
cancer, self-examination, as part of maintaining breast
awareness between annual mammograms, is often not
practised. It may help to identify women who may be
averse to self-examination, to see if the reasons for avoid-
ance can be overcome. We have shown that being diag-
nosed with cancer for the women in this study has not
been solely a negative experience. It may therefore benefit
asymptomatic women, who are particularly distressed
about their likelihood of developing breast cancer, to be
involved in a mentoring system with those who have
experienced the process of diagnosis and treatment in
order to improve their perceptions of their ability to cope
with a potential diagnosis of cancer.
Extending this work with a larger number of women
could enable an exploration for patterns within psycho-
logical reactions to screening and diagnosis, and pragmatic
reactions to risk management. Future work also needs to
explore the experiences of women who have put their
faith in a screening programme but whose cancers have
not been detected by an annual mammogram, or whose
cancers are at a much more advanced stage at the point of
diagnosis.
A C K N O W L E D G E M E N T S
We would like to thank those at the following centres who
helped in the recruitment of patients to this study: Breast
Test Wales – North, South East and South West Wales;
Royal Cornwall Hospital; Withington Hospital, Manches-
ter; Nottingham City Hospital and in particular Dinah
Winstone and Sue Thomas who facilitated this process.
We are indebted to the women who gave their time and
54. shared their experiences.
This work was supported by Cancer Research UK, grant
number C73/A2916.
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59. 3. Assignment of subjects to experimental or control groups
4. Study time period
5. Type of data to be gathered
6. Measures of meal options and of patient satisfaction
7. Method of data collection
8. Guidelines for data interpretation
After you complete building the study design, list three design
elements you considered in your study that were not readily
obvious in the one you read last week “Diagnosed with Breast
Cancer While on a Family History Screening Programme: An
Exploratory Qualitative Study.”