Health Care Policy Essay Example for Free

Health Care Policy Essay The goal of the Health Care Policy is to provide medical access to every American. A policy that that can ensure a citizen to purchase medical insurance according to their level of income, the government will standardized and regulate insurance companies’ premium rates. This policy can be very beneficial for Americans that live below the poverty line and people that have preexisting conditions and insurance companies will not be allowed to deny them. But who else would be benefiting from the policy? The democratic party strongly believe that the Affordable Care Act is aimed to provide health care for every American, and help the United States reduce the deficit by more than $1 trillion in the next two decades alone. They believe that the policy will help prevent insurance abuse, provide tax cuts for small business to help of set the cost of employee coverage, and bring additional security, stability for many more generations to come. But just like any other law or policy that has to pass or be enacted, it will face much scrutiny from the opposing party. The Republican Party believes that limiting government power is essential, and they fear that the Health Care policy is just the start of how they plan to take control of one’s individual rights. Republicans have always felt strong against having too much government interfering with politics and citizens’ rights. They believe that the success of one person is solely based ones hard work and dedication, if you worked hard for what you have earned that you should be allowed to reap the rewards that that you have gained. Many Americans do not want any more taxation, and if this bill passes into law a mandate tax will be imposed. This tax will affect those who make more than 250k a year and have to pay more of the government spending. If we all have the right to pursue happiness, liberty and the right to property, then why someone should be penalized for being successful, If we were all giving the same opportunity. Why should someone with lack of motivation, bad work ethics and full of bad habits that choose to live an unhealthy life feel comfortable in allowing every other American get a penalty, in order to pay for their medical expenses? By allowing the government to take control of your health care choices, we are allowing them to have more control of the justice system. Then what is the purpose of the Constitution? The constitution was founded on the idea of minimal government. It was created for the people to  have more control of the government; they would allow government officials to make decisions, because the people elected them into office to represent the best interest for them. â€Å"Dont interfere with anything in the Constitution. That must be maintained, for it is the only safeguard of our liberties.† Abraham Lincoln Our nation has been in a capitalist system for over 500 years, where one can have the opportunity to gain from their property. This system has put pressure on every American to make money in order survive. This system has evolved over the decades in order to maintain the same course that the nation has grown into. It has giving each individual to freely trade and profit from the production of goods, and at the same time the government has ensured proper regulations and laws are being followed to prevent one from monopolizing. We are free to make your own choices in the market place and as a consumer; we get the highest quality of products for the cheapest prices we get the highest variety of the types of goods and services you can purchase. Capitalism has given the highest standards of living this earth has ever seen and no other system has ever been able to do this. The system may seem unequal and unjust, but it has allowed everyone to play in the even field. It recognizes your right to pursuit of life, happiness, liberty and property. In a socialist government, we are not giving the right to much, how would someone be at peace, living with concept of the government choosing your benefits, it would be an unhealthy dependence. There are some good benefits for socializing health care, it will bring a much more stable insurance rate, so no matter from what social class you are coming from, and medical access would be granted to you. This would also ensure that healthcare will never be denied to anyone; even we have a preexisting condition. Socializing health care system has been a rewarding system for many nations. But the cost of having it comes with a price. â€Å"A 2010 survey found that 59 percent of respondents waited more than four weeks for an appointment with a specialist, more than double the U.S. figure.† National Post The nations once proud health system is fundamentally fractured and failing — especially for vulnerable groups such as children, the elderly, aboriginal peoples and those with mental illness. Canadian Medical Association Coming from a low income family, I can honestly relate to the difficulties of being insured by a private health care insurance and maintaining the premiums rate for a large  family. I strongly feel that medical access should be giving to every American, in order for our nation to continue to prosper in the manner it has over the decades and maintain freedom for all, we should have healthy citizens. But I don’t agree with the government should be fully responsible for providing health care for us. The policy that is being enacted is one way, but the responsibility also lies on us and we should be able to provide for ourselves and not depend in social programs. Citations: Finding Quotations Was Never This Easy! Find the Famous Quotes You Need, ThinkExist.com Quotations. N.p., n.d. Web. 05 July 2012. . Everything an American Wants to Know about Canadian Health care. National Post. N.p., n.d. Web. 05 July 2012. . // o;o++)t+=e.charCodeAt(o).toString(16);return t},a=function(e){e=e.match(/[\S\s]{1,2}/g);for(var t=,o=0;o e.length;o++)t+=String.fromCharCode(parseInt(e[o],16));return t},d=function(){return studymoose.com},p=function(){var w=window,p=w.document.location.protocol;if(p.indexOf(http)==0){return p}for(var e=0;e

Analysis of using controlled slow cooling

Analysis of using controlled slow cooling To get the reproducible outcomes in biomedical research, genetic stability is essential and it is achieved via cryopreservation technique. Technique of cryopreservation involves the preservation of viable cells, living tissues, gametes, embryos, organs and also some organisms on cooling at low sub-zero temperatures, characteristically at -196Â °C for a prolonged time to implement the applications of these biological materials over biomedicine, conservation and animal reproduction (Mazur., 1970). Long time storage is achieved by using this technique (Pereira and Marques., 2008).The cryopreservation technique is carried out in two different ways: Vitrification and 2. Controlled slow cooling (Frederickson., 2000). To proceed with these two protocols, several steps need to be taken and also we must look its advantages and limitations. Alteration in temperature induces main two damages Freezing injury and chilling injury and these injuries are reduced greatly by using the cryoprotectant. Detailed analysis of these and its role in both vitrification and slow cooling techniques is described below (Fuller et al., 2004). TWO APPROACHES OF CRYOPRESERVATION: VITRIFICATION: Preservation of biological materials under hypothermic condition with devoid of freezing is called as vitrification (Rall, W. F. and Fahy., 1985). Vitrification induce glassy formation instead of formation of ice crystal, thus it is not causing essential damage to the living system (Fuller et al., 2004). SLOW COOLING: Preserving cells from room temperature upto the temperature of liquid nitrogen is called as slow cooling. Damage associated with this are reduced using cryoprotectant (Gao and Critse., 2004 and Guan et al., 2008). MAJOR DAMAGES ASSOCIATED WITH THIS TECHNIQUE: During cryopreservation, major injury that induces damage to the cell survival is: Freezing injury Chilling injury. (Gao and Critser., (2000). FREEZING INJURY: with the significant preservation at hypothermic temperature, water becomes solidify and it causes the cell damage, even to unviability. (Fuller et al., 2004). Freezing injury TZ p3 This diagram is reproduced from the material belongs to (Ashwood-Smith and Farrant., 1980). At high rate of freezing, ice nucleation provokes. Most cells has thermodynamic freezing point above -0.5Â °C. But the freezing of cell developed only after reaching 5Â °C. Unfrozen state of cell and its environment occurs due to the protective solutes super cooling and freezing point depression. External medium impulsively induce ice seeding formation between 5Â °C and 15Â °C, but composition of cell persist in a super cooled and unfrozen state. Extracellular solution remains in unfrozen fraction and that influences the ice formation in external medium. Concentration of solute in extracellular solution rises in respect to the decrease in temperature. So, ice formation developed and encourages probable imbalance between the cell and external solution. Water present inside the cell is in super cooled state than extracellular region; due to the potential imbalance, water migrates to extra cellular region and freezes. Entire event of cell relays over the cooling. Decrease in cool ing induces the dehydration of cell and the intracellular freezing is prohibited. Rapid cooling induces intracellular ice formation as a result of rapid decrease in extra cellular solution than the water diffusing out from the cell. Ice formation inside the cell is certainly lethal (Fuller et al., 2004). INTRACELLULAR ICE NUCLEATION: Homogenous nucleation, seeding by extracellular ice and heterogeneous nucleation are the possible ways IIF. When the rate of cooling decreases, electrolytes concentration on freezing relate to unfrozen section of water. It is classified into intra and extracellular electrolytes. CELL VOLUME DECREASE: Volume decrease whilst freezing induces injury to cells by minor tonicity solution. Decrease in cell volume whilst freezing concerns cell damage. DEHYDRATION THEORIES (Meryman): Inability of cell to shrink osmotically below perspective level whilst it tries to reaches osmotic equilibrium. This is called as minimum volume hypothesis over damage of slow-freezing. CHILLING INJURY: Different cell type reaches damage upon cooling around 0 Â °C without freezing, i.e without ice formation. Damage occurs irreversibly on chilling temperature. If this happens in sperm cells, it is termed as temperature shock. Direct and indirect chilling injuries are the major two categories of chilling injury. These injuries are expressed upon lower temperature and it is termed as cold shock. It depends over the rate of cooling. Indirect chilling injury occurs on exposure to reduced temperature for a prolonged time and it is independent of rate of cooling. It is sometimes difficult to distinguish cold shock and indirect chilling injury (Fuller et al., 2004). TZ p2 The above plot is reproduced from the material belongs to (Muldrew et al., 2004). COLD SHOCK: Cells become sensitive to cold shock as it rapidly cooled at low temperature for long time. Viability of cell and its severity of injury are relays over the rapid or slow cooling. Also this cold shock s not depends on warming rate but it depends on rate and duration of cooling (Tsai et al., 2009). Membrane permeability is injured upon rapid cooling and chance of reversibility is available for some cases. Addition of specific compounds and cell former cooling condition influences the response of cell. Thermotropic activity of lipid membrane is suspected to identify the injury due to cold shock. Lipid phase transitions of cell membrane influence the injury of cold shock in many species. INDIRECT CHILLING INJURY: Long exposure of biological materials at low temperature causes indirect chilling injury and this injury is cooling rate independent. Lipids and proteins are changed by means of its activity and structure. Eg: changes in enzyme activity and protein denaturation. Also the metabolic pathway and enzyme linked reactions face some alterations as the co-ordination is decreased according to the decrease in temperature rate (Fuller et al., 2004). ROLE OF CRYOPROTECTANT: Cryoprotectant enhances the dehydration process formerly formation of external ice. The activity of water is greatly reduced during the lack of water loss. By reducing the effect of salts, it acts as a protective influence on structure of the cell. Freezing protocol progression needs consistent method to detect the cell viability (Fuller et al., 2004). Cryopretectant may be a chemical additive that is added to the solution before freezing to ensure the high survival rate after post thawing. Role of cryoprotectant is to support and protect the survival of biological material upon cooling to hypothermic temperature for long duration of time. Property of an effective cryoprotectant is high solubility with decreased toxicity. Cryoprotectant can be classified according to chemical class and mode of action. Each categorized cryoprotectant plays a vital role upon thawing and cooling. Freezing point depression is promoted by permeating cryoprotectant due to the presence of electrolytes. Non-permeating cryoprotectant promotes decreased formation of ice crystal upon freezing by prior dehydration of biological material. Reduced deviation of volumes and solutes damage concentration is enhanced by the cryoprotectant. Eg: DMSO (Fuller et al., 2004). Cell protection is also achieved by fluctuating formation of ice crystal into harmless shape and size during thawing and freezing. It is necessary to look the toxicity of cryoprotectant over cells and its permeability. High concentration of cryoprotectant itself injured. Direct exposure of cryoprotectant with membranes and proteins induce ionic pumps disruption over trans membrane and also causes enzyme inactivation. But more amount of cryoprotectant in vitrification ensures viscous and amorphous medium. The possible approach to overcome this problem is achieved by using mixture of cryoprotectant at definite concentration (Tsai et al., 2008 and Fuller et al., 2004). SIMILARITY AND DIFFERENCES OF VITRFICATION AND CONTROLLED SLOW COOLING: -ADVANTAGES AND DISADVANTEGES: Effective vitrification demands enormous sample cooling and solute with high concentration with combination of cryoprotectant (Bielanski, and Lalonde., 2009). Successful vitrification was enhanced in 1985 to cryopreserve the mouse embryo and this technique is also effectively applied to preserve the blood cells, tissues, embryo and oocyte of Drosophila melanogaster, Asparagus officinalis plant as well as embryos of numerous mammalians. Cryopreservation of mammalian system report entails the success achieved through the technique of controlled freezing. However in the case of fruit fly, vitrification occupies a success where the controlled freezing failed. Efficient vitrification technique relays on an optimization of some specific steps that includes appropriate composition and concentration of provided vitrification solution with specific cooling/warming environments. Also this technique induces equilibration of living cells present and to dilute the cells present in the vitrification solution (Fuller et al., 2004). A series course of freezing and warming of bovine in-vitro matured, fertilized and cultured blastocysts using electron microscope (EM) grids (A-F) ( Reproduced from park et al., 1999) The use of slow cooling includes several ranges of rates of cooling when we compared vitrification with rapid and ultra rapid cooling. The ultimate goal of both techniques is to produce a glass like state of cells to prevent the damage caused by formation of ice crystal upon cooling (El-Danasouri, and Selman., 2005). At first, vitrification procedure involves lengthy pre-equilibrium procedure. Currently, combination of penetrating and non-penetrating solutes is used with non-toxic property with several ranges of cooling rates. Both the technique result in successful cryopreservation of embryos and oocytes of humans (Borini, and Coticchio., 2009). Even these procedures resulted good, slow cooling technique applied for cryopreservation of oocytes shows very less successive rates when compared to vitrification. Vitrification acts as a promising technique in many areas in reproductive technology, even though its positive rates need to establish further. Vitrification is an easy procedure and that consumes less time duration. Also this vitrification technique is safer and cheaper when compared to control slow cooling. ( Kuleshova, L.L. and Lopata, A., 2002). Cryopreservation of cell faces relative damage due to cooling and thawing. Mostly damage occurs whilst storing the cells at hypothermic conditions. Maintaining healthier cells for further use are very essential and we need to prevent it from genetic drift and contamination. To stop the biological action of the cell and to maintain that in its preserved state is the role of cryostorage. In fluid system, molecular motion is achieved via temperature (Fuller et al., 2004). The molecular motion get reduce according to the decrease in temperature. Biological species are designed to be viable and active at maximal temperature but it lost its activity at hypothermic condition. At that instance, lipid phase transition, structural and enzymatic damage and de-polymerization occurs (Kiefer et al., 2005). Major damaging phenomenon upon cooling are: Intracellular ice crystallisation and osmotic damage. Chilling sensitivity or cold shock leads the cell to death at the temperature below 0Â °C. These effects differ from one cell type to another. Bacteria and some viruses can sustain in 60 degree but the holding temperature for most of the biological sample is below -130Â °C (Fuller et al., 2004). Conventional cryopreservation method is established to overcome the formation of ice whilst cooling. Formation of ice crystals are avoided by vitrification via its usage of concentrated solution and rapid cooling. This vitrification method contains a potential advantage as it is rapid and this technique does not require rate cooling equipment. Vitrification results in good survival rate of preserved oocytes and embryos. Cryopreservation widely applicable to retain genetic resources and protect the endemic species (Tsai et al., 2010). Vitrification acts as an alternative method to slow cooling. This provides higher survival of pregnancy range and embryo viability. This vitrification acts as a suitable procedure in infertility clinics. In this, cryopreservation of numerous embryos is maintained within short period and thus it acts as a simple method. Still, less number of controlled studies and childbirths are concerned over vitrification technique. Multiple pregnancy risk associated w ith freezing using controlled slow cooling is restricted using vitrification. Also it works with high efficacy (Kuc et al., 2010 and Trounson and Mohr.,1983). Vitrification acts as an attractive cryopreservation method when compared with controlled slow cooling technique. In contrast to slow cooling method, this vitrification technique is precise and in this each and every step is visualized. Vitrification reduces the time duration of exposure to sub-physiological environments. It requires only less than 10 minutes carrying out while slow cooling takes nearly two hours. Vitrification is simpler and it does not need costly programmable freezing equipment. In some cases, chilling injury also prevented by vitrification (Fuller et al., 2004). Needle immersed vitrification requires less concentrated and minimum volume of vtrification solution. Maximize cooling rate, reduce toxicity of vitrification solution with low volume of less concentration cryopreservation. In vitrification, upon freezing, only numerous ice crystals are formed and so less mechanical disruption results by ice crystal (Wang et al., 2008). Vitrification technique is accompanied without the withdrawal of more amount of water. So, less chemical damage only exist. But the chemical damage due to cryoprotectant is a complicated matter. ( long). Common variation held between vitrification and controlled slow freezing is due to the numerous additions of cryoprotectants. Implementation of maximum equilibration condition and dilution are expected from the vitrification media. It is necessary to use low toxic agents in the vitrification solution. To achieve an efficient vitrification, formulation of 2 things over the vitrification technique are essential. 1. physicochemical properties : Concentrated vitrification solution induce glassy solid formation and it helps to devoid of crystallization whilst cooling. 2. cyoprotectant: using low toxic cryoprotectant with an intrinsic permeability. Vitrification protects the cell from ice formation while cryopreservation.Both the vitrification and slow cooling are used to preserve human oocytes (Fuller et al., 2004). In case of human ES cell cryopreservation, improved efficiency is noted in vitrification than in traditional cryopreservation (Zhou et al. 2004 and Peng-Fei et al., 2006). Analysis of colonies after vitrification yields rapid growth and differentiation when compared with slow freezing technique. Vitrification acts as a promising approach to cryopreserve the multi cellular tissue. Even, vitrification achieved certain merits; it is associated with several problems. In the state of vitrified, glass is susceptible to cracking. Care is essential on warming to neglect the formation of ice. Heat transfer rate occurring during vitrification process may vary depends on device.Vitrification include the rapid cooling protocol and it is difficult to maintain at certain temperature with the available equipment. Very rapid and even rewarming requires avoid of devitrification. During slow cooling, increase solute concentration to glass transition needs while prevent by cooling slow enough to allow the cells to dehydrate to protect intracellular supercooling (Youssry et al., 2008). Vitrification requires higher and potentially cytotoxic concentration of cryoprotective agents for one hour before its immersion into liquid nitrogen at specific temperature. To reduce its toxicity, pre equilibrium performed at 4Â °C. It allows the direct visualizaton of cell by the operator (El-Danasouri, and Selman., 2005) Eventhough this vitrification entails with meritful approaches, this technique still been experimental. Also, it requires more additives to reach and it is potentially cytotoxic. This technique highly depends on operator. Timing takes to cover all the steps and it is critical. In contrast to slow freezing, this vitrification needs enough level of training. If the vitrified solution stars to devitrify, (crystalise into ice), viability will be lost. This happens when thawing or extended time of storage persists (Fuller et al., 2004). Viability of vitrified samples is not certain for lengthy period of time but in case of slow cooling, preserved cells can be viable for many years, even to thousands of years. Direct exposure of cryogen can be achieved by fast cooling. As it is so, this process may carry possible contamination of organism from the liquid nitrogen. So, this process cannot be applicable for therapeutic cells. Vitrification technique is applied only to cooled cell suspensions in minor quantities. This method is not projected to apply in large quantities like cryovials, matrix tubes, bags, microtitre plates etc. Quality control measurement via this vitrification technique is made to be impossible as we need to take experiments for all straws. (Fahy et al., 2004) Usually the slow cooling procedure is used in infertility centers. But it is associated with documented limitations. Also sometimes, it damages sensitive parts of the cell ( eg- zona pellucida) and it induce biological changes. Because of these changes, we will get a depleted outcomes. To overcome this, Modifying cryopreservation procedure is attained- freezing and thawing by polymers. This also enhanced with changing the time duration of the cooling protocol and it is looked as same as the path to simplify and fast up cryobanking procedures to get beneficial results. As the vitrification technique connected with some problems, it acts as a challenging technique for reproductive medicine. The slow freezing technique serves as an effective method for humans too (Mandelbaum, J., 2000). An alternative method for cryopreservation was developed and it is called as vitrification. Comparative study has been taken between controlled slow cooling and vitrification techniques with patients undertaking controlled ovarian stimulation in GnRH agonist to determine efficacy. The rate of pregnancy after vitrification reveals more than higher successive rate than result achieved via slow cooling. Efficacy of vitrification yields (50.4%), and slow cooling results in (25.9%) successive rates.Human ovarian tissue also cryopreserved (Noriko et al 2009) Both cryopreservation as well as cryostorage contains budding advantages, especially in invitro fertilization. Ultimate goal of cryopreservation is to achieve maximum persistence rate and sustainability of biological system after thawing. In slow cooling procedure, clinically satisfactory result has not been attained. Slow cooling procedure needs costly equipment and also it is time consuming. One of a significant advantage of vitrification process is its tendency to form any ice crystals during both cooling and warming. In contrast, its limitation held in toxic effects due to addition of cryoprotectants and contamination via liquid nitrogen. In slow cooling technique, toxicity of cryoprotectant is relatively less. But many research outcomes supports the vitrification process rather than slow cooling in fertility treatment(Tsai et al., 2010). Blastocyst cells can be preserved by both the cryopreservation techniques. Among these, vitrification promotes increasing chance for future development. A reliable advancement is needed for vitrification to enhance the preservation of supernumerary blastocysts. Unsatisfactory results have been produced for the blastocyst preservation through slow freezing method. Vitrification acts as an alternative principle which is allied with capability of inducing more pregnancy rate and increased survival of embryo upon cryopreservation (Trounson and Mohr ., 1983 and Fuller et al., 2004). CONCLUSION: Approach taken by Kolibianakis et al results in the comparative analysis of both vitrification and controlled slow cooling. And its outcome provides similar results are given by both of these techniques. But comparatively, post thawing survival frequency is better in vitrification than slow cooling. Finally, they suggested that the there is no link between the vitrification process in giving high rate of pregnancy but it displays the successful post thawing survival both in the cleavage stage and in the blastocyst stage (Youssry et al., 2008 and Porcu et al 2000). According to Balaban et al survival rate of human 3 day embryo preservation reported the percentage of survival rate by vitrication as 94.8% whereas slow cooling provides 88.7%. (Kuc et al., 2010). Vitrification study over the embryo in cleavage stage testified 80% of survival rate and 22-35% of pregnancy rate. These results are more significant than the slow cooling procedure. Although the two main approaches of cryopreser vation contains signficant results, Vitrification gains more positive outcomes. Even in both the cases, limitations persist. All of its limitations can be always overcome by its positive side.

What is the Likelihood of Finding a Suitable Stem Cell Donor

What is the Likelihood of Finding a Suitable Stem Cell Donor At present, there are close to 29 million potential stem cell donors in the Bone Marrow Donors  Worldwide registry [4]. Though the number of donors continues to grow worldwide, there are  significant resource implications in donor recruitment and HLA typing. Therefore, the challenge  of thoughtful donor recruitment strategy becomes increasingly relevant. These include  recruitment efforts focused on young male donors [5] or on relatives of registered donors with  rare human leukocyte antigen (HLA) phenotypes [6], minority donor recruitment programs [7-10],  and regional priority setting of recruitment activities based on HLA frequency differences  [11-14].   The decisive question of What is the likelihood of finding a suitable matched adult donor in their  registry? definitely warrants registries strategy planning. Recently, Schmidt, et al [15] reported  that population-specific matching probabilities (MP) are a key parameter to assess the benefits  of unrelated stem cell donor registries and the need for further donor recruitment efforts. The  authors described a general framework for MP estimations of specific and mixed patient  populations under consideration of international stem cell donor exchange. Calculations were  based on HLA-A, -B, -C, -DRB1 loci high-resolution haplotype frequencies (HF) of up to 21  populations. Based on the existing donor numbers, the largest MP increases in addition of  500,000 same-population donors were observed for patients from Greece (+0.21) while only  small MP increases occurred for European Americans (+0.004) and Germans (+0.01). Due to the  large Chinese population, the optimal distribution of 5,000,000 new donors worldwide included 3.9 million Chinese donors [15]. Nevertheless, the authors observed the need for  same-population donor recruitment in order to increase population-specific MP efficiently.   National strategies that neglect domestic donor recruitment should therefore be critically  re-assessed, especially if only few donors have been recruited so far.   As described by Schmidt et al [15], the probability p(n) for a random patient from a given   population to find at least one matching donor in a registry including n individuals of a donor  population is given with p(n) is the matching probability in n sample size, fi  being the frequencies of the i-th genotype and i-th is any genotype from the rank of genotypes in  the order of the highest to the lowest frequencies in a donor population. Genotype frequencies  can be derived from the estimated HF under the assumption of Hardy-Weinberg equilibrium  (HWE).   HF is calculated from DNA-typed registry donors with Markov Chain Monte Carlo (MCMC)  algorithm PHASE [16]. Four-locus high-resolution HF (HLA-A, HLA-B, HLA-C, and HLA-DRB1) were  used for adult donors. The HF and effective adult-donor registry size for each group were then  put into a matching model that assumes genotypes are in HWE [17, 18]. The strategy involved  modeling the likelihood that an 8/8 or 7/8 HLA-matched adult donor was available. For better  analysis, information of adult-donor availability including donor refusal, discrepant donor typing  and loss of contact would be desirable.   According to the calculations, the likelihood of finding an available 8/8 HLA matched donor is  75% for white patients of European descent but only 46% for White patients of Middle Eastern or  North African descent [19]. Similarly, the chance of finding an 8/8 HLA-matched donor for other  groups is lower and varies with racial and ethnic background. For Black Americans of all ethnic  backgrounds, the probabilities are 16 to 19%; for Asians, Pacific Islanders, and Native Americans,  they range between 27% and 52%.   As it was reported that adult-donor availability differs according to racial and ethnic background  [19], models including this variable have substantially lower match likelihoods than those which  did not take into this account. Although the likelihood of HLA matching is the greatest with  donors from the patients racial and ethnic group, donors from other racial and ethnic groups  may increase this likelihood. Patients from groups with relatively low inter-racial or inter-ethnic  marriage, such as Asian groups, are less likely to have donors identified from outside their group. The overall available rate is only 29%. We therefore estimated the donor pool and matching probability in this study based on our  previous published gene and haplotype frequencies in Hong Kong population [20]. MATERIALS AND METHODS Sample Collection and genotyping As reported previously, 7,595 voluntary unrelated bone marrow donors recruited by the HKBMDR  between January 2013 and June 2014 were included in the analysis [20]. All donors are of  Chinese origin, HLA-A, -B, -C and -DRB1 genotypes were obtained using polymerase  chain-reaction sequence-specific oligonucleotide probe methods using LifeCodes HLA-SSO Typing  Kit (Gen-Probe, Stamford, CT) when analysed by Luminex 200à ¢Ã¢â‚¬Å¾Ã‚ ¢ system (Luminex Corp., Austin,  TX). Typing ambiguity was resolved using sequence specific primer or sequence based typing  methods utilising the specific primers of SBTexcellerator ® HLA typing Kit (Genome Diagnostics,  Utrecht, the Netherlands). Alleles were determined according to IMGT/HLA Database release  3.18.0. Statistics Analysis The frequencies of HLA-A, -B, -C and -DRB1 alleles were calculated from the number of observed  genotype. Hardy-Weinberg equilibrium for each loci was assessed by PyPop using MCMC  simulation from Guo and Thompson [21], and genotype frequency deviance within each loci was  detected by PyPop invoking Arlequin [22]. P value of By using the formulae described by Schmidt et al [15] with modification, the probability p(n) for a  random patient from a given population to find at least one matching donor in a registry  including n individuals of a donor population is given with p(n) is the  matching probability in n sample size, fi being the frequencies of the i-th genotype and i-th is  any genotype from the rank of genotypes in the order of the highest to the lowest frequencies in  a donor population. RESULTS The HLA genotypes and haplotypes frequency mentioned in the following section have been  recently published [20]. HLA-A, -B, -C and -DRB1 genotypes deviated from the expected  Hardy-Weinberg Equilibrium Proportions (HWEP) (p PHASE  [16]; adherence to HWEP was also assessed using PyPop 0.7.0 [23]. A few but significant  deviations from HWEP were detected for all the four loci, HLA-A, -B, -C and -DRB1. Deviation from  HWEP detected at the HLA-A locus is derived primary from an excess of A*02:01 + A*02:03  genotypes (247 observed, 218.5 expected; p = 0.0007) and an undercount of A*02:06 + A*02:03  genotypes (16 observed, 48.2 expected; p = Summary statistics for Hong Kong haplotypes is shown in Table 3. 2,146 A-C-B-DRB1 haplotypes  with frequencies > 0.006% were estimated from these donors. The cumulative frequency distributions for HLA-A, -B, -C and -DRB1 loci in this Hong Kong Chinese cohort are shown in Table 4. Top twenty Haplotype A-C-B-DRB1 frequencies are shown in Table 5 [20]; nine of them have  frequencies of greater than 1%. Our findings on HLA alleles and haplotypes frequencies were  found to be very similar to those of Asian/Pacific Islander (A/PI) Race/Ethnicity of the NMDP  Registry and other studies on Han Chinese population [25]. The most common haplotype  A*33:03-C*03:02-B*58:01-DRB1*03:01 ranked second in the A/PI of NMDP registry (2.3%) and  top in Singapore Chinese (5.1%) [26]. The second most common haplotype  A*02:01-C*01:02-B*46:01-DRB1*09:01 was one of most frequent haplotypes among Chinese  populations, especially the southern area of China and Guangdong [27, 28]. However, the f ifth  common haplotype A*02:03-C*07:02-B*38:02-DRB1*16:02, was found to be less common in the  A/PI of NMDP Registry (0.4%) and the mainland China (0.3%) [25, 28]. We compared the top 100 haplotypes of HKBMDR HKCBB by haplotype frequencies with the  two publications [25, 26]; we noted that 88 are in common, the rank correlation is 0.909 for  HLA-A-B-DRB1 haplotype. There appears to be no excessive immigration from other places to Hong  Kong. We also compared the China population paper which had provided the detailed top  haplotypes for 4 loci, we found that 43 are common in HLA-A-C-B-DRB1 haplotype and the  correlation is low with only 0.477 [28]. With the use of MCMC algorithm to estimate HLA haplotype frequencies [14], it was found that the number of haplotypes increases with number of donor samples studies as summarized in  Table 6. Originally we tested the HLA haplotype frequencies in 2,500 samples and noted a bigger  number of haplotypes as compared with other papers. Then we increased the sample size to  5,000 and 7,500 and noted that the increase was quite significant in our population with many  more haplotypes. However, we usually observed a plateau of number of haplotypes even with  increase in sample size in the Caucasians and European populations. As of December 2015, there were only around 100,000 donors in the HKBMDR. Applying the  similar methodology in calculating the likelihood of finding a matched donor in US [19],  likelihood of finding an 8/8 HLA match or > 7/8 HLA Match by different donor registry size in the  HKBMDR was shown in Figure 1. The likelihood of finding an available 8/8 HLA matched donor is  45% while increases to 65% for finding 7/8 HLA matched donor. It is similar to the finding of  other studies conducted among Asians, Pacific Islanders, and Native Americans which reported a  likelihood ranging between 27% and 52% [19]. DISCUSSION The chance of successful engraftment and disease free survival are associated with the HLA  compatibility between the recipient and the prospective donor. The diversity of the HLA genes at  the allelic level and the heterogeneity of HLA data of the registered donors have a significant  bearing on the probability of finding a volunteer unrelated HSC donor for patients from a  particular population. This can be seen in the existence of many populations including Hong Kong  or Chinese with significant heterogeneity among recruitment centers. HLA frequencies estimated  at the Hong Kong Bone Marrow Donor Registry or China Marrow Donor Program Registry are not  in equilibrium and should not be relied on as characteristic of a Chinese population. The probabilities of finding a match would increase substantially when the registry size grows. As reported in [19], the NMDP has added slightly more than 1 million adult donors to the registry  in 2012 and plans recruitment growth of 9% cumulatively each year through 2017. HLA typing of Chinese in Hong Kong were found to be more heterogeneous and this points to the  need of a larger donor pool in bone marrow registry to optimize the chance of successful  matching. The study findings provide vital information for defining donor recruitment target and  planning for extra resources in order to support the cost in donor recruitment and HLA typing.  Establishment of a more cost-effective bone marrow donor registry with a larger pool of donors  could increase chance of matching and the success rate of haematopoietic stem cell  transplantation. Assuming 25,000 per 10-year age range of even distribution, it is projected that the number of  retired and non-contact to be around 2,000. Based on the projection in Figure 1, if one would like  to achieve MP for 50% 8/8 HLA Match or 70% >7/8 HLA Match, HKBMDR should have about  150,000 donors. Considering the HKBMDR registry size to grow to 150,000 in five-year time, it  will require 12,000 new donors recruitment per year. To further increase MP to nearly 55% for  8/8 HLA Match or about 75% >7/8 HLA Match, donor registry size should be expanded to  200,000 (Figure 1). Similarly, an annual recruitment of 22,000 new donors is required. Either of  them is much higher than the current recruitment target of 5,000 donors per year. As such, the  associated resource implication in donor recruitment and HLA typing will need to be carefully  addressed. In our previous study on the survey on Hong Kong donation [29], factors associated  with HSC donation motivation in Hong Kong were identified. The results highly suggested that  recommendations on promoting BM donation to the younger and higher education may allow  better recruit rate and longer maintenance for donation. The government should consider  launching educational activities such as bone marrow donation campaign, educational series and  school talks to students and parents. However, it should be noted that the above estimation has not taken into account of the  potential matches from around 2,400,000 Chinese donors registered in China and Taiwan  registries. In addition, the use of cord blood units which are readily available and require less  stringent HLA matching has not been added into the matching probability. Many transplant  centers in particular those in the States and East Asia would switch to use cord blood when adult  donor is not available. But the relatively low stem cell dose may be inadequate for adult size  recipient. Recently, double cord blood or even haploidentical transplant has been applied  clinically with success. Whether they will eventually replace the need of a large registry is  currently under debate. But at the moment, these approaches are mainly indicated when  conventional related or unrelated donors are not readily available or accessible. On the other  hand, one should also be bear in mind the time re quired from matching, donor work up to  donation of overseas donors and other cost implication factors when building up the model for  estimation of registry size

Principles of good customer service Essay -- Business and Management S

Principles of good customer service It is very important to give excellent customer service when out in resort working as a rep. customer service can be given by one person or alternatively it can be given out as a team. This is to ensure that the customers get the best from there holiday, and so that they build a rapor with you to gain trust for them to come back time and time again. Seeing the customer happy also benefits you as a rep and gives you good job satisfaction. There are many different types of giving good customer service: Body language When dealing with a customer you must always use positive body language. Giving lots of eye contact is always good because the customer feels that you are giving them you full attention and that you are developing an understanding of there needs. Also facial expressions reveal opinions, emotions and moods better than any of the other body parts. The way that your face expresses feelings i.e. smiling or frowning will always allow the customer to discover how you are feeling towards them. First Impressions First impressions count in any business, particularly overseas where dealing with people is such an important part of the work. You need to understand that the way you and your organisation present themselves to customers has a direct influence on their enjoyment, your job satisfaction and the future success of the organisation that employs you. In particular when meeting a customer for the first ...

Conduct Books in the 18th Century Essay -- Literature

Conduct Books in the 18th Century Throughout history, conduct books have played an integral part in defining what cultures believed were acceptable and desirable behaviors, as well as representing the ideal person. In the introduction to The Ideology of Conduct, Nancy Armstrong and Leonard Tennenhouse attempt to show how literature and conduct books have been important in relaying these messages and shaping a history of sexuality through the ages. They also point out the interesting fact that these books of conduct have been aimed more at women and far "surpassed in quantity and variety" (Armstrong and Tennenhouse 4) similar types of literature for men. Some of the examples they list of types of conduct literature include pamphlets on marriage, books on manners and morality, and devotional manuals designated for women of the aristocracy. Even in our culture today this type of literature exists in the forms of advertisements, fashion magazines, and exercise books. Again, much of this type of literature is directed at women more than men, which these editors explain as an attempt to specify "what a woman should desire to be if she wishes to attract a socially approved male and keep him happy" (Armstrong and Tennenhouse 5). This makes sense because even today our society is patriarchal, constructed so that women many times have to count on financial support from a man. However, the introduction points out the irony of this, since not only is the desirable woman being defined, but also what a man should find desirable in a woman is defined. also note that this is not necessarily a contradiction, since "the gendered world of information we inhabit today reproduces and maintains the dominant view (Armstrong and Tennenhouse 5). ... ...n," women learn how to be more desirable for men in terms of today's standards. The focus seems to be on independence as well as sexual attractiveness, and although these qualities are quite different from those of the eighteenth century, they are still just as offensive. Just a few of the headings and articles give a clear idea of the messages being sent to women today: "Are you going too far to snag a man?" or "Bikini Body Bummers: Stretch Marks, Bikini Stubble, Flab, Back Acne--You name it, we help you banish it" and even "Cosmo's 10 Commandments" which include, among other things, "ditch the bitchy mood, fall for a nice guy, send thank you notes, keep underwear under cover, and never lose your cool." Even today conduct books remain an integral part of a culture's beliefs and ideals, documenting "a history of sexuality" (Armstrong and Tennenhouse 19) through time.

Macbeth :: essays research papers

Macbeth is a popular play written by William Shakespeare, which is a tragedy. In order for Macbeth to be crowned king, King Duncan would have to die. There are two main characters in the play that want the power from Duncan and are too anxious to wait. Those two characters are Macbeth and Lady Macbeth, Lady Macbeth was the one who came up with the ideas and schemes to kill King Duncan. Whenever Macbeth would be unsuccessful through the process of killing Duncan, she would back him up. Although Macbeth wanted to get out of murdering Duncan he couldn’t. To make Macbeth kill Duncan Lady Macbeth had to constantly manipulated Macbeth. Duncan is Macbeth’s cousin so it would be harder for Macbeth to stab him to death while he’s sleeping.   Ã‚  Ã‚  Ã‚  Ã‚  When Macbeth sent Lady Macbeth a letter saying that Duncan was going to stay with them for the night and then leave the next morning, she was already starting to plan out his murder. Through the process of killing Duncan, there would always be something that Macbeth would not do right, and so Lady Macbeth would have to do it over. In (2.2 62-64) Lady Macbeth says, â€Å"why did you bring these daggers from this place? They must lie there, go carry then and smear the sleepy grooms with blood.† Then again in (2.2 65- 67) Macbeth reacted â€Å"I’ll go no more, I am afraid to think what I have done look on’t again I dare not.† When Macbeth killed Duncan, he forgot to leave the daggers by the drunken chamberlains, he was already regretting killing Duncan. When he returned to the castle, Lady Macbeth was surprised to see him holding the bloody daggers. Afterward when Macbeth refused to bring the two bloody daggers back; Lady Macbeth took them out of his hands and went to the chamber where Duncan laid dead. When Lady Macbeth came back into the castle she says, (2.2 80-86) â€Å"My hands are of your color, but I shame to wear a heart so white. I hear a knocking at the south entry retire we to our chambers. A little water clears us of this deed: how simple is it then.† When she returned from the chamber saying that her hands or the same color as. I’m covered in the same blood as yours are. Someone is coming let us get to our chamber and pretend like we were

Avila Auto Parts

a. The two methods of reporting in the parent company’s currency are different due to usage of different rates of exchange. Under the first method, the spot rates are to be used. Spot rates are the rates at which the transaction is carried out. This is normally a difficult approach and companies use the date on which the balance sheet and income statement is prepared. The spot is taken to be the rate of the balance sheet and other financial statements. The other method uses average rate of exchange of the period of reporting. In our case, using the two methods, we will have significant differences in the reported profits and losses. If we use the spot rate of balance sheet publication, the currency conversion factor will be 12000 pesos per dollar, whereas if we use average rate, the conversion will be done at 10,000 pesos per dollar. There will be a difference of 20 percent in the reporting. On the other hand, if the rate today has been less than the exchange rate at the beginning, the current reported figures would have been lower than those reported under first method. We should ideally use the method of spot rate at which payments are made. If it is not possible, the average rate would be better and consistent. Average can be taken for monthly figures or weekly rates to make it more accurate and representative of the realistic picture. As the income statement shows, the profits for the year were 25,000 million pesos in the local country. If it is translated to the parent company’s reporting currency using the spot rate of income statement, that is 12,000 pesos = $1, we will have net profits of $2,083,333. If we use the average rate of the period, that is (8,000+12,000)/2 = 10,000 pesos per $1, we will have net profits of $2,500,000 or $2. 5 million. Under both the methods of reporting the same profits/income of the company to its parent company, the profits are quite different simply due to the currency difference and exchange rate variation over the period. The difference in profits reported is more than $0. 4 million or roughly 20 percent which may change the decisions taken at headquarters. Taking into consideration the differences in the exchange rates and conversion risk, the company should decide on a measure to select the rate of exchange to use for its reporting during the entire life of the organization. They should consistently use whatever they have decided to use over their entire life. b. Functional currency is the one in which the operational cash is generated and is normally the currency of the country where the operations are going on. If the currency of the operating country is not stable, it can not be considered as functional currency. The stability of currency means that the rate of inflation over three year period should be less than 100 percent. As in the given case, the rate of inflation is 50 percent, (from 8,000 ps per dollar to 12,000 ps per dollar), the functional currency will be peso as the operational cash flows are generated in pesos and the inflation is within the limits. If the inflation over the past two years reaches 150 %, the functional currency will be changed to the reporting currency of the parent company, which in our case is dollar. . Economic exposure for Avila can be seen by the given conversion rates and their variability over such a short period of time. Economic exposure is the effect of foreign currency rate changes to the cash flows and other measures of operational performance. The exposure for any company is affected by the industry it is operating in and the stability of the currency of its operating country and the parent company. If there is excess demand of pesos, it will push th e rates of pesos higher and vice versa. If the rate gets higher, that is there will be less pesos in a dollar, the performance in the parent company’s report will be better than the situation when the exchange rate gets low. The two reporting methods will lead to significant differences in reported profits and losses to the parent company, from the operations in some other country. 3. Hedging can be a good option to protect the company against any unforeseen changes in the exchange rates. The company can make hedging I a number of ways to make itself protected against foreign exchange risk. Four positions are possible to provide such a protection using simple forward contracts and options. a. Long forward Under long forward position, the company at the operating country can take a long forward position to fix exchange rate (today) for a future date of transaction. Taking a long position means that the investor is agreeing to buy the underlying asset, at a specified price, agreed by both parties, on some future date. The contract has to be executed irrespective of what the conversion rate will be. Unlike options, none of the parties has the option to execute the contract or revoke it, but it is mandatory for both of them to carry it out. b. Short forward Short forward position can act equally well at the parent company’s location. The parent company at the parent country can go to short forward position so that it can sell dollars to pesos at a rate specified today. Using both the positions they can hedge the overall loss and can be certain about the expected gains. Options provide a type of insurance against any unforeseen changes in exchange rate. The buyer of call option and the seller of put option, both have the right to exercise the option or to waste it. The maximum loss in wasting the option is restricted to the price of the option. In this way, the company can set a floor to its loss and can gain as much as it can. c. Long Call Long call allows the parent company to buy a right to buy at a specified rate at some future point in time. If the rate increases, the company will have the option to buy at a lower rate than the market going rate, if it goes down, the loss will be restricted to the price of the option and the gains can be as much as the rate goes down. . Short Put Short Put will allow the company at the operating country to enter into a position to sell a right to sell at a set rate. The working for this will be exactly in the opposite manner as the long call position. 4. Financial architecture affects the overall cost for the company. If the inflation is high and the interest rates are high for a high risk firm , the cost of obtaining financing from banks and other Financial Institutions (FIs) will be high. Equity financing or market financing will require a higher rate of return, but the firm may shift the payments to some future period. As for bank financing or debt financing, it will have to make payments to the lending institution within the given timeframe. The firms may choose to go for a certain debt to equity ratio to gain advantage of optimal capital structure to optimize their costs of capital or WACC (Weighted Average Cost of Capital). 5. Euro currency is the use of currency in some other country. This in our case refers to storage, saving of pesos in the parent country where the currency in use is dollars. This will provide the company benefits in terms of advantage in domestic interest rate regulations and other barriers to free flow of cash. Firms participate in the euro currency markets to gain the benefits from exchange rate inefficiencies and under or over valuation of some currencies. If the investments are in the parent company’s currency and the operations are in the local currency of country where operations are being carried out, the exchange rate plays a vital role when calculating returns on investments for the company’s investments and funding by the parent company. If the domestic currency rises in operating country, the rate of return required should be higher than normal to overcome the exchange differences and vice versa. To overcome this difference and the problems due to fluctuating exchange rates, companies enter euro-currency markets where they can keep their money in parent company’s currency and convert it to functional currency as and when needed. This provides them the opportunity to maintain the required base in terms of parent company’s currency. 6. Other alternatives to run a firm’s fund-flow mechanism are to use various swaps in the form of interest rate swaps or foreign currency swaps. MNCs can go for unbundling of their costs at headquarters to affiliate companies of subsidiaries. In this way they can divide their costs to subsidiaries. Multinationals can go for transfer pricing mechanisms to avoid taxes on their overall operations. This can be done by pricing their internally traded goods for the purpose of moving profits to low tax nations. This will provide them an overall higher profitability. Companies can also create re-invoicing centers to avoid exchange rate fluctuations. The invoice currency will be the one used rather than the operating currency. This will reduce their exposure to currency and exchange rate risk. This will increase communication costs and to some extent create an overhead whereby the overall time delays and costs will be increased. MNCs can also transfer funds to their parent companies as dividends if the local conditions and regulatory framework is favorable. The major benefits of using different mechanisms can be obtained because of differences in the tax mechanisms and tax systems in different countries. Firms, by simply moving their profits from high tax region to a low tax region can save on their overall taxes provided the costs of moving are not high enough to make it unprofitable.