Calculate the Expected Value in Roulette

The concept of expected value can be used to analyze the casino game of roulette.  We can use this idea from probability to determine how much money, in the long run, we will lose by playing roulette.   Background A roulette wheel in the U.S. contains 38 equally sized spaces. The wheel is spun and a ball randomly lands in one of these spaces. Two spaces are green and have numbers 0 and 00 on them. The other spaces are numbered from 1 to 36. Half of these remaining spaces are red and half of them are black. Different wagers can be made on where the ball will end up landing. A common bet is to choose a color, such as red, and wager that the ball will land on any of the 18 red spaces. Probabilities for Roulette Since the spaces are the same size, the ball is equally likely to land in any of the spaces.  This means that a roulette wheel involves a uniform probability distribution. The probabilities that we will need to calculate our expected value are as follows: There are a total of 38 spaces, and so the probability that a ball lands on one particular space is 1/38.There are 18 red spaces, and so the probability that red occurs is 18/38.There are 20 spaces that are black or green, and so the probability that red does not occur is 20/38. Random Variable The net winnings on a roulette wager can be thought of as a discrete random variable. If we bet $1 on red and red occurs, then we win our dollar back and another dollar. This results in net winnings of 1. If we bet $1 on red and green or black occurs, then we lose the dollar that we bet. This results in net winnings of -1. The random variable X defined as the net winnings from betting on red in roulette will take the value of 1 with probability 18/38 and will take the value -1 with probability 20/38. Calculation of Expected Value We use the above information with the formula for expected value. Since we have a discrete random variable X for net winnings, the expected value of betting $1 on red in roulette is: P(Red) x (Value of X for Red) P(Not Red) x (Value of X for Not Red) 18/38 x 1 20/38 x (-1) -0.053. Interpretation of Results It helps to remember the meaning of expected value to interpret the results of this calculation. The expected value is very much a measurement of the center or average. It indicates what will happen in the long run every time that we bet $1 on red. While we might win several times in a row in the short term, in the long run we will lose over 5 cents on average each time that we play. The presence of the 0 and 00 spaces are just enough to give the house a slight advantage. This advantage is so small that it can be difficult to detect, but in the end, the house always wins.

Companies That Built Success on Business Data Free Essay Example, 1250 words

The big floods of data in corporations have made evaluating and analyzing easy which has led to the advancements and has given an upper hand in various business strategies. Using an analytical way of decision making minimizes risk which leads to more profit generation (McCafferty). The market of big data is advancing and progressing as faster than ever which has led to both challenges to counter unstructured and structured one while giving numerous opportunities to make advancements like never before. It has given the opportunity to advance at corporate levels where information technology is used as a viable tool to progress and make amends in the present strategies. Data mining is a big question when it comes to it because seeking the right type of information and manipulating it accordingly is necessary. Agreeing with the point that mixing new data with old data and then utilizing it for analytical purposes will lead to far better progress at the institutional level but this can a lso have a negative impact if misused or not properly used to gain results that are incorrect. Incorrect results lead to wrong decision making which then has an impact on the organization overall and its reputation can deteriorate heavily. We will write a custom essay sample on Companies That Built Success on Business Data or any topic specifically for you Only $17.96 $11.86/page

The Slavery Of The Slave Trade - 1104 Words

The Atlantic Slave Trade was about importing and exporting of commodities such as sugar, cotton and humans beings (slaves) which would be considered the most valuable product. A slave is defined as a person being held in servitude as the chattel (property) of another; one that is completely subservient to a dominating influence.† (Merriam-Webster) According to Paul Lovejoy â€Å"slavery was one form of exploitation. Its special characteristics included the idea that slaves were property; that they were outsiders who were alien by origin, or who had been denied their heritage through judicial or other sanctions;†¦.† This â€Å"slavery† commerce became a position of wealth in the African countries among its leaders, and spread throughout Europe†¦show more content†¦People were considered as wealth and security because they labored to produce food and other goods. It was the norm for the eldest man in the founding family to be the leader and that le ader used his leadership ability to distribute resources and make the important decisions as well as commanding respect. A strong leader had people who were loyal to them. A wealthy person was also a leader, but with the ability to organize labor in order to clear out and farm the land. Polygyny was also an accepted practice in the African culture which assisted in the production of labor power. Therefore African societies were not slave societies because wealth in people was the norm in African lifestyles. Rules of slavery were more dehumanizing in the American slavery methods. African slaves held positions in administration, served in the military, sometimes positions of command, personal servants and agricultural laborers. War was a vehicle to increase slaves by taking them Captive (outsiders). War was made by African rulers and was always a way to increase wealth. Waged war by African leaders was specifically for humans. The more humans, the more power, the more wealth accumulation. They sold people who were already Captives of war. Slaves held by the owner (European or African) and not immediately sold could be used to obtain additional resources that would â€Å"strengthen the king and his administration.† West Africa traded the largest majority of slaves. TheShow MoreRelatedSlavery And The Slave Trade1436 Words   |  6 PagesSlavery has been documented and has been part of the world for a very extensive time. Slaves as well-defined by numerous of individual’s state that slaves were a group of individuals who were legally bought and soon after, became the property of an owner and were forced to obey. No one knows when slavery actually came about, but we do know that it existed. So this being said, today I will be talking about the slave trade, comparing the differences of being an African slave and American slave, asRead MoreThe Slavery Of The Slave Trade1405 Words   |  6 PagesThe slave trade, which was once a legal part of the American constitution, has for many years become a form of piracy because it takes away the basic human rights of any person. The Atlantic slave trade was originated in West Africa and became a systematic institution in American and European economies. This plague brought about an inevitable existence of the nations greatest political conflict. The slave trade evoked heartbreak, and a horror to society as the nation became split over puritan valuesRead MoreThe Slavery Of The Slave Trade1328 Words   |  6 Pagesamounts of workers for cultivation infrastructure. For this reason, American settlers began the transatlantic slave trade trade. Christianity played an important role in advocating for the morality of the slave trade (Ri chard). In order to drive the slave industry, pastors across America used the traditions and stories found in the Bible to endorse and even encourage the practice of slavery. At this time, America was seeing ever dividing sects of protestantism. There were countless institutions anywhereRead MoreSlavery And The Slave Trade1498 Words   |  6 PagesThe phenomenon of new world slavery was a well-run business and the slaves were the product. Slavery was one of the few industries in history where assets exceeded liability and owner’s equity, which is an unusual occurrence considering the equation is normally that assets equal liability and owner’s equity. Throughout this essay, the rise of slavery and the slave trade will be explained and slavery will be illustrated as the product of a domino effect. Slavery was a process and it took many peopleRead MoreThe Slavery Of The Slave Trade1310 Words   |  6 PagesThe word slave is well-defined as an individual detained in se rvitude as the chattel of another, or one that is wholly impassive to a ruling power (American Heritage dictionary of the English language, 2011). The most renowned circumstances of slavery materialized throughout the settling of the United States of America. From 1619 until July 1st 1928 slavery was acceptable within United States of America the Slavery protestors endeavoured to end slavery, which at some point; they were effective atRead MoreThe Slavery Of The Slave Trade1295 Words   |  6 Pagesyou a few examples of how Atlantic slave trade came to be. What would be significant about it is that the laws, and rules that existed for the slave trade, were slightly confusing. Example not everyone knew or would agree to slave trade, the vast argument was whether slavery was a necessity or not and who would be considered a slave. Some say that without slaves, they would not get the proper work done such as field work is an example. Also others argued that slavery was not needed. As a result of theRead MoreSlavery And The Slave Trade Essay1313 Words   |  6 Pagesuse of the domestic slave trade because of the need for slaves in the tobacco planting lands. Many landowners and planters looked towards the Chesapeake area to seek for slaves. Many slave owners started looking towards that region because the International Slave Trade had been blockaded off. The domestic slave trade began something different; where African Americans were moved to a new location either through being sold or being transferred. Because of the desperate need of slaves in order to earnRead MoreThe Slavery Of The Slave Trade1987 Words   |  8 Pagesbe complete without the mention of the interstate slave trade. This is most applicable when we talk about one aspect of the slave trade that often gets overlooked, the Atlantic Slave Trade. When mentioning the Atlantic Slave Trade, it is the fact that southerners considered reopening the trade after its dissolution in the beginning of the nine teenth century. Interestingly enough, there were movements by southerners to reopen the Atlantic Slave Trade that were in the name of southern expansion. OneRead MoreSlavery And The Slave Trade2968 Words   |  12 Pageshistory of slavery is long, documented, captured in photos and personal narratives of slaves and slave owners. There are many accounts of how slavery started, the horrific stories of transporting slaves and what they were used for throughout history. To start at the beginning you have to start with how slaves were placed in different countries and continents where they were not born. Most know about the Atlantic slave trade that effected North America, South America and the Caribbean. Slavery existedRead MoreSlavery And The Slave Trade1889 Words   |  8 PagesFor over 2,000 years, slavery has been conducted in various parts of the world. From year 1500 to year 1900, Europeans stole individuals from West Africa, West Central Africa, and Southeast Africa and shipped them to the different parts of the Atlantic. This process dehumanized them of their identity. Europeans stole husbands, wives, merchants, blacksmiths, farmers, and even children. They removed them from their homelands and gave them new names: slaves. European slaveholders never thought to take

Classical Chinese Garden Of Suzhou And Japanese Dry...

The Interpretation of Nature in Classical Chinese Garden of Suzhou and Japanese Dry Landscape Garden of Ryoan-ji Luis Barragà ¡n, the influential Mexican minimalist architect and Pritzker Prize winner once said that, â€Å"In the creation of a garden, the architect invites the partnership of the Kingdom of Nature. In a beautiful garden the majesty of nature is ever present, but it is nature reduced to human proportions and thus transformed into the most efficient haven against the aggressiveness of contemporary life.† Such design principle, with a strong emphasis on the unity of man and nature as a way to build freedom and independence in the natural environment of gardens away from the unrest social political atmosphere, has not only been seen in Western minimalist architecture, but also has been extensively utilized in Classical Asian architecture. Classical Chinese Garden of Suzhou and Japanese Dry Landscape Garden are two typical examples that demonstrate such harmonious coexistence between artificiality and nature. Thus, with a focus on a comparison between the selected examples of Humble Administrator’s Garden of Suzhou (see fig. 1) and Ryoan-ji Dry Landscape Garden (see fig. 2), this essay aims to analyze the design techniques of the two gardens and how they respond to their social political and religious environments by conveying different interpretations of nature. Garden of the Humble Administrator, which consists of numerous pavilions and bridges set among a maze of

Cancer management Free Essays

Introduction The aim of this case report is to provide a source of information regarding patients with Bulky stage 1B cervical cancer by focusing on optimum care and treatment pathway of a patient. The author aims to describe important scientific observations from clinical trials, and therefore provide insightful information to expand knowledge and new research already present. Despite a ‘well established’ UK screening programme for detecting cervical pre-invasive disease there are still approximately 2,800 cases of cervical cancer per annum and 1,000 women still die from cervical cancer each year (Cancer research UK, 2003). We will write a custom essay sample on Cancer management or any similar topic only for you Order Now The case study focuses on a patient with squamous cell carcinoma of the cervix uteri (exocervix and endocervix), poorly differentiated and staged by FIGO staging system at IB2 N1 (appendix A). The FIGO staging system (Appendix 1), is based on clinical evaluation (inspection, palpation, colposcopy), radiological examination of chest, kidneys, and skeleton, and endocervical curettage and biopsies. The FIGO staging recommendations were last revised in 1995. Stage IB (T1b) includes all invasive tumours limited to cervix larger than stage 1A2 lesions. Stage T1b occult is no longer used. Stage IB lesions (confined to cervix) were subdivided into stage IB1 clinical lesions (?4cm in size) and stage IB2 lesions (4cm in size). There were no changes in other stages, including the 1987 definitions of stages IA, IA1, and IA2 (FIGO, 1995). Brady et al (1999) acknowledge squamous cell carcinoma of the uterine cervix originating at the squamous columnar junction (transformation zone) of the endocervical canal and portio of the cervix. This lesion is frequently associated with severe dysplasia and carcinoma in situ, which has the possibility of progressing to an invasive carcinoma in 10 to 20 years. The malignant process breaks through the basement membrane of epithelium and invades the cervical stroma. If invasion was less than 3mm, the lesion was classified as microinvasive or superficially invasive (stage IA1) the probability of lymph node metastasis is about 1% (Bohm et al, 1976). Perez et al (1998) suggested incidence of pelvic node metastases to be approximately 15% in stage IB, 25% to 30% in stage IIB, and 50% in stage IIIB disease.Incidence of para-aortic node metastases was found to be approximately 5% in stage IB, 19% in stage IIB, and 30% in stage IIIB disease. Fagundes et al (1992) submitted the tumour may spread to adjacent vaginal fornices or to paracervical and parametrial tissues, with eventual direct invasion of bladder, rectum, or both. They advocated the most common metastatic sites as lungs (21%), para-aortic nodes (11%), mediastinal and supraclavicular lymph nodes, bones, and liver. Literature review criteria: The most recent form of literature available was published scientific articles in form of electronic journals. Literature found included, reviews on the subject of Cervical cancer and published clinical trials which demonstrated clinical benefits and subsequent evaluation. Journals were accessed via internet using PubMed and Science Direct databases. Papers were selected based on merit of abstract and relevant articles were extracted from reference lists. Primary search terms: ‘Cervical cancer’ ‘Squamous cell carcinoma of cervix’ ‘Cancer of the cervix’ Secondary search terms: ‘Poorly differentiated IB2 N1 Cervical cancer’ ‘IB2 N1 Cervical Cancer’ ‘Ovarian Transposition + Cervical Cancer’ ‘Phase 1 trials +Cervical Cancer’ ‘Treatment pathway + Cervical Cancer’ ‘Supportive care + Cervical Cancer’ ‘HPV + Cervical Cancer’ Exclusion criteria: Most of the references used were less than eight years old, although older articles were reviewed to note development of treatment. Patient case presentation The patient case is of a twenty two year old women (gravida 0, para 0). She had no familial history of Cervical cancer or any other type. She consumes two units of alcohol per week and is an occasional smoker with a one pack per year history. She is currently employed and works thirty-six hour per week. In November 2008, patient presented with an abnormal cytologic (Papanicolaou) smear test and some postcoital spotting. She denied any forms of vaginal discharge but remarked a feeling of heavy fatigue and pelvic pain. A general physical examination of the patient was carried out with special attention to supraclavicular (nodal) areas, abdomen, and liver. A careful pelvic examination which included a bimanual palpation of the pelvis took place. Following an abnormal smear test the patient was referred for a colposcopic examination, where high grade cervical dysplasia was discovered. The patient was consequently referred in October to her local hospital for a LLETZ (large loop excision of transformation zone of cervix) biopsy of cervix. Specimens obtained during this procedure identified an invasive, moderately differentiated squamous cell carcinoma of large cell keratinising type. Vascular invasion was not identified. The tumour was staged as IB+. November 2008, contrast MRI of abdomen and pelvis completed, which concluded a large homogenous mass being seen arising from lower end of cervix extending slightly more to the right. Cervical canal was noted to appear preserved and the endometrium and rest of uterus appeared normal. There was suspicion of extension of tumour into the upper vaginal wall. A right sided simple ovarian cyst was noted, with a normal left ovary observed. A large lymph node was seen in the right pelvic sidewall highly suspicious of being metastatic. No Para- aortic lymphadenopathy noted. Concluding staging on MRI grounds was recorded as a Stage T2b, N2 cervical cancer. Based on MRI findings, patient was referred for EUA (examination under anaesthesia) for consideration of trachelectomy, in November. Trachelectomy is a surgical removal of the uterine cervix. EUA recorded a large 5cm exophytic tumour and on looking around it on 360? no macroscopic infiltration into vagina was seen.In order to give better definition an endo-cervical coil MRI was performed in December 2008, which further confirmed a definitive 6cm exophytic cervical cancer and enlarged right pelvic lymph node. Due to this the patient was not an ideal candidate for a trachelectomy. The patient was next referred for a EUA, cystoscopy, colonoscopy, sigmoidoscopy and biopsies. Procedure was uneventful. No vaginal or parametrial involvement were identified. Cystoscopy, sigmoidoscopy and colonoscopy were normal. This gave a concluding staging of Ib/2a. The patient’s case was discussed within a MDT (multi-disciplinary team) meeting. Here it was decided that chemo-radiotherapy would be preferred treatment. The patient’s main concern was preservation of fertility due to her young age. Due to the progression of disease and quick follow through from diagnosis to treatment, the patients family, patient and partner all became very distressed, and a referral was made to a specialist gynae – nurse, where information regarding treatment, prognosis and side effects could be explained and discussed again. The oncologist referred patient to a fertility specialist in December 2008, to discuss possible options for fertility sparing prior to patient commencing radiotherapy and chemotherapy. From this meeting it was decided that the patient was to undergo ovarian transposition to exclude them from the radiation scatter effect from the proposed adjuvant radiotherapy. Within the same procedure in December, patient underwent a laparoscopic para-aortic node assessment, which subsequently defined the radiotherapy field. The results of the assessment were discussed within a MDT meeting whereby it was found that the frozen section of the suspicious right obturator node confirmed malignancy, although, the para-aortic lymphadenectomy was negative. Patients consent, height and weight were taken in order to calculate Cisplatin chemotherapy dosage needed for concomitant chemotherapy. December 2008, patient proceeded to commencing radiotherapy prescribed at 50.4Gy in 28 fractions with a four field technique at 10MV. In addition to this she commenced her first concomitant chemotherapy of Cisplatin 40MG/M2 60MG, first of four cycles. The patient was reviewed throughout her radiotherapy and chemotherapy and tolerated both well with minimum side effects. Subsequently the patient was consented for intrauterine and intravaginal high dose rate brachytherapy for February 2009. The patient was noted to be down and depressed and very tearful and expressed concerns of not coping. The patient was referred to a CLIC/Sargent social worker for support and advice in January 2009. Prior to first fraction of brachytherapy, patient underwent EUA. It showed a good regression of tumour, but was still bulky. A smit sleeve was inserted as well as intrauterine tube and ovoids. Patient was admitted for brachytherapy (16.5Gy to point A in three fractions) which proceeded without complication, patient was subsequently discharged. Following brachytherapy, an external beam pelvic side wall boost was performed at 5.4Gy in three fractions. The patient was reviewed five weeks post treatment in March 2009. She noted slight bowel changes and noticed that she was leaking small amounts of urine. This was dismissed as radiotherapy related. The patient was given vaginal dilators and provided with instructions as well as an explanatory DVD. Patient relayed her fears of being re-infected by HPV. Patient was encouraged to talk with long partner regarding HPV testing. The patient also mentioned experiencing a few night sweats and hot flushes, actioning referral for an estradiol level, FSH and LH check. April 2009, patient was given news that hormonal tests taken showed signs of menopause. Patient devastated as ovarian transposition was not successful. Patient referred for hormone replacement therapy. Three month follow up MRI scan and clinical examination revealed no sign of disease. July 2009, three months post follow up, patient seen in clinic complaining of recurrent pain in right upper quadrant. Patient was on regular analgesics, but denied any per vagina bleeding or discharge. Bowels and micturation not working properly, denied it being associated with pain. Patient sent for CT scan of thorax, abdomen and pelvis in conjunction with FBC and U and E’s. Results of patient scans discussed within an MDT in August 2009, where it showed recurrent disease in the transposed side ovary. The plan decided within MDT is to perform a diagnostic laparoscopy and removal of said ovary. Patient and family were extremely distressed and emotional on hearing this news. Final pathology of biopsies taken laparoscopicaly in September 2009 confirmed malignancy in the right ovary. Following discussion at MDM, decision made to give the patient three cycles of Carboplatin and Taxol and reassess to see if surgical excision were possible. It was noted that peritoneal washings taken at time of biopsy were positive, which implies that peritoneal disease is elsewhere. Patient was consented for further chemotherapy and was distressed about possibility of hair loss due to chemotherapy. Patient was referred to MacMillan team for assessment of grant for financial assistance. An interval CT scan was taken post 3rd cycle of chemotherapy in November 2009. This showed a response in disease with the mass having reduced slightly in size. Patient proceeded with a further two cycles of chemotherapy with G-CSF support (granulocyte-colony stimulating factor) a growth factor that stimulates the bone marrow to produce more white blood cells. After the patient had finished five cycles of Carboplatin and Taxol, patient was consented and referred for a laparotomy and exploration of lesser sac and paracolic gutter in December 2009. This showed evidence of metastatic disease in form of omentum nodules, which subsequently tested positive for metastases on frozen section. The tumour was found in right hepatic flexure and was fixed to the right para-colic gutter involving head of pancreas and infiltrating liver. From this discovery of metastatic disease, it was considered inappropriate to proceed with the proposed right hemicolectomy, cholecystectomy, resection of part of liver and excision of the Gerota’s fascia. Patient and family were understandably very distressed about intra-operative findings. They were given a psychological support referral. Family were seen by a clinical psychologist, although the patient declined the appointment, but opted to speak to a CLIC Sargent social worker. Community palliative care team were to liaise and follow up with patient and family. The patient and family were additionally put in contact with a local hospice within their catchment Based on findings the clinical oncologist felt that the Carboplatin and Taxol regime was ineffective in controlling disease progression and spread and was therefore stopped. In December 2009, next chemotherapy line suggested was Topotecan, although a request was made to consider the patient for a Phase 1 agent. Due to patients increasing pain and problems with control the patient was not a suitable candidate for Phase 1 chemotherapy. Therefore patient was commenced on fives cycles of standard palliative chemotherapy Topotecan in January 2010. Patient had extensive meetings and liaisons with social worker for young people. Macmillan nurse, from hospice arranged for home visits to assess pain medication. The patients ECOG performance was ranked as 1 (Appendix 2). Re-staging CT was performed which showed an increase in size of tumour with further encroachment onto liver, new malignant lesions were identified as well as more dilated bowel loops. Patient completed intended cycles of Topotecan but was admitted for treatment of Sepsis with IV antibiotics in March 2010. Subsequent CT scans in April 2010 displayed disease progression despite Topotecan. Patient commenced on Tamoxifen therapy due to her disease having some ER positivity. Patient’s family were seen separately from patient, advised of patient’s prognosis to be less than 6 months. Patient’s mother raised concerns of patient expressing suicidal ideation. Macmillan nurse visited patient’s home. May 2010, patients pain became difficult to control, home visit made by consultant in palliative medicine as patient became increasingly drowsy. Patient deteriorated rapidly and was commenced on the Liverpool Care Pathway.Marie curie nurse, present most evenings with patient at familial home. June 2010, patient passed away with family around her. Screening and HPV testing Since first being introduced as a screening test for cervical cancer by Papanicolaou in 1927 (Papanicolaou, 1928), the cervico-vaginal smear test has proved to be one of the most cost effective test within medicine.The American Cancer society (1997) states that according to the National Cancer Institute, mortality rate from cervical cancer has dropped 70% over the last 70 years. Currently only 30% of cervical cancers are screen detected, the majority of these cases occur in women who have never had a smear (PAP- Papanicolaou) test or regularly attend a screening programme. The patient discussed (patient A), was part of this statistic as she had never had a smear test due to the UK cervical screening age being 25. Patient A presented with symptoms aged 22. Standard practice within the UK is for women aged between 25 and 60 to be contacted every 3 to 5 years and asked to go for a cervical screening test. In patients A case, a smear test was only done due to other symptoms such as post coital bleeding. An article in ‘The Times’ (2009) confirmed that new guidance will be issued to all GP’s and practice nurses to increase awareness and management of cervical cancer, but age at which women are screened will not be lowered to 20, announced by the department of health. This decision was finalised after a review by the Independent Advisory Committee on Cervical Screening (ACCS) which found that risks for women under 25 of false positive results and premature births outweighed benefit of identifying a â€Å"few extra cases†. The ACCS found that treating women for abnormal cervical cell changes has been linked to an increased risk of premature birth. While women of all ages who are treated are more likely to give birth prematurely, benefits of screening older women outweigh this risk, the panel said. One in three women under the age of 25 will have an abnormal result compared with one in fourteen for older women, the ACCS said, meaning that there are many false positives identifying abnormal changes in cells that often return to normal without treatment. A study by Sasieni et al (2009) further confirmed the ACCS’s findings that cervical screening in women aged 20-34 is less effective than in older women. By studying the effect of screening in smaller age groups, Sasieni et al showed that efficacy of screening decreases with decreasing age, even within the age 20-34. On average, participation in the UK cervical screening programme by a woman aged 35-64 reduces her risk of cervical cancer over the next five years by 60-80% and her risk of advanced cervical cancer by about 90%. The benefit of screening for women aged 25-34 is more modest. Screening in women aged 20-24 has little or no impact on incidence of cervical cancer under the age of 30. HPV is a factor being recognized as a major risk factor in pathogenesis of squamous cell carcinoma of cervix. Any woman who is sexually active is at risk of infection from human papillomavirus (HPV). Patient A was sexually active from aged 16. De Villiers et al (2004) identified Over 100 subtypes of HPV. A significant proportion of HPV disease is attributed to four subtypes; 6, 11, 16 and 18. HPV subtypes 16 and 18 cause approximately 70% of cervical cancer cases worldwide. HPV subtypes 6 and 11 infections are responsible for genital warts (Wiley et al, 2002). Arbyn et al (2007) acknowledge that HPV is the major cause of nearly 100% of all cervix cancers. This finding rapidly led to the development of vaccines against common and aggressive virus strains causing cervix cancer, the HPV genotypes 16 and 18 (Harper et al, 2006). According to Tornesello et al (2011), the role of HPVs in the etiology of cervical cancer precursor lesions and invasive carcinoma development has been well established. Bouvard et al (2009) found that at least 12 viral genotypes of alpha genus (HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 59) have been found associated with a high relative risk of cervical cancer and labelled carcinogenic to humans. Although holding different prevalence rates, HPV types 16 and 18 were the most common viral types in invasive carcinoma of the uterine cervix worldwide (Li et al 2008). Cheryl et al (2000) explain the HPV as replicating primarily within the proliferating basal cells of squamous epithelium. In order for the virus to infiltrate these cells, disturbance of the overlying epithelium must occur. Once present in the basal squamous cell, HPV early genes are expressed, which lead to viral replication and host cell duplication. Previously no specific antiviral treatments existed for HPV-associated diseases, including genital warts, cervical, vaginal and vulval dysplasia as well as cervical cancer. The development of vaccines against HPV is an attractive strategy for both prevention and therapeutic intervention against genital tract HPV infections (Sherman et al, 1998). Two HPV vaccines have been developed: Cervarix ® (GlaxoSmithKline, London, UK) a bivalent HPV (types 16, 18) vaccine and Gardasil ® (Merck Co., Whitehouse Station, NJ), a quadrivalent HPV (types 6, 11, 16, 18) vaccine. Both are prophylactic vaccines that have been shown to be effective in young women prior to HPV exposure. Following advice of the Joint Committee on Vaccination and Immunisation (JCV I) the Government and Department of Health (DOH, 2007) have introduced HPV vaccines for girls aged 12 to 13 years of age, starting from September 2008 (Garland et al, 2007). This was implemented three months after Patient A’s diagnosis. Cricca et al 2006 recognised an increased interest being focused on HPV detection in cervical lesions. They subsequently reported that detections of HPV DNA in the absence of cytological abnormalities may indicate persistent high-grade squamous lesions which may have been missed by PAP screening within the follow up of CIN3 – cervical intraepithelial neoplasia (severe dysplasia, carcinoma in situ- Dysplastic cells extend into the upper third and may occupy the full thickness of the epithelium) treated patients. A study carried out by Silvana et al (2007) found HPV testing significantly predicts disease clearance or persistence, in comparison to PAP smear whose results did not register any statistical significance. The study further suggested that after treatment women should be followed up at 6-month intervals, for a minimum of 2 years with both PAP and HPV testing being carried out. Patient A only received HPV testing after her abnormal smear test was analysed. Introducing routine HPV testing as part of screening process every three years could have had a marked impact on her prognosis. Fertility preservation Patient A’s initial main concern was preservation of fertility and a referral was made by the clinical oncologist for her to see a fertility specialist to seek advice. In women who preservation of fertility is anticipated, an alternative to simple/radical hysterectomy is a radical trachelectomy. This process requires vaginal resection of cervix, upper 1 to2 cm of vaginal cuff and medial portions of cardinal and uterosacral ligaments. The cervix is transected at lower uterine segment and a prophylactic cerclage is placed at time of surgery . Landoni et al (1997) argue that for early stage disease, surgery conserves ovarian function and avoids effects of early menopause. They further propose that less shortening and fibrosis of vagina occurs compared to radical radiotherapy which gives better results in terms of residual sexual function. Surgery was thought to be the preferred treatment option in young women excluding the presence of any contraindications. Patient A fell into the young woman classification and initially had no contraindications to surgery. Relative risks and benefits of different surgical management approaches should be thoroughly discussed with the patient on an individual basis (Shepherd, 2009). Patient A had a thorough consent process prior to each surgical procedure and was put in contact with a specialist gynaecological nurse to answer any further questions. Patient A presented with a 5cm exophytic tumour. She undertook a radical trachelectomy, although research suggests that it does not appear to increase rate of recurrence, provided tumour diameter is no greater than 2cm (Landoni et al, 2005). Safety of radical trachelectomy in women with lesions that are greater than 2cm in diameter is not known as the majority of reported cases of radical trachelectomy have been in women with tumours less than 2cm in diameter. A recent prospective multicentre study by Renaud et al (2004) of radical trachelectomy combined with laparoscopic pelvic lymphadenectomy reported three recurrences in 100 treated patients (FIGO IA1, IA2, and IB1). NICE (national institute for clinical excellence) guidelines (2010) state, that women requesting fertility conservation should be offered radical trachelectomy and pelvic lymph node dissection, providing tumour diameter is less than 2cm and no lymphatic-vascular space invasion is present. As established within the case notes, Patients A tumour presented at 5cms, which means guidelines were not properly followed. In addition to trachelectomy patient A underwent ovarian transposition. Preservation of ovarian function is an important concern in premenopausal cancer patients whose treatments include external beam radiation to pelvic structures that incorporate ovaries applicable to patient A. Ovarian transposition was developed to displace ovaries from their normal anatomic position and away from direct radiation, with goal of maintaining long-term ovarian function. Ovarian transposition is seen as 40-50% successful (Shepherd, 2009). Techniques for ovarian transposition using a laparoscopic approach depend on radiation field size and location. Tinga et al (1999) have described transposition of ovaries in a fixed position behind uterus (to lie beneath an external midline block) as well as a superior transposition to level of iliac crest. They contend that the disadvantage of midline oophoropexy (surgical fixation or suspension of an ovary) is a higher level of internal radiation scatter, as the area is generally surrounded by in-field radiation. Morice et al (1998) reported a series of 24 patients who underwent ovarian transposition to paracolic gutters, before radiation for gynecologic malignancies. Authors concluded that this procedure was a safe and effective method of preserving ovarian function. Complications in both of these reports were rare. The fact of Patients A recurrence being at sight of transposition was noted as extremely rare and was the first case experienced by the clinical oncologist. No li terature was found outlining risks of recurrence of cervical cancer with ovarian transposition. It could be noted that perhaps Patient A’s size of tumour was too large for radical fertility sparing surgery. Psychological Support Patient A and her family experienced a great deal of distress during the care pathway. In 1983 Derogatis et al acknowledged cervical cancer as having a significant psychological and psychosocial impact on the individual and felt it was important to develop strategies to deal with this. Fallowfield et al (2001) recognise psychological distress as being common in patients with all forms of cancer and advocate it as remaining undetected. Regardless of socio-demographic characteristics or clinical characteristics, the well-being of patients with cervical cancer changes during the course of their disease (Greimel et al, 2000). A study by Greimel et al (2000) of 119 patients’ newly diagnosed gynaecological cancer evaluated psychological well-being and functions of daily living before surgery, three months after surgery and one year after surgery. Greimel et al (2000) noted a decline in psychological well-being and functions of daily living scores at three months after surgery. After one year there was a significant improvement in psychological well-being and no significant difference in functions of daily living compared to before surgery. Greimel (2000) recognised that in patients treated with surgery, level of psychological distress may be related to extent of surgery. The multidisciplinary team (MDT) should routinely screen for presence of psychological distress and be aware of risk factors for very high levels of psychological distress from point of diagnosis onwards (including during follow-up review phases) (Fallowfield et al, 2001). The MDT team involved with patient A routinely screened her psychological well-being and monitored it closely due to the young age of the patient. Patient A had regular contact with a support group and social worker for young patients in a similar circumstance. She was able to discuss matters which she was unable to share with her family and partner, such as body image and sexuality issues. As illustrated by Fallowfield et al (2001), many of psychological, physical and practical challenges facing women with cervical cancer are common to all cancer patients. These include, coping with shock of diagnosis, pain, nausea, fatigue and disfigurement from surgery as well as treatment worries over practical issues such as travel costs and loss of income. These above challenges were all experienced by Patient A. MDT supported the patient through these challenges. There is evidence that providing psychological and practical support may have a positive effect on patients’ well-being (Slevin et al, 1996). Evidence identified in relation to support needs of cancer patients was from small heterogeneous studies such as Walker et al (1999) and types of help offered are very varied. No studies found were specific to patients with cervical cancer but were comparable to cervical cancer population. Interventions included structured psychological support, relaxation techniques, o rientation programmes and general psychological support. The interventions reduced anxiety levels and improved quality of life.There are many national and local support services, for example, voluntary agencies, clinical nurse specialists, liaison psychiatry, clinical psychologists, local support groups, drop-in centres and day centres. These support services may offer complementary therapy services, such as yoga, aromatherapy and reiki. Reflexology was undertaken by patient A which, was offered by one of these support services. NICE guidelines (2010) state that â€Å"Patients with cervical cancer should be offered psychological support at time of diagnosis and at intervals throughout their management. Information about local support services should be made available to patients. Carers, families and dependants should be made aware of support available including local and national organisations. Multidisciplinary teams across healthcare settings should have agreed protocols for offering support for carers, families and dependants of patients with cervical cancer.† These guidelines were adhered to in the treatment of patient A. Near the end of Patients’ A life, a MDT decision was made to commence the Liverpool Care Pathway. Over past few years a major drive has been underway to ensure that all dying patients, and their relatives and carers receive a high standard of care in the last hours and days of their life. The Liverpool Care Pathway for the Dying Patient (LCP) is a key programme within the palliative care pathway for a patient. LCP was recognised as a model of best practice in the NHS Beacon Programme (2001). It was recommended in NICE guidance on supportive and palliative care for patients with cancer (2004) as a mechanism for identifying and addressing the needs of dying patients. It was recommended in the Our Health, Our Care, Our Say white paper 2006 as a tool that should be rolled out across the country. It is recommended in the End of Life Care Strategy DH 2008. Optimal management of cervical cancer involves a multidisciplinary team as demonstrated in Patients A case. The challenge for the team is to individualise treatment. As cervical cancer commonly occurs between ages of 30 and 45, this includes offering women with early disease the option of having fertility conserving surgery, where appropriate. Patient A did not fall into common age group for occurrence of cervical cancer. Patient A presented aged 22. For those such as Patient A, with intermediate or advanced disease, aim is to minimise treatment side effects without compromising outcome. Chemotherapy and Trials Within the last ten years concomitant chemoradiation has been the standard of care for advanced cervical cancer. Patient A received Cisplatin with radiotherapy followed by Adjuvant Topotecan. Varying proposals have been made that to control occult metastatic disease adjuvant chemotherapy after chemoradiation will improve outcome. In 2009 Duenas-Gonzalez et al described results of a phase III randomized trial which compared chemoradiation with gemcitabine and cisplatin followed by adjuvant gemcitabine and cisplatin for two additional cycles VS chemoradiation with cisplatin in women with stage IIA to IVA cervical cancer. Results showed a significant survival benefit for patients receiving chemoradiation plus adjuvant chemotherapy, the results concluded a 3 year survival of 74% in the chemoradiation plus chemotherapy arm against 65% in the chemoradiation arm. In order to confirm these results future trials are imperative, Kitchener et al (2010) aim to randomise women receiving chemoradiaiton after radical hysterectomy to four additional cycles of carboplatin and paclitaxel or no additional therapy. Chemotherapy is recognised as a standard treatment for women with late stage disease and those with recurrence not eligible for chemoradiation or surgery applicable to patient A. Monk et al (2009) published results of a phase III trial which compared 4 platinum containing doublets. Patients were randomised to receive cisplatin combined with either paclitaxel (the reference arm), vinorelbine, gemcitabine or topotecan. The results showed that progression free survival and response rates were similar in all four arms. Cisplatin with paclitaxel was found to have the best toxicity profile with quality of life similar across the four arms Angiogenisis is the formation of new blood vessels that grow into the tumour, giving it nutrients and oxygen to assist its growth. As with other cancers the role of anti-angiogenic targeted agents are of interest and importance in the treatment of cervical cancer. A phase II trial of bevacizumab in women with persistent or recurrent cervical cancer concluded a median progression free and an average overall survival range 3.4 – 7.3 months thus showing favoribilty within cervical cancer (Monk et al, 2009). Leading from the results of this trial Kitchener et al (2010) constructed a phase III trial where women are randomised to one of four arms using bevacizumab with cisplatin/paclitaxel or topotecan/paclitaxel. Monk et al (2010) identified Pazopanib as a second anti-angiogenic agent usuable within the cervical cancer patient population. This agent is known as an oral tyrosine kinase inhibitor which targets the vascular endothelial growth factor receptor. It was found that patients treated with pazopanib had a median overall survival of 50.7 weeks. Patient A received topotecan as a single adjuvant agent, if combined with an anti-angiogenic agent such as bevacizumab or pazopanib she may have had a prolonged life expectancy. Funding, costing and PCT approval may have been a barrier to access. Conclusion Patients A case is a sad case. The patient underwent ovarian transposition in order to preserve fertility but unfortunately the disease recurred at this site. Perhaps if the transposition was not undertaken then she may have still been alive. Ultimately it was the patient’s choice and due to the patients young age fertility preservation was very much applicable and supported by the clinician. There is a lot of controversy surrounding the topic of lowering the age of PAP smear testing and the standardisation of HPV testing as routine. If patient A had had regular smear tests and HPV testing as research has proved beneficial her disease may have been identified earlier and put through radical treatment. The availability of anti angiogenic has not yet been standardised by some PCTs, patients A access to chemo drugs such as pazopanib may have prolonged her life further. Throughout the past years there have been many advances and discoveries in the prevention and treatment of cervical cancer, Within the next five years there are many other advcances and technologies that will possibly impact the management of this common indiscriminatory disease. Active areas of research that can change the management and practice include the use of PET/CT imaging to guide therapy and PET or high-field MRI to monitor response to treatment, combined use of hyperthermia and radiation therapy to treat locally advanced disease and the role of intensity modulated radiotherapy. Appendix 1 FIGO staging of cervical carcinomas Stage I: Stage I is carcinoma strictly confined to the cervix; extension to the uterine corpus should be disregarded. The diagnosis of both Stages IA1 and IA2 should be based on microscopic examination of removed tissue, preferably a cone, which must include the entire lesion. Stage IA: Invasive cancer identified only microscopically. Invasion is limited to measured stromal invasion with a maximum depth of 5 mm and no wider than 7 mm. Stage IA1: Measured invasion of the stroma no greater than 3 mm in depth and no wider than 7 mm diameter. Stage IA2: Measured invasion of stroma greater than 3 mm but no greater than 5 mm in depth and no wider than 7 mm in diameter. Stage IB: Clinical lesions confined to the cervix or preclinical lesions greater than Stage IA. All gross lesions even with superficial invasion are Stage IB cancers. Stage IB1: Clinical lesions no greater than 4 cm in size. Stage IB2: Clinical lesions greater than 4 cm in size. Stage II Stage II is carcinoma that extends beyond the cervix, but does not extend into the pelvic wall. The carcinoma involves the vagina, but not as far as the lower third. Stage IIA: No obvious parametrial involvement. Involvement of up to, upper two thirds of the vagina. Stage IIB: Obvious parametrial involvement, but not into the pelvic sidewall. Stage III Stage III is carcinoma that has extended into the pelvic sidewall. On rectal examination, there is no cancer-free space between the tumour and the pelvic sidewall. The tumour involves the lower third of the vagina. All cases with hydronephrosis or a non-functioning kidney are Stage III cancers. Stage IIIA: No extension into the pelvic sidewall but involvement of the lower third of the vagina. Stage IIIB: Extension into the pelvic sidewall or hydronephrosis or non-functioning kidney. Stage IV Stage IV is carcinoma that has extended beyond the true pelvis or has clinically involved the mucosa of the bladder and/or rectum. Stage IVA: Spread of the tumour into adjacent pelvic organs. Stage IVB: Spread to distant organs. Source: TNM Classification of malignant tumours. L. Sobin and Ch. Wittekind (eds.), UICC Internation Union against Cancer, Geneva, Switzerland, pp155-157; 6th ed. 2002 Appendix 2 ECOG Performance Status These scales and criteria are used by doctors and researchers to assess how a patient’s disease is progressing, assess how the disease affects the daily living abilities of the patient, and determine appropriate treatment and prognosis. ECOG PERFORMANCE STATUS GradeECOG 0Fully active, able to carry on all pre-disease performance without restriction 1Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work 2Ambulatory and capable of all self-care but unable to carry out any work activities. Up and about more than 50% of waking hours 3Capable of only limited self-care, confined to bed or chair more than 50% of waking hours 4Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair 5Dead As published in Am. J. Clin. Oncol. :Oken, M.M., Creech, R.H., Tormey, D.C., Horton, J., Davis, T.E., McFadden, E.T., Carbone, P.P.: Toxicity And Response Criteria Of The Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649-655, 1982 References Cancer Research UK. (2003) UK Cervical Cancer incidence statistics [online]. Available from http://info.cancerresearchuk.org/cancerstats/types/cervix/incidence/Information Services Division. Cervix Uteri (ICD-9 180; ICD-10 C53). (Accessed 16th February 2011) Bohm, J.W., Krupp, P.J. and Lee, F.Y.L., (1976) ‘Lymph Node Metastases in Microinvasive Epidermoid Cancer of the Cervix’. Obstet Gynecol. 48(1) pp 65-67. Perez, C.A. (1998) Principles and Practice of Radiation Oncology, 3rd Ed. Lippincott-Raven Publishers. Fagundes, H., Perez, C.A. and Grigsby, P.W. (1992) ‘Distant Metastases after Irradiation alone in Carcinoma of the Uuterine Cervix’. International Journal Radiation Oncology, Biology, Physics. 24 pp 195-204. Sasieni, P., Castanon, A., Snow, J. and Cuzick, J. (2009) ‘Effectiveness of Cervical screening with age: population based case-control study of prospectively recorded data’. British Medical Journal. 339 pp 2968. Available from http://www.bmj.com/content/339/bmj.b2968.full.pdf. Accessed 20th February 2011) Wiley, D. J., Douglas, J., Beutner, K., Cox, T., Fife, K. and Moscicki, A. B. (2002) ‘External Genital Warts: Diagnosis, Treatment, and Prevention’. Clinical Infectious Diseases. 35(Supplement 2) pp 210-24. Renaud, M. C., Plante, M., Francois, H. and Roy, M. (2004) ‘Vaginal Radical Trachelectomy: an oncologically safe fertility-preserving surgery. An updated series of 72 cases and review of the literature’. . Gynecologic Oncology, 94(3) pp 614-23. Landoni, F., Maneo, A., Colombo, A., Placa, F., Milani, R. and Perego, P. (1997) ‘Randomised Study of Radical Surgery versus Radiotherapy for Stage Ib-IIa Cervical Cancer’. Lancet. 350 (9077) pp 535-40. National Institute for Health and Clinical Excellence. (1999) Topotecan for the treatment of recurrent and stage IVB cervical cancer. Available from http://guidance.nice.org.uk/TA183/Guidance/pdf/English. (Accessed 20th February 2011) Tinga, D.J, Dolsma, W. V. and Tamminga, R. Y. (1999) ‘Preservation of Ovarian Function in 2 young Women with Hodgkin Disease by Laparoscopic Transposition of the Ovaries prior to Abdominal Irradiation’. Nederland Tijdschrift voor Geneeskunde. 143 pp 308–312. Morice, P., Castaigne, D. and Haie-Meder, C. (1998) ‘Laparoscopic Ovarian Transposition for Pelvic Malignancies: indications and functional outcomes’. Fertility and Sterility. 70 pp 956–960. Derogatis, L., Morrow, G. R., Fetting, J., Penman, D., Piasetsky, S. and Schmale, A. M. (1983) The Prevalence of Psychiatric Disorders among Cancer Patients. Journal of the American Medical Association. 249 pp 751-7. Fallowfield, L., Ratcliffe, V., Jenkins, V. and Saul, J. (2001) ‘Psychiatric Morbidity and its Recognition by Doctors in Patients with Cancer’. British Journal Cancer. 84 pp 1011-5. Greimel, E. R. and Freidl, W. (2000) ‘Functioning in DailyLliving and Psychological Well-being of Female Cancer Patients’. Journal of Psychosomatic Obstetrics Gynecology. 21(1) pp 25-30. Shepherd, J. H. (2009) ‘Challenging dogma: radical conservation surgery for early stage cervical cancer in order to retain fertility’. The Royal College of Surgeons of England – Hunterian Lecture. 91 pp 181- 187. Bouvard, V., Baan, R., Straif, K., Grosse, Y., Secretan, B. and EL, G.F. (2009) ‘A review of human carcinogens – Part B: biological agents’ . Lancet Oncology. 10(4) pp 321-322 Li, N., Franceschi, S., Howell-Jones, R., Snijders, P.J. and Clifford, G.M. (2010) ‘Human papillomavirus type distribution in 30,848 invasive cervical cancers worldwide: variation by geographical region, histological type and year of publication’. International Journal of Cancer. Tornesello, M.L., Losito, S., Benincasa, G., Fulciniti, F., Botti, G., Greggi, S., Buonaguro, L. and Buonaguro, F.M. (2011) ‘Human papillomavirus (HPV) genotypes and HPV16 variants and risk of adenocarcinoma and squamous cell carcinoma of the cervix’. Gynecologic Oncology. 121 pp 32-42. Arbyn, M. and Dillner, J. (2007) ‘Review of current knowledge on HPV vaccination: an appendix to the European guidelines for quality assurance in cervical cancer screening’. Journal of Clinical Virology. 38 pp 189-197. Harper, D.M., Franco, E.L. and Wheeler, C.M. (2006) ‘Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial’. Lancet. 367 pp 1247-1255. Rock, C.L., Michael, C.W., Reynolds, K.R. and Ruffin, M.T. (2000) ‘Prevention of cervix cancer’. Critical Reviews in Oncology/Hematology. 33 pp 169 – 185. Papanicolaou, G.N. (1928) ‘ New cancer diagnosis. Proceedings of the Third Race Betterment Conference’. P 528. American Cancer Society. Cancer Facts and Figures. Atlanta, GA: American Cancer Society, 1997:1997. Costa, S., Negri, G., Sideri, M., Santini, D., Martinelli, G., Venturoli, S., Pelusi, C., Syrjanen, S., Syrjanen, K. and Pelusi, G. (2007) ‘ Human papillomavirus (HPV) test and PAP smear as predictors of outcome in conservatively treated adenocarcinoma in situ (AIS) of the uterine cervix’. Gynecologic Oncology. 106 (2007) pp 170-176. Cricca, M., Venturoli, S., Morselli-Labate, A.M., Costa, S., Santini, D. and Ambretti, M. (2006) ‘HPV DNA patterns and disease implications in the follow-up of patients treated for HPV16 high-grade carcinoma in situ’. Journal of Medical Virology. 78 pp 494-500. Garland, S.M., Hernandez-Avilla, M. and Wheeler, C.M. (2007) ‘Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases’. New England Journal of Medicine. 356 pp 1928-1943. Duenas-Gonzalez, A., Zarba, J.J. and Alcedo, J.C. (2009) ‘A phase III study comparing comparing concurrent gemcitabine (Gem) plus cisplatin (Cis) and radiation followed by adjuvant Gem plus Cis versus concurrent Cis and radiation in patients with stage IIB to IVA carcinoma of the cervix’. Journal of Clinical Oncology. 27 (18) p CRA5507. Kitchener, H.C., Hoskins, W., Small, W., Thomas, G.M. and Trimble, E.L. (2010) ‘The development of priority cervical cancer trials: a Gynecologic Cancer InterGroup report’. International Journal of Gynecological Cancer. 20 pp 1092-1100. Monk, B.J., Sill, M.W., Burger, R.A., Gray, H.J., Buekers,T.E. and Roman, L.D. (2009) ‘Phase II trial of bevacizumab in the treatment of persistent or recurrent squamous cell carcinoma of the cervix: a gynecologic oncology group study’. Journal of Clinical Oncology. 27 pp 1069-1074. How to cite Cancer management, Essay examples

Woolworths Ltd - Financial Analysis Free Sample Solution

Question: Discuss about theWoolworths Ltd Financial Analysis. Answer: Introduction The emergence of the organization financial evaluation or analysis management is the procedure which is associated to the change in organization scenario, socio-economic and brought about by the advancement of computer and information technology, emergence of multi product and multi division corporations with complex and dynamic organization set-ups (Berk and DeMarzo, 2007). Thereby financial management is about managing the organization performance and understanding organizations strategic objective and goals based on underpinning service quality and accountability as much as managing company finance resources including currency in efficient manner. Thereby present aim of this assessment is to analyze and evaluate the financial statement of the company of last five year using quantitative as well as qualitative methods. In addition to this quantitative analysis involves ratios calculation and its analysis. Furthermore, present assessment deals with the analyzing and evaluation of the financial performance. Qualitative Analysis of the Company Company Background In order to assess the financial analysis most effective and efficient manner student selects Woolworths ltd. The company Woolworths limited is Australian based organization and listed in the Stock exchange with extensive retail sectors. The organization is the second largest organization in the Australia by profits and revenue. As per the given data it has been seen that the company at the end of 2015 financial year earned A$60.68 billion and profits earned in 2015 FY is A$2.45 billions that indicates the present performance of the company well as compare to other organizations in same sectors. Moreover, the company offered one billion shares and the issues oversubscribe by approximately more than 2.60 billion share applications that represents that the company market share as well as brand values are better compare to their competitors and due to this more shareholder wants to invest money in this company (woolworths, 2016). The organization revenue growth has been increased at constant rate from the FY2010 to 2015, improve in organization sales has been consistent from $51,918 to $60868 in FY2015. The launch of the Everyday low price and project refresh strategies represented with a focus of restructuring end to end and line items super market, supply chain enhancement. On the other hand the company imple ments cost savings and supply Chain efficiencies that indicates that in the past 10 years the company save its cost approximately $0.8 billion. Furthermore, cost of goods sales in the year of 2011 is $40,049.7 and in year of 2015 is $43,990.5 that represents that increase in sales in effective manner (woolworths, 2016). Instead of this, it has been seen that with organization i.e. Woolworths online available to approximately more than 84% of Australian people that could Cleary indicates that the company generate an effective consumer base eventually resulting in more profits. Thereby as per the qualitative analysis and interpretation, it has been gained that the company always aimed at earned more profits to its shareholders. With better growth rate, as well as continue expansion the company Woolworths has increased into an effective brand within the stock market. Thus, form the analysis it has been intended that the company generating better market values and achieving better customers satisfaction. Thereby, Strength of the company revenue growth over the past five years has make sure that value creation of its shareholder or investors and profitability of the organization. The company has to take advantage of on the market opportunity of capture and strengthen its position within the market. An improve in profits as well as sale of goods give the company to initiate huge scale expansion planning which the company has introduce its market in global such as china, south Africa and India. Quantitative Analysis of the Company Ratios analysis is the effective tools and techniques help the company to analyze and evaluate organization performance in most effective manner. Financial performance identification as well as evaluation of organization weakness and strengths has been done in successful manner with the help of financial tools and techniques i.e. ratios analysis. In order to assess the performance of the company student use, liquidity ratios, profitability ratios, capital structure as well as market values. Liquidity Ratios Liquidity ratios helps the organization to determine the capacity of the business to fulfills it financial responsibilities and requirements in short period of time. Ratio Computation Formals Values of last five years Liquidity ratios Current ratio Current Assets Current Liabilities 2011 .80 2012 .86 2013 .91 2014 .95 2015 .84 Current Ratios As per the calculation of current ratios, analysis and interpretation it has been gained that in organization improve its current ratios constantly from FY 2011 to FY2014. In the year of 2014, the company loses their current ratios and its values degraded approximately .12 from FY 2014 to FY 2015. Thereby as per the current ratios analysis it has been observed that current ratios of 2:1 is effective for the company it should be considerable. As per the above figure change occur from FY2014 to FY 2015 and main reason behind that their competitor performing well and providing same goods and services in fewer prices with quality (woolworths, 2016). Thereby in such situation, it has been suggested that company needs to implements an effective cost cutting strategies; this helps them to increase liquidity ratios in successful manner. Overall organization current ratios below one; this shows that company may have problem in paying money in time. Therefore from the calculation it has been s aid that company current ratios is not much effective than the industry average rate and thus in has states that company are not performing well and not to be effective to pay short term obligations (Bodie and Merton, 2000). Profitability Ratios Profitability ratios help the company to determine whether, or not organization produces effective returns for its shareholders as well as owners by making high revenue as compared to expenses (Fridson and Alvarez, 2002). Ratio Computation Formals Values of last five years Profitability ratios Net profit margin Net income Net sales 2011 3.89 2012 3.28 2013 3.85 2014 4.02 2015 3.53 Return of total assets Net income /average total assets 10.73 8.51 10.31 10.56 8.66 Net Profit Margin Net profit margin helps the company is to determine how much profits the company earned in financial year. A less net profits margin of the company shows that a less margin of safety where as a higher profit margin shows that company gain more profits and performed well within the market. As per the computation of the net profit margin it has been seen that organization net profits margin were 3.89%, 3.28%, 3.85%, 4.02%, 3.53% respectively in FYs 2011,2012,2013,2014 and 2015 (woolworths, 2016). Values of the change has been occurred from the FY 2014 to FY2015 and this represents that company pay more operating expenses such as utilities, salaries as well rents thereby to increase them in effective manner management of the company requires to implements an effective monitoring strategies that helps them to increase profits most effective manner. Thereby this figure indicates that the company has better net profits margin as compare to average trend of other organizations in same secto rs. Thereby this figure represents that the company in better in terms of pricing strategies, operating efficiencies as well as cost control strategies. Return on Total asset The company use ROA in order to measure efficiency of the organization as well as market values. Thereby as per the calculation of return on total asset using net income divided by average total assets it has been gained that in year of 2011, 2012,2013,2014 and 2015 are 10.73,8.51,10.31,10.56 and 8.66 respectively. Thereby from the FY2012 to FY2014 Company ROA has been increased effectively and in year of FY2015 company errand less ROA compare to FY2014 (woolworths, 2016). Thus as per the analysis it has been said that company ROA ratios are indicates upward trends. Thereby as ROA calculation, it has been said that company performing effectively and earning better revenues (Tripathi, 2008). Capital Structure Ratio Computation Formals Values of last five years Capital structure ratios Debt ratios Total Liabilities total assets 2011 0.64 2012 0.58 2013 0.49 2014 0.43 2015 0.44 Interest cover ratios EBIT/interest expense 10.85 11.19 12.21 13.58 11.94 Debt Ratios This ratio helps the company to determine the extent to which long term finance of the company is sourced from the debt. Ratios below 50 percentages considered higher ratios and optimum decease lender confidence and hamper opportunity borrowers. As per the calculation, it has been gained that at the end of FY2015 company debt ratios is 0.44, which is higher than previous financial data. In add ton to this figure represents that company generating better debt ratios from last five years and from available data, it has been intended that the companys resources are sufficient to fulfill its obligations and this shows underutilization of sources of finance that may represents restricted growth. Interest Cover Ratio Interest coverage ratio helps the company to determine that companys capability to make interest pay on its debt in effectively as well as timely manner. As per the above represented figure it has been gained that company interest coverage ratios has been increasing order from FY2011 to FY2014. At the end of FY2015, the company, interest coverage ratio has been decreased from 1.64. As per the data and it has been seen that company interest coverage ratios is much better and this indicates that company afford to make principle payment in successful manner. This figure indicates that companies has extremely liquidity and not have any issues getting a loan to capture and expend market operations and functions (Tripathi, 2008). Market Values Ratio Computation Formals Values of last five years Market values Price earning ratios Market values per share Earnings per share 2011 15.82 2012 17.94 2013 18.05 2014 18.01 2015 15.83 Price Earnings Ratio The price earnings ratios help the company to measure the company share price to the yearly net income achieved by the company per share. Thereby as per the calculation and observation, it has been seen that company has higher rations that indicates that company performance is well and prove better investment. The main reason to change the values form FY 2014 to FY2015 is that company competitor provides its goods and services in fewer prices (Robinson, 2009). In addition to this above figure also indicates that company growth in future is well and this means organization generating better profits. Calculate Values of Stock using Dividend Growth, Rate Model Aim of the present topic is to calculate stock return, divided growth rate as well as current price of the company. Procedure used to determine the estimation such as capital asset pricing model. Growth rate calculation g=ploughback ratio*ROE Ploughback ratio=1-payout ratios g=(1-0.8528)*0.2722=4.01% In order to determine accurate growth rate average is taken from 2010 to 2015 as given in the financial report represent in appendix. g=7.68% Determination of current share price With the help of using constant dividend growth model current share price is repressed in below; Dividend payment in 2014 is $67+59 i.e. 41.26 per share that is do and growth rate is estimated 7.68%. Dividend payment in 2014=1.26*(1+7.86) =$1.36 that is the total dividend for 2015. Determination of expected current stock price Current stock price is to be calculated with the help of constant dividend growth ratio model that is Gordons growth model (Berk and DeMarzo, 2007). p0=current share price d1=dividend payment for previous year RE=required rate g=growth rate d1=1.36*(1+7.68%) =$1.46 As per the data dividend yield =3.88%, RE=3.88+7.68=11.56% p0=1.46/ (11.56-7.68) =$37.63 Recommendation and Conclusion As per the above analysis and evaluation it has been said that Financial analysis is the procedure of analyzing organizations, budgets, project and other financial entities to identify organization suitability for investment. In addition to this from above calculation, it has been intended the management of the organization to evaluate whether organization is stable, liquid and beneficial uses financial analysis. In addition to this, it has been seen that organization primary purpose to improve profitability and this can be effectively obtained using enhancement of profit margin as well as return of total assets. Meanwhile, main propose of use of financial analysis by the management is to focuses upon the income, cash flow statement as well as balance of the company in financial years. In present section student is a deal with the company background and its performance using qualitative analysis. Thus, it has been recommended that to achieve more profits in effective manner company n eed to enhance market position with help of expansion of business operations (Fridson and Alvarez, 2002). From the calculation, it has been observed that company achieving better gross margin thereby this figure indicates that company has surplus values at the end of financial year 2015 thus it has been suggested that company requires investing these money in those area from where they earn profits and improve market share in effective manner (Tripathi, 2008). References asx. (2016).asx.. [online] Available at: https://www.asx.com.au/asx/research/company.do#!/WOW [Accessed 11 Jul. 2016]. Berk, J. and DeMarzo, P. (2007).Corporate finance. Boston: Pearson Addison Wesley. Bodie, Z. and Merton, R. (2000).Finance. Upper Saddle River, NJ: Prentice Hall. Fridson, M. and Alvarez, F. (2002).Financial statement analysis. New York: John Wiley Sons. Robinson, T. (2009).International financial statement analysis. Hoboken, N.J.: John Wiley Sons. Tripathi, M. (2008).Auditing and finance management. New Delhi: Navyug Publishers and Distributors. woolworths. (2016).woolworths. [online] Available at: https://www.woolworths.com.au/ [Accessed 11 Jul. 2016].

Rock Music, Brief Summary free essay sample

The most common instruments you would see at a Rock Show/ Stage: Guitars whether Acoustic or Electric, Bass Guitar, Keyboards (optionally), Drum Kit, and Of Course Microphones for Vocals, There are other Rock bands who like to experiment on different instruments and using them for regular use e. G. Different choice of guitars such as classical, acoustic and Double necked, More keyboards for experimentation e. Bass Pedals, Additional Keyboards or Piano For A quick change, Drum players are the most common to see a change to their Drum Kits e. G More Cymbals and Tom Toms, or by using additional percussion objects such as Cowbells, Wind chimes, Temple Blocks, etc. While Rock Music had a Different sound inspiration as time went by there was an impact on what kind of fans had listened to the music. The asss was the main developing tag of rock and with Groups like The Beetles and The Who were springing onto the future of Music. We will write a custom essay sample on Rock Music, Brief Summary or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page And the asss had a much broader audience of Fans springing onto a heavier/ classic period of Rock with Famous Groups such as Led Zeppelin, Boston and Rush. When Simply heavy guitar music had declined slightly in the sasss, people wanted a change into their sounds. This was when Synthesizers were a major part onto Rock Music, Groups like Simple Minds, Rush (They change their different ways of music mostly every Album) and Chooses had a main dueling offspring of Guitars and Keyboards.The Synch declined in the ass and Alternative/Garage Rock was the answer, A Chunky Raw Distortion Driving Teenagers insane with examples such as Nirvana, Alice in Chains and Sonic Youth are examples of the Raw sounds that were impacted. Rock has Traditional Sub Genres inflicting on different styles of traditional rock music and influences, they can include influences of which have lots of talent or no talent at all.