Fluorine

The Element Fluorine Fluorine is an element that appears in the periodic table. It is apart from the halogen series. It appears in group 17 and period 2. It is important to understand its structure ,physical , and chemical properties. Fluorine is the 13th most abundant element on earth and is very important to earth today. Fluorines mysterious structure reacts vigorously with itself and other elements making things that impacted our technology, history, and daily lives. Fluorine is the chemical element of atomic number 9, a poisonous pale yellow part from the halogen series.It is the most reactive element and is composed of diatomic molecule F2. Fluorine was discovered in 1886 by Joseph Henri Moissan, who also produced the first artificial diamond. The element Fluorine has nine protons and electrons and ten neutrons. Fluorines atomic mass is 188. 998404 amu. Fluorines atomic number is 9. Fluorines density at 293 K is 1. 696 g/cm. That makes fluorine about 1. 3 times as dense as air. The electron configuration of Fluorine is [He] 2s2 2p5. Its crystal structure is cubic. To continue Fluorines name origin came from the latin word fluo (flow).Fluorine went through a long process before being discovered. Georgius Agricola german mineralogist in the 1530s described the use of the mineral fluorspar in metal refinal. â€Å"Fluor† in fluorspar is where fluorine got its name. Although Agricola didn't realize fluorspar was a mineral of Fluorine. During that time Fluorspar became an intense subject to chemist. Around the1800s chemist carried out experiments on fluorspar in attempts to isolate fluorine. However they failed to do so , instead produced what we call now hydrofluoric acid, a deadly acid.Carl Wilhelm Scheele studied and set off intense work to the acid and its composition. All chemist knew already that there had been a never before seenelement. However little did they know the element they were searching for was dangerous. In attempts to isolate fluorine led to bindings and many fatalities. A chemist named Belgian paulin louied died from exposure to the chemical. Finally in 1988 fluorine was isolated. Moissan made a solution of hydrofluoric acid by putting it in potassium hydrogen fluoride. He cooled the solution to  ­23 and passed it through an electric current.And then finally the gas they been searching for, for decades appeared. Henri Moissan received the 1906 Nobel prize in chemistry for his great achievement. Fluorine has any different complicated physical properties. Did you know that glass, ceramics,carbon, finely divided metals, and even water burn in fluoride. Fluorines has a boiling point of  ­188. 14 c and a melting point of  ­219. 62 c. When not pale white, yellow, or colorless Fluorine is fluorescent. â€Å"Most common substances like fluorine exist as states of matter as solids,liquids,gases, and plasma† (fluorine properties).Fluorine has a pungent sharp strong smell that can be detected in very small amo unts, as low as 20 parts per billion. In liquid form fluorine is freely soluble in liquid oxygen and ozone. Fluorine is the most chemically reactive element and the most electronegative. Fluorides chemical element is F. Fluorine is highly poisonous and explosive. That is why it took 74 years of continuous efforts to isolate the dangerous and corrosive element. When fluorine is mixed with water it reacts explosively on the contrary fluorine cannot mix with oxygen. To continue fluorine is heat resistant however very flammable.Fluorines electronegativity according to Pauling is 4. Fluorines 1st ionization energy is 1680. 6 jk mol ­1. The second is 3134 kj mol  ­1 and the third is 6050 kj mole. It combines easily with every other element except helium, neon, oxygen , and argon. That is why element must be handled with extreme care. Furthermore fluorine may be a pale white highly destructive element however it is very useful to the world and important to economy and technology. It ha s many commercial, industrial, and medical uses. Did you know that fluorine is used in rocket fuel, it helps the oxidizer in rocket fuel to burn.To continue isotopically fractionated uranium is created with the help of fluoridated compounds, which is a very important step in uranium purification in Dover plants. Fluorine is also used in melting metals to make lenses for focussing infrared radiation. Without fluorine teens and children of our era would always be bored. Fluorine is also used in the production of computer chips, micro electronic sensors, and television screens. One of the most common uses of fluorine is that it is found in toothpaste and mouthwash. It helps prevents tooth cavities and and dental decay.Fluorinated compounds help in the production of polymers in plastics. It's used to make polytetrafluorethylene and manufacture retractable roofs. Fluoridated compounds are found in refrigerators, air conditioners, and spray cans. They are used to replace chlorofluorocarbo ns or CFCS, which are very dangerous for the ozone layer. Furthermore Fluorine is used for glass etching meaning creating art on the surface of glass . It is also used to obtain pure aluminum. When going into surgery and being put to sleep fluorine is needed. It is used in inhalation anesthetics.Furthermore fluorine is also used to mark light bulbs and in the purification of water supplies. Fluorine is a huge importance to nature and humans. It keeps our water safe to drink and shower with. Imagine without fluorine our teeth would be rotten and water supplies would be polluted. Traces of fluorine are present in bones, teeth, thyroid gland and skin. Fluorine is also said to prevents diseases from decaying the body. â€Å"It is a germicide, and acts as an antidote to poison, sickness, and disease† (fluorine and importance of nutrition). fluorine is found in a great variety of foods and provides nutrients.

How Entrepreneurs Impact an Economy

Introduction As economies continue to integrate due to globalisation and formally closed economies like India and China march toward total liberalisation, entrepreneurship is on the increase. A close analysis of developed and industrialised economies indicates a common denominator that stands out amongst all of them, which is the important role played by entrepreneurship and entrepreneurs in such economies.This phenomenon has proved to us that if an economy is to develop fully, entrepreneurship should be allowed to flourish. Therefore it is the objective of this paper to critically analyse the impact of entrepreneurs in any given economy. In this paper the writer will identify and discuss the many benefits afforded to an economy through entrepreneurs and entrepreneurship and the disadvantages of the same and draw conclusions on the overall impact of the entrepreneurs. InnovationIndividuals often resort to entrepreneurship for one of the following reasons, because they find a market n iche and have the solution to profit from such niche, because they have been unable to find suitable employment or a suitable means of income and therefore have resorted to using their creativity to generate an income for themselves, or because they have the technological know-how and the financial resources (or able to source all of the above) necessary to generate income by satisfying a need in the marketplace.Irrespective of which of the above led an individual to become an entrepreneur it is clear that innovation and creativity is the driving factor and therefore it can be stated that the biggest impact of entrepreneurs to an economy is the innovative contribution that they make. Job Creation As stated in the previous section one of the main reasons that individuals tend to become entrepreneurs is because they are unable to find suitable jobs.As a result, by being enterprising, creative and finding a market niche, not only are they able to generate an income for themselves but a lso to employ other individuals in their business operations. Therefore one of the most positive impacts that entrepreneurs make on an economy is job creation and the reduction of unemployment levels within that economy. In developed countries we see that almost 40 – 50% of the workforce are employed in small and medium scale business enterprises that were started up by very enterprising individuals.Likewise in countries like India we see that millions of women have been able to pull their families out of poverty through self employment and entrepreneurship that has been made possible by different Non Governmental Organisations and due to the availability of such resources through micro finance etc. Africa is another good example of small scale entrepreneurs helping to reduce poverty and help many avoid destitution. Therefore based on everything that has been stated above it is apparent that entrepreneurs can cause a great degree of impact on an economy through job creation a nd income generation.Increased Competition Another positive impact of entrepreneurship on an economy is the increasing level of competition in that economy as new entrepreneurs join the fray in existing domestic markets. While one may venture to say that this will only lead to market saturation, the upside of such a phenomenon is that it causes all the players in the market to re-evaluate their operational capabilities, increase value addition, lower costs and become more efficient.Thus it can be stated that competition reduces likelihood of monopolies and oligopolies in the marketplace and is beneficial to the customer and the economy as a whole. Increased Productivity One of the advantages of increased competition in an economy is that individuals and firms continue to source methods that can better improve their operations, use resources more efficiently and most importantly reduce costs while adding value. All this often results in an increase in productivity in an economy and a increase in the gross domestic product (GDP), which is indeed a benefit for the economy.While opponents tend to state that when productivity increases the unemployment can often increase, thus reducing the positive impacts, it is the opinion of the writer that increased productivity which can then lead to increased unemployment will then cause more individuals to be creative, find niche markets, become entrepreneurs and begin generating more employment opportunities, thus re-inventing the wheel and driving the economy forward.New Markets As stated in the previous section increased competition in the marketplace can cause saturation and as a result many entrepreneurs maybe driven to seek new markets for their products and services or adapt market penetration tactics.Either way such a phenomena of increased competition, which ultimately causes individuals to look for new markets can be considered as a positive impact on the economy and therefore entrepreneurs can be considered to pla y a very important role in the economy. As integration of economies continues due to globalisation entrepreneurs often tend to look for markets that are outside of their domestic sphere thus generating foreign revenue and increasing the prosperity of the economy as a whole.While this maybe a very simplistic explanation of the impact that entrepreneurs make on an economy, it is also safe to say that the employment generation, increased competition, market expansion, market penetration and sourcing new markets all result in income generation that ultimately help an economy to become more prosperous, draw millions out of poverty and generate funds for social welfare activities that ultimately uplift the living standards of its citizenry.Negative Impacts of Entrepreneurs The single largest negative impact of entrepreneurs on an economy is the plundering of resources, which can have a disastrous affect on the environment. While such negative impacts are mitigated to some extent in develo ped economies due to the enforcement of environmental protection standards and regulations, this is not the case in developing economies.Further entrepreneurship requires a certain degree of business knowledge and know how, without which entrepreneurial ventures can often fail, which can also cause many financial hardship that in extreme cases can even lead to destitution. Social Entrepreneurship Today we see the realm of social entrepreneurship growing exponentially which is a very positive sign and has helped to draw millions out of poverty, decrease unemployment, decrease the number of people dependent on social welfare and all in all uplift the living standards and quality of life of millions.Further social entrepreneurship initiatives are also often seen as ‘green initiatives’ that take into consideration the impact on the natural environment and therefore strives to keep this at a minimum, thus increasing awareness about such issues, avoiding plundering of natural resources and conserving the environment wherever possible. Therefore it can be stated that the negative impacts of entrepreneurs on an economy can be mitigated to some extent through social entrepreneurship. ConclusionBased on everything that has been discussed above it is apparent that the positive impacts of entrepreneurs on an economy, far outweigh the negative impacts. Job creation, reduction in unemployment levels, increased competition, opening new markets, increasing productivity, foreign income generation and poverty alleviation are some of the positive impacts that entrepreneurs have on an economy. However this is not to say that there are no negative impacts such as the wastage and plundering of resources, yet taken as a whole it is apparent that the entrepreneurs positively impact an economy.

Secession of the South: Causes for Tension

Throughout the 1840’s and 1850’s a growing tension developed between the Northern and Southern states of America. That tension was primarily focused on the existence of slavery in the Southern states. Most Northern states had abolished slavery by 1850 and made a promise to the people to end slavery completely. They wanted the South to begin to become similar to the North, and to live under the concept of free labor, and not rely on slavery for productivity. The resentment for the interference of the North angered southerners because they felt that it was not the place of the federal government to interfere.Ever since the American Revolution sectional differences arose, the first being those favoring greater states rights and those favoring greater federal rights. Ever since the Revolution more and more dissimilarities arose between the North and the South due to differences in modernization and societal development. These different ideals caused tensions between the two sections and difficulties in staying together as a single union. The Southern ways of life were being targeted and altered by the North’s inconsiderate decisions of their societies foundation, though the North had a strong basis.The southern secession in 1860 was in direct result of the inability for the North and South to cooperate and coexist, and was the only possible alternative, in the minds of the southerners, for the different methods of living to remain. There were many aspects that varied among the North and South states that lead to the Civil War and among these were economic, social and political differences. Economic and social divergences between the North and the South were one of the most prominent factors leading to Southern secession.The Southern economy was heavily supported on cotton, due to Eli Whitney’s invention of the Cotton Gin, which made cotton extraordinarily profitable for most southern plantation owners. The southerner’s focus shift ed from all other previous crops to cotton, but cotton still required labor to be taken from the fields. Slavery became an institution that, in a sense, was the foundation for southern economy because of the fact that it was an inexpensive and vastly available labor source. Completely opposing southern society was that of the North, which was an industrial based economy instead of an agricultural one.The North utilized the raw materials and turned them into finish goods, making slavery neither an immediate necessity nor a foundation for their economy. The economic attitudes that differentiated the North and the South were exceedingly dissimilar and there was not a great deal flexibility for change. The southern reliance on slavery for labor and the northern perception of the institution as cruel and inhumane, were conflicts that challenged the southerners’ way of life and arose much tension between the two.Social differences between the North and the South coincided with thei r economic differences. The South, being agriculturally based could not relate and could not be related to by the North. The North experienced industrialization and drastically modernized, but the South continued with the traditional plantation system and strict social order it had began with, creating the lack of connection between the two due to two completely polar opposite societies. The North’s attitude towards the South was perceived as the attacking of another societies lifestyle and existence.With the limitations on the expansion of slavery, the growing abolitionist movement in the north and the election of Abraham Lincoln, secession was the only way to escape the North’s condemnation of the South as a whole. States rights versus federal rights, was a problem that arose from the time of the Revolution, a problem that undermined the union of the north and the south. After independence from Great Britain was acquired, the issue of states rights versus federal rig hts was in need of a solution.The Articles of Confederation was the first government succeeding the Revolution, in which states rights were favored, and states were united under a weak confederation. Ultimately failing due to conflicts that developed within the nation, the United States Constitution was established which put power primarily in the hands of the federal government. The new form of government was not popular among many states because they felt that their own individual states rights were being disregarded and lost the ability to act autonomously.The Nullification Crisis, being one of the biggest conflicts, occurred when South Carolina attempted to void and not follow laws implemented by Congress if they were deemed unconstitutional by the state. This problem arose from the Tariff of Abominations, which taxed goods from Great Britain and disrupted the trade of cotton in exchange for manufactured goods. The southern economy was being threatened by the new ideas of the no rth, enraging southerners that the north was abusing the power they had over the country as a whole.The Fugitive Slave Act of 1850 was an addition to the compromise of 1850, stating that if a slave escapes and flees into another state, being free or slave, the return of said slaves was mandatory. The North, being for the most part anti-slavery, defied the Fugitive Slave Act and harbored escaped slaves without returning them (Northern Sate Defies Fugitive State Act, 1). The inability for the North to understand the situation of the South and the South to understand the northern way of thinking added more and more tension to the already unstable union of the two.Western territorial expansion was a major problem among pro-slavery and anti-slavery proponents. The immense amount of land attained from the Mexican war and the Louisiana Purchase was beneficial for the completion of the United States but the slavery issue was only worsened. In 1820, to lessen the tension without creating any hasty conflicts, the Missouri Compromise was passed to decide whether new states added to the Union from the Louisiana Purchase would be slave or free states. The agreement stated, frankly, that states that were admitted to the south were slave states and those of the north were free states.In 1850, after the Mexican war the question arose again whether states would be free or slave states and this time solution was different than the Missouri compromise. The Compromise of 1850 was a bill that clarified the controversies that came with the New Mexico territory and did not follow the aforementioned Missouri compromise. James C. Calhoun, in reaction to the Compromise stated, â€Å"that the agitation of the subject of slavery would, if not prevented†¦ end in disunion† (A Dying Statesman Speaks out Against the Compromise of 1850, 1).The southern pride in their societal and economic structure openly accepted from the beginning that if slavery remains the issue, then secessio n remains the solution. In 1854 the Kansas-Nebraska Act was passed, which repealed the Missouri Compromise and stated that to decide whether these new territories would be free or slave, popular sovereignty among the settlers would be the ultimate decision. The passing of the law was to settle all unfairness and let the people decide, but the law was taken advantage of by pro-slavery Missourians.Kansas immediately was filled with Missourians who wanted to ensure that Kansas was in favor of slavery and intended to do so by increasing the pro-slavery concentration there. Northerners, desiring slavery to be banned and abolished, did the same to ensure that the pro-slavery Missourians did not make Kansas a slave state (Free State Convention, 1). The accumulation of angry pro-slavery southerners and anti-slavery northerners in Kansas resulted in open warfare in the city of Lawrence, Kansas (Kansas Begins to Bleed, 3).This physical conflict, â€Å"Bleeding Kansas†, over the section al differences of the North and South defined the division of the United States as a whole. The Election of Abraham Lincoln in 1860 resulted in the immediate secession of the many southern states, and the formation of the Confederate states of America. Lincoln’s statement â€Å" I believe this government cannot endure permanently half-slave and half-free. I do not expect the Union to be dissolved – I do not expect the house to fall – but I do expect it will cease to be divided. It will become all one thing or all of the other.Either the opponents of slavery will arrest the further spread of it†¦ or its advocates will push it forward, till it shall become alike lawful states, old as well new – North as well as South† (Abraham Lincoln, A House Divided, 1). Stated straightforwardly by the president, Lincoln addressed the issue of slavery and sectional differences by stating that either slavery will be abolished and put into extinction or will be an institution in the North and the South, because â€Å" a house divided against it self cannot stand† (Abraham Lincoln, A House Divided, 1).Abraham Lincoln was perceived by the south as a Republican that would further limit states rights and therefore, acting as the final catalyst, forced South Carolina to secede from the Union. Slavery was not the reason that the American Civil War was fought, but it was an underlying area of focus. Slavery was an institution that was much less appealing to northerners but crucially essential for southerners. The northern intent was to completely abolish slavery but could not completely do so immediately due to the southern dependence on the institution.Southerners knew that if slavery was not permitted to expand with the countries borders then the institution could not progress and would fade away and taking along with it the southern way of life. The tensions arose from the belief that the northerners were dominating the South, and the l ast resort of the southern states, after countless attempts to coexist, was to disaffiliate and form an independent union in which they could live as they leased with no repercussions. The initial and overall conflict for the actual war between the North and the South were the issue of federalism versus anti-federalism and the lacking of a strong connection between the two, making them act as if they were separate entities. The Civil War was fought to keep the southern states from seceding and a consequence of the North’s winning was the abolition of the institution of slavery

Use of Torture to Gain Intelligence Research Paper

Use of Torture to Gain Intelligence - Research Paper Example There are various reasons for torture. They include punishment, revenge, political re-education, deterrence, interrogation or coercion. Mostly the torture proves to be deliberately fatal, however, most of the time this is not the case and killing and injuring the victim is not the sole purpose. According to research, torture is not a very good way of obtaining information and actionable intelligence. This is because after a person received physical or psychological punishment, the mind breaks down as a result of which the information is subject to inaccuracies in memory recall. It was until the development of Humanism in the 17th century, deliberately painful methods of execution for severe crimes was taken as granted as part of justice. Torture was sanctioned by some states previously. In the 21st century, most of the countries have prohibited torture under the international and domestic laws. Under the UN convention and declaration of human rights, it is unacceptable and is conside red the violation of human rights. One of the most controversial aspects of the global ‘war on terror’ was the use of torture during interrogations. The United States of America administration for combating the threat of global terrorism developed several new methods. This happened after the terrorist attacks on 11 September 2001. The detention and interrogation of the suspected terrorists have been the central to the United States struggle against global terrorism (Walton, 2008). According to the international laws of warfare, the same rules of lawful combatants were not applicable for detained terrorists since they were not fighting as lawful combatants. However, some policymakers of the US argued that the use of torture should be legalized to gain intelligence under certain extreme circumstances. During the Algerian war of Independence (1954-1962), the French armed forces along with the Algerian National Liberation Front (FNL) made use of torture.

Rights Of Workers Essay Example | Topics and Well Written Essays - 1500 words

Rights Of Workers - Essay Example Gonos, in his article entitled â€Å"Never a Fee!† explained the historical experience of the effects and consequences of the staffing industry to the real welfare of workers, stating that the few laws existing and the deregulation of the staffing business has further undermined the â€Å"workers’ ability to gain self-sufficiency† (Gonos, 2000-01). A further analysis of secret fees charged should therefore be made in order that appropriate policy changes for the protection of workers. The union organizing policy presented in the article entitled â€Å"Never a Fee!† written by George Gonos, which I think should be changed is their reliance on establishing a â€Å"national code of conduct† which appeals on all the staffing agencies concerned to make available to workers the information regarding the rate which client employers pay workers (Ziegler, 1999). This policy merely encourages and urges the staffing agencies and do not really oblige or mandate that the â€Å"hidden fees† or rates in employment contracts be revealed. Instead of lobbying for a legislation that would truly examine and delve into the fees that are charged especially on temporary and contract workers by either the client firms or staffing industries or both, they have merely settled on having such a national code of conduct (Gonos, 2000-01). The group pushing for this code of conduct consists of groups representing contingent workers and represent other diverse interests suc h as workers in the construction business, workers belonging to labor unions, professionals belonging to the high-tech industries, graduate assistants from various universities, and some undocumented immigrants (Community Partners, 2009).   There is a seeming lack of follow through or inconsistency on the part of workers’ group to lobby and support such a legislation that would reveal the so-called â€Å"hidden fees† in employment contracts which has been a

TLMT312 WEEK 6 FORUM Assignment Example | Topics and Well Written Essays - 250 words

TLMT312 WEEK 6 FORUM - Assignment Example Reliability based trust is a necessity in cooperative partnerships. However, reliability based trust is not a satisfactory state. A perfect example is in relation to a partner that often portends to discipline and constantly adheres to his or her word is undeniably reliable. However, the same cannot be said of his or her character. On the other hand, character based trust is founded on the philosophy, leadership and culture of an organization (Bowersox, Closs, & Cooper, 2007). In essence, it originated from the awareness that partners in a supply chain are concerned about their individual welfare. Character based trust is important in collaborative relationships because no partner is able to perform any action without due consideration on the emergent impacts on other partners (Bowersox, Closs, & Cooper, 2007). Furthermore, the gradual development of character based trust translates to minimal vulnerability from actions among partners. When trust is inculcated among partners they are able to safeguard the interests of all partners. Character based trust developed when the partners have an awareness that all their actions are equitable and fair among all

Fire detection and suppression systems Essay Example | Topics and Well Written Essays - 1250 words - 1

Fire detection and suppression systems - Essay Example This can be in form of sirens, flash lights, telephone calls and a signal sent to the city’s fire department. It comprises the following parts: The alarm system is composed of mainly the control panel, power supply, zone feature, input devices and the output devices. The input devices are the sensory zones of the alarm hence they include the smoke and heat detectors. If the signal is high enough, the control panel would provide notifications about the danger posed by the changes in the detectors. However, some signals may require immediate attention, for example a fire alert in a specific room of a building. In such an instance, the zone feature is programmed to activate instant sprinklers that would put off the fire. Finally, the output devices include the horns, voice announcements and flash lights that indicate danger (Hirschler, 1992). Fire alarm systems are very important in notifying the occupants of the building under fire to vacate. They are designed to use both sound and visual warnings hence ensuring evacuation of the buildings thus saving lives. In the recent models of the alarm systems, they are programmed to inform an individual the specific location of the fire hence giving him or her right direction of the nearest exit (Sturzenbecker, Adams & Burnside, 2012). The alarm systems assist the fire fighters to easily locate the building under fire thus facilitating quick response to the fire. In addition, the alarm system may produce a human voice that informs them of the location of the fire hence.

S4 W7 DQ1 Assignment Example | Topics and Well Written Essays - 250 words

S4 W7 DQ1 - Assignment Example The situation became worse as the situation in the country started impacting negatively in the neighboring countries. It was at the time that the Kenya Defense Forces (KDF) decided to launch an attack in country to flush out the terror group. Questions were being asked on where were the international bodies when the country needed liberation? Was the situation bad enough to capture their attention? It is for this reason that the west should focus on strengthening regional organizations (Clement & Smith, 2009). With organized regional organizations like the ECOWAS, situations like in Somalia would have dealt with before the country was fully paralyzed. With many regions across the globe having organizations controlling leadership and economic operations, the west should pick out these groups and develop proper security forces to deal with cases of insecurity among its member states (Clement &Smith, 2009). A good example is the League of Arab States which was formed with the aim of cushioning the region financially and economically. With the rise on the need for security across the Arab world, the body is playing a crucial role in ensuring its members states are provided with peacekeeping

Roles Reversal of the Democratic and Republican Party Research Paper

Roles Reversal of the Democratic and Republican Party - Research Paper Example Currently, democrats can be described as the real stewards of the status quo while Republicans are now struggling to bring changes in the United States. As much as the two parties have undergone modifications such that they appear to have reversed their positions, the royalty from the public has not changed. By this, I mean that those regions that were loyal to the conservative Republican remain loyal to the somehow radical Republican while the region royal to the radical Democratic Party remain loyal to the less liberal Democratic Party. However, it is irrefutable that certain aspects remain unchanged in either of the two parties. This paper argues that the Republican and Democratic parties have reversed their roles but most people remain loyal to either of the party because they do not know the history of the Democratic and Republican parties. Background of Republican and Democratic Parties Democratic Party origin can be traced back to the period before America attained independenc e from British. It was enhanced by Anti federalist factions. On the contrary, anti-slavery objectors instituted the Republican Party in 1854. However, Republican Party remained less popular until the Election of Abraham Lincoln who was the first Republican Party. During its foundation, Democratic Party was grounded on liberalism ideology while the Republican Party was based on conservatism. The different ideologies are depicted in personal and economic issues (Meyers web; Berg-Andersson Web). Liberalism advocate for individual autonomy over morality in addition to favoring economic equality over freedom. Liberalism also supports government actions to reduce poverty by redistributing the wealth. On the other hand, conservatism approves of personal morality over freedom and advocate for economic freedom over equality. Conservatives promote traditional principles such as strong patriotism (Parla Web; ProCon Web). Additionally, conservatism supports the idea that the government should n ot involve itself in role such as helping individuals and opposes attempts to redistribute income between the wealthy and the poverty-stricken. The ideologies also dictated the possible ways of reacting to different issues with Republicans being more likely to put economic freedom above equality while Democrats were likely to put equality over economic freedom (Berg-Andersson Web; Parla Web). Democrats are considered to be on the left side of the political spectrum and commonly referred to as the leftist while the republican are considered to be on the right. With time, the two parties have been characterized by change in their ideological platforms and specifics. Currently, neither of the two parties fully represents the same ideologies it did during the initial stages of the foundation. Additionally, the parties have undergone drastic changes in the past four decades, which has been portrayed by the change in the leadership styles by recent presidencies from each of the two partie s (Meyers Web; ProCon Web). The Democrats were initially a States Rights party, and strongly supported slavery. On the other hand, the Republicans started as an abolitionist party, whose members strongly opposed slavery. Currently, Republicans advocate and support States Rights, and are against any attempt by the government to increase taxes. On the other hand, Democrats prefer to use Federal funds and power to improve the lives of the poor as demonstrated by

Whether the No child Left Behind Act has an effect on graduation rates Essay

Whether the No child Left Behind Act has an effect on graduation rates and the economic growth of the State of Georgia - Essay Example For instance, the law requires states to test students in reading and math by 2014 which challenges their learning ability skills. Georgia is the state with most high school dropouts and poorest record in the percentage of high school graduates. Georgia attributes these poor records to the state’s vast economic challenges ever since the Great Recession period. In sum, it is clear from the report that the graduation rates as per ethnic groups in the U.S have increased since the implementation of the NCLB act. Evidence from the data that was statistically proven, it was realized that the African American graduation rate was at 44%; white’s graduation rate was 61% and Latinos was 32%. From the analysis all states in the U.S need to ensure that all students attend schools in order to increase graduation rates. Additionally, policymakers need to ensure that all ethnic groups attend schools to avoid the increase in number of school dropout as it is the case in Georgia. Center for Civic Innovation (CCI) At the Manhattan Institute. (April 2002). High School Graduation Rates in the United States. Web. 12 April 2014 Retrieved from

Mountain Man Brewing Co Essay Example | Topics and Well Written Essays - 1000 words

Mountain Man Brewing Co - Essay Example Mountain Man Lager will have to face the existing competition in new regions. Proven success with the blue-collar customer segment will help in identifying similar customer segment in new regions. Risk of losing or not establishing similar brand image in new markets amidst tough competition. Boost sales of Mountain Man Lager. Risk of not establishing market share as expected. Lack of knowledge of customers’ preferences in new markets. Roping in new distributors in the new regions will be a challenge. Increased distribution and logistics costs. Alternative two: Introduce new product line, Mountain Man Light in existing market targeting younger generations in the Eastern Central region of the US. Pros Cons Attract newer customer segment, which is already looking for products such as light beer. Risk higher costs versus profits initially. Capture diversified market segments through increased product lines. May not earn brand loyalty like MM Lager did, which might further affect b rand image of MM Lager. Improve market share while banking on existing brand image of Mountain Man. Loyalty could be due to Mountain Man Lager rather than MM Light. Disloyalty towards MM Lager by its customer segments. Workload on the smaller sales force. Competition from already existing brands that have better market share. Challenge of distributors’ acceptance of the new product. Huge competition from other companies in terms of variety, costs, and brands. Recommendation: Based on the information and data, better option for improving profitability of MMBC would be to expand their core brand, Mountain Man Lager, into other markets within the US. The Mountain Man Lager had occupied 70% s off-premise sales in East Central Region and almost 60% of blue collar males were the purchasers from these locations (Abelli, 3). To earn such market presence and earning distributors in new regions would be a challenge, for which existing sales force can be mobilized to use their expertise to get more off-premise locations to sell Mountain Man Lager in other states. Establishing similar brand image in new markets can be accomplished by using MMBC’s brand image and history of success to convince new distributors and off-premise owners. Some amount of market research would help in identifying customer preferences in new regions, and promotion of Mountain Man Lager can be focused on such customer segments. Distributors and/or off-premise locations in regions that contain better concentration of the suitable customer segments would be ideal target market for Mountain Man Lager in new regions. Moreover, Mountain Man Lager’s flavor, price, and quality will be able to counter competition from existing brands in new regions. This is because this product already established itself amidst competition from imported and craft beer products in East Central Region (Abelli, 4). Mountain Man Lager can be considered as the defensible strategy for MMBC, which was not cou ntered by other products serving this customer segment in the East Central Region for more than 50 years. In this region, the issue was with increasing customer segments that preferred other beer product categories (light beer), which posed a threat to the

Theory to Practice Essay Example for Free

Theory to Practice Essay The two parties involved never had a valid written contract. In the scenario, the parties negotiated for a period of 90 days and 3 days before the deadline set in the original negotiation contract they reached a verbal distribution agreement. In the original negotiation contract, it states that there would be no distribution contract unless it was in writing. When the BTT manager sent the e-mail to Chou, he mentioned the terms of a distribution agreement, but it does not make the email a contract due to the fact that neither party signed it. Only an oral agreement was reached. Without a legally binding draft and both parties signatures no contract exists. Though the contract was in process even the details had been identified, however; it fell through the cracks because of the management change at BTT. Initially, BTT paid Chou $25,000 for exclusive negotiation rights to his board game for a 90-day period and held meetings where details were discussed and agreed upon. This lead Chou to believe they were serious about finalizing an agreement on a distribution contract. Chou received an e-mail with the details of the contract, however; nowhere on the e-mail did it note that it was in-fact a contract. Chou received a fax from BTT requesting a draft for a distribution agreement contract. Chou immediately responded and then did not hear back from BTT for several months. New management at BTT took over and made the decision to inform Chou that they are no longer interested. Since the contract was not drafted within the original 90-day period, the new management was not obligated to distribute the board game, and therefore, had every right to turn Chou away instead of  honoring the oral contract. However, the statute of frauds also constitutes the e-mail as a sign document. â€Å"Case 6.3 Stevens v. Public is a great example of the court awarding the contract since the e-mails contained the name at the end of each message that signaled the author’s intent to validate its contents,† (Melvin, 2011, p. 152). The fact that both parties were communicating by email did not have an impact on my analysis of the situation. In the paperless world that has evolved, electronic communication is just as effective as paper communication. This e-mail shows an agreement by both parties on the key terms of the distribution agreement made in the meeting. Even though the e-mail never stated the word â€Å"contract,† this e-mail still shows an acknowledged contract of terms between BTT and Chou. Using the Mailbox rule, this e-mail had a name at the bottom of the page is considered a signature on an electronic document (Melvin, 2011, p. 137). Under the Uniform Commercial Code (UCC), the statute of frauds applies to any contract for the sale of goods for $500 or more, and any lease transaction for goods amounting to $1,000 or more (Melvin, 2011, p. 151). Chou received the $25,000 under the negotiation agreement, which should be considered under the sale of goods of the Strat game. Under UCC laws, the statue of fraud applies when a contract cannot be fulfilled within one year’s time. Under these stipulations, the statute would apply. However, there is one element required to meet this stipulation, and that is the signature of the party in the contract. The e-mail from BTT shows the acknowledged agreement between the two parties with a name at the bottom of the e-mail showing an electronic signature from the company. The issue of Chou being misled by the money, verbal agreement, and the e-mail could also be used in this scenario. BTT cannot avoid this contract with the doctrine of mistake because there was no unilateral mistake in the scenario (Melvin, 2011, p. 141). A mistake is defined under contract law as â€Å"The belief that is not in accord with the facts.† They have not done anything to indicate there were any mistakes on the agreements with Chou. Chou may have a unilateral mistake because his  90-days were up in just three days. He managed to get an oral agreement with BTT in a timely manner. Before Chou could type up their agreement, a BTT manager sent him the e-mail that stating the agreed information, he made the mistake of thinking this was the contract from BTT. Assuming arguendo that the e-mail constituted an agreement between BTT and Chou, both parties were in agreement to the terms of the distribution agreement even though it was only verbal. The verbal agreement was done within the 90-day period as specified by the negotiation agreement. Also, BTT gave a check for $25,000 for the exclusive negotiating rights shows that BTT intended to reach a contract with Chou. Both parties had been actively participating several months as if the agreement were in active status. Finally, BTT had also sent Chou a fax asking him to send them a draft of a contract for the distribution agreements. BTT has stated they are no longer interested in distributing Chou’s new strategy game, Strat. By BTT making this decision, they are breach of contract with Chou. Chou could be entitled to sue BTT in an attempt to recover damages. Remedies at law would constitute compensatory damages against BTT. Some of the claims that might be legitimate to this case are: 1. Breach of contract- There are some cases where the breach is not material, sometimes referred to as partial breach, where the nonbreaching party may not be relieved from performing. However, the nonbreaching party may still recover damages related to the breach from the breaching party (Melvin, 2011, p.168 ). 2. Compensatory damages- Cover a broad spectrum of losses for recovery of actual damages suffered by the nonbreaching party. These damages are an attempt to put the nonbreaching party in the same position she would have been in if the other party had performed as agreed. This includes such sums as out-of-pocket damages and even potential profits that would have been earned if performance had occurred (Melvin, 2011,p.171). 3. Injunctive relief- A court order to refrain from performing a particular act is known as injunctive relief (Melvin, 2011, p.173). 4. Promissory estoppel- Theory allowing for the recovery of damages by the relying party if the promisee actually relied on the promise and the promisees reliance was reasonably foreseeable to the promisor (Melvin,  2011, p.143). 5. Consequential damages- Consequential damages compensate the nonbreaching party for foreseeable indirect losses not covered by compensatory damages. An aggrieved party is entitled to recover consequential damages if the damages are caused by unique and foreseeable circumstances beyond the contract itself. In order to recover consequential damages, the damages must flow from the breach (i.e., the damages were a consequence of the breach) (Melvin, 2011, p.171). 6. Restitution- Restitution is a remedy designed to prevent unjust enrichment of one party in an agreement. In the event that one party is in the process of performing the contract and the other party commits a material breach, the nonbreaching party is entitled to rescind (cancel) the contract and receive fair market value for any services rendered (Melvin, 2011, p.172). 7. Liquidated damages- Liquidated damages are damages that the parties agree to ahead of time. In some cases it may be very difficult to determine actual damages, so parties may agree at the time of the contract that a breach would result in a fixed damage amount. Liquidated damages provisions are commonly used in license agreements (such as a software-user’s license) whereby the parties agree (Melvin, 2011, p.172). 8. specific performance- Specific performance is a remedy whereby a court orders the breaching party to render the promised performance by ordering the party to take a specific action. This remedy is only available when the subject matter of the contract is sufficiently unique so that money damages are inadequate. 17 Therefore, specific performance is rarely available in a sale of goods case unless the goods are rare (such as a coin collection) or distinctive (such as a sculpture) where the buyer cannot reasonably be expected to locate the goods anywhere else (Melvin, 2011, p.172). 9. Reformation- When the parties have imperfectly expressed their agreement and this imperfection results in a dispute, a court may change the contract by rewriting it to conform to the parties’ actual intentions. This contract modification is called reformation (Melvin, 2011, p.173). Technically a breach of contract only exists if BTT sent the e-mail within the 90 day period. If the e-mail was not sent within the 90 day period there is a possibility that the stipulations in the negotiation agreement will cause trouble for Chous case. However, BTT did eventually send the e-mail  which I believe will hold up in court, and give Chou the remedies he needs and deserves. There are many rules that one must follow to make a contract a legal document. Whether a document is written or an oral agreement, these must be followed exact. People whether they are business owners or not, face issues with contract on a daily basis. This is why there are laws in place to protect them and punish them when fraud occurs. References Melvin, S. P. (2011). The Legal Environment of Business: A Managerial Approach: Theory to Practice. New York, NY: McGraw-Hill/Irwin

The Study Of Female Deviance Criminology Essay

The Study Of Female Deviance Criminology Essay Living in a period which had totally ignored women and the study of female deviance (prior to 1960s), Professor Frances Heidensohn saw, as other criminologists, the immediate need for research and study on the deviant woman. As a pioneer of feminist perspectives in criminology, Heidensohns work provided the too much mans land of criminology and how women have been unfairly treated and neglected in previous studies. Heidensohn is considered to be a revolutionist in this field of criminology due to her pre-feminist work (Heidensohn 1968 and 1970) on the invisibleness and silence surrounding the female offender  [ii]  .Throughout her work and extensive research on a variety of different writers and criminologists, she stressed the lack of attention on gender dimensions and the tendency to over-sexualise women crimes. Clearly upset of this status quo, she pointed out also the necessity of taking into account autobiographical experiences of female offenders, who are the actual objects of this study. Frances Heidensohn; a professor in the Department of Sociology at London School of Economics, by her investigation on the study of gender in the context of crime, could be said to have set the foundations for next generations studies on feminist perspectives in criminology. Her biggest question mark was why the chapter of women and crime has been buried for such a long time and why there has been a failure to examine such an important issue. Most of her books and articles try to provide adequate aetiologies to all these question marks. Fortunately, things changed since the 1960s and feminism criminology was developed. As Heidensohn suggested in a metaphorical way, Like a wardrobe of new exciting clothes, a whole treasure generated in criminology. It offers us a great deal more to enrich our knowledge of women and crime. But there is much more on offer too.  [iii]  In other words, Professor Heidensohn held that even thought feminist criminology has been developed there are still many gaps and much more to be done. Thus, Heidensohn illuminated the path towards the understanding of female criminology. In the field of criminological study and most sociological research and writing, analyses of criminal women cannot be found before the 1960s. But even where they are considered, they are subject to marginalising and distorting treatment as Oakley noted in 1982  [iv]  or similarly as Klein suggested female criminality has often ended up as footnote to works on men that purport to be works on criminality in general  [v]  . This lack of interest was really surprising in Heidensohns eyes.  [vi]  As Frances Heidensohn noted in an important early article on deviance, virtually no serious scholarship has been undertaken to explain the dramatic difference between male and female lawbreaking.  [vii]  Hence, this status quo, which was much more due to male dominance, impelled her to start an extensive research on the subject to provide sufficient answers to all these questions raised. What was central to her work was the amnesia and neglect of women in previous studies in crimi nology and the fact that even where women were recognised, they were depicted in terms of stereotypes and based on their supposed biological and psychological nature  [viii]  . Her major argument which she highlights in all of her books, articles is the necessity of exploring gender in terms of understanding crime. Her discussion was concerned with personal experiences and autobiographies of women offenders in relation to the courts, the law and the police. She strongly stressed that at all levels women have been treated differently than men and in some cases harsher. Under the provisions of criminal law, women are theoretically equal to men. Conversely, she underlined that in many cases the laws on prostitution, for instance, prejudice against women and in general there is tendency to over-sexualise female crime. Frances Heidensohn objected this attitude towards female crime. Prostitution was seen only as sexual deviance and not as the rational choice for some women who need the financial support for themselves and their children (Heidensohn, 1968, p.168)  [ix]  . Klein also shared this opinion. Furthermore, criminal laws and lawyers tended to apply stereotype notions of what a proper woman is and does and dual assumptions such as virgin and whore were made when dealing with female offende rs. Yet, Heidensohn did not criticise that and she recognised that one cannot divorce the law and lawyer from the society in which they operate with its enormous cultural heritage and traditions  [x]  .Although she did argue about the too much mens world that existed, truly annoyed by the domination of men in administration as well as in the draft of legislation because of the implications that had on female offenders. Further, the courts even though women committed fewer and less serious crimes than men, were often harsher with women. According to Frances Heidensohn, there were several reasons that explained this stance by the courts. One of the strongest arguments that she made was that female criminals were considered to be doubly-deviant. Women criminals were very rare phenomena, a fact that biased the behaviour of the courts towards them. As Heidensohn had pointed out in one of her earliest presumptions, Women defendants therefore seem stranger and thus less comprehensible than men: they offend both against societys behavioural rules about property, drinking, or violence and also against the most fundamental norms which govern sex-role behaviour  [xi]  (Heidensohn, 1970, p.134). In other words, if they had been morally wrong, then they will be punished more; Courts and other agencies treat women as deviant twice over: they have broken criminal law and social expectations of proper female behaviour.  [xii]  In addition, the whole court procedure is something particularly bewildering, alien and unfair to female offenders.  [xiii]   While doing her research, Frances Heidensohn gave a great emphasis on the stereotype notions and the social standards that the society held for criminal women. In patriarchal societies, women were perceived as a source of disorder. Moral values and accepted social standards, especially in previous periods of time, rendered women subject to stricter rules. Moreover, the witch image as well as that of the whore seemed to be the key portrayals of the deviant women. The stereotype of witchcraft, which has always been linked to women, gave the idea of deviant women as especially evil, depraved and monstrous  [xiv]  . On the other hand, the tendency to sexualise the female offences portrayed them as whores. Professor Heidensohn argued that no such notions exist, equivalent to male deviants. On the contrary, male deviants either receive public approval-boys will be boys,- or are at least more positively portrayed  [xv]  . She continued her argument and she strongly criticized the ro le the media had overplayed in forming these ideas; male offenders in novels, films were presented as heroes, something that affected the public reaction and opinion. In reviewing traditional criminology and classical criminological writers, Heidensohn observed that female criminality was determined by their biology and psychology. Lombroso; the father of criminology, and Ferreros research, which focused on the meditation of the skulls, bones and appearance of female criminals, came to the conclusion that women deviants could be recognised by their physical appearance and they had very similar characteristics to male deviants. Women criminals like their masculine counterparts, had certain allegedly atavistic features, notably unfeminine features and built and dark masculine hair.  [xvi]  Additionally, they claimed that criminal women are abnormal. Following these lines, Professor Heidensohn found herself contrary to this presumption. She argued that his analysis of photographs of fallen women is as objective as adjudication in a beauty contest.  [xvii]  Furthermore, Lombroso and Ferreros theories did not provide us an adequate and precise understanding of female crime.What they did show us was the attempt to rationalise and justify the status quo, the existing position of women and the double standard of morals of their day.  [xviii]  Thus they did not draw away from the stereotype notions and the dual assumptions about women (good or bad, normal or abnormal). Deviant Womens experiences was a central method used by Frances Heidensohn and feminist writers towards the understanding of female delinquency; concentration on the researched and their experiences. Even though this methodology received much criticism (Ramazanoglu and Holland 2002)  [xix]  , Heidensohn and Gelsthorpe argued that close reading of feminist discussions ultimately reveal no fixed absolutes beyond the need for sensitivity in the research task, for personal reflexivity and commitment to make the research relevant to women.  [xx]  This methodology vested women the right to speak for themselves, their experiences, their feelings and thoughts. The technique of viewing the world through womens eyes was successful in making women visible in criminology and additionally created awomens world too. The concentration on womens experiences led to some crucial developments in female criminology and feminist contributions to criminology. Feminism standpoitism as Harding puts it (1987)  [xxi]  reflected the concept of viewing the world through womens eyes and encouraged both theoretical and personal reflexivity in relation to knowledge and the process of knowledge production through research.  [xxii]  However, the key aspect of focusing on the experiences of female criminals was that it rendered gender as the basis of understanding and interpreting crime and social conduct rather than simply as a statistical variable. As a synopsis of her study, Frances Heidensohn argued that what seems to be needed in the study of female deviance is a crash programme of research which telescopes decades of comparable studies of males.  [xxiii]  Also, she was consistent with what Mannheim recommended, who held that an objective and scientific approach should try to treat female crime as a topic in its own right.  [xxiv]  She therefore concluded in her book on Women and Crime that in order to gain understanding on women and crime other analyses such as family life, position and social control of women, male dominance should be taken into account. Arguably, she supported that this could not be achieved through feminist criminology or sociology of deviance.  [xxv]   Frances Heidensohns observations have not been subject to too much criticism as Lombrosos or other criminologists theories. However, some points that she did make were subject to debate and disapproval. Allison Morris was one of those who contravened with some of her presumptions. Her enantiosis was basically on the fact that the criminal justice system is a peculiarly alien an unfamiliar world  [xxvi]  only for women. Morrison focused on the belief that criminal law is sexist in the treatment of deviant girls and women and she went on to say that such factors as race, family circumstances and commitments, types of offence and previous record all clearly mediate the treatment of both female and male defendants and may be that some of those factors are as important as gender, if not more so.  [xxvii]  Indeed, Heidensohn relied on this assumption; that sex is the most crucial aspect and that it is not only women who are being deprived in the criminal justice system. However, wh at Morrison strongly argued was Heidensohns failure to identify other groups of people who could be treated unfairly under the criminal system or the court could be biased against them and to whom the whole process might be unfamiliar and alien. Such groups of people, as Morris suggests could be for young black and working -class men or minorities.  [xxviii]  Finally, she pointed out that it is wrong to present womens experiences in the criminal justice system as a unitary experience. We know that black women are over-represented in our prisons. We need to be able to account for this.  [xxix]  In my personal opinion Morrison made a full disclosure of the reality; that minorities or black people or people of different social standards, could also be treated unfairly in court or could be subject to discriminatory wrongs. She made a very strong argument which did take into account and tried to defend other social and powerless groups and not only women, something that Heidensoh n failed to do. Moreover, that could be the basis for other perceptions that Heidensohn provided. This is the one of economic rationality or that of stigma. Consequently it is not only women who can be motivated by the economic needs to commit a crime; people of a lower class can commit crimes as a result of poverty; or it is not only women who fear the idea of being stigmatised by their offences. Carlen Pat also argued at this part that this stance could cause race or class conflicts. Finally, in general Carlen suggested that no feminism theory could offer aetiologies to three major issues concerning female delinquency; that womens crimes are in the main, the crimes of the powerless; that women in prison are disproportionately from ethic minority groups; and that a majority of women in prison have been in poverty for the greater part of their lives.  [xxx]   Synoptically, Frances Heidensohns contribution to criminology was enormous in relation to female offenders. It could be said as having two sides of a coin. Her research in conjunction with that of other feminist criminologists illuminated the path towards the understanding of the female deviance. However, even though they shed some light on it there are still some dark aspects. As Frances Heidensohn pointed out, the study of female deviance has still a long way to go. The most crucial drawback that I can identify in her work was the lack of consideration of other factors that could play a valid role in the field of understanding crime such as race, class, nationality, age and other social characteristics rather than only focusing on gender dimensions and giving privileges only to women.

Treating Long Head of Biceps (LHB) Pathology

Treating Long Head of Biceps (LHB) Pathology Abstract Background Clinical examination of the shoulder joint has gained attention in recent years as clinicians aim to practice with an evidence-based and accurate clinical examination of the biceps tendon. There is an increased desire for proper diagnosis while simultaneously minimizing costly imaging procedures and unnecessary procedures. Thus, the purpose of this study is to create a decision tree analysis that enables the development of a clinical algorithm for diagnosing and subsequently treating long head of biceps (LHB) pathology. Methods A literature review of level one and two diagnostic studies was conducted to extract characteristics of clinical tests for LHB pathology through a systematic review of Pubmed, Medline, Ovid and Cochrane Review databases. Tests were combined in series and parallel to determine final sensitivities and specificities, and positive and negative likelihood ratios were determined for each combination using a subjective pre-test probability. The gold-standard for diagnosis in all studies included was arthroscopy or arthrotomy. Results Seven studies regarding LHB clinical diagnostic testing met inclusion criteria. The optimal testing modality was use of the uppercut test combined with the tenderness to palpation of the biceps tendon test. This combination achieved a sensitivity of 88.4% when performed in parallel and a specificity of 93.8% when performed in series. These tests used in combination optimize post-test probability accuracy greater than any single individual test; adding a third test decreases accuracy. Conclusion Performing the uppercut test and biceps groove tenderness to palpation test together has the highest sensitivity and specificity of known physical examinations maneuvers to aid in the diagnosis of long head of the biceps pathology as compared to diagnostic arthroscopy (The PEC exam). A decision tree analysis aides in the PEC exam diagnostic accuracy post testing based on the ordinal scale pre-test probability. A quick reference guide is provided to use in the clinical setting. Level of Evidence: II Systematic Review and Meta-Analysis Key Words: biceps tendon; long head; physical examination; pathology; diagnosis; shoulder examination Introduction The physical examination is a requisite and inexpensive component to medical diagnosis. The shoulder examination, in particular, encompasses a myriad of special provocative maneuvers, displaying a wide range of sensitivities and specificities pertaining to diagnostic accuracy. Accurate understanding from the correct sequence of maneuvers or tests increases diagnostic yield. In the modern era, clinical diagnosis heavily relies on imaging modalities including ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT), arthrography, and arthroscopy to diagnose shoulder pathology21,33. Current gold standard diagnostic testing options have limitations. MRI has poor statistical characteristics for diagnostic accuracy as it very reader and technician dependent, adds both direct and indirect costs, and may be less accurate than the physical exam37. Diagnostic arthroscopy is successful in diagnosing intra-articular pathology, but is limited in visualization for extra-articular pathology, is costly, and increases patient risk37. Increased use of diagnostic imaging contributes to rising health care costs14,30,32,38. According to the Centers for Medicare and Medicaid Services (CMS), diagnostic imaging costs are significant, accounting for up to 40% of overall healthcare expenditure increases over the past 10 years25. Advanced imaging techniques res ult in not only higher direct costs, but may increase indirect costs and jeopardize outcomes36,39. As the healthcare landscape transitions to cost minimization and value-based healthcare delivery, the development of an efficient, cost-effective, shoulder examination is desired. Shoulder examinations have poor sensitivity and/or specificity that makes diagnosing certain pathologies difficult4,28,30,33. Thus, evaluating the long head of the biceps brachii tendon (LHB) pathology with high-yield examination maneuvers can aid physicians through increasing the accuracy of shoulder diagnoses and aid in surgical decision making. Previously published studies focused on the following questions: whether physical examination special tests correlate with surgical findings; whether imaging correlates with surgical findings; and whether physical exam tests are accurate enough to diagnose pathology effectively5,9,10,26,28,29,33. Currently, there is a need to develop new algorithms to provide shoulder practitioners with a practical but comprehensive evidence-based approach to diagnose LHB pathology during an office visit and to further reduce the need for diagnostic imaging20,22,34. The purpose of this study was to perform a systematic review and a secondary sensitivity analysis based on pre-formed likelihood scenarios based on the history of present illness (HPI) past medical history (PMH), and epidemiology to provide clinicians a practical, evidence-based clinical (P.E.C) physical examination algorithm to accurately diagnose patients with LHB pathology. Specific objectives were to: compile the peak performing physical exam tests extracted from level I and II studies within the English literature; synthesizing the most accurate test combination; develop a clinical algorithm to provide quantify LHB diagnostic accuracy; and create a diagnostic accuracy reference guide. Materials and Methods A systematic literature review with the terms proximal, biceps, clinical and examination in the Medline database through the Pubmed, Medline, Ovid and Cochrane Review databases was completed in May 2015. The searches included the use of Boolean operators such as AND and OR. The databases were scrutinized independently by three authors. Inclusion criteria included studies that were focused on physical examination tests and compared to the diagnostic gold standard from Level I and II studies published in scientific journals. Exclusion criteria were: non-English, non-full text, level III of evidence or lower, related to superior labrum anterior to posterior (SLAP) lesions, investigated rheumatoid arthritis patients, or did not compare tests to a validated gold standard. The validated gold standard utilized for all studies and systematic reviews included were diagnostic arthroscopy or arthrotomy to confirm anatomical findings. Relevant studies were independently assessed, and conflicting studies were included only if there were consensus amongst the authors. References of included studies were additionally evaluated to identify additional articles for inclusion. Applicable data was extracted by reverse calculation where the information desired was not directly stated. Using PRISMA guidelines for systematic reviews (Fig. 1), our original search retrieved 2,086 studies from Pubmed, Medline, Ovid and Cochrane Review databases. Twenty-eight additional records were included through a review of references from each article included in the systematic review. After duplicates were removed, the initial search yielded 2,112 studies. Subsequently, 1,689 studies were removed for irrelevant titles or abstracts, and an additional 362 were excluded because they were not in English. Lastly, the remaining 63 articles were assessed for eligibility; 14 were excluded for non-full text, 22 were excluded for not being level I or II study, and 18 were excluded for non-relevant data. The data extracted was summarized and analyzed according to the statistical methods described by Eusebi et al. focusing on test specificity, sensitivity, positive predictive value and negative predictive value12. Next, clinical tests were combined to assess improved diagnostic accuracy. The clinical tests were applied both in parallel and in series. The first approach in parallel analysis, consists of two special tests performed in theory at approximately the same time. The parallel analysis can interpret the findings in an and or or technique. When a parallel analysis is performed in an or technique, the overall sensitivity of the two tests is greater than the sensitivity of either special test alone. This parallel analysis allows for two opportunities to observe the potential pathology. If both tests are negative then it is considered a negative finding in the algorithm and rule out the pathology, but if just one of the two special tests is positive then it is not considered a negative result in parallel analysis. The second approach in series analysis, consists of two special tests performed; however, the overall negative or positive finding depends on the outcomes of both special tests. By utilizing two special tests in an and technique in series, the specificity for both tests is higher than for either test alone. If both special tests are positive, then it is considered a positive result. If either special test is negative, then the in series analysis cannot be considered a positive result. In order to calculate the post-test diagnostic probability of LHB diagnosis, we performed calculations for each test with four pre-test probability options. Pre-test probability is defined as the probability of a patient having the target disorder before a diagnostic test result is known. Therefore, pre-test probability is based on patient history, subjective complaints, epidemiologic probability and the medical opinion of the provider ordering the test. The ordinal scale created has four different probabilities: very unlikely 0.2 (20%); unlikely 0.4 (40%); likely 0.6 (60%); and very likely 0.8 (80%). The physical exam test combination with the optimal test performance was identified (named the PEC exam). A decision tree analysis was developed to determine the PEC exam diagnostic accuracy post testing based on the ordinal scale pre-test probability. A table was created as a simple reference guide to use in the clinical setting. Results The initial electronic database search retrieved 2,112 unique articles, with 28 obtained from a manual search of reference lists. Of these, 2051 studies were found unrelated to the topic of interest based titles and abstract review, resulting in 63 full-text articles evaluated according to selection criteria. Fifty-four articles were excluded for the following: full-text unavailable (N=14), not a Level I/II study (N=22), and irrelevant data after full-text review (N=18). Seven relevant (N = 7) articles were identified through the systematic review and scrutinized (Supplementary Table S1). From the reviewed articles, special tests and modalities evaluated included Speeds, Yergasons, bicipital groove tenderness, uppercut, bear hug, belly press, OBriens, and anesthetic injection. Statistical characteristics for each test are documented in (Supplementary Table S2). The bear hug and uppercut special tests demonstrated the highest sensitivity for the physical examination special maneuvers (79%, 73% respectively), whereas the belly press and Yergasons tests demonstrated the lower spectrum of sensitivity (31%, 41% respectively). The belly press and OBriens special tests demonstrated the highest special test specificities (85%, 84% respectively), whereas the bear hug and bicipital groove tenderness tests showed the lowest specificities (60%, 72% respectively). Diagnostic ultrasound, used as a reference and also included to study as a potential application for in-office point of service testing, demonstrated the highest sensitivity and specificity of all statistical characteris tics revealed through the review (Sensitivity 88%, Specificity 98%). In series and in parallel assessments determined two physical exam tests improved test performance over any single test. Performing more than two physical examination tests decreased diagnostic accuracy. The uppercut test combined with the tenderness to palpation of the LHB test provided the highest physical examination accuracy for diagnosing pathology at the proximal biceps. This combination has a parallel testing sensitivity of 88.3% and a series specificity of 93.3%. We characterize this as the PEC exam. Additional combinations, including diagnostic ultrasound, are reported in (Supplementary Table S3). The uppercut test and diagnostic ultrasound in parallel revealed the highest sensitivity (97%). Each of the Speeds, Yergasons and upper cut tests paired with diagnostic ultrasound all achieved the highest specificity (100%). A decision tree analysis aides in the PEC exam diagnostic accuracy post testing based on the ordinal scale pre-test probability (Fig. 2). A quick reference guide is provided to use in the clinical setting (Fig. 3). Discussion LHB pathology is an increasingly recognized generator of shoulder pain and functional impairment in symptomatic patients. Physicians are faced with diagnostic challenges due to non-specific clinical presentations and lack of direction based on physical exam findings. As such, the purpose of this study was to perform a decision-tree analysis to create a clinical algorithm to diagnose biceps pathology with increased accuracy compared to previously reported diagnostic examinations 8,11,15-17,19,22,24. This was achieved by conducting a systematic literature review including only level I and II studies. Special test sensitivities and specificities were combined in series and parallel. Analysis showed that the uppercut test combined with tenderness to palpation of the LHB within the bicipital groove provided the highest accuracy physical exam tests for diagnosing pathology at the proximal biceps. Application of this PEC exam, coupled with pre-test probability assignments can now provide cl inicians diagnostic confidence in the office. In equivocal cases, point of care ultrasound examination can further improve diagnostic accuracy2,31. Applying the PEC algorithm provides a simple, efficient and reproducible physical examination protocol for shoulder clinicians yielding an accurate diagnosis in the clinic. Now, with the calculated accuracy reference guide available, a clinician may rely on the office-based diagnosis with improved certainty and may consider forgoing advanced imaging, thereby avoiding additional cost, treatment delays and possible patient risk. In order to cover an array of clinical scenarios, we used a pretest probability range of 20-80% at 20% increments according to the likelihood of pathology. After addressing the disease prevalence, HPI and PMH, the pre-test probability likelihood of long head bicep pathology was appointed. If the pre-test probability was above 90% or below 10%, we then assume there is no need to perform additional testing with acceptance of a 10% error rate. Combination of physical examination techniques demonstrated that the uppercut test combined with tenderness to palpation of the LHB provided the highest accuracy for diagnosing pathology at the proximal biceps. This combination has a parallel testing sensitivity of 88.3% and a series specificity of 93.3% (Supplementary Table S3). The values of the test used in series and in parallel were definitive and overpowered the value of the pre-test probability assessment in many clinical scenarios. This adds credibility to a reproducible, simplified two-step P.E.C. examination without the need for additional maneuvers to be performed. Furthermore, we feel that the application of the PEC test is generalizable to non-shoulder specialists, facilitating both increased utilization and diagnostic accuracy of LHB disease. Many studies have explored the accuracy of physical examination and special test maneuvers in diagnosing LHB pathology with limited conclusions regarding its efficiency18,22,23,37. However, our study is unique in that it additionally produces a diagnostic tool, both enabling accurate point of care diagnosis of LHB injury and minimizing the need for advanced imaging. The value of the P.E.C. examination corroborates with current clinical recommendations. In 2009, Churgay et al. stated that bicipital groove point tenderness is the most common isolated finding during physical examination of patients with biceps tendinitis, and that ultrasonography is the best modality for evaluating isolated biceps tendinopathy extra-articularly3,6. With regards to diagnostic accuracy and fluidity of exam, our study revealed that the best maneuver combination for diagnosing biceps pathology are the uppercut test and tenderness to palpation. Incidentally, our study has also concluded that use of ultrasound after equivocal physical examination findings improves the sensitivity and specificity of all evaluated test combinations. Unlike past studies, we incorporated a diagnostic algorithm to aid efficient shoulder examination and to increase physician confidence in biceps tendon diagnosis. In addition to enhancing diagnostic accuracy, development of a value-based clinical decision pathway may play a small, but essential role in the improvement of the current state of the healthcare system. High-yield, algorithm-derived examination like our proposed sequence further alleviate the number of follow-up visits needed until diagnosis, which often delay expedient care delivery35,39. Moreover, simplified diagnostic algorithms may also result in cost reduction and decreased iatrogenic injury associated with unnecessary advanced imaging studies. A shoulder examination that provides accurate diagnosis provides multiple advantages that benefits both physicians and the healthcare system with the ultimate goal of improving patient outcomes. However, it is important to note that clinical decisions should be tailored to patient clinical presentation, and that MRI may be a more appropriate diagnostic modality for surgical candidates or patients with inconclusive preliminary workup. These findings provide evidence towards the current trend in orthopedic surgery education as more national conferences and residency programs are increasing musculoskeletal ultrasound (US) courses incorporated into their curriculums. Accordingly, the American Medical Association for Sports Medicine has endorsed increased integration of sports US into sports medicine fellowship curriculums13. Studies have proposed that proficient level diagnostic skills may be quickly obtained by the inexperienced orthopedist with an established examination protocol1. Murphy et al. conducted a study investigating diagnostic improvement in four orthopedic surgeons who attended a formal training course to identify and size tears on the rotator cuff through US. In the later training period, results showed positive predictive value improving by 16%27. An additional study by Roy and colleagues also demonstrated improved diagnostic accuracy of US irrespective of whether a trained radiologist, sonographer or orthopedic surgeon operated the device32. US requires further studies to evaluate its cost effectiveness compared to advanced imaging techniques like MRI or arthroscopy, but an algorithm(Fig. 3) may provide a simple evidence-based decision analysis for physicians to rely on when considering LHB as the major source of pain. This study, however, also has its limitations. Foremost, a majority of the studies included in our data collection did not solely focus on LHB pathology. True positives may have included superior labrum, anterior to posterior (SLAP) lesions within the diagnosis of biceps pathology. Studies may have also incorporated biceps pathology into other diagnostic categories (e.g. impingement). Therefore, it was difficult to find studies which solely focused on diagnostic accuracy of LHB pathology. Additionally, only level I or II studies were considered for diagnosis, which routinely compare diagnostic testing algorithm (DTA) to the gold standard of diagnosis. Unfortunately, there is no clearly defined arthroscopic findings for diagnosis of LHB pathology. To aid in any study misinterpretations due to inaccurate language translations, only articles originally written in English were evaluated, and only published articles were included. This may have introduced both publication and/or selection bias. A method to eliminate some of these potential biases would be to perform a truly systematic review and meta-analysis combining results from multiple studies; however, even this can be hindered by bias with the lack of currently published methods for meta-analyses evaluating diagnostic testing. Another future direction for this study may be to further evaluate the accuracy of new special tests described to evaluate long head of the biceps pathology, specifically the uppercut test. Currently the uppercut test has only been described and analyzed in a single level I or II study that we utilized for our algorithm24. Further validation testing for this specific test may be warranted. Conclusion Performing the uppercut test and biceps groove tenderness to palpation test together has the highest sensitivity and specificity of known physical examinations maneuvers to aid in the diagnosis of long head of the biceps pathology as compared to diagnostic arthroscopy (The PEC exam). A decision tree analysis aides in the PEC exam diagnostic accuracy post testing based on the ordinal scale pre-test probability. A quick reference guide is provided to use in the clinical setting. References 1. Amoo-Achampong K, Nwachukwu BU, McCormick F. An orthopedists guide to shoulder ultrasound: a systematic review of examination protocols. Phys Sportsmed. 2016 Aug 22;1-10. doi: 10.1080/00913847.2016.1222224 2. Ardic F, Kahraman Y, Kacar M, Kahraman MC, Findikoglu G, Yorgancioglu ZR. Shoulder impingement syndrome: relationships between clinical, functional, and radiologic findings. Am J Phys Med Rehabil. 2006 Jan 1;85(1):53-60. doi:10.1097/01.phm.0000297449.72296.3d 3. Armstrong A, Teefey SA, Wu T, Clark AM, Middleton WD, Yamaguchi K, et al. The efficacy of ultrasound in the diagnosis of long head of the biceps tendon pathology. J Shoulder Elbow Surg. 2006 Jan-Feb;15(1):7-11. doi:10.1016/j.jse.2005.04.008 4. Arrigoni P, Ragone V, DAmbrosi RI, Denard P,Randelli F, Banfi G, et al. Improving the accuracy of the preoperative diagnosis of long head of the biceps pathology: the biceps resisted flexion test. Joints. 2014 Jul 8;2(2):54-8. doi:10.11138/jts/2014.2.2.054 5. Bennett WF. Specificity of the Speeds test: arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy. 1998 Nov-Dec;14(8):789-96. No doi 6. Churgay CA. Diagnosis and treatment of biceps tendinitis and tendinosis. Am Fam Physician. 2009 Sep 1;80(5):470-6. 7. Chu K. An introduction to sensitivity, specificity, predictive values and likelihood ratios. Emergency Medicine Australasia. 1999 Sep 8;11(3):175-81. doi:10.1046/j.1442-2026.1999.00041.x 8. Chen HS, Lin SH, Hsu YH, Chen SC, Kang JH. A comparison of physical examinations with musculoskeletal ultrasound in the diagnosis of biceps long head tendinitis. Ultrasound Med Biol. 2011 Sep 30;37(9):1392-8. doi:10.1016/j.ultrasmedbio.2011.05.842 9. Cohen SB, Valko C, Zoga A, Dodson CC, Ciccotti MG. Posteromedial elbow impingement: magnetic resonance imaging findings in overhead throwing athletes and results of arthroscopic treatment. Arthroscopy. 2011 Oct 31;27(10):1364-70. doi:10.1016/j.arthro.2011.06.012 10. Dinnes J, Loveman E, McIntyre L, Waugh N. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review. Health Technol Assess. 2003;7(29):iii, 1-166. doi:10.3310/hta7290 11. Dubrow SA, Streit JJ, Shishani Y, Robbin MR, Gobezie R. Diagnostic accuracy in detecting tears in the proximal biceps tendon using standard nonenhancing shoulder MRI. Open Access J Sports Med. 2014 Apr 28;5:81-7. doi:10.2147/OAJSM.S58225 12. Eusebi P. Diagnostic accuracy measures. Cerebrovasc Dis. 2013 Oct 16;36(4):267-72. doi:10.1159/000353863 13. Finnoff JT, Berkoff D, Brennan F, DiFiori J, Hall MM, Harmon K, et al.. American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships. Br J Sports Med. 2015 Feb;49(3):145-50. doi:10.1136/bjsports-2014-094220 14. Freeman R, Khanna S, Ricketts D. Inappropriate requests for magnetic resonance scans of the shoulder. Int Orthop. 2013 Nov;37(11):2181-4. doi:10.1007/s00264-013-1968-4 15. Gazzillo GP, Finnoff JT, Hall MM, Sayeed YA, Smith J. Accuracy of palpating the long head of the biceps tendon: an ultrasonographic study. PM R. 2011 Nov;3(11):1035-40. doi:10.1016/j.pmrj.2011.02.022 16. Gill HS, El Rassi G, Bahk MS, Castillo RC, McFarland EG. Physical examination for partial tears of the biceps tendon. Am J Sports Med. 2007 Aug;35(8):1334-40. doi:10.1177/0363546507300058 17. Gilmer BB, DeMers AM, Guerrero D, Reid JB, Lubowitz JH, Guttmann D. Arthroscopic versus open comparison of long head of biceps tendon visualization and pathology in patients requiring tenodesis. Arthroscopy. 2015 Jan;31(1):29-34. doi:10.1016/j.arthro.2014.07.025 18. Hanchard NC, Lenza M, Handoll HH, Takwoingi Y. Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement. Cochrane Database Syst Rev. 2013 Apr 30;(4):CD007427. doi: 10.1002/14651858.CD007427.pub2 19. Hashiuchi T, Sakurai G, Morimoto M, Komei T, Takakura Y, Tanaka Y. Accuracy of the biceps tendon sheath injection: ultrasound-guided or unguided injection? A randomized controlled trial. J Shoulder Elbow Surg. 2011 Oct;20(7):1069-73. doi:10.1016/j.jse.2011.04.004 20. Hegedus EJ. Physical Examination of the Shoulder and Elbow with a Focus on Orthopedic Special Tests. In: Park JY, editor. Sports Injuries to the Shoulder and Elbow. Heidelberg: Springer. 2015. p. 35-44. (ISBN No. 978-3-642-41794-8. doi:10.1007/978-3-642-41795-5 21. Hegedus EJ, Cook C, Lewis J, Wright A, Park JY. Combining orthopedic special tests to improve diagnosis of shoulder pathology. Phys Ther Sport. 2015 May;16(2):87-92. doi:10.1016/j.ptsp.2017.08.001 22. Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM, et al.. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012 Nov;46(14):964-78. doi:10.1136/bjsports-2012-091066 23. Jordan RW, Saithna A. Physical examination tests and imaging studies based on arthroscopic assessment of the long head of biceps tendon are invalid. Knee Surg Sports Traumatol Arthrosc. 2015 Nov 26 [Epub ahead of print]. doi:10.1007/s00167-015-3862-7 24. Kibler BW, Sciascia AD, Hester P, Dome D, Jacobs C. Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. Am J Sports Med. 2009 Sep;37(9):1840-7. doi:10.1177/0363546509332505 25. Health Care Spending and the Medicare Program. Medicare Payment Advisory Commission. Washington DC: 2011. p.1-207. 26. Momenzadeh OR, Gerami MH, Sefidbakht S, Dehghani S. Assessment of correlation between MRI and arthroscopic pathologic findings in the shoulder joint. Arch Bone Jt Surg. 2015 Oct;3(4):286-90. 27. Murphy RJ, Daines MT, Carr AJ, Rees JL. An independent learning method for orthopaedic surgeons performing shoulder ultrasound to identify full-thickness tears of the rotator cuff. J Bone Joint Surg Am. 2013 Feb 6;95(3):266-72. doi:10.2106/JBJS.K.00706 28. Naredo E, Aguado P, De Miguel E, Uson J, Mayordomo L, Gijon-Banos J, et al. Painful shoulder: comparison of physical examination and ultrasonographic findings. Ann Rheum Dis. 2002 Feb;61(2):132-6. doi:10.1136/ard.61.2.132 29. ÃÆ'-stà ¶r AJ, Richards CA, Tytherleigh-Strong G, Bearcroft PW, Prevost AT, Speed CA, et al. Validation of clinical examination versus magnetic resonance imaging and arthroscopy for the detection of rotator cuff lesions. Clin Rheumatol. 2013 Sep;32(9):1283-91. doi:10.1007/s10067-013-2260-0 30. Razmjou H, Fournier-Gosselin S, Christakis M, Pennings A, ElMaraghy A, Holtby R. Accuracy of magnetic resonance imaging in detecting biceps pathology in patients with rotator cuff disorders: comparison with arthroscopy. J Shoulder Elbow Surg. 2016 Jan;25(1):38-44. doi:10.1016/j.jse.2015.06.020 31. Read JW, Perko M. Shoulder ultrasound: diagnostic accuracy for impingement syndrome, rotator cuff tear, and biceps tendon pathology. J Shoulder Elbow Surg. 1998 May-Jun;7(3):264-71. doi:10.1016/S1058-2746(98)90055-6 32. Roy JS, Braà «n C, Leblond J, Desmeules F, Dionne CE, MacDermid JC, et al. Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis. Br J Sports Med. 2015 Oct;49(20):1316-28. doi:10.1136/bjsports-2014-094148 33. Sandrey MA. Special physical examination tests for superior labrum anterior-posterior shoulder tears: an examination of clinical usefulness. J Athl Train. 2013 Nov-Dec;48(6):856-8. doi:10.4085/1062-6050-48.3.14 34. Sciascia AD, Spigelman T, Kibler WB, Uhl TL. Frequency of use of clinical shoulder examination tests by experienced shoulder surgeons. J Athl Train. 2012 Jul-Aug;47(4):457-66. doi:10.4085/1062-6050-47.4.09 35. Seagger R, Bunker T, Hamer P. Surgeon-operated ultrasonography in a one-stop shoulder clinic. Ann R Coll Surg Engl. 2011 Oct;93(7):528-31. doi:10.1308/147870811X13137608454939 36. Skendzel JG, Jacobson JA, Carpenter JE, Miller BS. Long head of biceps brachii tendon evaluation: accuracy of preoperative ultrasound. AJR Am J Roentgenol. 2011 Oct;197(4):942-8. doi:10.2214/AJR.10.5012 37. Taylor SA, Khair MM, Gulotta LV, Pearle AD, Baret NJ, Newman AM, et al. Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex. Arthroscopy. 2015 Feb;31(2):215-24. doi:10.1016/j.arthro.2014.10.017 38. Voigt JD, Mosier M, Huber B. In-office diagnostic arthroscopy for knee and shoulder intra-articular injuries its potential impact on cost savings in the United States. BMC Health Serv Res. 2014 May 5;14:203. doi:10.1186/1472-6963-14-203 39. Zhang AL, Kreulen C, Ngo SS, Hame SL, Wang JC, Gamradt SC. Demographic trends in arthroscopic SLAP repair in the United States. Am J Sports Med. 2012 May;40(5):1144-7. doi:10.1177/0363546512436944 Figure and Table Legends Figure 1: PRISMA Systemic Review Flow Diagram: This figure displays the process and rationale behind why studies were omitted from the systemic review. Figure 2: (A) Diagnostic Combination to Rule in Pathology: These findings demonstrate that the combination of tests that best help rule out pathology are the TTP + Uppercut test when performed in series. If both tests are negative in a scenario with a low pre-test probability (i.e. prevalence), then there is a very small chance of pathology being present. TTP = Tenderness to palpation (of the long head of the biceps within the bicipital groove); Diamond = TTP + Uppercut in series, square = TTP + Speeds in Series, triangle = TTP + Yergasons in Series (B) Diagnostic Combination to Rule Out Pathology: These findings demonstrate that the combination of TTP + upper

Data WareHouse :: Technology, Database

Being a market leader today requires competitive advantage over rival organizations. By investing in data warehouses, organizations can better predict the trends in market and offer services best suited to the needs of their customers. A Data Warehouse (DW) can be defined as a subject-oriented, non-volatile database having records over years [1,2]. DWs support the strategic decision-making process and help to answer questions such as "Who was our best customer for this item last year?"[3]. Different DW systems consists of different components, however, some core components are shared by most DW systems. The first component is the data sources. DW receives input from different data sources (such as Point-Of-Sales (POS) systems, Automated Teller Machines (ATM) in banks, checkout terminals etc). The second component is the data staging area. The data comes from data sources and it is placed in the staging area, where the data is treated with different transformations and cleansed of any anomalies. After this transformation, the data is placed in the third component which is known as storage area, which is usually a Relational Database Management System (RDBMS). This process of data extraction from data sources, transformation and finally loading in storage area is regarded as Extract, Transform and Load (ETL). The saved data from the storage can be viewed by reporting units. Different On-line Analytical Processing (OLAP) tools assist in generating reports based on the da ta saved in the storage area [4,5,6,7,8]. We believe that testing should be ingrained in DW development. Thus, each of the DW components should be tested. One of the main challenges in testing the DW systems is the fact that DW systems are different among organizations, each organization has its own DW system that conforms with its own requirements and needs, which leads to having differences between DW systems in several aspects (such as database technology, tools used, size, number of users, number of data sources, how the components are connected, etc.)[9]. Another big challenge that is faced by the DW testers is regarding the test data preparation. Making use of real data for testing purpose is a violation of citizen’s privacy laws in some countries (for example, using real data of bank accounts and other information is illegal in many countries). For a proper testing of a DW, presence of a huge amount of test data is necessary. In real-time environment, the system may behave differently in the presence of terabyt es of data [10].

Madonna Kolbenschlags Lost in the Land of Oz Essay -- Madonna Kolbens

Madonna Kolbenschlag's Lost in the Land of Oz "In "Lost in the Land of Oz", Madonna Kolbenschlag explores the way old societal myths, which are created from the metaphors in our life, are no longer useful in today's society. The author believes we need to embrace the ego archetype of the orphan, the most influential metaphor for the self, in order to become a whole and complete person. Madonna Kolbenschlag discusses how our society is particularly hostile towards women, resulting in an acute feeling of self-loathing, doubt, loneliness, and guilt. Today, women as the orphan feel a complete sense of powerlessness and abandonment, not only by everyone around her but also by God. Instead of suppressing our anxiety, Kolbenschlag advises that we should deal with it and remove the hidden layers of denial. We need to befriend the orphan within us and through all of this we will grasp a new insight and develop new spiritual consciousness. I feel the book is geared more towards women reclaiming their cultural and spiritual power. Chapter Four, "Women-Out of the Cave, Into the Desert," discusses this issue, including the modern problems facing women and some solutions. Today, women struggle to rediscover and reconcile their new societal roles with their feminine identity. In the book, Kolbenschlag uses Dorothy of the "Wizard of Oz" as the feminine model that must confront the psychological challenges along her path in order to reintegrate her true feminine self. (p.20) Women are orphaned in so many ways by our society, but through realizing certain truths can we befriend the orphan within us. Previously, Kolbenschlag felt that there were only two levels of feminine consciousness: those asleep and those who were awaking. (p.78) However, in today's society distinguishing these levels have become more complex. Through her "liberation index," she identifies the five levels of feminine awareness of modern times, which are innocence, denial, escape, defection, and deviance. Many young women are in the first stage of innocence because they have been sheltered from the realities of life, coming from a "picture perfect" life. Poor women are also in this stage because they believe that their reality is the only way of being for them. In the level of denial, women recognize their options, but feel that it is more beneficial for them to stay in their present state. On... ...d independence is another great dilemma that I think many women go through, especially those in professional arenas and takes many of them a long time to resolve the two. Growing up in a matriarchal family, my mother has always instilled through actions the need for a woman to be independent. She raised my sister and I alone and I have seen her struggle with this dilemma, when she remarried. As Kolbenschlag said, often dependency is equated to domination, which is not what most women want. I think that sometimes everyone wishes that they had someone that they could lean on, especially through trying times, but that doesn't mean they want that person to take over the situation. I also do not believe that for a woman to be considered "independent" she must give up her femininity and individuality. In my opinion a male-dominated society has no authority to dictate the characteristics of femininity to a woman. As a conscious, young man, I know that are many obstacles in the path of women, some involving race and others gender. I am a combination of many characteristics, values, and beliefs. While I do not think I am ready to befriend my inner orphan yet, I know one day I will be.