Exam 1 Assignment Example | Topics and Well Written Essays - 1000 words

Exam 1 - Assignment Example There are 44 questions, be sure to answer them all. MULTIPLE CHOICE (1 pt each) 1. Which of the following includes all the others? A) atom B) cell C) organism D) ecosystem 2. In science, a hypothesis must be A) testable B) a known fact C) able to be proven absolutely true D) derived from a theory 3. A chlorine atom has 17 protons, 18 neutrons, and 17 electrons. The atomic number of chlorine is A) 8 B) 17 C) 35 D) 52 4. If you place the probe of a pH meter in an unknown liquid and it reads pH 1, the liquid is A) an acid B) neutral C) a base 5. This polysaccharide forms fibers that are a major component of plant cell walls: A) glucose B) cellulose C) starch D) glycogen 6. Glycerol is a building block of A) starch B) enzymes C) vegetable oil D) DNA 7. Which of these types of molecules contain nitrogen? A) proteins B) phospholipids C) polysaccharides 8. Prokaryotic cells, with no nucleus or membranous organelles, are found in A) animals B) bacteria C) fungi D) plants 9. If the concentrat ion of glucose in the water outside of a cell is lower than the concentration inside, A) water will tend to leave the cell by osmosis B) water will tend to enter the cell by osmosis C) glucose will tend to leave the cell by osmosis D) glucose will tend to enter the cell by osmosis 10. ... Which of these does not have to be present for photosynthesis to occur? A) water B) carbon dioxide C) glucose D) chlorophyll 13. The oxygen in our atmosphere is produced by A) photosynthesis B) cellular respiration C) greenhouse effect D) volcanic eruptions 14. Yeast cells break down glucose anaerobically into A) ethanol and CO2 B) lactic acid and CO2 C) lactic acid and H2O D) ethanol and H2O 15. The net energy gain from complete cellular respiration is A) 2 ATP B) 4 ATP C) 8 ATP D) 36-38 ATP 16. Carbon dioxide is released in A) the light-dependent phase of photosynthesis B) the Calvin cycle C) glycolysis D) the Krebs cycle 17. Which of the following is not a characteristic of enzymes? A) they are proteins B) they speed up the rate of chemical reactions C) they act on specific substances called substrates D) they are used up in each reaction, thus need to be produced in large quantities 18. Each new cell produced by this process will have an identical copy of all chromosomes and gene s possessed by the parent cell: A) meiosis B) mitosis 19. During the first division of meiosis, A) homologous chromosomes separate B) chromosomes separate at the centromere C) chromosomes become triploid 20. The number of chromosomes in a human sperm cell is A) 4 B) 8 C) 23 D) 46 21. Exchange of genes between maternal and paternal chromosomes before the first division of meiosis is caused by A) crossing over B) X-linkage C) cytokinesis D) replication 22. If a heterozygous male mates with an albino female, what percentage of albino children would be expected? A) 0% B) 25% C) 50% D) 75% E) 100% 23. Queen Victoria's son Leopold had hemophilia, which is caused by a sex-linked recessive gene (Xh). Leopold lived to be 31 years old and fathered a normal daughter. What is the

Treatments for Patients with Prostate Cancer

Treatments for Patients with Prostate Cancer EFFECTIVE TREATMENT FOR PATIENTS WITH PROSTATE CANCER TO ACHIEVE A BIOCHEMICAL RECURRENCE FREE SURVIVAL Mariam O. Akinwale MEDICAL UNIVERSITY OF THE AMERICAS Mentor: Dr. Akintola Odutola Manuscript word count: 4205 HYPOTHESIS: In the treatment of aggressive and metastatic prostate cancer, patients who undergo radical prostatectomy with additional radiation therapy and/or hormonal therapy have less recurrence rate in comparison to those who receive radical prostatectomy alone due to its additive curative effect. ABSTRACT (word count: 275) Hypothesis: In the treatment of aggressive and metastatic prostate cancer, patients who undergo radical prostatectomy with additional radiation therapy and/or hormonal therapy have less recurrence rate in comparison to those who receive radical prostatectomy alone due to its additive curative effect. Method: The articles reviewed in this studies were obtained from PubMed. The database search combined terms from three themes: men above the age of 50, radical prostatectomy, radiation therapy or hormonal therapy and prostate cancer remission. This search yielded 72 articles after inclusion criteria were considered. A total of 32 articles were used for final review after excluding 40 articles that did not compare management options for treatment of prostate cancer. Result: Better life-expectancy have been indicated in patient treated with radiotherapy with hormonal therapy compared to patient treated with radical prostatectomy only. However, radical prostatectomy and radiotherapy with hormonal therapy are far more efficient compared to radiotherapy with hormonal therapy. The use of hormonal therapy for treatment of prostate cancer has always been frowned at because of its life-threating side effects but its patient-survival rate supersedes that of radical prostatectomy as a monotherapy. Conclusion: Combination therapy of radical prostatectomy with radiotherapy and hormonal therapy for treatment of patients with either benign or metastatic prostate cancer have a longer life-expectancy than radiotherapy with hormonal therapy, while patients treated with radiotherapy and hormonal therapy have a longer life-expectancy than those with radical prostatectomy with radiotherapy even after considering the side effects of hormonal therapy. Screening tests may help with early detection of biochemical recurrence and also prevent overtreatment with radiotherapy and/or hormonal therapy after radical prostatectomy. Keywords: radical prostatectomy, adjuvant radiation therapy, hormonal therapy, biochemical recurrence, prostates cancer INTRODUCTION Prostate cancer (PCa) is the second commonest cancer in males above age 60. African- Americans have the highest prevalence in the US. Risk factors include diets high in beef and milk. Two hundred and thirty-three thousand new cases are diagnosed yearly with 29,480 mortality reported in 2014. (American Cancer Society, 2014) Given these statistics, it is very important to diagnose and treat PC early in order to reduce the risk of high mortality. Several treatments options are available in the management of PCa. Low- risk prostate cancer is managed by active surveillance in order to prevent unnecessary exposure to radiation or surgery. Intermediate or high- risk non-metastatic prostate cancer is treated with prostatectomy or radiation therapy (Zietman et al., 2010). Aggressive and metastatic prostate cancers are treated with variable combinations of radical prostatectomy (RP), radiation therapy (RT), chemotherapy, cryosurgery, hormonal therapy (HT) and bisphosphates. These combination therapeutic options address the tendency of aggressive PCa to metastasize to neighbouring structures/organs. This study is designed to evaluate a specific combination of treatment option in the management of aggressive and metastatic PCa. It is hypothesized that patients with aggressive PCa who undergo radical prostatectomy and adjuvant radiotherapy have less recurrence rate compared to those who receive radical prostatectomy alone due to its additive curative effect (Thompson et al., 2013). This study is significant because evidence suggests that different combination treatments of aggressive PCa are associated with different recurrence rate. The identification of the combination therapy with the lowest recurrence rate and longer life-expectancy is essential in this study. I chose this topic because it is important for family practice physicians to have accurate information to give to their patients regarding best treatment options for aggressive metastatic PCa. METHOD The articles reviewed in this studies were obtained from PubMed. The database search combined terms from four themes: specific population (older men OR men above 50 OR prostate cancer patient OR post prostatectomy patient OR recurrent prostate cancer patient), intervention (prostate cancer adjuvant therapy OR prostate cancer adjuvant radiotherapy OR prostate cancer adjuvant chemotherapy), comparison (radical prostatectomy) and possible outcomes (prostate cancer recurrence OR prostate cancer remission OR prostate cancer curative OR prostate cancer life span OR prostate cancer prognosis OR prostate cancer quality of life). Boolean operators used were OR and AND. OR was used to capture each term within a theme and AND was used to link each theme within parentheses. Filters used were: article types (randomized controlled trial), text availability (free full text), publication dates (5 years), and limited to human. Inclusion criteria Articles that were included in the systematic review of this study had to meet the following criteria: used randomised clinical trials, cohort studies and meta-analysis; prostate cancer population; radical prostatectomy with adjuvant radiotherapy and hormonal therapy as intervention; radical prostatectomy only as comparison; and prostate cancer recurrence, prostate cancer remission, prostate cancer curative, prostate cancer life span, prostate cancer prognosis, prostate cancer quality of life as outcome. Localized and high risk prostate cancer management were included in the study. Exclusion criteria Population of women and men below the age of 50 were excluded. Articles published prior to 2011 and were not written in English language were excluded. Articles that were not free full text were excluded. Articles that did not compare RP+RT+HT with radical prostatectomy only were excluded. RESULTS This search yielded 72 articles after inclusion criteria were considered. A total of 27 articles were used for final review after excluding articles that did not compare management options for treatment of prostate cancer. Treatment of Prostate Cancer with Radical Retropubic Prostatectomy (RRP) And Pelvic Lymph Node Dissection (PLND) Before we can lay emphasises on other possible treatments to prevent biochemical recurrence (BCR) after RP, we have to talk about RRP and PLND. According to one of the studies cited in this systematic review, ten of 11 patients with histologically confirmed lymph node metastasis (LNM) showed a PSA response (Winter et al., 2015). Three of 10 patients with single LNM had a complete biochemical remission (median follow-up 72months, range 31.0-83) (Winter et al., 2015). In five cases with single LNM PSA decreased et al., 2015). All of the additionally removed 30 LNs were completely negative (Winter et al., 2015). Treatment of Prostate Cancer with Radical Prostatectomy (RP), PLND and Hormonal Therapy (HT) The above combination therapies have been reported to be commonly used for the treatment of metastatic PCa to lymph nodes and other neighboring tissues than localized PCa due to its higher efficacy and potency for the treatment of metastatic PCa. The first article I will be talking about under this subtopic had a mean follow-up of 5.3 years and LNM occurred in 140 patients. An average of 10.9 lymph nodes was dissected from patient with pN1 through a method known as extended sentinel lymph node dissection (eSLND) (Muck et al., 2015). After the surgery, 121 patients with pN1 patients received adjuvant ADT for a sort period of time (Muck et al., 2015). Average survival year for; recurrence-free survival (RFS), RFS after secondary treatment, case-specific survival (CSS), and overall survival (OS) were 4.7, 7.0, 8.8, and 8.1 years, respectively (Muck et al., 2015). RFS, CSS, and OS were significantly correlated with tumor staging (Muck et al., 2015). The second article focuses on the 67 Chinese patients with lymph node metastasis (LNM) after RP and extended PLND, and these patients received continuous adjuvant ADT. The median follow-up of this study was 46.7 months and two patients were lost to follow-up. BCR-free survival was recorded annually indicating 52%, 40%, 22% for the first 3 years respectively and a more significant survival was observed in patients with 5-year BCR free-survival which shows a 93% free-local recurrence, 83% free-systemic metastasis and 96% cancer death-free (Qin et al,2015). Postoperative BCR-free survival was 27.5 months (Qin et al.,2015). Even though a lot of articles support the positive effect of HT as a treatment for PCa, we also have to consider the adverse effect of HT including depression. According to Lee et al, 2015, patients who are treated with ADT have shown to a significant prolonged depressive state (pet al.,2016). The depressive state in correlation to ADT is confirmed when compared to a control by indicating a p value less than 0.001 (Lee et al.,2016) Apart from the adverse effect associated with HT, metastasis have been reported after adjuvant ADT has been used for treatment of both localized and high-risk PCAa (Taguchi et al., 2014). Taguchi et al. reported 9 (4.6%) patients developed metastasis and 6 (3.0%) died from PCa. Eight of nine metastatic patients had a GS greater than 9 and developed a metastasis to the bone, while the remaining one had a GS greater than 7 and developed lymphatic spread (Taguchi et al.,2014). Based on the findings above, optimal timing of salvage ADT for BCR after RP is crucial. According to a study by Taguchi et al., biochemical recurrence was seen in one patients (2.0%) in the ultra-early group and seen in 12 patients (17.1%) in the early salvage ADT group (Taguchi et al.,2014). Only one patient in the early salvage ADT group developed metastasis to a left supraclavicular lymph node, and no patient died from PCa during follow-up (Taguchi et al.,2014). Treatment of prostate cancer with Radical Prostatectomy (RP) and Radiation Therapy (RT) In order to examine the effect of RT after RP, an article which compared outcome of patients treated with radiotherapy after radical prostatectomy and patients who were under active surveillance after radical prostatectomy (Petruzzeillo et al., 2014). Patients who were under surveillance had a longer follow-up but higher recurrence rate and short life-expectancy (Petruzzeillo et al.,2014). Another article was able to back-up this finding, indicating significant longer life-expectancy and lower risk of recurrence (Gandaglia et al.,2014). However, the earlier administration of radiotherapy after RP is very essential. Studies had if indicated that patients who had ultra-early radiotherapy after RP had lower recurrence and longer life-expectancy (Azelie et al.,2012). A number of reports have associated early RT after RP to decrease risk of BCR and longer overall survival (OS). According to Gandaglia et al, patients with high risk score benefitted more from early radiotherapy compared to patients with lower risk scores (Gandaglia et al.,2014). The risk scores were determined based on its association to increasing 5- to 10- year prostates cancer mortality rates with a p value less than 0.001 (Gandaglia et al.,2014). the risk score was associated with increasing 5- and 10-year cancer-specià ¯Ã‚ ¬Ã‚ c mortality rates (P et al., 2014). However, adjuvant RT after RP have shown to present with gastrointestinal and genitourinary toxicities. A study indicating the use of real-time tumor-tracking intensity-modulate radiation therapy (RT-IMRT) as a much preferable RT for treatment of PCa with less adverse effects (Shinohara et al.,2013). In patient treated with RT-IMRT have shown to have better quality of life with little or no risk of urinary and sexual dysfunction (Shinohara et al., 2013). No patients treated with RT-IMRT after RP have gastrointestinal discomfort (Azelie et al.,2012). An article has indicated that earlier RT can lower the risk of adverse effect such as gastrointestinal and urinary dysfunction (Hegarty et al.,2015). Another concern is excessive treatment of PCa with RP+RT using standardized guideline. Patients who underwent RT after RP using this standard guideline 27 patients out of 163 patients had recurrence and 3 out 87 with PSAet al.,2014). Hence the other patients were over treated and therefore exposing them to preventable adverse effects. Treatment of Prostate Cancer with Radical Prostatectomy(RP), Radiation Therapy(RT) and Hormonal Therapy (HT) For the treatment of high-risk prostate cancer (PCa) different evidence-based therapies exist such as (RT+HT), (RP+RT), and (RP+RT+HT). RT + HT resulted in a longer life-expectancy which is always greater than 1 compared to RP+RT (Parikh et al.,2012). However, RP+RT+HT combination have a greater than 0.5 longer life-expectancy compared to RT+HT after considering their side effects (Parikh et al.,2012). Treatment of Prostate Cancer with Radical Prostatectomy (RP), Radiation Therapy (RT), Hormonal Therapy (HT) and Neoadjuvant Chemotherapy (NCHT). Patients with local and metastatic PCa are prone to recurrence after RP. Hence adjuvant therapies are required to reduce biochemical failure and also prolong life-expectancy. Therefore, it is important to study the adverse effect of these combination therapies (RP+RT+HT+NCHT). The major adverse effect associated with these combinations are gastrointestinal and urinary dysfunction while leucopenia and neutropenia mainly for NCHT (Guttilla et al.,2014) and (Thalgotti et al.,2014). Gastrointestinal and urinary dysfunction are seen in low grade pathologically (Guttilla et al.,2014). Thalgotti et al.,2014 reviewed the percentile of blood toxicity after patients have been administered the combination therapies; 90% had neutropenia and 53.8% leucopenia in the studied patients (Thalgotti et al.,2014). Effective Screening Test to Aid Prevention of Biochemical Recurrence (BCR) Eighty-eight miRNAs were identified to be significantly (p36months) (Bell et al.,2015). Nine miRNAs were identified to be significantly (pet al.,2015). Based on the efficacy of the above result a new prognostic stick has been created, composed of miRNA-4516 and miRNA-601, Gleason score and lymph node status (Bell et al.,2015). A study was done to assess which patients would benefit the most from RT after RP using 11C-choline PET/CT. In order to identify which patients would benefit the most from restaging 11C-choline PET/CT before RT, 11C-choline PET/CT was positive in 28.4% of patients (172/605) (Castellucci et al, 2016). Castellucci et al.,2016 categorized these patients based on staging: Eighty-three of 605 patients were positive locally, 72 of 605 patients had systemic metastasis, and 17 of 605 patients had both local recurrence and systemic metastasis (Catellucci et al., 2016). At multi-analysis; PSA, PSA doubling time (PSAdt), and ADT were signià ¯Ã‚ ¬Ã‚ cant predictors for positive scan results, whereas PSA and PSAdt were signià ¯Ã‚ ¬Ã‚ cantly related to distant recurrence detection (Pet al.,2016). Genomic classifier (GC) used to predict biochemical recurrence and distant metastasis in men receiving radiotherapy (RT) after radical prostatectomy (RP). Illustrating Den et al.,2015, the measurement of GC was used to predict recurrence of PCA at 5 years after receiving RT (Den et al.,2015). A multi-analysis was done which no correlation between GC and PSA before RP. However, patients with low GC had no significance recurrence at 5 years after RT while patients with high GC had recurrence at 5 years after RT (Den et al.,2015). DISCUSSION This reviews attempted to answer the question: Can adjuvant therapy be used in patients that have undergone radical prostatectomy to prevent local recurrences? The general collective consensus of articles included in this review supported the hypothesis that in the treatment of aggressive and metastatic prostate cancer, patients who undergo radical prostatectomy and adjuvant radiotherapy with hormonal therapy have less recurrence rate in comparison to those who receive radical prostatectomy alone due to its additive curative effect (Parikh et al.,2012; Kyrdalen et al.,2012; Hayachi et al., 2012; Shinohara et al.,2013; Kaplan et al.,2013; Linder et al.,2013; Azelie et al.,2012; Miyake et al.,2014; Taguchi et al.,2014; Muck et al.,2014; Gandaglia et al,2015; Den et al.,2014; Castellucci et al.,2014; Lee M. et al., 2015; Kang et al.,2014; Thalgotti et al.,2014; Sato et al.,2014; Gutilla et al.,2014; Kim et al.,2016; Rosenkrantz et al.,2015; Petruzzeillo et al.,2014;Den et al.,2014; Lee J. et al.,2015; Qin et al.,2015; Mizowaki et al,2015; Winter et al.,2015; Bell et al,2015; Hegarty et al.,2015; Den et al., 2015; Taguchi et al.,2014). Only one article concluded that patient with High Gleason score (GS) carry a risk of bone metastasis and cancer specific-death after RP with ADT (Taguchi et al.,2014). Seven articles laid more emphasise on the combination therapys adverse effects such as gastrointestinal, genitourinary toxicities and sexual dysfunction (Shinohara et al.,2013) and specifically; diabetes mellitus, heart disease, osteoporosis (Parikh et al.,2012) and depression for HT (Lee M. et al.,2015). However, few articles addressed these adverse effects by recommending ultra-early RT after RP (Azelia et al.,2012 and Hegarty et al.,2015) and early HT after RP (Taguchi et al.,2014 and Sato et al., 2014). However, early RT after RP does not only reduce gastrointestinal and gastrourinary toxicities but it also prolongs quality-adjusted life expectancy (QALE) and lowers biochemical recurrence (BCR) (Azelie et al.,2012, Sato et al.,2014 and Gandgalia et al.,2014). Radiotherapy such as Real-time tumor-tracking intensity-modulated RT (RT-IMRT) may be a better treatment for localized PCa even though it has a similar effect as RP because of the adverse effects associated with RP such as urinary incontinence and erectile dysfunction (Azelie et al.,2012). Hence, better quality of life with RT compared to RP (Shinohara et al.,2013). An article compared RT after RP with observation alone (OA) after RP which reviewed 87.1% to 30% biochemical progression-free survival, respectively (Petruzzeillo et al.,2014). This result lays further emphasises on the efficacy of RT after RP. Despite all the articles emphasizing the efficacy of adjuvant RT and androgen deprivation therapy (ADT) after RP, there is concern for excessive treatment of PCa using AUA/ASTRO guideline on adjuvant RT. A particular article stretched on the concern by concluding that patients treated with RT who met the AUA/ASTRO guideline should be carefully considered to prevent excessive treatment (Kang et al., 2014). This is because in the article, among 163 patients with high risk BCR according to AUA/ASTRO guideline, only 27 patients developed BCR and treated with RT (Kang et al., 2014). In addition, in 87 patients with pre-operative PSAet al., 2014). Some articles (Gutilla et al,2014; Gutilla et al,2014 and Thalgott et al.,2014) considered the effectiveness of screening test on predicting biochemical failure in order to prevent BCR after RP. Several screening test were considered and tested. Specific miRNA (miR-4516 and miR-601), 11C-Choline PET/CT, Genomic Classifier (GC) and whole-lesion histogram apparent diffusion coefficient (ADC) metric have sensitivity and specificity for BCR after RP (Bell et al.,2015; Castellucci et al.,2015; Den et al.,2015; Den et al.,2014 and Rosenkrantz et al.,2015). These screenings can help to identify specific treatment for BCR, for example, patients with low GC scores are best treated with RT only, whereas those with high GC scores beneà ¯Ã‚ ¬Ã‚ t from additional therapies (Den et al., 2014). Some studies verified that the trimodality therapy (RP+RT+HT) has shown an increase in quality of life expectancy (QALE) (Parikh et al.,2012; Guttilla et al.,2014; Kyradalen et al.,2012 and Den et al.,2014). Limitations of the search strategy include searching only one database (PubMed), only one source of information is used (database), only published data is included, only data from the last 5 years is included, only articles published in the English language are included, and only one reviewer is reviewing the abstracts. The major limitation of this systematic review is use of more retrospective cohort than clinical trials and use of only free-full articles and also broad question covering several treatment options such as different types of adjuvant radiation therapies, hormonal therapies and inclusion of some chemotherapies. Future research may consider comparing multiple interventions in a single randomized clinical trial with several approaches to allow for better comparison across clinical outcome measures. Further research may consider more screening test to prevent overtreatment. APPENDICES First Author Date of Publication Study Design Level of Evidence Study Population Therapy Outcome Azelie C. 2012 Randomized Clinical trial 1b 178 patients were referred for daily exclusive image guided IMRT (IG-IMRT) and 69 patients were the control group IG-IMRT vs RP+IMRT Patients with low risk PCa treated with IG-IMRT had a more significant outcome compared to the control group (patient treated with RP + IMRT) Bell E. March, 2015 Prospective Cohort Study without controls 4 43 patients who undergone RT after RP miRNAs miRNA signatures (Notably, two novel miRNAs: miR-4516 and miR-601) can be used as a diagnostic tool to determine patients who will benefit from additional therapy after RP. Castellucci P. Nov., 2015 Case series 4 605 patients treated with RT after RP. RT+RP vs ADT at the time of 11C-choline PET/CT At the early stage of BCr after RP 11C-choline PET/CT should be suggested before ADT is administered. Den R. March, 2015 Randomized Clinical Trials 1b 188 patients with positive margin of PCa at Thomas Jefferson University and Mayo Clinic between 1990 and 2009 were considered. Neoadjuvant HT, IMRT, salvage RT, ART In patients treated with RT after RP,genomic classifier (GC) was a good prognostic tool for determining metastasis. Den R. August, 2014 Randomized Clinical trial 1b 139 patients who underwent RT after RP that were identified with pT3 or positive prostate margin. Using genetic classifier to predict biochemical failure after RP+RT The genetic classifier (GC) predicted biochemical failure and metastasis after RP +RT. Patients with lower GC may benefit from delayed RT, as opposed to those with higher GC. Gandaglia G. August, 2014 Randomized Clinical trial 1b 7616 prostate cancer patients treated with RP. Early treatment with RT after RP vs not receiving early RT after RP Patients with two or more adverse pathological characteristics at RP might beneà ¯Ã‚ ¬Ã‚ t the most from adjuvant RT in terms of reduced cancer specific mortality. Guttilla A. 2014 Randomized Clinical Trial 1b 35 patients with newly diagnosed high-risk localized prostate cancer IMRT, RP, ADT, docetaxel-based chemotherapy This treatment phase for high-risk PCa indicated an acceptable oncological outcome. Hayashi S. July, 2012 Retrospective Cohort Study without controls 4 41 patients were treated with external beam RT as salvage RT because of increasing PSA levels following RP. RT after radical prostatectomy Lymphatic invasion is reported after RT+RP Vascular invasion is not associated with biochemical failure in PCa treatment. Hegarty S. February, 2015 Prospective Cohort Study without controls 4 Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we identified 6,137 prostate cancer patients diagnosed during 1995-2007 who had one or more adverse pathological features after prostatectomy. RT after RP RT after RP is associated with adverse effects such as gastrointestinal and genitourinary toxicities while early treatment with RT is not associated with these adverse effects. Kaplan J. 2013 Retrospective Cohort Study without controls 4 577 men with LN metastases discovered during RP and 177 men underwent ART with no distant metastases Adjuvant RT, RP ART after RP in men with LN-positive prostate cancer was associated recurrence free-survival. Kang J. 2014 Retrospective Cohort Study without controls 3b 163 men who had pT2-3 with undetectable PSA level after RP who had metastasis. Adjuvant RT (ART) after RP ART in patient who met the ASTRO/AUA criteria should be applied more selectively to avoid overtreatment. Kyrdalen A. 2012 Randomized Clinical Trial 1b 771 compliers were divided into four groups (i) no treatment, (ii) RP, (iii)RT without HT and (iv) RT+HT No treatment vs RP vs RT vs RT+HT No treatment group: had the highest level of moderate/severe bladder outlet-obstruction. RP group: reported more urinary incontinent compared to other treatment groups and also the highest prevalence of poor erectile functions. RT group: reported highest gastrointestinal dysfunction and fecal leakage compared to RP and no treatment group. Bladder outlet obstruction and poor sexual drive were significantly associated with low quality of life. Lee J. July, 2015 Prospective Cohort Study without controls 4 307 patients who underwent RP at Seoul National University Hospital between January,2006 and July,2007. RP According to this finding, SHBG may be useful in selection of candidate for adjuvant treatment following RP. Lee. M 2015 Observational studies with controls 3b 61 men with prostate cancer and their match control group (n=61) without cancer ADT This article indicates an association with PCa patient developing depression after receiving ADT. Linder B. 2013 Retrospective Cohort Study without controls 4 419 patients who received additional HT Adjuvant HT after RP Adjuvant HT after RP with high-risk PCa does not increase non-prostate cancer (such as cardiovascular disease) mortality, even in patient with multiple comorbidities. Mizowaki T. April, 2015 Observational Study with controls 3b Patients with localized PCa from the Japanese Radiation Oncology Study (JROSG) who were treated with RP before 2005 and those who received RT in 2007.. HT, RT Hormonal therapy was combined with radiotherapy which resulted in a longer life- expectancy. Muck A. March, 2014 Retrospective Cohort Study without controls 4 819 patients with localized prostate cancer (PCa) Extended sentinel lymph node dissection (eSLND) and RP. The use of ESLND and RP in patients with low risk can serve serve as complete cure for BCR. Parikh R. Jan., 2012

Alienation Exposed in Richard Wrights Black Boy :: Wright Black Boy Essays

Alienation Exposed in Black Boy  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   From the early days of Richard’s childhood, Richard was always alienated from his environment.   Even though he tried to distance himself from the prejudice all around him, the white people still tried to turn him into the stereotypical southern black person.   However, throughout the story Richard is also alienated by his own people and perhaps even more then from the white people.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Richard was always a rebel, from his boyhood to his older teenage years.   Richard’s grandmother was always excessively beating him.   From the beginning, Richard would not subdue himself to the white man like the other black people around.   The white people knew that he was different from other black men.   Whites were scared because Richard challenged the system that they had created to insure white supremacy.   They feared Richard, and some of the white people felt it necessary to act out their racist feelings in order to cover up their fear.   White coworkers beat Richard because his boss was kind to him. Richard later had to leave a good job because those racist co-workers would â€Å"kill† him.   When the principal at Richard’s school had asked Richard to give a speech to a large audience of white and black people, Richard refused to read the principal’s prepared speech. By reading the principal’s speech, Richard was saying what the white power wanted him to say and to Richard this would be giving in to the very thing he hated so much.   Richard was willing to leave school without a diploma instead of this.   White people alienated Richard from his environment because he did not accept the way of life that other black people did.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Richard’s relatives never understood Richard and because of this he was alienated from his family and his own people.  Ã‚   Shorty is the young black boy who gets beat by the white people and jokes about it.   Richard hates Shorty because he accepts what Richard finds so disgusting.   Richard goes over in his mind the different choices he can make to deal with the feelings he has.   Richard does not want to â€Å"give in† and be a slave to the white people.   He would never give in and become a slave because he has hated that idea since day one.   Richard contemplates transferring his hatred and frustration out on other blacks, but knows that will not aid the situation.

Metafiction and Happy Endings (Margaret Atwood) Essay

Metafiction A. Definition: The narrator of a metafictional work will call attention to the writing process itself. The reader is never to forget that what she is reading is constructed–not natural, not â€Å"real.† She is never to get â€Å"lost† in the story. B. Possible Contents: intruding to comment on writing involving his or herself with fictional characters directly addressing the reader openly questioning how narrative assumptions and conventions transform and filter reality, trying to ultimately prove that no singular truths or meanings exist C. General Characteristics Metafiction often employs intertextual references and allusions by: examining fictional systems; incorporating aspects of both theory and criticism; creating biographies of imaginary writers; presenting and discussing fictional works of an imaginary character. Authors of metafiction often violate narrative levels by: intruding to comment on writing; involving his or herself with fictional characters; directly addressing the reader; openly questioning how narrative assumptions and conventions transform and filter reality, trying to ultimately prove that no singular truths or meanings exist Metafiction also uses unconventional and experimental techniques by: rejecting conventional plot; refusing to attempt to become â€Å"real life†; subverting conventions to transform reality into a highly suspect concept; flaunting and exaggerating foundations of their instability; displaying reflexivity (the dimension present in all literary texts and also central to all literary analysis, a function which enables the reader to understand the processes by which he or she reads the world as a text). It also poses questions about the relationship between fiction and reality by drawing  attention to its characteristic as an artifact by itself. No sense of reality in its entire spectrum as a genre even though the extremes of each end are minute acceptance and merely exploration of fictionality to the other end being utter denial of reality itself. D. Examples: Adams, Douglas. The Hitchhiker’s Guide to the Galaxy. 1979. Mitchell, David. Cloud Atlas. 2004. HAPPY ENDINGS A. Characters: The author uses common names for the characters which allows him the versatility of putting them into different situations. Doing so supports the way the author puts much importance on what happens during the story instead of how it ends. John one of the most common boy names, has ranged from musicians (John Lennon), to leaders (John F Kennedy), to philosophers (John Locke) etc. This can emphasize the author’s use of putting the character into different contexts, changing the plot and how he plays different roles, yet emphasizes that it all ends the same (death). -Idea that the ending of a story is always the same, but only the middle matters In the story he is a loving husband, adulterous partner, womanizer Mary meaning of the name Mary is: Wished-for child; rebellion; bitter. Famous Bearers: the Virgin Mary; Mary Magdalene; Mary, Queen of Scots. Also shows how the author putes his characters in different situations. James -minor character Fred – minor character Madge – minor character B. Setting: The author employs the use of place as setting in the story. Various examples of setting seen in the story are an apartment, as seen in story B, and a â€Å"charming house,† as seen in story A, C and As seen in the line, â€Å"Remember, this is Canada. You’ll still end up with A, though in between you may get a lustful brawling saga of passionate involvement, a chronicle of our times, sort of,† the setting of the story and each of its segments is a medium for what each character does before he reaches the end. The setting of the story could have an influence on what one could do before he dies, the end which everyone eventually reaches. This is seen in the story wherein each segment (letters) had different bodies of story, yet everything â€Å"continues as in A† in which the characters live on with their lives then die. D. Concepts: Ex: How do elements in the story help to create meaning? Like: setting, tone, imagery, symbol, irony, etc Metafiction in Happy Endings  The author tackles the â€Å"What?† question in the writing process through his story Happy Endings. He goes through many scenarios but shows us that the conclusion to each scenario is the same. The question â€Å"What?† only leads to the ending of the story which we already know will be the same. The important things to ask rather are â€Å"How?† and â€Å"Why?†. These questions make up the middle of the story, the events that happen, the part that counts. Textual Irony Title is Happy Endings but the real endings are al the same and result in death Conflict Is always changing depending on the situation given. Always has something to with the subject of love. SYMBOLS E. Title â€Å"Happy Endings† Most people usually focus on the ending of a story Everyone wants a happy ending, but in reality we all meet an equal end which is that we eventually die There is no such thing as a happy ending. All are the same in which we all eventually pass away. What matters is what is done as we reach the end. F. Theme What matters the most in the story is not the ending, but what what we do on the way there, because we can change our situations by choosing to act in the present, but not matter what you do you can’t change your inevitable end. —————————————————————————————————————————- RANDOM NOTES Margaret Atwood’s Happy Endings is an illustration of the idea that the ending of a story is always the same, but only the middle matters. And Love plays an important factor in all scenarios. SYNOPSIS: It includes six stories in one, each ending with death. The author believes that this is the only sure ending to anything. The stories are all inter-related, containing the same characters and similar actions. Behind the obvious meaning of these seemingly pointless stories lies a deeper and more profound meaning†¦. What is the common denominator between all these scenarios? In case you missed it, Atwood sums it up in her concluding remarks. ‘John and Mary die. John and Mary die. John and Mary die.’ ‘Happy Endings’ forces us to question the point of life. Every story, carried to its ultimate logical conclusion, has the same ending, because all lives have the same ending. We may die in the heat of battle; we may die in our sleep. We may die in infancy, in a gang war, in a nursing home. But we’re going to die. The story isn’t in the ending — it’s in what we do on the way there. RESOURCES USED http://ronosaurusrex.com/metablog/list-of-metafictional-works/ http://www.geneseo.edu/~johannes/Metafiction.html http://postcolonialstudies.emory.edu/metafiction/#ixzz2e1Z087Wr http://www.storybites.com/book-reviews/happy-endings-by-margaret-atwood.php characters http://www.bookrags.com/studyguide-happyendings/char.html themes http://www.bookrags.com/studyguide-happyendings/themes.html (online copy: http://web.ics.purdue.edu/~rebeccal/lit/238f11/pdfs/HappyEndings_Atwood.pdf )

Research Survey on Use of Opportunity Cost in Project Evaluation

RESEARCH SURVEY ON USE OF OPPORTUNITY COST IN PROJECT EVALUATION AT SELECTED COMMERCIAL BANKS IN THE KINGDOM OF BAHRAIN A RESEARCH PAPER PRESENTED TO THE SCIENTIFIC RESEARCH AND DEVELOPMENT OFFICE AMA INTERNATIONAL UNIVERSITY KINGDOM OF BAHRAIN BY MUBEEN FATIMA August, 2012 ABSTRACT Accounting and Economics work for two different purposes. Today managerial decision making uses economics, as well as accounting concepts, methods & practices of scrutiny given by decision sciences.Literature shows that there are four basic tools and techniques of decision making used by economists, these are; augmentation, statistical valuation, projecting, numerical study, and game theory, most of which are equally procedural in nature they helps us to gather the idea of how decisions are made in economics. Since resources are limited relative to wants, the usage of resources in one way hinders their use in other means.This implies the cost of opportunity, which is lost, is actually the profit of whose output is given up, this indicates that, lost time, satisfaction or any other benefit that provides usefulness should also be taken as opportunity cost. Opportunity cost in literature is the cost referred as the next-best choice available to a rational consumer who has to select between a number of mutually distinct projects. It is, thus the key concept in economics. It has been illustrated as conveying â€Å"the basic relationship between deficiency and choice. Yet its relation to the economic profit is seldom discussed.CHAPTER 1 INTRODUCTION Background of the Study Prior research work provides us the idea that opportunity costs is one of the key differences between the concepts of economic cost and accounting cost. Being treated as a cost, opportunity cost had always been considered vital in calculation of the true cost of a project & has always effected a management accountant decision However the modern economists, particularly the Austrian school of thought treats opportunity cost as something that has neither existence nor has any importance in decision making.Though the field of economics gave birth to the concept of opportunity cost, the awareness about assessing the second best alternate is now taken over by management accounting, today this concept is being taught in academic graduate courses of economics however; in practice, the economists today emphasize on mathematical techniques in decision making there by ignoring various conceptual factors like opportunity costs and worth of projects being missed. Evaluating opportunity costs is important to find out the true cost of any project under consideration.If the financial worth of second best alternative of an investment project is low, then, overlooking that opportunity costs, gives an impression that benefits of next best alternative, cost practically nothing. The invisible opportunity costs then become one of the hidden costs of that particular project. Mr. John Stuart Mill, a British philosopher and a civil servant was the first man to give the idea of Opportunity Cost in his economic theory of free markets as well as explaining his concept of liberty and an individual and freedom of choice.Opportunity costs are thought of as the retrospective costs that cannot be recovered in the field of Economics and Corporate decision making. Opportunity costs are occasionally compared with â€Å"potential costs† which obviously are the future costs that may or may not incurr depending upon the decision taken. Both past aswell as prospective costs can be either static or dynamic Austrian school of thought pay attention to the concept of opportunity costs on both sides of the market links very deeply to the importance of finance and economic profit estimation in their model of the market process.They argue that the money of an investor having opportunity cost means that his money has many uses but the uses are not unlimited. With the assumption of a market with seamlessly exclusi ve capital goods, those goods will have no opportunity cost as every exclusive good has only one yield. In a market of seamlessly standardized capital goods, they have no opportunity cost because all of the goods are same in terms of use and benefit thus can be used equally well for each yield. In practice the calculation of project cost by an accountant is different from that of an economist.This variance is not grounded in different fundamentals on what to assess or how, but lies in the basic difference in understanding-of costs and profits. However if opportunity costs are not ignored by the economist then while calculating the GDP of Country the economist must also consider the large scale pearl diving industry in certain areas of Bahrain. Statement of the Problem The study aims to discuss the relevance of the concept of Opportunity Cost in project evaluation procedure adopted by commercial banks in Kingdom of Bahrain.The opportunity cost has different importance in the opinion of economists and accounts professionals and therefore the use of this concept in project costing . This research will attempt to find out importance of Opportunity cost while considering an investment proposal. Specifically it sought to answer the succeeding questions. 1. What is the status of the opportunity cost in project evaluation at Selected Commercial banks in Kingdom of Bahrain? 2. What are the banking operations where opportunity cost is deemed important by Commercial Banks in Kingdom of Bahrain? 3.What are the factors effecting the importance of opportunity cost faced by Commercial Banks in Kigdom of Bahrain? 4. What are the problems encountered in application of Opportunity cost concept by the Bankers while evaluating a project? Assumption The study assumed that the respondents are honest in answering all the questionnaire Significance of the Study The study is beneficial to the following: Decision Makers: the study will help the decision makers in Commercial Banking ind ustry to find the true cost of a project and therefore finding the true profit or loss generated by itFuture Researches: the study will help in relating the two concepts i. e, opportunity cost and Project Costing by using the quantitative methodology of research. It will further help in decision making and project evaluation for the accounts Managers and Economists. Scope and Limitation The aim of this study is to deliberate the significance of the concept of Opportunity Cost in project evaluation procedure adopted by Commercial banks in Kingdom of Bahrain. The opportunity cost has different importance in the pinion of economists and accounts professionals and therefore the use of this concept in project costing . The study includes Bank Officers at selected Commercial Banks working in Kingdom of Bahrain. The target population is Executives and managers (top and middle level ) who are directly involved in decision making This research focused on finding out importance of Opportunity cost while considering an investment proposalstudy is conducted in Commercial Banks of Bahrain, the responses therefore reflect the most important sector of Bahrain economy. The study is conducted in the natural settings i. during the business hours and responses are taken while the samples are on their work places, therefore 100 percent reliability of responses is not possible due to various un controllable distractions. The period covered by this study is January till December 2012. All the data is collected in Bahrain and responses therefore will represent the local population. Definition of Terms Opportunity Cost (OC) The cost of an alternative that must be forgone in order to pursue a certain action. Put another way, the benefits you could have received by taking an alternative action (John Stuart Mil)Economic Value Added (EVA) A measure of a company's financial performance based on the residual wealth calculated by deducting cost of capital from its operating profit (Stern St ewart) EVA is also referred to as â€Å"economic profit†. CHAPTER 2 Review of Related Literature and Studies Foreign Literature Mankiw ( 2000) from Harvard University USA and the author of† Principles of Microeconomics† explained here that Economic profits are calculated by using both explicit as well as implicit costs however Accounting profits are calculated using only explicit costs.Therefore , accounting profits are higher than economic profits Neale( 2001) have found that due to forgoing opportunity costs, delayed decisions can be seen as option between certain loss and the risk of greater or zero loss. Chung, (2005)from Princeton University have conclude in their work â€Å"The Opportunity Cost of Admission Preferences at Elite Universities† that economic cost of a decision relies on the cost of the project that is selected and also the profits that the second best alternative project may had given if selected.This perspective of scarcity of resource leads to the dimension of opportunity cost. Hawkins et. al ( 2008 ) in their article â€Å" Cost and benefit Analysis† are of the view that the â€Å"next best alternative† is an important concept in cost and benefit analysis (CBA). The benefits gone by not implementing the second favorite choice are known as opportunity costs. Opportunity costs are relevant in calculating costs of a project. Opportunity costs help in economic scrutiny. In financial investigation market values are used as the market price for man power has the market value same as a person’s wageThe Indian scholars are also of the view that Opportunity Cost of Idle Capacity Zero, supporting the work of (Coase 1938). The researchers of M2 Presswire publications have found that opportunity cost of ignoring the markets, have disastrous results as eBay failed to beat yahoo in this regard. Buchanan (1969 ) says that it is just to bind the term opportunity cost to this idea that only decision changing cost represents an analysis of given up â€Å"opportunities. † and to invent other vivid terms to mention ecision altering cost in a logic of choice and to the objective cost of the predictive theory. Hebert (1985 ) gave a very comprehensive idea about the market value. Yet his belief of fundamental value has quite possibly been a red-herring in the antiquity of economic analysis, according to him market value is sensitive to elements other than â€Å"on record costs† few of them are independent. Horwitz (2010) identifies the partiality of opportunity costs on either sides of the market connections so well to the importance of capital and economic calculation in the Austrian theory of the market process.Aherns (2008) says that management accountants’ most prior duty is to relate the available reserves with the future dealings of the business. Whereas this process is rather simpler in economics to determine which of the available alternates is going to pay off h ighest future cash flows Kearing et. al (2005) are of the view that multiple allocation of capital funds , commercial analysis and manufacturer side opportunity costs are all the unified part of the Austrian ideology. Woodbery (2000) says that the true opportunity cost of using the additional capability is the change in the worth of the firm's choices.By emphasizing on the state-contingent nature of best decisions, his framework distinguishes that the cost is not always identical to the present value of explicit venture or manufacturing decisions. Taylor (2005) suggests that many proficient economists may not completely comprehend opportunity cost. Frank (2005) said that comparative prices helps in finding out the comparative worth of ordained opportunities. His hypothesis is based on an indepth study of consumer indifferense curves. According to the author the economic cost is virtually the opportunity cost.Samuelson( 2009) puts stress on a close link between opportunity costs and cost of available resources. Economic cost consist of not only the noticeable monetary purchases or on record financial transactions but also more indirect opportunity costs, such as the profits on the manpower supplied by the owner of a resource company and other returns of similar nature. The factors mentioned are firmly controlled by the quotations available and demand in competitive markets. Henderson (2011), said that by â€Å"opportunity cost† of a resource, the economist mean the financial worth of the second favourite utilization of the available resource.Opportunity costs as in (Lawrance Gitman 2000) are those profits or returns that could be obtained from best alternative use of an a retained asset. So opportunity cost is the cash that shall not be obtained because of engaging an asset in project under consideration. Due to this, opportunity cost should be included as an expense or loss while doing the project evaluation. Raftery et. al(1999) writes that considerati on of opportunity cost is essential for the economist's while determining the costs. As resources are less compared to the needs, so application of resources in one profitable project hinders their use in other profitable pojectsBauman (2011) says that opportunity cost is the second best choice, he said that it is difficult to clearly frame the opportunity cost as identifying second best choices is a knotty matter. According to him the concept of opportunity cost can only be clearly defined in academic problems as in practical field a project â€Å"price to worth† calculations are complex Kimberly (1998) said that computerized accounting systems today solely emphasize on cash in and out of the firm, this eventually attracts clever dealers to dump credits that produce a big accounting profits.By the introduction of opportunity cost in persuit of calculating the true costs enforces further control on reporting process. Such concept implication helps the auditors to identify the fake earnings shown in the financial statements made in the year end. Recklies (2001) argues that from economic perspective the cost include all those expenditures that are crucial for perpetual succession of a business as as going concern, it also consist of the reimbursement for owners in shape of profit so that they maintain their investment portfolio within the firm.Marshall (2009) identifies the income as a total of personal skills, capital funds invested, assets possessed and the reputation of the business. Leeson (2008) has explained in his research work the uses if the concept of uncertainty and derives from this concept of the value of information and how it can be calculated. And emphasized upon the role of management accounting in the decision-making Berntell (2005) have focused on the optimum utilization of scarce resources like water to give maximum utility by reducing various costs and losses. For which economist must make a clear cut cost and benefit analysisDmytrenk o (1997 )has elaborated in his price to value investigation the opportunity cost of increased automation in a firm via changing the human resource by computers and equipment Caplan (2003) says that the term opportunity cost is sometimes confusing. Sometimes it is used to submit to the profit foregone from the next best option, and Often it is used to mention the difference in benefit of decision made and the benift of second favourite decision that is given up Fraker( 2006) suggests that EVA is a unique financial performance determining tool .Unlike other financial efficiency ratios, it gives a different outlook of a Bank’s financial health by including the cost of Capital employeed in the business and is more of concern to its shareholders. Shcherbakov( 2012) explains that implication of the concept of EVA is an enhanced measuring technique to find out the effect of internationalization on the commercial performance of any business King (2009) explained that Accountancy and Economics work for different purposes. He explained the multi-national corporation scenarios and compared the use of economic profits with that of accounting profitsLocal Literature (Hasan Al-Basteki 1998) worked on the use of modern Accounting techniques in the decision making in Bahrain and he concluded that not just the western world is implementing the new costing techniques but the middle east is also adopting the modern techniques Synthesis of the Literature Review The synthesis of the literature reviewed enlightens few similarities and differences with this research studies . The main similarities found in the literature are as follows i) Opportunity cost has been used in different parts of the world particularly in Banks and Construction industry ii) The No. f alternatives available influence the Opportunity Cost iii) Economic factors like inflation has effect on the project evaluation by the Banks . A closer review of these research papers show that Economists belonging to the Austrian school of thoughts are of the view that i) Opprtunity cost is not as important as Economic Profits are for economic decision making ii) Scarcity of resource is a factor which effects the decision makers approach The literature explains the significance of opportunity cost in framing the actual picture of the financial position of a company, same is the case evaluation of an investment project.Opportunity cost helps identifying the true cost of a project Opportunity cost is important in the determining the accurate financial position, hence in this research the relationship between the factors effecting opportunity cost and decision making is under study Theoretical Frame Work The study tends to explore the Opportunity cost and EVA for a given project in order to understand their relationship with each other. Very little literature is available in Economics and Accounting to determine the true profits of an organization(Denise Woodbery).The idea behind this research is t o establish the nature of relationship between Economic value added that reflects the monetory importance of a given project or in other words the economic profit and that of Opportunity Cost that reflects the accounting profit of the same project. Conceptual Frame Work The idea behind this research is to find out how effective is Opportunity cost in project evaluation perceived by the Bankers in the Kingdom of Bahrain.The data is collected and analysed to understand what status opportunity cost concept holds in project financial evaluation and its relative efficiency perceived by the bankers at selected commercial banks of Kingdom of Bahrain The study tends to explore the two concepts for a given project in order to understand their relationship with each other. The Opportunity cost as discussed in literature like any other relevant cost adds to the overall project expenditure (Ferraro & Laura O Taylor)Opportunity cost effects the total Cost of a Project , any increase in Opportuni ty cost means increase I nthe total cost of the project The higher the Opportunity Cost of a Project is the Smaller will be the net profit of it However the higher the net profit of the project is Opportunity Cost of the Project will be lower. Financial decision making tends to go for a project with smaller cost and hence inclusion of opportunity cost will alter the project cost and alter the decision ultimately.Various factors like availability of alternatives (James Raftery 1999), Scarcity of resources (Robert Frank 2005), Economic factors like trade cycle recession, inflation (Peter T leeson 2008) effects the use of opportunity cost in Project costing CHAPTER 3 RESEARCH METHODOLOGY This chapter presents the research design and methodology, sampling design, respondents of the study, research instrument, validity and reliability of the instrument, data gathering procedures, and statistical treatment of the gathered data.Research Design This study used the descriptive type of resear ch which involves assembling data which provide knowledge about the variables and then systematically tabularizing, portraying, and defining the data gathered (Glass & Hopkins, 1984). To get evidence concerning the current standing of the incidences to describe what happens in terms of change in value of the variables or settings in a state of research.. Opportunity Cost reflects the monetary importance of the next best alternative project.The study helps to find out how effectively this concept is incorporated in project evaluation procedure Research Design This is a descriptive research in which the population from which data is collected are the Management Personals from different business concerns established and working in Kingdom of Bahrain, directly or indirectly associated with the decision making and investment evaluation . Respondents of the Study The target population includes the working class particularly the managers , assistant managers and executives who work in Bahr ain and their field esponsibility include Investment Analysis ,Project evaluation and decision making of similar nature. Sample Size The sample size is 50 and the response rate is well above the international standard of quantitative research required to validate the result of the study Sampling Design There are many methods of sampling; however for this study Random Sampling is used that is from the target population a sample of 100 is collected on random basis.The study uses random sampling for convenience and to avoid bias of respondents that work in one organization have one opinion(as in cluster sampling) Research Instrument The instrument used in this study is Questionnaire, the content of the questionnaire that consist of 20 queries the first five of which are about the general information of the respondent, remaining queries for which the respondents will answer on a Likert Scale. All the queries will help to find the relation between the two variables Opportunity Cost (IV) and Decision Making (DV)Part I: Provide demographics of the respondents in terms of age , gender, educational attainment, work experience in years Part II: Provide the data about the respondents opinion on various factors that influence their decision while making financial evaluation of a project. The answers to these questions will be given on a five point rating scale. 5. Strongly Agree 4. Agree 3. Moderately Agree 2. Disagree 1. Strongly Disagree Validity of the InstrumentThe validity of instrument is carefully checked by the research committee that includes research professors, statisticians and advisors. The recommendations were incorporated. The justification of this validation was to avoid vague items and bias statements which have been correctly achieved. Reliability of the Instrument The questionnaire is pre-tested to test the reliability of it, with a small group of individualsworking in different companies in the Kingdom of Bahrain, in order to check their understanding of the questions.Data collection Method Questionnaire copies were distributed among bank officers in different branches of distinct commercial banks in various regions of Kingdom of Bahrain. The target respondents are expected to be acquainted with the subject and questions, included in the questionnaire. There are other methods of data collection like documentary analysis and interview however for this study survey methodology is opted. A copy of questionnaire is provided in the appendix Statistical Treatment of the DataThere are many choices of appropriate statistical methods however Correlation Coefficient as statistical method is used, so to find out the relation between the two variables. The survey form was used the Likert five point scale for the respondents to choose from as follows: [pic] Very few enterprises are using opportunity cost for just one reason. It is clearly evident that Opportunity cost related information is being used to accurately manage wide range of activi ties across a banking organization. Activities influenced by Opportunity cost calculation Activities |% of respondents | |Product Costs & Profitability |65 | |Performance Measurement |47 | |Shared Service Costing |41 | |Planning & Budgeting |40 | |Customer costing |38 | |Customer/Channel Costs & Profitability |38 | |Transfer pricing |25 | |Outcome / Output based management |25 | Expectedly, opportunity cost is used for product costing by approximately two by three of those respondants working in banking sector. It’s precision over traditional costing methods is borne out later in the survey with 87% finding that their Opportunity Cost product costs differed substantially from traditional costing methods, leading around 50% to reprice their products as a result!Validating the views expressed by Kaplan & Norton in their latest book ‘Strategy Maps: Converting Intangible Assets into Tangible Outcomes’, which lays emphesisis on the importance of using Opportunity Cos to support a Balance Scorecard, nearly half of all respondents are using their Opportunity Cost data to support their Performance Management The use of Opportunity Cost to support Shared Services costing has increased in popularity over the last few years. Now that internal services are represent up to 30% of an organisation’s costs, it has become imperative to accurately reflect how those services are consumed by business units. Over 40% of respondents are using opportunity cost to support Shared Service costing, enabling them to understand who and what is driving consumption of their internal services, and thereby increasing the effectiveness of their focus an core business. These trends are repeated by those who do not yet use opportunity cost, but are planning to. They want to use opportunity cost to support Initiative |% of respondents planning to use OPPORTUNITY COST | |Product Costing |55 | |Planning & Budgeting |36 | |Customer costing |27 | |Process/Continuous Improve ment |27 | The most noticeable difference is that only 18% are planning to use the information to support Performance Measurement. This could well be because the ease of which opportunity cost lends itself to Performance Measurement is not evident until an opportunity cost is up and running.Alternatively, the respondents may be looking to introduce opportunity cost to solve a pressing business requirement, and the links between Opportunity Cost and performance metrics are not immediately apparent. Opportunity Cost for Planning The emphasis of Bankers has moved from historical costs to future costs. An enormous 94% of those questioned are now using opportunity cost, or plan to use, opportunity costs for developmental drives. Opportunity cost Planners are looking at all aspects of their organisations in order to identify improvement opportunities. Some 60% are looking to identify process improvements, with 55% looking at activity level improvements via resource planning, and 49% looki ng to affect strategy formulation. However, only 13% are questioning their organisation’s process design in a fundamental way.Consistent with historic uses of opportunity Cost planning data is being used to support a variety of initiatives, although there is a surprising focus on opportunity cost for goal setting. |Initiative |% of OPPORTUNITY COST Planners | |Shared Service Costing |51 | |Product Costing |49 | |Defining team/dept goals |27 | |Defining organisational goals |13 | Product/Service Costing and Customer ProfitabilityBy using cause and effect tracing rather than allocations, opportunity cost better reflects the value chain of how organisations consume costs and provides more accurate product, service and customer costings than achieved using traditional costing techniques. The difference in opportunity cost product costs to absorption or other allocation based costings can be dramatic. The survey shows that 87% of practitioners found that their product and service costs differed from traditional costings markedly. The majority had an average variation of between 5 and 10%, which can be dramatic at a gross or net margin level. However, a surprising number of respondents (11%) experienced variations of over 100%! |Average variation |% |Maximum variation % | |0 |13 |; 10% |25 | |1-5% |15 |10-25% |17 | |5-10% |26 |25-50% |25 | |10-15% |13 |50-75% |14 | |15-20% |10 |75-100% |8 | |; 20% |23 |; 100% |11 | Cost Reduction and Process ImprovementThat ABC can improve your bottom line is beyond doubt, with potential cost savings amounting to 25% of cost bases being identified. Some organisations are yet to find where they can reduce their costs, but it is worth noting that over 70% of those who have not identified cost savings have less than 100 activities in their model. Whilst it is important to prevent ABC models become too large and unmanageable (primarily because they can induce analysis paralysis), it is essential that a reasonable level of detail is available, so that there is sufficient information on which to make cost reducing or revenue enhancing decisions. After all, profit outcomes are the result of process design and activity workflow†¦ Maximum potential cost saving as a % of cost base |% | |0% |18 | |1-5% |21 | |5-10% |33 | |10-15% |8 | |15-20% |13 | |20-25% |2 | |;25% |5 | A variety of methods are being used to help organisations translate their ABC data into real cost reductions. Cost driver analysis is the most frequently used method for aiding cost reduction and/or process redesign, with 67% of organisations using this technique. Process mapping and benchmarking are also popular, as is repricing of products and/or services, and analysis of the value that an activity adds to an organisation. Top techniques used to aid cost reduction |% | |Cost driver analysis |67 | |Process mapping & redesign |52 | |Benchmarking |52 | |Repricing |50 | |Value adding analysis |42 | |Product rationalisation |38 | |Value chain an alysis |32 | Conclusions ABC can, and does, add value to organisations. 96% of respondents have found the experience to be beneficial to their organisations, and 98% are expecting their implementations to deliver even more positive returns on their investment in the future Level of benefit delivered by ABC |% achieved |% future | |Adverse impact |4 |2 | |Negligible benefit |22 |13 | |Moderate benefit |54 |60 | |Substantial benefit |20 |25 | Regardless of the benefit analysis above, respondents recommend the use of ABC unanimously! In particular, practitioners recommend using ABC for product costing and cost reduction, to derive the most benefits, although there is a general belief held by ABC practitioners that the methodology should be broadly used as shown below. ABC supporting |% of organisations | |Product/service costing & profitability |80 | |Cost reduction |65 | |Continuous Improvement Program |56 | |Business Process Re-engineering |55 | |Shared Services Costing |51 | |Custom er, channel or value chain analysis |44 | ABC is generating real benefits for all sorts of organisations across Australia. These benefits can only increase as more organisations are looking to start an ABC project for the first time, but the full potential of ABC will not be realised as so many existing ABC users are still not employing ABC to its full capabilities. It is important that experienced ABC companies capitalise on their implementations to achieve the maximum possible benefits.Increasing the scale of an ABC project need not be an expensive, time-consuming process. There are cost-effective solutions that combine ABC, Process Mapping and Balanced Scorecard, to produce automated, regular reports with a minimum of manual intervention. With organisation-wide implementations providing much greater cost savings, expanding your ABC project can only be advantageous to your organisation’s bottom line. CHAPTER 4 Analysis and interpretation The data collection method for this study is survey questionnaire conducted face-to-face with 51 randomly chosen Bankers from various commercial banks in Bahrain from various cities. The questionnaire includes multiple choice, open-ended, and Likert scale questions.Some questions of the survey were adopted form various previous studies (Brierly et al. , 2001; Van Triest and Elshahat, 2007; Wijewardena and Zoysa, 1999). The data collection period ranges from October 2012 to November 2012. (1) general information on the business organizations and respondents; and (2) cost and management accounting practices. Table 4. 1 Information gathered from the first part of the questionnaire. |Bank Classification |Percent | |Commercial Banks |  40 | |Islamic Banks |  10 | |Other Banks |  1 | |No. f Employees |Percent | |10 to 49 |   | |50 to 99 |  90% | |100 and more |  10% | |Age of the Banks |Percent | |10 years or less |  10% | |20 year or less |  80% | |20 years or more |  10% | In the Table 1, Bank classifica tion, position of respondent, number of employees, and age of Banks are presented. In Bank classification, the highest percentage belongs to commercial banks (5banks), and â€Å"others† includes Banks dealing particularly in investment (1 bank) 4. 1. Product costing methodsThe respondents were asked to specify the cost factors they implement in an investment project costing. According to the answers, the most widely used costing factor is Financing cost (31 respondent), followed by opportunity cost (11 respondent) and loan process cost (9 respondents). In Table 2, which shows the detailed answers to this question, the most significant points are the financing cost widely by lower managerial levels, and that of opportunity cost largely by top managerial level. Primary cause for the financing cost by banks is that they offer more of the saving accounts than fixed deposit accounts. Table 4. 2 Most important Cost elements in an Investment Project Bank Classification |Financial Co st |Loan Processing Cost |Opportunity Cost |Other | |Commercial Banks |  20 |  3 |  3 |  0 | |Islamic Banks |  6 |  3 |  5 |  0 | |Other Banks |  5 |  3 |  3 |  0 | |Total |31 |9 |11 |0 | 4. 2. Complications faced in product costing The respondents were also asked to point out the difficulties they encounter in Investment project costing. Out of 51 respondents, 22 see the limited Complexity in cost evaluation as top difficulty (43 percent), availability of alternative resources(33. 3 percent), followed by economic instability (24. 7 percent). 4. 3. Role of Opportunity Cost in Management Accounting PracticesIn another part of the survey, which was adopted from Van Triest and Elshahat (2007)’s study, respondents were asked to score the role of opportunity cost in various financial analysis on a Likert scale of 1 (no role) to 5 (major role). To evaluate the results, one sample t-test was conducted (Table 4). The results showed that pricing decisions are t he most important area where opportunity cost is deemed important at an average of 4. 16, followed by customer profitability and activity analysis at 4. 07. Performance measurement and make or buy decisions with an average of 4. 04 and 3. 96 respectively are also important areas where opportunity cost is used. However, opportunity cost is not seen important in product mix decisions, and adding or deleting products as much as other areas. Management Accounting Practicies |Mean |S. D |t-test | |Pricing decisions |  4. 15 |  1. 146 |4. 29 | |Customer profitability |  4. 08 |  1. 034 |  4. 01 | |Performance measurement |  4. 03 |  1. 071 |  3. 714 | |Activity analysis |  4. 08 |  1. 120 |  3. 793 | |Make or buy decisions |  3. 96 |  0. 62 |  3. 576 | |Product mix decisions |  3. 54 |  1. 168 |  0. 289 | |Adding or deleting products |  3. 47 |  1. 370 |  0. 199 | Table 4. Results of one sample t-test for use of Opportunity cost in management accoun ting practicies (Test value=3. 5) |Management Accounting Practicies |Mean |S. D |t-test | |Pricing decisions |  4. 15 |  1. 146 |4. 9 | |Customer profitability |  4. 08 |  1. 034 |  4. 01 | |Performance measurement |  4. 03 |  1. 071 |3. 714 | |Activity analysis |  4. 08 |  1. 120 |  3. 793 | |Make or buy decisions |  3. 96 |  0. 962 |  3. 576 | |Product mix decisions |  3. 54 |  1. 168 |  0. 289 | |Adding or deleting products |  3. 47 |  1. 370 |  0. 199 |Furthermore, the findings are compared with the results of Van Triest and Elshahat (2007). The comparison indicated that two studies yielded parallel results. As seen in Table 5, first three items with the highest mean are the same. In both countries, pricing decisions, customer profitability, and performance measurement are the most prominent areas in which costing information is applied. Among the remaining four application areas, the rank of activity analysis is different. In this study, ac tivity analysis is the fourth in ranking, but it is the last in ranking in Van Triest and Elshahat (2007)’s study. Table 5. Comparison of results with the results of Van Triest and Elshahat (2007) Management Accounting Practices |Mean |Rank |Mean* |Rank* | |Pricing decisions |  4. 15 |  1 |  4. 44 |  1 | |Customer profitability |  4. 06 |  2 |  4. 19 |  2 | |Performance measurement |  4. 06 |  3 |  4. 11 |  3 | |Activity analysis |4. 08 |  4 |  2. 33 |7 | |Make or buy decisions |3. 99 |  5 |  3. 5 |  4 | |Product mix decisions |  3. 54   |  6 |  3. 33 |  5 | |Adding or deleting products |  3. 50 |  7 |  2. 89 |  6 | * The results of Van Triest and Elshahat (2007) 4. 5. The ratio of opportunity cost to total cost In the questionnaire survey, the ratio of opportunity cost to total cost (O. C/T. C) was also questioned. Overall mean for all the banks is 34. 48 percent. (Table 6) was conducted to see the significant differences a mong banks. The results showed that there is a significant difference among industries (significant at 0. 10).Duncan test from Post Hoc tests showed that Commercial Banks has the highest OC/TC ratio and is significantly different than Islamic Banks and Investment Banks and miscellaneous Banks. Table 6. The ratio of opportunity cost to total cost (percent) 4. 6. The reasons for the increased interest in opportunity cost manifestation in banks dealing The respondents were asked to score the reasons for the increased manifestation of Opportunity cost in their daily dealing on a Likert scale of 1 (completely disagree) to 5 (completely agree). A list of reasons was provided for the respondents so that they evaluated each. The results of one-sample t-test in Table 7 showed that decreasing profitability (4. 9) is the primary reason which increases the importance of opportunity cost. Other reasons which increase the importance of opportunity cost are increasing costs (4. 57), increasing dom estic and global competition (4. 30), and economic crises (4. 23). Actually, means of four items above 4. 00 indicate that they are all factors considered important for the increased interest in opportunity cost . This means profitability of companies is decreasing, possibly due to increasing costs, and increasing domestic and global competition. Economic crises which hit companies from time to time are also important reason for the increased interest in opportunity cost identification and implication. Table 7.The reasons for the increased interest in opportunity cost Calculation (Testvalue=3. 5) |Mean |S. D |t-test | |Decreasing profitability |  0. 566 |14. 170   | |Increasing costs |  0. 666 |  11. 929 | |Increasing domestic and global competition |  0. 940 |  6. 450* | |Economic crises |  1. 020 |  5. 399* | Significant at 0. 001 level 4. 7. Perceived importance of opportunity cost in overall Banking Operation Lastly, the respondents were asked to evaluate the per ceived importance of Opportunity cost that are utilized in banking organizations on a Likert scale of 1 (unimportant) to 5 (very important). The results of one-sample ttest in Table 8 indicated that the most important management accounting practices in decreasing order are budgeting (4. 48), planning and control (4. 33), cost-volumeprofit analysis (4. 3), target costing (4. 16), quality cost reporting (4. 09), performance measurement and evaluation (4. 02), responsibility accounting (4. 0), standard costing and variance analysis (3. 89), and strategic planning (3. 78). Transfer pricing (3. 65) is unique practice that is significantly not important based on test value of 3. 5. These findings indicate that companies perceive traditional management accounting tools still important. For example, budgeting, planning and control, and cost-volume-profit analysis are perceived the most important of all management accounting practices. Quality costing and target costing as new management acc ounting practices are utilized by the companies. However, strategic planning, and transfer pricing are perceived the least important ones. This may be due to size of the sample firms.Since the sample consists mostly of small and medium-sized enterprises (according to number of employees), some tools may be too sophisticated to be utilized. Szendi and Shum (1999) states that the larger the firm the more sophisticated the management accounting system and the more likely isthe firm to utilize sophisticated management accounting techniques and practices. Abdel-Kader and Luther (2008) also proved that large firms adopt more sophisticated management accounting techniques and practices than small firms. Table 8. Perceived importance of Opportunity Cost in routine banking operations (Test value=3. 5) |Mean |S.D |t-test | |Budgeting |0. 754 |  9. 911** | |Planning and control |0. 819 |  7. 500** | |Cost-volume-profit analysis |  0. 871 |  6. 900** | |Target Costing |  0. 849 |  5 . 820** | |Total Quality Management |  1. 115 |  3. 890** | |Performance measurement and evaluation |  1. 027 |  3. 39** | |Responsibility accounting |  1. 056 |  3. 450** | |Standard costing and variance analysis |  1. 140 |  2. 480* | |Strategic planning |  1. 011 |  2. 050* | |Transfer pricing |  1. 300 |  0. 860 | ** Significant at 0. 001 level * Significant at 0. 05 level CHAPTER 5 Summary and Conclusion The survey revealed the perceived importance of Opportunity Cost at selected commercial banks in the Kingdom of Bahrain.The findings are expected to contribute to the existing literature about the subject, especially in developing markets. The major findings of the study are as follows: The most vital cost element for Commercial Banks is financial cost The complexity in loan costing poses as the highest ranking difficulty due to the availability of alternative projects, Customer Activity Analysis and pricing decisions are the most important area where op portunity cost is calculated (parallel to the finding of Van Triest and Elshahat, 2007), Overall mean of the ratio of overhead to total cost is 34. 48 percent for all Commercial Banks in the Kingdom of Bahrain,The highest opportunity cost/total cost ratio belongs to non-islamic Commercial Banks, Decreasing profitability, increasing costs and competition, and economic crises are reasons which increase the importance of opportunity cost The most important use of Opportunity Cost is in Budgeting out of all routine functioning of Commercial Banks (parallel to the finding of Chenhall and Langfield-Smith, 1998) The findings indicate that Banks perceive traditional management accounting tools less important. The new management accounting practices such as strategic planning, and transfer pricing are perceived more important than traditional ones. Therefore, the banks have been calculating the Opportunity Costs for these management accounting tools. Scope for further researchSince the sampl e consists mostly of medium sized local branches of International banks , they may not reflect the applications of large scale banking corps. Secondly, the results are confined to the Commercial Banks and should not be generalized to the other sectors. Thirdly, since the survey conducted on companies operating in Bahrain , the findings may not be generalized for the worldwide policies of the Banks. For future research, whole region wide and more comprehensive survey could be conducted with the participation of more banking companies from different countries. Moreover, case studies can be conducted to make more in-depth analysis about cost and management accounting practices.