Market Strategy of Blue Cross Blue Shield Assignment

Market Strategy of Blue Cross Blue Shield - Assignment Example Conducive research indicates that even during the financial crisis of 2008, the organization has been stellar because of their high customer equity and premiums. Healthcare is one the elements that were always solid. Looking at the financial statements, the company made annual sales of $75.7 million. This allowed the company to leverage itself in the industry.   One of the major strengths of the organization is its ability to have a strong customer base supported by its technological infrastructure. The infrastructure is heavily supported by its business model and understanding how technology can serve its needs. However, the key benefit that the Blue Cross achieved was the fact that it allowed its customers to the accessibility of information without much delay. In an industry where information is vital, this organization was able to accommodate the needs of their growing customers as well as provide information that was compliant with HIPAA and ACA.   One of the major strengths, as mentioned before, was the fact that it had a strong customer and revenue base. The premiums that were being derived from the organization truly harnessed growth and allowed the company to get a strong threshold as a company.   One of the major challenges of the company was to expand its private and public cloud with compliance. It was evident that the risk management involved in the insurance business is a huge focal point.   Blue Cross had a huge dilemma of expanding their IT infrastructure boundaries by maintaining old records and creating space for new customers. Furthermore, the company’s auditing team was able to ensure the legitimacy of network passwords within their own IT infrastructure. When it comes to cloud computing, many flavors are present.

Theme Duality in My Papa's Waltz Essay Example | Topics and Well Written Essays - 1000 words

Theme Duality in My Papa's Waltz - Essay Example The initial reading may make people comment that y Papa's Waltzis simply a delightful childhood incident a tender moment between father and son. While another interpretation is the that the boy in the poem is being abused by his father that is the child ancesunwillingly. Whether the poem is a about a positive or negative relationship between a father and son, Roethke goal as an author is clear. He wanted to write a poem in which the reader can just as much part in determining the theme as the author. Meaning and theme of any piece of literature is partly determined by the author and also by the audience. y Papa's Waltzexemplifies the situation in which personal and past experience determines the ultimate theme. Due to the various discussions over the meaning of the poem, the reader neglects the grace and skill of the writing. Roethke creates this split meaning poem by skillfully using a number of literary elements. Roethke in y Papa's Waltzemploys the use of contrasting images, allit eration,and meter to create the poem's dual theme. y Papa's Waltzis poem about a ancebetween a father and child. Roethke uses the metaphor of the waltz as a way to show the relationship between a father and child. The waltz is a dance between two people, like all dances someone must lead and someone must follow. This is true in all parent child relationships. The drunk father and son dance in the poem knocking over items, bumping into things while the mother looks on disapprovingly. The father dances the son right into the bed. However, the poem is not that straight forward. There are several components of the poem which are not light hearted or fun. It is obvious that t

Analysis of Healthcare Leadership Essay Example | Topics and Well Written Essays - 1250 words

Analysis of Healthcare Leadership - Essay Example In the healthcare sector, the provision of quality healthcare has always been a key point of concern. The reason is that in healthcare, the lives of patients and their future lie in the hands of hospital practitioners like doctors, nurses and the support staff. All of these fragments of the hospital structure work together in liaison with the administration to ensure that quality service is provided to better the lives of the patients. To achieve quality; however, flexible and appropriate leadership styles need to be applied to ensure that the whole hospital structure's coordination effects service provision. To bring about this quality also requires effective leadership styles that aim to address any resistance to change and flexibility. In leadership, understanding the application and development of leadership theories prepares a healthcare manager in his tasks of predicting, explaining ad controlling operations. I challenge the validity of Kumar’s support for the transforma tional style of leadership and propose that the contingency style of leadership is the best option for ensuring change through the engagement of those resistant to it. Good leadership in health care has increasingly become a major issue as stakeholders have made the realization that through effective leaders, institutional change can occur. Robin Kumar in Leadership and Healthcare proposes that the transformational style is most effective in leadership since it attracts followers to own change.

Islam a Religion of Peace Essay Example for Free

Islam a Religion of Peace Essay And then there is the question of characterizing Islam as â€Å"peaceful† and doing so under duress. That is, when you are being pursued and hounded by people who brand you as totally irrational and uncontrollably violent. So, you have a knee-jerk reaction, purely defensive and purely self-protective and blurt out that you are a â€Å"peaceful religion. † And you are absolutely and one hundred percent right in saying that. For, Islam is all about peace and truth and justice and kindness and compassion. But that is not what your accusers and tormenters are saying. They are pointing to all the violence that is going on in different parts of the Muslim world, violence in which Muslims are involved in one way or another, and saying that it is all Islam’s fault. But what some of these people conveniently forget is that there are all kinds of background factors and conditions that lead to violence in individuals, groups, nations and societies. They forget that peace is one state of human life and reality. Another is strife and conflict. A third reality of human life is force. Peace is the ideal state to which we all aspire and toward which we all work. Strife is the sad and gloomy reality in which human life is all too often mired. Legitimate, lawful and societally sanctioned force is the instrument that human beings have devised for minimizing and controlling strife and for maximizing peace. The foundation of true and lasting peace on earth and in any society is justice, love, compassion, integrity, truth, reasonableness and sound morality. Where this foundation is absent or weak, and where people’s most basic needs and legitimate rights and aspirations are not met, and are persistently and blatantly denied, chances of stable and lasting peace are minimized or jeopardized. All too often, then, those who have been systematically denied their basic and legitimate rights, and who are not allowed by nations, societies and governments any rightful recourse to the redress of their lawful grievances, begin to resort to force and violence as an instrument of resistance to their domination, subjugation and exploitation by others and for the amelioration of their situation. There are all kinds of university books, full of all kinds of theories, that explain why and how people develop violent tendencies and behavior.

Value Added Services In Logistics Operations Marketing Essay

Value Added Services In Logistics Operations Marketing Essay Logistics is a procedure to optimize all activities to ensure the delivery of cargo through a transport chain from one end to the other. The comparative efficiency of a countrys trade logistics chain is of vital importance in enhancing competitiveness of its industry and commerce. In this regard, international differences in trade logistics efficiency determine in large extent the efficiency and sustainability of the economies. In developed countries such as the U.S. and Japan, logistics costs are about 10 per cent of GDP. For some less developed economies, these costs exceed 30 per cent. Moreover, these differences among countries appear to be widening. According to the European Logistics Association, the logistics costs in relation to annual turnover can amount to more than 30 per cent in the food industry, 27 per cent in the metal industry, 23 per cent in the chemical industry, 15 per cent in the automotive sector. The percentages may differ from country to country and industry by industry, but many of the critical cost factors are influenced by public policy. The logistics chain consists of activities that facilitate the movement of goods from supply to demand. As many such activities require the use of ports, port authorities have taken a particular interest in the various port activities involved in logistics. Logistics costs are not limited to costs consumed in carrying out logistics activities. Rather, they should be understood as all costs input into a given logistics system for the provision of logistics service. According to the US Department of Transportation, logistics is defined to be the method that service groups position themselves to perform activities such as transportation, warehousing, inventories, information processing and customer relations. Advanced logistics is the term used when the firms make use of technologies and permits to reduce costs by substituting large inventories, multiple warehouses and customer service outlets with transportation, e-commerce and just-in-time deliveries. To reap the benefits of advanced logistics, firms have restructured themselves in relation to transporting of goods from one point to another and improving infrastructure. During the 1970s typical logistics functions focused on traditional physical distribution activities, including the movement and storage of finished goods between the producer and consumer. Those specific functions were identified in the 1985 A.T. Kearney study of logistics organizations as outbound transportation, logistics administration, intracompany transportation, logistics control, finished goods field warehousing, and logistics systems planning. These activities were eventually determined to be quite narrow in terms of meeting customer needs. Therefore, they provided the foundation for broader interpretation of logistics, which led to inclusion of various activities like the processing of orders and development of customer relations, finished goods plant warehousing, finished goods inventory management, and inbound transportation. The third phase in this evolutionary process was identified to include logistics engineering, production planning, sourcing or purchasing, raw mater ials or work-in-process inventory management, sales forecasting, and international logistics. This evolutionary process moves logistics from its traditional physical responsibility to an integrative value added role in the business. As logistics becomes more important in an organization, it encompasses more functional areas within a single responsibility center to provide more coordination and more highly integrate the logistics channel. Because of the evolution of the logistics operations, its responsibility travels further back through the supply chain to the raw material source. When logistics operations is linked with manufacturing operations, it can be seen that the aspects of manufacturing activities with logistics operations activities address the common underlying foundations that contribute to the value of the products and services offered to customers. According to a study conducted by Frost Sullivan in 2009, about logistics operations in ASEAN countries, it was found that Singapore accounts for the lowest percentage of logistics as a part of total sales at 8 percent while Indonesia has the highest at 19 percent. According to this 2009 study, Malaysia and Thailand accounts for 17 and 12 percent, respectively. It has been noted that the high logistics costs may be attributed to inefficiency in operations. The inefficiency may be linked to the lack of trained man power and inadequate support to facilities and infrastructure, which has led to the slow flow of cargo and distribution of goods. Based from this study it can be deducted that an efficient operation is due to the presence of trained professionals, high quality and an array of logistics services offered and an excellent infrastructure and communications or information system. As of present date, studies have shown that transportation is the largest contributing factor to the cost acquired by most companies. Currently, the primary reason of most consumers for engaging in a third party logistics provider or what is known to be a trucking service is to enhance the efficiency of logistics operations through professional intervention. Engaging in a trucking service also has its cost advantages and thereby acts as a cost saving move for most companies. An arrangement with a logistics company also provides the consumer the ability to focus on other concerns such as their own competency and reliability. It is no surprise therefore that the main criterion evaluated by most companies engaging in this service is the cost savings factor. There is only Malaysia that evaluates the services offered and the condition of the equipments when choosing their logistics service provider. Meanwhile, it has also been found out that across ASEAN countries, technology is the least considered factor. On the other hand, it can be noted that the most efficient country in logistics operations, Singapore, is heavily focused in the communications area. This countrys most influential consideration factor is the network coverage employed by the logistics service provider since Singaporean companies are main players in the international market. Technology wise, there are sixty percent of consumers adopting technology are heavily rely on warehouse management and the bar coding system. On the other hand, transportation planning system and vehicle tracking system are yet to be embraced by more than sixty percent of the end-users. The use of the smart labeling system or RFID for public vehicles is still low. The adoption and usage for RFID or smart labeling system are still low mainly because of the high cost of implementation and the less mature technologies across South East Asia. Among all the activities in logistics operations, transportation is the most utilized activity accounting for more than seventy percent of end users outsourcing such logistics activities to service providers. Freight forwarding comes to a close second to transportation followed by inbound warehousing accounting for more than fifty percent. On the other hand, processes like the packing and labeling of goods and management of fleet are the value added services that are most utilized. DISCUSSION AND ANALYSIS Value Added Services (VAS), which is loosely defined as a collection of specific requirements mandated by customers involving additional processing of a product or an order beyond the simple picking of the product for an order, is an especially common practice in the retail supply chain and is estimated to consume +10% (and growing) of total labor hours. According to Logistics Managements 2nd Annual Warehouse Operations Survey, 80% of respondents are dealing with some form of VAS in their DCs. This was confirmed during in-depth interviews conducted by Distribution Digest for our report on Automated Case Picking (ACP). Value added services are offered by the logistics companies in order for customers to benefit from their full use and application. This may include anything from routine maintenance and customer technical support; to customization and application training; to real-time inventory management and state-of-the-art channel support. It refers to the process of developing rela tionships with customers through the provision of an augmented offer, which may encompass many aspects of value-added activities. Value added services are aimed at ensuring that special requirements of customers are met and that product is received as ordered. These services are integrated with logistics operations through a global network of agents and coordinated at either point of origin or final delivery location. These services may include: complete shipping documentation from start to finish; cooperation with convention/trade show coordinator; pickup and delivery of time definitive freight; unpacking and setup assistance including the removal of packing materials; repackaging of materials at end of trade show; pickup and return; logistics consulting; performance reporting and distribution services. Through out the years, an evolution to the terminologies relating to the consumer has been witnessed in the logistics industry. Logistics initially gave birth to the concept of customer relations which represents the combined output of the various processes in logistics. Eventually, end products of marketing and logistics activities were connected to customer relations to create customer satisfaction. Most recently, the concept of customer success has been introduced to link the service provided by the firm not only with the satisfaction of the customer, but with the success that the customer realizes in attaining its organizational objectives. Since, transportation, warehousing and freight forwarding are activities that are most likely to continue in the next 2-3 years, there is an increasing trend for consumers to look for companies that can supply value added services. The value added service employed by the logistics companies are created through the eyes of the logistics executi ve. It is critical that the strategies and tactics used influence the perception that the customer has of the organization and has the potential of transaction creation during the short term as well as the long term. Therefore, the logistics executives perception of value is directly linked to the firms ability to satisfy the customer. This can result in customer satisfaction, which can ultimately lead to a positive attitude by the customer towards the service provider. The value of the logistics service provided is measured by an assessment of the logistics executives perception of how customers perceive the service provided by the firm and how they react, or respond to this service. This measure, called customer reaction, include the level of perceived satisfaction with the existing service levels, whether customers are inclined to reduce or increase their business with the firm if the service levels change relative to their expectations, and whether customers can recognize change s in the service levels provided by the firm. These days, the commercial success of a logistics operation could stem from a productivity advantage in traditional cargo-handling service, from value-added service, or from a combination of the two. Productivity advantages come mainly from economies of scale and economies of scope, suggesting that the most productive ports will be those that are equipped to handle large cargo volumes and significantly reduce unit costs through efficient management. Shippers and carriers select individual ports not only based on their cargo handling service capabilities, but also on the benefits they are capable of delivering. Unless a port can deliver benefits that are superior to those provided by its competitors in a functional aspect, customers are likely to select logistics providers based merely on price. This fact raises the question of how to one logistics company can stand out from the rest of the companies that are in the market or what is known to be value differentiation. In the 1970s, almost every logistics company provided the same basic package of services to almost every customer. Nowadays, however, it is more difficult for service providers to compete on the basis of cargo-handling service. There has been a convergence of technology within cargo-handling service categories. This means that though new technology may sometimes provide a window of opportunity for productivity improvement, in many cases that same technology is also available to competitors. It is no longer possible to compete effectively on the basis of basic, traditional functions. Thus, there is a need for logistics service providers to seek out new means of gaining a competitive edge. The late 1980s saw the emergence of major changes. Consumers began to ask service providers to provide a greater variety of services. Providing value-added services is a powerful way for logistics companies to build a sustainable competitive advantage. Shippers and customers are becoming increasingly demanding. Customers now tend to look at value-added logistics services as an integral part of their supply chain. As a result, service providers must attempt to satisfy these needs by offering differentiated services. This poses a particular challenge for logistics operators in the industry. Studies show that the most successful logistics service providers are those that not only have a productivity advantage in cargo-handling services, but that also offer value-added services because operators who do not provide additional services are indistinguishable to their competitors. Although there have been researches that have found that there continues to be a need for operators to provide the basic, traditional cargo-handling function and that there continue to be many customers for such services, it is clear that, in the future of the logistics operations industry, there will be fewer ports that prosper only in this area. Rather, we will see the dominance of superior service leaders that possess both a productivity advantage and a value-added service advantage. Logistics companies that provide value-added services are on their way to becoming the more superior logistics company. The advanced ports around the world have continuously emphasized the function of logistics centres mainly due to the high degree of global production and the need for value added services. These trends in international logistics strongly suggest that the trend toward value added services is likely to continue into the future. Currently, the logistics discipline continues to revolutionize itself with the adaptation of various e-business practices and forms of just in time delivery. The nature of these adjustments may result to more single package deliveries requiring additional transport services. KEY RECOMMENDATIONS Therefore, for logistic operations to have an edge, it is recommended that logistics companies incorporate valued added services to the array of services that they provide in a matter that is cost efficient. There is also a need for service providers to be able to offer services of high quality and as well as cost reducing solutions. Service providers must also take a closer look at the activities in operations and ensure that there are no repetitions of activities for maximum optimization. The elimination of redundant activities results in more efficiency and cost reductions. Providing trainings for inexperienced personnel is also vital in achieving maximum customer satisfaction in the future. The ultimate output of the quality effort by the logistics organization should be through the customers reaction in the market. This reaction is continually perceived by the logistics executive in the form of individual customer sales, business in specific traffic lanes, changes in facility in ventory levels, or changes in the volume of customer complaints to the customer service department. However, the simple truth is that when you are processing thousands of cases an hour and shipping dozens of trailers per day, there just isnt a lot of time for value added services, especially that which doesnt provide real benefit. In the end engaging in value added services is a business decision. A customer can be told that the service provider can do just about anything they want, but the customer must also know that its not free. Value added services make the services provided by the logistics service providers more expensive. The customer needs to gauge how important it is to its business. Sometimes retailers are surprised that their requests dont add any value. As an example, in a certain logistics company, one Vice President of Operations, described a situation where an existing customer ordered standard 12 packs last year, however this year all their orders were in 6 packs. The Operations VP went back to the customer explaining that when youre handling 80,000 cases verses 40 ,000 there is a big difference in handling and processing cost. That particular customer understood the logistics cost impact for the DC, as well as for them, and immediately changed their Purchase Order back to 12 packs. Still, for some companies the consequences of value added services have been more frequent shipments and in smaller quantities, forcing many of them into piece-pick operations where they had previously been a full case-based pick. Or, at the very least, having to open full cases to apply tickets and other paperwork and then manually applying a special shipping label.    If it is determined that the cost absorption for a specified value added service is too great, the logistics company has the option to try and work out a deal with the customer to obtain waivers, or in some extreme situations refuse to comply. On the other hand, a major component of an efficient supply chain is getting everything done on the first touch. Therefore, it can be logically argued that in many cases moving value added services upstream to the manufacturing level is moving it in the right direction. à ¢Ã¢â€š ¬Ã‚ ¢

Results Chapter on CMV Infection Research

Results Chapter on CMV Infection Research Results This study has been conducted on 366 patients with suspected CMV infection attending pediatric department at Zagazig University Hospital. Table (1): Age distribution of the studied patients (except for neonates with congenital anomalies) (N=344)       Studied patients (N=344) No. % Age (years) Mean  ± SD 9.9  ± 3.4 Median (Range) 10.0 (3.5 18.0) The mean age and standard deviation (SD) of ages of the studied patients (except for neonates with congenital anomalies) in years as shown in table (1) was 9.9  ± 3.4. Table (2): Age distribution of neonates with congenital anomalies (N=22) Studied patients (N=22) No. % Age of neonates with congenital anomalies group (days) Mean  ± SD Median (Range) 4.1  ± 1.6 4.0 (2.0 7.0) Table (2) shows that The mean age and standard deviation (SD) of ages ofneonates with congenital anomalies were 4.1  ± 1.6 days Table (3): Sex distribution of the studied patients (N=366) Studied patients (N=366) No. % Sex Male 202 55.2% Female 164 44.8% Table(3) shows that 55.2% (202 out of 366) of the studied patients were males, while 44.8% were females. Figure (1): Pie diagram showing sex distribution of the studied patients (N=366) Table (4): Distribution of the risk factors among the studied patients (N=366) Risk factors Studied patients (N=366) No. % Malignant hematological disease with chemotherapy 43 11.7 % Receiving repeated blood transfusion 164 44.8 % Fever of unknown origin 16 4.4 % Critically ill patients lying in the ICUs with prolonged hospitalization 28 7.7 % Receiving corticosteroids or other immunosuppressives for long period 22 6 % Chronic renal failure with haemodialysis 64 17.5 % Fever with pancytopenia 7 1.9 % Neonates with congenital anomalies 22 6 % As shown in table (4) and figure (2),44.8% of the studied patients were receiving repeated blood transfusion, 17.5% were suffering from chronic renal failure and receiving haemodialysis, 11.7% were suffering from Malignant hematological disease and receiving chemotherapy, 7.7% were critically ill patients lying in the ICUs with prolonged hospitalization, 6% were receiving immunosuppressive agents for long period, 6% were   neonates with congenital anomalies, 4.4% had fever of unknown origin, and 1.9% suffered from fever with pancytopenia. Figure (2): Pie diagram showing Distribution of the risk factors in the studied patients (N=366). Table (5): Results of ELISA IgM and IgG for CMV in the enrolled patients (N=366) ELISA results Studied patients (N=366) IgM Positive 60 16.4 % Negative 306 83.6 % IgG Positive 93 25.4 % Negative 273 74.6 % Over all seropositivity Positive both IgM and IgG 109 29.8 % As shown in table (5), out of the 366 studied patients, 60 (16.4%) and 93 (25.4%) were positive for CMV IgM and IgG in an ELISA test respectively. Table (6): Agreement between ELISA IgM and IgG in the studied patients (N=366) ELISA IgM ELISA IgG Total #Test P-value Negative Positive Negative No. 257 49 306 0.469 0.000* (HS) % 94.1 % 52.7 % 83.6 % Positive No. 16 44 60 % 5.9 % 47.3 % 16.4 % Total No. 273 93 366 % 100.0 % 100.0 % 100.0 % #  Ã‚   Kappa measure of agreement P< 0.05 is significant. Statistical Significance Standards for strength of agreement for the kappa coefficient: ≠¤0=poor, .01-.20=slight, .21-.40=fair, .41-.60=moderate, .61-.80=substantial, and .81-1=almost perfect. Table 6 shows that there is a moderate agreement between ELISA IgM and IgG in the detection of CMV in children with high statistical significance. Table (7): Prevalence of CMV IgM seropositivity among different risk groups Risk Factors No. Studied patients (N=366) Positive IgM No. % Malignant hematological disease with chemotherapy (43) 8 18.6 % Receiving repeated blood transfusion (164) 36 21.9 % Fever of unknown origin (16) 8 50 % Critically ill patients lying in the ICUs with prolonged hospitalization (28) 0 0 % Receiving corticosteroids or other immunosuppressives for long period (22) 0 0 % Chronic renal failure with haemodialysis (64) 8 12.5 % Fever with pancytopenia (7) 0 0 % Neonates with congenital anomalies (22) 0 0 % Table (7) and figure (3) show that the highest prevalence (50%) of CMV IgM seropositivity was reported from patients suffering from fever of unknown origin. Figure (3): Bar chart showing prevalence of CMV IgM seropositivity among different risk groups Table (8): Association between CMV IgM seropositivity and different risk factors Risk factors No. Studied patients (N=366) Test p-value ELISA IgM Positive (N=60) Negative (N=306) No. % No. % Malignant hematological disease with chemotherapy (43) 8 18.6 % 35 81.4% #11.17 0.010 (S) Receiving repeated blood transfusion (164) 36 21.9 % 128 78% Fever of unknown origin (16) 8 50 % 8 50% Chronic renal failure with haemodialysis (64) 8 12.5 % 56 87.5% #  Ã‚   chi square test P< 0.05 is significant. *statistical Significance Table (9): Prevalence of CMV IgG seropositivity among different risk groups Risk factors No. Studied patients (N=366) Positive IgG No. % Malignant hematological disease with chemotherapy (43) 0 0 % Receiving repeated blood transfusion (164) 63 38.4 % Fever of unknown origin (16) 0 0 % Critically ill patients lying in the ICUs with prolonged hospitalization (28) 0 0 % Receiving corticosteroids or other immunosuppressives for long period (22) 0 0 % Chronic renal failure with haemodialysis (64) 8 12.5 % Fever with pancytopenia (7) 0 0 % Neonates with congenital anomalies (22) 22 100 % Table (9) and figure (4) show that the highest prevalence (100%) of CMV IgG seropositivity was reported from neonates with congenital anomalies. Figure (4): Bar chart showing prevalence of CMV IgG seropositivity among different risk groups. Table (10): Association between CMV IgG seropositivity and different risk factors Risk factors No. Studied patients (N=366) Test p-value ELISA IgG Positive (N=93) Negative (N=273) No. % No. % Receiving repeated blood transfusion (164) 63 38.4% 101 61.6% 53.96 0.000* (HS) Chronic renal failure with haemodialysis (64) 8 12.5% 56 87.5% Neonates with congenital anomalies (22) 22 100% 0 0% #  Ã‚   chi square test P< 0.05 is significant. *highly statistical Significance Table (11): Results of real time PCR for CMV in the enrolled patients (N=366) Real time PCR Studied patients (N=366) Positive 36 9.8% Negative 330 90.2% Table (11) shows that 9.8% (36 out of 366) of the studied patients were positive for CMV in real time PCR test. Table (12): Results of nested PCR for CMV in the enrolled patients (N=366) Nested PCR Studied patients (N=366) Positive 29 7.9% Negative 337 92.1% Table (12) shows that 7.9% (29 out of 366) of the studied patients were positive for CMV in nested PCR test. Figure (4): Results of real time PCR and nested PCR for CMV in the enrolled patients. Figure (5): 1st run nested PCR showing band at 435 bp. Figure (6): 2ndrun nested PCR showing band at 159 bp. Table (13): Prevalence of CMV infection in the studied patients (using real time PCR as a gold standard test) Risk factors No. Studied patients (N=366) Positive No. % Malignant hematological disease with chemotherapy (43) 36 83.7% Receiving repeated blood transfusion (164) 0 0% Fever of unknown origin (16) 0 0% Critically ill patients lying in the ICUs with prolonged hospitalization (28) 0 0% Receiving corticosteroids or other immunosuppressives for long period (22) 0 0% Chronic renal failure with haemodialysis (64) 0 0% Fever with pancytopenia (7) 0 0% Neonates with congenital anomalies (22) 0 0% As shown in table (13), CMV infection (using real time PCR as a gold standard test) was only reported from patients suffering from malignant hematological disease and receiving chemotherapy, where   83.7% of these patients were positive for CMV. Figure (7): Figure (8): Table (14): Titer of CMV viremia in patients with malignant hematological disease receiving chemotherapy Quantitative PCR Studied patients (N=366) Mean  ± SD 6907.30  ± 15846.04 Median (Range) 623.50 (3.70 57500) The mean titer and SD of titers of CMV viremia in patients with malignant hematological disease receiving chemotherapy as shown in table (14) was 6907.30  ± 15846.04. Table (15): Results of Nested PCR for CMV among different risk groups Risk factors No. Studied patients (N=366) Positive No. % Malignant hematological disease with chemotherapy (43) 29 67.4% Receiving repeated blood transfusion (164) 0 0% Fever of unknown origin (16) 0 0% Critically ill patients lying in the ICUs with prolonged hospitalization (28) 0 0% Receiving corticosteroids or other immunosuppressives for long period (22) 0 0% Chronic renal failure with haemodialysis (64) 0 0% Fever with pancytopenia (7) 0 0% Neonates with congenital anomalies (22) 0 0% Twenty nine out of 43 patients suffering from malignant hematological disease with chemotherapy with a percentage of 67.4 were positive for CMV in a nested PCR test as shown in table (15). Table (16): Relation between ELISA IgM and real time PCR and nested PCR in the studied patients (N=366) Agreement between ELISA IgM and real time PCR and nested PCR in the studied patients (N=366) Laboratory findings ELISA Test P-value Positive IgM (N=60) Negative IgM (N=306) No. % No. % Real time PCR Positive (n=36) 8 22.2 % 28 77.8 % # 0.05 0. 320 (NS) Negative (n=330) 52 15.8 % 278 84.2 % Nested PCR Positive 8 27.6 % 21 72.4 % #0.082 0.090 (NS) Negative 52 15.4 % 285 84.6 % #  Ã‚   Kappa measure of agreement P< 0.05 is significant. Statistical Significance Standards for strength of agreement for the kappa coefficient: ≠¤0=poor, .01-.20=slight, .21-.40=fair, .41-.60=moderate, .61-.80=substantial, and .81-1=almost perfect. As shown in table 16, there is poor statistical agreement between ELISA IgM and PCR reactions in the detection of CMV in children with no significance. Table (17): Relation between ELISA IgG and real time PCR and nested PCR in the studied patients (N=366) Agreement between ELISA IgG and real time PCR and nested PCR in the studied patients (N=366) Laboratory findings ELISA Test P-value Positive IgG (N=93) Negative IgG (N=273) No. % No. % Real time PCR Positive (n=36) 0 0 % 36 100 % # -0.137 0.001* (HS) Negative (n=330) 93 28.2 % 237 71.8 % Nested PCR Positive 0 0 % 29 100 % #-0.165 0.000* (HS) Negative 93 27.6 % 244 72.4 % #  Ã‚   Kappa measure of agreement P< 0.05 is significant. *highly statistical Significance Standards for strength of agreement for the kappa coefficient: ≠¤0=poor, .01-.20=slight, .21-.40=fair, .41-.60=moderate, .61-.80=substantial, and .81-1=almost perfect. A high statistically significant non-agreement is present between ELISA IgG and PCR reactions in the detection of CMV in childrenas shown in table 17. Table (18): Relation between real time PCR and nested PCR in the studied patients (N=366) Agreement between real time PCR and nested PCR in the studied patients (N=366) Laboratory findings Nested PCR Test P-value Positive (N=29) Negative (N=337) No. % No. % Real time PCR Positive (n=36) 29 100 % 7 2.1 % # 0.882 0.000* (HS) Negative (n=330) 0 0 % 330 97.9 % #  Ã‚   Kappa measure of agreement P< 0.05 is significant. *highly statistical Significance Standards for strength of agreement for the kappa coefficient: ≠¤0=poor, .01-.20=slight, .21-.40=fair, .41-.60=moderate, .61-.80=substantial, and .81-1=almost perfect. Table 18 shows that there is an almost perfect statistical agreement between real time PCR and nested PCR in the detection of CMV in children with high significance. Table (19): Relation between real time PCR and nested

Essay --

Daniel Nitinthorn Professor John Ganim English 020A December 13, 2013 Progress of Literature Language and experimental form define the Modern period as ideas that were originally forbidden began to surface and writers especially began to express new notions of humanity through these developments. In William Butler Yeats’ â€Å"The Second Coming,† the reader gets glimpses of the combinations of religions and how they represent a cultural language that is on a different spectrum than writing in the Victorian era. Ulysses by James Joyce begins to experiment with form and surfaces ideas so novel that they are too vulgar to show to the general public. There is a change in the culture during this era that is shown through the the experimentation of writing and the topics being written about. â€Å"The Second Coming,† with its christian title refers to the British culture and how it will relate to the rest of the world. It is a poem that talks about the second coming of the savior who will only come after the beast of the apocalypse, or the antichrist. There is a notable change in the language as Yeats refers to this antichrist as looking like an Egyptian sphinx but relates both Egyptian culture and a Christian, British culture. While the Victorian era was heavily influenced by the idea of â€Å"otherness,† the Modern period began to see connections between all of the world’s cultures and how it relates to their own. One of these mixing of cultures comes when Yeats says, â€Å"The Second Coming! †¦A shape with a lion body and the head of a man† (2482). He shows â€Å"The Second Coming,† which is a Christian idea and then brings in the Egyptian sphinx. The mixing of these images presents a language that would not have been heard ear lier as this now relates two... ...ses, as it relates to â€Å"The Second Coming,† is a play on form of literature to help express new ideas that needed to be presented in this new era of culture The experimentation of language and form are focal points in the Modern period. As this new era was forming, there was a call for a new form of literature especially to fill the new literate classes that rose due to an increase in those who had access to education. This new form helped express new ideas of the era that would not have the same effect with earlier language. Ulysses is the major change in form that helped show human consciousness by spilling out the thoughts of the characters. New ideas about culture and humanity rose from â€Å"The Second Coming† due to the improvements in the English language. The experimentation of form and language allow literature to present emerging ideas in a newly formed era.