College and Herb Block Foundation

Of all your courses, activities, internships, and work experience, which one did you ? nd most rewarding or personally satisfying? Explain why. The most rewarding work experience that I have had was to work as a volunteer for the International office at Northern Virginia Community College. Personally, I considered volunteering responsible work because it requires time effort and commitment. Working as a volunteer with the International Office was meaningful to me because I was able to assist so many students in achieving their dream of obtaining an American college education.I was able to help the International Students and to give them a better understanding of the resources that NOVA offers to international students. Furthermore, my responsibility was to arrange student get-togethers and in so doing build a sense of community and cohesion. My purpose for volunteering was to assist international students, many of whom are away from home with very little support at a very young age, with making a smooth transition in to a new coulter. This is particularly important to me because I am a dual citizen of America and Pakistan and understand the difficulty of assimilating into a new culture.FUTURE GOALS Based on your current achievements and interests, describe the kind of work that you plan to be doing in 10 years, both in your career and in your community. My goal is to get my Masters in Information System and Operation Management (ISOM). I chose this major because I have strong curiosity to learn about Information System Technology. However, I am also interested in business. I am excited about my major because ISOM, which is a mixture of IT and business, will prepare me to be successful in the future.Furthermore, in 10 years, I hope to be working with Multi Complex Corporations well established in a successful career, after earning Masters in (ISOM) Information System and Operational Management. I am very confident that in next 10 years, I will be in a position t hat will to utilize my talents and use my skills to solve important problems facing our world today. I see myself inviting new and exciting challenges in ISOM field. Also, I believe that throughout my study I will be able to help my community by providing them information about IT skills and about its advantages which would encourage young people to learn more about it.How has a family member, mentor, or personal experience been in? uential in your life? My personal experience and family background have a strong influence on me and on my education. I am motivated to graduate college because neither of my parents graduated from college. I am only the second person in my family to attend college and hopping to achieve my goal of obtaining my Associates of Science in Information Technology and then attending a four years institution. Moreover, the hard work of my parents has always inspires me.In addition, I am very thankful to them for supporting me in my efforts in of obtaining an ed ucation. Form my cultural background perspective, very often girls are not allowed to get an education but I really appreciate my family for providing me the opportunity to get a good education so I can have a brighter future. In 2012, I graduated with 3. 8 GPA form T. C Willims’s high school and last semester at NOVA I finished with a 3. 4 GPA. I am very passionate about my studies.However, my financial situation has proven to be an obstacle in my pursuit of academic success. My financial situation does not allow me to focus solely on my academics; this is why I am applying for the Herb Block Foundation Scholarships. I hope through this scholarship, I will be able to finish my community college career without finances being a barrier to my success. With the help of the Herb Block Foundation I will forge a brighter future my family my community and myself and ultimately the world at large.

Travel and Tourism component industries and their organisations Essay

Types of Tourism There are three types of tourism: domestic, outbound and inbound. Domestic tourism is when you travel within the country normally for a day trip; for example, someone traveling from London to Brighton for the day would be a domestic tourist. An outbound tourist is when someone travels outside the country. So someone travelling from the UK to France would be an outbound tourist to the UK. An Inbound tourist is when someone travels to another country; for example, someone travelling to Spain from France would be an inbound tourist to France. However these three categories have been split further into another three sub-categories stating the purposes for travel, these are: leisure, business and visiting friends and relatives (VFR). Someone travelling for holiday, cultural events, recreation, sport, religion and study would be classed as travelling for leisure. Someone travelling for business would be if they were meeting with an overseas client, meetings, conferences and exhibitions. Vi siting friends and family accounts for many trips especially within the UK. Accommodation Accommodation can be both serviced: your meals are on offer and you room is cleaned, or non-serviced: you look after yourself which includes cleaning, shopping and cooking. Hotels Hotels can be both independently owned or chain owned. The chain hotels tend to have the same layout and offer the same facilities no matter where you are because they are more impersonal but provide high quality consistently around the world, such as the Mercure Hotel in London and Paris. Also, hotels tend to cater for both business and leisure customers with a large range of products, such as a conference room for the business tourists, and activities for the leisure customers. Domestic tourism tends to be better independently owned hotels as the tourists will probably be visiting family and friends or staying for a limited time so they don’t need a wide range of facilities available, just the basics. However a chain hotel may also be used such as a travel lodge as this may be cheap and it offers the minimum products. Except for if the tourist is travelling for business purposes, as  it is most likely that the company will be paying for the hotel so the person may upgrade themselves and stay in luxury rather than a travel lodge. Inbound tourism is better for hotels that are part of a large chain as they will be well known to people from other countries; most of the time, whether the tourist is travelling for leisure or business, they will want to stay in a luxury hotel over a hotel with less available to them. Independently owned hotels usually reflect the countries own style whereas chain owned hotels look the same in every country and make the customers feel more at home. Outbound tourism tends to benefit independently owned hotels within the home country as some tourists stay over in a hotel near the airport so that they don’t have to travel far the next day or get up as early as some tourist’s class this as their holiday starting early. As they are staying there for normally 1 night they will just stay at an independent hotel as it will normally be cheaper but sometimes a chain hotel such as a travel lodge or a premier inn will be cheaper. Guest accommodation Guest accommodation is normally extra space that homeowners have and want to earn money for; this includes guesthouses, farmhouses and bed and breakfast accommodation. Moreover, there is also the option for self-catering, this normally occurs when people rent out there apartments or holiday cottages however this is also available at holiday parks. Kitchens and appliances are provided for the self-catering option. Many tourists consider guest accommodation as it is seen as charming and an opportunity to experience local culture. Domestic tourists enjoy guest accommodation as it gives them the opportunity to experience local culture within the town they are visiting, and most of the time they will probably be eating out at restaurants or pubs so they won’t need to be given 3 meals a day at their accommodation. Bed and breakfasts are a good option for domestic tourists as they won’t have to go out for breakfast but it gives them the chance to look around the town, eat out and enjoy their time. Inbound tourists may stay at guest accommodation if they are staying in a small town or village and want to see what the local culture is like. This would give them the opportunity to experience more than if they were to stay in a hotel as hotels can be quite impersonal, so by staying in guest accommodation they will feel more included and like they are getting a one-to-one experience with the staff of  the accommodation. Outbound tourists may stay at guest accommodation if they are traveling to the airport as it can be cheaper than a hotel. They would also not need the set meal times like you get at a hotel as they would probably be leaving early and would only be there for one meal. By this logic it would seem more appropriate if outbound tourists stayed at a bed and breakfast the day befor e travelling to a different country. Transport-road Cars Most cars in the UK are privately owned and are used for domestic day trip travel. This allows people to travel at their own pace and take their own route than if they were to take a coach or train. In addition, many people choose to hire a car when abroad, leading to the growth in the hire-car sector. Popular hire- car groups in UK include Hertz, Avis and Europcar have all expanded overseas and now have international operations. As the car-hire sector grows, the technology along with it does too. This means that it has now become easier and more convenient for customers as you can now pre-book by telephone or on-line. You also have the option for airport pick-up and drop-off and you also don’t need to drop it off at the same place that you picked it up (one way rental). There is also a wide range of vehicles available to suit a range of people and all insurances are included within a fixed price meaning that there are no hidden costs. Domestic tourists are most likely to use their own private car for travel as they will most likely be taking day trips and don’t want to have to limit themselves to what they can do because they have to be somewhere at a certain time to get home. Moreover, if they are spending longer in one place, for example a week, then they would also want their own private car so that they can go and do what they want and aren’t restricted to certain times due to public travel. Inbound tourists would hire a car if they wanted to travel and take small day trips during their visit to certain places and didn’t want to have to change bus or train to get to where they are going and take more time out of their day travelling rather than doing the things they want to. They may have brought their own car over from their home country if they travelled by ferry, such as from France. People travelling for business purposes might hire a car as their company would pay for it and they wouldn’t have to wait  for public transport or a taxi. Outbound tourists may use their own car if they are travelling by ferry and want to use a private car rather than use coaches with other people. However they may also use a hire car when travelling to the airport as they could drop it off at the car centre and won’t have to pay for their own car to be kept in the car park whilst they are away. Coaches Coaches today are very luxurious as they now can come with comfortable toilets, refreshments and DVD facilities. They have also adapted to meet customers changing needs, for example, a fly-coach option is now available so as to reduce the initial journey time, but have the benefit of coach travel for touring. There are several coach networks all over the UK for people to travel to different towns and cities and also into Europe; National express is a good example of this. By travelling by coach customers have the opportunity to see places that wouldn’t have seen if they travelling within a private car. Domestic tourists may use this option if they are not able to drive (pensioners) or unable to afford to drive (students). A coach option can be relatively cheap and you may not want to use your car whilst you are visiting another town so by travelling by coach you would spend less than if you were to travel by train, however it will take longer to travel by coach. Inbound tourists may use a coach so that they can go on tours and see more of the country or town that you are visiting. They may also use a coach to travel to their hotel or accommodation as this will be cheaper than taking a taxi. Moreover, they would also get more information about where they are staying and the places that they see than if you were to travel in a private hire-car. Outbound tourists would use a coach when travelling to the airport or their port that they are leaving by ferry as this means that they would not have to pay for their car to stay in a car park whilst they are away. They would also not have to pay for diesel or petrol bringing down their costs of travel even more. This would appeal to more people that lived far away from their travelling destination. Transport- rail The national network rail is own and run by Network Rail whose job it is to maintain the train lines and lay new tracks when needed. There are 29 Train-operating systems (TOCs) in the UK who lease their trains from rolling-stock companies and who compete for franchises to run each passenger service. The department of transport issues the franchises and also monitors the TOCs to make sure that everything is running well and that passengers are safe; they are also able to fine the TOCs if they don’t meet the agreed standards. TOCs are commercial companies and aim to make a profit such as Virgin Trains and South West Trains. However they do still receive grants from the government. Other aspects of the rail system are the London Underground, Docklands Light Railway and the Eurostar. Eurostar operates from St Pancras International in London and Ashford in Kent to Paris, Lille and Brussels transporting passengers through the channel tunnel. Eurostar is owned by London and Continental Railways, and run by a management company. Domestic tourists use the railway service when travelling either to a place quite far away as the train is the quickest land public transportation or when travelling through densely populated areas such as London as the streets can be too busy to use the roads and there is a congestion charge when using your car within central London. Travelling by train is a good option if you want to spend a day trip somewhere and it will take a while to get to if you uses the roads. Depending on where in the country you take the train and at what time (peak times) the price will vary so it can be relatively cheap if travelling from somewhere such as North Devon to Exeter on a Saturday morning, but quite expensive if travelling from London to Liverpool at 5 o’clock on a weekday. However the time it takes to travel by train is a lot less than by road so this option does appeal to people despite the price. Inbound tourists will not usually have a car or bus pass so the next option is to travel by train. If inbound tourists are travelling around somewhere like London, they have the option of travelling to almost anywhere in central and greater London. During the day prices can be quite cheap and a day ticket to use the London Underground for an adult is  £8.80, this relatively cheap to be able to travel at any time as many times needed in one day. Outbound tourists might use the rail service when travelling to the airport as it is the quickest way to travel there by land, this would decrease the initial travel time as travelling by road takes longer. There are many trains travelling all over the country making it easy for anyone to get to anywhere they need by taking multiple train lines, this makes it  easier for people that are travelling from quite far to reach the airport or ship port. Outbound tourists from the UK may also use the Eurostar to travel from London to France as it is cheaper than flying. The Eurostar is quite luxurious as there are comfy chairs, a bar to get food and drink and comfortable toilets seats. Travel-sea The UK is an island surrounded by water so transport by sea as always been an important art of the travel and tourism industry. Ferries The English Channel used to be the main mode of transport to the continent cross the sea; however 50% of the market was taken by the channel tunnel, but passenger ferries have also had some of the market taken by low-cost airlines offering cheap fares. It is often cheaper to fly and hire a car rather than taking your own vehicle. Dover is the biggest port in the UK and in 1997 over 21 million passengers passed through it; however, by 2003 numbers had declined to just under 15 million and have not since increased. Other ferry operators within the Channel include Sea France and Brittany Ferries. Brittany Ferries operates on longer routes to France and Spain, for example Poole to Cherbourg, Plymouth to Santander and Portsmouth to Caen, St Malo or Cherbourg. Ferries also travel to the Channel Islands, for example Jersey and Guernsey. One of the main companies offering transport across the Channel is P&O, as some operators such as Hoverspeed and Speedferries have ceased operating. Not all ferry travel is across the Channel, some other are: Stranraer to Belfast Fleetwood to Larne Fishguard to Rosslare Holyhead to Dun Laoghaire Hull to Zeebrugge Hull to Rotterdam Holyhead to Dublin Pemboke to Rosslare Douglas to Liverpool Ryde to Portsmouth Domestic tourists would use ferries when travelling within their own country,  for example if you live within the UK you may take a ferry from St Mawes to Falmouth or Liverpool to London. A ferry may be used as it can be quicker than travelling by car and you have the option of taking your vehicle with you. Ferries are a good way to travel if taking a day trip if you are travelling to a small island off the coast. They can also be a way of cutting time off of your travel if you are travelling by car as you may need to get from one end of the coast to another and the mouth of a river is in the way, for example if you are travelling from Falmouth to St Mawes. Inbond tourists might use ferries as a way of travelling around the country when travelling close to water. They could also be used when giving tours, for example: if an inbound tourists visiting the UK wanted to go on a tour of london and see some of the sights, they might take a ferry as this would give a tour of all of the attractions by the river Thames; this is considered a scenic route as you wouldn’t have to worry about the congestion on the roads. Outbound touristsmight use ferries to travel to a different country; such as someone travelling from the UK to France, they would use the channel ferry to travel from the country. A ferry might also be used by outbound tourists when travelling to the airport or dock to leave the country. This would mostly be used by people who are travelling by public transport in areas surrounded by water as this would not be applicable to someone who lived in greater London travelling to heathrow airport, however this would be an option for someone who lived on an island or across a large river, for example: if you live on the isle of wight. Cruises The cruise industry is enjoying steady growth and as a result of this companies are investing in new liners. Some of the new ships include the Azura, Queen Elizabethand Seabourn Odyssey introduced in 2010. May cruise companiesyou may have heard of are P&O Cruises, Cunard, Royal Caribbean and Princess. In 2008 the number of Europeans taking cruise holiday reached an all-time high, with the UK topping the list with the greatest number of cruise passengers, reaching 1.5 million.Cruise companies are doing their best to reach new markets, such as families and younger people, rather than just the older age groups who traditionally take cruises. If there is a business failure then the Passenger Shipping Association (PSA) provides finanicial protection to their customers. River cruises are also growing in  popularity especially those on the rivers Rhine, Moselle, Danube and the Nile. Domestic tourists may use cruises when travelling around their own country and wanting to see other places along the coast. This would seem a more appealing option than travelling by coach or car as they would have activities to do on board whilst traveling to the next destination rather than being stuck in one position, they would also have somewhere to sleep on board whilst still travelling rather thyan having to stop at night and finding somewhere to stay. This would also cut time off of the trip as a whole. Inbound tourists may use a cruise when visiting another country to visit more places during their trip rather than staying in one place. This would be a good option for anyone who wants to see lots of different sights and visit different places. Cruises will also allow people to relax whilst travelling usually by a swimming pool or doing activities, this is a good option for families as sometimes the children want to just play rather than looking around a town, so it is a good way for families to have the option. Outbound tourist may use a cruise when leaving the country to travel to another country. People will travel to a dockland around the UK such as in Portsmouth, Liverpool or Dover and pick up a cruise ship to start their journey. They would visit different countries and leave those countries on the ship, most of the tourists time would be spent on the ship as all of their possessions are on the ship as well as a room and catering. However when visiting another country a day or two would be spent exploring the towns and experiencing the local culture and then returing to the ship at a certain time I order to leave and visit the next destination. Transport-Air Airports The major organisation in airport ownership in the UK is the British Airport Authority (BAA); it is owned by Airport Development and Investment (ADI) Limited. BAA owns the airports at: London Heathrow London Stansted Glasgow Edinburgh Aberdeen Southampton Naples (65% stake) Over 140 million people travel through the six BAA airports every year in the UK. They also have stakes in other airports outside the UK, plus retail management contracts at two airports in the USA. Regional airports have grown in popularitywith airports such as Leeds Bradford and East Midlands offering many short-haul flights. An airport provides products and services to various groups of people and businesses, this can be complex but profitable. Some examples of the products and services provided by an airport are: Airlines are provided with the space and services to operate their flights. Customers are provided facilites such as restaurants and shops. Other businesses are provided with a location in which they can operate, for example, car hire,retailing or groung handling. The airports work hard to keep all of its groups and customers happy whilst earning revenue. Domestic tourists may use an airport when wanting to travel to a different destination by using a range of airlines, coach, bus or train. There are a range of travel options from an airport as they all interlink to make travelling easier for tourists, this is because airports are one of the most popular destinations within a country where tourists from the same country and internationally meet making it the perfect place to have a range of travelling options available at the tourists’ disposal. Inbound tourists use an airport when entering another country; this is where they gain entry to that country by going through immergration and having their passports checked. There is also the option for partaking in some duty free shopping, having something to eat or continuing on the tourists’ travels. There is the option for joining a conecting flight, taking a train, hiring a car or using another form of transport. Outbound tourists may use an airport when traveling out of the country by airplane. Here they are checked in with their chosen airline and have the opportunity to do some duty free shopping just like if you were travelling from Heathrow airport from terminal 5. Here, the customer would have access to over 40 stores with duty free shopping along with a selection of restaurants and cafes before boarding their British Airways flight to wherever they are travelling to. Airlines All UK airlines are privately owned. British Airways (BA) is one of the most famous airlines in the world and is the largestin the UK and in terms of  international scheduled services. It flies to more than 200 worldwide , however, in 2009 its passenger numbers had fallen by 4.3% due to the recession. British Airways main bases are at the London airports Gatwick and Heathrow terminal 5. The airline’s products include four different types of cabin service ranging from Economy to Club World. Other major UK airlines include British Midland and Virgin Atlantic, these are scheduled airlines; there are also many charter airlines such as Monarch and Thompson, however, Monarch also operates a a sechuled service. Hundreds of other airlines from all over the world fly in and out of UK airports, paying for the services they use. Domestic tourists may use airlines if they want to travel within the same country but want a fast alternative to driving. Such as traveling within the UK from london to Edingburgh with Virgin Atlantic from  £90 return ticket. By travelling by plane the use of a vehicle to travel to their destination would not be needed. With the cost of petrol/deisel to travel by car, plus food and other neccessities when travelling this would cost almost the same as flying, therefore if someone wants to spend more time in edingburgh for their trip rather then travelling then this is a good option. Inbound tourists would use an airline when entering another country by plane. They would have had the option to purchase food or products on the plane when flying to their destination. They would of also received a good level of customer service when flying to the country to make sure that the customer has had the best experience possible and will hopefully fly again with that airline. Outbound tourists would use an airline when leaving a country to visit another. The first point of contact for them would be at check-in inside the airport, they would not have contact with that airline staff again until boarding where they will take their seats on the plane. A safety presentation will be given to the passengers on board the plane, they will then be offered food and products to purchase on the aircraft. The whole time they have contact with any of the staff from the airline they will be judging them on their customer service skills and their overall experience flying with that company, this will determine if the airline gets repeat customers or not, how popular they are to consumers and their market share within the airline industry. Low-cost airlines The idea behind low-cost airlines is too keep costs as low as possible, with  few or no ‘extras’ on offer to the customer without further charge, this is so the low-cost operators can offer cheap flights. The low-cost airlines are scheduled airlines, for example easyjet and Ryanair. Domestic tourists may use a low-cost airline if they are taking a short-haul flight as they wouldn’t need any extras, eliminating most or all hidden costs. Most of the time holdall baggage would not be needed cutting down the time spent at the airport. This is a good option for people travelling for business purposes as it is quicker with less hassle to claim baggage when entering arrivals at the customers destination. Inbound tourists would use a low-cost airline if they wanted to pay less for flights. By doing this more money can be spent on accommodation or used for spending on their trip. Also with less baggage in the holdall there will be less people trying to get their bags at baggage claim making it easier for inbound tourists to get their bags and leave. Outbound tourist may use a low-cost airline as they would spend less time at the airport as the airline want to keep costs down. This means that the waiting time to board the plane would be cut down resulting in the travel time being cut down. Regulation of air travel Te Civil Aviation Authority (CAA) is an independent statutory body who regulates the UK aviation sector. The Air Travel Users Council (AUC) is the UK’s consumer council for air travellers; it recieves its funding from the CAA. Its job is to act as the independent representative for air passengers and aims to assist the CAA in helping the interests of passengers. National Air Traffic Services (NATS) is responsible for air traffic control. It is a public/private partnership owned by the government and looks after the UK airspace, but also the eastern part of the North Atlantic. NATS handles more than 2 million flights a yea, carrying over 220 million passengers. The major air traffic control centres are at Swanick in Hampshire and Prestwick in Ayrshire, but there are also contrl services at the country’s major airports. Domestic tourists, inbound tourists and domestic tourists would all be interested with the AUC as they look out for air passengers and make sure that the CAA are keeping an interest with their assengers no matter where they are traveling from or visiting. Attractions The UK officially has 6500 visitor attractions which are important to both the domestic tourism market and the inbound tourism market. There are hundreds of different types of attractions, however they can be divided as follows. Natural Attractions These include beaches, lakes and landscapes; in order to protect them some are designated Areas of Outstanding Natural Beauty (AONBs), National Parks or Heritage Coasts. Domestic tourists visit these natural attractions as day trips because it is a cheap way to have a day out. These attractions are a good way to spend time with the family as you would only need to pay for petrol/deisel and food whereas with other attractions you have to pay for entry, food, drinks and travel. It is also a way to experience nature at its best as when living in a city or town natural attractions are hard to come by. Inbound tourists may visit natural attractions as a way to experience the culture, countryside and the nature at a low cost. Outbound tourists wuld not visit a natural attraction if they were leaving the country, however they might visit one before they leave the country. Heritage Attractions In the UK there is a range of historic houses, often cared for by the National Trust or English Heritage. There are also museums and galleries such as Tate Britain and Tate Modern, the Victoria and Albert Museum, the National History Museum in London and the National Media Museum in Bradford. Domestic tourists visit heritage attractions as a way to see the history within their own country. Most museums are free and are a great learner resource for schools and people who have an interest within a certain subject matter. Inbound tourists would visit heritage attractions to learn about that countries history and culture. Most are free or charge a small fee but it is a great day out and is a popular option for most tourists. Domestic tourists would only visit a heritage attraction before they left to travel to a different country. Purpose-built Attractions Purpose-built attractions can be historic also, such as museums as most are purpose-built. Some popular purpose-built attractions include theme parks, for example the theme park Thorpe Park. Domestic tourists may visit a theme park for a day out with friends and family as a treat as some can be really expensive to visit. However, most theme parks give you special deals such as a child under a certain age/height can enter for free, for example, thorpe park offers you a bounce back pass where you visit the park one day at full price but can purchase a pass to get to in the following day at a reduced rate. They also offer you the chance to purchase a merlin pass that can get you into a range of attractions around the UK for free when you purchase the pass. Inbound may visit a theme park for a day trip with children a a special day ouut. However some people visit a country just to go to a theme park such as Disney World or Disney Land. These holidays can cost a lot but are a good source of income for the parks. Outbound tourists may visit a purpose-built attraction before they leave a country to visit another. Events Events such as the Edingburgh Festival and the Notting Hill Carnivalnattract many visitors. There are events in the business tourism sector too, such as the World Travel Market. Domestic tourists visit festivals and carnivals as they enjoy the atmosphere that surrounds the event and is a great day out. Some events are a great way to raise money to a certain cause or even to produce revenue. The Notting Hill Carnival is very famous for bringing together lots of different ethnicities to one event as celebrating how diverse London is, this attracts many tourists both Domestic and Inbound. Domestic tourists may visit an event before leaving the country. Associations The British Association of Leisure Parks, Piers and Attractions (BALPPA) was founded in 1936, it is non-profit-making whose role is to represent the interests of owners, managers, suppliers and developers in the UK’s commercialleisure parks, piers, zoosand static attractions sector. The international Association of Amusements Parks and Attractions (IAAPA) is a similar organisation to BALPPA, but it is an international association and has members all over the world. The association promotes safe operations, global development, proffesional growth and commercial success in the amusement industry. Domestic, Inbound and Outbound tourists would all be interested in the IAAPA as this effects attractions all over the world, but only tourists who visit attractions in the UK would be interested with the BALPPA. Tour Operators The role of tour operator is to put together all the different components that make up a holiday and sell them to the consumer as package deals. They make contracts with hoteliers, airlines and other transport companies to produce these package deals, these are then described in a brochure which is distributed either to travel agents or directly to customers. Mass-market tour operators Mass-market tour operators dominated the outbound market for years, these include: Thomson, First Choice and Thomas Cook. Thomson and First Choice both belong t the parent company TUI. These major tour operators were considered to be mass-market tour operators as they sold similar holidays in packages that appealed to the majority of holidaymakers. However, specialist tour opperators sold more individually tailored holidays or specialised in one destination or activity, but today, many large tour operators also offer many specialist products. TUI AG is the largest travel group in the world, which does not just include tour operators. Thomson, for example, is also a travel agency brand and an airline; First Choice has a major travel agent in its portfolio and its own branded airline. First choice offers holidays in destinations such as Majorca, Menorca, the Canaries, Spain, Turkey, Greece and the Caribbean. Winter sports destinations include France, Austria, Italy, Andorra, Bulgaria a nd Switzerland. Thomas Cook also has travel agencies, airlines and hotels as well as tour operator brands. Tour perators that offer air-inclusive packages are required by law to have Air Travel Organisers’ Licence (ATOL). This scheme protects air travellers and package holiday makers from losing money or being stranded abroad if air travel firms go out of business. When a tourist books a holiday the cost of this financial protection is included in the price. Any package firm that includes a flight should by law hold a licence. Domestic tourists may use a tour operator when visiting a part of their own country that they have never seen before. They could then have a guided tour around an area that they want to visit and know more about. Inbound tourists may use a tour operator to help with their arrival to a new country, helping them to settle into their accommodation. They would also be given a tour of the local sights giving tourists an idea of things to do during their visit. Outbound  tourists may use tour operators when travelling to their destination to leave the country as they would not have to find their own travel to the airport or docklands. Specialist tour operators Some tour operators specialise in particular destination, or a product, such as a diving holiday. Specialist tour operators respond well to the trend for tailor-made holidays with their specialist products. Some tour operators specialise in a certain destination, for example, Anatolian Sky specialises in holidays in Turkey. Inbound tour operators cater for the needs of overseas visitors to the UK, an example is British Tours Ltd, which claims to be the longest-established inbound operator. It offers tours for different group sizes and has a ide variety of products icluding a Harry Potter tour. These tours are available in many languages. Domestic tour operators specialise in holidays within the UK for Uk residents, they include coach companies which place advertisments in the local newspapers. Similar to outbound operators they offer beach, city, touring and special-interest holidays. Tour operators association UKinbound is the trade body which represents tour operators and tourism suppliers to the UK. It was founded in 1977 to represent the commercial and political interests of incoming tour operators and suppliers to British inbound tourism industry. It is a non-profit-making body governed by an elected council and funded by its members and from revenue-generating activities. The Assocciation of Independent Tour Operators (AITO) is an organisation which represents 160 of the UK’s specialist tour operators. AITO members are independent companies, most of which are owner-managed, specialising in particular destinations or types of holiday. The Federation of Tour Operators (FTO) is an organisation for outbound tour operators, its aim is to ensure the long term success of the air-inclusive holiday. Members pay annual subscribtion based on the size of their organisation. The FTO produces health and safty guidelines for tour operators. The FTO has always worked very closely with ABTA and the two organisation merged in 2008 to become ABTA- The Travel Association. Travel agents The role of a travel agent is to give advice and information to sell bookings  for a number of tour operators. They also sell flights, ferry bookings, car hire, insurance and accommodation as separate products. Travel agents may operate through: Retail shops Business shops A call centre The internet Most travel agents are part of a multiple chain and these dominate the market. Chains such as Thomson and Thomas Cook are linked to tour operators and may try to prioritise their own company’s products. ABTA- The travel assocciation has operators as members, in 3009 it had over 900 members and represented over 5000 travel agencies. There has been a reduction in the amount of agency branches in the past few years as customers choose to buy travel and tourism products through other means, particularly through travel websites. Business travel agents Business travel agents specialise in the business market, they aim to handle all travel arrangements for large companies. ‘Implants’ are travel agents located within another business, they set up office within a company so that they are on hand to deal with travel arrangements for the company’s personnel. Doomestic, inbound and outbound tourists would only use a business travel agent if their was one within the company that they worked for and they were travelling for business needs. Call centres More and more customers are booking holidays over the telephone or online rather than bu visiting a travel agent. Call centres are normaly in out-of-town areas where the rent and labour is cheaper, some companies have relocated to India to take advantage of the low costs.Some call centres are operator or airline owned and sell on behalf of that company only, others are specialist call centres and handle calls and bookings for many companies. Call centres rely on high staff productivity to be successful, they motivate staff through incentives such as bonuses on sales targets reached. Call answering time, call durations, sales and complaints ratios are carefully monitored. Domestic, Inbound and Outbound tourists would all use a call centre when booking a holiday as it can be less hassle then going  into a travel agents centre. On-line travel agents Websites are the most up-to-date means of distributing travel and tourism products and services. Domestic, Inbound aand Outbound tourists would all use on-line travel agents as, similar to call centres, it can be less hassle than going into travel agents centre. It is also easier to compare prices and deals. Tourism development and promotion The development and promotion of tourism in the UK is mostly undertaken by organisations in the public sector such as VisitBritain and VisitWales. Within the public sector in the UK, the Developmet for Culture, Media and Sport (DCMS) is responsible for supporting the tourism industry at a national level. The Department for Transport looks after avition, railways, roads and the London Underground. The Department for Children, Schools and Families (DCSF) has responsibility for sector skills councils and training organisations. The department for the Environment, Food and Rural Affairs (DEFRA) is responsible for issues affecting the countryside, wildlife and waterways. The UK has four tourist boards: VisitBritain, VisitScotland, the Northern Ireland Tourist Board (NITB) and VisitWales. VisitBritain reports to the DCMS; VisitWales reports to the National Assembly for Wales and VisitScotland reports to the Scottish Executive. The NITB reports to the Northern Ireland Assembly. The overseas offices work closely with British diplomatic and cultural staff, the local travel trade and media, to stimulate interest in the UK. Another example of the role of VisitBritain is its campaign to persuade high-spending tourists to come to the UK, it is imortant that inbound tourists spend money and boost the UK economy. Regional Development Agencies (RDAs) RDA’s have responsibility for tourism in their regions and usually work closely with Regional Delivery Partners (RDPs). There are nine RDAs in England; an RDA has a regional economic and regional economic and regional tourism strategy. RDPs are responsible for delivering the strategies, sometime the partners are tourists boards with a different name to explain what they do. An example is VisitManchester, an organisation that looks  after tourism development, business tourism, leisure touriism and isitor services in Manchester. The government replaced RDAs with local economic partnerships (LEPs), this happened in March 2012 with the LEPsto cover smaller areas than the RDAs. Local Authority tourism development Local Authorities play an important part in supporting the tourism industry because tourism is a major contributor towards the economy. Most towns have have a Tourist Inormation Centre (TIC) subsidised by the local council. The TIC provies a full information service for both residents and visitors, it gives information on visitor attractions and on accommodations. It usually provides a booking service for accommodation and often incorporates a shop selling localy made crafts and gifts, as well as books of local interest. The shop is a way of generating funds for the local community. Trade associations and regulatory bodies The Association of Independent Tour Operations (AITO), and other trade associations and regulatory bodies have a role to play in development and promotion. They represent the interests of their members and help them operate successfully in business. Ancillary services This term refers to organisations that do not have a direct role in travel and tourism, but play a supporting role. Examples include insurance companies that offer travel insurance and car parks operators that provide parking facilities at airports as well as in other locations.

Data Server Technology - Database Modeling and Implementation For Essay

Data Server Technology - Database Modeling and Implementation For International Parcel Deliveries - Essay Example The paper tells that upon studying the system requirements, it was analysed that the application/business would require capturing 3 different types of details for each transaction: customer details, order details and invoice details and a look up database for obtaining the cost for the each item on the order based on the destination and the item type. Customer details would include a customer id that uniquely identifies each customer, customer name, address, postal/region code and the type of the customer (business/Private). The order details would include an order id that uniquely identifies the each order, order date, item to be shipped, destination details like name and address, destination Company and destination country, order arrival date and departure/shipped date, charge for the order, payment method and the payment status, and the order status. The invoice details would include an invoice id that uniquely identifies an invoice, invoice amount, invoice created and the due dat e and the invoice status. Using these general idea, the conceptual model or the ER (Entity Relationship) model can be created using UML (Unified Modeling Language). From the above requirement analysis, the entities are identified as customer, order invoice and cost. The ER diagram is first defined for each entity along with their attributes as shown in the below figure. Each Customer can have zero/one/more Orders, but no two customers can have same order id (one order contains information for one customer only). Customer/Invoice: Each Customer can place zero/one Invoice and no two customers can have same Invoice id (One invoice is created for one customer only). Order/Shipment: One order can be sent to one or more shipments (shipment here just means number of items but destination is same) depending upon the number of items but each shipment contains information about one order only. Cost/Shipment: One entry in the cost lookup can be supplied to one/many shipment (order id + item no combination) but no two cost entry should be available for one shipment (one shipment contains only one entry from cost entity). Assumptions: The above model is designed based on the following assumption: All the fields entered by the user in the web application are validated for invalid input errors before storing it in the database. Destination field in the web application is filled by the user from a predefined list (may employ a drop-down list) whose values for pulled up from the destination look up table and not by entering the text for destination manually. b) Relational Model: The first step in creating the relational model is normalization. Normalization is the process of eliminating data redundancy and update anomalies (the errors while inserting, updating or deleting the database due to improper relations definitions) in order to efficiently organise the data in the database. 1st Normal Form (1NF): 1NF requires that each group of related items must be stored in a separate table with a unique column (primary key) which identifies each row in the table and all occurrences of a record type

Describe the best tactics and techniques for message presentation, Essay

Describe the best tactics and techniques for message presentation, regardless of medium - Essay Example People spend their time reading blogs, and they end up trusting bloggers. It is important to know how to pitch a campaign to bloggers. Bloggers always require the right approach from any prospective client (Eberhart, 2012). Firstly, they require the client to formulate an exciting offer. The client should assure the blogger of some benefit from pitching the campaign on his or her blog. Secondly, the theme of the message should be simple and straight to the point. The subject should not sound as if the blog is trying to promote sales. Third, when pitching a campaign to bloggers, always bear in mind that the blog is about them. Bloggers strive to be successful, and the message ought to deliver value. Lastly, the most important point is that the pitches should always be as personal and customized as possible for a specific blogger (Townsend, 2009). Individuals should exhibit readership qualities if they are willing to identify the best blogger. An individual who has been active in reading the blogger’s work would know their recent blogs and what they prefer to write about. Such an individual would have some opinion towards the blogger’s work. A blogger should maintain a high ‘post frequency’ to be relevant and to maintain an engagement with the audience. The blogger’s relevance would be evident if his or her blogs maintain a strong social presence and receive comments, and he responds to the comments. Identifying specific blogs would entail evaluating their potential reach. A blog’s potential reach should be directly proportional to its amount of subscribers. There are numerous avenues on the internet where people can find specific blogs or bloggers to pitch their campaigns. Social media sites are the readily available and easily accessible online platforms where to search for specific blogs or bloggers. They include; Facebook, Twitter, Google+, Tumblr, Wordpress, and Linkedln Influencers. There exists a link between the presentation of the

Project management---management of project organization Essay - 1

Project management---management of project organization - Essay Example The United Nations; Food and Agriculture Organization (FAO); The World Bank Group; International Committee of the Red Cross; CARE; Mercy Corps; President’s Emergency Plan for AIDS Relief (PEPFAR); Oxfam; World Vision International; Plan International; ActionAid; Doctors Without Borders; Greenpeace; World Wide Fund for Nature; ADRA; CAFOD; Save the Children International; SOS Children’s Villages. In project-oriented organizations personnel and departments are organized around individual projects. For instance, many project-oriented organizations have project managers that manage teams of personnel. These personnel are usually from different departments and have different responsibilities, but all are required to successfully implement the project. Typically, many teams operate simultaneously, but they do not have to interact with each other because each is focused on completing its own project (Cordes 2013, pg. 37). Project-oriented organizations employ structures borrowed from organizations based on functions, hierarchies, and operations. They use a matrix structure in which important organizational functions are housed in a management structure, while the work is conducted in project-based teams that have a hierarchical structure. Unlike the construction contractor, the management consulting company would have an organizational structure that is umbrella-based. This means that it includes all organizational structures that are not based around projects. It would, in summary, employ a functional model as its organizational structure, unlike the construction contractor’s matrix model. In the functional model, a manager supervises several different department heads, each of who manages one department in which specific tasks are carried out (Gibbons 2013, pg. 12). For instance, the management consulting company may have several departments for accounting, human resources,

The Character Sketch of the Movie the Black Balloon Assignment

The Character Sketch of the Movie the Black Balloon - Assignment Example One path is his regular teenage life, where he has a crush on a girl. The other path is full of responsibilities; he has to take care of his autistic brother who is a big baby. He faces the ultimate sibling conflict. The family moves to a new place, and the time is the 1990s. Thomas is shown to be anxious about making new friends and all he wants is to fit in. The plot is so refined that it shows the power that went behind the writing. The parents have a hard decision to make where they want to give equal attention and love to each of their children. The mother is inclined to take more care of the one who lacks understanding, social skills and cognitive ability than the other normal people. Sometimes the normal children are supposed to take on more responsibilities and acquire leadership and caring skills. If it were a normal family Thomas would have lesser responsibilities. But his parents cannot always be around Charlie, especially when he goes to school, and during playtime, those activities are accompanied by people of the same age. Â  Thomas is a 15-year-old normal teenager. His family moves to a new home. He is going through a phase feeling like he needs to fit in with his new friends at the school. He struggles with fitting in because his family is unusual; he has an autistic brother who gets the attention of the parents all the time. This makes Thomas feel neglected. However, Thomas loves his brother Charlie and takes very good care of him. Charlie enjoys playing video games, wearing a monkey costume and receiving stars for good behavior. Maggie, their mother, is heavily pregnant, and her doctors have advised her to take rest. Eventually, Thomas has to be in charge of Charlie. This is not an easy task as he has to chase Charlie down when he shoots out of the house.

Painting Styles, Impressionist, Post-Impressionist & Modern Essay

Painting Styles, Impressionist, Post-Impressionist & Modern - Essay Example The essay "Painting Styles, Impressionist, Post-Impressionist & Modern" explores such painting styles as Impressionist, Post-Impressionist & Modern. The group included the rebellious young Artists looking for new ways for the expression of ideas in painting. They attempted to question the traditionalists by portraying objects and scenes that lacked definition, and tried to explain how the eye interpreted objects. Exponents of ‘Impressionism’ also exploited the light sources for exploration and translation of light on the canvas, and the subject matter was the modern world, particularly landscapes. The founding members of ‘Impressionism’ were Claude Monet, Edgar Degas and Camille Pissarro."Images of suburban and rural leisure outside of Paris were a popular subject for the Impressionists.† The artistic technique of ‘Impressionism’ includes strong strokes of brush on canvas, and this style uses vibrant shades and attempts to translate scenes with mood and feeling. The Painting-â€Å"Autumn Evening,† by the Russian Painter Oleg Frolov in the year 2001, an oil painting on canvas, can be considered as an example of typical ‘Impressionist Painting.’ Post-Impressionism: Post-Impressionism is less easy to define and it differs from Impressionists on dissimilarity in personal styles, and subjects. In the transitory effects of light and spontaneous compositions, they share similar interest with Impressionists and concern with light, but their personal styles vary greatly. The term Post-Impressionism was coined.

Torts 10 ind wrk 1 Essay Example | Topics and Well Written Essays - 250 words

Torts 10 ind wrk 1 - Essay Example But changes are made in some state laws to recognize the special bond between the animal and its owner (Randolph, n.d). Normally, the owner of the pet will try to reach a compromise with the vet. In other cases, the owner of the pet stores a complaint with the authorization of the state that issues licenses and supervises veterinarians. The Board takes the necessary measures as revealed through their review and investigation of the case (Randolph, n.d). The owner of the animal may even file a complaint against the veterinarian or veterinary hospital - even though the case may cost expensive and time consuming. These controls on veterinary practices will also help curb the malpractice veterinary possible (Randolph, n.d). The claim of the owner of the animal that has suffered damage and / or injury caused must prove that it occurred during the performance veterinary. Therefore, the jurisprudence of the Courts, in veterinary liability requires that the claimant prove the following requirements: The existence of a causal link between the damage and / or injury suffered and the negligence of the veterinarian (for example, the dog had not died, if the vet would not put a doubled amount of anesthesia necessary). Wet in result of claims can raised the argument that the teeth cleaning procedure was correct but due to negligence of the owner the dog died. The owner did not bring back the dog to me when its condition

Efficient Management of Cost Centers in an Organization Research Paper

Efficient Management of Cost Centers in an Organization - Research Paper Example EVA accepts that capital is not available for free and imputes a notional value on the capital used by a business unit after considering the inherent risk involved in a business and the weighted average cost of total capital employed in the business. The earnings for the year are then examined in detail and any unusual or abnormal earnings and expenditures are removed to derive the normal earning for that year. If such adjusted earning is more than the cost of capital, the organization has created value; else, it has destroyed it (Grant 2003). Thus, EVA encourages managers to increase operating profits without injecting fresh capital, finding avenues for investment that would generate higher returns and reallocating funds from less profitable ventures to ones that are more profitable. This approach does not depend merely on the proper management of the balance sheet but also on the level of efficiency of an organization. If the balance sheet is not properly managed, a company might c arry a lot more capital than it actually requires thus unnecessarily increasing the desired levels of operating profit that would just match the weighted average cost of capital. Again, if the company is not run efficiently it would not be able to earn sufficient operating profits so as to qualify as a value creator. Definitions of cost centres vary from country to country and it would be worthwhile to investigate how cost centres are perceived in Germany and the United States. In Germany, Grenzplankostenrechnung (GPK), a common approach to cost accounting in that country, defines a subunit of an organization as a cost centre if the output of that subunit can be measured by a single unit.

Economics Essay Example | Topics and Well Written Essays - 500 words - 2

Economics - Essay Example Due to current civil unrest in Bahrain and neighboring locations there are no current statistics available. However, the rate of inflation in 2010 was 3.3% which was up sharply from the reported 2.8% in 2009. One author from the Wall Street Journal wrote, â€Å"In its statement, Egypt's Central Bank said deteriorating regional political circumstances, including a civil war in Libya as well as violence in Syria, Yemen and Bahrain, could drive up oil prices and further slow the continuing global economic recovery.† (Bradley) The Bahrain Economic Development board is positive in the most recent release, â€Å"In Q4 2010, the Bahrain economy is expected to post similar growth to that seen in the third quarter growth†¦over 4%† (Bahrain Economic Quarterly p. 4). Overall there is growth occurring especially in the tourism section as oil only accounts for approximately 15% of the economic outlook. With the civil unrest and potential for continuing problems there may be a d rop in tourism as a result. It will be necessary to see what the results are before making long term forecasts. Bahrain Economic Quarterly, . "Bahrain 2030, Bahrain Economy." Bahrain Economic Development board. N.p., First Quarter 2011. Web. 28 Apr 2011. http://www.bahrainedb.com/uploadedFiles/Bahraincom/BahrainForBusiness/BEQ%20Q1%202011.pdf Bradley, M. "Egypt Central Bank Keeps Key Interest Rates Unchanged ." Wall Street Journal. Dow Jones and Company, 28 April 2011.

Crisis Intervention Essay Example for Free

Crisis Intervention Essay PART 2: Application of Crisis Assessment Intervention Skills 1. Tour 1st task of this qn is to comprehend the given case scenario below: Kelvin Lemmy just celebrated their 10th weding anniversary. Lemmy was 39yrs old and expecting her 1st baby. She and her 41yrs old husband Kelvin were eagerly waiting the birth of their child. The child was also the 1st grandchild in the family on both sides At 17 weeks she went to her pediatrician for a scheduled check up. Subsequent to an examination and ultrasound examination, she learnt that the baby had died. She was thrown into a state of shock, simultaneously both angry and sad and cried uncontrollably. You were being called in to talk to Lemmy. 2. U r to use the 6-step crisis intervention model together with other aspects we have covered thus far. 3. The various steps must be clearly indicated in your ans 4. Pay close attention to demonstrating ur understanding of all the elements of the ci model including appropriate use of Triage Assessment System, Worker’s Continuum, Suicide Risk Assessment, The Crisis Trigger and the likely meaning that might be attached to the triggering event 5. When addressing step 4, 5 6 pls keep in mind the distinction between intervention in crisis state, as opposed to intervention when the client is stable and mobile(i. e. counseling). I will need to see that u hav a plan that focuses on immediate action aimed at restoring mobility stability, not one which target long term decision making personal change

Anti Smoking Promotion Policies Difference Health And Social Care Essay

Anti Smoking Promotion Policies Difference Health And Social Care Essay According to the Oxford Medical Companion (1994) cited in the WHO report on the global tobacco epidemic 2008, tobacco is the only legally available consumer product which kills people when it is used entirely as intended. Tobacco is the leading preventable cause of death in the World which causes one in ten deaths among adults worldwide and in 2005, tobacco caused about 5.4million deaths, an average of one death every six seconds. At the current rate, the death toll was projected to reach more than eight million annually by 2030 (over 175 million deaths by then as shown in figure 1) and a total of up to one billion deaths in the 21st century (WHO 2007).Certain behaviours have been labelled as risky behaviours associated with negative health outcomes among which smoking is and which has been the subject of UK national health strategies (Naidoo Wills 2005). Smoking causes about one fifth of all deaths in the UK, most of which are premature and has hugely significant impacts on the wid er environment and community through causing air pollution, fires, litter and environmental damage (Ewles 2005). This essay will look into why smoking is an important public health issue in England by defining it from various perspectives and will analyse why people smoke. Also, it will examine various demographical and epidemiological data related to smoking and in addition, it will examine how smoking is addressed in International, National and Local policy. It will also analyse various measures adopted at various geographical levels to address inequalities in health on promoting anti-smoking. In addition, it will look into various values, norms and ethical principles that influence anti-smoking policy development. From the gaps identified, recommendations and conclusions will be made. According to Ewles (2005), smoking in the UK can be defined from three different perspectives in terms of; the activity, the product and the market. In terms of the activity, it is the largely use of tobacco in manufactured and hand-rolled cigarettes which is the most common form of tobacco use since the early twentieth century. In terms of the product, the manufactured cigarette consists of chopped tobacco that has been cured and mixed with a variety of additives to add flavour, increase nicotine availability from smoke and improve shelf life all rolled up in a paper tube with a filter at one end. In terms of the market, UK is home to several Worlds major tobacco companies such as the Imperial Tobacco, British American Tobacco, Gallagher and Rothmans UK who all together employ 9000 people in the UK and have more than 90% of UK cigarette market. The principal constituents of cigarette smoke are tar, carbon monoxide and nicotine and the paper used for manufacturing cigarettes is treated with chemicals to prevent self-extinguishing whenever the cigarette is lit. The filter usually consists of cellulose acetate which traps some solid particles in smoke and cools it (Ewles 2005). The principal constituents of cigarette smoke are carbon monoxide, tar and nicotine which is highly addictive (Cancer Research UK 2009). FIGURE 1: Cumulative tobacco- related deaths, 2005- 2030. Source: http://www.who.int/tobacco/mpower/mpower_report_tobacco_crisis_2008.pdf The impact of tobacco smoking on public health extends beyond the direct effects on the individual smoker and personal health being to economic, environmental and social effects (Ewles 2005). Tobacco smoking is an important public health issue because the smoke is very toxic to every human tissue it touches on its way into, through and out of the smokers body (Ewles 2005). Smoking harms nearly every organ of the body thereby causing many diseases, reducing quality of life and life expectancy. Also it has been estimated that in England, 364,000 patients are admitted to NHS hospitals each year due to smoking related diseases which translates into about 7,000 hospital admission per week and 1,000 admissions per day (ASH 2006). In the UK, smoking causes about a fifth of all deaths, approximately 114,000 each year, most of which are premature with an average of 21 years early (Ewles 2005). According to Peto et. al. (2003) cited in Ewles (2005), most premature deaths caused by smoking are Lung and coronary cancer, chronic obstructive heart diseases and coronary heart diseases with 42800, 29100 and 30600 deaths respectively every year. In addition, smoking is known to also bring increased risk of many debilitating conditions like impotence, infertility, gum disease, asthma and psoriasis (Ewles 2005). Research has also shown that non-smokers are put at risk by exposure to other peoples smoke which is known as passive or involuntary smoking and is also referred to as second-hand smoke (SHS) or environmental tobacco smoke (ETS) (Cancer Research 2009). Tobacco was first introduced to Britain way back in the sixteenth century when it was commonly smoked in pipes by men. Later snuff and cigar smoking became popular among men but as a result of the invention of the cigarette making machines in the latter part of the nineteenth century, mass consumption of tobacco was made possible and in 1919, more tobacco was sold as cigarettes than in any other form (Wald Nicolaides- Bouman 1991). According to Wald Nicolaides- Bouman (1991) cited in Cancer Research UK (2009), smoking was firstly common among men and the consumption rose steadily until 1945 when it peaked at 12 manufactured cigarettes per adult male per day. After the Second World War, there was a slight dip in consumption but thereafter it remained at around 10 manufactured cigarettes per day until 1974 which marked the beginning of a steady and continuous decrease to about 4.6 manufactured cigarettes per adult male per day in 1992. On the other hand, women began to smoke cigarette s in the 1920s but not in large numbers until after the Second World War when they were smoking 2.4 cigarettes per adult female per day. Later, consumption among women continued to increase until it reached 7.0 cigarettes per day in 1974 after which it declined to 3.9 cigarettes per day in 1992 (Cancer Research UK 2009). HISTORY The link between smoking and life threatening diseases began in the early 1950s when Dr Richard Doll and Prof Austin Bradford conducted the first ever large scale study between smoking and lung cancer which was later published in 1954. In 1957, the British Medical research Council announced that, there is a direct causal connection between smoking and lung cancer. Later in 1962, the Royal College of Physicians concluded that smoking causes lung cancer, bronchitis and coronary heart diseases and recommended tougher laws on cigarette sales, advertising including smoking in the public places. In 1965, the British Government banned cigarette advertising on television and in 1971, there was an agreement between the Government and the tobacco industry that, Government health warnings must be carried out on all cigarettes packet sold in the UK. In 1973, the first tar/nicotine tables was published in UK which was later upgraded and divided cigarettes into five categories of tar content in 19 74. In 1975, the Imperial Tobacco agreed to drop brand names and logos from racing cars in UK races as control of tobacco advertising switched from the Industry to the Independent advertising Standards Authority. In 1976, Prof Sir Richard Doll and Richard Peto published the results of 20 years study of smokers and concluded that, one out of three people died from the habit. In 1983, the Latest Royal College of Physicians report featured passive smoking for the first time and asserted that more than 100,000 people died every year in the UK from smoking -related illness which later resulted in the banning of smoking on London Underground trains in 1984. In 1985, the smoking ban was extended to stations that were wholly or partly underground and in 1986, new advertising and promotion guidelines agreed on including banning tobacco advertising in cinemas. In 1987, the London Underground smoking ban was extended to entire network following the Kings Cross station fire outbreak in which 31 people died. The Independent Scientific Committee on Smoking and Health report in 1988 concluded that, non-smokers have a 10-30% higher risk of developing lung cancer if exposed to other peoples smoke and in June 1988, a UK court ruled that injury caused by passive smoking can be an industrial accident. The first nicotine skin patch became available for prescription in the UK in 1992 and in 1993, Sir Richard Dolls study results suggested that smokers were three times more likely to die in middle-age than non-smokers and up to half of all smokers may eventually die from the habit. In May 1997, the New Labour Government pledges to ban tobacco advertising and in the same year, the Government called for Formula One to be exempted from proposed EU directive on tobacco advertising and sponsorship but later backed down in the face of widespread criticism that was threatening the entire directive. In 1998, a White Paper named Smoking Kills was published after the Government -appointed Scie ntific Committee on Tobacco and Health announced that, passive smoking was responsible for causing lung cancer and heart disease in adults. In 2001, their was a new EU directive requiring larger and more prominent health warnings on tobacco packaging and in 2002, the British parliament passed legislation that began as a Private Members Bill, banning tobacco advertising named the Tobacco advertising and promotion Act. In December 2002, the British Medical Association called for the banning of smoking in the public places because of threat to non-smokers and young children. The Cancer Research UK launched an advertising campaign in 2003 and was funded by the Department of Health which target smokers of mild brand of cigarette, warning on the risk associated with the habit. In January 2004, the British Heart Foundation used graphic images to reinforce the Government -sponsored anti-smoking campaign. In March 2004, the Irish Republic introduced the toughest anti-smoking laws in Europe d escribed as the landmark legislation with a complete ban on smoking at workplaces. In November 2004, a Public Health White Paper proposed to introduce smoking ban in workplaces in 2008 with the exemption of private members club and pubs that do not serve food. In, March 2005, the British Medical journal report produced data showing that smoking killed 11,000 a year in the UK and in April 2005, MSPs voted by 83 to 15 to introduce a ban on smoking in public places from April 2006 and any smoker who defy is liable to pay a  £1,000 fine. In October 2005, the discussions over the England smoking ban broke down at the cabinet level causing severe delays. In December 2006, the Government announced the smoking ban in public spaces in England known as Smoke free England, which began on the 1st of July 2007 (BBC NEWS 2007). On the 1st of October 2007, the law for selling tobacco changed and became illegal to sell tobacco products to anyone under the age of 18 (an increase from 16) (Smoke fr ee England 2007). In May 2008, the Health Bill then called the National Health Service Reform Bill was contained in the Draft Legislative Programme published and it was announced in the Queens speech during the state opening of Parliament on 3rd December 2008. The Bill was later introduced into the House of Lords on 15th January 2009 and was published on the 16th January 2009 which proposes measures to improve the quality of NHS care, the performance of NHS services and to improve public health (DOH 2009). DEMOGRAPHY EPIDEMIOLOGY The United Kingdom of Great Britain and Northern Ireland (UK) is located in Northern and or Western Europe and it comprises the Island of Great Britain (England, Scotland and Wales) and the Island of Ireland (Northern Ireland) (Wikipedia 2009). According to the 2001 census, the population of the United Kingdom was 58,789,194 and has increased to 60,587,300 according to mid -2006 estimates by the Office for National Statistics. EPIDEMIOLOGY The prevalence of smoking varies widely around the World and has been observed to be on the increase in many developing countries thereby creating huge health problems for the future. Approximately 1.3 billion people smoke cigarettes or other tobacco products Worldwide (WHO 2003) and Figure 2 shows the worldwide tobacco epidemic model which describes the rise and decline of smoking prevalence followed by similar trends for smoking. The first stage is characterized by a low smoking prevalence of less than 20%, which is commonly observed among the males with no increase in lung cancer and other chronic diseases caused by smoking. Countries in this stage includes those in the Sub-Saharan Africa that have not yet been drawn into the global economy but are vulnerable to growth and changing strategic initiatives of transnational tobacco companies (WHO 2003). Stage two of the model is characterized by increase in smoking prevalence to above 50% in men with early increase in cigarettes smoki ng among women and a shift towards smoking initiation at younger age with an increasing burden of lung cancer and other tobacco-attributable diseases. These are characteristics of countries in the Asia, Latin America and North Africa continents. In these regions, tobacco control activities have been observed to be poorly developed and the health risks associated with tobacco smoking are not well understood. There are very low public and political supports for the effective implementation of tobacco control policies (WHO 2003). The third stage is characterized by a decline in smoking prevalence in men and gradual decline among women. Here, there is a convergence of male and female smoking prevalence at 45% and the burden of smoking attributable diseases is on the increase. Also, smoking-attributable deaths comprises of 10%to 30% of all deaths within the region which is about three quarters of men. Countries within this stage are those in the Eastern and Southern Europe where health e ducation about the diseases caused by smoking decreases with the public acceptance of smoking, most especially among the educated ones (WHO 2003). The fourth stage is characterized by a decline in smoking prevalence among men and women with deaths attributable to smoking peaked at 30% to 35% of all deaths most of which are middle aged men. Among the women, smoking attributable deaths rose to about 20% to 25%. Examples of countries within this stage are the United States and United Kingdom where England falls. FIGURE 2: Four stages of the Worldwide Tobacco Epidemic. (Source: WHO 2003). According to the Cancer Research UK (2009), the survey of smoking in Britain began in 1948. Then, smoking was extremely prevalent among men and the survey showed that 82% smoked some form of tobacco while 65% smoked cigarette. Later on, smoking prevalence fell rapidly through the 1980s until the mid 1990s when the overall smoking rates stabilizes just below 30% among the population as shown in figure 3. The sharp fall in smoking prevalence during this period is as a result of several interventions put in place by the Government then such as banning of tobacco advertisement on TV in the 1960s and others. Since the mid 1990s, the rate of fall has been very slow and in 2007 it was observed that 22% of men aged 16years and over smoke cigarette. The percentage of female smokers on the other hand has remained constant between 1948 and 1970 as shown in Figure 2. Between 1970 and 2007, the % of women who smoked dropped from around 43% to 20 % still due to certain measures developed in the la te 1960s. FIGURE 3. % of person aged 16+ who smoke cigarettes in Great Britain from 1948 to 2007. Source: General household survey, ONS. Available from: http://publications.cancerresearchuk.org/WebRoot/crukstoredb/CRUK_PDFs/lung/cs_lu_f6.1.xls FIGURE 4: Prevalence of Cigarette smoking by sex, England and Govt. Office Regions 2005. Source: Cancer Research UK. Figure 4 shows the cigarette distribution of cigarette smoking prevalence in England and it can be observed that, the overall smoking prevalence in England is about 25% among men and around 22% among the women. Within the various regions in England, smoking prevalence is higher among men and women in the North East because the region is economically active and home to 588 overseas companies from 32 different countries employing over 27,000 people (UK Trade Investment 2009). There has been a link between socio economic class and high prevalence of smoking as demonstrated in Figure 5 which buttresses the reason why the prevalence is high in Northeast England. Regions with high manual employee, occupation and high numbers of Industrial factories are characterised by high smoking prevalence. FIGURE 5: Prevalence of cigarette smoking by sex and socio-economic groups in England in 1992, 1998 and 2002. Source: Cancer Research UK. As shown in figure 5, smoking prevalence is observed to be higher among manual workers than non-manual workers. From 1992 to 2002, smoking prevalence reduced as a result of some interventions introduced within these years especially the White Paper on Smoking Kills introduced in 1998 making the prevalence to reduce from 33% in 1998 among the manual workers to 28% in 2002. FIGURE 6: Prevalence of cigarette smoking by age, persons aged 16+ in Great Britain, 1974-2005. Source: Cancer Research UK. FIGURE 7: Self reported cigarette smoking percentages by sex and minority ethnic group persons aged 16+ in England 2004. Source: Cancer Research UK. Smoking is more prevalent among the younger age groups of 16-19, 20-24 and 25-34 as shown in figure 6, where highest rate was observed among the 20-24 age group. Between 1974 and 2005, smoking prevalence among the 20-24 age groups fell from 48% to 32 %. On the other hand, among the 60+ age group, smoking prevalence halved between the same year intervals from 32% to 14%. Therefore, smoking prevalence has been observed to reduce with age as smokers tend to give up in middle age or die of smoking-related illnesses. (ONS 2002). Smoking prevalence has been observed to vary among different ethnic minority groups in England as shown in figure 7. Smoking prevalence is higher among the Bangladeshi men of about 41% but rare among the women with about 3%. Although this rate is alarming but there has been a decrease as to what was observed in 2001, when cigarette smoking and tobacco use was around 44% among the men with a relatively small percentage among the women (ONS 2001). FIGURE 8: Prevalence of cigarette smoking and use of tobacco products among ethnic minorities in England 2001. Source: DOH 2001. SOCIO-ECONOMIC FACTORS Smoking in the UK has been observed to be closely associated with social class and deprivation. The prevalence of smoking among the low paid groups has been observed to be twice those of the affluent groups because of the great difficulty people in the less affluent groups experience in stopping smoking (Ewles 2005). Tobacco smoking is also widely recognised as a cause of health inequality in the UK because it is common among the deprived groups and also compromises the already poorer health of deprived population such as those that fall within the marginalized groups. Examples are people with mental problems and prisoners, who are more likely to smoke and less likely to have access to mainstream smoking cessation services (Ewles 2005). The Index of multiple deprivation ranks areas from the most deprived to the least deprived and the odds of smoking increases as deprivation in the area increases (The NHS Information centre 2008). Children smoke for all sorts of reasons. Some smoke to show their independence, others because their friends do while some smoke because adults tell them not to and others do smoke to follow the example of role models. There is no single cause. Parents, brothers and sisters who smoke are a powerful influence. Also is the way it is been advertised and the tobacco companies sponsor sport which makes children want to try it (DOH 1998). The problems of smoking during pregnancy are closely related to health inequalities between those in need and the most advantaged. Women with partners in manual groups are more likely to smoke during pregnancy than those with partners in non-manual groups: 26 per cent of women with partners in manual groups smoke during pregnancy, compared with 12 per cent with partners doing non-manual work (DOH 1998). Education is also another social determinant of health for smoking. Education empowers individuals to make healthy choices and provides practical, social and emotional knowledge needed to achieve a full and healthy life (The Annual Report of the Director of Public Health for Newham 2007). The relationship between education and smoking has been extensively examined in developed countries and in the1989 US Surgeon General report analyzed by Bao-ping et al.(1996), it was stated after reviewing the literature of smoking that, education is the best socio demographic predictor for cigarette smoking pattern. The general agreement was that, the fewer the year of education one has, the more likely the person smokes and this again accounts for why there is high smoking prevalence among the ethnic minority groups in England. Another factor is the social norms whereby, in environments where smoking is freely permitted, it becomes a normal thing and becomes more difficult for individuals to opt out from (Ewles 2005).Other factors that prompt people to start smoking includes, the price and availability of cigarette, colourful advertisement and accessibility to treatment facilities for those that want to stop, the more available the facilities, the more people will be willing to use the facilities and stop smoking (Ewles 2005). In response to the global tobacco epidemic, May 31st of every year was declared as the World No Tobacco day, so as to globally address the danger associated with smoking tobacco. Also, the World Health Organization developed a WHO Framework Convention on Tobacco Control in May 2003 (WHO 2003), which later came into force on the 27th o February 2005 (WHO 2009). This was the first global treaty for public health negotiated under the auspices of the WHO and requires participating countries to implement a range of legislative and other measures to control smoking by taking appropriate action on passive smoking, banning tobacco promotion, providing services to smokers , monitoring smoking prevalence and international cooperation to control smuggling (Ewles 2005).In order to expand the fight against tobacco epidemic, the WHO introduced the MPOWER package of six proven policies namely: Monitor tobacco use and prevention policies, Protect people from tobacco smoke, Offer help to quit tobacco use, Warn about the dangers of tobacco use, Enforce bans on tobacco advertising promotion and sponsorship, and Raise taxes on tobacco. (WHO 2008) Smoking has been addressed at Government level in the UK since the publication of the White Paper Smoking Kills in 1998 which takes a comprehensive approach and prioritises people who want to give up, pregnant women, children and young people (DOH 1998). Between 1998 and 2009, various policies have been developed as stated earlier in this essay under the historical perspective of smoking in England which includes; 1998: Smoking Kills à ¢Ã¢â‚¬  Ã¢â‚¬Å" 2002: Tobacco Advertising and Promotion Act à ¢Ã¢â‚¬  Ã¢â‚¬Å" 2006: Health Act à ¢Ã¢â‚¬  Ã¢â‚¬Å" 2007: Smoke Free England. à ¢Ã¢â‚¬  Ã¢â‚¬Å" 2008: National Health Service Reform Bill à ¢Ã¢â‚¬  Ã¢â‚¬Å" 2009: Health Bill. GOVERNMENT MEASURES TO TACKLE SMOKING In line with the WHO directive to address tobacco epidemic, the UK signed into the International WHO framework Convention on Tobacco Control in 2003 and has implemented a range of legislative measures to control smoking at different geographical levels and between various population groups. The overall measures were broadly classified into three sets of overlapping effects namely; Changing social norms, Influencing attitudes, and Supporting individual behavioural change (Ewles 2005). Measures classified under the changing social norms and influencing attitudes includes; educational programmes such as the Government-funded mass media education campaigns aimed to educate the public on the danger associated with smoking, bans on tobacco promotion with health warnings covering 30% of the front and 40% of the back of tobacco packaging while terms such as low-tar and light have been prohibited on cigarette packet (DOH 2003). Also education on the benefit of quitting smoking was also part of the measure and explaining why people get fat after quitting as a result of increased eating unbalanced by increase activity because smoking has slight appetite suppressant effect (Ewles 2005). In addition, picture warnings started appearing on tobacco products in autumn 2008 and by October 1st 2009, all cigarette packs will have to carry picture warnings including other tobacco products by 1st October 2010 (DOH 2003). Also, another measure employed was prohibiting sales of tobacco products to people under the age of 18 by directing tobacco retailers to ask for form of identification from buyers who are teenagers. Taxation has also been used frequently to increase the price of smoking with rises in duty imposed in each years budget by the Government (Ewles 2005). On average, a price increase of 10% on a packet of cigarette reduced consumption by about 4% in developed countries, however, price control is undermined by tobacco smuggling which currently accounts for 16% of the UK market (Cancer Research 2009). Another measure is ensuring a smoke free environment which has been introduced in 2007 as smoke free England whereby smoking in enclosed public places is illegal. Under the supporting individual behavioural change is the cessation treatment programme, examples of which includes; a national telephone help lines and NHS specialist services for smokers who want to stop (Ewles 2005). To help smokers quit, the NHS Stop Smoking Services was set up between 1999 and 2000 following the recommendations of the White Paper Smoking Kills in 1998(DOH 1998). It was later observed that between April and September 2006, approximately a quarter of a million people (246,254) in England set a quit date through this NHS Stop Smoking Services and majority of these people receiving Nicotine replacement therapy (The Information Centre 2007). CHALENGES OF PUBLIC HEALTH POLICY FORMULATION AND PRACTISE The formulation of anti-smoking policy in England has always been big issue in most developed countries. In the UK, the Government needs people to smoke because the economy largely depends on it. The Government obtains  £8billion per year from excise duty on tobacco products which is approximately 2% of its annual revenue (Ewles 2005). Both in the policy formulation and in the implementation phase conflicts of commercial and health interests have been strongest on three issues: the ban on advertisement and sales promotion, the setting of upper limits for harmful substances in tobacco products, and proposals for an efprice policy. In the political process Parliament has been much more sensitive to the public health interest and to public opinion than to the lobbying power of the tobacco industry and trade, which has been more clearly visible in many Government decisions MEASURES TO REDUCE INEQUALITY IN SMOKING/ POLICY CRITIQUING After thorough review of the various policies aimed towards reducing cigarette smoking at the International, National and Local level, various gaps have been identified. Firstly, banning of smoking in public places is not enough to reduce the effect of smoking on health because be it passive or active smoking, it still endangers the life of the smoker. Therefore, abstinence should be the only message since smoking is a major cause of litter. In the UK, 200million cigarette ends are discarded each day and each takes 18months or more to biodegrade (Ewles 2005). Also, smoking in bus stops tends to serve as passive smoking to others waiting to join buses and therefore smoking in areas like this also needs to be banned. Another lapse in the smoking in the public places law is that, when people are not allowed to smoke in public places, they tend to do so when they get into their private cars and homes and these could be dangerous to young children living in the same house. Another area worth reviewing is the use of taxation to increase the price of tobacco products. High price has helped dissuade people especially young children from smoking and prompted many smokers to stop; however, smoking is concentrated among the lowest paid sector of the society and common among the addicted population who continue smoking despite prices, therefore such measures by the Government is not fair because the poor people pay disproportionately more as a consequences of their acquired addiction caused by the Government originally (Ewles 2005). Another misconception of tackling smoking is the youth smoking prevention programme which has always assumed to be the best way to tackle smoking among children and youths. The Youth-oriented media campaigns has a poor record of credibility among the target group (youths) and is often difficult to differentiate between those created by the health organizations and those created by the tobacco manufacturing companies. Therefore, discrediting smoking among the adult population will lessen the attraction for the youths because they tend to smoke in aspiration to be more adult (Ewles 2005). In addition, the law prohibiting sales to under -18s tend to add to the allure of smoking as an adult activity and thus creating challenges to children on finding a way around it buy getting the cigarette through adult friends, older siblings or black market routes(Ewles 2005). Also people who stop smoking through the nicotine replacement therapy gets addicted to the cessation programme and use the product beyond the recommended period. Since the nicotine delivery rate in the content is slow, it mostly prompts a relapse making people return to smoking (Ewles 2005). Reducing inequality in smoking has always been an issue the UK Government have been addressing and in response to this, a specific inequality target on smoking was set up in The NHS Cancer plan and the Public Service Agreement (PSA) 2004 aimed to reduce smoking rates among manual groups from 32% in 1998 to 26% by 2010 in order to reduce the health gap between the two groups. (DOH 2000). RECOMMENDATION/ CONCLUSION Evaluation of smoking patterns indicates that there has been an historic reversal of trends in total consumption, but distributional data show a widening social gradient in smoking. Two developments are needed for further improvement: a price policy that would support health policy and not contradict it, and better understanding of the socio-cultural dynamics of smoking which would be required for new innovative approaches in health education. REFRENCES Action on Smoking and Health (2006). Smoking Statistics; Illness and death. [Online]. Available from: http://old.ash.org.uk/html/factsheets/html/fact02.html (Accessed 25/04/2009). Bao-ping, Z., Giovino, G., Mowery, P. Eriksen, M. (1996). The Relationship between Cigarette Smoking and Education Revisited: Implications for Categorising persons educational status. American Journal of Public Health.1996. Vol.86, No 11. British Broadcasting Corporation (2007). Timeline: Smoking and Disease. [Online] Available from http://news.bbc.co.uk/1/hi/health/4377928.stm (Accessed 28/09/2009). <

Diagnostic Imaging for Breast Cancer Symptoms

Diagnostic Imaging for Breast Cancer Symptoms The role of diagnostic imaging in the initial investigation of female patients symptomatic for breast cancer, and its subsequent application in the staging process. Introduction Breast Cancer is the term used for cancers found within the breast tissue. Usually breast cancer is the result of a small change in the regulatory cycles that the tissue goes through. Any changes in these can result in malignant growths within the breast tissue. As stated by Breast Cancer Now (2016), Breast cancer is the most commonly diagnosed cancer in women in the UK with over 50,000 new cases diagnosed in women each year, in the UK alone, thus approximately 1 in 8 women will be diagnosed with some form of breast malignancy in their lifetime. Furthermore, not all breast cancer occurs in females, in the UK roughly 350 men are also diagnosed with breast cancer each year. The survival rate of breast cancer is quite high at around 90%, states Breast Cancer Care (2016), which highlights how effective treatment currently is. However, it is the most common cause of death in women aged 40-50. Vaidya, J.S. et al (2012a). Per Sestak, I. et al (2012), there are many factors that can predispose a person to the risk of breast cancer. These include: increasing age, geographical variation, breast density, age at first pregnancy, age at menarche and menopause, family history, genes, previous breast disease, radiation, lifestyle, oral contraceptives and hormone replacement therapy. As stated by Vaidya, J.S. et al (2012a), Breast cancer lumps are usually hard and painless, with an irregular shape. They are approximately 2cm before they are palpable and can be felt. Most lumps are found in the upper outer quadrant of the breast. A lump is the most common symptom but there are other signs and symptoms that can be indicative of breast cancer. These other symptoms include: bleeding from the nipple (rare), change in shape or size, ulceration, swelling in breast or arm due to blockage of lymphatic circulation, peau dorange which is usually the result of fluid in the dermis and axillary lumps. These symptoms are not present in all cases and are indicative of the different stages and kinds of breast cancer. Content Discussion People with breast cancer symptoms usually undergo what is known as a Triple Assessment. A triple assessment comprises of a clinical examination, imaging examinations and pathological evaluation. This assessment process is usually able to diagnose 95% of malignant breast cancers. Vaidya, J.S. et al (2012b) Vaidya, J.S. et al (2012b) also states that before a clinical examination occurs, the patients history is taken into consideration, as this can aid the diagnose or other potential causes of the symptoms. Usually the history that is considered includes: the history of the current complaint, family history of breast or ovarian cancers, HRT and oral contraceptives history, previous diseases and surgeries, allergies and smoking history. Clinical Assessment of Breast Cancer As stated before clinical examination is the first step in a triple assessment to diagnose breast cancer. Clinical examination is done to assess dimpling, which is usually an early sign, as it occurs because of the contraction of the ligaments of Cooper. Clinical examination can also distinguish between coarse nodular tissue and an actual lump in the breast tissue. The colour and site of any discharge at the nipple is also recorded and tested for any blood within the discharged fluid. Vaidya, J.S. et al (2012b). Imaging in Diagnosis of Breast Cancer As stated by Vaidya, J.S et al (2012b), Both mammography and ultrasonography have important roles in the diagnosis of breast cancer, but the use of other modalities, such as magnetic resonance and infrared imaging, is being developed. Mammography can detect over 95% of clinically detectable cancers. However, it does not aid the diagnosis of a patient with a discrete lump. In this case diagnosis relies heavier on cytology and histology. It may also be of use in the detection of cancer in patients with coarse nodular breasts and is particularly useful in dense breast tissues. Vaidya, J.S. et al (2012b) Another use for mammography is to accurately assess where the cancer is located. This information can also be used to aid biopsy and surgeries.ÂÂ   Mammography can also reveal that there is an impalpable lump in the other asymptomatic breast which otherwise would have gone undetected. Vaidya, J.S. et al (2012b) If a mass is detected on a mammogram, a range of codes are typically used to determine the potential malignancy of the mass. These are defined by Willet, A. et al, for the Association of Breast Surgery (2010) as: M1 Normal M2 Benign M3 Indeterminate/Likely Benign M4 Suspicion of Malignancy M5 Highly suspicious of Malignancy. Another key imaging technique used in the diagnosis of breast cancer is ultrasonography. Ultrasound shows the difference between a cyst or a more solid mass. Therefore, a mass can be confirmed to be a cyst and can be drained using needle aspiration. However, a blood-stained aspirate may be a result of a cancer within the cyst which was previously unidentified. The sensitivity and specificity of ultrasound in the diagnosis of breast lumps has continued to improve with growing technological advances. Benign lumps appear as well-defined masses with no acoustic shadow. Malignant lumps are ill-defined masses, with a varying echogenicity and/or have evidence of microcalcifications within them. Ultrasound is also the preferred imaging method in women under the age of 30, as their breasts tend to be less dense and are therefore radiosensitive. Vaidya, J.S. et al (2012b). The NICE Guidelines (2015), also state that, ultrasound evaluation of the axilla should be performed for all patients bein g investigated for early invasive breast cancer. Fine-needle aspiration cytology is also used in breast cancer diagnosis by inserting a small needle into a lump which is located during the examination using ultrasound. The aspirate on the needle is then examined under a microscope by a pathologist which can then diagnose a breast cancer with almost 100% specificity depending on their level of skill and training. Vaidya, J.S. et al (2012b) Imaging in Staging of Diagnosed Breast Cancer If the tumour is large and there is extensive lymph-node involvement, preoperative staging is prudent. Vaidya, J.S. et al (2012b) As stated by RCR guidelines (2014), the objectives of staging are to: assess the size of a tumour, assess for other involvement of the skin or chest wall, assess multifocality of tumour, to assess the nodal status and to assess for any metastatic spread. MRI is used in staging any indeterminate lesions. The expense of MRI is now becoming less of an issue as the cost of an MRI breast coil is considered relatively low. The injection of a contrast agent during MRI enables the vascularity of a lesion to be visualised. The downside of this is that a specifically trained team is required to undergo this route of imaging. Vaidya, J.S. et al (2012b) NICE guidelines (2015), state that MRI is not recommended in the preoperative assessment of patients with invasive breast cancer that has been proven by biopsy or ductal carcinoma in-situ. It should only be offered to those where the extent of metastases is indeterminate, breast density has caused mammography to be indefinite or to assess tumour size to aid surgery for invasive lobular cancer. Computed Tomography is stated by the RCR Guidelines (2014), to be used with patients who have advanced symptoms and are suspected to have a further progressed cancer. Reasons for request of a CT to stage breast cancer include: bone pain and breathlessness. If the use of CT for staging is used, intravascular contrast media should be employed during the scan. The scan should include the supraclavicular fossa, the chest and the liver. The RCR Guidelines (2014), state that Photon Emission Tomography should not be used for early stage breast cancer but should be used more to assess metastatic spread. It is also used to assess potentially multi-focal disease or suspected recurrence if a patient has particularly dense breasts. Axially node status is usually assessed by using US, with the use of fine-needle aspiration or biopsy of any suspicious nodes. RCR Guidelines (2014). Vaidya, J.S. et al (2012b) also suggest that routine staging in early breast cancer, as the results are usually less than 4%. Thus, these investigations can slow down the otherwise relatively quick treatment and can cause the patient unnecessary anxiety as they await results. Follow-up and Surveillance after treatment of Breast Cancer It is suggested by Vaidya, J.S. et al (2012b) that patients who have had a mastectomy are at a higher risk of developing cancer in the remaining breast and should therefore undergo regular mammograms for surveillance. They also suggest that colour Doppler ultrasound scanning of a breast that has had a malignant tumour postoperatively is likely to increase the chances of an early diagnosis should there be any recurrence. RCR guidelines (2013) state that women who have been treated for breast cancer under the age of 50 should have a yearly mammogram as surveillance follow up. After 50 the guidelines are unclear but it is currently recommended that surveillance mammograms are routinely performed every 2-3 years. NICE guidelines (2015), also state that an annual mammography should be offered to all those with early breast cancers, including DCIS until they reach the age for screening. These guidelines recommend that patients of the age for screening should have also annual mammograms for 5 years. The NICE guidelines (2015), further suggest that US nor MRI should be offered in post-treatment surveillance for those who have been treated for DCIS or other early stage breast cancers. Conclusion In summary, it is essential that patients presenting symptoms which usually pertain to a breast cancer undergo a thorough assessment, including multiple imaging examinations not just for the diagnosis of the cancer, but also the staging and the follow-up once the cancer has been successfully treated. Mammography and Ultrasound are the two key imaging techniques that are vital in my opinion within diagnosis. They enable a fast and usually efficient result which can then be used for staging. Ultrasound can be seen to have more benefits as it does not use ionising radiation unlike mammography, but mammography is essential is those patients who have highly dense breast tissue. This is usually postmenopausal patients who tend to be the high-risk group of developing breast cancer. CT and Ultrasound are mainly used during staging. This stage is vital in patients with more progressive breast cancer, but if the tumour has been caught in the early stages, staging methods can usually be skipped as it is more efficient to immediately commence treatment methods. Follow-up imaging is also essential as those who have undergone treatment of breast cancer are at higher risk of recurrence in either breast. In conclusion, imaging is one the most essential tools available in the diagnosis, staging and follow-up of breast cancer. Without the current imaging techniques, we have today the 95% survival rate of breast cancer would likely be nowhere near as high. Reference List: Breast Cancer Care. (2016). Prognosis. Available: https://www.breastcancercare.org.uk/information-support/facing-breast-cancer/diagnosed-breast-cancer/diagnosis/prognosis. Last accessed 27th Mar 2017. Breast Cancer Now. (2016). Breast Cancer Statistics. Available: http://breastcancernow.org/about-breast-cancer/what-is-breast-cancer/breast-cancer-statistics. Last accessed 27th Mar 2017. NICE guidelines. (2015). Early and locally advanced breast cancer: diagnosis and treatment. Breast Cancer. Last Accessed: 30th Mar 2017 Sestak, I et al. (2012). Breast Cancer: Epidemiology, Risk Factors and Genetics. In: Dickson, J ABC of Breast Disease. 4th ed. London: BMJ Books. p41-47. The Royal College of Radiologists (2013). Guidance on screening and symptomatic breast imaging. 3rd ed. London: The Royal College of Radiologists.ÂÂ   Pg.7 The Royal College of Radiologists (2014). Recommendations for cross-sectional imaging in cancer management. 2nd ed. London: The Royal College of Radiologists. P2-4 Vaidya, J.S., Joseph, D. Jones, A. (2012b), Fast Facts: Breast Cancer Diagnosis, 4th ed. edn, Health Press Limited, Abingdon.ÂÂ   P47-64 Vaidya, J.S., Joseph, D. Jones, A. (2012a), Fast Facts: Breast Cancer Pathophysiology, 4th ed. edn, Health Press Limited, Abingdon.ÂÂ   P28-46 Willet, A. et al. (2010). Diagnosis and Imaging.ÂÂ   Best Practice Diagnostic Guidelines for Imaging of Symptomatic Patient. Department of Health. p 49.