Literature Review on Breast Cancer Research

Literature Review on Breast Cancer Research Aashiyana Vadsariya Introduction    Evaluation is a process of reviewing of any programme, project or policy, its design and results. The main objective of doing evaluation is to measure the effectiveness of the programme or policy, its impact and sustainability. Evaluation helps to solve the problem as well as to build the knowledge and it enhances the decision making process and thus evaluation is an important part of quality improvement (The Health Foundation, 2015). There are different types of evaluation such as formative evaluation, outcome evaluation, process evaluation, impact evaluation and economic evaluation which can be conducted to ensure programme activities. Moreover, vigorous evaluation provides not only about intervention that is worked but it also describes why and how that allows an individual to discover new interventions in healthcare settings. Additionally, it involves ethical approval, collection and analysis of data (Centre for Disease Control and Prevention, 2015). Background of the study According to Ministry of Health (2015), Breast cancer is the third most common cancer in New Zealand. It causes more than 600 deaths every year. Breast cancer is most common over the age of 50 and risk of developing breast cancer increases as age increases. Approximate 80% of women are over 50 years of age who died because of breast cancer. There are 8 cases diagnosed with breast cancer every day, out of them 1 will be Maori and pacific women who are at higher risk of dying from breast cancer. Maori women are more likely to develop breast cancer about 33% than non-Maori women (The New Zealand Breast Cancer Foundation, 2013). National Breast Cancer Foundation describes certain risk factors which increases the chance of developing cancer such as age, gender, positive family history, personal health history and genetic factors. Ministry of Health have started the programme called Breast Cancer Screen Aotearoa to fight against breast cancer by providing free breast screening to the women aged 45-69 years of age. The main objective of this programme is to reduce number of deaths from breast cancer by providing them regular screening (National Screening Unit, 2014). This paper will critically evaluate five (5) research papers of breast cancer that were published worldwide focusing on their significance, methodology and quality and will analyse the four (4) audit and evaluation processes and approaches such as outcome, process, impact, economic evaluation from the evaluated breast cancer research papers. Economic evaluation of the breast cancer screening programme in the Basque Country: retrospective cost-effectiveness and budget impact analysis. This study evaluated the breast cancer early detection programme in Basque country in relation to cost effectiveness and budget impact from 1996 to 2011. The researcher has used population level and single cohort analysis methodology. Annual costs were taken into consideration for budget impact analysis. The results of this study showed that total cost of breast cancer screening program was 1,127 million euros and 6.7 million QALYs over the lifetime of the target population, bringing about a pickup of 8,666 QALYs for an extra cost of 36.4 million euros (Arrospide, Rue Van Ravesteyn et al., 2016). The researcher has finally summed up that the breast screening programme ran in Basque country was cost effective and as per determined budget impact. This study contributes to measure cost effectiveness of this breast cancer screening programme and evaluate its budget in order to decide the future of this programme. A review of breast cancer awareness among women in India: Cancer literate or awareness deficit? This study was conducted to assess the level of awareness about risk factors leads to breast cancer in Indian women and healthcare professionals through literature review. The researcher used bibliographic databases such as MEDLINE, SCOPUS, Cochrane database of systematic reviews and Cumulative Index to Nursing and Allied Health. The findings of the research suggested that total 7066 number of women between ages of 15-70 years reflected different level of awareness on risk factors such as family history (13-58%), obesity (11-50%) and reproductive history around 1-88% (Gupta, Shridhar Dhillon, 2015). Low cancer literacy on risk factors of breast cancer among Indian women and healthcare professional noted during research process irrespective of their socio-economic status and education was (Gupta, Shridhar Dhillon, 2015). This study contributes to aware the nation about programmes and to improve the cancer literacy rate in India by engaging various stakeholders of society and health system. National Breast Cancer Screening Programme, Singapore: Evaluation of participation and performance indicators. The researcher evaluated participation rates and performance indicators in the National Breast Cancer screening programme in Singapore during this study. This study involved the use of retrospective evaluation approach by using the BSS system and the Singapore Cancer Registry data on women aged 40-69 screened in period of 2002-2009. The results showed that participation rate was more than 10% since 2005 and performance indicators (such as screen detection rates, small tumour detection rates, recall rates, accuracy and interval cancer rates were improved from 2002-2006 to 2007-2009 (Loy, Molinar Chow, 2015). This study indicated that there is room for improvement in participation rate in breast cancer screening in Singapore by providing screening packages, reducing screening cost and targeting underserved populations. This study contributes to improve the participation rate of breast cancer screening programme for the effectiveness of the BreastScreen Singapore by providing training opportunities to the healthcare professionals. Impact of mammographic screening on ethnic and socioeconomic inequities in breast cancer stage at diagnosis and survival in New Zealand: a cohort study. This study was conducted to determine the impact of differences in rates of mammographic screening on inequities in cancer stage at diagnosis and survival between Maori and Pakeha women. The researcher used Waikato Breast Cancer Register and the National Screening Database to compare the data for diagnosis and survival between screen detected and non screen detected breast cancer by socio-economic status and ethnicity. The results indicated that there were lower rate of screen detected cancer in Maori women and also they had lower 10 year breast cancer survival rate as compared to Pakeha women (46.5% vs. 73.2%) (Seneviratne, Campbell Scott, et al., 2015). The study determined that lower rate of screening detected breast cancer was the important reason for lower rate of survival for Maori women in comparison to European women. This study contributes to assess the screening rates, to improve the survival for Maori women and to reduce inequity for the breast cancer survival among Maori and New Zealand European women. An ongoing case-control study to evaluate the NHS breast screening programme This research was carried out to evaluate the national breast screening programme in England. This study estimated the effects of the national breast screening programme in regards to breast cancer incidence, mortality and over-diagnosis of breast cancer. The researcher has used quantitative methodology and retrospective case control study to describe the policy on mammographic screening. The findings suggested that there is decrease in incidence by screening, excess risk of disease in screened ages from 47-54 years and potential deficit in risk seen between the ages of 65-69 years up to 15 years of screening (Massat, Sasieni Parmar et al., 2013). This research concluded that case control evaluation strategy relates the clinical endpoints to the screening history. This study contributes to measure the effectiveness of the national breast screening programme in England, benefits on mortality from and on incidence of invasive primary breast cancer and harms from over-diagnosis. Audit and Evaluation processes Economic evaluation of the breast cancer screening programme in the Basque Country: retrospective cost-effectiveness and budget impact analysis. Economic evaluation is one of the most important forms of evaluation which measures the expenditure and their consequences and also describes about allocation of the resources (Cunningham, 2000). In this research, the researcher has used economic evaluation to measure cost effectiveness of the breast cancer screening programme in the Basque Country from 1996 to 2011. This study was mainly based on budget impact analysis and retrospective cost effectiveness evaluation to determine what resources are being used in programme and their costs as compare to outcomes (Arrospide, Rue Van Ravesteyn et al., 2016). Economic evaluation in this research took a step back and looked objectively in context to appropriate role and use of cost effective analysis in order to determine the outcome of the breast cancer screening programme. This research revealed that the breast screening programme was found to be cost effective within determined budget impact (Arrospide, Rue Van Ravesteyn et al., 2016). A review of breast cancer awareness among women in India: Cancer literate or awareness deficit? Outcome evaluation identifies the effects of the programme in target populations by reviewing effectiveness of programme (Centre of Disease Control and Prevention, 2015).The researcher used outcome evaluation to determine awareness levels of risk factors for breast cancer among women and healthcare professional in India. This outcome evaluation was undertaken through a structured literature review by using bibliographic databases journals (Gupta, Shridhar Dhillon, 2015). The main purpose of this outcome evaluation in this study was to assess the cancer literacy among women in India because of the rising incidence and mortality rates from breast cancer. Furthermore, the researcher concluded that there was a low literacy rate among Indian women regarding risk factors that causes breast cancer through this evaluation study (Gupta, Shridhar Dhillon, 2015). National Breast Cancer Screening Programme, Singapore: Evaluation of participation and performance indicators. Process evaluation was conducted to assess how this breast screening programme is being implemented whereas outcome evaluation was conducted to measure the outcome and effectiveness of this programme (NYS Health Foundation, 2016). The researcher used outcome and process evaluation to evaluate the participation rates and performance indicators in the National Breast Cancer Screening programme in Singapore. Data was collected on women aged 40-69 screened during period of 2002-2009 from the BreastScreen Singapore and Singapore Cancer Registry (Loy, Molinar Chow, 2015). Process and outcome evaluation was helpful to determine the rate of participation and performance indicators, to measure the quality of the programme delivered and to assess the effectiveness of the breast screen Singapore programme. This evaluation allows researcher to examine the performance of this Breast Screen Singapore programme and to recommend further changes if required. Impact of mammographic screening on ethnic and socioeconomic inequities in breast cancer stage at diagnosis and survival in New Zealand: a cohort study. Impact evaluation measures whether the programme is effective in achieving its goal or not. Generally, it identifies long term effects and changes in outcome based on cause and effect analysis (Collins, 2017). The researcher utilised impact evaluation to determine the impact of mammographic screening on ethnic and socio economic inequities in breast cancer stage at diagnosis and survival between Maori and European women. The researcher collected data by using National Screening Database and Waikato Breast cancer Register (Seneviratne, Campbell Scott, et al., 2015). Impact evaluation was carried out to measure the impact of screening programme on ethnic and socio economic inequities for breast cancer survival rate which can be useful for government to take necessary actions and to form policies in healthcare settings to reduce inequalities in health. An ongoing case-control study to evaluate the NHS breast screening programme Process evaluation determines the effectiveness of the programme and how well the programme is working (Community Interventions for Health, 2017). The researcher used process and impact evaluation to evaluate the national breast screening programme in England. Impact evaluation was helpful to identify the impact of breast cancer screening on breast cancer incidence and mortality. Data was gathered by traditional retrospective case control study of deaths and incidences cases of breast cancer in England within 2 years of period during this ongoing evaluation (Massat, Sasieni Parmar et al., 2013). The main purpose of impact evaluation is to see that breast cancer screening programme is working effectively and is doing well than harm. Process evaluation can help to ensure that the breast screening programme continues to deliver the predicted health benefits and potentially improve the programme by assessing the good and bad practices. Evaluative Model The (CIPP) model The CIPP evaluation model is developed by Stufflebeam in 1983 which provides comprehensive framework for the evaluation of the programmes. The CIPP model consists of four components which are context, Input, Process and product evaluation. The CIPP model mainly focuses on improvement of the programme rather than justifying about the programme. The main purpose of this CIPP model is to offer critical and rational basis for the programme decision making by applying different aspects of this evaluation model according to the needs of decision makers and programme activities based on the planning and implementation for the continuous improvement of the programme (Kellaghan Stufflebeam, 2003). The context, input and process evaluation approach are based on formative evaluation whereas product approach is useful for summative evaluation study. The four elements of the evaluation model must be taken into consideration otherwise it could reduce the effectiveness of the project. The context evaluation study can be conducted when a new programme is being planned which helps to identify the program goals and objectives by assessing needs whereas the input evaluation study can be conducted during resource allocation to assess the feasibility or the cost effectiveness of the alternate approaches. It provides systematic approach to programme design and helps the evaluators and experts to develop the programme which is most likely to work better (Frye Hemmer, 2012). Source: Adapted from Stufflebeams CIPP Evaluation Model (1983). Retrieved from http://arcmit01.uncw.edu/jonesi/Evaluation.html The process evaluation helps the evaluators and stakeholders to assess the implementation of the programme and to interpret the outcomes of the programme through document review, observation and participant interview. On the other hand, the product evaluation is similar to outcome evaluation which focuses on assessing the outcomes of the programme including positive or negative, short term or long term outcomes. In general, the CIPP model provides information about improvement of the programme, interpretation of the programme outcomes and information for accountability. However, careful planning is needed while applying this model. This model is useful for retrospective evaluation of a completed programme (Kellaghan Stufflebeam, 2003). This evaluation model can contribute to measure the effectiveness of the breast cancer screening programme run by Ministry of Health in New Zealand. The four elements of the model can be used to improve the programme by identifying the non-compliance of women for the breast screening programme. Auditing and evaluating the breast cancer screening programme helps to know the barriers and promote the awareness regarding breast cancer to provide beast quality care services to the New Zealanders. Furthermore, staying healthier is one of priorities of the Ministry of health. It can be achieved through evaluating the programme and implementing a change accordingly if needed. Conclusion Evaluation research is an essential tool to evaluate the effectiveness of the programme or to know how well the programme is working. Evaluation research helps managers and stakeholders of the organisation to improve the performance of the organisation and to provide the quality care health services. Staff and clients can be encouraged to provide useful feedback about the programme which helps in decision making and policy formation about the programme and thus improving the services provided by organisation. References Arrospide, A., Rue, M., Van Ravesteyn, N. T., Comas, M., Soto-Gordoa, M., Sarriugarte, G., Mar, J. (2016). Economic evaluation of the breast cancer screening programme in the Basque Country: retrospective cost-effectiveness and budget impact analysis. BMC Cancer, 16(1). doi:10.1186/s12885-016- 2386-y Centre for Disease Control and Prevention. (2015). Types of evaluation. Retrieved from https://www.cdc.gov/std/Program/pupestd/Types%20of%20Evaluation.pdf Collins, K.B. (2017). What is Impact Evaluation. Retrieved from http://programs.online.american.edu/online-graduate-certificates/project- monitoring/resource/what-is-impact-evaluation Community Interventions for Health. (2017). Process Evaluation. Retrieved from http://www.oxha.org/cih_manual/index.php/process-evaluation Cunningham, S.J. (2000). Economics: Economic evaluation of healthcare is it important to us? Retrieved from http://www.nature.com/bdj/journal/v188/n5/full/4800444a.html Frye, A. W., Hemmer, P. A. (2012). Program evaluation models and related theories: AMEE Guide No. 67. Medical Teacher, 34(5), e288-e299. doi:10.3109/0142159x.2012.66863 Gupta, A., Shridhar, K., Dhillon, P. (2015). A review of breast cancer awareness among women in India: Cancer literate or awareness deficit? European Journal of Cancer, 51(14), 2058-2066. doi:10.1016/j.ejca.2015.07.008 Kellaghan, T., Stufflebeam, D. L. (2003). International handbook of educational evaluation. Dordrecht: Kluwer Academic Publishers. Retrieved from http://link.springer.com/chapter/10.1007%2F978-94-010-0309-4_4 Loy, E. Y., Molinar, D., Chow, K. Y., Fock, C. (2015). National Breast Cancer Screening Programme, Singapore: Evaluation of participation and performance indicators. Journal of Medical Screening, 22(4), 194-200. doi:10.1177/0969141315589644 Massat, N. J., Sasieni, P. D., Parmar, D., Duffy, S. W. (2013). An ongoing case- control study to evaluate the NHS breast screening programme. BMC Cancer, 13(1). doi:10.1186/1471-2407-13-596 Ministry of Health. (2015). Breast Cancer. Retrieved from http://www.health.govt.nz/your-health/conditions-and-treatments/diseases- and-illnesses/breast-cancer National Screening Unit. (2014). BreastScreen Aotearoa. Retrieved from https://www.nsu.govt.nz/breastscreen-aotearoa/about-breast-screening- programme NYS Health Foundation. (2016). Process Evaluation. Retrieved from http://nyshealthfoundation.org/our-grantees/grantee-resources/process- evaluation Seneviratne, S., Campbell, I., Scott, N., Shirley, R., Lawrenson, R. (2015). Impact of mammographic screening on ethnic and socioeconomic inequities in breast cancer stage at diagnosis and survival in New Zealand: a cohort study. BMC Public Health, 15(1). doi:10.1186/s12889-015-1383-4 The Health Foundation. (2015). Evaluation: what to consider. Retrieved from http://www.health.org.uk/sites/health/files/EvaluationWhatToConsider.pdf The New Zealand Breast Cancer Foundation. (2013). New Zealand Breast Cancer Facts. Retrieved from http://nzbcf.org.nz/BREASTCANCER/Overview/BreastCancerinNZ/Fastfacts.a spx

Literature Review on Breast Cancer Research

Literature Review on Breast Cancer Research Aashiyana Vadsariya Introduction    Evaluation is a process of reviewing of any programme, project or policy, its design and results. The main objective of doing evaluation is to measure the effectiveness of the programme or policy, its impact and sustainability. Evaluation helps to solve the problem as well as to build the knowledge and it enhances the decision making process and thus evaluation is an important part of quality improvement (The Health Foundation, 2015). There are different types of evaluation such as formative evaluation, outcome evaluation, process evaluation, impact evaluation and economic evaluation which can be conducted to ensure programme activities. Moreover, vigorous evaluation provides not only about intervention that is worked but it also describes why and how that allows an individual to discover new interventions in healthcare settings. Additionally, it involves ethical approval, collection and analysis of data (Centre for Disease Control and Prevention, 2015). Background of the study According to Ministry of Health (2015), Breast cancer is the third most common cancer in New Zealand. It causes more than 600 deaths every year. Breast cancer is most common over the age of 50 and risk of developing breast cancer increases as age increases. Approximate 80% of women are over 50 years of age who died because of breast cancer. There are 8 cases diagnosed with breast cancer every day, out of them 1 will be Maori and pacific women who are at higher risk of dying from breast cancer. Maori women are more likely to develop breast cancer about 33% than non-Maori women (The New Zealand Breast Cancer Foundation, 2013). National Breast Cancer Foundation describes certain risk factors which increases the chance of developing cancer such as age, gender, positive family history, personal health history and genetic factors. Ministry of Health have started the programme called Breast Cancer Screen Aotearoa to fight against breast cancer by providing free breast screening to the women aged 45-69 years of age. The main objective of this programme is to reduce number of deaths from breast cancer by providing them regular screening (National Screening Unit, 2014). This paper will critically evaluate five (5) research papers of breast cancer that were published worldwide focusing on their significance, methodology and quality and will analyse the four (4) audit and evaluation processes and approaches such as outcome, process, impact, economic evaluation from the evaluated breast cancer research papers. Economic evaluation of the breast cancer screening programme in the Basque Country: retrospective cost-effectiveness and budget impact analysis. This study evaluated the breast cancer early detection programme in Basque country in relation to cost effectiveness and budget impact from 1996 to 2011. The researcher has used population level and single cohort analysis methodology. Annual costs were taken into consideration for budget impact analysis. The results of this study showed that total cost of breast cancer screening program was 1,127 million euros and 6.7 million QALYs over the lifetime of the target population, bringing about a pickup of 8,666 QALYs for an extra cost of 36.4 million euros (Arrospide, Rue Van Ravesteyn et al., 2016). The researcher has finally summed up that the breast screening programme ran in Basque country was cost effective and as per determined budget impact. This study contributes to measure cost effectiveness of this breast cancer screening programme and evaluate its budget in order to decide the future of this programme. A review of breast cancer awareness among women in India: Cancer literate or awareness deficit? This study was conducted to assess the level of awareness about risk factors leads to breast cancer in Indian women and healthcare professionals through literature review. The researcher used bibliographic databases such as MEDLINE, SCOPUS, Cochrane database of systematic reviews and Cumulative Index to Nursing and Allied Health. The findings of the research suggested that total 7066 number of women between ages of 15-70 years reflected different level of awareness on risk factors such as family history (13-58%), obesity (11-50%) and reproductive history around 1-88% (Gupta, Shridhar Dhillon, 2015). Low cancer literacy on risk factors of breast cancer among Indian women and healthcare professional noted during research process irrespective of their socio-economic status and education was (Gupta, Shridhar Dhillon, 2015). This study contributes to aware the nation about programmes and to improve the cancer literacy rate in India by engaging various stakeholders of society and health system. National Breast Cancer Screening Programme, Singapore: Evaluation of participation and performance indicators. The researcher evaluated participation rates and performance indicators in the National Breast Cancer screening programme in Singapore during this study. This study involved the use of retrospective evaluation approach by using the BSS system and the Singapore Cancer Registry data on women aged 40-69 screened in period of 2002-2009. The results showed that participation rate was more than 10% since 2005 and performance indicators (such as screen detection rates, small tumour detection rates, recall rates, accuracy and interval cancer rates were improved from 2002-2006 to 2007-2009 (Loy, Molinar Chow, 2015). This study indicated that there is room for improvement in participation rate in breast cancer screening in Singapore by providing screening packages, reducing screening cost and targeting underserved populations. This study contributes to improve the participation rate of breast cancer screening programme for the effectiveness of the BreastScreen Singapore by providing training opportunities to the healthcare professionals. Impact of mammographic screening on ethnic and socioeconomic inequities in breast cancer stage at diagnosis and survival in New Zealand: a cohort study. This study was conducted to determine the impact of differences in rates of mammographic screening on inequities in cancer stage at diagnosis and survival between Maori and Pakeha women. The researcher used Waikato Breast Cancer Register and the National Screening Database to compare the data for diagnosis and survival between screen detected and non screen detected breast cancer by socio-economic status and ethnicity. The results indicated that there were lower rate of screen detected cancer in Maori women and also they had lower 10 year breast cancer survival rate as compared to Pakeha women (46.5% vs. 73.2%) (Seneviratne, Campbell Scott, et al., 2015). The study determined that lower rate of screening detected breast cancer was the important reason for lower rate of survival for Maori women in comparison to European women. This study contributes to assess the screening rates, to improve the survival for Maori women and to reduce inequity for the breast cancer survival among Maori and New Zealand European women. An ongoing case-control study to evaluate the NHS breast screening programme This research was carried out to evaluate the national breast screening programme in England. This study estimated the effects of the national breast screening programme in regards to breast cancer incidence, mortality and over-diagnosis of breast cancer. The researcher has used quantitative methodology and retrospective case control study to describe the policy on mammographic screening. The findings suggested that there is decrease in incidence by screening, excess risk of disease in screened ages from 47-54 years and potential deficit in risk seen between the ages of 65-69 years up to 15 years of screening (Massat, Sasieni Parmar et al., 2013). This research concluded that case control evaluation strategy relates the clinical endpoints to the screening history. This study contributes to measure the effectiveness of the national breast screening programme in England, benefits on mortality from and on incidence of invasive primary breast cancer and harms from over-diagnosis. Audit and Evaluation processes Economic evaluation of the breast cancer screening programme in the Basque Country: retrospective cost-effectiveness and budget impact analysis. Economic evaluation is one of the most important forms of evaluation which measures the expenditure and their consequences and also describes about allocation of the resources (Cunningham, 2000). In this research, the researcher has used economic evaluation to measure cost effectiveness of the breast cancer screening programme in the Basque Country from 1996 to 2011. This study was mainly based on budget impact analysis and retrospective cost effectiveness evaluation to determine what resources are being used in programme and their costs as compare to outcomes (Arrospide, Rue Van Ravesteyn et al., 2016). Economic evaluation in this research took a step back and looked objectively in context to appropriate role and use of cost effective analysis in order to determine the outcome of the breast cancer screening programme. This research revealed that the breast screening programme was found to be cost effective within determined budget impact (Arrospide, Rue Van Ravesteyn et al., 2016). A review of breast cancer awareness among women in India: Cancer literate or awareness deficit? Outcome evaluation identifies the effects of the programme in target populations by reviewing effectiveness of programme (Centre of Disease Control and Prevention, 2015).The researcher used outcome evaluation to determine awareness levels of risk factors for breast cancer among women and healthcare professional in India. This outcome evaluation was undertaken through a structured literature review by using bibliographic databases journals (Gupta, Shridhar Dhillon, 2015). The main purpose of this outcome evaluation in this study was to assess the cancer literacy among women in India because of the rising incidence and mortality rates from breast cancer. Furthermore, the researcher concluded that there was a low literacy rate among Indian women regarding risk factors that causes breast cancer through this evaluation study (Gupta, Shridhar Dhillon, 2015). National Breast Cancer Screening Programme, Singapore: Evaluation of participation and performance indicators. Process evaluation was conducted to assess how this breast screening programme is being implemented whereas outcome evaluation was conducted to measure the outcome and effectiveness of this programme (NYS Health Foundation, 2016). The researcher used outcome and process evaluation to evaluate the participation rates and performance indicators in the National Breast Cancer Screening programme in Singapore. Data was collected on women aged 40-69 screened during period of 2002-2009 from the BreastScreen Singapore and Singapore Cancer Registry (Loy, Molinar Chow, 2015). Process and outcome evaluation was helpful to determine the rate of participation and performance indicators, to measure the quality of the programme delivered and to assess the effectiveness of the breast screen Singapore programme. This evaluation allows researcher to examine the performance of this Breast Screen Singapore programme and to recommend further changes if required. Impact of mammographic screening on ethnic and socioeconomic inequities in breast cancer stage at diagnosis and survival in New Zealand: a cohort study. Impact evaluation measures whether the programme is effective in achieving its goal or not. Generally, it identifies long term effects and changes in outcome based on cause and effect analysis (Collins, 2017). The researcher utilised impact evaluation to determine the impact of mammographic screening on ethnic and socio economic inequities in breast cancer stage at diagnosis and survival between Maori and European women. The researcher collected data by using National Screening Database and Waikato Breast cancer Register (Seneviratne, Campbell Scott, et al., 2015). Impact evaluation was carried out to measure the impact of screening programme on ethnic and socio economic inequities for breast cancer survival rate which can be useful for government to take necessary actions and to form policies in healthcare settings to reduce inequalities in health. An ongoing case-control study to evaluate the NHS breast screening programme Process evaluation determines the effectiveness of the programme and how well the programme is working (Community Interventions for Health, 2017). The researcher used process and impact evaluation to evaluate the national breast screening programme in England. Impact evaluation was helpful to identify the impact of breast cancer screening on breast cancer incidence and mortality. Data was gathered by traditional retrospective case control study of deaths and incidences cases of breast cancer in England within 2 years of period during this ongoing evaluation (Massat, Sasieni Parmar et al., 2013). The main purpose of impact evaluation is to see that breast cancer screening programme is working effectively and is doing well than harm. Process evaluation can help to ensure that the breast screening programme continues to deliver the predicted health benefits and potentially improve the programme by assessing the good and bad practices. Evaluative Model The (CIPP) model The CIPP evaluation model is developed by Stufflebeam in 1983 which provides comprehensive framework for the evaluation of the programmes. The CIPP model consists of four components which are context, Input, Process and product evaluation. The CIPP model mainly focuses on improvement of the programme rather than justifying about the programme. The main purpose of this CIPP model is to offer critical and rational basis for the programme decision making by applying different aspects of this evaluation model according to the needs of decision makers and programme activities based on the planning and implementation for the continuous improvement of the programme (Kellaghan Stufflebeam, 2003). The context, input and process evaluation approach are based on formative evaluation whereas product approach is useful for summative evaluation study. The four elements of the evaluation model must be taken into consideration otherwise it could reduce the effectiveness of the project. The context evaluation study can be conducted when a new programme is being planned which helps to identify the program goals and objectives by assessing needs whereas the input evaluation study can be conducted during resource allocation to assess the feasibility or the cost effectiveness of the alternate approaches. It provides systematic approach to programme design and helps the evaluators and experts to develop the programme which is most likely to work better (Frye Hemmer, 2012). Source: Adapted from Stufflebeams CIPP Evaluation Model (1983). Retrieved from http://arcmit01.uncw.edu/jonesi/Evaluation.html The process evaluation helps the evaluators and stakeholders to assess the implementation of the programme and to interpret the outcomes of the programme through document review, observation and participant interview. On the other hand, the product evaluation is similar to outcome evaluation which focuses on assessing the outcomes of the programme including positive or negative, short term or long term outcomes. In general, the CIPP model provides information about improvement of the programme, interpretation of the programme outcomes and information for accountability. However, careful planning is needed while applying this model. This model is useful for retrospective evaluation of a completed programme (Kellaghan Stufflebeam, 2003). This evaluation model can contribute to measure the effectiveness of the breast cancer screening programme run by Ministry of Health in New Zealand. The four elements of the model can be used to improve the programme by identifying the non-compliance of women for the breast screening programme. Auditing and evaluating the breast cancer screening programme helps to know the barriers and promote the awareness regarding breast cancer to provide beast quality care services to the New Zealanders. Furthermore, staying healthier is one of priorities of the Ministry of health. It can be achieved through evaluating the programme and implementing a change accordingly if needed. Conclusion Evaluation research is an essential tool to evaluate the effectiveness of the programme or to know how well the programme is working. Evaluation research helps managers and stakeholders of the organisation to improve the performance of the organisation and to provide the quality care health services. Staff and clients can be encouraged to provide useful feedback about the programme which helps in decision making and policy formation about the programme and thus improving the services provided by organisation. References Arrospide, A., Rue, M., Van Ravesteyn, N. T., Comas, M., Soto-Gordoa, M., Sarriugarte, G., Mar, J. (2016). Economic evaluation of the breast cancer screening programme in the Basque Country: retrospective cost-effectiveness and budget impact analysis. BMC Cancer, 16(1). doi:10.1186/s12885-016- 2386-y Centre for Disease Control and Prevention. (2015). Types of evaluation. Retrieved from https://www.cdc.gov/std/Program/pupestd/Types%20of%20Evaluation.pdf Collins, K.B. (2017). What is Impact Evaluation. Retrieved from http://programs.online.american.edu/online-graduate-certificates/project- monitoring/resource/what-is-impact-evaluation Community Interventions for Health. (2017). Process Evaluation. Retrieved from http://www.oxha.org/cih_manual/index.php/process-evaluation Cunningham, S.J. (2000). Economics: Economic evaluation of healthcare is it important to us? Retrieved from http://www.nature.com/bdj/journal/v188/n5/full/4800444a.html Frye, A. W., Hemmer, P. A. (2012). Program evaluation models and related theories: AMEE Guide No. 67. Medical Teacher, 34(5), e288-e299. doi:10.3109/0142159x.2012.66863 Gupta, A., Shridhar, K., Dhillon, P. (2015). A review of breast cancer awareness among women in India: Cancer literate or awareness deficit? European Journal of Cancer, 51(14), 2058-2066. doi:10.1016/j.ejca.2015.07.008 Kellaghan, T., Stufflebeam, D. L. (2003). International handbook of educational evaluation. Dordrecht: Kluwer Academic Publishers. Retrieved from http://link.springer.com/chapter/10.1007%2F978-94-010-0309-4_4 Loy, E. Y., Molinar, D., Chow, K. Y., Fock, C. (2015). National Breast Cancer Screening Programme, Singapore: Evaluation of participation and performance indicators. Journal of Medical Screening, 22(4), 194-200. doi:10.1177/0969141315589644 Massat, N. J., Sasieni, P. D., Parmar, D., Duffy, S. W. (2013). An ongoing case- control study to evaluate the NHS breast screening programme. BMC Cancer, 13(1). doi:10.1186/1471-2407-13-596 Ministry of Health. (2015). Breast Cancer. Retrieved from http://www.health.govt.nz/your-health/conditions-and-treatments/diseases- and-illnesses/breast-cancer National Screening Unit. (2014). BreastScreen Aotearoa. Retrieved from https://www.nsu.govt.nz/breastscreen-aotearoa/about-breast-screening- programme NYS Health Foundation. (2016). Process Evaluation. Retrieved from http://nyshealthfoundation.org/our-grantees/grantee-resources/process- evaluation Seneviratne, S., Campbell, I., Scott, N., Shirley, R., Lawrenson, R. (2015). Impact of mammographic screening on ethnic and socioeconomic inequities in breast cancer stage at diagnosis and survival in New Zealand: a cohort study. BMC Public Health, 15(1). doi:10.1186/s12889-015-1383-4 The Health Foundation. (2015). Evaluation: what to consider. Retrieved from http://www.health.org.uk/sites/health/files/EvaluationWhatToConsider.pdf The New Zealand Breast Cancer Foundation. (2013). New Zealand Breast Cancer Facts. Retrieved from http://nzbcf.org.nz/BREASTCANCER/Overview/BreastCancerinNZ/Fastfacts.a spx

Literature Review on Breast Cancer Research

Literature Review on Breast Cancer Research Aashiyana Vadsariya Introduction    Evaluation is a process of reviewing of any programme, project or policy, its design and results. The main objective of doing evaluation is to measure the effectiveness of the programme or policy, its impact and sustainability. Evaluation helps to solve the problem as well as to build the knowledge and it enhances the decision making process and thus evaluation is an important part of quality improvement (The Health Foundation, 2015). There are different types of evaluation such as formative evaluation, outcome evaluation, process evaluation, impact evaluation and economic evaluation which can be conducted to ensure programme activities. Moreover, vigorous evaluation provides not only about intervention that is worked but it also describes why and how that allows an individual to discover new interventions in healthcare settings. Additionally, it involves ethical approval, collection and analysis of data (Centre for Disease Control and Prevention, 2015). Background of the study According to Ministry of Health (2015), Breast cancer is the third most common cancer in New Zealand. It causes more than 600 deaths every year. Breast cancer is most common over the age of 50 and risk of developing breast cancer increases as age increases. Approximate 80% of women are over 50 years of age who died because of breast cancer. There are 8 cases diagnosed with breast cancer every day, out of them 1 will be Maori and pacific women who are at higher risk of dying from breast cancer. Maori women are more likely to develop breast cancer about 33% than non-Maori women (The New Zealand Breast Cancer Foundation, 2013). National Breast Cancer Foundation describes certain risk factors which increases the chance of developing cancer such as age, gender, positive family history, personal health history and genetic factors. Ministry of Health have started the programme called Breast Cancer Screen Aotearoa to fight against breast cancer by providing free breast screening to the women aged 45-69 years of age. The main objective of this programme is to reduce number of deaths from breast cancer by providing them regular screening (National Screening Unit, 2014). This paper will critically evaluate five (5) research papers of breast cancer that were published worldwide focusing on their significance, methodology and quality and will analyse the four (4) audit and evaluation processes and approaches such as outcome, process, impact, economic evaluation from the evaluated breast cancer research papers. Economic evaluation of the breast cancer screening programme in the Basque Country: retrospective cost-effectiveness and budget impact analysis. This study evaluated the breast cancer early detection programme in Basque country in relation to cost effectiveness and budget impact from 1996 to 2011. The researcher has used population level and single cohort analysis methodology. Annual costs were taken into consideration for budget impact analysis. The results of this study showed that total cost of breast cancer screening program was 1,127 million euros and 6.7 million QALYs over the lifetime of the target population, bringing about a pickup of 8,666 QALYs for an extra cost of 36.4 million euros (Arrospide, Rue Van Ravesteyn et al., 2016). The researcher has finally summed up that the breast screening programme ran in Basque country was cost effective and as per determined budget impact. This study contributes to measure cost effectiveness of this breast cancer screening programme and evaluate its budget in order to decide the future of this programme. A review of breast cancer awareness among women in India: Cancer literate or awareness deficit? This study was conducted to assess the level of awareness about risk factors leads to breast cancer in Indian women and healthcare professionals through literature review. The researcher used bibliographic databases such as MEDLINE, SCOPUS, Cochrane database of systematic reviews and Cumulative Index to Nursing and Allied Health. The findings of the research suggested that total 7066 number of women between ages of 15-70 years reflected different level of awareness on risk factors such as family history (13-58%), obesity (11-50%) and reproductive history around 1-88% (Gupta, Shridhar Dhillon, 2015). Low cancer literacy on risk factors of breast cancer among Indian women and healthcare professional noted during research process irrespective of their socio-economic status and education was (Gupta, Shridhar Dhillon, 2015). This study contributes to aware the nation about programmes and to improve the cancer literacy rate in India by engaging various stakeholders of society and health system. National Breast Cancer Screening Programme, Singapore: Evaluation of participation and performance indicators. The researcher evaluated participation rates and performance indicators in the National Breast Cancer screening programme in Singapore during this study. This study involved the use of retrospective evaluation approach by using the BSS system and the Singapore Cancer Registry data on women aged 40-69 screened in period of 2002-2009. The results showed that participation rate was more than 10% since 2005 and performance indicators (such as screen detection rates, small tumour detection rates, recall rates, accuracy and interval cancer rates were improved from 2002-2006 to 2007-2009 (Loy, Molinar Chow, 2015). This study indicated that there is room for improvement in participation rate in breast cancer screening in Singapore by providing screening packages, reducing screening cost and targeting underserved populations. This study contributes to improve the participation rate of breast cancer screening programme for the effectiveness of the BreastScreen Singapore by providing training opportunities to the healthcare professionals. Impact of mammographic screening on ethnic and socioeconomic inequities in breast cancer stage at diagnosis and survival in New Zealand: a cohort study. This study was conducted to determine the impact of differences in rates of mammographic screening on inequities in cancer stage at diagnosis and survival between Maori and Pakeha women. The researcher used Waikato Breast Cancer Register and the National Screening Database to compare the data for diagnosis and survival between screen detected and non screen detected breast cancer by socio-economic status and ethnicity. The results indicated that there were lower rate of screen detected cancer in Maori women and also they had lower 10 year breast cancer survival rate as compared to Pakeha women (46.5% vs. 73.2%) (Seneviratne, Campbell Scott, et al., 2015). The study determined that lower rate of screening detected breast cancer was the important reason for lower rate of survival for Maori women in comparison to European women. This study contributes to assess the screening rates, to improve the survival for Maori women and to reduce inequity for the breast cancer survival among Maori and New Zealand European women. An ongoing case-control study to evaluate the NHS breast screening programme This research was carried out to evaluate the national breast screening programme in England. This study estimated the effects of the national breast screening programme in regards to breast cancer incidence, mortality and over-diagnosis of breast cancer. The researcher has used quantitative methodology and retrospective case control study to describe the policy on mammographic screening. The findings suggested that there is decrease in incidence by screening, excess risk of disease in screened ages from 47-54 years and potential deficit in risk seen between the ages of 65-69 years up to 15 years of screening (Massat, Sasieni Parmar et al., 2013). This research concluded that case control evaluation strategy relates the clinical endpoints to the screening history. This study contributes to measure the effectiveness of the national breast screening programme in England, benefits on mortality from and on incidence of invasive primary breast cancer and harms from over-diagnosis. Audit and Evaluation processes Economic evaluation of the breast cancer screening programme in the Basque Country: retrospective cost-effectiveness and budget impact analysis. Economic evaluation is one of the most important forms of evaluation which measures the expenditure and their consequences and also describes about allocation of the resources (Cunningham, 2000). In this research, the researcher has used economic evaluation to measure cost effectiveness of the breast cancer screening programme in the Basque Country from 1996 to 2011. This study was mainly based on budget impact analysis and retrospective cost effectiveness evaluation to determine what resources are being used in programme and their costs as compare to outcomes (Arrospide, Rue Van Ravesteyn et al., 2016). Economic evaluation in this research took a step back and looked objectively in context to appropriate role and use of cost effective analysis in order to determine the outcome of the breast cancer screening programme. This research revealed that the breast screening programme was found to be cost effective within determined budget impact (Arrospide, Rue Van Ravesteyn et al., 2016). A review of breast cancer awareness among women in India: Cancer literate or awareness deficit? Outcome evaluation identifies the effects of the programme in target populations by reviewing effectiveness of programme (Centre of Disease Control and Prevention, 2015).The researcher used outcome evaluation to determine awareness levels of risk factors for breast cancer among women and healthcare professional in India. This outcome evaluation was undertaken through a structured literature review by using bibliographic databases journals (Gupta, Shridhar Dhillon, 2015). The main purpose of this outcome evaluation in this study was to assess the cancer literacy among women in India because of the rising incidence and mortality rates from breast cancer. Furthermore, the researcher concluded that there was a low literacy rate among Indian women regarding risk factors that causes breast cancer through this evaluation study (Gupta, Shridhar Dhillon, 2015). National Breast Cancer Screening Programme, Singapore: Evaluation of participation and performance indicators. Process evaluation was conducted to assess how this breast screening programme is being implemented whereas outcome evaluation was conducted to measure the outcome and effectiveness of this programme (NYS Health Foundation, 2016). The researcher used outcome and process evaluation to evaluate the participation rates and performance indicators in the National Breast Cancer Screening programme in Singapore. Data was collected on women aged 40-69 screened during period of 2002-2009 from the BreastScreen Singapore and Singapore Cancer Registry (Loy, Molinar Chow, 2015). Process and outcome evaluation was helpful to determine the rate of participation and performance indicators, to measure the quality of the programme delivered and to assess the effectiveness of the breast screen Singapore programme. This evaluation allows researcher to examine the performance of this Breast Screen Singapore programme and to recommend further changes if required. Impact of mammographic screening on ethnic and socioeconomic inequities in breast cancer stage at diagnosis and survival in New Zealand: a cohort study. Impact evaluation measures whether the programme is effective in achieving its goal or not. Generally, it identifies long term effects and changes in outcome based on cause and effect analysis (Collins, 2017). The researcher utilised impact evaluation to determine the impact of mammographic screening on ethnic and socio economic inequities in breast cancer stage at diagnosis and survival between Maori and European women. The researcher collected data by using National Screening Database and Waikato Breast cancer Register (Seneviratne, Campbell Scott, et al., 2015). Impact evaluation was carried out to measure the impact of screening programme on ethnic and socio economic inequities for breast cancer survival rate which can be useful for government to take necessary actions and to form policies in healthcare settings to reduce inequalities in health. An ongoing case-control study to evaluate the NHS breast screening programme Process evaluation determines the effectiveness of the programme and how well the programme is working (Community Interventions for Health, 2017). The researcher used process and impact evaluation to evaluate the national breast screening programme in England. Impact evaluation was helpful to identify the impact of breast cancer screening on breast cancer incidence and mortality. Data was gathered by traditional retrospective case control study of deaths and incidences cases of breast cancer in England within 2 years of period during this ongoing evaluation (Massat, Sasieni Parmar et al., 2013). The main purpose of impact evaluation is to see that breast cancer screening programme is working effectively and is doing well than harm. Process evaluation can help to ensure that the breast screening programme continues to deliver the predicted health benefits and potentially improve the programme by assessing the good and bad practices. Evaluative Model The (CIPP) model The CIPP evaluation model is developed by Stufflebeam in 1983 which provides comprehensive framework for the evaluation of the programmes. The CIPP model consists of four components which are context, Input, Process and product evaluation. The CIPP model mainly focuses on improvement of the programme rather than justifying about the programme. The main purpose of this CIPP model is to offer critical and rational basis for the programme decision making by applying different aspects of this evaluation model according to the needs of decision makers and programme activities based on the planning and implementation for the continuous improvement of the programme (Kellaghan Stufflebeam, 2003). The context, input and process evaluation approach are based on formative evaluation whereas product approach is useful for summative evaluation study. The four elements of the evaluation model must be taken into consideration otherwise it could reduce the effectiveness of the project. The context evaluation study can be conducted when a new programme is being planned which helps to identify the program goals and objectives by assessing needs whereas the input evaluation study can be conducted during resource allocation to assess the feasibility or the cost effectiveness of the alternate approaches. It provides systematic approach to programme design and helps the evaluators and experts to develop the programme which is most likely to work better (Frye Hemmer, 2012). Source: Adapted from Stufflebeams CIPP Evaluation Model (1983). Retrieved from http://arcmit01.uncw.edu/jonesi/Evaluation.html The process evaluation helps the evaluators and stakeholders to assess the implementation of the programme and to interpret the outcomes of the programme through document review, observation and participant interview. On the other hand, the product evaluation is similar to outcome evaluation which focuses on assessing the outcomes of the programme including positive or negative, short term or long term outcomes. In general, the CIPP model provides information about improvement of the programme, interpretation of the programme outcomes and information for accountability. However, careful planning is needed while applying this model. This model is useful for retrospective evaluation of a completed programme (Kellaghan Stufflebeam, 2003). This evaluation model can contribute to measure the effectiveness of the breast cancer screening programme run by Ministry of Health in New Zealand. The four elements of the model can be used to improve the programme by identifying the non-compliance of women for the breast screening programme. Auditing and evaluating the breast cancer screening programme helps to know the barriers and promote the awareness regarding breast cancer to provide beast quality care services to the New Zealanders. Furthermore, staying healthier is one of priorities of the Ministry of health. It can be achieved through evaluating the programme and implementing a change accordingly if needed. Conclusion Evaluation research is an essential tool to evaluate the effectiveness of the programme or to know how well the programme is working. Evaluation research helps managers and stakeholders of the organisation to improve the performance of the organisation and to provide the quality care health services. Staff and clients can be encouraged to provide useful feedback about the programme which helps in decision making and policy formation about the programme and thus improving the services provided by organisation. References Arrospide, A., Rue, M., Van Ravesteyn, N. T., Comas, M., Soto-Gordoa, M., Sarriugarte, G., Mar, J. (2016). Economic evaluation of the breast cancer screening programme in the Basque Country: retrospective cost-effectiveness and budget impact analysis. BMC Cancer, 16(1). doi:10.1186/s12885-016- 2386-y Centre for Disease Control and Prevention. (2015). Types of evaluation. Retrieved from https://www.cdc.gov/std/Program/pupestd/Types%20of%20Evaluation.pdf Collins, K.B. (2017). What is Impact Evaluation. Retrieved from http://programs.online.american.edu/online-graduate-certificates/project- monitoring/resource/what-is-impact-evaluation Community Interventions for Health. (2017). Process Evaluation. Retrieved from http://www.oxha.org/cih_manual/index.php/process-evaluation Cunningham, S.J. (2000). Economics: Economic evaluation of healthcare is it important to us? Retrieved from http://www.nature.com/bdj/journal/v188/n5/full/4800444a.html Frye, A. W., Hemmer, P. A. (2012). Program evaluation models and related theories: AMEE Guide No. 67. Medical Teacher, 34(5), e288-e299. doi:10.3109/0142159x.2012.66863 Gupta, A., Shridhar, K., Dhillon, P. (2015). A review of breast cancer awareness among women in India: Cancer literate or awareness deficit? European Journal of Cancer, 51(14), 2058-2066. doi:10.1016/j.ejca.2015.07.008 Kellaghan, T., Stufflebeam, D. L. (2003). International handbook of educational evaluation. Dordrecht: Kluwer Academic Publishers. Retrieved from http://link.springer.com/chapter/10.1007%2F978-94-010-0309-4_4 Loy, E. Y., Molinar, D., Chow, K. Y., Fock, C. (2015). National Breast Cancer Screening Programme, Singapore: Evaluation of participation and performance indicators. Journal of Medical Screening, 22(4), 194-200. doi:10.1177/0969141315589644 Massat, N. J., Sasieni, P. D., Parmar, D., Duffy, S. W. (2013). An ongoing case- control study to evaluate the NHS breast screening programme. BMC Cancer, 13(1). doi:10.1186/1471-2407-13-596 Ministry of Health. (2015). Breast Cancer. Retrieved from http://www.health.govt.nz/your-health/conditions-and-treatments/diseases- and-illnesses/breast-cancer National Screening Unit. (2014). BreastScreen Aotearoa. Retrieved from https://www.nsu.govt.nz/breastscreen-aotearoa/about-breast-screening- programme NYS Health Foundation. (2016). Process Evaluation. Retrieved from http://nyshealthfoundation.org/our-grantees/grantee-resources/process- evaluation Seneviratne, S., Campbell, I., Scott, N., Shirley, R., Lawrenson, R. (2015). Impact of mammographic screening on ethnic and socioeconomic inequities in breast cancer stage at diagnosis and survival in New Zealand: a cohort study. BMC Public Health, 15(1). doi:10.1186/s12889-015-1383-4 The Health Foundation. (2015). Evaluation: what to consider. Retrieved from http://www.health.org.uk/sites/health/files/EvaluationWhatToConsider.pdf The New Zealand Breast Cancer Foundation. (2013). New Zealand Breast Cancer Facts. Retrieved from http://nzbcf.org.nz/BREASTCANCER/Overview/BreastCancerinNZ/Fastfacts.a spx

batch process of wine making Essay -- essays research papers

Introduction   Ã‚  Ã‚  Ã‚  Ã‚  The homemade production of wine is a fun and challenging hobby that many people can enjoy. In this paper the reader will be taken through several different steps and processes that must be accomplished for your wine to be of satisfactory flavor and clarity. Crushing and stemming This first step may be performed by hand or by machine. For handling a ton or more of grapes, use a mechanical crusher-stemmer. Using a small crusher-stemmer, two persons can crush and stem a ton of grapes in about one hour. To collect the crushed grapes, which are also called the must, the machine is placed and supported above a container. A large polyethylene plastic tub or garbage can is sufficient. The important objective is to minimize bitterness by thoroughly crushing the berries without macerating the seeds, and while recovering all of the skins and juice in the must. After stemming and crushing, the fermentors are filled with the must to about two-thirds capacity, to avoid foaming-over during fermentation. After all of the must has been poured into the fermentors and the sulfur dioxide has been added, the fermentors should be covered with cheesecloth or plastic to keep out insects. Temperature, total soluble solids, titratable acidity, and the free and total SO2 of the must in each fermentor should be determined and the results recorded. Adding sulfur dioxide   Ã‚  Ã‚  Ã‚  Ã‚  Sulfur dioxide (SO2) is a chemical compound that has been used in winemaking for more than a century. Because it is known that wine yeast produce small amounts of SO2 during fermentation, SO2 can be considered a natural constituent of wine.   Ã‚  Ã‚  Ã‚  Ã‚  Judicious and moderate use of SO2 has long been recommended. Recent research shows that the best quality wines are made when SO2 has been used both before and after fermentation.   Ã‚  Ã‚  Ã‚  Ã‚  For grapes free of mildew, rot, or mold, usually from 50 to 100 parts per million (ppm) is used or about 75 ppm is adequate. This mild antiseptic is commonly used in the form of potassium metabisulfite (K2S2O5), and is available from home wine making suppliers. To obtain 75 ppm of SO2, add  ¼ ounce to each 10 gallons of juice or must. For grapes that have appreciable amounts of moldiness, rot, or broken berries, use twice this amount of SO2. To add SO2, dissolve the metabis... ... examination for desired clarity, smell, and taste. Check the free and total SO2. It is customary to adjust the free SO2 as needed to about 25 to 30 ppm at bottling. This helps to prevent oxidation of the wine after bottling due to dissolved oxygen that may be picked up during bottling.   Ã‚  Ã‚  Ã‚  Ã‚  When selecting bottling devices, it is highly desirable to minimize aeration, which in turn will minimize oxidation of the wine after bottling. This is best achieved using devices that provide for gravity flow of the wine and fill the bottles from the bottom of the storage container. Such bottling devices are often referred to as â€Å"gravity bottom filling†. New wine bottles should be rinsed in hot water to remove dust particles and air dried before use. Conclusion Hopefully after reading this paper, the reader has obtained more insight in creating a homemade wine that everyone can enjoy. The process may seem lengthy, but time is normally essential in the completion of many things. And if your first batch does not come out correct, do not get discouraged. Try again until things get better. Before you know it, you will be able to consider yourself a wine connoisseur. batch process of wine making Essay -- essays research papers Introduction   Ã‚  Ã‚  Ã‚  Ã‚  The homemade production of wine is a fun and challenging hobby that many people can enjoy. In this paper the reader will be taken through several different steps and processes that must be accomplished for your wine to be of satisfactory flavor and clarity. Crushing and stemming This first step may be performed by hand or by machine. For handling a ton or more of grapes, use a mechanical crusher-stemmer. Using a small crusher-stemmer, two persons can crush and stem a ton of grapes in about one hour. To collect the crushed grapes, which are also called the must, the machine is placed and supported above a container. A large polyethylene plastic tub or garbage can is sufficient. The important objective is to minimize bitterness by thoroughly crushing the berries without macerating the seeds, and while recovering all of the skins and juice in the must. After stemming and crushing, the fermentors are filled with the must to about two-thirds capacity, to avoid foaming-over during fermentation. After all of the must has been poured into the fermentors and the sulfur dioxide has been added, the fermentors should be covered with cheesecloth or plastic to keep out insects. Temperature, total soluble solids, titratable acidity, and the free and total SO2 of the must in each fermentor should be determined and the results recorded. Adding sulfur dioxide   Ã‚  Ã‚  Ã‚  Ã‚  Sulfur dioxide (SO2) is a chemical compound that has been used in winemaking for more than a century. Because it is known that wine yeast produce small amounts of SO2 during fermentation, SO2 can be considered a natural constituent of wine.   Ã‚  Ã‚  Ã‚  Ã‚  Judicious and moderate use of SO2 has long been recommended. Recent research shows that the best quality wines are made when SO2 has been used both before and after fermentation.   Ã‚  Ã‚  Ã‚  Ã‚  For grapes free of mildew, rot, or mold, usually from 50 to 100 parts per million (ppm) is used or about 75 ppm is adequate. This mild antiseptic is commonly used in the form of potassium metabisulfite (K2S2O5), and is available from home wine making suppliers. To obtain 75 ppm of SO2, add  ¼ ounce to each 10 gallons of juice or must. For grapes that have appreciable amounts of moldiness, rot, or broken berries, use twice this amount of SO2. To add SO2, dissolve the metabis... ... examination for desired clarity, smell, and taste. Check the free and total SO2. It is customary to adjust the free SO2 as needed to about 25 to 30 ppm at bottling. This helps to prevent oxidation of the wine after bottling due to dissolved oxygen that may be picked up during bottling.   Ã‚  Ã‚  Ã‚  Ã‚  When selecting bottling devices, it is highly desirable to minimize aeration, which in turn will minimize oxidation of the wine after bottling. This is best achieved using devices that provide for gravity flow of the wine and fill the bottles from the bottom of the storage container. Such bottling devices are often referred to as â€Å"gravity bottom filling†. New wine bottles should be rinsed in hot water to remove dust particles and air dried before use. Conclusion Hopefully after reading this paper, the reader has obtained more insight in creating a homemade wine that everyone can enjoy. The process may seem lengthy, but time is normally essential in the completion of many things. And if your first batch does not come out correct, do not get discouraged. Try again until things get better. Before you know it, you will be able to consider yourself a wine connoisseur.

Marketing 570 Proposal

Marketing Research Project Proposal I proposed to do my final course project on market research on service quality at Starbucks Coffee restaurants. Background on Company Beginning in 1971 with only one shop in Settle’s historic Pike Place Market for coffee and tea, Starbucks has managed to become one of the most successful companies in the world. It has become number one in the coffee industry. As of June 2012 Starbucks owns 19,763 coffee shops in 59 countries which includes 12,848 in the United States, 1,264 in Canada, 973 in Japan, 778 in Great Britain, 621 in China, 441 in South Korea, 350 in Mexico and 269 in the Philippines.Offering to its consumers’ different coffees with unique flavors, tea and beverages, including food snacks and coffee accessories Starbucks has attracted consumers and turned them into loyal customers. (Starbucks Coffee Company, 2012) Introduction Recently, the new trend that is developing is narrowed toward offering to the customer good service despite the good product. Having high service quality is accepted as one strong competitive advantage that is difficulty built but it brings high success for the company if managed properly.Service quality is following the perceptions of the customer of what he/she thinks that quality of service is about and meeting exactly their experience. So the question is what factors are there that are shaping service quality at Starbucks? Theoretical Background Service Quality Defining service quality may mainly be based on assumptions because of the intangible nature that services have. Moreover, there are many circumstances that might shape the definition of service quality differently. Brown, 1999) Despite the intangibility that describes the services, the second very important element when giving theory based on service quality is that services are heterogeneous. Presenting them varies from producer to producer or from client to client. Finally, the last characteristics describing the se rvices is the inseparability of the production and the consumption. Mainly, in most of the cases service quality arises in the duration of the process of interaction between the customer and the provider. (Berry, 1990)The latest definition for what service quality stands for according to Javadi (2011) is: â€Å"The extent to which the customer’s perceptions of service differs from his/her expectations. † Javadi (2011) has described 10 dimensions of service quality which regularly are used in constructing the customer’s opinions on services: 1. Tangibility- The appearance of the facilities where the service is provided. 2. Reliability- How consistent is the service? 3. Competence- Employees’ speed of delivering the service in the appropriate way. 4. Responsiveness- Personnel’s capabilities and skills for servicing the customer. . Courtesy- Employees’ good manners and politeness. 6. Credibility- Confidentiality and honesty of staff. 7. Securit y- 8. Access- Convenience of services. 9. Communication with the customer. 10. Understanding the customer- Perception of customers’ needs and wishes. Importance of Marketing Research for Service Quality Conducting marketing research in order to examine service quality in any business is very important, because the high service quality will bring customer satisfaction, and the customer satisfaction will create loyal customers which is a very important part for a company in order to make profits.According to Siddiqi (2010) customer satisfaction is the most important part of marketing, it connects the purchase of a product or service with the post purchase phenomena that reflects into a repeated purchase. Moreover, by managing to create repeated purchase, the loyal customer will operate as a positive word of mouth. Research Objectives 1. Examine the customer’s Starbucks experience. 2. What are the factors that are shaping service quality in Starbucks? 3. Are customers sat isfied by Starbucks’ offers? 4. Identify employees obstacles to improve service quality.Methodology The research of service quality for Starbucks will be structures in a survey questionnaire format. In order to make statistical research by using questionnaires, the formal standardized questionnaires type must be followed. Meeting the research objectives is the aim of a successful survey. For the purpose of examining the service quality in Starbucks store in the area of Northwest Indiana, 10 different closed ended questions will be used. By doing this the respondents are going to have the option of choosing from the given alternatives.By giving this kind of questionnaire the information that is going to be gathered is easier to analyze, bearing in mind that specific answers are needed for statistical research. The questions that are included are from various types such as: Dichotomous questions (influencing audience to reply with specific answers like Yes/No, True/False or Agr ee/Disagree responses). Example of questionnaire as follows: 1. Age Group & Occupation ( This will be the only open-ended question on the survey) 2. How often do you visit Starbucks? Here I would ask 1-2 times per week, 3-4 times per week and so on) 3. What products do you purchase? ( Multiple answers given to choose from) 4. Are you currently satisfied with the menu selections? 5. How satisfied are you with the cleanliness of the store? 6. How satisfied are you with the staff? 7. How convient is the locations of the Starbucks store? 8. How satisfied are you with the prices that Starbucks are currently offered? (Scale of 1-10) 9. Would you recommend Starbucks to friends and family? 10. Would you choose Starbucks over the competitors?Secondary Data Sources Much of my data will be taken from Government statistics such as population censuses, social surveys, family expenditure surveys and production statistics. I would also utilize commercial services which would show publish market re search reports and other publications that are available from a wide range of organizations that are similar to Starbucks but, this information may have a small charge for their information. Target Population My target population would consist of the working adults and college students.The reason for this target population is because these individuals are on the go every day. Many of them prefer to utilize fast food restaurants for breakfast, lunch and dinner. This population is also known as the individuals who would spend multiple dollars for cappichino, flavored coffees and pastries. This group is more technology savvy where they use cloud computing and they rather sit in coffee shops and etc. to complete work and school assignments throughout the day and establishments like Starbucks is a good source for these individuals.

Fundamentals for Chemistry-Quantitative Measurements

1 Lab Assignment #5 Write-Up 2 General Info: Name: Date: Purpose: Of Exp #5: In this experiment we will learn about the spectroscope and how it works. To learn the concept of quantitative measurements, to construct a spectroscope and, to use it for taking quantitative measurements. Experimental Questions: Please complete this section of your write-up as you work on the experimental portion of this lab. 1. Hold the grating several inches from your face, at an angle. Look at the grating that you will be using. Describe what you see at the grating surface. I see different color of the rainbow and when I change the angle that am holding the diffraction grating Hold the grating up to your eye and look through it. Describe what you†¦show more content†¦- Figuring wavelengths using a calibrated light rod: This is an e-mail that I sent to a student last quarter. She had already figured out how many nm each light rod division was worth, butShow MoreRelatedFundamentals for Chemistry-Quantitative Measurements1681 Words   |  7 Pages1 Lab Assignment #5 Write-Up 2 General Info: Name: Date: Purpose: Of Exp #5: In this experiment we will learn about the spectroscope and how it works. To learn the concept of quantitative measurements, to construct a spectroscope and, to use it for taking quantitative measurements. Experimental Questions: Please complete this section of your write-up as you work on the experimental portion of this lab. 1. Hold the grating several inches from your face, at an angle. Look atRead MoreAnalytical Chemistri Intro1796 Words   |  8 PagesAnalytical Chemistry I 1 Course Outlines ï‚â€" ï‚â€" ï‚â€" ï‚â€" ï‚â€" ï‚â€" ï‚â€" ï‚â€" LU1 :Analytical Chemistry Overview LU2: Measurements and Data Treatment LU3: Stoichiometric Calculations LU4: General Concepts of Chemical Equilibrium LU5: Gravimetric Methods LU6: Acid-Base Equilibria LU7: Acid-base titrations LU8: Analytical Separations Course Assessment Laboratory reports (15%) ï‚â€" Assignments (15%) ï‚â€" MidTerm Examination (30%) ï‚â€" Final Examination (40%) ï‚â€" 3 References 1. Christian, G.D. (2003)Read MoreThe History of Chemistry Up to the XIX Century Essay912 Words   |  4 PagesHistory of chemistry encompasses a span of time reaching from ancient history to the present. By 1000 BC, ancient civilizations used technologies that would eventually form the basis of the various branches of chemistry. Examples include extracting metals from ores, making pottery and glazes, fermenting beer and wine, extracting chemicals from plants for medicine and perfume, rendering fat into soap, making glass, and making alloys like bronze. The protoscience of chemistry, alchemy, was unsuccessfulRead MoreDetermination of Copper(Ii) Concentration by Spectrophotometry2699 Words   |  11 PagesQUANTITATIVE DETERMINATION OF COPPER (II) CONCENTRATION BY SPECTROPHOTOMETRY D.DEL PRADO1, J. BELANO1, M.MAHUSAY2,and M.FRANCISCO2 1 DEPARTMENT OF FOOD SCIENCE AND NUTRITION, COLLEGE OF HOME ECONOMICS 2INSTITUTE OF CHEMISTRY, COLLEGE OF SCIENCE UNIVERSITY OF THE PHLIPPINES, DILIMAN, QUEZON CITY 1101, PHILIPPINES DATE SUBMITTED: 12 MARCH 2013 DATE PERFORMED: 7 MARCH 2013 ------------------------------------------------- ------------------------------------------------- ABSTRACT -------------------------------------------------Read MoreHistory of the Science of Chemistry Essay882 Words   |  4 PagesThe history of chemistry makes a span of time reaching from ancient history to the present. By 1000 BC, ancient civilizations used technologies that would eventually form the basis of the various branches of the subject. Examples include extracting metals from ores, making pottery and glazes, fermenting beer and wine, extracting chemicals from plants for medicine and perfume, rendering fat into soap, making glass, and making alloys like bronze. The science of chemistry, alchemy, was unsuccessfulRead MoreIntroduction to the Analytical Balance1021 Words   |  5 Pagescertain influences that somehow affected the precision and accuracy in weighing. All in all, the objectives of the study were met.  INTRODUCTION ​The analytical balance is a fundamental measuring device for all types of quantitative work in analytical chemistry. It is designed for great precision in quantitative chemical analysis. It yields readability to four decimal places to the right of the decimal point (up to .0001 g). It is extremely sensitive and requires a draft-free location on aRead MoreEvaluating Kuhn ´s Theory of Scientific Development Essay1545 Words   |  7 Pagesas Antoine-Laurent Lavoisier’s paradigm is incommensurable with that of Joseph Priestley’s in chemistry (Oberheim Hoyningen-Huene, 2012). Paul Feyerabend used incommensurable to describe the lack of logical relations between the concepts of fundamental theories in his critique of logical empiricist’s models of explanation and reduction. Stating that in the event of scientific revolution, when fundamental change occurs there is a change in perspective which is the birth of a new conception of theRead MoreQuantitative Me thods for Business Paper1652 Words   |  7 PagesKent Jackson 11AM-12:20PM GB 202 Quantitative techniques are mathematical and reproducible. Regression analysis is an example of one such technique. Statistical analysis is also an example of a quantitative technique. Quantitative techniques are applied for business analysis to optimize decision making IE profit maximization and cost minimization. It covers linear programming models and other special algorithms, inventory and production models. Albert Humphrey, a managementRead MorePhysics Of X Ray Fluorescence1167 Words   |  5 Pagesanalyzing time. The vacuum and atmosphere are switched to the measurement atmosphere by the operation of one button. When X-rays (primary X-rays) are illuminated from the X-ray tube to the specimen, fluorescence X-rays having wavelengths (energies) peculiar to the constituent elements of the specimen are generated from the elements. Qualitative analysis can be made by investigating the wavelengths of the fluorescence X-rays and quantitative analysis by investigating the X-ray dose. The energies areRead MorePhysics Of The Jsx 3222 Analyzer1156 Words   |  5 Pagesswitched to the measurement atmosphere by the one button operation. When X-rays (primary X-rays) are illuminated from the X-ray tube to the specimen, fluorescence X-rays having wavelengths (energies) peculiar to the constituent elements of the specimen are produced from the elements. There are two methods to investigate the energies. The first method is Qualitative analysis which can be made by investigating the wavelengths of the fluorescence X-rays and the other method is quantitative analysis by