Monastic Buddhism in South East Asia Research Paper

Monastic Buddhism in South East Asia - Research Paper Example Within a modern context, Buddhism may be divided into two separate schools which are known as Theravada, also known as ‘Southern’, Buddhism and Mahayana, which is called ‘Northern’, Buddhism. Theravada is the main tradition within Sri Lanka and it is thought that this country has had the most ancient incessant history of Buddhism. (Kapstein, 1087) Mahayana, on the other hand, is the leading Buddhist tradition found in Tibet and, although the geneses of this tradition are debatable, it is a diverse and varying tradition from that of the Theravada. (Jones, 121) The Theravada and Mahayana Buddhist conventions share ordinary viewpoints such as the Four Noble Truths, the Eightfold Path and Dependent Origination. Other similarities include similar principles such as Anicca, Dukkha, Annata, Sila, Samadhi, and Panna. In addition to this, the two traditions also share a rejection of the notion of a supreme creator. However, Theravada and Mahayana differ on some impor tant aspects such as the final goal of practice and their perspective on the notion of Buddha-nature as well as other doctrinal differences. There are neither rites of passage nor a special ceremony in becoming Buddhist. There is a long process of disciplinary training and education given to those seeking to become a monk (Bhikkhu). Anyone seeking to become a Bhikkhu is known as a novice. ... ly and no other monks has any objection to the given answers, this person is acknowledged into the Sangha, the monk community, and in this way, their training commences. Southeast Asian Countries and Monastic Education According to historical findings, Thaton was an operational port of call on the course between India and other prominent countries of southeastern Asia. From religious perspective, missionaries happened to come regularly from the eminent mission training centers of Conjeeveram and Amaravati and proceeded on from there to Cambodia, Thailand, and Java. At that time, though, these missionaries were Theravada Buddhists and the region around Thaton remained Theravada, it should be kept in mind that side by side with the stretch of Theravada, there was also a tough Mahayana movement from China, Malaya, Cambodia, and northern India. When King Anawrahta controlled to the throne in Pagan in northern Myanmar, he was not happy with the religious practice of his people, which was a weird combination of Tantrism, Mahayana, and Hinduism. So, when he held meeting the Arahat Shin Arahan and came to know about the simple yet reflective teaching of the Theravada, he was instantly converted and requested the Arahat to stay at Pagan for the establishment of the Dhamma. At Arahan's suggestion, King Anawrahta asked the king of Thaton for some relics and copies of the Tipitaka, and when he was refused, he attacked and occupied Thaton and brought to Pagan all the relics and copies of the Tipitaka as well as a large number of monks to sermonize the Dhamma. He ruled over most of Myanmar, established communications with the Buddhists of Ceylon, and started a great building program at Pagan which continued for two centuries until the country was overrun by the armies of Kublai

Project E Essay Example | Topics and Well Written Essays - 250 words

Project E - Essay Example perceive sound that comes from sound or a speaker while listening is the ability to comprehend or decode the meaning of the information from the speaker or sound. Students can be tested for their audio literacy skills by giving them tests to see if they both heard and listened to the lessons that were taught in class. Another method is to give the students audio books of tutorials that teach how to operate certain software and ask them to demonstrate their understanding of the software. There are a number of ways that can help you improve your listening skills. Hearing is one thing and listening to the information is another. It always advisable to be attentive when listening so that the information being conveyed is understood. I will explain four ways to help you improve your listening skills. I would like to conclude by saying that hearing and listening go together. Meaning that one must hear first before listening. If you fail to hear you will not listen. There are four ways of improving your listening skills and they include: maintenance of eye contact, avoiding obstruction, concentration on the message’s content and reading the body

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

Synopsis - Assignment Example Under the new role women were to be confined into homes as guardians of family and hearth. All major decisions were to be done by men only, women should take care about home, bare children and take care of them and keep the institution of family working properly. This, de facto and de iure, was a huge step back for women of Germany who were among the first in the world to be granted voting rights under the Weimar Republic. Yet, somehow large numbers of German women supported Hitler. They were, as Koonz describes, devoted to the cause and, almost religiously committed to it. That way a paradox arose in Nazi Germany, a paradox in which women supported something that will give them a second class citizen status at best. Koonz asserts that women in Germany were same as men distrustful of democracy, liberal and modern ideas, and at the same time, intensely nationalistic. To best illustrate her point Koonz included in the book an interview she did with Gertrud Scholtz Klink in the early 1980’s. Scholtz was a former Head of Frauenschaft, Women’s Department under the Nazis. She, as interview done four decades after the fact shows, embodied exactly what Koonz was claiming. Even then she stated numerous times how proud she was of her so called new power given to her and women in general by Hitler. The whole conversation proved, beyond any doubt, that â€Å"female supporters of the Nazis accepted the Nazi division of the sexes into a public sphere for men and a private sphere for women.† Professor Koonz, also, explores the process in which German women politically influenced the country at that time. By sheer logic, women making one half of German population and having voting rights at the time, were very instrumental in aiding Hitler’s rise to power, which in turn, allowed him and the Nazis to implement their policies and commit atrocities in the coming years. In those years of the Third Reich, German women, like

Resarch critical appraisal Essay Example | Topics and Well Written Essays - 1500 words

Resarch critical appraisal - Essay Example urvey, using a 17-item questionnaire, of 112 respondents between the ages of 37 to 87 years old of both male and female genders, all of whom speak Swedish. The actual research did not entail significant ethical concerns considering that much of it was presumably done personally and voluntarily by the respondents by filling up the 17-item questionnaire after informed consent was obtained. Aside from the individual informed consent, the researchers also acquired prior approval from Research Ethical Committee at the University of Gothenburg. The researchers, however, failed to state how they were able to gain access to hospital data regarding patients who are scheduled for THA. Privacy and confidentiality of medical records relative to medical research studies have always been problematic areas from the perspectives of patients (Lo 2009 82). It is notable, however, that the research has specifically excluded patients who are critically ill and mentally impaired. Employment of mentally impaired persons in research studies is ethically questionable considering that historically they have often been subjected to research abuses (Lo 2009 145) . Pain management, which is the focus of the research paper, is an important area in nursing (Holzemer 2009 39) making the paper significantly relevant to the profession. Although the subject itself is well delimited, the research may not have successfully delimited the parameters of participating respondents considering that their ages ranged from 37 to 87 years old. The variance of pain experience between age groups is noted by the researchers themselves who made a vague reference to it on page 454 of the research paper. In addition, the paper fails to explicitly state its working theory at the beginning as such although the entire paper is obviously underpinned by it and refers to it under a different heading. It is evident that the research is trying to prove that a realistic expectation of the pain entailed by a THA surgical

Iran-Iraq War Essay Example for Free

Iran-Iraq War Essay The Iran-Iraq War is considered as one of the longest and most violent battles in history. This eight-year long armed conflict was actually the result of many events. The rivalry between Iran and Iraq can be traced from the seventh century. It was a rivalry grounded on the antagonism between Persians and Arabs, just as it was based on the conflict between Sunni Muslims and Shi’a Muslims. These ethnic and religious divisions were further intensified by territorial disputes, which would continue until the 20th Century. In addition, politics played a role in initiating the war itself. The rivalry existed many years ago, but the war was aggravated by the changes in governance in both countries. The Iran-Iraq War was a violent combat between the aforementioned nations from September 1980 until August 1988. The conflict was only stopped with the intervention of the United Nations. The battle proved to be a long and tedious one, as the tension between the countries extended for years. There were also countless casualties as a result of the disastrous occurrence. When the war ended, neither nation could truly be declared the victor. Both Iran and Iraq did not succeed in gaining new territories or political advantages. It is important to note that Iraq was the nation responsible for starting the war. However, the aggression of Saddam Hussein was not the main cause of the war’s occurrence. In fact, there is no single cause to be blamed for the war. The origins of the Iran-Iraq War are deeply rooted in ethnic, religious and territorial conflicts which date back from the seventh century; it was exacerbated in the modern era due to ambitions of dominance. This term paper aims to discuss the reasons behind the Iran-Iraq War on two accounts: the dispute over the Shatt al-Arab river and the political tension caused by the Islamic Revolution and the rise of Ba’ath regime. The Iran-Iraq War occurred because of various reasons. The conflict between the two nations involved was characterized by other conflicts. The tension that had long persisted between Iran and Iraq were caused by differences in religious beliefs and political positions, as well as disagreements on the borders (Iran Chamber Society [ICS], 2009). The problem between the countries was fueled by the problems between the following opposing parties: Sunnis and Shia Muslims, Arabs and Persians, Ayatollah Ruhollah Khomeini and Saddam Hussein (Ehteshami Hinnebusch, 1997). Moreover, both Iran and Iraq sought to gain supremacy in the region (Brown, 2008). The Iranian-Iraq War which started in September 1980 was a testament to the extended conflict regarding the boundaries of their territories and their share in the Shatt al-Arab river (Hunseler, 1984). The war was also a result of the struggle of both parties to become the most dominant and influential in the region. However, it is important to point out that there is a significant difference between the 1980 war and the conflicts prior to it. The early conflicts between Iran and Iraq were settled with the interference of European countries which only meddled to safeguard their respective interests. As for the 1980 war, both sides fought to preserve their own interests. No external power intervened with that war. Two main reasons why the conflict became prolonged are the mutual disputes over territory (especially the Shatt al-Arab) and the involvement of both sides in the domestic problems of the other (Hunseler, 1984). The Beginning of the Persian-Arab Conflict The origins of the conflict between Iran and Iraq started many centuries before both nations were established. It is important for one to be familiar with the history of the conflict why the 1980 war began in the first place. According to Hunseler (1984), the Iran-Iraq tension had its roots in the seventh century with the Arab-Persian conflict. It was this centuries old rift which ignited the battle over the Shatt al-Arab. Persia stood out from the others because despite being under the control of the Arabs, it retained its national identity (Hunseler, 1984). In AD 636, the Sassanids of Persia lost to the armies of Arab General Sa’d bin Abi Waqqas at the Battle of Qadisiya. Meanwhile, the Persian Empire became dissolved in AD 642 due to the Battle of Nihawand. While they held on to their state’s culture and territorial honor, the Persian population embraced Islam in the aftermath of the collapse of the Persian Empire. The Arabs and the people they conquered viewed Islam and Arabism as a union. However, despite being under the influence of Islam, the culture of Persia cannot be restrained (Hunseler, 1984). An important thing to consider in understanding the history of Persia and its political and social existence is what Hunseler (1984) called the â€Å"juxtaposition of Persia and Islam† (p. 8). The principle was said to have been derived from the notion of the state based on Zoroastrianism. According to the Zoroastrian notion of a state, it must have the following: â€Å"a secularly-legitimized kingship, the survival of the Persian language and the proud awareness of a distinct Persian history† (Hunseler, 1984, p. 8). After two centuries, the Sunni-Arab Abbasid caliphate had become interested in the Persian literature (Hunseler, 1984). In time, the Persian families which belonged to the caliphate of the Abbasids began to assume control by grabbing power repeatedly. From AD 954 until 1055, the Buyid dynasty possessed enough authority to manipulate politics in the western portion of Persia and Iraq. In addition, they also had the power to strictly limit the function of the caliphs of Abbasid to religion only. This was the reason why the legacy left by the Buyids in Iraq was considered as the conflict between Persianism and Arabism (Hunseler, 1984). In the 17th century, the Safavids in Persia declared Shi’ism as the state religion (Hunseler, 1984). The Safavids exerted influence on Persia for 15 long years; they stayed in the state from 1623 to 1638 (Hiro, 1991). The declaration was seen as Persia’s attempt to establish its boundaries and separate itself from Arab nations while keeping the matters under the influence of Islam. Shi’ism became a crucial part of Islamic history, as it was the first to present a rift in the unified world of Islam. This was because Shi’ism founded itself in a separate state. The kings of the Safavids considered themselves as mainly secular leaders; they assigned the religious functions to the theologians. In turn, the Shi’a ministers did not want to give up their posts which were assigned to them under the Safavid rule. Most especially during the time of the Qajar leaders, the clergy were given money and land. The awarding of such gifts allowed them to be financially independent from the king; it also gave them the opportunity to exert political influence. Meanwhile, no such similar progress had occurred in the Sunni Arab states (Hunseler, 1984). The Sunni-Shi’a Problem The existing Persian-Arab conflict had taken a complicated turn with the addition of yet another conflict: the Sunni-Shi’a problem (Hunseler, 1984). The problem was not exactly about tension between the differing branches of Islam. Instead, there was antagonism due to the amount of influence that a particular religion has on the development of political power in the state. The conflict continues at present day, as there are still areas wherein the Arab communities consist of both Sunni and Shi’a factions (Hunseler, 1984). Those who head the Shi’a clergy in Arab countries such as Iraq and Bahrain found difficulty in assuming certain social positions (Hunseler, 1984). In Persia, the Shi’a clergy had no problems exerting influence in society because Shi’ism was revered with national significance. In addition, Shi’a leaders faced with two issues regarding loyalty. First, they encouraged the spread of Shi’ism in states whose population were not exclusively Shi’a. Therefore, they became involved in the centuries-old conflict between the Shi’a and Sunni. Second, they were victims of the suspicions of Arab rulers who thought they were submitting to the influence of non-Arabs (Persians). They were often seen by their Arab counterparts as promoting non-Arab causes. This situation caused the Arab Shi’as to be constantly detached from their political leaders. The separation was also caused by doubt on secular leadership, as well as Shi’a millennialism (Hunseler, 1984). The Persian-Arab conflict and the attempts of both sides to become more dominant and influential than the other in the Middle East became evident in areas where the Sunni and Shi’a groups, and the Arabs and Persians, fought against each other (Hunseler, 1984). Even though the Persians and Arabs in the Arabian peninsula had the Persian-Arab Gulf to set them apart in terms of geography, the conflict eventually made itself apparent on the boundaries on land. This was the primary reason why the conflict persisted for many years; both sides incessantly tried to acquire the territories of the other and the quest for a mutual border dragged on (Hunseler, 1984). The Origin of the Conflict over the Shatt al-Arab The conflict between Iran and Iraq over the Shatt al-Arab river originated in the 17th century and began as the rift between the Ottoman Empire and Persia (Hunseler, 1984). The sultan of Turkey, Murad IV, captured Baghdad in 1638 and the initial resolution regarding the boundaries with Persia was drafted a year later. The Kurds and the Armenians occupied the north while the Arabs dominated the south. The boundary fell on areas wherein the tribes did not consider either the Persians or Turks as their masters. As a result, the border settlement was drafted with consideration to the tribes and the names of the places. The agreement also took in consideration the intention of both parties to unite the tribes of Istanbul or Esfahan. The Kurdish-Armenian boundary caused many conflicts after it was established, but order was always restored in reference to the 1639 resolution. Unfortunately, the 1639 agreement proved lacking in setting the boundaries in the Shatt al-Arab region. On one hand, Persians believed the river itself was a natural border. On the other hand, the Turks upheld the claim that the river belonged to the Ottoman Empire. According to the Turkish point of view, the Arab tribes which occupy both sides of the river are considered a single entity from Arabistan. Arabistan is part of the Ottoman Empire. Hence, the Shatt al-Arab was to be considered as under the possession of the Ottoman Empire (Hunseler, 1984). In the 19th Century, boundary problems continued. In 1823, a boundary problem surrounding the Muhammarah surfaced and Persians settled in the city (Hunseler, 1984). Both Russia and Great Britain extended their assistance on the matter. On May 15, 1843, a boundary committee was formed and gathered in Erzerum, a city in Turkey. The committee consisted of representatives from Turkey, Persia, Russia and Britain. A treaty was created on May 31, 1847, and contained three major guidelines. First, Muhammarah and its harbor, as well as Khidhr Island, were awarded to Persia. Meanwhile, Turkey was granted admission to Zuhab and Sulaymaniyah. Second, the committee was designated â€Å"in situ† to delineate the specific course of the boundary (Hunseler, 1984, p. 11). Lastly, the Ottoman Empire was given the entire Shatt al-Arab extending to the marker on the east, except for the territories mentioned above (Hunseler, 1984). The treaty of 1847 was rather ambiguous, and its inherent vagueness proved to be its biggest flaw (Hunseler, 1984). The treaty did not address the question of which nation had the responsibility over the eastern shore. While the Shatt al-Arab was placed under Turkish jurisdiction, the specifications of the border were not indicated. Turkey wanted to resolve the issue over the treaty’s vague statements regarding Arabistan/ Khuzistan. As a result, Russia and Great Britain included an â€Å"explanatory note† to assert that the problem raised by Turkey was not compromised by the treaty’s lack of clarity (Hunseler, 1984, p. 11). Turkey declined to approve the treaty until Persia acknowledged the note as part of the treaty (Hunseler, 1984). Mirza Muhammad Ali Khan acknowledged the note and signed the treaty as a delegate of the Persia. After the Persian administration discovered the inclusion of the added note, it nullified the treaty and failed to approve it. They argued that the Persian representative had no power to sign the document (Hunseler, 1984). To address the issue, the boundary committee inspected the Turkish-Persian border from 1850 until 1852 (Hunseler, 1984). Unfortunately, the commission was not able to do its job properly because of the opposing claims of Turkish and Persian commissioners. Persia maintained that they were given the entire expanse found east of the Shatt al-Arab, while Turkey opposed the claim. The committee was unable to provide a definite proposition to solve the problem. While the committee continued its efforts in the northern area of the Shatt al-Arab, the determination of the boundaries of the river’s region was postponed indefinitely (Hunseler, 1984). Persia was relentless in its efforts to claim territories and continued to bring up its border issues in the succeeding years. Persia sought Russia and Britain to mediate on the border problem (Hunseler, 1984). Persia wanted to share control of the Shatt al-Arab with Turkey; the state also wanted to discuss the rights with regards to the harbor. Unfortunately, Britain and Russia were not in agreeable terms since the mid-19th Century. Hence, both nations were not prepared to mediate in behalf of the Shatt al-Arab tension. On August 31, 1907, the Anglo-Russian convention had an agreement. This agreement divided Persia into three separate zones. In the northern part of Persia, Russia maintained a sphere of influence. In the southern area, Britain had its own sphere. Meanwhile, the middle area was considered as neutral ground. It was not until after this division was established that the Anglo-Russian concern for the Turkish-Persian border was revived (Hunseler, 1984). Russia became once again involved with Persian-Turkish affairs because it was specifically interested with the province of Azerbaijan in Persia (Hunseler, 1984). The interest was the result of strategic and economic factors in relation to Turkey. On the contrary, Britain was different from Russia because its interests were not limited to Persia alone. Britain was also focused on the Turkish territory of the Shatt al-Arab because it played a crucial part in British interests in the Gulf area. In July 1911, an Anglo-Turkish mediation in attempt to come up with a resolution that would define the territorial claims and rights in the Arab-Persian Gulf region began. On July 29, 1913, the resolution was signed by Turkey and Britain. The agreement included the decisions regarding the status of Arab sheikdoms. The resolution also included the agreements about the Shatt al-Arab and its significance to the increasing British authority in Arabistan and Iraq. The resolution proved to be beneficial for Turkey, but only because Britain acted on it for its own advantage. Meanwhile, Russia was outraged by the Anglo-Turkish agreement and initially renounced it. Britain caught Russia by surprise by awarding the Shatt al-Arab in its entirety to Turkey. Russia had its own interests to protect in Shatt al-Arab and the Gulf area, and the agreement served as a hindrance to the Russian cause. However, Britain gave Russia the guarantee that it would offer assistance in the latter’s interest in the northern section of the Turkish-Persian border. After Britain gave its guarantee, Russia acknowledged the Anglo-Turkish agreement (Hunseler, 1984). On December 21, 1911, Persian Foreign Minister and Turkish representatives from Tehran gathered in Istanbul to create a boundary commission to resolve the Turkish-Persian border problem (Hunseler, 1984). The commission began to meet in March 1912; by August, the commission had convened a total of 18 times. In the beginning, the efforts of the commission seemed futile due to Persia’s disapproval of a specific â€Å"note explicative† of April 26, 1847 (Hunseler, 1984, p. 13). However, Russia exerted influence and Tehran was forced to agree on the note on August 15, 1912. The early progress of the Turkish-Persian commission was accompanied by statements already found in the Four-Power Protocol of Constantinople dated on November 17, 1913. With regards to the area of the Shatt al-Arab, the definition of the border was determined in conformity with the Second Treaty of Erzerum of 1847. According to the treaty, the Shatt al-Arab is considered as a Turkish territory excluding the limitations concerning Abadan and Muhammarah. By November 1913, two-thirds of the border assignment was completed. The task of settling the complete boundary was given to a Four-Power Delimitation Commission. This commission had to define the border based on what was 1869’s â€Å"carte identique† (Hunseler, 1984, p. 13). The commission started working in 1914. Unfortunately, the First World War broke out. The emergence of the war hindered Persia and Turkey from acknowledging the border (Hunseler, 1984). The Aftermath of World War I: The Iranian-Iraq Disagreement on the Shatt al-Arab The conflict and rivalry between Iran and Iraq officially started after the First World War (Hunseler, 1984). The outcome of the war significantly altered the issue over the borders concerning the Shatt al-Arab. Hunseler (1984) explained: â€Å"The British mandate of Iraq, which had come about in Mesopotamia, entered into the Turkish boundary claims against Iran, although it also impinged upon British navigational privileges on the Shatt al-Arab† (p. 14). The aftermath of the Great War also allowed Iran to experience a dramatic political transformation. In 1921, Muhammad Reza Khan came into power. Under his reign, Iran became resistant to the established agreements regarding the Shatt al-Arab (Hunseler, 1984). It was also in 1921 when Khaz’al, the Sheik of Muhammarah, lost. Khaz’al was a known supporter of the British cause. With his defeat, Iran was granted the opportunity to fervently defend its own interests on the Shatt al-Arab conflict. Due to the new found empowerment of Iran, Britain was suddenly placed in a position wherein it should implement its rules without putting its Iranian interests in jeopardy (Hunseler, 1984). Meanwhile, Iraq asserted its control over the Shatt al-Arab (Hunseler, 1984). Due to the claim, Iran declined to recognize the state of Iraq. In 1929, Iran did give diplomatic recognition to Iraq, but only because it sought to gain the attention of Britain. Iran hoped that by acknowledging Iraq as a state, Britain would be sympathetic towards the Iranian cause. Britain was still interested in Iran because of economic reasons; the former is involved with the latter through the Anglo-Persian Oil Company. Moreover, Britain was still interested with the Shatt al-Arab issue. This was because it could provide the British complete access to the refineries located in Abadan. On August 11, 1929, the Iranian and Iraqi governments had interchanged several notes. This exchange gave way to the establishment of a temporary arrangement to manage the relations between the two states involved. The arrangement included settlements on trade and navigation. However, the negotiations failed because Iraq and Britain refused to recognize the jurisdiction of Iran on the half of the river (Hunseler, 1984). When Britain decided to remove its authority on Iraq and break away from their alliance in 1930, it imposed the right of the British navy to pass through the Shatt al-Arab anytime, regardless if it was wartime or peacetime (Hunseler, 1984). However, Iran had no intention in being involved in a peaceful settlement. The Iranian government also declined to accept the legitimacy of the border. On March 25, 1924, Iran announced its non-acceptance of determination of the boundary as stated in the Constantinople Protocol. The Iranian government also refused to recognize similar settlements created on September 20 and December 2 in 1931. The situation worsened when Iran sent four gunboats to pass through Shatt al-Arab and proceed until Muhammarah. Due to this incident, problems regarding the pilot and the flags of the ships were added to the already intense conflict (Hunseler, 1984). The boundary issue as well as the flag and pilot inquiries which remained unanswered increased the tension surrounding the conflict (Hunseler, 1984). On November 29, 1934, the Iranian government was forced to seek assistance from the League of Nations in an effort to address the problem. Unfortunately, the League of Nations and the representatives it sent failed to bring any positive change in the current situation. The only thing which provided temporary resolution to the problem was the Middle East pact of 1935, which Iran had introduced with the help of Turkey. The pact presented an opportunity wherein all points of disagreement could be settled. On July 4, 1937, a treaty on the Iranian-Iraqi border was agreed upon in Tehran. The treaty upheld the conditions indicated in the 1913/14 Protocols of Constantinople. According to the treaty, the Iran-Iraq border would remain along the east bank of the Shatt al-Arab. There were specific considerations made for Abadan and Muhammarah. Iran was also awarded an anchorage zone in Abadan which was four miles long. In addition, the treaty rendered the river as open territory, as it allowed access to naval ships of Iran and Iraq and traders of all countries. A transit fee was imposed, but this would be utilized for purposes of maintenance as well as the development of the shipping lanes in the river. In another decision, both sides agreed to accept the protocol within two years after the agreement had been reached (Hunseler, 1984). The adoption of the covenant was not implemented (Hunseler, 1984). On December 8, 1938, the commission in charge of the Iranian-Iraqi boundary started working on the confluence of the Shatt al-Arab and the Khayeen. The efforts of the commission were stalled by opposing translations of the treaty and the definite determination of the border. The Iranian government submitted suggestions regarding the balance of power between Iran and Iraq with regards to supervising and safeguarding the Shatt al-Arab shipping lanes. Meanwhile, the Iraqi administration saw this move as a threat to the sovereignty of the Iraqis on the river (Hunseler, 1984). In the 1950s, Iran and Iraq had another opportunity to resolve their issues regarding the Shatt al-Arab border (Hunseler, 1984). In 1955, both countries, along with Britain, Pakistan and Turkey agreed upon the Baghdad Pact (Karsh, 2002). This pact was initiated by the West and was established to strengthen defense and security in the region. In October 1957, King Faisal of Iraq paid a state visit to Iran (Hunseler, 1984). In this encounter, both nations reached an agreement regarding the Shatt al-Arab problem. Iran and Iraq agreed on two points. First, there will be a commission to be based in Baghdad which is assigned to work out the details of the joint supervision of the Shatt al-Arab. Second, a Swedish adjudicator will be in charge of delineating the border; this arbitrator is to be situated in Tehran and must work with the joint commission. Once again, an agreement between Iran and Iraq was hindered by yet another occurrence. On July 14, 1958, a revolution broke out in Baghdad (Hunseler, 1984). The change in Iraqi governance eventually disrupted the recently resumed development of Iranian-Iraqi ties (Hunseler, 1984). Also, the political change once again awakened the border conflict on the Shatt al-Arab and the land borders. Four short months after General Abd al-Karim took control, the revolutionary administration of Iraq declared that they would extend their claim on the river to 12 miles. On November 28, 1959, Iranian Shah Reza Pahlevi revived their request to have the border line of the river drawn along the middle. He justified his demand on grounds of Iraq’s clear violation of the 1937 treaty. He also argued that because they were already in the 20th Century, a river which served as a boundary such as Shatt al’Arab cannot be attached to the absolute sovereignty of either nation. General Qasim addressed the demand of the shah with another demand. Iraq sought to regain the anchorage zone awarded to Iran in the 1937 treaty. Despite their counter demand, Qasim still wanted to resolve the dispute through peaceful means. Iraq was willing to withdraw their claim of the anchorage zone if Iran would acknowledge the Iraq’s demands on the river and the treaty of 1937. The peaceful settlement was not reached. On December 10, 1959, Abbas Iranian Foreign Minister Abbas Aram declined Iraq’s offer. Nine days later, General Qasim reasserted Iraq’s legal right to the anchorage zone without insisting on its return. He also appealed for Iran to value the early treaties. General Qasim suggested that they could address the problem with the help of the United Nations. However, Iran provoked Iraq again when the local newspaper Ettelaat stated that â€Å"the existence of Iraq was in any event a historical misunderstanding and the whole of Iraq a Persian province† (as cited in Hunseler, 1984, p. 17). An armed struggle between Iran and Iraq was quelled before the further tension could develop. On March 5, 1959, Iran became involved with the United States in a defense settlement (Hunseler, 1984). Soon after, Iran felt coerced by Russia. Iran had reasons to be concerned. It was threatened by Soviet influence and the possible circulation of further revolutionary ideals. Meanwhile, Iraq was also concerned with the threat of the United Arab Republic, a state established in 1958 as a result of the merger between Syria and Egypt. Abd al-Karim Qasim was frightened that Syria might provide assistance to Iraqi Nasserites if and when a war with Iran occurs. Hence, there was no real war between both parties at that time. The tension manifested itself through a media war between Iran and Iraq (Hunseler, 1984). In 1967, Britain declared its wishes to pull out from the Gulf area. Prime Minister Harold Wilson expressed the desire of the British administration to remove its military troops located ‘east of Suez’ (as cited in Hunseler, 1984, p. 17). With this announcement, Iran wanted to replace British forces with their own troops on the moment of the latter’s departure (Hunseler, 1984). The 1967 blockage of the Suez Canal was a welcome development, as it prevented Soviet activity in the Gulf region. In terms of security concerns, Iran wanted to unify and lead the Arab countries in the region. The supposed partnership had the goal of preventing the spread of Soviet control and power of revolutionary nations and factions, such as South Yemen and Iraq. The Arab countries in the Gulf were cautious in dealing with Iran. While they were hesitant to collaborate with Iran which was associated with Israel, they did not want to create a rift among the states (Hunseler, 1984). Iran continued to strongly pursue its ambition of becoming an unshakeable force in the Gulf region (Hunseler, 1984). In 1969, it condemned the 1937 treaty. The shah knew that if Iran wanted to govern and manipulate the shipping lanes in the Gulf, it must have exclusive control of the river. This move would also liberate the Iranian ports on Abadan and Khorramshahr from Iraqi jurisdiction. On one instance, an Iranian vessel sailed despite the absence of an Iraqi pilot. It departed from the Khorramshahr port with the assistance of Iranian patrol vessels and successfully arrived at the Persian-Arab Gulf. Iraq was aware of the violation, but it did not wage a war against Iran due to the weakness of the military (Hunseler, 1984). After 1972, the shah became more determined to cripple Iraq. After the completion of the Iraqi-Soviet friendship treaty, the Shah approached American President Richard Nixon to ask for assistance in the Kurdish cause in Iraq (Hunseler, 1984). This action was done with the objective of weakening the Iraqi army through an attack on its internal disputes. In August 1972, another uprising emerged in Kurdistan. The Iraqi administration and Kurdish chief Mullah Mustafa Barzani met in March 1970 and agreed on the autonomy of Kurdistan beginning in 1974. However, the agreement was threatened by the support of Iran and the United States for Barzani. Because of this, the Kurdish insurgents continued to hold on to their weapons and proceed with the civil war. Meanwhile, the Iraqi forces benefited from the Iraqi-Soviet friendship treaty, for it allowed for a steady supply of ammunition from Russia. The weapons were instrumental in guaranteeing the military success of Iraq. Nevertheless, the malfunctioning of the army’s weapons and the failure of the Soviet Union to provide more ammunition endangered the progress Iraq had in its fight against the Kurds. In the early part of March 1975, the Iraqi government was prompted to consider Iran’s proposition that it would refrain from supporting the Kurds if the former would approve the latter’s suggestion to resolve the border issue by placing the border line along the thalweg (Hunseler, 1984). On June 13, 1975, Iran and Iraq agreed on yet another treaty in Baghdad (Hunseler, 1984). The treaty consisted of four crucial agreements. First, the boundaries will be definitely marked based on the Constantinople Protocol of 1913 and the 1914 proposal created by the committee regarding the establishment of the boundary. Second, the river boundaries would be situated in the middle, or the thalweg. According to Willet (2004), the thalweg was the â€Å"central deepest part of the river† (p. 7). Third, there are two things to be rebuilt: the mutual trust between both nations as well as the security of the land boundaries they shared. Also, the invasion on both sides will be stopped. Lastly, the problem will be settled upon with the acknowledgement of the aforementioned points. When Iraq signed the treaty, the country accepted the thalweg agreement for the first time. After five years, it became evident that the said recognition was merely the result of coercion from Iran’s side. The acceptance of Iraq was also caused by the failure of the Soviet Union to provide weapons. Nonetheless, the compromise made regarding the Shatt al-Arab paved the way for the Kurdish civil war to stop. Meanwhile, the relevance of the river in terms of Iranian strategy was relatively reduced. This was because Iran transferred its navy from Khorramshahr to the Bandar Abbas port in August 1978 (Hunseler, 1984). The Iran-Iraq War from a Political Perspective The dispute over the borders and boundaries of the river of Shatt al-Arab was instrumental in the emergence of the war between Iran and Iraq in 1980. While the territorial conflicts played a crucial role in causing the war, the political conditions in both countries must also be considered as initiators. The transition in the governments helped influence the leaders on how to deal with the Shatt al-Arab issue. In Iran, there was a dramatic shift in leadership as the Shah was removed from power through a revolution led by a radical Muslim. In Iraq, several coups have altered governance while the rise of the Ba’ath Socialist Party to power resulted in the domination of Saddam Hussein. Both countries longed to dominate the other and emerge as the most powerful in the region (Jacoby, 2008). The Iranian-Iraqi situation under the Rule of the Shah In the 1970s, the tension between Iran and Iraq was heightened (Karsh, 2002). This was because of the Shah of Iran, Mohammed Reza Pahlavi, became aggressive and tried to present Iran as the dominant force in the Persian Gulf. The Shah had been governing the Iran for decades. However, he was temporarily overthrown from power. In 1953, the head of the Iranian Parliament started a coup to remove the Shah (Willett, 2004). The coup succeeded and Pahlavi vacated the Iranian leadership for a brief time. However, the United States

Spider Womans Granddaughters by Paul Gunn Allen Essay Example for Free

Spider Womans Granddaughters by Paul Gunn Allen Essay In the introduction of Spider Womans Granddaughters, by Paul Gunn Allen, she provides background information pertaining to Native American history and culture. The purpose of this preface is to offer the knowledge necessary to understand the stories. She achieves this goal with the employment of the rhetorical strategies pathos and reference to authority. Allen strongly utilizes pathos. Her use of vocabulary conveys an extremely negative perception of the Anglo-American interactions with the Native Americans. Allen initially describes a road that travels through an Indian Territory in Oklahoma as a beautiful drive, lined tastefully with billboards however then reveals that the roadside signs mark the sites of starvation and slaughter. She continues to portray Anglo-Americans as insidious and pernicious. Allen also illustrates the affects of the massacring of the Native Americans: our numbers were horrifyingly diminished. These desperate, emotional words are deliberately used to provoke pathos effectively. Allens reference to authority compliments her appeal to emotion, as her points are represented with the words and opinions of indubitably respected figures. She shows the stubborn and misunderstanding views of Senator Dawes: He noted that Indian people had a good literacy rate, adequate food and shelter, medical care for all, and a thriving economic base, but he was disturbed because they continued to live communally. She includes this adamant refusal of the Indian lifestyle that was ultimately the cause of the suffering and injustice endured by the Native Americans, and reflects it in the words of an American leader. Allen exhibits the opinion of William Brandon: Of the approximately 150 million acres owned by the Indians in 1880 over ninety million acres were extracted from the Indians pocket. She also alludes directly to the holocaust by describing the westward expansion as such, and provides further allusion by relating schools to concentration camps. Paul Gunn Allens use of the rhetorical strategies of pathos and reference to authority create a nearly irrefutable vision of the Native Americans inauspicious history. Given this overview, the reader is provided the  necessary intellect to fully comprehend the stories.

MRI as a Breast Cancer Screening Tool

MRI as a Breast Cancer Screening Tool Chapter 1 Introduction In the United States, one in eight women will be diagnosed with breast cancer, accounting for 26% of all cancer cases in women (Jiao, 2014). The standard of care for women over the age of 40 is mammography. It has been shown to increase life expectancy by detecting breast cancer through a quick and easy x-ray. Magnetic resonance imaging, which is more sensitive to breast cancer is costlier and produces more false-positive results, therefore it is not used as often. When mammography is the only test being done, breast cancer is more likely to go undetected in patients with dense breasts and those with small lesions. In high-risk women, MRI has been shown to detect breast cancer in earlier stages than mammography. MRI screening is successfully reported between 77% and 91% (Jiao, 2014). Most detections from MRI are located within axillary lymph nodes during stage 1 breast cancer. A patient may simply refuse yearly mammograms, when she goes five years later breast cancer may be in the fi nal stage whereas MRI could’ve detected it years earlier. Women are recalled more often for additional diagnostic testing when screened less frequently and recalled less often when screened more frequently (Orel, 2005). The American Cancer Society recommends MRI testing for women with the BCRA1 & BCRA 2 genes or a lifetime risk of 20% or greater for breast cancer (Saslow, 2007). Women who inherit the BRCA1 or BRCA2 gene have a 45% to 65% chance of developing breast cancer (Plevritis, 2006). BRCA 1 gene carriers are at a greater risk for developing breast cancer at an aggressive pace. Tumors in women screened with mammography alone are larger and more likely to have metastasized to axillary nodes (Taneja, 2009). MRI is approximately ten times more expensive than mammography making its cost effectiveness a critical consideration (Jiao, 2014). Due to its lower specificity than mammography increased costs are related to biopsies and additional exams. Estimated lifetime costs for 10,000 women would be higher by $10.6 million with MRI in combination with mammography than with mammography alone. In 2009, the costs billed to Medicare for a bilateral mammography was $49.76 while a bilateral MRI was $965.57 (Jiao, 2014). The price per quality adjusted life year would be $310,616 when MRI was performed with mammography (Fieg, 2009). MRI screening is most cost effective if the cost of MRI decreased or the cost of mammography decreased, when the risk of breast cancer increases, when mammography performance worsens, and if greater quality of life is accomplished (Orel, 2005). MRI becomes cost effective when patients with high-risk profiles are treated. If cancer was detected early enough, chemotherapy can be reduced. MRI is also needed for surveillance when breast conserving therapy results in recurrences. MRI would yield an additional 106 years of life per 10,000 women (Fieg, 2009). Women with BRCA1 and BRCA2 start mammograms at the age of 25 which makes MRI more cost effective and would decrease their radiation dose. Given the aggressive nature of breast cancer, screening with MRI whether alone or with mammography is cost effective and will prolong life expectancy (Berg, 2012). Contrast enhanced MRI is proven to detect breast cancer in the earliest stages compared to ultrasound and mammography. Statement of the Problem and Professional Significance Is MRI effective as screening tool for breast cancer? Which modality is the most effective study for diagnosing breast cancer? Are imaging modalities other than MRI a waste of time and money for patients? Mammography is seen as the first step in preventing breast cancer when a patient turns 40. For some patients, it might already be too late. Mammography is quick and low cost but does not detect breast cancer in patients with dense breasts or small lesions. MRI is considered the gold standard in imaging but is used with fewer women. As the population grows and rates of cancer increase, patients are demanding precise diagnosis and early detection for cancer. What factors should stand out to differentiate who receives MRI vs. mammography? By gathering medical history and diagnosis from several women receiving breast MRI’s, data will be examined to determine whether or not breast MRI’s were needed for proper diagnosis and if testing detected further malignancies. Research Hypothesis 1. It is hypothesized that MRI will be more effective in detecting breast abnormalities than Ultrasound or Mammography. This can be tested by comparing the results of their MRI with results of previous tests.    2. It is hypothesized that at least 50% of patients will feel more confident regarding their diagnosis following a MRI scan. This can be tested by having patients rank how they felt before and after having the test and talking with a radiologist on staff (using a scale of 1-10). 3. It is hypothesized that patients will not have had a mastectomy or received radiation until an MRI is performed. By surveying patients to determine who was and wasn’t diagnosed prior to MRI and what measures they took to prevent the malignancy from spreading I can determine these results.    4. It is hypothesized that patients positive for breast cancer will have at least one lesion undetected on mammography or ultrasound because of its small size or position in the axillary region.   This can be tested by comparing MRI test results with other imaging modalities. 5. It is hypothesized that 10% of participants will have had inconclusive results. This can be determined by whether the radiologist recommends a breast biopsy. MRI can produce false-positives, which cause the radiologist to compare results with past imaging. 6. It is hypothesized that at least 50% of the participants were recommended to have an MRI after inconclusive testing in other modalities. This information will be obtained through obtaining previous medical history in the survey. Definitions Breast cancer Uncontrolled growth of breast cells resulting in a malignant tumor (Medical Dictionary Online, 2018). Malignant Cancerous tumor that can spread to other parts of the body. Benign Tumor that is not dangerous to health. Quality adjusted life year Used to assess the value for money of medical intervention. One QALY = one year of perfect health (Science Direct Online, 2018). Probabilistic sensitivity analysis Technique used in economic modeling that allows the modellar to quantify the level of confidence in the output of the analysis (Science Direct Online, 2018). National comprehensive cancer network Not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. BRCA 1 breast cancer type 1 susceptibility protein- Identified in 1990 and is on chromosome 17, increases likelihood of cervical, uterine, and colon cancer (National Cancer Institute, 2018). BRCA 2 breast cancer type 2 susceptibility protein- Identified in 1994 and is on chromosome 13-, increases likelihood of stomach cancer, gallbladder cancer, and melanoma (National Cancer Institute, 2018). Ultrasound Imaging test using high frequency sound waves. MRI Imaging test that used magnets to generate a detailed picture. Mammography Images produced from low dose radiation. Gadolinium Chemical element of atomic number 64, injected into patients as contrast during MRI. Ductal carcinoma in situ (DCIS) Presence of abnormal cells inside a milk duct in the breast (Medical Dictionary Online, 2018). Mastectomy Surgical operation to remove a breast. Stereotactic biopsy Procedure that uses mammography to precisely identify and sample an abnormality within the breast. Limitations and Delimitations This study will survey twenty women (all ages) who are scheduled for breast MRI’s at Geisinger Community Medical Center during September-November 2018. I will conduct surveys with the patient prior to their MRI. Breast MRI’s will be conducted on a 1.5T, Siemens machine. All patients will be scanned using the same protocol for imaging regardless of medical history. External limitations are obtaining a medical history, incompletion of the patient’s MRI, lack of intravenous access for contrast, claustrophobia, and no show appointments. I will rely on patients to give me a detailed, accurate medical history. Assumptions During a typical work day in MRI at Geisinger Hospital a breast MRI is completed once. Within a typical month at least 20 scans are completed. This should allow me to survey enough patients over a six-week period. Permission for this study will come from patients who allow me to ask questions regarding their medical history and diagnosis. In accordance with HIPAA, I will keep all patient names and identifying information anonymous. Chapter 2 Introduction The purpose of this research project is to determine if MRI is effective as an imaging tool for diagnosing breast cancer. By surveying women, who have been diagnosed or are currently being diagnosed, collecting medical history, and analyzing data, imaging modalities will be examined to determine the most reliable, accurate, and timely way to diagnose breast cancer. If MRI is more efficient than mammography and ultrasound, time and money spent on those modalities could be eliminated. Women can be treated faster, and cancer could be diagnosed earlier when proper testing is ordered. Breast cancer during stage one is treatable, thousands of lives could be changed when it is diagnosed in a timely manner. Cancer is the overall most common cause of death in America with breast cancer being the most common type (Jiao, 2014). One in eight women will be diagnosed with breast cancer during their lifetime making it a very costly disease. Standard protocols for screening are determined by the American Cancer Society. Screening mammography is recommended for women with a 25-30% lifetime risk of breast cancer (National Cancer Institute, 2018). This includes women treated for Hodgkin disease and those with a family history of breast or ovarian cancer. Screening mammography typically starts at age 40 unless preexisting conditions are present, screening begins at age 25. The Gail, Claus, and Tyrer-Cusick models are used to estimate breast cancer based on family history. Breast cancer genes 1 and 2 (BRCA) are found in 1/500-1/1,000 women. Women of Jewish ethnicity have a 1/50 risk (National Cancer Institute, 2018). Those who test positive have a 65% chance of breast cancer by 70 years old (Saslow, 2007). What are American Cancer Society Guidelines? Recommendations for women at average risk of breast cancer are women between 40 and 44  have the option to start screening with a mammogram every year. Women ages 45 to 54  should get mammograms every year. Women 55 and older  can continue with mammograms every year or switch to having mammograms every other year (American Cancer Society, 2018). Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer. Not all types of breast cancer cause a lump in the breast. Many breast cancers are found on screening mammograms which can detect cancers at an earlier stage, before the mass can be felt, and before symptoms develop. Women who are at high risk for breast cancer based on certain factors should get and MRI and a mammogram every year, starting at age 30 (American Cancer Society, 2018). This includes women who have a lifetime risk of breast cancer of about 20% to 25% or greater, have a known BRCA1 or BRCA2 gene mutation, have a first-degree relative (parent, brother, sister, or child) with a  BRCA1 or BRCA2 gene mutation, had radiation therapy to the chest when they were between the ages of 10 and 30 years, or have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes. (American Cancer Society, 2018). The American Cancer Society recommends against MRI screening for women whose lifetime risk of breast cancer is less than 15%. MRI in this case would be less cost-effective and timelier for patients to get done. How does MRI detect breast cancer? There are three imaging modalities that can effectively detect breast cancer. MRI, mammography, and ultrasound are commonly used in different combinations. MRI uses magnetic fields to produce cross-sectional images of breast tissue. Hydrogen atoms in fat and water contribute to the signal that is produced (Pilewskie, 2014). Gadolinium, IV based contrast, is administered to detect lesions and cancer. Subtraction images are obtained to differentiate fat from enhancing lesions. MRI produces high quality imaging from signal to noise ratio and high spatial resolution (Pilewskie, 2014). MRI is safe for all women (unless contraindicated by pregnancy) and doesn’t use radiation. A drawback to MRI is false positives that are produced and additional testing that this creates. On the other hand, additional testing leads to a higher number of cancer detected. The more women who are being closely watched and recommended for further tests, the greater their likelihood of being diagnosed earl y. In a study in the UK involving high risk populations, 4% found MRI â€Å"extremely distressing† and 47% reported having disturbing thoughts about it six weeks after (Saslow, 2007). Due to the psychological distress of MRI, other testing needs to be considered. Imaging Limitations Unlike other imaging tests, MRI candidates need to be screened for metal before considering the test. Pacemakers, aneurysm clips, specific stents and filters, and neuro-stimulators are not allowed in the machine. Body habitus and claustrophobia are also factors to consider. A small, loud environment can cause emotional distress and anxiety for a patient, some patients will refuse MRI testing. Breast MRI testing should be completed with and without contrast. Gadolinium, MRI contrast, can only be injected in patients with a glomerular filtration rate of >60. Patients on dialysis, with impaired kidney function, diabetes, high blood pressure, or certain allergies may not be able to receive contrast, making the test inconclusive. MRI results can also be misleading. False-negatives and false-positives occur from technical limitations, patient characteristics, quality assurance failures, human error, and heightened medical concern. A false negative exam looks normal even though the patient has breast cancer. They are more likely to occur in younger patients with dense breasts. MRI is commonly used for dense tissue to differentiate benign and malignant lumps. A false positive test looks abnormal even though the patient doesn’t have cancer. False positives occur in half of women getting mammograms over a ten-year period (Gillman, 2014). MRI’s and MRI guided biopsies are usually recommended for more accurate diagnosis. A patient’s need for definitive findings may increase testing ordered. According to the American Medical Association, 7% of women are biopsied only because of MRI findings. The call back and biopsy rates of MRI are higher than mammography in high risk populations due to the increased sensitivity of MRI (Gillman, 2014). MRI is also able to obtain images for women with breast implants. 3D and 2D images are acquired in all planes, whereas mammography could miss an area of interest and compromise the breast implant.    Economic Impact   Cancer treatment can be impacted by lack of insurance, proximity to health care facilities, and availability of services. According to  Cancer Facts & Figures 2018, â€Å"Uninsured patients and those from many ethnic minority groups are substantially more likely to be diagnosed with cancer at a later stage, when treatment can be more extensive, costlier, and less successful.† (American Cancer Society 2018). Without routine mammograms, breast cancer can go undiagnosed and impose much higher costs when it’s found in a later stage. Early detection can potentially eliminate radiation, chemotherapy, mastectomy, and breast reconstruction. In 2009, the average Medicare reimbursement for a bilateral mammogram was $49.76, a bilateral MRI $965.57, and mastectomy $13,590.03 (Moore, 2009). These procedures drastically differ in costs therefore insurance companies use cost effectiveness and quantity adjusted life years as means in determining which patient will benefit from costlier studies. MRI screening becomes more cost effective as the cost of MRI decreases or the cost of mammography increases. It is also more cost effective for patients with higher risk profiles such as BRCA1 & BRCA2 genes. MRI combined with mammography would produce 106 years of life per 10,000 women compared with mammography alone (Taneja, 2009). The drawback is that MRI in addition to mammography would increase lifetime health care costs for those 10,000 women by $10,600,000 (Taneja, 2009). What does insurance cover? Breast cancer is the costliest cancer to treat. In 2010, it cost $16.5 billion in the United States to treat breast cancer. A major concern when ordering breast MRI’s is that insurance will deny it or charge a high co-pay. MRI’s cost more due to radiologist, facility, contrast, and technology fees. According to a survey by the American Cancer Society, many patients are cutting prescriptions, not going to their doctor, and not getting preventive services due to the high costs. Yearly mammograms are covered by insurance companies. The average cost of a breast MRI in the United States is $1,325 with prices ranging from $375 to $2,850. Patients with health insurance are responsible for paying their deductible, copay, and coinsurance amounts. The amount of each of these costs depends on their health plan. Patients without health insurance are responsible for 100% of mammogram and MRI costs. Case Study In a study published by the New England Journal of Medicine, titled MRI evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer, 969 women with a diagnosis of unilateral breast cancer and no abnormalities on mammography went for a breast MRI. MRI detected clinically occult breast cancer in the contralateral breast tissue in 30 women (Lehman, 2007). Biopsies were performed on 121 of the 969 women whose MRI showed breast cancer (Lehman, 2007). Of those 121, 30 were tested positive. MRI was able to detect cancer that was missed by mammography and clinical exam. Within the 969 women, 33 tumors were diagnosed with 30 being from MRI. The three others were diagnosed from a mastectomy specimen before a biopsy could be performed. Those three samples contained ductal carcinomas in situ and measured 1, 3, and 4 mm in diameter. The most common types of invasive cancer found on MRI was ducal carcinoma (67%), invasive lobular carcinoma (22%), and tubular carcinoma (Le hman, 2007). 96.7% of cancer found was stage 0 or 1. The overall high accuracy of MRI is due to technology and interpretation of results. Contrast enhanced MRI aids in distinguishing benign from malignant patterns. This study also showed that screening MRI can improve on mammography by detecting cancer in women at high risk especially those with aggressive cancers. When ordering MRI, cost effectiveness continues to be a major concern. In the article, American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography, benefits of MRI’s sensitivity in detecting lesions is noted but without data on the recurrence and survival rates, MRI is not recommended as a screening exam. The article compares study results from six published studies, sensitivity for MRI is consistently higher than mammogram and ultrasound while specificity was lower than mammogram and ultrasound. High sensitivity means MRI correctly identifies a patient with cancer. Low specificity means MRI is not able to correctly reject a patient without cancer as accurately as other modalities. MRI has higher error but in calling back more patients and performing more biopsies, it diagnoses cancer more accurately. With this being said, the article does not recommend MRI as a screening tool unless women are at an increased risk of breast cancer, have a fami ly history, or carry the BRCA gene (Stephens, 2011). Conclusion Women who present with signs and symptoms of breast cancer or have a family history should be screened with MRI in addition to mammography. It is not acceptable to deny patients imaging studies that can prolong their life. Breast cancer is 100% treatable when caught early. Due to advances in technology and a growing healthcare system, facilities are more readily available to treat women. Patients no longer need to wait months for tests or results. Steps should be taken to reduce anxiety associated with MRI cancer screening and wait time. Patients should be informed about the likelihood of false-negative and false-positive findings. Whether or not patients need to go through additional imaging, the chance of early detection outweighs the stress of additional testing. MRI is a very useful imaging test that can save lives if performed. Patients who want to be proactive in their treatment should be encouraged to get routine imaging tests done and educate themselves on different stages of breast cancer, so they understand the process they are going through. By creating high resolution imaging, MRI proves to be the most effective study for diagnosing breast cancer. MRI is able to detect smaller masses and abnormalities than other imaging tests miss. Utilization of MRI is crucial for early detection, with its results breast cancer can be highly treatable and late stages along with metastases can be stopped. MRI used in screening for women with high risk factors proves more cost effective than mammography and ultrasound because it detects cancer in earlier stages which reduces the need for more invasive, long term care. MRI is also able to cover a larger area including axillary lymph nodes where cancer is commonly missed on mammograms. References: Jiao, X., & Hay, J. (2014). Cost-Effectiveness Of Breast Mri And Mammography For Screening High Risk Population.  Value in Health,17(3). doi:10.1016/j.jval.2014.03.780 Orel, S. (2005). 1–10 Efficacy of MRI and Mammography for Breast-Cancer Screening in   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Women With a Familial or Genetic Predisposition.  Breast Diseases: A Year Book Quarterly,16(1), 37-38. doi:10.1016/s1043-321x(05)80023-2 Saslow, D., Boetes, C., Burke, W., Harms, S., Leach, M. O., Lehman, C. D., . . . Russell, C. A.   Ã‚   (2007). American Cancer Society Guidelines for Breast Screening with MRI as an   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Adjunct to Mammography.  CA: A Cancer Journal for Clinicians,57(2), 75-89.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   doi:10.3322/canjclin.57.2.75 Feig, S. (2009). Cost Effectiveness of Breast Cancer Screening With Contrast-Enhanced MRI in High-Risk Women.  Breast Diseases: A Year Book Quarterly,20(4), 383-385. doi:10.1016/s1043-321x(09)79390-7 Berg WA, Zhang Z, Lehrer D, et al. Detection of Breast Cancer With Addition of Annual   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Screening Ultrasound or a Single Screening MRI to Mammography in Women With Elevated Breast Cancer Risk.  JAMA.2012;307(13):1394–1404. doi:10.1001/jama.2012.388 National Cancer Institute. (2018). 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The Role of Dynamic Contrast-Enhanced Screening Breast MRI in Populations at Increased Risk for Breast Cancer.  Womens Health,10(6), 609-622. doi:10.2217/whe.14.61 Pilewskie, M., & King, T. A. (2014). Magnetic resonance imaging in patients with newly diagnosed breast cancer: A review of the literature.  Cancer,120(14), 2080-2089. doi:10.1002/cncr.28700 Heil, J., Czink, E., Schipp, A., Sohn, C., Junkermann, H., & Golatta, M. (2012). Detected, yet not Diagnosed Breast Cancer Screening with MRI Mammography in High-Risk Women.  Breast Care,7(3), 236-239. doi:10.1159/000339688 Lehman, C. D. (2007, March 29). MRI Evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer. Retrieved September 19, 2018, from http://www.nejm.org/ Stephens, T. (2011). Breast Cancer Screening With Imaging: Recommendations From the Society of Breast Imaging and the ACR on the Use of Mammography, Breast MRI, Breast Ultrasound, and Other Technologies for the Detection of Clinically Occult Breast Cancer.  Yearbook of Diagnostic Radiology, 2011, 46-47. doi:10.1016/s0098-1672(10)79236-5 Plevritis, S. K., Kurian, A. W., Sigal, B. M., Daniel, B. L., Ikeda, D. M., Stockdale, F. E., & Garber, A. M. (2006). Cost-effectiveness of Screening BRCA1/2 Mutation Carriers With Breast Magnetic Resonance Imaging.  Jama,295(20), 2374.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   doi:10.1001/jama.295.20.2374 Taneja, C., Edelsberg, J., Weycker, D., Guo, A., Oster, G., & Weinreb, J. (2009). Cost Effectiveness of Breast Cancer Screening With Contrast-Enhanced MRI in High-Risk Women.  Journal of the American College of Radiology,6(3), 171-179. doi:10.1016/j.jacr.2008.10.003 Moore, S. G., Shenoy, P. J., Fanucchi, L., Tumeh, J. W., & Flowers, C. R. (2009). Cost-  Ã‚   effectiveness of MRI compared to mammography for breast cancer screening in a high risk population.  BMC Health Services Research,9(1). doi:10.1186/1472-6963-9-9