How to Tame a Wild Tongue Essay

The writer dialogue within relation to a dilemma she faced about her own language and how she represents herself through her language. Gloria Anzaldua who is a Chicano talks about how Chicanas have problems expressing their feelings. Since they lack a native language, instead it is a product of several languages. And their language Chicano Spanish has incorporated bits and pieces of several versions of Spanish. The author speaks about people who are neither Spanish nor live in a country in which Spanish is the first language; for a people who live in a country in which English is the reigning tongue but who are not Anglo; for a people who cannot entirely identify with either standard Spanish no standard English. So she emphasizes the importance to have their owned language. A language which they can connect their identity to , one capable of communicating the realities and values true to themselves- a language that comprises a variation of two languages. I knew after reading the first few paragraphs of Anzaldua’s â€Å"How to Tame a Wild Tongue† (1987) that she was going to have a lot to say. In this passage Anzaldua expresses the challenges she faced growing up in America as a Chicano. She gives a brief breakdown of who she is, where she comes from and which languages she prefers to speak. Her argument starts off explaining how she was made to be ashamed of existing. She then walks us through how she overcame the tradition of silence. Inspired by Mexican movies since her childhood, it was the shock of reading a published Chicano novel that gave her the strength to bite back. She wrote† When I saw poetry written in Tex-Mex for the first time, a feeling of pure joy flashed through me. I felt like we really existed as people† (pg40). As a child she was told by the dentist that he had never seen anything as strong and stubborn as her tongue. It would push out wads of cotton, drills and needles. It was her tongue that would got her three licks on the knuckles at recess if she was caught speaking Spanish in school. She writes† I remember being sent to the corner of the classroom for â€Å"talking back† to the Anglo teacher when all I was trying to do was tell her how to pronounce my name. †If you want to be American†, speak American. If you don’t like it, then go back to Mexico where you belong† (pg34). Language cannot be separated from the culture as an independent aspect. Any language is a culture itself and there is no language in the world which does not express the heart and spirit of people who speak this language. Gloria Anzaldua is famous for her books written in an amusing blend of English and all possible Spanish dialects; she wrote about the numerous layers that could be found when studying thoroughly any language, and she also used Spanglish as it is impossible to stop the assimilation of the cultures and languages. She also argues that there is a linguistic terrorism makes her language constantly change. I totally agree with her and firmly believe that this mimicry is not positive assimilation but a gradual wiping off the limits holding connection between people and their history, traditions and roots. It seems to me, people have stopped appreciating the non-material values, such as language. This issue is widely discussed but does not seem to be altered though. I think we start losing our genuine culture because of unwilling to read classical literature or have any particular interest in the way the language is built. When reading Anzaldua I thought about how stubborn she was in her intention to sharpen everything she did. I admired her skill to listen and to her, she taught me to be attentive to what people actually say. I felt deeply sorry about â€Å"linguistic terrorism† happening with Chicano language and I hope for better.

Aircraft Maintenance manuals

An airport cannot function without management. An airport manager may work for a large international airport or they may work for a small municipal airport, but generally the job duties and description will be almost the same. The main responsibility of the airport manager is to ensure the safe and efficient operation of the airport on a daily basis.This includes supporting staff and making sure that all staff is able to provide polite, prompt and correct information to travels, know airport policies and procedures, scheduling the appropriate number of staff, ensuring that all ticketing and security systems are in excellent working condition and troubleshooting any problems are all part of the airport managers job. The airport manager works closely with federal and state aviation committees and department that generate rules and regulations for all aspects of airport business and security.The airport manager must ensure that all aspects of the airport are functioning within these reg ulations or he or she must take the necessary actions to bring them into compliance. This may mean directly working with airport staff or working with the employees or businesses that rent space in the airport terminal. With working with airport staff, the manager must have a good amount of knowledge to understand the issues the staff is working with, such as aircraft maintenance. Aircraft maintenance is an important matter in which managers should have a good understanding of.Without good management in aircraft maintenance, conflicts can damage the safety and efficiency of an airport. As a manager, it is important to hire the most qualified technician and mechanic for operating on aircraft systems and maintenance. The aviation technician should be able to catch up with the new technologies as quickly as possible. New aircraft technology is brought in regularly, aircraft are regularly upgraded. Choosing the appropriate training methods and developing efficient and helpful training m aterial presumes an improved level of significance in current aviation maintenance atmosphere.Training and management entail the capability to evaluate workers' needs, assess personality traits, and develop challenging performance requirements. Training should be regarded as an integral part of the aviation management for attaining the safest maintenance. Having a maintenance program is also essential for achieving the highest possible level of safety for an airport. Managers should know if each of their aircraft is airworthy and properly maintained for operations in air transportation.The aircraft maintenance manual is a great guide in performing in accordance to for all maintenance on the aircrafts. Aircraft maintenance manuals must comply with FAR Parts 135 and 121, which is required by the Federal Aviation Administration regulations. In this manual, a manager can find sections of administrative policies and procedures, detailed instructions for administration, management, and ac complishment of the maintenance program, and technical manuals that describe maintenance standards, methods, techniques, and procedures (Aircraft Maintenance, 8).In addition to knowing maintenance regulations, a manager should also know and understand inspection regulations as well. It is highly important to have the correct inspections and know when to have those inspections for each aircraft in order for them to be airworthy. Having this knowledge will help maintain a safer and more efficient program, because if there were some aircrafts that are unairworthy, then that would waste time and costs for getting out of the way and getting it done. It is always important to sustain an inspected and maintained aircraft for the safety of the air transportation environment.Aging aircraft could also present particular dangers to personnel and passengers. Some aircraft remain in use far beyond the lifetimes initially envisioned when they were manufactured (Ells). Aircraft managers, therefore , should have a thorough plan in place for the maintenance of aircraft that are aging. In such a case, particular teams of people could also be assigned to the regular inspection and repair of such aircraft. The AOPA (Ells) provides a list of sources that should be inherent in a maintenance plan for aging aircraft.A complete list of logbook entries, for example, could provide valuable information relating to maintenance trends and the probably current level of repair. Major repairs should also be listed in such a logbook. Aircraft records from the FAA are also an important component of this investigation and can provide information such as bills-of-sale, repair, and alterations to the aircraft. Having such information on hand will make it much easier to investigate the state of repair of aging aircraft and also to plan for future inspection and repair efforts.It is vital that aging aircraft and all other aircraft to be kept in good working condition to minimize breakdown and acciden ts. Managers have the responsibility to ensure that all maintenance is performed in accordance with FAA and company guidelines. It is always important to know the aircraft systems, how they function and their errors, and know when aircraft inspections and maintenance should occur. Having a well-organized maintenance program will guarantee a safe and efficient airport. References (2012). Airport Management Jobs.Retrieved from http://www. avjobs. com/careers/detail. asp? RecID=65#. UHTLvFEkosw (2011). Federal Aviation Regulations. Retrieved from , http://www. risingup. com/fars/info/part121-135-FAR. shtml (2012). Aircraft Maintenance. Retrieved from https://erau. blackboard. com/bbcswebdav/institution/Worldwide_Online/MGMT_203/pre sentations/mgmt_203_m5_aiircraft_maintenance. pdf Ells, Steven. (2011). Retieved from http://www. aopa. org/members/files/pilot/2000/aging0006. html

Araling Panlipunan

Central Bank is the bank of a country a nation. Its main function is to issue currency known as ‘Bank Notes'. This bank acts as the leader of the banking system and money market of the country by regulating money and credit. These banks are the bankers to the government, they are bankers' banks and the ultimate custodian of a nations foreign exchange reserves. The aim of the Central Bank is not to earn profit, but to maintain price stability and to strive for economic development with all-round growth of the country There is now hardly any country which does not have a Central Bank of its own.It acts as a great engine of growth of a State. In India, the RBI was established in 1935 and this Bank has since been functioning as the Central Bank of the country (this is not to be confused with ‘Central Bank of India', which is only a commercial bank). The Central Bank of different countries is known by different names like Reserve Bank in India, Bank of England in U. K. , Feder al Reserve System in U. S. A. , etc. (ii) Commercial Banks: A bank, which undertakes all kinds of ordinary banking business, is called a commercial bank. It is so called because it provides money and credit for commercial and trade activities.They receive short and medium term deposits from the public and grant short-term loans, and advances. They supply working capital to industries and enable them to carry on production and manufacturing activities. They grant loans and advances on the stocks of agricultural commodities, industrial goods, etc. They discount internal and foreign bills and thereby finance the International trade. They also perform certain agency services such as collection of cheques, dividends, interest on investments, issue of drafts, letter of credit, Travelers' Cheques, Investment Advisory Services, etc.(iii) Industrial Banks or Financial Institutions: An Industrial Bank is one which specialises by providing loans and fixed capital to industrial concerns by subs cribing to share and debenture issued by public companies. They play an important role in the establishment and growth of industries. The block capital required for the acquisition of fixed assets, etc. , is supplied by investment banks. They provide long-term loans and credits for periods varying between 5 and 15 years for industries to acquire fixed assets.They may serve as catalytic agents in mobilisation of capital in other forms of assistance such as, underwriting, guarantee, etc. These banks are nowadays grouped as ‘Development Financial Institutions'. These banks are very popular in Germany and Japan. In India, we have several Industrial Finance Corporations in addition to the â€Å"Industrial Development Bank of India†. Both, Development Financial Institutions and Commercial banks, nowadays, finance infrastructural development activities, which include construction of transport facilities, building of power-supply stations, etc.(iv) Exchange Banks (Authorized De alers in Foreign Exchange): These types of banks are primarily engaged in transactions involving foreign exchange. They deal in foreign bills of exchange import and export of bullion and otherwise participate in the financing of foreign trade. They do a number of incidental services such as opening of letters of credit, issue of Foreign Currency Drafts and Travellers' Cheques and supply of information about foreign customers. They provide credit and loans in foreign currency and also accept deposits in Foreign Currency.They require huge capital and trained staff as it is a risky business. They maintain branches in foreign countries at important trade centres. In the past foreign banks operating in India would deal in foreign exchange and were known as exchange banks. Nowadays, many Indian banks deal in foreign exchange with special authorisation from Reserve33ank of India and known as Authorised Dealers in Foreign Exchange. As per Foreign Exchange Regulation Act banks dealing in For eign Exchange related activities require the permission of Reserve Bank of India.This is applicable to both Indian and Foreign Banks. (v) Co-operative Banks: They are organized on co-operative principles of mutual help and assistance. They grant short-term loans to the agriculturists for purchase of seeds, harvesting and for other cultivation expenses. They accept money on deposit from and make (vi) Land-mortgage Banks (Presently known as Agriculture and Rural Development Banks): They are agriculture development banks. The Land-mortgage banks supply long-term loans for a period up to 15 years for development of land to improve agricultural yields.They grant loan for permanent improvements in agricultural lands. They create negotiable bonds out of real estate like land, buildings, etc. They raise funds by floating debentures and by borrowing from the government. The Agriculture Finance Corporation was the first Indian Institution to set up finance for development of Agriculture. The National Bank for Agriculture and Rural Development (NABARD) was constituted by the Government to promote rural development. (vii) Indigenous Banks:The Central Banking Enquiry Commission defined an indigenous banker as an individual or firm accepting deposits and dealing in indigenous lending of money to the needy. They form unorganised part of the banking structure, i. e. , these are unrecognised operators in receiving deposits and lending money. In India the Marwaris, the Multanis, the Jains, the Sowcars, the Nattukottai chettiars are some of the leading indigenous bankers who charge high rates of interest on their lendings. In rural areas, they still provide substantial finance to agriculturists and small traders.(viii) Savings Banks: These are institutions which collect the periodical savings of the general public. Their main object is to promote thrift and saving habits among the middle and lower income sections of the society. They have certain restrictions on number of withdr awals in a year to discourage spending. In almost all countries, postal authorities also run savings bank accounts and their working is regulated by the government. The first savings bank was started in Hamburg in 1765. In India, we have postal savings accounts. These days separate savings banks as such are very rare.In India, all commercial banks have savings accounts. The minimum balance which is required to be kept in the accounts differs from banks to banks. The rate of interest payable on the accounts by banks is determined by RBI. Presently it is 4. 5 per cent per annum. Co-operative banks are normally allowed to pay an additional 0. 5 per cent interest per annum. Interest rate on savings accounts with post offices is determined by Government of India. (ix) Supranational Banks: Special Banks have been created to deal with certain international financial matters.World Bank is otherwise known as International Bank for Reconstruction and Development (IBRD) which gives long-term l oans to developing countries for their economic and agricultural development. Asian Development Bank (ADB) is another Supranational Bank which provides finance for the economic development of poor Asian countries. They generally provide finance at concessional interest rates and for long-term needs. These institutions are the creations of World bodies promoted by various countries or central banks of different countries.The European Central Bank established in June 1998 by countries in the European Union is another example of Supranational Bank. (x) International Banks: International Banks are those which are operating in different countries. While, the registered office/head office is situated in one country, they operate through their branches in other countries. They specialize in Banking business pertaining to foreign trade like opening of letters of credit, providing short-term finance in foreign currency, issue of performance guarantee, arranging foreign currency credits, etc. They are the main traders in International Currencies like US ‘dollars', Japanese ‘Yen', the new-born European Currency ‘Euro', etc. They also perform Currency Risk Management functions for clients. These banks are also known as Multinational Banks since, they operate from many countries. These banks make possible the flow of money/credit from one country to from the above, it can be understood that the classification of banks cannot be rigid. We find that banks are providing finance in more than one field that is why, it is rightly said that they are â€Å"Departmental stores of Finance†.

Portrait of a Teacher Essay Example | Topics and Well Written Essays - 500 words

Portrait of a Teacher - Essay Example rtunities to express opinions, as well as share stories and experiences; inviting students to speak up and ask questions; and even to express contentions and disagreement to arguments. The educational environment in the U.S. perfectly encourages principles of democracy in education through voicing out what is in one’s mind whether or not, it is supportive of the educators’ points of views and perspectives. Critical and analytical thinking and expressing of one’s thoughts, concepts, and ideas are frequently encouraged. Nothing conflicted with this standard as compared to a culturally diverse elementary school I went to over 20 years ago. There was no democracy in the classroom back then. The teacher would always be the one to choose what we do and how to do it. Critical thinking was not encouraged at all. When an educational structure or any educator imposes one’s thoughts and actions to another, the principles of democracy would be deemed violated. However, one must realize that democracy in education must be practiced while adhering to rules of conduct and discipline along the standards enumerated within a learning environment. As emphasized in the discourse on Democratic Principles in Education, â€Å"discipline in an educational institution is closely related to the behaviour of both teachers and pupils, their motives and their understanding of each other† (Unit 4: Democratic Principles in Education 55). Therefore, as early as elementary education, molding the appropriate princip les of democracy in education should be inculcated by teachers to establish the appropriate foundation for respect, understanding and discipline. As a future teacher, the methods by which a classroom climate would promote the standard of adhering to the principles of democracy in education are: (1) respecting that each student is unique and diverse whose needs and competencies differ and therefore should be addressed according to the development of a â€Å"balanced and harmonious

Post-war Economy in Japan and China Essay Example | Topics and Well Written Essays - 2000 words

Post-war Economy in Japan and China - Essay Example General Douglas MacArthur held the fort of the Supreme Command of Allied Powers (SCAP), thereby commencing the reformation process that was essential for rebuilding the devastated nation (Caprio & Sugita, 2007). MacArthur endorsed an extensive series of social, political, militaristic and economic reforms that got rid of the feudal society. In 1945, the International Allied Council for Japan, whose creation was essential for assisting the United States, presided over the disbanding of Japan’s naval and military forces (Dower, 2000). Conversely, the Council controlled the dissolution of the colonial empire that was still in existence in Japan. The occupation policy by the Americans was not only essential for demilitarizing the country, but it was vital for destroying the existing conditions that had made Japan into an aggressor country (Dower, 2000). It was necessary for America to destroy these conditions to transform Japan into a democratic and peaceful nation that could not threaten other countries or international peace. The most apparent changes experienced were political. The political democratization focused on revising the Meiji constitution, leading to the promulgation of a new constitution in 1947 (Dower, 2000). Apart from expanding the electorate to accommodate every adult, including women, the new constitution guaranteed the citizens fundamental political and civil rights. Other guaranteed rights were inclusive of the rights to collective bargaining and the right of labor. Economically, America instituted land reforms, which was an essential consideration that could support the political changes made. The provision took away land from big landowners, thereby distributing the large tracts to the farmers who constituted approximately 50% of the labor force in the country (Dower, 2000). The Japanese inhabitants welcomed the changes implemented.

Project Progress Report Essay Example | Topics and Well Written Essays - 4000 words

Project Progress Report - Essay Example At present moment, reservation of a book is done manually. For this, the library users have to complete a reservation card and hand it to the librarian for reserving book and have to check regularly or have to wait for postcard, which is sent to their home address to confirm that the book is arrived and they can collect it. The library for which this database is being created is Wood Green Central Library and is located at 187-197A Wood Green High Road, London N22 6XD. The library has approximately 50 employees, has a turnover of 3 million, and is the main library for the borough of Haringey. Government grants helped to provide the library with a Learning Centre, a number of computers for public use, additionally several reading groups operate from this library, and there is space to host art exhibitions. The purpose of this reservation system is so that students, teachers and the housebound can gain a better service of the library and can take their time to search for a particular book that they want, whether it is for coursework or for teaching purposes. This system will be useful, efficient and user-friendly. In this reservation system, the user has an option either to search by title, author, publication or class (subject). This will be achieved by creating a simple reservation system for the local library by using Microsoft Access to produce a database. This work will be useful to other students who might be creating a database on a particular subject, as they will be able to gain ideas from the database that will be created. This paper is a project progress report (PPR) for a database reservation system for the library. This PPR will cover different topics, such as the scope and objectives of the project, database design and information analysis, methodology and approach, software/tools and modelling languages, schedule of the planned work, progress against the planned work, evidence for the progress claimed, current and

MARKETING PLAN Essay Example | Topics and Well Written Essays - 2500 words

MARKETING PLAN - Essay Example are creating the new plan, all details of the   company’s existing electronics marketing plan are to be considered irrelevant. The intent is   that current strategies, practices, etc., will be considered for relevance and possible   continuance only after your new plan has been presented to and is understood by top   management.   Given:   Company G’s team of engineers and designers have developed a line of top-quality small   appliances, and through concept and prototype testing, they have shown that the visual   design features are very appealing to potential buyers and give a distinct impression   associated with quality and artistic elegance. ... ach of the products in the line at a cost that   should enable them to emerge as the lowest-cost producer in the small-appliance industry.   Company G has a low debt-to-equity ratio and a high credit rating. It enjoys excellent   relationships with current suppliers, but because of differences in material requirements,   new raw material suppliers will be needed to support the small appliance line. Company G   will also need new suppliers for two component parts that will be purchased ready for   assembly into some of the small appliances.   The credit terms Company G offers to intermediaries in their distribution channel are typical   for their industry. Marketing research has shown that the company’s XG brand and logo are   readily recognized by most categories of electronics product consumers.   Abstract In the modern environment of commerce, companies must understand the purpose of gaining the technology leverage that is lacked from their competitors. I n this particular work, a company known as â€Å"Company G’s† marketing plan will be developed in order to ensure its supremacy in the market. Creating a market plan would allow the company to understand the risks and explore any opportunities that are available. As society progresses to 21st century, the fierce competition that looms in commerce as dramatically been enhanced. In this particular situation, Company G’s mission statement is â€Å"We enable consumers to improve the quality and convenience of their lives by providing  high-quality, innovative electronic solutions.†Ã‚   This same philosophy applies in their product line. Providing superior quality products is the focal point for this organization as it strives to enhance research and development. The revenue that companies accumulate is funded to

Perspectives Assignment Example | Topics and Well Written Essays - 750 words

Perspectives - Assignment Example It looks at how one thing relates to the other branches of the society. For example, how industrial or capitalistic relations coordinate with the economic, political and social relations of the said society. In the unitary perspective, any form of disagreement is viewed as very disruptive, unwanted and generally irrational (Waiganjo & Ng’ethe, 2012). This is because it is bound to spoil the state of tranquility that exists in this setting, which in normal cases is almost like a family. Conflicts are therefore solved through discussions, since the relationship here is taken to be mutually exclusive (Gordon, 2014). This essentially locks out the need for trade unions which usually should have taken this role of negotiation. As a result, the trade unions force themselves into the setup. In case they successfully do, they are in most cases pushed to the periphery of the organization since they are not really needed. Job regulation is perceived to be very mutual, where the needs, skills and requirements of the employee balance with those of the employer. As a result, employees enjoy their jobs and minima sackings or job discontinuities are observed. In the pluralist setup, conflicts and disagreements between the management and the employees is assumed to be a very normal occurrence. The leadership realizes that it has rival allegiances and attachments from its employees and an equilibrium has to be established (Michael, 1999).As a result negotiation and intensive arbitration are deemed necessary hence the need for trade unions, which are seen as essential for the rights of employees. They serve to agitate for the rights of the employees. Meanwhile, both parties are required to tread in a flexible manner, in order to avoid hard line stances that might scamper any negotiation attempt. Job regulation is maintained since the needs of the employee almost balance with the targets of the employer, and in case they don’t, trade

Module 2 Case Assignment Study Example | Topics and Well Written Essays - 1250 words

Module 2 Assignment - Case Study Example CPI/Original Year CPI) * 100 = ((234-217)/217)*100 =7.834 Part III: 1. Unemployment Rate = (Number of people Unemployed / Number of people in the civilian labor force) * 100 = (2500/30000) * 100 = 8.33 % 2. Now 500 people have stopped looking for a job so they will not be counted, as unemployed neither they will be counted in the total labor force. So now unemployment rate is: ={(2500-500)/(30000-500)} * 100 =(2000/29500) * 100 =6.78% Part IV: 1. As we can see that the interest rates on the treasury bonds tends to increase over the years. The difference among the rates in the bonds is caused by Maturity Risk Premiums. This is because to invest for a longer period is relatively risky due to the uncertainty in the economic conditions. 2. The statement that ‘the liquidity premium requires that an asset can be sold both quickly and for fair market value’ is false. This is because the liquidity premium is paid to the investors as a security. Since, the bonds ‘cannot be easily converted to cash’. They are paid a premium to compensate for the illiquidity. 3. Inflation over the years = (Change in CPI / Original CPI) * 100 = ((105-102.5)/102.5)*100 = 2.439 % Therefore, annual inflation rate over the 3 years is 1.02439. Divide 1 by the number of years, so we get 1/3. Now, 1.02439 ^ (1/3) is 1.00806. And subtracting 1 from 1.00806 will give us the annual inflation rate, which is 0.008064 or 0.8064 %. Investors should require a 0.8064% inflation premium. 4. The yield curve will not have an upward slope but rather a flatter curve since the investors will not get high rates of interest on purchasing bonds as the risk of investing is zero and the value of their capital will remain the same. Part V: 1. As we compare the GDP levels of the US, Japan, Canada and the UK, we can see the trends of the rate of their GDP growth in the respective years from 2008 till present. During 2008, the GDP of all the countries increased by a similar figure that is aroun d 1 to 1.5 percent. During 2009 the trends changed for all countries as we can see however to varying extents. The GDP of all countries decreased. This is visible from the negative rate of growth as we can see where the GDP of Japan was highly affected and it fell by 9 percent. However, the GDP of UK fell by 6 percent, of US around 5 percent and 4 percent for Canada. After 2010, the economic situation seemed better and the economies started to recover where Japan hit the rate of almost 14 percent, from a negative rate of 9 % to a positive 5. Other countries GDP also increased with UK increasing least. In 2011, the trend seemed somewhat stable for the US and Canada. The rate decreased a little for the UK. However, it was very static in the case of Japan until 2012. 2. The prices were increasing persistently during 2008 in all the countries. However, inflation rate in the US and in the UK was highest of about 4 percent. The inflation rate in Canada was about 3 percent while in Japan i t was 2 percent. During 2009, because of the economic crisis prices actually decreased, as it is visible from the figure, with Japan facing deflation 2 percent and the US of about 1.75 percent. Canada faced deflation of about 1 percent. While the prices in the UK did not decrease, they rose at a lesser rate. Gradually prices started rising during 2010 until 2012, with UK facing highest rate of inflation, following the US and Canada at a similar pace. And Japan was still stuck in

Ethics concepts Essay Example | Topics and Well Written Essays - 2000 words

Ethics concepts - Essay Example "Modern fertility treatments became the focus of much media attention in 1993 after the widely publicised case in which a 59 year old woman was enabled to give birth to twins by means of in vitro fertilisation with donated eggs and her partner's sperm. Fertility treatments raise a wide range of ethical and social issues" (Koch, 1993, p.143). Such factors as the potential child's welfare and interests are critical reasons for refusing to provide a couple with fertility treatment. In spite of the fact that the issue of conception is foremost in the present discussion, I would like to exemplify the situation with the process of child adoption. Even though it differs from conception, because the child already exists, authorities have established a number of criteria for adoption: parents' welfare, their personal qualities, health status and other information should be taken into account. These criteria are partially determined by supply and demand: for instance, potential parents are forced to compete with each other, because the number of infertile families is larger that the number of orphans who are to be adopted. Similarly, in vitro fertilization, associated with conception, poses following question: (bluntly speaking) will the child benefit from being born to these parents or would it be better if he/she never existed The likelihood of the particular potential child being born to another couple simply does not exist, and conception therefore is dissimilar to adoption in this sense. Naturally, it is hard to determine when it would be more preferable if the potential child didn't exist; the fundamental worth of an individual's life cannot be either measured or quantified, least of all if this life hasn't been started yet. It is possible to say, however, that the level of parents' responsibility would be rather low for it to be more favorable not to be born. Society's unwillingness to take care of a child excepting the most traumatic circumstances of horrible parenting proves this (Koch, 1993). Using the example of the 59-year old woman who gave birth to twins, a most important obstruction is that the mother will probably die when they are still at the stage of childhood, i.e. not having brought them up. "No doubt, other things being equal, it is preferable to have a mother who survives well into one's own adulthood. But to put this forward as a sufficient reason for denying fertility treatment is tantamount to claiming that it is better never to have existed than for one's mother to have died when one is still quite young" (Brindsen, 1992,p.280). In addition, in the case of in vitro fertilization, the interests of society are masqueraded as the potential child's interests. The procedure of selecting couples for the fertilization itself looks like the other official procedures that involve difficulties in distributing resources. There are two major hazards in failing to differentiate between the interests of the certain potential child and those of the potential children who might be born if resources were used to help other prospective parents instead. The first risk is that medical specialists may wrongly withhold the fertilization of the certain couple even if refusal to help them is not likely to bring benefit to other couples. The second hazard is that society may fail to support the process of

Learning Team Reflection Essay Example for Free

Learning Team Reflection Essay Learning Team D discussed the learning objectives provided for Week Three. Each Team Member posted a response to three informational questions posted by the Team Leader. During week three The Team Members felt comfortable with different topics. Sherly, Andrea and Katrina all felt the most comfortable with the topics dealing with Technology, R D, and Efficiency which were covered in chapter 11W. Sherly found the topic of invention the most fascinating because it allows people to just think up of an idea, experiment with it and develop it before finally developing it with the intent of putting it out on the market and earning some profits. An example of invention at work is a TV show on ABC called Shark Tank where inventors present their invention to members of the panel who are entrepreneurs/potential investors with the intention of selling a percentage of their business or product. Andrea felt that the chapter was an easy read and was more of a review on how businesses stay profitable and viable. From this chapter Andrea was able to learn that creating a fresh product at the optimal price is the key to success. Katrina was most interested in Technological Advance and Efficiency section covered in the chapter. The fact that improving ones technology can also contribute to economic efficiency was something that Katrina found interesting. Mark was comfortable with all the topics covered in week three and especially enjoyed learning more about the differences in operating in a monopoly, monopolistic competition, and an oligopoly. Danielle felt most comfortable with the process of supply and demand and how it plays an important role in the economy. Danielle feels that understanding how the supply and demand process works is beneficial and can be used to analyze decisions about prices and quantity. For Danielle having Learning Team D struggled with different topics that were covered during week three. Sherly struggled with Exploiting University and Government Scientific Research. Sherly thought that any product or potential product created by an individual or members of an organization could be patented. Andrea found it hard to understand visual presentations of the data by the example graphs. Andrea considered herself to be a visual learner but cannot seem to understand the graphs given. Katrina, like Andrea, found it hard to follow the examples given within each chapter but the reason behind her confusion dealt with actually being able to match the example to the reading. Katina felt that having to flip back and forth while reading to match the example that was given within the reading caused her to not fully understand what the example was trying to get across. Nonprice barriers to entry was the topic that Mark felt the most unsure about this week. Mark found it challenging to look beyond the numbers when analyzing something. Danielle struggled with pricing decisions, price elasticity, inelasticity, and elasticity of demand. The differences in monopolies and oligopolies was a bit of a struggle for Danielle but the examples that were provided within the reading helped her to grasp the information better. Each Team Member was able relate topics of the week to their organization’s field of business. Sherly works as an underwriter for an insurance company which provides health, life and disability insurance products and services. Reduced cost via process innovation was the topic that Sherly felt related to Underwriting. Sherly and her team are always looking for ways to change/update processes, reduce turnaround times between the receipt of an application for life/disability insurance coverage request to making the final determination whether to approve, postpone or decline a file. As an example, the introduction of a new system where applicants could go online to apply and depending on the information entered and the amount being requested, a determination can be done right there. This new system saved the company both time and money. We do not have to go through the omission process with this system since every question must be answered for the online application to be processed. When, we have to send applicants omission letters, the entire process takes longer since we have to wait to receive the missing information back from the applicant before the application can be processed. Andrea works in the finance industry for an airport. Andrea was able to apply the topic of mergers the most to my daily business field. At the airport, the airlines and rental car agencies combined resources on a regular basis. Department of Justice generally gets involved with these types of mergers to prevent monopoly behavior. For example, American and US Airways are currently under review and comment period for their merger. In addition to combining ticket counter space, it is anticipated that gates will be combined as well. The airport will lose money on the merger but customers will benefit from lower fares. The more customers that fly will make up for the shortfall in revenue for space rent lost by the airport. Katrina works in the field of Worker’s Compensation as a Claims Assistant. The topic of invention related the most to the type of work Katrina does at her job. Each day new claims are called into her office on a day to day bases and the way in which those calls are entered into the system must be efficient. Katrina and her team at her office created a new system for entering a new claim that is called into the office. Mark relates the topic of most of cost control and using developing technologies to lower cost to his field. That is an area we are constantly trying to improve upon whether the ideas come from our staff or from outside our organization and we work out a plan to implement them to help our business. Our franchise location does not develop technology but we have the opportunity to seek technology to increase the efficiency of our workers and also help save costs. Danielle works as a project manager for an energy efficiency consulting agency. As a project manager Danielle’s role is very significant in budgeting for a project for he/she is the one who determines the project costs and project budgets in line with the stakeholder’s specifications and resources. Budget allocation, collaborates with the project stakeholders and project financial coordinators to build a sensible budget plan that will sustain the whole project in all of its phases. Using cost control measures to insure they are staying within budget, as we understand the importance of increasing revenue and staying within budget. Revenue management is integral to a companys long-term strategy; without adequate income administration, the company may not be around long enough to implement its operating tactics. Each member of the Learning Team experienced a learning curve for Week Three. Sherly learning curve increased a little bit during this week. The additional information on monopoly provided Sherly with more information that helped her better understand what was taught in week two. The fact that certain opics such as monopoly, oligopoly, short run and long run, are being covered more in depth has also helped to increase her learning curve. Andrea’s still struggles with the graphs presented representing the demand curves. The economy of scale section has also been a struggle for her this week but Andrea has gone over the text in these sections multiple times for a better understanding. To increase her learning curve she finds that the lectures provided by our instructor breakdowns the topics in a mor e day to day format for easier comprehension. This week Katrina’s learning curve increased because she started to feel more comfortable with the terms and having a chapter that was easy to read through and understand made her feel more at ease with learning new Economic information. Mark’s learning curve for this week was changing his focus to look at big picture items using more theoretical concepts rather than concrete numbers. Mark enjoys the challenge that is presented by applying a different approach to analyzing what will impact a business from a market structure standpoint which will continue to increase his learning curve. Danielle feels that she’s beginning to understand the importance of Economics and how it relates to more than just money. Danielle hopes to continue to improve her understanding of the mathematical equations and graphs representing demand curves as the week’s progress. As the weeks go by the team still struggles with a few concepts but as the team moves forward they are developing and getting a better hold on the topics that are covered on a week to week bases.

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Gainesboro Machine Tools Corporation Essay Kendle International Inc. We looked at the competitive landscape and, based on what was happening, knew we were either going to sell Kendle, grow or disappear. It was May 1997, and Candace Kendle, the chairman and chief executive officer of Kendle International Inc. (Kendle), and her husband Christopher C. Bergen, the president and chief operating officer, were reviewing the strategic options for their Cincinnati, Ohio based company. Kendle, a business they had founded over 15 years previously, conducted clinical trials for pharmaceutical and biotechnology companies to test the safety and efficacy of their new drugs. The company had grown successfully to $13 million of sales and had attracted significant business from major pharmaceutical and biotechnology companies. Kendle was competing, however, with several larger contract research organizations (CRO), many of which had an international presence that allowed them to do clinical studies outside the United States and gave them an advantage when competing for major projects. To compete more effectively, Candace and Chris had embarked on a plan to grow through acquisition, particularly internationally, and to finance this growth through a public offering of equity. Toward this end, by the spring of 1997 Kendle had lined up two potential European acquisitions—U-Gene, a CRO in the Netherlands with 1996 sales of $12.5 million, and gmi, a Germanbased CRO with $7 million in sales. To finance these acquisitions, Kendle had worked out possible debt financing with Nationsbank and was working with two investment banks on an Initial Public Offering (IPO) that would repay the bank debt if successful and provide the equity base for future acquisitions. It was now time to decide whether to go ahead with the full program of two acquisitions, a large debt financing and an equity issue. Kendle History Candace and Chris met in 1979 while working at The Children’s Hospital of Philadelphia. Candace had received her doctorate in pharmacy from the University of Cincinnati, then taught in North Carolina and Pennsylvania. Her scientific specialty was virology. At the Children’s Hospital, Candace was serving as the director of pharmacy, working as an investigator on a study of an antiviral drug for the pharmaceutical company Burroughs Wellcome. Chris, a Wharton MBA, was a senior administrator at the hospital. Research Associate Indra A. Reinbergs prepared this case under the supervision of Professors Dwight B. Crane and Paul W. Marshall as the basis for class discussion rather than to illustrate either effective or ineffective handling of an administrative situation. Copyright  © 2000 by the President and Fellows of Harvard College. To order copies or request permission to reproduce materials, call 1-800-545-7685, write Harvard Business School Publishing, Boston, MA 02163, or go to http://www.hbsp.harvard.edu. No part of this publication may be reproduced, stored in a retrieval system, used in a spreadsheet, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without the permission of Harvard Business School. 1 Looking for something new, Candace and Chris began to discuss the idea of going into business together. One day in early 1981 Candace received an unexpected visit from a new physician, replacing the usual medical monitor for her project with Burroughs Wellcome. This physician was a pioneer in the  contract clinical research business. As he described how his business worked, Candace became more and more intrigued. When he left that day, she immediately called Chris and said, â€Å"I’ve got a business idea!† The concept was to set up a small research consulting firm that would take on outsourced research and development (RD) work on a contract basis from large pharmaceutical and biotechnology companies. Based on the positive response she received from potential clients, Candace left her job at the hospital in June 1981 and Chris left his job in December 1981. Kendle International Inc. was incorporated in Cincinnati, Ohio in 1981, with Candace taking 55% of the shares, and Chris 45%. Candace had strong ties to the Cincinnati area. Her grandfather, a coal miner, had moved there from Appalachia, and the clan had grown to about 140 members, including Candace’s two sons from a previous marriage. By January 1982, Candace and Chris were working from Candace’s parents’ home. Kendle started as a small company with a few contracts, and business grew slowly through referrals from professional colleagues. Kendle suffered the usual bumps of a start-up business, particularly in the late 1980s when it suffered a loss for two years and ran up $1 million in bank debt on a $250,000 line of credit. Afraid that its bank would call the loan, the company went through a bankruptcy scare. Fortunately, Kendle succeeded in attracting business from a new client, the pharmaceutical company G.D. Searle Co. (Searle). By the early 1990s, the company was turned around and it generated annual sales of about $2.5 million. Candace and Chris were married in 1991. The Pharmaceutical Lifecycle The clinical research process was influenced by government regulations that required drugs to pass through a series of steps before they could be marketed for public use. In the United States, the Food and Drug Administration (FDA) regulated pharmaceuticals. To receive FDA approval, a drug had to meet safety and efficacy standards for a specific indication (medical diagnosis). A drug for hypertension, for example, would have to lower blood pressure by a certain statistically significant amount without  producing unacceptable side effects. The entire FDA approval process could take from 8 to 15 years and involve several thousand patients.1 After a pharmaceutical company discovered a new drug and completed pre-clinical testing on animals in the laboratory, an Investigational New Drug application was filed with the FDA. The drug then passed through three phases of clinical testing on humans. Before beginning each subsequent phase, the drug company had to submit additional regulatory information to the FDA. Phase I Phase I studies were primarily concerned with assessing the drugs safety. This initial phase of testing in humans was done in a small number of healthy volunteers (20 to 100), such as students, who were usually paid for participation. Phase II Once Phase I testing had proven the drug’s safety, Phase II tested its efficacy in a small number of patients (100 to 300) with the medical diagnosis. It was specifically designed to determine the likely effective dose in patients. Phase III In a Phase III study, the drug was tested on a larger patient population (1,000 to 3,000) at multiple clinical sites. The purpose was to provide a more thorough understanding of the drugs effectiveness, benefits, and the range of possible adverse reactions. Most Phase II and Phase III studies were blinded studies in which some patients received the experimental drug, while control groups received a placebo or an already approved drug. Once a Phase III study was successfully completed, a pharmaceutical company requested FDA approval for marketing the drug by filing a New Drug Application, which averaged about 100,000 pages. †¢ 200-033 Phase IV Post-marketing testing (of at least 300 patients per trial) was sometimes conducted for high-risk drugs to catch serious side effects (liver toxicity) and monitor them for long-term effectiveness and cost-effectiveness. The pharmaceutical companies traditionally designed and conducted their own clinical trials. They selected the research sites and recruited investigators to conduct the trials of the new drug. Investigators were often medical school professors at teaching hospitals, but they could also be professional investigators who conducted clinical trials at dedicated centers or occasionally regular physicians who ran trials, particularly Phase IV trials, out of their private practices. These investigators then recruited patients, sometimes with the help of the pharmaceutical company, to participate in the study. After patients were recruited, there was a considerable amount of data collection by the investigators, monitoring of the process and data retrieval by the pharmaceutical company, and analysis of the data to determine whether the statistical criteria for safety and efficacy were met. Finally, there was the complicated process of compiling the data and preparing the long report for the FDA. The Contract Research Business In the 1970s, large pharmaceutical concerns in the United States began to look for ways to outsource their clinical testing work as their RD budgets grew. At the beginning, contract research was a small cottage industry and the work was awarded on a piecemeal basis. As Chris recalled, â€Å"For years, there had been companies conducting animal testing and Phase I, but there was no one managing the entire research and development process. The acronym ‘CRO’ (contract research organization) did not exist, pharmaceutical companies gave out only small contracts, and did not have much confidence in for-profit research managers.† The growth of the CRO industry was stimulated by pricing pressures on drug companies that led them to try to transfer the fixed costs of clinical research into a variable cost through outsourcing. As Chris described, The general problem that drug companies face is balancing a variable workload with a fixed workforce. The problem is that you don’t know when the guy in the white lab coat will come running down the hall, beaker in hand, shouting, ‘Eureka, I’ve got it, it’s going to cure disease X’. When he does that, you know your workload is going to spike. Your workload is impacted by the rate of discovery, the number of projects killed in vitro and, subsequent to that, how many studies get cancelled due to safety or efficacy problems in human testing. Pure CROs like Kendle derived their income solely from the outsourced portion of the RD budget of pharmaceutical clients. In theory, any part of the clinical testing process could be outsourced. While most pre-clinical discovery was conducted in-house by drug companies, the trend in the 1990s was for CROs to receive contracts to manage the entire clinical research piece, especially 3 Phases II and III. The whole process was an incredible race against time, as every day for which FDA approval was delayed could cost the pharmaceutical client over $1 million in lost revenues. Pharmaceutical contracts ranged in duration from a few months to several years. For multi-year contracts involving clinical trials, a portion of the contract fee was paid at the time the trial was initiated, with the balance of the contract fee payable in installments over the trial duration, as performance-based milestones (investigator recruitment, patient enrollment, delivery of databases) were completed. Contracts were bid by CROs on a fixed-price basis, and the research was a labor-intensive business. The contract bids depended on careful estimation of the hourly labor rates and the number of hours each activity would take. The estimation process involved statistical algorithms, which took into account the length of the study, frequency and length of site visits, the number of sites involved, the number of patients involved, and the number of pages per report form. A premium would be added for more complicated therapeutic testing. As the chief financial officer Tim Mooney described the business, The way that Kendle makes money is like any professional service firm—We focus on maximizing labor utilization, especially at the operational level. We assume a 65% to 70% utilization rate, so profit margins are higher if we have a higher utilization rate of personnel. We have the same assumed profit margin on all levels of people, but we can charge higher rates for contracts where we have specific therapeutic expertise that is in demand. Margins can also be higher on some large projects when we can share overhead costs across more sites. The business of contract research entailed several types of business risk. With contracts running at an average of $1 million for companies of Kendle’s size, client dependence was a major risk. Project cancellation by the client and â€Å"change orders† to reduce project costs were also increasingly frequent in the CRO industry, as healthcare cost pressures intensified. On the other hand, product liability for medical risks was borne by the pharmaceutical company. Competition in the 1990s By the mid-1990s, contract research had evolved into a full-service industry, recognized by both the pharmaceutical/biotech industries and the financial community. In 1995, worldwide spending on RD by pharmaceutical and biotechnology companies was estimated at $35 billion, with $22 billion spent on the type of drug development work that CROs could do. Of the $22 billion, only $4.6 billion was outsourced to CROs in 1995. While RD spending by pharmaceutical companies was growing at 10% a year, CROs were growing at twice that rate.2 Specialized CROs could manage increasingly complex drug trials—in the previous decade, the number of procedures per trial and average number of patients per trial had doubled—far more efficiently than their pharmaceutical clients.3 Kendle participated in this growth in clinical research. Its net revenues grew 425% from $2.5 million in 1992 to $13 million in 1996. From a loss of $495,000 in 1992, its net income rose to $1.1 million by 1996. By 1996, Kendle had conducted clinical trials for 12 of the world’s 20 largest pharmaceutical companies. Kendle’s three largest clients were G.D. Searle, Procter Gamble, and Amgen, which generated 48%, 19%, and 13% of Kendles 1996 revenues, respectively. (See Exhibits 1 and 2 for Kendle’s income statements and balance sheets.) 2 J.C. Bradford Co., analyst report, January 15, 1998, pp. 5-6. 3 The Economist, â€Å"Survey of the Pharmaceutical Industry,† February 21, 1998, p. 4.200-033 The contract research industry was very fragmented, with hundreds of CROs worldwide. In the 1990s, in response to the increased outsourcing of pharmaceutical RD, and a demand for global trials, consolidation among the CROs began. A few key players emerged and went public, creating a new industry for Wall Street to watch. Many CRO start-ups were founded by former drug company executives who decided to form their own operations. After a period of internal growth, some of the start-ups began growing through a financial â€Å"roll-up† strategy. An industry publication listed 18 top players in North America, with total contract research revenues of $1.7 billion. The top five public companies, ranked by 1996 revenues, were Quintiles Transnational Corp. ($537.6 million), Covance Inc. ($494.8 million), Pharmaceutical Product Development Inc ($152.3 million), ClinTrials Research Inc. ($93.5 million), and Parexel International Corp. ($88 million).4 (See Exhibit 3 for recent sales and pr ofit data on CROs.) With its talent pool of scientists at the Research Triangle and U.S. headquarters of the pharmaceutical giants Glaxo and Burroughs Wellcome (later merged as Glaxo Wellcome), the state of North Carolina quickly became the center of the burgeoning CRO industry. Two of the â€Å"big five† companies, Quintiles and Pharmaceutical Product Development, were started there by academic colleagues of Candace’s. Quintiles Transnational was considered to be the †gold standard of the industry.† Quintiles was founded in 1982 by Dennis Gillings, a British biostatistician who had worked at Hoechst and was a professor at the University of North Carolina, where Candace completed her postdoctoral work. After raising $39 million in a 1994 IPO, Quintiles went on an acquisition spree, adding other professional service businesses. For example, the firm provided sales and marketing services to support the launch of new drug products. By the end of 1996, Quintiles was the worldâ€⠄¢s largest CRO, with 7,000 employees in 56 offices in 20 countries. A typical clinical study managed by Quintiles was conducted at 160 sites in 12 countries, involving 10,000 patients. Quintiles was more diversified than many of its CRO competitors, with about 65% of revenues derived from the  core CRO business and 35% from other services.5 Pharmaceutical Product Development (PPD) was founded in 1989 by Fred Eshelman, a colleague of Candace’s from the postdoctoral program in pharmacy. Like the founder of Quintiles, Eshelman had worked in drug research for several pharmaceutical firms, including Glaxo and Beecham. PPD’s revenues jumped 500% between 1990 and 1994, based on such work as multi-year contracts for AIDS research for the National Institutes of Health. PPD conducted a successful IPO in March 1996, with its stock jumping from $18 per share to $25.50 per share on the first day of trading. PPD bought a U.K. Phase I facility in November 1995, and in September 19 96 merged with another leading CRO. Their combined net revenues exceeded $200 million. Kendle at the Crossroads To Candace and Chris, it was clear that certain competitive capabilities were necessary for companies of Kendle’s size to compete successfully with the major CROs: therapeutic expertise (in specific medical areas) broad range of services (pharmaceutical companies wanted to work with fewer CROs, with each offering a wide range of services across multiple phases of the RD process); integrated clinical data management (the ability to efficiently collect, edit and analyze data from thousands of patients with various clinical conditions from many geographically dispersed sites); 4 â€Å"Annual Report: Leading CROs,† RD Directions, September 1997, pp. 28+. 5 William Blair Co. LLC analyst report, Quintiles Transnational Corp., June 20, 1997, p. 3. international, multi-jurisdictional presence (to speed up drug approval, tests were being launched in several countries at once); With the exception of international presence, Candace and Chris felt comfortable with their ability to meet these criteria. Kendle’s staff had scientific expertise in multiple therapeutic areas, including cardiovascular, central nervous system, gastrointestinal, immunology, oncology, respiratory, skeletal disease and inflammation. The company also had broad capabilities, including management of studies in Phases II through Phase IV. It did not consider the absence of Phase I capabilities to be an issue, since this activity was quite separate. (See Exhibit 4 for a comparison of CRO geographical locations.) To build an integrated clinical data management capability, Chris had directed the development of TrialWare ®, a proprietary software system that allowed global data collection and processing and the integration of clinical data with clients’ in-house data management systems. TrialWare ® consisted of several modules including a database management system that greatly reduced study start-up costs and time by standardizing database design and utilizing scanned image technology to facilitate the design of data entry screens, the point-and-click application of edits from a pre-programmed library, and workflow management (parallel processing). Other modules included a system that coded medical history, medication and adverse event data and a touch-tone telephone system that was used for patient  randomization, just-in-time drug supply and collection of real-time enrollment data. Against the backdrop of a changing industry, Candace and Chris felt the need to develop additional business skills and focus Kendle’s strategy. To clarify their management roles, Candace and Chris switched their existing responsibilities. Chris pointed out, â€Å"Candace became CEO as we realized that her focus was long-range and I took over as Chief Operating Officer to focus on the short-range. In addition, the marketing strength of our competitors was propelling them further and further ahead of Kendle. Candace brought her science background and entrepreneurial skills, while I brought my management. The problem was that we were relatively weak in sales and marketing.† To broaden their skills, Candace went off in 1991 to the Owner/President Management Program (OPM), an executive education program run by Harvard Business School for three weeks a year over three years. Chris followed her to OPM in 1994. After completing the OPM program, Candace assessed the situation, We have to be big enough relative to our competitors to take on large, international projects. When Searle was looking for CROs for international work, all we could do was possibly subcontract it out to small shops. In contrast, Quintiles had six overseas offices of its own. Furthermore, when Searle calls and says, ‘I just got off the phone, Quintiles will cut their price by a million dollars,’ if you’re too small, you’re not going to be able to respond to that. Candace and Chris realized that Kendle could not grow fast enough internally to keep up with its peers and did not have the cash for acquisitions. They entertained the thought of selling Kendle, and were approached several times about a sale. But by nature, they were a competitive, athletic couple. Chris got up to play squash every morning at 7 AM, and Candace was an avid rower, recently winning a gold medal in a Cincinnati regatta. Perhaps not surprisingly, Candace and Chris decided to grow the firm and take it public rather than sell. As Candace described their motivation, â€Å"We were not driven to be a public company as such, but primarily to be bigger, and for this, we  needed public financing to succeed in the new competitive landscape. The whole target was not to let the big guys get too far out ahead of us.† Preparations for Growth By 1994, Kendle had grown to $4.4 million in revenues. Candace, the driving force throughout the IPO process, sought advice from an old college friend, a well-known Cincinnati businessman. He advised her, â€Å"before you go public, practice being a public company.† Candace therefore formulated a plan for Kendle to go public in 1999. Kendle began hiring key managers to build up functional units. Between 1994 and February 1997, new directors of clinical data management, information technology, biostatistics, finance, mergers and acquisitions, regulatory affairs, and human resources were hired. As Chris described, â€Å"the plan was to put this infrastructure in place to look and act like a public company— communications, IT, finance. The idea was hire at the top and they’ll fill in their organization.† Many of these new managers had previously worked together at other companies. To prepare for Wall Street scrutiny, Kendle began issuing internal quarterly fi nancial statements and sharing them with employees in an open-book management style. Candace and Chris tried to make the growing number of employees feel like â€Å"part of the family† in other ways, too. The Kendle â€Å"photo gallery† displayed professional portraits of employees with their favorite hobbies. In 1995 Chris led the development of a corporate mission statement and a document on strategic plans that was shared with all employees. Kendle was organized in a matrix fashion (see Exhibit 5 for organizational chart). Each department was treated as a strategic business unit (SBU) with a director who established standards and carried profit responsibility. At the same time, each research contract was managed by a project manager who assembled a team from across the various SBUs. Clinical trials involved five functional SBUs at Kendle: 1. Regulatory Affairs recruited investigators, helped them with FDA registration forms, and obtained approval from ethics boards. Regulatory Affairs maintained a database of 5,000 investigators. 2. Clinical Monitoring sent clinical research associates (CRA) out to the testing sites (every 4 to 6 weeks) to enforce Good Clinical Practice regulations. The CRAs were typically young, single health care professionals who spent a significant amount of their time on the road. The CRA would collect data from investigators, resolve queries generated by Clinical Data Management, and promote patient enrollment. 3. Clinical Data Management produced a â€Å"locked† database that could be submitted to the FDA. Data from case report forms were input into a computer system and â€Å"cleaned† through a manual review of the forms and an automated check of the databases. The challenge was to lock a database quickly while maintaining data quality. 4. Biostatistics would â€Å"unblind† the locked database and analyze it to determine if the data confirmed that the test results met the criteria for safety and efficacy. Biostatistics also defined the scope of new studies. 5. Medical Writing generated â€Å"the truckload of paper submitted to the FDA† for a New Drug Application, including a statistical analysis, a clinical assessment, preclinical and clinical data, a description of the manufacturing process, and the supporting patient documentation. 1996: The Celebrexâ„ ¢ Study, Filing Preparations, and European acquisitions 1996 was a busy year for Candace, Chris, and Kendle’s new management team. They simultaneously began conducting a major drug study, working with underwriters on IPO preparations, and looking for overseas acquisition targets. In 1996 Kendle managed 62 clinical studies at 4,100 sites involving approximately 20,000 patients. Celebrexâ„ ¢ Study In January 1996, Kendle began working on a major drug called Celebrexâ„ ¢ (celecoxib). Its client Searle was engaged in a neck-and-neck race with Merck, the largest U.S. drug company, to be the first to market a COX-2 inhibitor. A COX-2 inhibitor was a new type of anti-inflammatory drug that promised low incidence of bleeding ulcers in long-term, high-dosage users such as arthritis patients. The Searle-Merck race was closely followed in the business press. Searle awarded the international portion of the Celebrexâ„ ¢ contract to another CRO, since Kendle only had facilities for testing in the United States. However, Kendle did win the contract to conduct all the U.S. Phase II and III trials. The Celebrexâ„ ¢ contract was a â€Å"huge feather in our cap,† recalled the chief financial officer. â€Å"In order to beat Merck, we worked very hard and kept compressing the timelines.† To head the Celebrexâ„ ¢ project, Kendle hired Bill Sietsema, PhD, as assistant director of clinical research. A therapeutic expert in skeletal diseases and inflammation, Sietsema had worked at Proctor Gamble for 12 years. While Sietsema served as overall program director, Chris acted as the operational project manager, meeting with his Searle counterpart in Chicago on a monthly basis. In early 1997, Kendle also set up a new regional office in Chicago, close to Searle headquarters. For Kendle, the Celebrexâ„ ¢ project was a chance to â€Å"show what we could do and to develop a reputation as a leader in the field of skeletal disease and inflammation.† Kendle actively helped investigators recruit arthritis patients, running television advertisements, directing interested volunteers to a call center. Three hundred  investigators enrolled over 10,000 patients, producing over one million pages of case report forms. Most importantly, through close integration of information systems with Searle, Kendle was able to beat an industry standard. Instead of taking the typical six months to one year, the time span between the last patient in Phase II and the first in Phase III, which began in June 1996, was only 22 days. Preparation for SEC Filing By the time the Celebrexâ„ ¢ program rolled around, Candace and Chris felt that they might have to go public earlier than intended because of the competitive landscape. The new chief financial officer, Tim Mooney, took a leading role in the preparations. Prior to joining Kendle in May 1996, Mooney had worked as CFO at The Future Now, Inc., a computer reseller and Hook-SupeRx, a retail drugstore chain. At Kendle, Mooney replaced the controller with an audit manager from Coopers Lybrand to beef up his staff. Mooney also led the building of many of the other financially related departments at Kendle. To act as the lead underwriters on the IPO, in August 1996 Mooney chose two regional investment banks, Chicago-based William Blair Company, L.L.C., which had handled the 1995 IPO of Kendle’s competitor Parexel, and Wessels, Arnold Henderson from Minneapolis. William Blair began putting Kendle through the paces of preparing to file a preliminary prospectus with the U.S. Securities and Exchange Commission (SEC). The process of going public generally took from 60 to 180 days. One of the key steps in the process was the conversion of Kendle from a subchapter corporation to a C corporation at the time of the IPO. (Subchapter S corporations were entities with 35 or fewer shareholders that were treated like partnerships for tax purposes. Corporate income tax was passed through tax-free to the owners who then paid personal income taxes due.) U-Gene In October 1996 Mooney hired Tony Forcellini, a former colleague, as director of mergers and acquisitions (MA). Tony had worked at Arthur Andersen in the tax department, and then as a treasurer at Hook-SupeRx with Mooney. The search for European acquisition targets was mainly conducted by Candace and Tony Forcellini, with back-up support by Tim Mooney and Chris. All the while, Chris and Bill Sietsema were working away on the Celebrexâ„ ¢ program. Forcellini’s first decision was easy—whether to pursue an offering memorandum that landed on his desk shortly after he arrived. The company for sale was U-Gene Research B.V. (U-Gene), a CRO based in Utrecht, the Netherlands. U-Gene was represented by Technomark Consulting Services Ltd. (Technomark), a London-based consulting firm uniquely specializing in the healthcare industry. Technomark had an extensive database on European CROs and was primarily in the business of matching its pharmaceutical company clients’ trial s with appropriate European CROs, but it also had a small investment banking division. U-Gene, a full-service CRO, was an attractive target for Kendle. The venture capitalist owners were actively looking for buyers. With a 38-bed Phase I facility in Utrecht and regional offices in the United Kingdom and Italy, U-Gene could increase both Kendle’s service offering and geographic presence. Since its founding in 1986, U-Gene had served more than 100 clients, including 19 of the worlds largest pharmaceutical companies. In 1996, U-Gene participated in 115 studies at approximately 500 sites involving approximately 4,700 patients and recorded net revenues of $12.5 million, a 37% increase over the prior year, and operating profit of $1.3 million, a 47% increase over the prior year. Because of its U.K. and Italian offices, U-Gene viewed itself as on the way to becoming a pan-European CRO.  (See Exhibit 6 for U-Gene financial statements.) With momentum building, in November 1996, Forcellini seized upon U-Gene as Kendle’s possible entry into Europe and submitted a bid, offering cash and private stock. Unfortunately, Kendle lost out on this bid to a competitor, Collaborative Clinical Research, Inc, as U-Gene’s owners either wanted a full cash deal or stock from a public company. Collaborative was a competitor slightly larger than Kendle ($25.7 million in revenues) that had gone public in June 1996 and had established a software partnership with IBM. Although it had access to investigators outside the United States, Collaborative also viewed U-Gene as the establishment of a European presence. On February 12, 1997 Collaborative announced that it had signed a letter of intent to acquire U-Gene in exchange for 1.75 million newly issued shares. While this put Kendle out of the picture, the prospects of a deal were not completely killed. On the same day, February 12, 1997, Collaborative also announced that its first-quarter 1997 earnings would be significantly below expectations. On the next day, on analyst speculation that a major client contract had been lost, their stock fell by 27.3%, closing at $9.00.6 This put Collaborative’s UGene deal in jeopardy. Underwriter Concerns About two weeks after Collaborative’s announcement, on February 25, 1997, another CRO, ClinTrials, also suffered a drop in stock price. ClinTrials’ stock lost more than half its market value,  dropping 59%, to $9.50 per share. The fall began when an analyst from Wessels Arnold downgraded the ClinTrials stock to â€Å"hold† from â€Å"buy,† citing a number of key management departures, and continued after ClinTrials announced that its first-quarter earnings would be half its year-earlier profit. The reason for the unexpected earnings decline was the cancellation of five projects totaling $37 million, with the possibility of even lower earnings due to an unresolved project dispute with a client.7 ClinTrials’ negative performance began to affect other CRO stocks, including that of Quintiles.8 With client concentration an issue in ClinTrials’ stock performance, William Blair developed doubts about the timing of Kendle’s IPO. Although Kendle was close to filing its preliminary prospectus, on the day after ClinTrial’s stock dropped, William Blair analysts had a meeting with Kendle’s management and told them that they had decided to withdraw as lead underwriters in the IPO. Candace was resolved to keep going. She said, â€Å"There’s no way out of the concentration issue. We can’t buy our way out of it, because we can’t do MA deals until we have a public currency, and every day Searle is bringing us more work, we won’t tell them no.† She then asked Mooney to find new investment bankers, and he thought, â€Å"what am I going to do now?† Hoping for a lead, Mooney called up a former security analyst from Wessels Arnold who had gone to work at Lehman Bros. Although Kendle was smaller than Lehman’s usual clients, Lehman agreed to underwrite Kendle’s IPO, with the reassurance that â€Å"we think we can sell through the client concentration issue.† After an agreement with New York-based Lehman was reached, Mooney searched for a regional firm because, as he decided, â€Å"I didn’t want two New York-size egos. J.C. Bradford, based in Nashville, Tennessee, had a good reputation in the industry, and struck us as a nice regional bank. They were more retail-oriented than institutional-oriented, so they wouldn’t directly be competing with Lehman in types of clientele.† Bradford had managed the IPO of the first large CRO to go public (ClinTrials, in 1993) and Lehman had led the IPO of PPD in January 1996. Gmi and U-Gene revisited At the same time, Forcellini was moving ahead on the acquisition search. In January 1997 he tasked Technomark with using its CRO database to generate a list of possible European acquisition targets that met the following criteria: â€Å"ideally a CRO with United Kingdom headquarters; $5 million to $7 million in revenues; no Searle business; certain types of therapeutic expertise; strong in phases II through IV; and certain country locations.† The initial list had 50 European CROs, which Kendle narrowed down to 14 prospects. Technomark then contacted these 14 prospects to sound out their willingness to sell, bringing the number down to five candidates: three CROs in Germany, two in the United Kingdom, and one in the Netherlands (not U-Gene). To assess the prospects, Kendle used information from Technomark on comparable MA deals. Candace and Tony Forcellini then traveled around Europe for a week visiting the five companies. They decided to further pursue two companies: a small, 15-person monitoring organization in the United Kingdom and one in Germany. The U.K. prospect was quickly discarded because of an aggressive asking price and accounting problems. Kendle then moved on to the German target, a company named gmi. Its full name was GMI Gesellschaft fur Angewandte Mathematik und Informatik mbH. Founded in 1983, gmi provided a full range of Phase II to IV services. gmi had conducted trials in Austria, the United Kingdom, Switzerland and France, among other countries, and had experience in health economic studies and 7 â€Å"ClinTrials Predicts Sharply Lower Profit: Shares Plunge 59%†, The Wall Street Journal, February 26, 1997, p. B3. 8 David Ranii, â€Å"Investors avoiding Quintiles,† The News Observer, Raleigh, NC, February 27, 1997, p. C8. professional training programs. In 1996, gmi participated in 119 studies at multiple sites and recorded net revenues of $7 million, a 32% increase over the prior year, and operating profit of $1.4 million, a 16% increase over the prior year. At March 31, 1997, gmis backlog was approximately $9.6 million. gmi considered itself to be especially good at Phase III trials. (See Exhibit 7 for gmi financial statements.) While Candace and Forcellini were narrowing down European targets, Mooney was hunting for cash. In February 1997 Kendle met at a special lunch with its existing bankers, Star Bank (later renamed Firstar), in Cincinnati. Mooney recalled the conversation vividly: â€Å"After Candace and Chris described their plans, Star Bank’s CEO made a proposal, ‘If you keep Kendle a private company and avoid the hassles of being public, we’ll lend you the money you need for acquisitions.’† With the financing in hand, Candace and Forcellini visited gmi in Munich. While gmi’s owners were willing to talk, they did not have much interest in selling. As Mooney described it, â€Å"gmi was a classic case of having grown to a certain size, had a comfortable level of income, but weren’t interested in putting in the professional systems to grow beyond that level.† After several conversations in March, it was not clear that Kendle and gmi’s owners w ould be able to reach a mutually agreeable price. At this point in early April 1997, the possibility of U-Gene as an acquisition candidate heated up. After the U-Gene deal with Collaborative Research began to collapse, Kendle had initiated a carefully structured inquiry about U-Gene’s interest in renewed discussions. This inquiry led to further discussions and a request in April for Kendle to meet in Frankfurt to try to reach an agreement. With the gmi deal in doubt, Kendle agreed to try to reach closure with U-Gene. After some discussion, both sides agreed on a price of 30 million Dutch guilders, or about US$15.6 million, $14 million of which would be paid in cash, and the remaining $1.6 million would be in the form of a promissory note payable to the selling shareholders.  U-Gene wanted to complete the transaction within the next several weeks, so it would have to be financed at least initially by borrowings. Even if Kendle went ahead with an IPO, the equity financing would not be completed until the end of the summer. Discussions with gmi continued through this period since Kendle was confident about its ability to obtain financing from Star Bank. Ultimately, Kendle’s team was able to agree upon a price with gmi. The owners were willing to accept a price of 19.5 million Deutsche marks, or about US$12.3 million, with at least $9.5 million in cash. They would accept shares for the remaining $2.8 million, if Kendle successfully completed an IPO. The owners were willing to hold off the deal until the IPO issue was resolved. Closing the Deals and IPO Decision To complete both the U-Gene and gmi deals, Kendle would need to borrow about $25 million to $28 million, so financing became critical. Mooney went back to Star Bank to take the bankers up on their promise. He described their reaction: â€Å"Star Bank said they couldn’t lend $28 million to a company that only has $1 million in equity. Nobody did that. They might be willing to finance one acquisition, with the help of other banks, but there was no way that they would provide $28 million.† Mooney was quite angry, but had no choice but to look for other sources of financing. He first tried to get bridge financing from Lehman and Bradford, but they refused, saying that they had â€Å"gotten killed on such deals in the 1980s.† There was also a possibility of financing from First Chicago Bank, but this did not materialize. Finally, in late April 1997, Mooney contacted NationsBank, N.A., which was headquartered in Charlotte, North Carolina and provided banking services to the CRO industry. Nationsbank expressed interest, but only in a large deal. Even $28 million was a small amount to Nationsbank. In 11  a few short weeks, Nationsbank ended up structuring a $30 million credit for Kendle, consisting of a $20 million, three-year revolving credit line and $10 million in five-year, subordinated notes. The interest rate on the credit line was tied to a money market base rate plus 0.50% (currently totaling 6.2%), and the subordinated debt carried a 12% rate. †So NationsBank stepped up in a pretty big way. They could have ended up with Kendle as a private company, with $30 million in debt.† Because of the risk, Nationsbank would also take warrants giving the bank the right to purchase 4% of Kendle’s equity, or up to 10% if the IPO was delayed and Kendle had to borrow the full amount to do both acquisitions. Lehman Brothers was confident about an IPO. The underwriters felt Kendle could raise $39 million to $40 million at a price between $12 and $14 per share, and that Candace and Chris could sell some of their shares as well. Premier Research Worldwide Ltd., a CRO with $15.2 million in 1996 revenues, had raised $46.75 million from its recent IPO in February 1997. Kendle felt they had a much better track record than Premier. Kendle now faced some difficult decisions. It could do the full program, including both acquisitions, taking the $30 million Nationsbank deal, and planning for an IPO in late summer. The successful acquisitions of gmi and U-Gene would establish Kendle as the sixth largest CRO in Europe, based on total revenues, and one of only four large CROs able to offer clients the full range of Phase I through Phase IV clinical trials in Europe. The pricing on the two acquisitions of 8 to 10 times EBITDA seemed in line with recent CRO deals (see Exhibit 8). And, once the IPO was completed, Kendle would have both a cash cushion and stock as a currency to help finance future growth and acquisitions. Assuming an IPO of 3 million new shares at a price of $13.00, Kendle would have a cash position of about $14 million and no debt in the capital structure. (See Exhibits 9 and 10 for pro forma  income statements and balance sheets showing the impact of the acquisitions and the IPO.) A related issue was how many of their shares Candace and Chris should sell if an IPO were done. Their current thinking was to sell 600,000 shares. Thus, a total of 3.6 million shares would be for sale at the time of the IPO, including a primary offering of 3 million shares and a secondary offering of 600,000 shares. This sale would reduce holdings controlled by Candace and Chris from 3.65 million shares (83.1% of the shares currently outstanding) to 3.05 million shares (43.4% of the new total outstanding). Doing the full IPO and acquisition program, however, was unprecedented among Kendle’s peers. â€Å"Nobody does this combination all at once—an IPO, senior- and sub-debt financing, and MA deals,† as Mooney described the situation. Furthermore, the stock prices of public CROs had been falling since last February (see Exhibits 11 and 12 for stock market valuation and price information). If Kendle bought into the full program and the market crashed or the IPO was unsuccessful, the company would have almost $30 million of debt on its books with a very modest equity base. Perhaps it would be better to do just the U-Gene acquisition and use Star Bank to finance it. After completing this acquisition, it could then pursue the IPO. This approach was safer, but of course Kendle might miss the IPO window and miss the opportunity to acquire the second company. Indeed, instead of discouraging Kendle from doing an IPO, the fall in CRO stock prices might be taken as a signal tha t Kendle should forge ahead before the window closed completely.

Trabecular Bone Structure of the Distal Radius

Trabecular Bone Structure of the Distal Radius Background information The distal end of the radius forms two palpable points, radially the styloid process and Listers tubercle on the ulnar side. Many studies have been carried out using a variety of methods to evaluate bone strength, mineralisation and architecture. Using skeletal remains to identify degradation of the trabecular bone in both male and female of various ages at death. Previous research in the field of forensic anthropology has shown that regional variation across such sections may be masked through use of a global analysis provides good results but with room to improve as technology becomes increasingly available (Boyd, S. 2015). Sode et al carried out a study that looked at sectioning the distal radius into axial sections and using high resolution peripheral quantitative computed tomography (HR-pQCT) to conclude whether similar results were obtained through global analysis and sectional analysis. The distal end of the radius forms two physical points, the styloid process on the radius side and Listers tubercle on the ulnar side. A medullary cavity is enclosed in a strong wall of compact bone, which is thickest at the interosseous border and thinnest at the extremities. The trabeculae of the spongy tissue arch at the upper end and pass from the compact layer of the shaft to the articular head. The radius has a body and two extremities. Sectioning the distal radius and taking images that can be analysed, measured and averages taken will provide higher accuracy and minimise artefacts found in other studies. HR-pQCT is a non-invasive, method for assessing bone microarchitecture and volumetric bone mineral density in cortical and trabecular compartments of the distal radius that has a low radiation risk. Its use in clinical research has increased enormously in recent years and has changed the understanding of age-related changes and sex differences in bone microarchitecture. Changes in bone structure across a wide range of bone metabolic disorders, fracture risk have also benefitted from this method. The accessibility of HR-pQCT has made it viable to gage three-dimensional bone microarchitecture and volumetric bone mineral density in vivo, with an accuracy that had yet to be achieved with other methods ( ). Recent studies using this new imaging tool has amplified understanding of age-related changes and sex differences in bone microarchitecture. The use of finite element analysis modelling to non-invasively estimate bone strength and predict fractures using reconstructed three-dimensional images is a great benefit and more suitable than invasive techniques using stronger doses of radiation. Regional analysis, by dividing the HR-pQCT images of the radius cross-section, provides corresponding information about the core structural diversity of trabecular structure that is coupled with underlying biomechanical conditions. We hypothesize that trabecular bone structure varies spatially across the trabecular compartment at the distal radius, and the degree of differences due to gender and age depend on the region. Gordon et al suggests the increased sensitivity achieved by their indices suggests that an in vivo assessment of trabecular bone structure can contribute significantly to the identification of persons at risk of fracture in the living (Gordon, C., Webber, C., Adachi, J. and Christoforou, N.2017). AIM OF PROPOSED RESEARCH Regional variation in trabecular structure across axial sections is often obscured by the conventional global analysis, which takes an average value for the entire trabecular compartment. The objective of this study is to use in vivo HR-pQCT to investigate regional variations in trabecular structure at the distal radius and its differences due to gender and age. HYPOTHESIS As age progression occurs, the bone volume fraction in trabecular bone of the distal radius will decrease as age increases. The null hypothesis concur that the bone volume fraction will show no change as age increases. RECRUITMENT       Access to a large, modern, well documented bone collection is available. Provenance, age, sex and cause of death are known. Radial bones will be sourced from this collection to include individuals ranging from 18 78 years of age. Two groups, male and female will be used. Statistical values were calculated and are shown in table 1. Table 1: Results of the statistical calculations used on the data set. An estimation of 278 samples is needed for this study. However, for research to progress, this data and calculation will again be confirmed to ensure the figures are correct for valid results. INCLUSION AND EXCLUSION CRITERIA Bones from the radius will be used from the collection and taken from individuals of both genders aged 18 -78 at time of death. Any specimens indicating pathology will be void from this study. ASSUMPTIONS AND PRECAUTIONS Based on a previous study, carried out by Boyd et al states that HR-pQCT is a non-invasive, low-radiation method for the analysis of bone specimens meaning that very limited exposure will result. Health and safety will be witnessed while using the apparatus necessary to obtain the images. In agreement with guidelines published by the health and safety executive in 2012 the doses of radiation will also be monitored and recorded. Personal protective equipment to include a laboratory coat, gloves and goggles will be worn to prevent contamination or damage to the bone collection. As demonstrated in numerous studies conventional global analysis can obscure regional differences. MATERIALS Equipment required for this study is based on the study using HR-pQCT led by Sode et al (Sode et al., 2008) High-resolution peripheral quantitative computed tomography (HR-pQCT)- the XtremeCT Image Processing Language (Scanco Medical AG, Brà ¼ttisellen, Switzerland) Matlab Finite element analysis (FEA) modeling   Ã‚   The x-ray source potential was 60 kVp with a current of 900 ÃŽÂ ¼A. A two-dimensional detector containing 3072 ÃÆ'- 256 CCD elements was used to acquire 750 projections at a 100 ms integration time per projection. The 12.6 mm field of view was reconstructed across a 1536 ÃÆ'- 1536 matrix, yielding 82 ÃŽÂ ¼m isotropic voxels. The images were segmented and managed in agreement with the standard patient-style analysis protocol using Image Processing Language (Sode et al., 2008). ANALYSIS The HR-pQCT systems have been thoroughly tested for both accuracy and precision using ÃŽÂ ¼CT of ex vivo bone as the gold-standard (Sode et al., 2008). The distal radius of each subject was imaged using an in vivo HR-pQCT scanner. A 10mm section of the radius was imaged on both sides to avoid dominant hand Bias. Acquisition time per image was 3 minutes per scan and images were instantly reviewed for artifacts and repeated if any were detected (Boyd, 2015). 9 images were excluded due to artifacts. A semi-automated edge-defining algorithm was applied to mark areas of cortical bone and the target trabecular bone on the surface. The cortical and trabecular regions were sectioned automatically by the analysis protocol as described in detail by Laib et al (Laib et al,1996). Using MATLAB, the trabecular region was divided into inner and outer sub regions. Additionally, inner and outer trabecular compartments were divided into bony quadrants at each section based on the defined reference line from MATLAB to give 8 sub regions in total. Statistical analysis was undertaken using a Shapiro-Wilk test to predict the normality of the data. Due to separation and standard deviation of trabecular separation the data was not normally distributed so non-parametric statistical analysis was carried out. RECOMMENDATIONS FOR FUTURE WORK This method of analysing trabecular bone thickness will be a valuable tool both with cadaveric material and living individuals due to the low radiation risk associated. In terms of research to aid the living many fields could gain invaluable knowledge of the risk of fractures and the development and tracking of disease such as osteoporosis. The repeatability of this study will enable others to repeat with greater sample numbers. However, at present its high cost means HR-pQCT is still a research tool, the high resolution and efficiency of this method exposes advantages over the methods used at present for bone assessment which will in time prove an invaluable clinical tool. In the future, regional differences in age-related changes of trabecular structure at the distal radius should be examined in a longitudinal study using slighlty larger radial cross sections. References Boutroy, S., Van Rietbergen, B., Sornay-Rendu, E., Munoz, F., Bouxsein, M. and Delmas, P. (2007). Finite Element Analysis Based on In Vivo HR-pQCT Images of the Distal Radius Is Associated with Wrist Fracture in Postmenopausal Women. Journal of Bone and Mineral Research, 23(3), pp.392-399. Boyd, S. (2015). High resolution imaging of bones by high-resolution peripheral quantitative computed tomography. Bone Abstracts. Clarke, B. (2017). Normal Bone Anatomy and Physiology. [online] Clinical journal of the American society of nephrology. Available at: http://cjasn.asnjournals.org/content/3/Supplement_3/S131.full [Accessed 19 Mar. 2017]. Dalzell, N., Kaptoge, S., Morris, N., Berthier, A., Koller, B., Braak, L., van Rietbergen, B. and Reeve, J. (2009). 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Li, H., Zhang, A., Bone, L., Buyea, C. and Ramanathan, M. (2014). A Network Modeling Approach for the Spatial Distribution and Structure of Bone Mineral Content. The AAPS Journal, 16(3), pp.478-487. MacNeil, J. and Boyd, S. (2007). Accuracy of high-resolution peripheral quantitative computed tomography for measurement of bone quality. Medical Engineering Physics, 29(10), pp.1096-1105. McDonald, J. (2012). Standardisation in Standards. Radiation Protection Dosimetry, 148(4), pp.387-388. Melton, L., Riggs, B., van Lenthe, G., Achenbach, S., Mà ¼ller, R., Bouxsein, M., Amin, S., Atkinson, E. and Khosla, S. (2007). Contribution of In Vivo Structural Measurements and Load/Strength Ratios to the Determination of Forearm Fracture Risk in Postmenopausal Women. Journal of Bone and Mineral Research, 22(9), pp.1442-1448. Moore, K., Agur, A. and Dalley, A. (2015). Essential clinical anatomy. 1st ed. Philadelphia: Wolters Kluwer Health. Popp, A., Buffat, H., Eberli, U., Lippuner, K., Ernst, M., Richards, R., Stadelmann, V. and Windolf, M. (2014). Microstructural Parameters of Bone Evaluated Using HR-pQCT Correlate with the DXA-Derived Cortical Index and the Trabecular Bone Score in a Cohort of Randomly Selected Premenopausal Women. PLoS ONE, 9(2), p. e88946. Sode, M., Burghardt, A., Kazakia, G., Link, T. and Majumdar, S. (2010). Regional variations of gender-specific and age-related differences in trabecular bone structure of the distal radius and tibia. Bone, 46(6), pp.1652-1660. Sode, M., Burghardt, A., Nissenson, R. and Majumdar, S. (2008). Resolution Dependence of the Non-Metric Trabecular Structure Indices. Bone, 42(4), pp.728-736. White, T. and Folkens, P. (2005). The human bone manual. 1st ed. Amsterdam: Elsevier Academic, pp.31-48.