Human Activities Undermine the Environment Research Paper

Human Activities Undermine the Environment - Research Paper Example Interestingly, man’s exploitation of the environment can be traced throughout medieval history from the days of the scratch-plow and cross-plowing in the European continent; the subsequent invention of a more efficient plow that could cut the line of the furrow sharply defined man as the master of the environment rather than part of nature. Man’s power over nature has been captured vividly in western illustrated calendars before A.D. 830, which depict man as the exploiter of the environment through actions such as plowing, harvesting, chopping trees as well as butchering pigs (White, 1974). This clearly shows that man and the environment are entirely different things and that man has authority over his surroundings; in that respect, man’s exploitative relation with nature is not an entirely new phenomenon, given its documentation in medieval times. Biblically, man is charged as the custodian of the environment with all creation meant for man’s use; this al so underscores man’s authority over nature that has been the focus of Christian beliefs. The idea that man is superior to nature has inevitably informed man’s exploitative attitudes and tendencies that have in most cases rendered ecologies derelict through human maneuverings that have inevitably instigated numerous negative impacts.  There is great need for rethinking of man’s relation to nature, particularly given that the conceptualization of this man-nature relationship determines man’s impact on the environment.

British Airways Essay Example for Free

British Airways Essay I remember going to parties in the late 1970s, and, if you wanted to have a civilized conversation, you didnt actually say that you worked for British Airways, because it got you talking about peoples last travel experience, which was usually an unpleasant one. Its staggering how much the airlines image has changed since then, and, in comparison, how proud staff are of working for BA today. British Airways employee, Spring 1990 I recently flew business class on British Airways for the first time in about 10 years. What has happened over that time is amazing. I cant tell you how my memory of British Airways as a company and the experience I had 10 years ago contrasts with today. The improvement in service is truly remarkable. British Airways customer, Fall 1989 In June of 1990, British Airways reported its third consecutive year of record profits,  £345 million before taxes, firmly establishing the rejuvenated carrier as one of the worlds most profitable airlines. The impressive financial results were one indication that BA had convincingly shed its historic â€Å"bloody awful† image. In October of 1989, one respected American publication referred to them as â€Å"bloody awesome,† a description most would not have thought possible after pre-tax losses totalling more than  £240 million in the years 1981 and 1982. Productivity had risen more than 67 percent over the course of the 1980s. Passengers reacted highly favorably to the changes. After suffering through years of poor market perception during the 1970s and before, BA garnered four Airline of the Year awards during the 1980s, as voted by the readers of First Executive Travel. In 1990, the leading American aviation magazine, Air Transport World, selected BA as the winner of its Passenger Service award. In the span of a decade, British Airways had radically improved its financial strength, convinced its work force of the paramount importance of customer service, and dramatically improved its perception in the market. Culminating in the privatization of 1987, the carrier had undergone fundamental change through a series of important messages and events. With unprecedented success under its belt, management faced an increasingly perplexing problem: how to maintain momentum and recapture the focus that would allow them to meet new challenges. Crisis of 1981 Record profits must have seemed distant in 1981. On September 10 of that year, then chief executive Roy Watts issued a special bulletin to British Airways staff: British Airways is facing the worst crisis in its history . . . unless we take swift and remedial action we are heading for a loss of at least  £100 million in the present financial year. We face the prospect that by next April we shall have piled up losses of close to  £250 million in two years. Even as I write to you, our money is draining at the rate of nearly  £200 a minute. No business can survive losses on this scale. Unless we take decisive action now, there is a real possibility that British Airways will go out of business for lack of money. We have to cut our costs sharply, and we have to cut them fast. We have no more choice, and no more time . Just two years earlier, an optimistic British government had announced its plan to privatize British Airways through a sale of shares to the investing public. Although airline management recognized that the 58,000 staff was too large, they expected increased passenger volumes and improved staff productivity to help them avoid complicated and costly employee reductions. While the 1978-79 plan forecasted passenger traffic growth at 8 to 10 percent, an unexpected recession left BA struggling to survive on volumes, which, instead, decreased by more that 4 percent. A diverse and aging fleet, increased fuel costs, and the high staffing costs forced the government and BA to put privatization on hold indefinitely. With the airline technically bankrupt, BA management and the government would have to wait before the public would be ready to embrace the ailing airline. The BA Culture, 1960-1980 British Airways stumbled into its 1979 state of inefficiency in large part because of its history and culture. In August 1971, the Civil Aviation Act became law, setting the stage for the British Airways Board to assume control of two state-run airlines, British European Airways (BEA) and British Overseas Airways Corporation (BOAC), under the name British Airways. In theory, the board was to control policy over British Airways; but, in practice, BEA and BOAC remained autonomous, each with its own chairman, board, and chief executive. In 1974, BOAC and BEA finally issued one consolidated financial report. In 1976, Sir Frank (later Lord) McFadzean replaced the group division with a structure based on functional divisions to officially integrate the divisions into one airline. Still, a distinct split within British Airways persisted throughout the 1970s and into the mid-1980s. After the Second World War, BEA helped pioneer European civil aviation. As a pioneer, it concerned itself more with building an airline infrastructure than it did with profit. As a 20-year veteran and company director noted: â€Å"The BEA culture was very much driven by building something that did not exist. They had built that in 15 years, up until 1960. Almost single-handedly they opened up air transport in Europe after the war. That had been about getting the thing established. The marketplace was taking care of itself. They wanted to get the network to work, to get stations opened up.† BOAC had also done its share of pioneering, making history on May 2, 1952, by sending its first jet airliner on a trip from London to Johannesburg, officially initiating jet passenger service. Such innovation was not without cost, however, and BOAC found itself mired in financial woes throughout the two decades following the war. As chairman Sir Matthew Slattery explained in 1962: â€Å"The Corporation has had to pay a heavy price for pioneering advanced technologies.† Success to most involved with BEA and BOAC in the 1950s and 1960s had less to do with net income and more to do with â€Å"flying the British flag.† Having inherited numerous war veterans, both airlines had been injected with a military mentality. These values combined with the years BEA and BOAC existed as government agencies to shape the way British Airways would view profit through the 1970s. As former director of human resources Nick Georgiades said of the military and civil service history: â€Å"Put those two together and you had an organization that believed its job was simply to get an aircraft into the air on time and to get it down on time.† While government support reinforced the operational culture, a deceiving string of profitable years in the 1970s made it even easier for British Airways to neglect its increasing inefficiencies. Between 1972 and 1980, BA earned a profit before interest and tax in each year except for one. â€Å"This was significant, not least because as long as the airline was returning profits, it was not easy to persuade the workforce, or the management for that matter, the fundamental changes were vital. Minimizing cost to the state became the standard by which BA measured itself. As one senior manager noted: â€Å"Productivity was not an issue. People were operating effectively, not necessarily efficiently. There were a lot of people doing other peoples jobs, and there were a lot of people checking on people doing other peoples jobs† . . . As a civil service agency, the airline was allowed to become inefficient because the thinking in state-run operations was, â€Å"If youre providing se rvice at no cost to the taxpayer, then youre doing quite well.† A lack of economies of scale and strong residual loyalties upon the merger further complicated the historical disregard for efficiency by BEA and BOAC. Until Sir Frank McFadzeans reorganization in 1976, British Airways had labored under several separate organizations (BOAC; BEA European, Regional, Scottish, and Channel) so the desired benefits of consolidation had been squandered. Despite operating under the same banner, the organization consisted more or less of separate airlines carrying the associated costs of such a structure. Even after the reorganization, divisional loyalties prevented the carrier from attaining a common focus. â€Å"The 1974 amalgamation of BOAC with the domestic and European divisions of BEA had produced a hybrid racked with management demarcation squabbles. The competitive advantages sought through the merger had been hopelessly defeated by the lack of a unifying corporate culture.† A BA director summed up how distracting the merger proved: â€Å"There wasnt enough management time devoted to managing the changing environment because it was all focused inwardly on resolving industrial relations problems, on resolving organizational conflicts. How do you bring these very, very different cultures together?† Productivity at BA in the 1970s was strikingly bad, especially in contrast to other leading foreign airlines. BAs productivity for the three years ending March 31, 1974, 1975, and 1976 had never exceeded 59 percent of that of the average of the other eight foreign airline leaders. Service suffered as well. One human resources senior manager recalled the â€Å"awful† service during her early years in passenger services: â€Å"I remember 10 years ago standing at the gate handing out boxes of food to people as they got on the aircraft. Thats how we dealt with service.† With increasing competition and rising costs of labor in Britain in the late 1970s, the lack of productivity and poor service was becoming increasingly harmful. By the summer of 1979, the number of employees had climbed to a peak of 58,000. The problems became dangerous when Britains worst recession in 50 years reduced passenger numbers and raised fuel costs substantially. Lord King Takes the Reins Sir John (later Lord) King was appointed chairman in February of 1981, just a half-year before Roy Wattss unambiguously grim assessment of BAs financial state. King brought to British Airways a successful history of business ventures and strong ties to both the government and business communities. Despite having no formal engineering qualifications, King formed Ferrybridge Industries in 1945, a company which found an unexploited niche in the ball-bearing industry. Later renamed the Pollard Ball and Roller Bearing Company, Ltd., Kings company was highly successful until he sold it in 1969. In 1970, he joined Babcock International and as chairman led it through a successful restructuring during the 1970s. Kings connections were legendary. Hand-picked by Margaret Thatcher to run BA, Kings close friends included Lord Hanson of Hanson Trust and the Princess of Waless family. He also knew personally Presidents Reagan and Carter. Kings respect and connections proved helpful both in recruiti ng and in his dealings with the British government. One director spoke of the significance of Kings appointment: â€Å"British Airways needed a chairman who didnt need a job. We needed someone who could see that the only way to do this sort of thing was radically, and who would be aware enough of how you bring that about.† In his first annual report, King predicted hard times for the troubled carrier. â€Å"I would have been comforted by the thought that the worst was behind us. There is no certainty that this is so.† Upon Wattss announcement in September of 1981, he and King launched their Survival plan— â€Å"tough, unpalatable and immediate measures† to stem the spiraling losses and save the airline from bankruptcy. The radical steps included reducing staff numbers from 52,000 to 43,000, or 20 percent, in just nine months; freezing pay increases for a year; and closing 16 routes, eight on-line stations, and two engineering bases. It also dictated halting cargo-only services and selling the fleet, and inflicting massive cuts upon offices, administrative services, and staff clubs. In June of 1982, BA management appended the Survival plan to accommodate the reduction of another 7,000 staff, which would eventually bring the total employees down from about 42,000 to nearly 35,000. BA accomplished its reductions through voluntary measures, offering such generous severance that they ended up with more volunteers than necessary. In total, the airline dished out some  £150 million in severance pay. Between 1981 and 1983, BA reduced its staff by about a quarter. About the time of the Survival plan revision, King brought in Gordon Dunlop, a Scottish accountant described by one journalist as â€Å"imaginative, dynamic, and extremely hardworking,† euphemistically known on Fleet Street as â€Å"forceful,† and considered by King as simply â€Å"outstanding.† As CFO, Dunlops contribution to the recovery years was significant. When the results for the year ending March 31, 1982, were announced in October, he and the board ensured 1982 would be a watershed year in BAs turnaround. Using creative financing, Dunlop wrote down  £100 million for redundancy costs,  £208 million for the value of the fleet (which would ease depreciation in future years), even an additional  £98 million for the 7,000 redundancies which had yet to be effected. For the year, the loss before taxes amounted to  £114 million. After taxes and extraordinary items, it totalled a staggering  £545 million. Even King might have admitted that the worst was behind them after such a report. The chairman immediately turned his attention to changing the airlines image and further building his turnaround team. On September 13, 1982, King relieved Foote, Cone Belding of its 36-year-old advertising account with BA, replacing it with Saatchi Saatchi. One of the biggest account changes in British history, it was Kings way of making a clear statement that the BA direction had changed. In April of 1983, British Airways launched its â€Å"Manhattan Landing† campaign. King and his staff sent BA management personal invitations to gather employees and tune in to the inaugural six-minute commercial. Overseas, each BA office was sent a copy of the commercial on videocassette, and many held cocktail parties to celebrate the new thrust. â€Å"Manhattan Landing† dramatically portrayed the whole island of Manhattan being lifted from North America and whirled over the Atlantic before awestruck witnesses in the U.K. After the initial airing, a massive campaign was run with a 90-second version of the commercial. The ad marked the beginning of a broader campaign, â€Å"The Worlds Favourite Airline,† reflective of BAs status as carrier of the most passengers internationally. With the financial picture finally brightening, BA raised its advertising budget for 1983-84 to  £31 million, compared with  £19 million the previous year, signalling a clear commitment to changing the corporate image. Colin Marshall Becomes Chief Executive In the midst of the Saatchi Saatchi launch, King recruited Mr. (later Sir) Colin Marshall, who proved to be perhaps the single most important person in the changes at British Airways. Appointed chief executive in February 1983, Marshall brought to he airline a unique resume. He began his career as a management trainee with Hertz in the United States. After working his way up the Hertz hierarchy in North America, Marshall accepted a job in 1964 to run rival Aviss operations in Europe. By 1976, the British-born businessman had risen to chief executive of Avis. In 1981, he returned to the U.K. as deputy chief and board member of Sears Holdings. Fulfilling one of his ultimate career ambitions, he took over as chief executive of British Airways in early 1983. Although having no direct experience in airline management, Marshall brought with him two tremendous advantages. First, he understood customer service, and second, he had worked with a set of c ustomers quite similar to the airline travel segment during his car rental days. Marshall made customer service a personal crusade from the day he entered BA. One executive reported: â€Å"It was really Marshall focusing on nothing else. The one thing that had overriding attention the first three years he was here was customer service, customer service, customer service—nothing else. That was the only thing he was interested in, and its not an exaggeration to say that was his exclusive focus.† Another senior manager added: â€Å"He has certainly put an enabling culture in place to allow customer service to come out, where, rather than people waiting to be told what to do to do things better, its an environment where people feel they can actually come out with ideas, that they will be listened to, and feel they are much more a part of the success of the company.† Not just a strong verbal communicator, Marshall became an active role model in the terminals, spending time with staff during morning and evenings. He combined these actions with a nu mber of important events to drive home the customer service message. Corporate Celebrations, 1983-1987 If Marshall was the most important player in emphasizing customer service, then the Putting People First (PPF) program was the most important event. BA introduced PPF to the front-line staff in December of 1983 and continued it through June of 1984. Run by the Danish firm Time Manager International, each program cycle lasted two days and included 150 participants. The program was so warmly received that the non-front-line employees eventually asked to be included, and a one-day â€Å"PPF II† program facilitated the participation of all BA employees through June 1985. Approximately 40,000 BA employees went through the PPF programs. The program urged participants to examine their interactions with other people, including family, friends, and, by association, customers. Its acceptance and impact was extraordinary, due primarily to the honesty of its message, the excellence of its delivery, and the strong support of management. Employees agreed almost unanimously that the programs message was sincere and free from manipulation, due in some measure to the fact that BA separated itself from the programs design. The program emphasized positive relations with people in general, focusing in large part on non-work-related relationships. Implied in the positive relationship message was an emphasis on customer service, but the program was careful to aim for the benefit of employees as individuals first. Employees expressed their pleasure on being treated with respect and relief that change was on the horizon. As one frontline ticket agent veteran said: â€Å"I found it fascinating, very, very enjoyable. I thought it was very good for British Airways. It made people aware. I dont think people give enough thought to peoples reaction to each other. . . . It was hardhitting. It was made something really special. When you were there, you were treated extremely well. You were treated as a VIP, and people really enjoyed that. It was reverse roles, really, to the job we do.† A senior manager spoke of the confidence it promoted in the changes: â€Å"It was quite a revelation, and I thought it was absolutely wonderful. I couldnt believe BA had finally woken and realized where its bread was buttered. There were a lot of cynics at the time, but for people like myself it was really great to suddenly realize you were working for an airline that had the guts to change, and that its probabl y somewhere where you want to stay.† Although occasionally an employee felt uncomfortable with the â€Å"rah-rah† nature of the program, feeling it perhaps â€Å"too American,† in general, PPF managed to eliminate cynicism. The excellence in presentation helped signify a sincerity to the message. One senior manager expressed the consistency. â€Å"There was a match between the message and the delivery. You cant get away with saying putting people first is important, if in the process of delivering that message you dont put people first.† Employees were sent personal invitations, thousands were flown in from around the world, and a strong effort was made to prepare tasteful meals and treat everyone with respect. Just as important, BA released every employee for the program, and expected everyone to attend. Grade differences became irrelevant during PPF, as managers and staff members were treated equally and interacted freely. Moreover, a senior director came to conclude every single PPF session with a question and answer session. Colin Marshall himself frequently attended these closing sessions, answering employee concerns in a manner most felt to be extraordinarily frank. The commitment shown by management helped BA avoid the fate suffered by British Rail in its subsequent attempt at a similar program. The British Railway program suffered a limited budget, a lack of commitment by management and interest by staff, and a high degree of cynicism. Reports surfaced that employees felt the program was a public relations exercise for the outside world, rather than a learning experience for staff. About the time PPF concluded, in 1985, BA launched a program for managers only called, appropriately, Managing People First (MPF). A five-day residential program for 25 managers at a time, MPF stressed the importance of, among other topics, trust, leadership, vision, and feedback. On a smaller scale, MPF stirred up issues long neglected at BA. One senior manager of engineering summarized his experience: â€Å"It was almost as if I were touched on the head. . . . I dont think I even considered culture before MPF. Afterwards I began to think about what makes people tick. Why do people do what they do? Why do people come to work? Why do people do things for some people that they wont do for others?† Some participants claimed the course led them to put more emphasis on feedback. One reported initiating regular meetings with staff every two weeks, in contrast to before the program when he met with staff members only as problems arose. As Marshall and his team challenged the way people thought at BA, they also encouraged changes in more visible ways. In December 1984, BA unveiled its new fleet livery at Heathrow airport. Preparations for the show were carefully planned and elaborate. The plane was delivered to the hangar-turned-theater under secrecy of night, after which hired audio and video technicians put together a dramatic presentation. On the first night of the show, a darkened coach brought guests from an off-site hotel to an undisclosed part of the city and through a tunnel. The guests, including dignitaries, high-ranking travel executives, and trade union representatives, were left uninformed of their whereabouts. To their surprise, as the show began an aircraft moved through the fog and laser lights decorating the stage and turned, revealing the new look of the British Airways fleet. A similar presentation continued four times a day for eight weeks for all staff to see. On its heels, in May of 1985, British Airways unveiled its new uniforms, designed by Roland Klein. With new leadership, strong communication from the top, increased acceptance by the public, and a new physical image, few on the BA staff could deny in 1985 that his or her working life had turned a new leaf from its condition in 1980. Management attempted to maintain the momentum of its successful programs. Following PPF and MPF, it put on a fairly successful corporatewide program in 1985 called â€Å"A Day in the Life† and another less significant program in 1987 called â€Å"To Be the Best.† Inevitably, interest diminished and cynicism grew with successive programs. BA also implemented an â€Å"Awards for Excellence† program to encourage employee input. Colin Marshall regularly communicated to staff through video. While the programs enjoyed some success, not many employees felt â€Å"touched on the head† by any successor program to PPF and MPF.

Treatment of Rituximab in Pemphigus Vulgaris Patients

Treatment of Rituximab in Pemphigus Vulgaris Patients Part 3: Clinical Research 2 INTRODUCTION Pemphigus is the name of a group of life-threatening blistering diseases of the skin and mucous membranes. The base of treatment for this disease is corticosteroids; however, recently, new drugs, such as rituximab, have been verified for more severe forms of it. In the authors previously unpublished study, the effect of rituximab on variation in the laboratory indices of pemphigus vulgaris patients is addressed. After investigation of the files of pemphigus patients who received rituximab in Razi Hospital, Tehran, Iran from 2008 to 2013, 39 patients were entered into the study. All patients had lab sheets containing CR (creatinine), urea, ALT (alanine aminotransferase), AST (aspartate aminotransferase), Plt (platelet), Hgb (hemoglobin), and WBC (white blood cell) before and after receiving rituximab. The patients received rituximab 4 times at a dosage of 500 mg in 4 successive weeks. The lab results before receiving the first dose of rituximab were compared to the results after receiving treatment. The effect of rituximab on the variation in lab indices with the adjustment effect of age, gender, disease duration, sites of involvement, received adjoins, and the background disease were also investigated. In the initial analysis, rituximab only had a significant effect on urea reduction. In the CellCept ® (mycophenolate mofetil) receiving subgroup, the mixed consumption of rituximab led to a significant reduction in WBC. In the subgroup having background disease, rituximab had a statistically significant impact on platelet reduction. In the subgroup having no background disease, rituximab had a statistically significant effect on urea reduction. The lab indices were shown to have no significant relationship with age and disease duration. Thus, it can be predicted that disease duration and age would have no effect in the relationship between rituximab and lab indices variations. Although in stratified single-variable analysis for adjusting the effect of other variables (involvement sites and received adjoins) on the relation of rituximab and lab indices, some of these variables showed interacting effects with rituximab on the variations of lab indices. However, due to the low volume of sample and non-normal distribution of most of these variables, it was impossible to do multivariable analysis for investigation of their independent and interactive effects on variations of lab indices in an integrated manner, therefore, we can not make certain comments about their relationships. Chapter 1 Pemphigus is the name of a group of life-threatening blistering diseases that have characteristic acantholysis leading to formation of intraepithelial blisters in mucus and skin [1]. The acantholysis process is induced via attachments of flowing autoantibodies to adhesion molecules in the cells [2]. Patients with pemphigus have mucosal erosions, blisters, papules, and cutaneous erosions. The different types of pemphigus are pemphigus vulgaris, pemphigus foliaceus, immunoglobulin A (IgA) pemphigus, and paraneoplastic pemphigus. Different types of pemphigus are differentiated by clinical symptoms, related autoantigens, and histological methods. Pemphigus vulgaris has mucosal and mucocutaneous involvement. The blisters are acantholytic and suprabasal. The autoantibodies responsible for the disease are against desmoglein (DSG) 1 or both desmoglein 3 and 1. Pemphigus foliaceus only involves the skin. The blisters are acantholytic and subcorneal. The responsible autoantibodies are against desmoglein 1. IgA pemphigus has the form of grouped erythematous crusts, papules, and vesicle plucks. Blisters can be subcorneal or intraepithelial and acantholytic. The responsible autoantibodies are against desmocollin (DSC) 1 [3]. Paraneoplastic pemphigus involves vast and resistant stomatite along with different cutaneous findings. The responsible autoantibodies are against desmoplakin (DSP) or other desmosomal antigens. Pemphigus vulgaris is the most common type of pemphigus, but is still very rare. The chance of its occurrence is between 0.1 to 0.5 per 100,000 people [4]. Pemphigus often happens among adults and the average age of onset is 40 to 60 years old. It is very rare among children [5,6]. Its prevalence is almost the same in the 2 sexes [7]. Almost all the pemphigus vulgaris patients have mucosal involvement. The mouth is the most common site of involvement and is often the first site of involvement. Other mucosal membranes such as conjunctivae, nose, esophagus, vulva, vagina, cervix and anus are rarely involved [8]. As mucosal blisters are fragile and burst easily, in clinical examination it is difficult to find intact blisters, and instead the examiner tends to find mucosal erosions. Buccal and pa latal mucosa are the most common sites of blister involvement in the mouth cavity [9]. Mucosal involvement can be very painful. This pain often increases by chewing and swallowing, which can result in improper alimentation and weight reduction. Most of the patients also have cutaneous involvement appearing in the form of soft blisters in healthy skin or erythematosus. The blisters easily break, resulting in painful erosions. Pemphigus vulgaris rarely causes pruritis. Almost any part of body skin can be involved, but the palmar aspects of the foot and hands are rarely involved. The Nikolsky sign is often observed among these patients (mechanical pressure on the healthy skin results in blistering). Pemphigus is diagnosed based on the clinical, histological, immuno-pathological symptoms and laboratory findings. Even in cases where the clinical symptoms are intensively supporting pemphigus, laboratory investigation is still needed to confirm the diagnosis, as other diseases may have the same symptoms. The first line of treatment of pemphigus is systemic corticosteroids, an d addition of adjuvants may also be needed. Patients who do not respond to the first line of treatment might need additional interventions. In such patients, cyclophosphamides, rituximab, intravenous immunoglobulin (IVIG) or plasmapheresis may be helpful. Initial treatment of pemphigus vulgaris is systemic glucocorticoid, which is often applied in combination with other non-steroidal immunosuppressants such as azathioprine and mycophenolate mofetil. Pemphigus resistant to treatment is a type of pemphigus that does not respond to the aforementioned treatments. Pemphigus is a chronic disease that needs long-term treatment. A retrospective study was conducted during 1982-1993 on 40 patients [8]. On average, these patients achieved complete remission after 7.7 years; 25% had remission after 2 years; 50% after 5 years; and 75% after 10 years [8]. Most pemphigus vulgaris patients respond to initial treatments [9]. The first step, in the patients who do not respond to initial treatment, is increasing the dosage of systemic corticosteroids (1.5-2 mg/kg of prednisolone per day) or adjuvant drug. The adjuvant drug can also be changed (changing azathioprine to mycophenolate mofetil). In resistant cases, cyclophosphamides, rituximab, IVIG, and plasmapheresis could also be used. As pemphigus is an auto-immune disease caused by autoantibodies, treatments that reduce B cells are investigated [10-13]. Rituximab is a monoclonal antibody that targets CD20, located on B-lymphocytes, as its antigen. This drug has been shown to have profound effects on pemphigus treatments [13,14]. In a multicenter study conducted on 14 pemphigus vulgaris patients and 7 pemphigus foliaceus patients, both groups were resistant to systemic glucocorticoids and experienced several relapses during glucocorticoid tapering. They were then put on 1 cycle of rituximab with a weekly dosage of 275 mg/m2 for 4 weeks, and this addition proved advantageous [15]. Although, severe infections were reported in the patients under rituximab treatment, its effect on risk of infection is not clear, as other immunosuppressants were also concurrently used. Reactions during injection are among the most common side effects of rituximab. Deep vein thrombosis (DVT), pulmonary embolism, long-term hypogammaglobu linemia, and neutropenia were also common among the patients under rituximab treatment. Regarding the excellent impact of this drug on treatment of resistant pemphigus, and also on other diseases such as idiopathic thrombocytopenic purpura (ITP), vasculitis, lymphocytic leukemia, systemic lupus erythematosus (SLE), we decided to evaluate the effects of this drug on the variation of lab parameters such as white blood cell (WBC), Hemoglobin (Hg), platelet (Plt), aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine (CR). So far, no study has been conducted on investigation of these variations due to receiving rituximab. OBJECTIVES AND HYPOTHESES Major Objective Investigation of laboratory variations after injection of rituximab in pemphigus vulgaris patients. Minor objectives of the project: Determination of rituximab impact on laboratory indices Determination of rituximab impact on laboratory indices by adjusting for the effect of age Determination of rituximab impact on laboratory indices by adjusting for the effect of gender Determination of rituximab impact on laboratory indices by adjusting for the effect of other treatment methods Determination of rituximab impact on laboratory indices by adjusting for the effect of disease duration Determination of rituximab impact on laboratory indices by adjusting for the effect of disease involved sites Determination of rituximab impact on laboratory indices by adjusting for the effect of Underlying disease Application objectives: Enhancement of health level among pemphigus vulgaris patients and paying attention to laboratory effect of patients after rituximab consumption. Research questions or hypotheses: Rituximab affects the laboratory indices Rituximab affects the laboratory indices with age effect adjustment Rituximab affects the laboratory indices with gender effect adjustment Rituximab affects the laboratory indices with disease duration effect adjustment Rituximab affects the laboratory indices with previous treatment effect adjustment Rituximab affects the laboratory indices with other disease effect adjustment Rituximab affects the laboratory indices with involved sites effect adjustment Chapter 2 Literature Review In 1997, rituximab was approved by the US Food and Drug Administration (FDA) as a treatment for non-Hodgkins lymphoma of B-cell that was resistant to chemotherapy. After that, it was applied for treatment for other diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Wegeners granulomatosis, idiopathic thrombocytopenic purpura (ITP), and Sjà ¶grens syndrome. Ten years later, its impact on the treatment of blister diseases such as pemphigus was shown [16]. In a 2006 study by Larrar et al, 2 children with autoimmune hemolytic anemia who were treated with rituximab experienced acute thrombocytopenia and neutropenia [17]. They resolved in several days, which showed that these hematologic effects are directly dependent on the toxicity of rituximab. In a study by Chairwatanatorn et al in 2003, neutropenia following application of rituximab was tested in 53 patients [18]. All patients except one were under Hodgkins lymphoma treatment. Eight cases of grade 4 neutropenia were observed after 1 to 5 months of rituximab treatment (5 patients only received rituximab and 3 patients were also under additional chemotherapy); 3 patients advanced toward sepsis. Neutropenia was not related to other diseases or treatments, and was related with reduction of neutrophil precursors, except for one of the patients whose bone marrow had hypoplasia. All cases of neutropenia occurred among the patients whose polymorphonuclear neutrophils (PMN) were normally or weakly reduced [18]. In a study by Tesfa et al in 2008, neutropenia occurred 4 or more weeks after rituximab treatment in lymphoma patients [19]. However, the mechanism of how rituximab causes neutropenia is still unknown. In a retrospective study of 113 lymphoma patients under rituximab treatment (alone or along with chemotherapy), 8 patients (7%) had neutropenia. The average onset was 88 days after receiving their last dosage of rituximab. The average time interval of neutropenia was 54 days. Four of the 8 patients underwent stem cell transplantation, 3 patients had neutropenia with fever and 2 of them needed granulocyte-colony stimulating factor (G-CSF) treatment. In the patients who had neutropenia, a cessation in maturation was observed in the promyelocytes category (the same as congenital neutropenia or Kostmann disease) [19]. A study by Otrock in 2005 addressed 2 patients who had acute thrombocytopenia after receiving rituximab [20]. One of the patients had hairy cell leukemia and the other one suffered from mantle cell lymphoma. In these patients, thrombocytopenia improved without the need of any treatment after several days. The reason for this is unknown. A study by Leo et al was conducted in 2004 for investigating the safety of rituximab [21]. In this study, the mixture of fludarabine, rituximab and cyclophosphamide was applied for treatment of follicular lymphoma. Surprisingly, severe thrombocytopenia with World Health Organization (WHO) grades 3 and 4 were observed in the patients, which resulted in the end of trial. Cytological and serological analysis was based on direct toxicity of rituximab. Chapter 3 Investigation Method 39 Therapy resistant pemphigus patients in Razi Hospital in Tehran, who had received rituximab from 2008 to 2012 were considered for inclusion in this retrospective cohort study. Data was collected before and after rituximab treatment. The variables included WBC, Hg, Plt, AST, ALT, Urea, and Cr and age, gender, involved sites, previous therapies, underlying disease, and disease duration. Test sheets associated to before and after rituximab application, containing WBC, Hg, Plt, AST, ALT, Urea and Cr were compared. Type of Study This study is a retrospective cohort study conducted on the pemphigus patients resistant to therapies who had received rituximab in 2008-2012. Studied Population Therapy-resistant pemphigus patients who were treated with rituximab in Razi Hospital, Tehran, Iran in 2008-2012. Inclusion Criteria Pemphigus patients who did not respond to the initial therapies (therapy-resistant pemphigus), and then were treated with rituximab. Exclusion Criteria Patients with no required tests before application of rituximab in their file Patients with no follow-up after receiving rituximab Patients whose first follow-up, after the last dosage of rituximab, is greater than 1 month. Sampling Method According to the available files, files of all the patients who had received rituximab from 2008 to 2012 were considered for inclusion. Data Collection The data collection tool included a checklist divided into 2 parts: one for the data before and one for the data collection after rituximab treatment. The variables included WBC, Hg, Plt, AST, ALT, Urea, and Cr and age, gender, involved sites, previous therapies, underlying disease, and disease duration. Project Implementation After studying the files of therapy-resistant pemphigus patients, the patients who had required data in their files were entered into the research. Rituximab treatment was defined as receiving 4 doses of 500 mg for 4 weeks, along with normal saline. Test sheets associated to before and after rituximab application, containing WBC, Hg, Plt, AST, ALT, Urea and Cr were compared. (The maximum time interval between the second test sheet and the last dosage of rituximab could be 1 month.) Data Analysis Finally, the finalized cases that had the inclusion criteria, were analyzed in Stata statistical software (StataCorp, Texas, USA) in terms of variations in WBC, Hg, Plt, AST, ALT, Urea and Cr after application of rituximab as the major variable and investigation of minor variables. Problems and Limitations As the base of this research was on filed files of hospital, inadequacy of data either before or after rituximab application excluded a bunch of samples from the study in a way that among 105 available files, only 39 files had the required data. Variables Major variables: quantitative measurement of white blood cells (WBC), Hemoglobin (Hgb), platelets (Plt), aspartate aminotransferase (AST), ALT, urea, and creatinine (Cr) before and after application of rituximab Minor variables: Gender Age Involved sites Previous therapies Underlying disease Disease duration The data of variables were collected according to the positive findings in the patients files (Table 1). Table 1 Patient variables. Title Variable Type Quantitative Qualitative Scientific Practical Definition Measurement Method Scale Independent Dependent Continuous Discrete Nominal Ranking WBC Number of WBC per ÃŽ ¼(mu)L of blood File reading Cell/mCl Hgb Amount of hemoglobin File reading Gr/dl Plt Number of plackets in patient blood File reading Cell/mcl AST * Amount of AST File reading IU/L ALT Amount of ALT File reading IU/L Urea Microgram of urea per deciliter of blood File reading Mg/dl Cr * Keratin amount File reading Mg/dl age * Years from birth File reading year gender * According to patient phenotype File reading Male/female Underlying disease * Existence of systemic disease File reading Having/not having Previous therapies * Received adjoin before rituximab File reading Azathioprine, IVIG Cyclophosphamide, CellCept ®, methotrexate Involved sites * Involved sites before starting rituximab File reading Upper body, lower body, face. Genitalia, sculp, mucus Disease Duration Months passed from onset to receiving rituximab File reading Month WBC white blood cell, Hgb hemoglobin, Plt platelet, AST aspartate aminotransferase, ALT alanine aminotransferase, CR creatinine, IVIG intravenous immunoglobulin Chapter 4 Results Among 105 therapy-resistant pemphigus patients who received rituximab treatment in Razi Hospital, Tehran, Iran from 2008 to 2012, only 39 patients managed to enter the study. The others were excluded due to inadequate data. Also in the included patient group, the maximum time interval between the last dosage of rituximab and follow-up was 1 month. The data of the remaining 39 patients were analyzed by Stata statistical software (StataCorp, Texas, USA) and the following results were obtained: The age of the patients ranged from 16 to 67 with a mean of 36.46 years. Their disease duration from the beginning of the disease until receiving rituximab ranged from 5 to 84 months with a mean of 39.30 months. Of the patients, 25 (64%) were men and 14 (36%) were women. It does not seem that the sex difference is related to therapy-resistant pemphigus, it is rather associated with the data collection method and exclusion of patients with incomplete files. Investigation of the involved sites showed that 25 patients (64%) had mucosal involvement, 20 patients (51.3%) had upper body involvement, 18 patients (46.2%) had lower body involvement, 19 people (48.7%) had genitalia involvement, 23 people had facial involvement, 36 people (92%) had body involvement, and in 22 patients (56.4%) the scalp was involved. The lab result variations of the mentioned patients were investigated in terms of the involved sites. The patients, before application of rituximab, were simultaneously under treatment with prednisolone and other adjoins. To summarize the unsuccessful treatments, 5 patients had cyclophosphamide, 18 of them received CellCept ® (mycophenolate mofetil), 7 people (17.9%) had intravenous immunoglobulin (IVIG), 5 patients were treated with methotrexate, and 22 patients had azathioprine. All these patients did not respond to corticosteroid and had active disease. In terms of variation in lab test results after receiving rituximab, the patients were investigated in terms of the previous adjuvants as well. Among 9 patients, 12 of them (30.8%) had systemic underlying diseases such as hypertension (HTN), diabetes mellitus (DM), Ischemic Heart Disease (IHD) and many more. The major variables were WBC, Hgb, Plt, AST, ALT, Urea and Cr before and after application of rituximab. Before Receiving Rituximab: The WBC range was 4,000-14,800 with average of 10,092. The Hgb range was 9.1-16.8 with average of 13.8. The Plt range was 100,000-683,000 with an average of 243,384. The AST range was 6-64 with average of 24.56. The ALT range was 10-143 with average of 43.92. The Urea range was 12-145 with average of 37.25. The Cr range was 0.5-1.2 with average of 0.87. After Receiving Rituximab: The WBC range was 5,400-19,000 with average of 9,964. The Hgb range was 7.4-16.7 with average of 13.42. The Plt range was 110,000-440,000 with average of 232,512. The AST range was 10-121 with average of 25.43. The ALT range was 12-144 with average of 48.46. The Urea range was 15-54 with average of 29.12. The Cr range was 0.6-1.2 with average of 0.85. The WBC had no statistically significant variations. The Hgb had no statistically significant variations. The Plt had no statistically significant variations. The AST had no statistically significant variations. The ALT had no statistically significant variations. The Urea had statistically significant variations. The Cr had no statistically significant variations. After receiving rituximab and adjusting for the effect of gender: The WBC had no statistically significant variations. The Hgb had no statistically significant variations. The Plt had no statistically significant variations. The AST had no statistically significant variations. The ALT had no statistically significant variations. The Cr had no statistically significant variations. In the case of Urea, we concluded that it depends on gender, as in men the variation was significant while in women the variations were not statistically significant. When investigating the results with adjustment of the involved sites, the following results were obtained: In patients with lower body involvement, rituximab had no significant effect on WBC, Plt, AST, ALT, Urea and Cr, but it had significant impact on Hgb reduction. In patients whose lower body was not involved, Urea significantly increased after receiving rituximab. In patients whose lower body was involved, rituximab caused a significant reduction in Cr, Urea, and Hgb. In patients whose upper body was not involved, rituximab had no significant effect on the variables. In the patients with or without facial involvement, rituximab had no significant impact on any of the variables. In patients whose genitalia region was involved, rituximab has no significant impact on any of the major variables. In patients with no genitalia involvement, rituximab resulted in significant reduction of urea. In patients with body involvement, rituximab resulted in significant reduction of urea. In patients with scalp involvement, rituximab resulted in significant reduction of urea. The adjustment of previous therapies was also addressed. As all the patients received prednisolone, the effect of adjoins (azathioprine, CellCept ®, cyclophosphamide, IVIG and methotrexate) was addressed: In patients who had received cyclophosphamide, rituximab has no statistically significant impact on the major variables. In patients who had not received cyclophosphamide, rituximab led to statistically significant reduction of urea. In patients who had received CellCept (mycophenolate mofetil), rituximab has statistically significant impact on reduction of urea and WBC. In patients who did not use IVIG adjoin, rituximab had a significant impact on reduction of urea. In patients who did not use methotrexate adjoin, rituximab had significant impact on reduction of urea. In patients who used azathioprine adjoin, rituximab had significant impact on reduction of urea. The adjustment impact of systemic underlying diseases (such as HTN, DM, IHD) was also addressed. In patients with systemic underlying disease, rituximab had significant impact on platelet reduction. In patients with no systemic underlying disease, rituximab had significant impact on urea reduction. There was no statistically significant relationship between the lab test result variations and disease duration and age (Table 1 through Table 8). TABLES Table 1 Age distribution in the studied patients Min Max Standard Deviation Average Age 16 67 13.48 36.48 Table 2 Disease duration distribution in the studies patients Min Max Standard Deviation Average Disease duration 5 84 20.28 29.30 Table 3 Absolute and relative frequency distribution of patients based on their gender Number % Men 25 64.1 Women 14 35.9 Total 39 100 Table 4 Absolute and relative frequency of involved sites at the time of rituximab injection. Frequency % Upper body 20 51.3 Lower body 18 46.2 Face 23 59 Genitalia 19 48.7 Body 36 92.3 Mucus 25 64.1 Scalp 22 56.4 Table 5 Absolute and relative frequency of received adjoins before application of rituximab Frequency % cyclophosphamide 5 12.8 CellCept ® 18 46.2 IVIG 7 17.9 methotrexate 5 12.8 azathioprine 22 56.4 IVIG intravenous immunoglobulin Table 6 Absolute and relative frequency of the patients based on having or not having underlying disease. Frequency

Armand Fernandez :: Armand Fernandez Artists Painters Essays

Armand Fernandez Born as Armand Fernandez in 1928 at Nice, the son of an antique dealer. His first lessons in painting were given him by his father. He took his Baccalaurà ©at in philosophy and mathematics in 1946 and began to study painting at the École Nationale d'Art Dà ©coratif, Nice. In 1947 he met Yves Klein and Claude Pascal in Paris and accompanied them on a hitch-hiking tour of Europe. Completing his studies in Nice in 1949, he enrolled as a student at the École du Louvre, where he concentrated on the study of archaeology and oriental art. His pictures at this time were influenced by Surrealism. In 1951 he became a teacher at the Bushido Kai Judo School. He completed his military service as a medical orderly in the Indo-Chinese War. He did abstract paintings in 1953. He took part in actions with Yves Klein, with whom he had been discussing subjects such as Zen Buddhism and astrology since 1947. He married Eliane Radigue. He was impressed by a Kurt Schwitters exhibition in Paris in 1954 which inspired him to begin his work with stamp imprints, the Cachets. He earned his living during this period through occasional jobs, selling furniture and harpoon fishing. He had his first one-man exhibitions in London and Paris in 1956. In 1957 he travelled in Persia, Turkey and Afghanistan. In 1958 he dropped the "d" in his name, inspired by a printer's error. He started his monotypes using objects, his Allures. In 1959 he did his first Accumulations and Poubelles. The Accumulations were assemblages of everyday objects and similar consumer articles displayed in boxes. The Poubelles were similar, but used collections of rubbish. In 1960 he became a founding member of the Nouveaux Rà ©alistes. Through this group he made contact with members of the Zero group. H e showed in New York and Milan in 1961 and made his sliced and smashed objects (Couples, Colà ¨res). In 1962 he showed in various European cities and also in Los Angeles, where he was assisted by Edward Kienholz. He started his so-called Combustions, or burned objects, in 1963. He also took up part-time residence in New York. In 1964 he had his first museum retrospectives at the Walker Art Center, Minneapolis, and at the Stedelijk Museum, Amsterdam. Polyester now became his most important material. In 1965 and 1966 he was given large retrospective exhibitions in Krefeld, Lausanne, Paris, Venice and Brussels.

Mathew Malefanes Painting of Nelson Mandela Essay -- Art

Mathew Malefane's Painting of Nelson Mandela Mathew Malefane was born in Soweto; he was one of the privileges children and went to a school in Cape Town to study filmmaking. He now makes documentaries in Johannesburg. He taught himself to paint, and this painting Of Nelson Mandela made a very deep impression on all black Africans. Mathew Malefane chose to paint Nelson Mandela for a number of reasons. One could be as a role model to all black Africans as he fought for their rights and freedom. It could be symbolising slavery, or the Apartheid. A painting is a very good way to show emotion and feeling, and he could of painted Nelson Mandela, as he was delighted and pleased that he was set free. Nelson Mandela stood up for his rights and for the rights of all black people. He believes that they should be equal and respected as human beings. As he stood up and believes this he was put in prison for 20 years. As he was imprisoned there was many protests and riots, and when he was released he was voted for the government. He then won the election, and gave moving, emotive, and touching speeches, which won over all the Africans and he finally became the leader of the African National congress. In the painting, the uses of certain colours are very symbolic. The background is painted in blocks of yellow, green, and black. These are all the colours of his flag. The yellow is surrounding his head, and this symbolises him coming into the light and out of the dark prision he was in. T...

The Gym Essay -- Descriptive Essay Examples

The gym where I train and workout, the Dubuque Martial Arts Group, is a place where I know who I am. It is a place I can go to escape my problems for a while and release some stress. It's not the actual physical building, but rather the events that have occurred there over the years. It's where I have formed some of my closest friendships. It is the place I have invested years of hard work for many of my accomplishments. To some it may seem odd that a place associated with sweat, blood and physical pain mean so much to someone. However, in my eyes it's almost like a second home. Â   A certain familiarity is developed over time that makes it home. Sitting here I can vividly picture being there. I drive my car into the pot-hole filled parking lot off the highway and park in the same spot I always have, people just seem to know that's my spot. Walking around to the back I open the brown door and enter. The familiar damp smell of sweat still pierces my nose when I walk into the hallway even after all these years. The rhythmic beating of the speedbag and clanging of the punching bag hanging from the ceiling echo through the hall. When I walk into the gym I see our instructor Dean with his long dreads sitting at his desk talking on the phone. It sounds as if he is trying to set up some fights for us. I turn my head to the left and see everyone doing their own thing. Chris is kicking the stuffing out of the heavy bag, he thinks he's such a bad-ass. Mitch and Don are goofing around as if they were fifteen, even though they're almost forty. Stretching out is Cara, she's the only female fighter but I wouldn't mess with her. Â   I head to the locker room to change my clothes. In the locker room are Dan and Jason. I say hello an... ...ng side of it tend to invest much more time and effort into what we do there. Therefore we spend a lot more time together than with any of the others. A unique bond forms between us. We are almost like a family. We know what each of us goes through while we are there. We all know what it feels like to work ourselves to exhaustion night after night in preparation for a fight. We know the dread of waking up before the suns up to run. We know the feeling of stepping into the ring in front of a thousand pairs of eyes looking only at you. We know what it feels like to look across the ring and stare into the eyes of a man who would like nothing better than to knock you out cold. We know the adrenaline rush followed by the ring of the bell. Only we feel the pride accompanied when our hand is raised in victory, or the disappointment of having it left hanging in defeat. Â  

Walmart Profile

Organizational Profile: Wal-Mart Wal-Mart is the largest retailer in the world. The position Wal-Mart holds gives the company a large responsibility to contribute to the community that supports the stores. As an organization Wal-Mart owes its success to the stake holders of their business. Wal-Mart requires the community to continue business operations, Trevino and Nelson state that â€Å"a major stakeholder in business must be the communities of which corporations and other organizations are a part† (2011). Wal-Mart must consider the community happiness with their business decisions to remain profitable.Wal-Mart gives back to the community in several ways including donations to charitable foundations and by offering affordable grocery good to impoverished areas. According to Feedingamerica. org Wal-Mart gave â€Å"$2 million donation to help food banks save money on their energy bills† (2011). The donation allowed 16 food banks to improve their efficiency and provide m ore services to the community for the same amount of funding. Wal-Mart has also received the â€Å"MOWAA Corporate Friend of the Year† (Meals on Wheels Association, 2012) award for its donation to the organization. Wal-Mart has proven that it contributes to the communities it supports.The contributions, when compared to Wal-Marts yearly profit, of â€Å"$16,389 million in FY2011† (Datamonitor, 2011, p. 4) seem miniscule. The true test of adequacy of Wal-Marts contribution to the communities it operates in will be if it can remain in business for the long term. According to â€Å"Paymar Communications†, â€Å"Wal-Mart also has been going through a major transformation and committing itself to progressive policies in the realm of corporate social responsibility, particularly when it comes to the products it sells and major efforts to promote energy conservation† (2010, paragraph two).Wal-Mart, as the biggest retail store in the United Sates, has a social re sponsibility to provide quality products to the customers. In 2010, the company took the initiative to reduce unhealthy levels of salts, fats, and sugars in their products. They also decreased the prices of healthy foods to encourage customer to purchase them. Wal-Mart also developed a seal to place on healthier foods with nutrition information rating the levels of sodium, fat, and sugar content (â€Å"Paymar Communications†, 2010). The leading factor in Wal-Mart taking this initiative was to reach customers with an interest in a healthy lifestyle.With obesity on the rise across the nation people are becoming more conscious about what they eat and offering healthier foods, organic products, and enhanced labels on the foods will give the customer more options to choose from within the store. By reducing the prices of these healthy products Wal-Mart can increase their customer base, specifically those with an interest in a pursuing a healthy life style. Additionally this will e nsure Wal-Mart is leading their competition and could be the benchmark for such companies as Target, K-Mart, Sears, and Costco.The factors influencing the organizations strategies are contingent on the need, not only of the customers, but also Wal-Mart’s increase in sales and profitability. Wal-Mart wants to ensure they not only have healthy customers but also that the organization will garner major gains in sales from these changes. The â€Å"Paymar Communications† (2010) website also states that through forging these initiatives, Wal-Mart has figured out a formula to be a good corporate citizen, give consumers superior bargains and still make tons of money; $14. billion in profits in 2009. It is the consummate win-win-win for the organization and customers alike. Wal-Mart’s social initiative is to help stop hunger in the communities in which it operates. Also Wal-Mart is providing healthful products to gain health-conscious customers and to help their customer s maintain a healthy lifestyle at a low cost. References DATAMONITOR: Wal-Mart Stores, Inc. (2011). Wal-Mart Stores, Inc. SWOT Analysis, 1-13. Paymar Communications. (2010). Retrieved from http://paymarcommunications. om/the-united- states-of-wal-mart-and-corporate-social-responsibility/ Trevino, L. K. , & Nelson, K. A. (2011). MANAGING BUSINESS ETHICS Straight Talk About How To Do It Right (5th ed. ). Retrieved from The University of Phoenix eBook Collection database. Walmart Foundation Gives $2 Million to Help ‘Green' Food Banks. (2011). Retrieved from http://feedingamerica. org/press-room/press-releases/walmart-green-initiative-2011. aspx We Are Meals On Wheels Association of America. (2012). Retrieved from http://www. mowaa. org/Page. aspx? pid=600