Saturday, January 25, 2020

Lower Lip Shave for Squamous Cell Carcinoma Reconstruction

Lower Lip Shave for Squamous Cell Carcinoma Reconstruction Lower lip shave for reconstruction of lower lip squamous cell carcinoma Introduction Global estimates of the incidence of oral squamous cell carcinoma vary slightly between various sources, but it appears to be around the eighth commonest site for malignant tumours, with approximately 300,000 cases per year (Shaw, Pace-Balzan, Butterworth, 2011, Parkin et al. 2005) (Shaw et al. 2011) (Scully Bagan, 2009) (Saman Warnakulasuriya, 2009). The relative incidence of lower lip cancer is 35%, which is the highest among oral cancers sites and is most likely due to chronic exposure to sunlight (Bauer et al. 2014).Although the modifiable risk factors such as tobacco, alcohol, diet and lifestyle (S. Warnakulasuriya, 2009) have been identified in the past, only a modest decline in incidence has been reported in recent decades (Chaturvedi et al. 2008). Moreover, an increase of oropharyngeal cancer cases has been related to HPV infections, highlighting the role played by HPV 16 as well as sexual behaviour in head and neck cancer (Chaturvedi et al. 2008; Marur et al. 2010). Despit e the decline in the prevalence of smoking in industrial countries, there is no noticeable reduction in oral squamous cell carcinoma (OSCC) incidence (Shaw et al. 2011). Cancer is a disease that is perhaps more dreaded by more people than any other ailment. The prognosis, in the early stages, therefore, is favourable. The most satisfactory results are obtained when the disease is detected early and treated promptly. A sound and suggestive approach to the problem of cancer control. Patient and methods A 55-year-old patient was referred by a General Medical Practitioner (GMP) regarding a one year history of recurrent lower lip swelling and infection. The patient reported having a lump on her lower lip for approximately one year. At first it was smaller in size and eventually almost occupied the whole lower lip within the one year. The patient complained of intermittent pain and dryness with occasional suppurative discharge from the lower lip. She had had frequent courses of antibiotics and at the time of initial consultation was on a course of fluconazole. The patient had a history of biopsy previously with the diagnosis of oral lichen planus in this region. Although, there had been an improvement of the symptoms after previous treatment at that time, a significant deterioration of symptoms had recurred with advanced swelling and crusting of the lower lip. According to the GMP and the patient, the lesion was worsening and had become resistant to topical medical treatment. There was no weight loss, abdominal or other systemic features observed. The patient’s appetite, sleep and mood were good. The patient had also been diagnosed with mild asthma 5 years prior. The patient consumed minimal amounts of alcohol, did not use any tobacco products and most of her time was spent indoors. Clinical examination Extra-oral examination; there was no detectable lymphadenopathy. 20mm haemorrhagic and crusting lump present on the lower lip and tender on touch, nodular in nature. Intra-oral examination; the oral mucosa was well lubricated and mild reticular white lines were present bilaterally on the buccal mucosa with no oral mucosa speckling or ulceration evident. The patient wore upper and lower complete acrylic dentures. An incisional biopsy was performed on initial consultation. The incisional biopsy report of the sample taken showed moderate dysplasia but given the clinical examination and the nature of the long history of symptoms, it might have been that the biopsy represented only a particular part and very likely that there had been invasive components to the other parts of the lip. The patient was referred urgently to the Oral and Maxillofacial Surgery Department for further treatment even though the lip was healing well after the incisional biopsy. Method of Treatment The Oral and Maxillofacial Consultant decided to perform a lip shave of the vermilion (Kolhe Leonard, 1988) and a tumour biopsy. This method of treatment is advisable in potentially malignant and early malignancy of small lesions and where there is no metastasis present. Involvement of the lymph nodes was not observed, thus the operative removal of the lymph node was not indicated. The vermilionectomy, also and better known colloquially as the lip shave, lip peal, or lip scalp operation, refers to the elliptical, horizontal excision of the exposed mucous membrane or vermilion of the lip, generally of the lower one, with resurfacing or retreading of the surgically created defect by the advancement of the undermined labial mucosa, thereby providing fresh covering which will tolerate many more years of wear (Kurth, n.d.). This procedure is a relatively simple, well-standardised, non-deforming plastic procedure of short duration. After general anesthesia has been performed, surgical preparation of the field with colourless antiseptic solution is applied, and after appropriate draping, the exposed area of lip vermilion to be excised is first outlined with a methylene blue guide mark, after which the underlying tissues are locally infiltrated with Lignospan 2% (1:80000) solution. The outlined mark is incised throughout its entire extent while the lip is firmly immobilized with the thumb and index finger of the free hand, with care being taken to make vertical rather than oblique shelving incisions so that subsequent closure will be facilitated and hypertrophic scarring prevented. After the mucosa is first elevated by sharp dissection from one corner, it can then most conveniently be removed by curved, pointed scissors down to the muscular layer. In cases of superficial malignancy, even a deeper resection can be performed without impairing the watertight closure of the lips or jeopardizing the cosmetic result. A fter haemostasis has been secured with 3-0 Prolene, the labial mucosa is undermined for an appropriate distance down to the deep muscular plane, the surgically created defect being closed by the advancement and approximation of this mobilized flap, which is then united to the cutaneous edge. To achieve an even and symmetrical closure three key sutures are first inserted, the first in the mid-portion of the lip and the remaining two bisecting the distance between the first suture and the commissures. The continuous sutures of 6-0 Prolene can then be inserted consecutively from the wound edge. The knots should not overlay the suture line so as not to retard healing. The donor site was sutured with continuous Vicryl 3.0 suture. The excised mucosal lesion was ellipsoid in shape with the parameters of 14mm horizontally x 20mm from superior to inferior x 8mm in depth. The mucosal excision was marked with the suture material (long stitch right-sided. Short stitch lingual) and sent for histopathological examination. The patient was given broad spectrum antimicrobial (Amoxicillin 500mg) injections for at least 3 days postoperatively and advised to use the lips as little as possible. The wound was kept moist during the day with frequently changed dressings of sterile normal saline which contributed considerably to the patients comfort. At night a thick layer of Aureomycin was advised, to be applied to the suture line to prevent crusting and infection. After three days the alternate sutures could be removed, and the remaining ones on the next day following the healing having progressed satisfactorily. The patient was instructed to keep the resurfaced lip well lubricated with Vaseline, lanolin, or similar preparations for quite some time postoperatively, and was also advised to avoid undue exposure to the sun. Conclusion Although, the patient had been primarily treated for symptomatic oral lichen planus, the condition had worsened significantly within a year. A second incisional biopsy showed moderate dysplasia. Furthermore, the history of rapid symptom progression of the lesion justified the performance of a prompt excisional biopsy under general anesthesia. The most recent hisopathological report confirmed the moderately differentiated squamous cell carcinoma diagnosis, whereas moderate dysplasia was representative of only part of the lesion. Tumour thickness was about 4mm (exophytic and endophytic components) with focally non-cohesive invasion pattern. The lesion was successfully removed within excision margins from 2mm to over 5mm. Nevertheless, close follow up will be continued and the necessity of radiotherapy has been considered at a multidisciplinary meeting as margin dysplasia was found of varying grades at all margins. The lip shave is thus a non-deforming plastic operation of great value in the prophylaxis and treatment of lip cancer and in the cosmetic correction of certain congenital, neoplastic, and traumatic lip deformities. (Kurth, LIP SHAVE OR VERMILIONECTOMY : INDICATIONS AND TECHNIQUE). This is obviously not a technique suitable for all lip defects, but in selected cases it gives a very satisfactory result. Discussion Tumours are divided into two main classes; one being benign and the other, malignant. A tumour may show any degree of malignancy, which in turn has an important bearing on the prognosis and on the prospect of successful treatment. The carcinoma is a malignant epithelial tumour. It is the commonest of all malignant tumours. Among the most important carcinomas is the squamous cell carcinoma. It grows particularly on the skin, lip, tongue, larynx, cervix, and urinary bladder. Ulcers about the mouth or lips that does not heal in ten days to two weeks is a significant sign of oral cancer. If detected early and properly diagnosed, cancer is often cured or at least controlled. Incidences of oral cancer have been rising in many countries around the world (Saman Warnakulasuriya et al. 2008). The 5-year survival rate for oral cancer has not significantly improved in the past 30 years and remains at approximately 50% (Jemal et al. 2004). Many oral squamous cell carcinomas are preceded by clinically evident oral potentially malignant disorders (OPMDs) (Saman Warnakulasuriya, Mak, Mà ¶ller, 2007). It is very important to prevent malignant change in people diagnosed with OPMDs, but the hazard ratios of various OPMDs are not well known. OPMDs include hyperkeratosis or epithelial hyperplasia, epithelial dysplasia (Schepman et al. 1998, â€Å"Oral Leukoplakia and Malignant Transformation†, 1984) erythroplakia (Reichart Philipsen, 2005) and oral submucous fibrosis (Murti et al. 1985, Pindborg et al. 1984) and their clinical phenotypes are well documented. Hyperkeratosis or epithelial hyperplasia, epithelial dysplasia and OSF are the most common oral mucosal disorders in the regions where areca quid chewing is prevalent, such as India, Taiwan, and other Southeast Asian countries (Pindborg et al. 1984, Reichart Philipsen, 2005, Lee et al. 2003, Silverman et al. 1976, Kaas et al. 1994, Chung et al. 2005). The malignant potential of oral lichen planus (OLP) remains controversial because of the absence of universally accepted diagnosis criteria (Chung et al. 2005). The malignant transformation rates of OPMDs show a great variation; for example, 10–20% of hyperkeratosis or epithelial hyperplasia, epithelial dysplasia may transform to cancer and the estimated annual rate is 1.4%–7% (Schepman et al. 1998, â€Å"Oral Leukoplakia and Malignant Transformation,† 1984). In oral cavity squamous cell carcinoma (SCC) there have been many efforts to identify the factors that will allow staging in a way that accurately predicts prognosis. Many different factors have been investigated as possible predictors of outcome including patient age (Thoma et al. 2014), performance status (Rades et al. 2011) laboratory (Wittekindt P. et al. 2013) histologic grade (Arduino et al. 2008, Weijers Snow et al. 2009, Caslin R. et al. 1992, Piffkà ² et al. 1997, Brandwein-Gensler et al. 2005, Lindenblatt et al. 2012, Kurokawa et al. 2005), and various biomarkers (Ziober et al. 2008, Grimm, 2012). Current staging criteria from the American Joint Committee on Cancer (AJCC) for head and neck cancer rely only on tumour size, node status, and the presence of distant metastasis (TNM). Extracapsular nodal spread, positive margins, and lymphovascular invasion are used as indications for adjuvant radiation or chemotherapy but are not part of the staging criteria. Histologic grade is not included in the current staging criteria because its ability to predict a prognosis has historically been controversial (Roland et al. 1992). Although SCC staging protocol in the seventh edition of the AJCC Cancer Staging Manual seems to represent an improvement from previous editions, there are still significant shortcomings, the greatest of which is a lack of practicality. Several studies have questioned the prognostic accuracy of the TNM system for oral cancer since neither patients comorbidity, specific tumour related factors nor multimodal treatment regimens such as preoperative radiochemotherapy (RCT) are incorporated (Kreppel et al. 2013). Nevertheless, a strong association between conventional cytology grade and survival in patients has been stated by several investigators (Weigum et al. 2010, Editor Kurtycz, 2011, Thomas et al. 2014). A high histologic grade in early stage oral cavity cancer is associated with poorer survival and carries independent prognostic value, in addition to tumour size, node status, and the presence of a distant metastasis (TNM) stage. Thus, histologic grade is considered clinically when making treatment decisions, and multivariable models of survival should include grade as a covariate to improve prognostic accuracy (Thomas et al. 2014). Lip tumours are usually low grade, whereas tumours from teeth to back of tongue are increasing in malignancy as we pass back (Grade 2); tumours of pharynx-high-grade malignancy (grade 3). Grading is a useful method of communication between pathologist and surgeon and is also used as a guide to treatment. Briefly, grades 1 and 2 are usually treated surgicall y, whereas grades 3 and 4 require radiation. Furthermore, the influence of immunological parameters on the prognosis of OSCC has already been discussed in the 1970thand 1980th[References 8,9]. Despite the fact that oral cancer and its causes are well known to the medical and dental professions, and that the tissues of the mouth are accessible for early detection of any abnormal condition, intraoral cancer continues to present an important problem. Selection of early cancer diagnosis is often difficult, especially in some cases where early symptoms are not present or misleading such as in the present case. The gross appearance first presents a local induration, then a warty mass followed by deep infiltration. The malignant ulcer is slow-growing, hard, indurated, and invasive with round edges. It may or may not involve the lymphatic nodes. Furthermore, the risk factors associated with these OPMDs and oral cancers have been established. Tobacco use, alcohol abuse and areca quid chewing habits are important risk factors. The associated factors in the progression of the disease and malignant transformation of OPMDs have not been well defined in previous studies: lesion type (Schepman et al. 1998, â€Å"Oral Leukoplakia and Malignant Transformation,† 1984, Murti et al. 1985, Pindborg et al. 1984, Lumerman A. et al. 1995, Hsue et al. 2007), age (Hsue et al. 2007), lifestyle habits (Schepman et al. 1998, Hsue et al. 2007, Chen S. et al. 2000) and lesion subsites (Scully et al. 2003) were significant factors related to malignancy, but the results from different studies vary and firm conclusions cannot be drawn. Excision of the exposed mucosa or vermilion of the lips can be safely performed even under local anaesthesia and is particularly indicated in situations requiring resurfacing of the lip, notably extensive precancerous leukoplakia or chronic solar cheilitis à ¢Ã¢â€š ¬Ã¢â‚¬â„¢ the chronic sunburn of the weather-beaten farmers or sailors skin or tropical skin of the inhabitants of sunny climates. (Kurth, Lip Shave or vermilionectomy: indications and technique). Furthermore, according to the author the best results with local flaps are achieved in midline defects of the lower and upper lip. References A, M. R. L., Kaas, W., Ja, L., Nw, J. (1994). Role of areca nut in the causation of orai submucous fibrosisà ¢Ã¢â€š ¬Ã‚ ¯: a case- control study in Pakistan. Allen, E. C. M., Lumerman, H., Freedman, P., Kerpel, S. (1995). ORAL AND MAXILLOFACIAL PATHOLOGY Oral epithelial dysplasia and the development of invasive squamous cell carcinoma, 79(3), 321–329. Arduino, P. G., Carrozzo, M., Chiecchio, A., Broccoletti, R., Tirone, F., Borra, E., †¦ Gandolfo, S. (2008). Clinical and histopathologic independent prognostic factors in oral squamous cell carcinoma: a retrospective study of 334 cases. Journal of Oral and Maxillofacial Surgeryà ¢Ã¢â€š ¬Ã‚ ¯: Official Journal of the American Association of Oral and Maxillofacial Surgeons, 66(8), 1570–9. Bauer, A., Hault, K., Knuschke, P., Beissert, S., Bauer, A. (2014). These articles have been accepted for publication in the British Journal of Dermatology and are currently being edited and typeset . Brandwein-Gensler, M., Teixeira, M. S., Lewis, C. M., Lee, B., Rolnitzky, L., Hille, J. J., †¦ Wang, B. Y. (2005). Oral Squamous Cell Carcinoma. The American Journal of Surgical Pathology, 29(2), 167–178. Chung, C.-H., Yang, Y.-H., Wang, T.-Y., Shieh, T.-Y., Warnakulasuriya, S. (2005). Oral precancerous disorders associated with areca quid chewing, smoking, and alcohol drinking in southern Taiwan. Journal of Oral Pathology Medicineà ¢Ã¢â€š ¬Ã‚ ¯: Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, 34(8), 460–6. Editor, S., Kurtycz, D. F. I. (2011). The Role of Cytology in Oral Lesionsà ¢Ã¢â€š ¬Ã‚ ¯:, 40(1), 73–83. Grimm, M. (2012). Prognostic value of clinicopathological parameters and outcome in 484 patients with oral squamous cell carcinoma: microvascular invasion (V+) is an independent prognostic factor for OSCC. Clinical Translational Oncologyà ¢Ã¢â€š ¬Ã‚ ¯: Official Publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico, 14(11), 870–80. Hsue, S.-S., Wang, W.-C., Chen, C.-H., Lin, C.-C., Chen, Y.-K., Lin, L.-M. (2007). Malignant transformation in 1458 patients with potentially malignant oral mucosal disorders: a follow-up study based in a Taiwanese hospital. Journal of Oral Pathology Medicineà ¢Ã¢â€š ¬Ã‚ ¯: Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, 36(1), 25–9. Jemal, A., Tiwari, R. C., Murray, T., Ghafoor, A., Samuels, A., Ward, E., †¦ Thun, M. J. (2004). Cancer statistics, 2004. CA: A Cancer Journal for Clinicians, 54(1), 8–29 Kolhe, P. S., Leonard, a G. (1988). Reconstruction of the vermilion after â€Å"lip-shave†. British Journal of Plastic Surgery, 41(1), 68–73 Kreppel, M., Dreiseidler, T., Rothamel, D., Eich, H.-T., Drebber, U., Zà ¶ller, J. E., Scheer, M. (2013). The role of clinical versus histopathological staging in patients with advanced oral squamous cell carcinoma treated with neoadjuvant radiochemotherapy followed by radical surgery. Journal of Cranio-Maxillo-Facial Surgeryà ¢Ã¢â€š ¬Ã‚ ¯: Official Publication of the European Association for Cranio-Maxillo-Facial Surgery, 41(1), 22–7. Kurokawa, H., Zhang, M., Matsumoto, S., Yamashita, Y., Tomoyose, T., Tanaka, T., †¦ Takahashi, T. (2005). The high prognostic value of the histologic grade at the deep invasive front of tongue squamous cell carcinoma. Journal of Oral Pathology Medicineà ¢Ã¢â€š ¬Ã‚ ¯: Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, 34(6), 329–33 Kurth, Lip Shave or vermilionectomy: indications and technique. British Journal of Plastic Surgery.1957 Jul;10(2):156-62. Lee, C.-H., Ko, Y.-C., Huang, H.-L., Chao, Y.-Y., Tsai, C.-C., Shieh, T.-Y., Lin, L.-M. (2003). The precancer risk of betel quid chewing, tobacco use and alcohol consumption in oral leukoplakia and oral submucous fibrosis in southern Taiwan. British Journal of Cancer, 88(3), 366–72. Lindenblatt, R. D. C. R., Martinez, G. L., Silva, L. E., Faria, P. S., Camisasca, D. R., Lourenà §o, S. D. Q. C. (2012). Oral squamous cell carcinoma grading systemsanalysis of the best survival predictor. Journal of Oral Pathology Medicineà ¢Ã¢â€š ¬Ã‚ ¯: Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, 41(1), 34–9. Murti, P. R., Bhonsle, R. B., Pindborg, J. J., Daftary, D. K., Gupta, P. C., Mehta, F. S. (1985). Malignant transformation rate in oral submucous fibrosis over a 17-year period. Community Dentistry and Oral Epidemiology, 13(6), 340–1. Oral Leukoplakia and Malignant Transformation. (1984). Peter, F., Wittekindt, C., Finkensieper, M., Kiehntopf, M., Guntinas-Lichius, O. (2013). Prognostic impact of pretherapeutic laboratory values in head and neck cancer patients. Journal of Cancer Research and Clinical Oncology, 139(1), 171–8. Piffkà ², J., Bà  nkfalvi, a, Ofner, D., Bryne, M., Rasch, D., Joos, U., †¦ Schmid, K. W. (1997). Prognostic value of histobiological factors (malignancy grading and AgNOR content) assessed at the invasive tumour front of oral squamous cell carcinomas. British Journal of Cancer, 75(10), 1543–6. Pindborg, J. J., Murti, P. R., Bhonsle, R. B., Gupta, P. C., Daftary, D. K., Mehta, F. S. (1984). Oral submucous fibrosis as a precancerous condition. Scandinavian Journal of Dental Research, 92(3), 224–9 Rades, D., Seibold, N. D., Gebhard, M. P., Noack, F., Schild, S. E., Thorns, C. (2011). Prognostic factors (including HPV status) for irradiation of locally advanced squamous cell carcinoma of the head and neck (SCCHN). Strahlentherapie Und Onkologieà ¢Ã¢â€š ¬Ã‚ ¯: Organ Der Deutschen Rà ¶ntgengesellschaft [et Al], 187(10), 626–32 Reichart, P. a, Philipsen, H. P. (2005). Oral erythroplakiaa review. Oral Oncology, 41(6), 551–61 Roland, N. J., Caslin, a W., Nash, J., Stell, P. M. (1992). Value of grading squamous cell carcinoma of the head and neck. Head Neck, 14(3), 224–9. Schepman, K. P., van der Meij, E. H., Smeele, L. E., van der Waal, I. (1998). Malignant transformation of oral leukoplakia: a follow-up study of a hospital-based population of 166 patients with oral leukoplakia from The Netherlands. Oral Oncology, 34(4), 270–5. Scully, C., Bagan, J. (2009). Oral squamous cell carcinoma: overview of current understanding of aetiopathogenesis and clinical implications. Oral Diseases, 15(6), 388–99. Scully, C., Sudbà ¸, J., Speight, P. M. (2003). Progress in determining the malignant potential of oral lesions. Journal of Oral Pathology Medicineà ¢Ã¢â€š ¬Ã‚ ¯: Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, 32(5), 251–6. Shaw, R. J., Pace-Balzan, A., Butterworth, C. (2011). Contemporary clinical management of oral squamous cell carcinoma. Periodontology 2000, 57(1), 89–101. Shiu, M. N., Chen, T. H., Chang, S. H., Hahn, L. J. (2000). Risk factors for leukoplakia and malignant transformation to oral carcinoma: a leukoplakia cohort in Taiwan. British Journal of Cancer, 82(11), 1871–4. Silverman, S., Bhargava, K., Smith, L. W., Malaowalla, a M. (1976). Malignant transformation and natural history of oral leukoplakia in 57,518 industrial workers of Gujarat, India. Cancer, 38(4), 1790–5. Thomas, B., Stedman, M., Davies, L. (2014). Grade as a prognostic factor in oral squamous cell carcinoma: a population-based analysis of the data. The Laryngoscope, 124(3), 688–94. Warnakulasuriya, S. (2009). Causes of oral canceran appraisal of controversies. British Dental Journal, 207(10), 471–5. Warnakulasuriya, S. (2009). Global epidemiology of oral and oropharyngeal cancer. Oral Oncology, 45(4-5), 309–16. Warnakulasuriya, S., Mak, V., Mà ¶ller, H. (2007). Oral cancer survival in young people in South East England. Oral Oncology, 43(10), 982–6. Warnakulasuriya, S., Parkkila, S., Nagao, T., Preedy, V. R., Pasanen, M., Koivisto, H., Niemelà ¤, O. (2008). Demonstration of ethanol-induced protein adducts in oral leukoplakia (pre-cancer) and cancer. Journal of Oral Pathology Medicineà ¢Ã¢â€š ¬Ã‚ ¯: Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, 37(3), 157–65. Weigum, S. E., Floriano, P. N., Redding, S. W., Yeh, C.-K., Westbrook, S. D., McGuff, H. S., †¦ McDevitt, J. T. (2010). Nano-bio-chip sensor platform for examination of oral exfoliative cytology. Cancer Prevention Research (Philadelphia, Pa.), 3(4), 518–28. Weijers, M., Snow, G. B., Bezemer, P. D., van der Waal, I. (2009). Malignancy grading is no better than conventional histopathological grading in small squamous cell carcinoma of tongue and floor of mouth: retrospective study in 128 patients. Journal of Oral Pathology Medicineà ¢Ã¢â€š ¬Ã‚ ¯: Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, 38(4), 343–7. Ziober, B. L., Mauk, M. G., Falls, E. M., Chen, Z., Ziober, A. F., Bau, H. H. (2008). LAB-ON-A-CHIP FOR ORAL CANCER SCREENING AND DIAGNOSIS, (January), 111–121.

Friday, January 17, 2020

Coke & Pepsi learn to compete in India Essay

Timing of entry into the Indian market brought different results for PepsiCo and Coca-Cola India. What benefits or disadvantages accrued as a result of earlier or later market entry? Coca-Cola (1990) Benefits: advantages as „Early-Followerâ€Å", possibility to use reliable market information that ´s already existing take-over of standards position as international market leader Disadvantages: expert knowledge of competitors has to be overtaken gain trust of new customers as „anotherâ€Å" foreign company PepsiCo (1986) Benefits: early entry while the market is developing achievement of a good market position enforcement of product standards early impact on local producers (26% market share for Pepsi Food) Disadvantages: high costs for tapping a new market local demand for carbonated drinks very low at that time The Indian market is enormous in terms of population and geography. How have the two companies responded to the sheer scale of operations in India in terms of product policies, promotional activities, pricing policies and distribution arrangements? Coca-Cola Product policies: focus on all beverages that are non-carbonated Kinley Brand of bottled water introduction of new brands, introduction of new size „Miniâ€Å" Promotional activities: build a connection with the youth market Business plan: â€Å"Think local – act local†: Lucky draws where you can win a free trip to Goa, TV campaigns, employing local and regional festivals and sport events, building a connection with the youth: use of music and ballet, short films, work with actors and actresses Campaign slogan: †Cool means coca cola† Retail outlet â€Å"Red Lounge† where the youth can spent time and consume Coke products. Pricing policies: Low prices and later on even reducing of prices (Skimming pricing) Price bundles („Buy one – get one freeâ€Å") Distribution arrangements: Red Lounge Focus on Southern India Pepsi Product policies: bolstering non-cola portfolio and other categories: fruit juices juice-based drinks and water, introduction of new products Promotional activities: Sponsorship of garba, TV campaigns, employing local and regional   festivals and sport events, sponsorship of Cricket and Football as well as a music video with Bollywood stars. Pricing policies: aggressive pricing policy (impact on local producer Parle) Distribution arrangements: focus on northern and western parts of India Which of the two companies has better long-term prospects for success in India? Why? PepsiCo has better long-term prospects for success in India  earlier market entry than Coca Cola  non-cola portfolio makes one-fourth of the overall business in India (e.g. significant player in the packaged water market)   following the consumers lifestyle of sports and exercise through fitting advertisement not as bad as Coca-Cola involved in the pesticide accusation What lessons can each company draw from its Indian experience as it  contemplates entry into other big emerging markets? It’s not possible to transfer the complete marketing strategy from Europe or US to the Asian market. You have to know about the cultural and governmental   specifics of the market where you want to be successful. Communication policy: In India people interpret a policy of silence as guilt so the company has to get into a street fight if something wrong is published.  It’s important to know much about the local market: Which products are sold to which price? Who are the  market leaders? How aggressive is the competition?

Thursday, January 9, 2020

American University Should Seriously Consider Lowering...

The price of a Soft Taco Supreme at Taco Bell is $1.49. The price of attending New York University (NYU) is about $61,997 (Jacobs, 2013). That is approximately 41,609 Soft Taco Supremes from Taco Bell, enough to feed someone for 38 years if they ate one for every meal. While most universities in the USA do not cost quite as much as NYU, tuition is still very high, even for in-state public schools. If tuition continues to rise, the amount of students that cannot afford to go to college will increase, and these students will not be able to achieve their full potential. Because of this, colleges and universities in America, particularly public colleges, need to reconsider the cost of tuition. One of the wonderful aspects about college is that students are able to choose what college they want to go to, as opposed to being districted to a specific school, as many students are for high school. Potential students have the opportunity to browse schools based on options such as their major, what type of school they want to go to, and location. Now, however, more students are increasingly choosing their schools because of price. Because of this, some students may not get the most out of their education. Many students forego going to a school specialized or focused on their program due to the high costs associated with it. Students fear becoming burdened with debts and not receiving enough financial aid, and choose to go to affordable schools over their â€Å"dream school.† (Medrano,Show MoreRelatedIkeas Organizational Behavior8907 Words   |  36 Pagesits product. That means employing strict manufacturing methods and supply processes so that materials, technologies and transportation have the least damaging effects on the environment.1 - Rene Hausler, Partner, IKEA-San Diego Franchisee. We consider IKEA to be setting an excellent example for other corporations to follow. 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Discuss Road-map of HRM VU Lesson 1 LESSON OVERVIEW This chapter introduces the studentsRead MoreStudy Guide Essay25129 Words   |  101 PagesPearson 925 North Spurgeon Street, Santa Ana, CA 92701 Phone: 714-547-9625 Fax: 714-547-5777 www.calcoast.edu 10/14 Study Guide Seventh Edition, 2013 BAM 411 Human Resource Management Message From the President W elcome to California Coast University. I hope you will find this course interesting and useful throughout your career. This course was designed to meet the unique needs of students like you who are both highly motivated and capable of completing a degree program through distance learningRead Morepaul hoang answers72561 Words   |  291 Pagesanswers/solutions to all 217 case studies. I hope you will find these solutions as a useful starting point. As with all BM mark schemes, the solutions in this Answer Book should be used with caution and flexibility. Students who take an alternative approach to the suggested solutions should still be credited where appropriate; teachers should use their professional judgment in such cases. Since the Answer Book is 178 pages long, colleagues may find the use of ‘short keys’ useful when searching for answersRead MoreFundamentals of Hrm263904 Words   |  1056 PagesYour WileyPLUS Account Manager Training and implementation support www.wileyplus.com/accountmanager MAKE IT YOURS! Fundamentals of Human Resource Management Tenth Edition David A. DeCenzo Coastal Carolina University Conway, SC Stephen P. Robbins San Diego State University San Diego, CA Tenth Edition Contributor Susan L. Verhulst Des Moines Area Community College Ankeny, IA John Wiley Sons, Inc. Associate Publisher Executive Editor Senior Editoral Assistant Marketing ManagerRead MoreHuman Resources Management150900 Words   |  604 PagesCHAPTER 1 Changing Nature of Human Resource Management After you have read this chapter, you should be able to: ââ€"  Identify four major HR challenges currently facing organizations and managers. List and define each of the seven major categories of HR activities. Identify the three different roles of HR management. Discuss the three dimensions associated with HR management as a strategic business contributor. Explain why HR professionals and operating managers must view HR management as anRead MoreStephen P. Robbins Timothy A. Judge (2011) Organizational Behaviour 15th Edition New Jersey: Prentice Hall393164 Words   |  1573 Pages Organizational Behavior This page intentionally left blank Organizational Behavior EDITION 15 Stephen P. Robbins —San Diego State University Timothy A. Judge —University of Notre Dame i3iEi35Bj! Boston Columbus Indianapolis New York San Francisco Upper Saddle River Amsterdam Cape Town Dubai London Madrid Milan Munich Paris Montreal Toronto Delhi Mexico City Sao Paulo Sydney Hong Kong Seoul Singapore Taipei Tokyo Editorial Director: Sally Yagan Director of Editorial Services:Read MoreLogical Reasoning189930 Words   |  760 Pagesupdated: April 26, 2016 Logical Reasoning Bradley H. Dowden Philosophy Department California State University Sacramento Sacramento, CA 95819 USA ii iii Preface Copyright  © 2011-14 by Bradley H. Dowden This book Logical Reasoning by Bradley H. Dowden is licensed under a Creative Commons AttributionNonCommercial-NoDerivs 3.0 Unported License. That is, you are free to share, copy, distribute, store, and transmit all or any part of the work under the following conditions:Read MoreDeveloping Management Skills404131 Words   |  1617 Pagesbuilt-in pretests and posttests, focus on what you need to learn and to review in order to succeed. Visit www.mymanagementlab.com to learn more. DEVELOPING MANAGEMENT SKILLS EIGHTH EDITION David A. Whetten BRIGHAM YOUNG UNIVERSITY Kim S. Cameron UNIVERSITY OF MICHIGAN Prentice Hall Boston Columbus Indianapolis New York San Francisco Upper Saddle River Amsterdam Cape Town Dubai London Madrid Milan Munich Paris Montreal Toronto Delhi Mexico City Sao Paulo Sydney Hong Kong Seoul SingaporeRead MoreProject Managment Case Studies214937 Words   |  860 Pagesauthorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400, fax (978) 750-4470, or on the Web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748-6011, fax (201) 748-6008, e-mail: permcoordinator@wiley.com. Limit of LiabilityDisclaimer of Warranty: While the publisher and author

Wednesday, January 1, 2020

Essay about My Philosophy of Education - 1380 Words

My Philosophy of Education There are all different kinds of students and each of them deserve the chance at a fulfilling education that improves their self - esteem and self - efficiency in the world. Every child deserves a teacher that is fair and understanding of the different ability levels of each student in their classroom. This is my philosophy of education. In preparing to become a teacher who truly tries to understand the vast differences between children, I want to address the nature of students, the nature of knowledge, the purposes of public education, the methods of teaching, and the curriculum area that I am studying. First, I believe Rousseau?s theory of people being born with a blank slate. Children are not good or†¦show more content†¦Memorization does not really indicate that something is learned except for only a short while. There was a time for a few short days that I knew the entire Gettysburg Address, but after I said it in class, it was gone in a few hours. I can still say part of it, but that is because I have heard ?Fore score and seven years ago thousands of time before. This is where experience comes in, if I said the Gettysburg Address everyday for the rest of my life, that would be an experience, not a one-time memorization. I personally am a relative learner. I have to experience or do something before I can learn a difficult concept really well. If I do experiments, sing a song, coloring activities, or some dramatization, I will learn better than if just read it and have to memorize it. I believe that I how a lot of students need to learn. Although there are stud ents who can read something one time, and get it. When it comes too absolute knowledge mathematics comes to mind. There is a formula for almost everything that you do in math, and whether you get that process or not, it will always be true; it does not depend on the person, place, or time. It is always true. Absolute knowledge is hard for many students to grasp because most of it is abstract there is not always a concrete thing to put in front of student to make them understand the concept you are trying to teach them. Thirdly, I believe theShow MoreRelatedMy Philosophy On The Philosophy Of Education844 Words   |  4 PagesIn mathematics, as in life, everything must be brought to the simplest of terms. I base my teaching philosophy on the foundation that every student is capable of learning mathematics. I will strive, as a teacher, to ensure that my students are able to have a strong foundation of mathematical skills when they leave my classroom. Some students believe that they are not mathematically gifted; therefore, incapable of learning mathematics. I believe to the contrary, all students with motivation, sustainedRead MoreMy Philosophy On Philosophy Of Education852 Words   |  4 PagesMy Philosophy of Education My philosophy of education is founded on a belief that all students have a desire to learn and to feel accepted. Learning takes place when students are able to have their specific needs meet inside the classroom, to feel accepted in the environment, and find the learning to be meaningful. I believe that before learning can take place a proper educational environment must be present inside the classroom. In order to make any classroom work I believe you need meet three criteriaRead MoreMy Philosophy Of Education As A Education864 Words   |  4 Pagesdifferent philosophy of education, and what purpose education serves in a child’s life. The five philosophies of education that we recognize are: Essentialism, Perennialism, Progressivism, Social Reconstructionism, and Existentialism. I would most recognize my philosophy of education as Essentialism. Essentialism has been a dominant influence in American education since World War II. It focuses on core curriculum of traditional academic topics. I believe that the purpose of education is teachingRead MoreMy Philosophy of Education824 Words   |  4 Pages13 February 2011 My Philosophy of Education I believe that progressivism educational philosophy most closely matches my educational ideals. In my opinion based on the progressivism educational philosophy, the purpose of education is to enable students to learn useful knowledge that has meaning to them in the future. Thus, the most useful education for students is the skill of â€Å"learning how to learn†. When students understand the methodsRead MoreMy Philosophy Of Education And Education1038 Words   |  5 PagesMy Philosophy of Education When trying coming up with a personal philosophy of education, I had to ask myself what the purpose of education is. To me, the purpose of education is to teach students knowledge that is needed to make it through school and to succeed in the world after graduation. Anyone can go into teaching, but not every teacher can teach. Teachers go above and beyond to introduce methods, philosophies, and strategies to help their students learn, as well as, retain the informationRead MoreMy Education Philosophy 1511 Words   |  6 PagesPersonal Mission Statement Education is the imparting and acquiring of knowledge and skills through teaching and learning. As an educator, my personal mission statement is to master my subject area in order to serve as a role model for my students thereby producing students who thoroughly understand the subject matter, and who develop holistically. In order to achieve this goal I must have a set education philosophy with a strong Christian worldview. I must also have a general understanding of theRead MoreMy Philosophy Of Education1056 Words   |  5 PagesPhilosophy of Student Engagement My philosophy of education is that every child should receive high quality education that is inclusive, relevant and meaningful to their life. I am a firm believer of making pedagogy relatable to my students. My vision is driven by my personal experiences with the American school system. I was what is thought of as â€Å"A child at risk†. I am an immigrant, black, Muslim student. My life is transactional as I am a part of multiple marginalized groups. Most of my teachersRead MoreMy Philosophy Of Education And Education864 Words   |  4 PagesPhilosophy of Education Children are the future and their education is the key to our society’s success. When considering this, I realize I have an immense responsibility as an educator. The main focuses of my teaching are active learning, building character within students, and providing meaningful curriculum. I want to create a comfortable setting where every student feels safe to learn. In many ways, my philosophy agrees with the holistic approach to education. I feel this challenges the studentRead MoreMy Philosophy on Education814 Words   |  3 PagesMy Philosophy of Education I think when I made the decision to become a teacher I was not thinking the seriousness of this decision. When we become teachers we also become the molder that will shape our student to be successful in life. But when you decide to become a teacher in a Christian school you are not only shaping this student to be successful in life but we are also shaping their Christian mind to do things with a feeling knowing that they are shape and where made by the image of GodRead MoreMy Philosophy Of Education1015 Words   |  5 Pagesimmediately sparked my interest in becoming an educator and share my personal beliefs on the important aspects of education. In addition to this, I will present various traits I believe are essential and critical for teachers to successfully fulfill their role as an educator. During my elementary years, I developed an urge to frequently ask many questions during the school day. Being able to question anything was astonishing to me. This was because my parents were unable to answer my questions and help