Light and Dark in Cnrads Hearte of Darkness and Secret Shar essays

Light and Dark in Cnrad's Hearte of Darkness and Secret Shar essays Joseph Conrad uses the words light and dark to show many different points throughout the novel Heart of Darkness and the novella The Secret Sharer. He uses the words in showing the differences in good and evil. He also uses these terms to contrast differences in civilization and the uncivilized, loneliness/isolation and happiness, and sanity to insanity. Conrad, no doubt, relates characters in his stories. In Heart of Darkness, Conrad uses Marlows personal confession, a profound discussion of mans moral complexity,(Concise Dictionary, p.69) to outline the story. He obviously relates the character of Marlow to himself, as he had experienced many bought with, dark, lung ailments as a child, and also had a want to explore. (p. 69) In Heart of Darkness, Conrad explores his memories of a journey through the Congo. His memories include his feelings of sympathy towards the natives of the Congo, as well as his hatred of the Imperialist. He uses the memories to add to the perceived, darkness, of the jungle to give a gloomy overall effect. Seemingly Conrad is fed up with mans ability to make other men suffer. Conrad even uses Marlow to show how England once was dark, uncivilized country. England is shown in its primitive stage of development. By the same token many people have compared Marlows journey into the Congo as a journey through Hell. (2 p.136-137) In Heart of Darkness Conrad uses the character of Kurtz to show supreme darkness. Kurtz embodies everything wrong about man, from greed, to power, to reality. Some have compared Kurtz to Satan himself, or Satans incarnate. Some interpret the use Kurtzs way of leading people away from the light, or sanity, to argue their point while others regard Kurtz as a great leader/businessman who did whatever it took to get the job done. The most profound usage of darkness in Heart of Darkness is the death of Kurtz. When M...

Metal Jewelry Stamps Marks

Metal Jewelry Stamps Marks Jewelry made from precious metals often is stamped with a mark to indicate the chemical composition of the metal. A quality mark contains  information about metal content that appears on an article. It is usually stamped or inscribed on the piece. There is considerable confusion about the meaning of quality marks that are seen on jewelry and other items. Here is some information that will de-mystify terms such as plated, filled, sterling, and others.​ Gold Quality Marks karat, carat, Karat, Carat, Kt., Ct., K, C Gold is measured in karats, with 24 karats being 24/24ths gold or pure gold. A 10 karat gold item contains 10/24ths gold, a 12K item is 12/24ths gold, etc. Karats may be expressed using a decimal figure, such as .416 fine gold (10K). The minimum allowable quality for karat gold is 9 karats. Karats are not to be confused with carats (ct.), which are a unit of gemstone mass. One carat weighs 0.2 gram (1/5 of a gram or 0.0007 ounce). A hundredth of a carat is called a point. Gold Filled and Rolled Gold Plate gold filled, G.F., doublà © dor, rolled gold plate, R.G.P., plaquà © dor laminà © The quality mark for gold filled is used for an article (except optical frames, watch cases, hollowware, or flatware) consisting of a base metal to which a sheet of at least 10 karat gold has been bonded. Additionally, the weight of the gold sheet must be at least 1/20th the total weight of the item. The quality mark may specify the ratio of the weight of the gold in the article to the total weight of the article as well as a statement of the quality of the gold expressed in karats or decimals. For example, a mark of 1/20 10K G.F. refers to a gold filled article that consists of 10 karat gold for 1/20th of its total weight. Rolled gold plate and gold filled may utilize the same manufacturing process, but the gold sheet used in rolled gold usually is less than 1/20th the total weight of the article. The sheet must still be at least 10 karat gold. Like gold filled articles, the quality mark used for rolled gold plate articles may include a weight ratio and a statement of quality (for example, 1/40 10K R.G.P.). Gold and Silver Plate gold electroplate, gold plated, G.E.P., electroplaquà © dor or or plaquà ©, silver electroplate, silver plate, silver plated, electroplaquà © dargent, plaquà © dargent, or the abbreviations of these terms The quality marks for gold-plated indicate that an article has been electroplated with gold of at least 10 karats. The quality marks for silver plated indicate that an article has been electroplated with silver of at least 92.5% purity. There is no minimum thickness required for silver plated or gold plated articles. Silver Quality Marks silver, sterling, sterling silver, argent, argent sterling, abbreviations of these terms, 925, 92.5, .925 The quality marks or a decimal figure may be used on articles containing a minimum of 92.5% pure silver. Some metals may be called silver when, in fact, they are not (except in coloration). For example, nickel silver (also known as German silver) is an alloy consisting of about 60% copper, about 20% nickel, about 20% zinc, and sometimes about 5% tin (in which case the alloy is called alpaca). There is no silver at all in German/nickel/alpaca silver or in Tibetan silver. Vermeil vermeil or vermil The quality marks for vermeil are used on articles made of silver of at least 92.5 percent purity and plated with gold of at least 10 karats. No minimum thickness is required for the gold plated portion. Platinum and Palladium Quality Marks platinum, plat., platine, palladium, pall. The quality marks for platinum are applied to articles composed of at least 95 percent platinum, 95 percent platinum and iridium, or 95 percent platinum and ruthenium. The quality marks for palladium are applied to articles composed of at least 95 percent palladium, or 90 percent palladium and 5 percent platinum, iridium, ruthenium, rhodium, osmium or gold.

Power and Politics Paper Research Proposal Example | Topics and Well Written Essays - 1000 words

Power and Politics Paper - Research Proposal Example Power and politics go side by side in an organization and if they are separated, the organization is affected negatively. Organizational politics are employed to gain reputation, to get some self-concerned benefit, to get promotion, to get financial increase, to get influence, to make decisions, to attain power, to get knowledge related to some confidential information and much more (Aronow, 2004). Organizational leaders such as the employers and other persons having power and influence make use of organizational politics to support the organization in terms of its interests. Leaders after attainment of information concerning organizational politics and their impact make use of them in order to enable the organization to get benefits in all terms such as expansion, financial gains and business development and much more (Aronow, 2004). While politicizing any issue in an organization, the leaders make sure that they inform about their participation to the management. They also make sure that they are backed by the management in their decisions and proposals. In change management and management of crises, organizational politics play a significant part (Malott, 2008). The organizational leaders have to identify and gather the people that are at their side. People are gathered at one side only because of organizational politics. Leaders are considered at the back of organizational politics as they exercise enough authority and influence on other employees of any organization. For the obtainment of power and influence, again organizational politics play a crucial role. The leaders are able to get reputation on the basis of the power that they can exercise on their co-workers (Malott, 2008). Politics can be found in any group working together. Some people consider that organizational politics are wholly disruptive. These people attempt at staying away from all kinds of organizational politics because according to them hard work

How will basic business skills play a role in your professional life Assignment

How will basic business skills play a role in your professional life - Assignment Example For every input, that loop completes itself while generating an output against every input. In Python, we have for loops, while loops, and nested loops. For loop sets a loop variable and repeats the set of instructions for a set limit. While loop repeats the set of instructions while a certain condition is true. Nested loops contain loops within loops. An example of loops in real world is the expiration of session after a certain period of time. There are some websites that expire the user’s sessions after a set period of time. Hence, for example, the loop is: Answer: Basic business skills enhance a person’s decision-making and problem-solving skills. Without basic business skills, it takes much time and effort for an entrepreneur to come at par with the competitive business world. For example, effective communication is a very basic business skill. It is the key to success as you can better communicate and negotiate with your partners, stakeholders and clients. Other helpful basic business skills include time management, goal setting, relationship building and desire to learn (CBS Interactive, n,d). CBS Interactive. (n.d.). 12 business skills that will never, ever go out of style. The Bulletin. Retrieved February 8, 2015, from

Benefits Of Multinational Corporations In Developing Countries Economics Essay

Benefits Of Multinational Corporations In Developing Countries Economics Essay Low economic growth rates, obsolete technology, less capital, high unemployment rate and poor standard of living are the characteristics of developing countries. According to UNCTAD (2008), these countries usually invest 3 to 4 % of their GDP against estimated 7 to 9% annually in infrastructure which in results into gap in current volume of investments. This is where Multinational Corporations (MNC) maximizes their benefits by investing in host developing countries through their technological and other assets advantage.  These corporations are usually large firms operating in imperfect market to open up new sources of information and knowledge and broaden the options of strategic moves which make the company competing with its home and global competitors. In the 19th  century, the newly emerged capitalist in developed Europe started to invest in less developed countries of the world including United States. This gave rise to Multinational enterprise in those countries particularly held by France, Germany, Britain and Holland. A multinational enterprise is an enterprise that engages in foreign direct investment and owns or, in some way, controls value-added activities in more than one country (Dunning Lundan 2008). These firms have substantial direct investment in foreign countries and manage their operations both strategically and organizationally. Examples of MNCs include American Express, Wal-Mart, IBM, Hitachi and Unilever. About 85% of worlds automobiles, 70% of computers and 65% of soft drinks are produced and marketed by MNCs. According to World Development Report, about 450 companies with annual revenues in excess of $1billion account for over 80% of the total investment made by all companies outside their home countries. One of the traditional motives for companies to invest abroad was the need to  secure key supplies  such as Standard Oil interested to open up new fields in the Middle East, Canada and Venezuela which turned out to be largest emerging MNCs of 19th  century. Companies like Nestle, Ford and Bayer expanded internationally mainly in search of new market due to insufficient support from their small home markets compare to the technology and volume-intensive manufacturing process they pursue. In 1984, Nike shutdown its last US factory and shifted companys total production to the cheap labour in Asia to have access to  low-cost factors of production.   Apart from labour,  lower-cost capital  also became a strong traditional cause for internationalization such as subsidies from host countries government. These driving traditional factors push companies mainly from the US Europe to become Multinational Corporations. According to the World Investment Report 2002, the overall val ue-added of ExxonMobil in 2000 was $63 billion and the value-added GDP of Chile was $71 billion in 2000. According to Professor Vernon, companies developed a much richer foundation for their international operations as the global business environment became more complex and complicated. As MNCs established international sales and production operations, their strategy became more integrated in global sense. The first new first emerging set of forces were the rising economies of scale, expanding RD investments and shortening product life cycles which became necessary for firms to survive in those businesses. Global scanning and learning was the second factor that often became essential to a firms global strategy to enhance their technological or marketing advantage. Lastly, it became evident that firms started to bring competitive positioning as the third factor for internationalization by cross-subsidization of markets.  This clearly evaluate firms were rarely driven by a single motivation factor. According to Dunnings eclectic paradigm, multinational enterprises must meet three prerequisites for their existence. Firstly, foreign countries must offer certain location-specific advantages to motivate MNCs to invest there. Secondly, in order to counteract or match with some strategic capabilities with foreign markets, the company must provide a unique strategic competencies or ownership-specific advantages. Lastly, company must have some internalization advantages or organizational capabilities to earn good returns from leveraging its strategic strengths internally rather than externally through licenses or contracts. Companies like Wal-Mart entered in UK by buying supermarket chain ASDA with high-commitment-high-control mode of operating. Amazon.com, for example, uses same approach in Canada by managing its website control from the United States and securing reliable Canadian postal service for order fulfilment. Dragon multinationals from developing countries like Asia Pacific succeed regardless of limited primary resources, skills and knowledge, and social capital. In the era of state-driven development, these firms often internationalized to avoid extreme regulation at their home countries. Their main driver was to search for new markets and technological innovation by using strategies of linkage, leverage and learning. According to World Investment Report 2004, few top Dragon multinationals from developing economies are Hutchison Whampoa (Hong Kong), Singtel (Singapore), Petronas (Malaysia) and Cemex (Mexico). In the light of the degree of commitment and risk involved, set against the level of control and closeness of market, there are range options available for firms looking to internationalise its operations. The firm can choose range as per their growth of experience and degree of commitment to operate globally. Exporting is the first stage where firms can enter international business. It involves selling goods or services from one country to another in two ways. Technic group a UK based tyre making company developed its overseas business by arranging exclusive distribution agreements in each country for the two brands it manufactured which is direct exporting. Flymo a medium-sized British lawnmower making company shifted its overseas business from a distribution to more direct control to think long term for its own export success. This is an example of indirect exporting. Licensing is another stage where firms enter foreign market by providing license to a host countries firm to utilize or sell intellectual property in exchange for financial returns. A major potential drawback in any licensing is when the agreement between the two firms comes to an end; the licensor firm may stand up as a potential powerful competitor. In 1969, the French magazine Elle granted a license for a Japanese version to a local firm, Mag House to sell its magazine. But the Japanese version advanced beyond the original concept and the contract was void in 1988.Franchising is a phenomenal growing form of licensing for firms to internationalize their operations abroad. In UK, franchise accounts for 10% of retail sales with expected increase to 25-30% in coming years. Benetton is a good example whose shop grew from 0 to 650 in US in five years by providing franchisee to firms who can use companys marketing benefit as a well known trademark against agreed payments and systems of c ontrol. But many problems are associated with franchising which revoke a franchise and end up being very costly. Due to failure of operating 14 outlets according to McDonalds standards, company had to withdraw the license of its largest franchisee in France. In the post-war period, there has been substantial growth in joint venture activity which is the second stage strategies for firms operating internationally. The General Motors Toyotas joint venture NUMMI is an equity joint venture with a separate legal personality which operates in US with an agreed life of 12 years in the initial agreement for long term commitments. Another type of business venture between firms where no separate legal personality is formed is described as contractual join venture. Here firms will assist and share the risks and rewards of the collaboration in a clear specific ways. British Aerospace and Taiwan Aerospace in 1993 agreed to set up a joint venture for the manufacture of a regional jet aircraft. This enabled British Aerospace to shift some of its final assembly work to Taiwan to access lower labour costs. However, due to potential conflicts between partners can lead to the termination of the co-operation agreement such as operational disagreements or d isagreements over use and requisition of profits. Firms can also internationalize through other contractual forms of international business such as management contracts, turnkey operations, contract manufacturing and countertrade. According to Financial Times report (1992), Canadas Four Seasons Hotels will under take management of five Japanese Regent International hotels under an agreement becoming worlds largest operator of luxury hotels. But one of the top stage strategies for firms becoming multinational enterprise is Foreign Direct Investment (FDI) where firm is seeking high growth of experience with high degree long-term commitment. FDI has been defined as the acquisition or establishment of profit-generating assets in a host country over which the investing firm has control. According to Financial Times report (1989), Bosch a company from West Germany decided to invest  £100 million on a production facility in Miskin, north west Cardiff in order to produce high technology car alternators. The decision got finalized due to l ower labour cost in Britain compared to Germany and availability of Welsh labour force who demonstrated its keenness and flexibility to adapt at Japanese transplants. But there limitations for FDI such as the security of fixed and liquid investments, the business units economic feasibility, and ability to move currency freely inside and outside of the host country. Despite these limitations, countries like US and UK had the largest stock of outward FDI in 1991 i.e. $385 billion and $226 billion respectively. Due to the emergence and the growth of the MNCs, there have been massive changes in the world economy. The scopes of MNCs operations in the number of host countries and all kind of strategic alliances have expanded. Also, there have been remarkable changes in the relations with home and host governments as well as with international governmental and non-governmental organizations.

Market Analysis of L’Oreal and Garnier

Garnier is a brand that epitomizes smart marketing practice. This is a brand that came to India in 1991 and crafted a special place for itself in the Indian market. This is one global brand, which has understood the dynamics of Indian market. Garnier came to India with its Ultra Duox range of shampoos. The brand is amass market brand from Loreal which has a range of global premium personal care brands like Maybelline, Ralph Lauren. , Diesel ,Vichy etc. Loreal started its operations as a joint venture with MJ Group, Later in 1994, the company started its own operations.All through these years, Garnier had a very consistent marketing approach. What I liked about this brand was the kind of investment that it had put in for marketing activities. Of course all these happened because it had the support of its parent company. Garnier can be considered as a masstige brand. Although positioned as a premium offering, the brand was wise enough to price it reasonable. Currently Garnier is target ing the middle and upper socio-economic class. Globally Loreal is a company that is famous for its product innovation.Garnier too has built its brand by launching new products on a regular basis. A strategy based on product innovation works best for a brand like Garnier. When the consumer sees regular new product flow from the brand, it creates a sense of excitement with in the consumer, which will prompt her to stick to this brand. Garnier was the first brand to introduce a cream based hair coloring solution. Garnier is now present in a diverse range of personal care product categories. It is present in the hair-care and skin-care segments.The brand has two sub-brands: Garnier Fructis and Garnier Ultra Doux. Fructis is an interesting sub-brand which has clicked in the Indian market because of its positioning as a fruit based product. Consumers readily embraced this variant because it made sense to depend on a natural shampoo rather than chemical based one. Garnier is positioned as a nature- based (green) innovative personal care brand, which takes care of your skin. The brand has a very catchy tagline † Take Care † Garnier's positioning strategy is more products based in the sense that it as tried to emphasis individual product properties rather than a common brand image. Most of its commercials are emphasizing on product strengths and innovation. The brand is an example of the success of rational product based advertising success. The brand is also sending a message that Indian consumers are also influenced by rational messages. Another interesting marketing strategy adopted by Garnier is its advertising execution. True to its global parentage, Garnier was careful in its advertising theme. It uses a blend of foreign and Indian models and themes for its campaign.Garnier ads can be termed as localized international advertising, which has a global touch but does not appear alien to Indian realities. The brand uses a careful blend of celebrities and models in their campaigns without relying much on their individual persona. Their products are always the stars in their campaigns. Whether these innovations fail or succeed, Garnier gains much equity through this steady stream of product launches. The premium positioning, smart pricing, heavy investment in brand promotion, innovative products and strong distribution reach has enabled this brand to create a special place in the Indian personal care industry.

Comparative Health Policy and Outcomes of Breast Cancer Care in The United States versus Germany - Free Essay Example

Sample details Pages: 9 Words: 2600 Downloads: 2 Date added: 2019/02/05 Category Medicine Essay Level High school Tags: Breast Cancer Essay Did you like this example? Cancer is a collection of related diseases where some of the body’s cells begin to divide out of control and spread throughout the body. The normally orderly process of cell division becomes unchaperoned, meaning cells can divide and avoid death with nothing to stop them. Cancer can start anywhere in the body, but for the purposes of this paper, I will be focusing on cancer of the breast. Don’t waste time! Our writers will create an original "Comparative Health Policy and Outcomes of Breast Cancer Care in The United States versus Germany" essay for you Create order This type of cancer normally begins as a lump in the breast tissue of men and women, and if not detected early, it can quickly spread to other tissues of the body (most commonly the lymph nodes). You can lower your risk for breast cancer through a myriad of lifestyle factors, but while there is no set cure for cancer, breast cancer is a very treatable disease if caught early. Imaging such as X-rays, mammograms, and tomography are all ways to catch breast cancer, followed by treatment options such as radiation, chemotherapy, or the more drastic mastectomy. Specialists typically needed through the stages of screening, diagnostics, and treatment include gynecologists, imaging technicians, radiologists, oncologists, surgeons, and nurses. Treatments for women with breast cancer vary depending on the stage they are diagnosed in, with higher survival rates the earlier the cancer is found (as well as some genetic factors that I consider too in-depth for this paper). At stage I, the cancer is still contained in the breast tissue and will normally be treated with breast-conserving surgery along with a check of the nearby lymph nodes, followed by some type of radiation therapy to lessen the chance of the cancer returning. At stage II, the cancer is normally larger than stage I and has spread to a few nearby lymph nodes. This stage will normally be treated with surgery and radiation therapy similar to stage I, but with the addition of chemotherapy. At stage III, the tumor is large and has begun spreading to lymph nodes and nearby tissues. The normal treatment at this stage can either be chemotherapy followed by surgery followed by radiation therapy, or surgery first followed by chemotherapy followed by radiation. Finally, at stage IV, the cancer has spread to various parts of the body and is normally treated with various systemic drug therapies along with surgery and radiation (1). While the level of prevention, screening, and treatment varies slightly from country to country, so do the health care policies that dictate the responsibility of the patient versus the specialist versus the institution. In this paper, I will be discussing the health care organization differences between United States and Germany when it comes to preventing, screening, and treating breast cancer, as well as the associated outcomes when it comes to remission and mortality rates. United States In the United States, breast cancer is the most common type of cancer, with over an estimated 266,000 new cases in 2018 so far (which constitutes over 15% of all new cancer cases), with a median age of diagnosis of 62 years of age. Breast cancer also accounts for almost 7% of all cancer deaths, with over 40,000 deaths reported in 2018 so far, with a median age of death of 68 years of age. It also has a 5-year survival rate of just under 90%. As shown in Figures 1 and 2, while breast cancer diagnoses are fairly consistent between non-Hispanic, white, and black women (followed by minority populations of Asian, Hispanic, and American Indian), black women are much more likely to die from the disease than all other races/ethnicities (2). In 2014, the percentages of breast cancer diagnoses at each stage were roughly 66% localized (or stage I/II) and 33% regional/distant (or stage III/IV) with the remaining 1% being unstaged (3). The largest determinant of the stage at diagnosis is preventative measures such as routine screening. According to the American Cancer Society, for women with an average risk of breast cancer, it is currently recommended in the United States to have yearly mammogram screening starting at age 45 (with an option to begin at 40), and transition to biennial mammograms starting at age 55. In the United States, cancer treatments and preventative measures have been affected most recently by the Affordable Care Act (ACA) enacted in 2010. Under the ACA, private insurance companies cannot limit how much they cover during the course of your lifetime. In the past, private insurers could cap their coverage, meaning the patient was responsible for all cancer treatment costs afterwards. Also, preventative screenings, such as mammograms every year or two for women over 40 are now fully covered, meaning the patient does not pay anything. For the actual cancer treatments after the initial diagnosis, out-of-pocket expenses will apply to the patient, but the amount of these expenses will vary depending on the type of insurance program the patient has (if any). The main types of insurance range from private (HMO and PPO), savings accounts (FSA and HSA), and government-sponsored (Medicare and Medicaid). In terms of biases in the United States, the main three are access, cost, and education. A large part of preventative screening and treatment for breast cancer has to do with having a qualified location that people can get to. In rural, or sometimes even urban areas, these places are not easily accessible. The working hours of these qualified locations may also hinder a person from getting screening or treatment if the location is not open on evenings or weekends. The cost of care is also a large bias in this system. While screenings are now completely covered, most people do not realize that there is a timeline between screening and diagnosis. The mammogram might find an abnormality, but the next steps would include further imaging like ultrasound, as well as biopsies, to determine if the abnormality is cancer or not. These further tests are not covered under the â€Å"preventative screening† for insurance companies, and patients will have to pay out-of-pocket for whatever pe rcentage their insurance doesn’t cover. In terms of education bias, there are many people who a) do not know how often they are supposed to be screened, and b) do not realize that screenings are free and/or the steps following are not fully covered. Socioeconomic status also plays a role in United States cancer care. Wealthier people can afford the best health care plans in the country, meaning more of their costs of treatment will be covered before they have to pay out-of-pocket expenses. Those closer to the poverty line who may be on government-sponsored insurance will have to pay more out-of-pocket expenses to receive the same treatment. This may cause people to have an extremely large financial burden, or not receive treatment at all. One important aspect to note about the United States cancer system is that providers will give any type of treatment they deem necessary to each patient, regardless of cost, which aids to the United States’ healthcare costs increasing. While racism between patient and provider might not have a large role in United States cancer care, race itself does play a role. As stated earlier, new cases being diagnosed between white and black women is fairly comparable. However, the death rate among black women with breast cancer is much higher. The main reason for this is that black women are far more likely to be diagnosed at a later, deadlier stage. A few factors that are behind this go along with the structural biases of access and socioeconomic status in regards to screening and treatment, but also their higher likelihood of having dense breast tissue, making it more difficult for providers to find the cancer even if they do get their recommended screenings. Policy-making in terms of United States cancer care has become much more patient-centered in the recent years. There is much more collaboration between specialists when it comes to treatment, and patients have much more say in what treatment they receive. In 2010, the United States spent about $125 billion on cancer care, with breast cancer accounting for 13% of all direct medical spending on cancer (4). With medical treatments shifting from more volume-based to more value-based, the expense of the newest and best technologies used in cancer care also have to be taken into account. This means even more spending per person on treatment and drug costs. Many states have tried to at least pass laws to keep the cost of some life-saving cancer drugs under a certain price, to make them more accessible to all patients. Germany According to the American Institute for Cancer Research and the World Cancer Research Fund, breast cancer is the most commonly diagnosed cancer in women and the second most common cancer in general (5). There were over 2 million new cases in 2018. Outlined in Table 1 are the top 25 countries with the most prevalent rates for the diagnosis of breast cancer in 2018. The United States and Germany are quite similar in rates of new breast cancer cases. In contrast to the U.S., the breast cancer screening program in Germany covers mammography screening (at no cost) for all women between the ages of 50 and 69, every two years (6). Although mammography does not provide any prevention for breast cancer, the objective is to detect the cancer at the smallest, earliest stage, providing for the best possible treatment and increasing the chances of survival. The costs are covered by statutory health insurers (i.e. single payer system). If imaging results show abnormalities, additional imaging or other tests are then required to finalize a diagnosis. This additional imaging may include ultrasound scans or Magnetic Resonance Imaging of the breast, and are often enough to exclude a diagnosis of breast cancer. If such additional testing does not provide peace of mind, typically a biopsy of the breast tissue is required. Breast cancer screening in the German population, yields approximately 2 cancers per 1,000 women screened (Figure 3). This data refers to the actual outcomes of one mammogram. Female participants in Germany’s breast cancer screening program may receive a total of up to ten free mammograms throughout their lifetime. It’s possible that the woman could have abnormal results subsequent to any of their screening mammography tests. While breast cancer screening is paid for on this limited basis, treatment differs from the U.S. in that German patients do not have as much control in their tre atment decisions. Similar to the U.S., about 5 out of 6 women who are diagnosed with breast cancer, have developed an invasive tumor. If left untreated, the invasive type of tumor often metastasizes to other areas/organs of the body. About 1 out of every 6 women diagnosed with breast cancer have diseased breast tissue referred to as a ductal carcinoma in situ (DCIS). The DCIS describes the abnormal cells that have developed in the milk ducts. This also means that the breast cancer cells have not spread beyond that area. In some patients, DCIS remains harmless while in others, it advances into an invasive tumor. Because no one can predict how or when the DCIS will remain intact or harmless, patients are usually advised to pursue recommended treatment (7). When a diagnosis of breast cancer is finalized, treatment depends principally on the progression of the cancer. Most women are counseled to have the tumor surgically removed along with some of the surrounding tissue. Those with advanced stage or larger tumors, may be advised to proceed with removal of the whole breast (mastectomy). Following surgical excision, additional treatment options may include radiotherapy, hormone therapy and chemotherapy. The most appropriate treatment methodology, hinges on the exact diagnosis. According to a German study of out-of-pocket-payments (OOPS) and the financial burden on German breast cancer patients, they often face payments related to their disease or treatment which are not covered by their health insurance. This study concluded that German cancer patients face relatively high OOPPs during their cancer journey. These payments may burden cancer patients, especially certain subgroups like low-income patients (8). In Germany, OOPPs are used in the health care system mainly for three reasons. First, they provide some financial relief to the governmental health insurance system by having patients responsible to offset some of the cost. Secondly, they raise the efficiency of medical services by allocating them only to medically justifiable cases (as determined by panels of Medical Necessity experts). Finally, the third, OOPPs help to reduce the risk of â€Å"moral hazard† which occurs when individuals access health services without medical necessity, simply because they do not have to pay for the services directly. Unfortunately, other studies have shown that OOPPs may cause inequities in the use of health care services by German breast cancer patients; the system of overburdening certain subgroups stems from preventing patients from using beneficial medical services or treatment because they simply cannot afford the expense. That same risk group may ultimately change their adherence to established treatment plans by rationing medications, choosing more radical treatments (i.e. mastectomy which would allow them to possibly skip radiation or chemotherapy), or skipping follow up examinations to reduce OOPPs. Germany’s single payer system covers approximately 87% of the German population. While the balances of patients are covered under other private insurers, all are entitled to medical services under German control. Similar to U.S. health insurers, patients are responsible for health services or treatments that are not covered by insurance and deductibles. There are also other structural biases related to certain threshold caps for any coverage. Financial burdens not only affect patients on an economic basis, but may also influence the psychological well-being. The term â€Å"financial toxicity† has been used to describe this combination where patients are forced to opt towards the most economical decision rather than the best treatment decision. Discussion/Conclusions Figure 4 takes a look at how spending on healthcare in the United States compares to other countries that are similarly large and wealthy, such as Germany (based on GDP and GDP per capita). In proportion to the size of its capital, the U.S. spends an unbalanced amount on health care. As expected, wealthier countries typically spend more per person on health care and the associated costs than countries with lower incomes. However, the U.S. spends more on health care per person than other high income countries. Per person, health spending in the U.S. was over $10,000 in 2016 – 90% higher than Germany (and 31% higher than the next highest-spending country per capita, Switzerland). Typically, other high income countries spend around half as much on health per person than the U.S. does. In recent years, health spending growth has slowed in the U.S. and Germany, related mainly due to value based practices taking importance over volume based practices. However, while the U.S. has similar public spending, its private sector spending is nearly 5 times that of Germany (Figure 5). When asking to think of the â€Å"perfect balance† of policies between the United States and Germany, Markus Holzhauer, MD, a board certified diagnostic radiologist specializing in mammography working locally at Windsong Radiology Group and a dual citizen of the U.S. and Germany says â€Å"The easy answer in theory is the Solidarity Principle, which is the foundation of 90% of healthcare coverage for which the citizens in Germany receive. It only works with a mandate for health insurance coverage because it aims to fundamentally share both the advantages, i.e. prosperity, and the burdens equally and justly among members. When we talk about social solidarity in healthcare, we are talking about providing equity and social solidarity through pooling of risks and funds.† The U.S. may not yet be ready to create one public health fund with adequate resources to plan for, and effectively meet, health needs of the entire population, not just for a selected few who can afford it†¦but the debate will continue.