Community Service Essay

Community service is very important because it helps build character, which is something that the Dalton School and the Detroit News would agree with me on. Having community service as a requirement to graduate is a good idea as long as the student can choose what type of community service they want to do; because it forces students to go out in their community and help others. Community Service doesn’t have to have a negative effect on people, it can and usually has a good effect. Willie Grothman and Tim Phang are two high school students who started a community service club that helped a lot of people in their community. Community service can be extremely valuable in the development of both character, academics and it gives students a chance to give back to their community. Community service builds character because after accomplishing something, it gives people a feel of satisfaction and accomplishment that makes students feel good about themselves. The Dalton School believes when an individual goes out in the world and interacts with other people in the spirit of bettering, that individual makes a contribution and will feel a sense of accomplishment. But on the other hand, some people argue that it is wrong to force students into doing community service. Arthur Stukas, Mark Snyder, and E. Gil Clary said students were less affected even if they had a choice of community service. These scientists also say that researchers have found that students who initially did not want to volunteer found that they actually enjoyed helping others if requirements were applied gently and with their input and involvement in the process. In my opinion that is what we want to happen when students are involved in community service. From graph two that Mark Hugo presents is that community service has a high rating from the students who are educationally successful which shows that community service can have a positive affect on people. In the Detroit News, they talked about a thirteen year-old boy named John Prueter and the type of community service he did and the positive affect it had on him. He volunteered at the Alterra Sterling House, an assisted living home in Hampton Township. From this experience from John, he now wants to study nursing and he said he became interested in the field because of his volunteer work. This shows the positive result of community service because it can also lead you into the career path you would have never known you liked until you volunteered. Putting time into your community is a way of â€Å"giving back†. The Dalton School says the moral center of a community, that place where we can find the values of empathy, compassion, and caring, is the basis for civic responsibility and the success of that community. In the Washington Post by Tara Bahrampour, she writes about two high school students, Willie Grothman and Tim Phang of Washington- Lee High School experienced the succ ess of community service. They formed a community service club called the Willie Grothman Club and they held things like walking for AIDS, for the homeless and for breast cancer in an event in which they took turns walking relays all night around a track in the rain. For these events they collect pledges of money from friends and family members for each mile they walked or each bowling pin they knocked down. These guys were some of the most inspiring people because they were not just helping their community, but the people in their community who were homeless, had AIDS, etc. Not only did this club change the members’ lives, but also it changed the lives of others around them, and the people they were helping. Community service does not have to be a negative because it can always turn into a positive. In the Dalton School, the Washington Post, the Detroit News, and Arthur Stukas, Mark Snyder, E. Gil Clary, and Mark Hugo, they all helped me determine that community service should be a requirement to graduate because it can change peoples lives for the better. Thank you for reading my essay but I have another question, which introduction sounds better, the one above or this one: Community service is very important because it helps build character. Having community service as a requirement to graduate is a good idea because it forces students to go out in their community and help others. Community Service doesn’t have to have a negative effect on students, it can have a good effect or no effect at all. Willie Grothman and Tim Phang – two high school students who started a community service club that helped a lot of people in their community-, The Dalton School, and The Detroit News- who did a story on John Prueter- would agree that community service is important. Community service can be extremely valuable in the development of both character, academics and it gives students a chance to give back to their community.

Pnb Project Report

Research Project on Application & Management of Information System in Punjab National Bank IN PARTIAL FULFILLMENT OF MASTER’S DEGREE IN BUSINESS ADMINISTRATION INDRAPRASTHA UNIVERSITY (2008-2010) Submitted by: Pratik Jain — 0781563908 Northern India Engineering College (N. I. E. C), Delhi Under the valuable guidance of: Mrs. Shaveta Kumar (Faculty, N. I. E. C) Subject: Information System Management Course Code: MS-205 Submitted on: 30 17 November, 2009 AcknowledgementThis formal piece of acknowledgement is an attempt to express the feeling of gratitude towards people who helped me in successful completion of research project. I would like to express my deep gratitude to Mr. B. D Sharma (branch manager, PNB), for his constant co-operation. He was always there with his competent guidance and valuable suggestion throughout the pursuance of this research project. Special thanks to Mrs. Shaveta Kumar, my internal coordinator who guided me to work honestly and to give valuabl e suggestion for improving my work.Above all no words can express my feelings to my parents, friends all those persons who supported me during my project. I would also like to thank almighty God for his blessings showered on me during the completion of project report. INDEX | | | | | |S. NO |Sub Topic |Topic Name |Page Number | | |S.NO | | | |1. |Acknowledgement |2 | |2. |COMPANY PROFILE | | | |1. |Origin – Punjab National Bank |4 | | |2. |Profile |5 | | |3. Vision and Mission |6 | | |4. |Financial Performance Comparison |7 | |3. |INFORMATION SYSTEM IN PNB | | | |1. |History of Information System in PNB |8 | | | |1. 2000- The Beginning | | | | |1. b 2001-2003- Long Term Strategy | | | | |1. c 2004-2007- Growth | | | | |1. d 2008- Rural Initiative | | | | |1. 2009- 100% CBS Implementation | | | |2. |Other Banking Applications |12 | | | |2. a Straight to Processing (STP) | | | | |2. b Depository Setup | | | | |2. Bank Mate & EDI | | | |3. |PNB IT Setup |13 | | | |3. a S ystems | | | | |3. b Network Design | | | | |3. Storage, WAN & Connectivity | | | | |3. d Security Systems | | | | |3. e Hardware & Software Resources | | | |4. |Organizations Other Computing Resource |15 | | | |4. Payroll TPS | | | | |4. b Online Assistance | | | | |4. c Account Opening – MIS | | | | |4. d SPNS, RTGS & Mobile Alert Service | | |4. IMPACT OF INFORMATION SYSTEM | | | |1. |Finacle’s Impact |16 | | |2. |Impact on Employees, Customers |17 | |5. |Available Alternatives |18 | |6. |Conclusion |19 | |7. Suggestion |20 | |8. |References |21 | Company Profile – Punjab National Bank Origin Established in 1895 at Lahore, undivided India, Punjab National Bank (PNB) has the distinction of being the first Indian bank to have been started solely with Indian capital.The bank was nationalized in July 1969 along with 13 other banks. From its modest beginning, the bank has grown in size and stature to become a front-line banking institution in India at pre sent. |[p|A professionally managed bank with a successful track record of over 110 years. | |ic| | |] | | |[p|Largest branch network in India – 4668 Offices including 432 Extension Counters spread throughout the country. |ic| | |] | | |[p|Strategic business area covers the large Indo-Gangetic belt and the metropolitan centers. | |ic| | |] | | |[p|Ranked as 248th biggest bank in the world by Bankers Almanac, London. |ic| | |] | | |[p|Strong correspondent banking relationships with more than 217 international banks of the world. | |ic| | |] | | |[p|More than 50 renowned international banks maintain their Rupee Accounts with PNB. |ic| | |] | | |[p|Well equipped dealing rooms; 20 different foreign currency accounts are maintained at major centers all over the globe. | |ic| | |] | | ProfileWith its presence virtually in all the important centers of the country, Punjab National Bank offers a wide variety of banking services which include corporate and personal banking, industria l finance, agricultural finance, financing of trade and international banking. Among the clients of the Bank are Indian conglomerates, medium and small industrial units, exporters, non-resident Indians and multinational companies. The large presence and vast resource base have helped the Bank to build strong links with trade and industry.With over 38 million satisfied customers and 4668 offices, PNB has continued to retain its leadership position among the nationalized banks. The bank enjoys strong fundamentals, large franchise value and good brand image. Besides being ranked as one of India's top service brands, PNB has remained fully committed to its guiding principles of sound and prudent banking. Apart from offering banking products, the bank has also entered the credit card & debit card business; bullion business; life and non-life insurance business; Gold coins & asset managementsbusiness,setc.Since its humble beginning in 1895 with the distinction of being the first Indian ba nk to have been started with Indian capital, PNB has achieved significant growth in business which at the end of March 2009 amounted to Rs 3,64,463 crore. Today, with assets of more than Rs 2,46,900 crore, PNB is ranked as the 3rd largest bank in the country (after SBI and ICICI Bank) and has the 2nd largest network of branches (including three overseas offices).PNB has always looked at technology as a key facilitator to provide better customer service and ensured that its ‘IT strategy’ follows the ‘Business strategy’ so as to arrive at â€Å"Best Fit†. The bank has made rapid strides in this direction. Along with the achievement of 100% branch computerization, one of the major achievements of the Bank is covering all the branches of the Bank under Core Banking Solution (CBS), thus covering 100% of its business and providing ‘Anytime Anywhere’ banking facility to all customers including customers of more than 2000 rural branches.The bank has also been offering Internet banking services to the customers of CBS branches like booking of tickets, payment of bills of utilities, purchase of airline tickets etc. Towards developing a cost effective alternative channels of delivery, the bank with more than 2150 ATMs has the largest ATM network amongst Nationalized Banks. With the help of advanced technology, the Bank has been a frontrunner in the industry so far as the initiatives for Financial Inclusion is concerned. With its policy of inclusive growth in the Indo-Gangetic belt.The Bank has launched a drive for biometric smart card based technology enabled Financial Inclusion with the help of Business Correspondents/Business Facilitators (BC/BF) so as to reach out to the last mile customer. The BC/BF will address the outreach issue while technology will provide cost effective and transparent services. The Bank has started several innovative initiatives for marginal groups like rickshaw pullers, vegetable vendors, dairy far mers, construction workers, etc. The Bank has already achieved 100% financial inclusion in 21,408svillages.Backed by strong domestic performance, the bank is planning to realize its global aspirations. In order to increase its international presence, the Bank continues its selective foray in international markets with presence in Hongkong, Dubai, Kazakhstan, UK, Shanghai, Singapore, Kabul and Norway. A second branch in Hongkong at Kowloon was opened in the first week of April’09. Bank is also in the process of establishing its presence in China, Bhutan, DIFC Dubai, Canada and Singapore. The bank also has a joint venture with Everest Bank Ltd. EBL), Nepal. Under the long term vision, Bank proposes to start its operation in Fiji Island, Australia and Indonesia. Bank continues with its goal to become a household brand with global expertise. Amongst Top 1000 Banks in the World, ‘The Banker’ listed PNB at 250th place. Further, PNB is at the 1166th position among 48 In dian firms making it to a list of the world’s biggest companiesscompiledsbysthesUSsmagazines‘Forbes’. Punjab National Bank continues to maintain its frontline position in the Indian banking industry.In particular, the bank has retained its NUMBER ONE position among the nationalized banks in terms of number of branches, Deposit, Advances, total Business, operating and net profit in the year 2008-09. The impressive operational and financial performance has been brought about by Bank’s focus on customer based business with thrust on SME, Agriculture, more inclusive approach to banking; better asset liability management; improved margin management, thrust on recovery and increased efficiency in core operations of the Bank. Vision and Mission Vision To be a Leading Global Bank with Pan India footprints and become a household brand in the Indo-Gangetic Plains providing entire range of financial products and services sssssssunder one roof† Mission â€Å"Ba nking for the unbanked† Performance Comparison over the years [pic] During the FY 2008-09, the bank achieved a net profit of Rs 3,091 crore, maintaining its number ONE position amongst nationalized banks. Bank has a strong capital base with capital adequacy ratio at 14. 03% as on March’09. As on March’09, the Bank has the Gross and Net NPA ratio of 1. 77% and 0. 17% respectively.During the FY 2008-09, its’ ratio of priority sector credit to adjusted net bank credit at 41. 53% & agriculture credit to adjusted net bank credit at 19. 72% was also higher than the respective national goals of 40% & 18%. Information System in PNB History of Information System at PNB 2000 – The Beginning In March 2000, the penetration and use of IT was not very high at PNB. PNB was relying on manual processes to collect, store, and analyze business data. Its retail branches were not connected and it was difficult for management to understand business drivers and impediment s.This situation made it difficult for PNB to provide optimum customer service and resulted in lost opportunities. Manual operations were also costly to support. The bank used seven different software, which ran on 13 different flavors of UNIX, on standalone PCs. The 500-odd branches were not networked and only 35 percent of the bank's business was computerized. The overall expertise in IT among users was low. The Central Vigilance Commission (CVC) issued a directive to the bank to computerize at least 70 percent of its business by December 2000.This prompted the bank to work out a strategy to tackle the daunting task in the short period of time. At that time there were various factors which caused a barrier in implementing an Information System for centralized banking. These weaknesses were:- †¢ Different Unix OS used in different branches. †¢ Different standalone financial applications on PCs at different branches. †¢ Lack of interoperability due to disparity in sys tems. †¢ Limited expertise on the software packages currently deployed. †¢ Most branches did not have a proper LAN in place.PNB hired a consultant and devised a two-pronged plan of action. The plan comprised: †¢ A short term goal – To meet the CVC deadline of 70 percent computerization. †¢ A long term goal – To create a dependable core banking infrastructure and build a nationwide network to connect different branches to the core infrastructure. PNB chose a product from a company called Nelito. It was a DOS-based, ‘Partial Branch Automation' application. Standalone versions were chosen since there weren't LANs in place, and deployment of LANs at branches would take so long that the CVC deadline couldn't be met.The interface was simple in design, and thus easy for the bank personnel to use. The bank requested CVC for an extension of the deadline and was granted time till March 2001. By March 2001, 70. 60 percent of the bank's business was compu terized. 2001-2003 – The Long Term Strategy In the long-term, PNB wanted a technology that would consolidate all its business resources and sustain the bank's future growth. It also wanted to create its own network, which would play a vital role in its success. Three consultants were appointed to review technology options for long-term adoption.The verdict of the consultants was to deploy a centralized core banking architecture. On 30 March 2001, the bank used the services of Infosys for the deployment of Finacle. A core team was selected, which would be the heart of the project. Infosys trained 200-odd personnel from a core team over six months. The core team modified and customized the package according to its specific needs. As the time passed besides making a mark in terms of revenues, the bank— among the few technology-savvy PSUs—set up examples for other banks, especially PSUs in early of this decade.Institute for Development and Research in Banking Techno logy (IDRBT), a division of the Reserve Bank of India (RBI), presented PNB with the award for excellence in banking technology in 2002. This was quite an achievement considering that the technology transformation started only two-and-a-half years back at PNB. In March 2000, the bank had only 36 percent of its businesses covered on computers, as against 84 percent in 2002. PNB purchased servers, security infrastructure, and storage equipment and decided to house it in its own central data center in New Delhi.A lot of infrastructure from Cisco has been used to build the data center. In April 2002 the bank rolled-out Finacle in 7 branches as a pilot venture. This was done because the bank had seven different application packages, and it wanted to ensure smooth migration of the data into Finacle. By mid May 2002, all data from other software was successfully migrated into Finacle and by end of year, the number of locations has increased to 12. As far as the centralized core banking syst em is concerned, PNB has a data centre at the corporate office and all these 12 centers have an extension to that data.This system enables an individual having an account in any of our branches to conduct transactions/operate the account from any of these 12 branches. 2004-2007 – The Growth Stage In 2004, India's National Association of Software and Service Companies (NASSCOM) nominated Punjab National Bank (PNB) as the best user of technology in its sector. The bank continued to spread the technology to more of its branches and centers. The adoption of Core Banking Solution not only ensured standardization of products, but also enabled quick launch of the new and innovative financial products ensuring sufficient lead time to market it.The core banking solution offered seamless platform for integrating various such initiatives and also reduces the cost of transaction, thereby offering financial products at an affordable cost. On May 27,2004 Punjab National Bank (PNB) has intr oduced Loans and Advances Data Desk for Evaluations and Reports, (LADDER), a computerized management information system for rationalization of returns, asset classification and provisioning, credit monitoring and NPA management. The implementation of the system comprised two modules. The first module would require branches to capture data on borrowal accounts as a | |one-time activity with transaction updates at periodic intervals. | |   | |The second module for implementation of the software envisages collection of information on the loan accounts from the stage of receipt of | |application to disbursement of sanctioned loans. | | |With the implementation of this system, manual collation of a large number of loan-related returns become redundant and branch staff | |concentrated on business development and objective monitoring of asset quality. | 2008 – Rural Initiative Infosys Technologies Ltd (Infosys) and Punjab National Bank (PNB) in 2008 announced that PNB has chosen Finacle from Infosys to power its core banking initiative for rural banking deploying Finacle across PNB’s six Regional Rural Banks (RRBs) covering 1300 branches.Punjab National Bank took lead in business excellence and commitment to customers by providing core banking coverage to its 4850 service outlets. Due to the remoteness of rural branch locations, there were issues such as connectivity of branches for operational ease, centralization of data, and enhancement of customer service as well as innovation in banking products. Moreover, all this is needed at a substantially lower cost for RRBs as their operations were relatively less complex. Finacle from Infosys recognized this need of RRBs and adapted its industry leading core banking solution to suit the requirements of these institutions.PNB management selected this platform to transform and standardize the operations of its RRBs. A majority of Indian banks were already ahead in terms of adoption of new age technology. Ex tending the benefits of technology to RRBs helped sponsor banks in not just priority sector lending but also present an additional business avenue with tremendous potential. Finacle enabled RRBs to better manage audit processes, adhere to statutory compliance, enhance internal MIS requirements and offer customers competitive services on par with commercial banks. 2009 – 100% CBS ImplementationIn Feb, 2009 India's second largest public sector bank, announced that it has completed 100 per cent core banking implementation at its 4604 branches and extension counters through the FinacleaUniversalaBankingaSolutionafromaInfosys. The bank implemented industry-leading Finacle CBS across its operations running a flexible and scalable database platform from Oracle and innovative and cost-effective Sun SPARC enterprise serversafromaSunaMicrosystems. Finacle has enabled the bank to consolidate and centralize its operations, improving branch efficiency and productivity per employee.Consoli dation has also resulted in reduction of revenue leakage and cost, while increasing ease of technical support and maintenance at branches. The solution's scalability has also enabled the bank's scalability to be the best in the countryawithatheanumberaofapeakatransactionsaata3. 5amillion. Further, the bank has covered all the branches under CBS platform including extension counters. As a result, 38 million PNB’s customers are enjoying the facility of â€Å"one bank – one account†. In addition, the bank has intended to build a data center capable of handling business of 6000 branches and 1 lakh terminals.The bank was awarded â€Å"IBM green award† for adopting environment friendly technology for data warehouse implementation during the year. Other Banking Applications The banking major also introduced a number of value added services like ATMs, Tele-banking, SMS banking, mobile banking and Internet banking, remote access facility through its website, etc. under a license from RBI to launch Internet banking. The bank also enabled customers to avail of the Straight to Processing (STP) facility. The biggest advantage of STP is that if a person with an account in Delhi deposits a cheque in Chennai, his account in Delhi gets updated the same day.PNB’s team has also customized this package to suit the typical requirements of a public sector bank. â€Å"As PNB handles huge number of government accounts—public provident fund, deposit of income tax, deposit of different duties and treasury payments, PNB had to customize it and also built a module for government businesses into this package. The bank also has a depository set-up (to store dematerialized share certificates) at its corporate office in New Delhi and another in Mumbai. Customers owning shares and bonds can deposit them at these depositories after which the hard copies are destroyed.The bank, on the other hand, keeps a digital copy of all these documents. Thus, one d oes not have to bother about the loss of paper, or a signature that does not match and so on. Customers can now instruct the bank at any point of time to transfer these securities. Another very interesting development with PNB is its contract with Indian Railways. It is putting up an ATM machine at the New Delhi station’s reservation office, which is going to be a interface between the Railways’ server and the bank’s server.Once this is functional, customers can collect their tickets from the ATM machine and the payment can be made using credit or debit cards. Once this is successful and the interface is done, the bank plans to enable all their ATMs across the country on this platform. Electronic Data Interchange (EDI) is another technology initiative that the bank has taken up. It has entered into an agreement with the Customs department wherein the Customs’ server is connected with the bank’s corporate office server, which is further connected to several branches of PNB and also to importers.Thus, whatever duties are required to be deposited with the Customs department can be debited from the importer’s (read customer’s) account automatically. The pilot project for this has already been carried out and the bank plans to introduce this service soon. The PSU has also introduced bilingual software known as Bank-mate. With the help of this software one can generate reports in Hindi and also can get his/her passbook in Hindi. This is already in operation at around various branches and PNB is also getting orders for this package from other banks. PNB’s IT SetupPNB also has a number of applications running on its network like any other Financial Institution. The bank has standardized all its platforms on UNIX operating system and RDBMS on Oracle. Other OS like Microsoft’s windows 2000/ XP are also enabled in centers. As far as the hardware platform is concerned, PNB has Sun Microsystems’ Web serv ers at the data centre. Apart from this, they are also using Compaq, IBM and Xeon servers. At some locations, the bank is still using DOS machines to run some of their ATMs. Systems Before deploying the core banking architecture, PNB used servers which were NT-based, from IBM, and from other vendors.The bank conducted benchmarking tests for Finacle on various server platforms. And it was satisfied with the performance of Sun's hardware on Solaris. Sun's Fire servers, Solaris OS, and Oracle's RDBMS are now in use. Network design Cisco has tied up with PNB to evolve the network design and implement a nationwide network backbone to connect all its offices. Cisco will assist the bank in understanding and implementing the various technologies associated with the project. The converged network infrastructure allowed PNB to standardize the applications and software needed to provide the banking services.The various branches are connected to the data center using new-world routing and switc hing technologies. Storage systems The bank has followed RBI's storage requirement guidelines. Provisions have been made to store transaction data for around 10 years. In some cases, data is stored permanently. Around 164 Sun enterprise class servers are used in DAS architecture. The total capacity is of multiple TBs. The Sun hardware uses an in-built storage management tool. Later look over a storage management application from VERITAS. WAN and connectivity 101 branches of the bank were on a WAN in 2000.The bank put 500-odd branches on the WAN in 2002, and in three years the WAN had 2000-odd branches. The bank tried a number of connectivity options. 802. 11b wireless connectivity was installed in five branches to begin with. The bank then explored the option of leased lines and used connectivity from MTNL and BSNL. It also used Bharti's leased line between Mumbai and Delhi. The bank also used Reliance Infocomm's fiber optic backbone along with the leased lines in locations where th e optic fiber does not reach. PNB had appointed HCL Com-net to carry out 24Ãâ€"7 monitoring of the countrywide network.There's a live link between HCL and PNB's IT head office. The network is monitored remotely and can also be viewed at the bank's IT facility, where a separate monitoring system is used. Security Systems Security was especially important because the bank could afford no compromise. The security architecture had to be robust, reliable, and scalable to meet current and future needs. Cisco was chosen as the service provider who could meet these stringent requirements. The bank uses a range of security products like Firewalls and IDSs from Cisco for its security needs in its LANs and WAN.All data transactions between its routers and switches are encrypted. It has appointed Ramco Systems as the security integrator. The security integrator is responsible for the complete security infrastructure and is answerable for any security breach or lapse. The bank appointed securit y administrators. VeriSign provided the necessary Public Key Infrastructure (PKI) to the bank for secure transactions. Software Resources PNB is using various software’s for its operational activities for its smooth and efficient running, the Software used by PNB include:-  ¬ Microsoft office 2003 Acrobat Reader  ¬ Bank-mate  ¬ Attack Filters: – Spyware, Trojan, VoIP etc.  ¬ Protocols: – IP, VLAN, DNS, HTTP, FTP, TCP, TELNET, UTP etc.  ¬ Operating System’s:- UNIX, Solaris, Windows NT, 2000 Server, XP etc..  ¬ Databases: – MS Access, MS SQL, Oracle, FoxPro. Hardware Resources To fulfill the requirement and as per compatibility with software these hardware are used:-  ¬ HCL, IBM etc Desktops,  ¬ Printer  ¬ NT Based servers from IBM,  ¬ Sun’s hardware for Solaris,  ¬ Network Cards.  ¬ Routers, Scanners etc†¦ Organizations Other Computing Resources Payroll Transaction Processing SystemPayroll TPS, which is a typical accounting transaction processing system found in PNB. A payroll system keeps track of the money paid to employees. The master file is composed of discrete pieces of information (such as a name, address, or employee number) called data elements. Data are keyed into the system, updating the data elements. The elements on the master file are combined in different ways to create reports of interest to management and government agencies and to send paychecks to employees. Management notices the record of the employee’s efficiency to work and may declare added bonus or other incentive.This report is checked and approved by the branch manager after which cheque is issued to the employee. Online Assistance PNB provides its customers online assistance by providing i-banking, online complaints, providing them information about various products and services. These complaints and assistance are processed by customer care services executive. Account Opening In account opening the MIS is used, every information about the customer is recorded like their name, address, account, type of account, account information, their sample signature, these helps in Identification of customer instantly and creating a database at faster rate.This includes the filling of KYC and AC forms. SPNS (Shared Payment Network System) Swadhan, the first SPNS launched in Mumbai by IBA. The banks that participate on this network could issue the cards to customers for transacting on networks. RTGS (Real Time Gross Settlement) RTGS System is a payment settlement system that minimizes the credit risk in the prevalent cheque clearing system. Under RTGS the funds are settled on a near real time basis across Banks in different locations.Bank offers this immediate electronic fund transfer facility to RTGS enabled bank branches across through the country its designated RTGS enabled locations. Mobile Alert Service The clients now have the facility to subscribe to Mobile Alert Service for receiving alert s on registered mobile phone numbers instantly after the funds are pooled. Impact of Information Systems An information system is there to empower its users. A database simply provides data, but an information system is all about providing the best information the user needs to do their task more effectively.It also takes into account that different users doing their own specific tasks may need to see their information presented in differing ways. The benefits of an information system follow when the user can quickly access, understand and respond correctly to that information. The implementation of Information Systems in PNB and other financial institutions had a vast impact on the Employees (the way they work), Customers, The industry & Government. The system provides information on the past, present and project future and on relevant events inside and outside the organization. Finacle’s ImpactFinacle core banking solution is a comprehensive, integrated yet modular business solution that effectively addresses the strategic and day-to-day challenges faced by banks. It is highly parameterizable providing that much-needed flexibility to adapt to a dynamic environment. The solution has an integrated CRM module enabling banks to offer a rich and differentiated value proposition to customers. The layered Service Oriented Architecture (SOA), STP capabilities, web-enabled technology and 24 X 7 operations ensure multi-channel, multi-country and multi-currency implementations.The functionality-rich modules in the solution provide banks with a varied palette of features to continuously innovate on their product and service offerings. With Finacle core banking solution, banks can meet the challenges of managing change, competition, compliance and customer demands effectively. †¢ Differentiated Product Spread Finacle core banking solution offers an unlimited palette of features for banks to design and deploy products for varying market segments.The product bu ndling capabilities of the solution offers a wide range of possibilities for banks to create products with innovative features. The facilities provided for differential pricing, channel rules and customization through Finacle Studio – the scripting engine, empower banks to continuously innovate and extend their suite of products, across segments. †¢ Agile Operations The Service Oriented Architecture (SOA) enables the IT team at the bank to effect changes without touching the base code, ensuring lesser vendor dependency and faster adaptability to changing business conditions. Robust Cross-sell Framework The CIF and CRM capabilities in Finacle offer a unified view of the customer across the entire solution and across multiple back-end applications, enabling the bank to view the customer from a completely informed angle. This empowers banks to effectively manage customer relationships and aggressively explore cross-sell opportunities. †¢ Increased Operational Efficienc ies and Productivity Finacle core banking solution supports business events automation and process orchestration, thus eliminating manual tasks and reducing process time.The elimination of error and data redundancies also results in increased branch productivity. Straight through Processing (STP) abilities enhance reduction in turnaround and processing time, increasing output and enabling speedy completion of tasks. The multilingual web-based single repository of information enables remotely located bankers to collaborate and transact seamlessly. Impact on Employees Information System serves employees with user friendliness, easy storage and access of data, removal of redundancies, fastening up of the processes and providing up of multiple views at same time.In beginning the issues were mostly cultural. Most staffers were used to working in a manual environment, and some had worked in standalone environments. In the new networked environment, personnel at the node/counter didn't act ually ‘see' the transactions updating in the various account books. This gave rise to a number of queries and suggestions from personnel. It took around six-eight months for the personnel to felt that the environment ‘change' had done them good, and they were used to working on the systems. Other Available AlternativesThe Indian banking sector is slowly coming of age and hand grooming this sector is the banking solution market, which has carved a name for itself in the global arena. Not to forget the pro-active government reforms that are helping the Indian banking market reach greater heights and adding glitz and glamour to Indian economy as a whole. Other then Finacle from Infosys there are various available alternatives for which the banking industry and financial institutions can opt. These are:- †¢ Office Accounting Professional 2009 †¢ SAP ERP Financials †¢ Tally 9: Financial Accounting and Inventory Management Software †¢ Flexcube – â₠¬Ëœi-flex solutions’ Hyperion Financial Management – System 9 While in past i-flex solutions’ flagship product Flexcube has been rated the #1 banking product in the world by UK based IBS, an independent banking solutions rating vendor, but Infosys Technologies’’ Finacle doesn’t took long enough to overtake Flexcube. But now a day’s SAP ERP programmes are giving a tough competition to Finacle. Conclusion A management information system is a system or process that provides the information necessary to manage an organization effectively. MIS and the information it generates are generally considered essential components of prudent and reasonable business decisions.This report starts with the Punjab National Bank with overview of PNB followed by history of information system and the steps taken by PNB to be effective in banking industry by using information’s technology. Information Technology (IT) innovations in the last few years have changed the landscape of banks in India. Today, IT seems to be the prime mover of all banking transactions. Electronic and Information Technology together are bringing a swift change in the way banks operate, especially offering better delivery channels and customers’ friendly services.Anywhere banking, telebanking, mobile banking, net banking, automated teller machine(ATMs), credit cards, debit cards, smart cards, call centers, CRM, data warehousing have totally transformed the banking industry. Today almost all the major banks in India like ICICI Bank, UTI Bank, Citibank, Standard Chartered Bank, ABN Amro, SBI and PNB are offering online services to their customers. ATMs have emerged as the most favored channel for offering banking services to the customers in the world.One of the biggest benefits that the bank has derived out of IT has been the tremendous saving on recruitment front—the bank has not recruited more staff even while the business and work pressure s have gone up five times. Consequently, PNB’s profitability has also increased. To train users the bank has set up more than 15 computer training labs across the country. It explains all the TPS how the transactions are made by the bank, using of these TPS from the new events such as account opening, new allowances etc†¦ to the routine work including cash and payments record, updating of records, payroll and the processing of the complaints.These TPS holds all the activities from the manager and employees to the customers. The report discuses the inbound and the outbound logistics and relate all the processes of TPS used in the bank with the Information System is enabling the bank to provide the quality and satisfactory services to their customers. Suggestions The bank is using information system efficiently and it has increased the customer satisfaction, efficiency, data storage, fast data retrieval. But to improve more and regarding future success of PNB here are the some suggestions. The bank must update Hardware to get maximum performance from Information Systems in order to allow the IS to procure the least amount of system resources it requires for functioning.  ¬ The bank should update all their software, networks etc to keep information system up to date for competitive edge, customer satisfaction.  ¬ Steps should be taken to increase the safety & to avoid the unethical practices like phishing.  ¬ Need for improved training for using Information Technology and tools to employees.  ¬ Intra firm communication should be improved.References Websites:- http://www. networkmagazineindia. com/200305/tech4. shtml http://www. expresscomputeronline. com/20021202/banks7. shtml http://www. business-standard. com/india/news/pnb-to-implement-loan-data-software/151819/ http://www. financialexpress. com/news/pnb-in-networking-pact-with-cisco/64296/ http://www. pnbindia. com/ http://netpnb. com/ Books:- PNB Vision 2007-2008 Zonal Training Centre Gui de. ———————– (The name you can bank upon) All Banks Average Punjab National Bank (Performance Chart) (Amount in Rs Crore)

Do universal moral principles exist If so, what are these universal Research Paper

Do universal moral principles exist If so, what are these universal morals - Research Paper Example The issue seems endless, the answer unreachable on any proven level, yet is sparks fire in the hearts of even the judges in courtrooms who must apply the law to ‘hard cases’ and stretch its definition whilst keeping in line with written provisions. Indeed, there are strong arguments both for and against the existence of universal moral standards. The issue is not one of proof; it is rather one of providing the most plausible argument. So what is a universal moral principle? It is an objective knowledge of right and wrong; a confidence in the natural goodness of human nature. Our reflective intellect possesses a direct knowledge of the qualities from which conclusions might be drawn about what these moral rules are. The biggest problem faced by this contention is answering the question: where do they come from? Are they inherent within us, or do they come from a higher being? Do we learn them over time as we grow, or were we born with the ability to access these moral principles? Aquinas makes reference to the existence of natural laws created by God, which we access by intellectual reasoning given to us by Him (Aquinas 1920, Q.2-94:2). Hare states that human logic applies to our moral assertions, allowing us to arrive at an objective standard of moral principles. Rousseau argued that we were born with a certain set of natural rights, which are then transpired into the moral respect we give each other Rousseau (17 62). If these different contentions are right, they all point to one thing; an existing set of moral principles, followed universally. So, everyone considers murder, or the taking of another’s life to be immoral. This is very plausible if one considers the law and punishment severity in law for murder; we all arguably believe in the preservation of life. However, in some societies this means killing the

CULTURAL DIMENSIONS IN ADVERTISING Research Paper

CULTURAL DIMENSIONS IN ADVERTISING - Research Paper Example Therefore, the researcher found that a mix of Spanish and English is most effective in these populations, as it mixes accommodation and respect (the Spanish part of the ad) with a positive feeling of linguistic security (the English part of the ad). Meanwhile, in all countries, there is a negative side to advertising. This negative side is that advertising encourages a feeling of inadequacy, and advertising also denigrates traditional social norms. The question that needs to be answered is what are the specific connotations that English convey in the different countries that are covered by the research, and why is advertising considered to be negative in some instances? I. Sociolinguistic Aspects of English Advertising A. In Japan The use of English in the country of Japan is becoming an increasingly popular phenomenon. The attribution of the high number of loan words in Japan dates back to the Meiji Restoration in 1868, in which Japan was transformed from feudal to a modern state by adopting Western civilization (Takashi, 1990, p. 327). There are a high number of English loan words in the Japanese language, much more so than loan words from European nations. English loan words represent 80.8% of Western loan words in Japan, with the other western loan words coming from France, Germany, Italian and Dutch (Takashi, 1990, p. 327). This is because the Japanese study English more than any other foreign language. There is some thought that the Japanese people regard English as representative of something cosmopolitan and international, and modern English words are seen as conveying sophistication and modernity, especially in they are used in advertising. (Takashi, 1990, p. 327). Part of the reason for this is because, before, 1931, English words were used in Japan for new concepts and things (Takashi, 1990, p. 327). Previous studies indicate that Japanese males use English loan words more when talking about academic subjects, as opposed to every day life, while Japa nese females use English when speaking on every day topics, as opposed to academic topics. (Takashi, 1990, p. 328). Other studies indicated that commercials that were aired in European languages, such as English, German, French and Italian, and used Western imagery, such as background music, scenery, and a Western person, conveyed the social values and stereotypes attached to these languages. (Takashi, 1990, p. 328). Still other studies showed that young Japanese girls use English loanwords when they want to appear fashionable. (Takashi, 1990 328). Takashi's (1990) study focused upon the language of contemporary advertising, particularly the usage of English in the Japanese contemporary advertising. The focus was on the use of English loan words in Japanese advertising, with 506 Japanese commercials with English loan words and 413 print advertisements with these loan words. For the purpose of this study, the term â€Å"loan word† denoted any English word that had been morphol ogically, phonologically and syntactically integrated into the Japanese language. The study also delineated advertisements that were aimed at specific populations, such as female, young and old, and sought to discover how loan words were used in these specifically targeted advertisements. The study found a total of 5,556 English loan words

Cross culture Essay Example | Topics and Well Written Essays - 2500 words

Cross culture - Essay Example The international transfer department is responsible devising policies related to the international assignments. As regarded by LVMH â€Å"international mobility† is the essence of career development which helps the potential candidates to acquire the requisite competencies. This case study delineates the procedure of international mobility. This assignment focuses on some of the key issues of international mobility so as to bring in light the challenges faced by the company and ways to tackle with them. Challenges faced by LMVH: LVMH, being a global company, required the expertise of personnel having international experience. To assure the availability of potential human resource who could operate anywhere in the dominated market, company decided to build in a pool of such asset by moving them internationally as part of their career development process. International mobility is the reality which has become pertinent for almost every global organization to work effectively in a cut throat competition. International assignments are considered as one of the most potent means of developing â€Å"Global leaders† (Stroh & Black, 2005). ... This at times become quite frustrating, time consuming and even more expensive when dealing with the potential subject’s non-technical requirements. The situation grows even more problematic when people try to compare there package with others holding same position in different companies within the group. LVMH follows a â€Å"balance sheet approach† to devise an appropriate salary for the expatriates. This approach is widely used owing to its advantages for an international assignments; it treats all the employees with equity without creating a difference in their salaries owing to the market rate of the host country, this in turn reduces the chances of uncertainty thus encouraging employees to take on the assignment (Stroh & Black, 2005). However, the increase in the firm size surges the administrative burdens and thus the cost. â€Å"Security benefits† is yet one other concern that needs to be dealt with appropriately when laying out the package. Security packa ges generally differ in each country. Devising a package keeping in view the host countries requirement at times is problematic owing to the complexities involved in it. Every country has its own rich culture strongly held by its dwellers. Cultural differences strongly impede the process of adjustment by a foreigner because of differing managerial values (Bigoness &Blakelly, 1996). Thus to ease out the process, LVMH believes in the training its employees. However training process is time consuming and the adjustment is left on the employees to deal with. Moreover devising and then implementing appropriate cost effective policies for managing international assignments and recruiting process pose a significant risk to

Corporate social resposibilty for cannon Essay Example | Topics and Well Written Essays - 2750 words

Corporate social resposibilty for cannon - Essay Example Sustainability marketing adopts business practices, which promote sustainability in various aspects. These offer a remedy to environmental problems, and include a company’s production methods, as well as products, and marketing activities, which should result in minimal or no environmental pollution and depletion of resources (Charter et al 2002). Nonetheless, sustainable marketing is beneficial to a company in many ways. Sustainability marketing helps in the optimization of the performance of a company. According to Hunt (2010), adoption of sustainable marketing gives a company a competitive advantage. This will then result in an increased financial performance of a company. Often, companies compete for a competitive advantage in resources, which will offer them a position of competitive advantage in the market, and this is achieved by adoption of sustainable marketing. ... This is because customers and businesses are not restricted to buying the brand only. These also buy the philosophies and policies of a company. Therefore, most clients will purchase from a company that prioritizes environmental, social, and ethical issues (Charter et al 2002). Sustainable marketing also helps a company to create strong relationships with its customers, employees, other companies, and the community. If a company adopts sustainable marketing, this gives it brand trust. Therefore, customers and other stakeholders will have trust in the company, thus show their loyalty to the company, and this boosts positive relationships in the company, which is important for the prosperity and sustainability of a company (Diane & Schouten 2012). Question 2 According to Belz & Peattie (2012, p.29) sustainability marketing involves â€Å". . .planning, organizing, implementing, and controlling marketing resources and programmes to satisfy customers’ wants and needs, while consi dering social and environmental criteria and meeting corporate objects.† Therefore, using the sustainability marketing framework by Belz & Peattie (2012), it is possible to evaluate how Dannon integrates different elements of sustainability marketing into its business approach. In this sustainability marketing framework, two major aspects are essential are important, and these include the consumer behaviour and socio-ecological problems. Therefore, when developing different sustainability marketing elements, Dannon had to consider the behaviour of its customers in the market, as well as the present socio-ecological problems, which are prevalent in this 21st Century, where increased globalization and technological advances are experienced (Lofdahl

The Buying Patterns of the Consumers Essay Example | Topics and Well Written Essays - 1750 words

The Buying Patterns of the Consumers - Essay Example When flaws in this approach became apparent, during the mid-1990s, the focus shifted towards product orientation, which urged the marketers to spend all their resources in perfecting the quality of their products. The next ideology shift during the late 1970s brought the selling orientation, which preached the idea that in order to ensure sales and profits, companies should follow highly aggressive sales strategies (Lancaster & Massingham, 2010, p. 20).   Nevertheless, all these ideologies were stepping stones in allowing marketers to come up with the marketing innovation, which puts customers at the top of everything which the motto, â€Å"a customer is always right†. Marketing approach urges marketers and companies not to engage in â€Å"hunting† but â€Å"gardening†. Marketers agree that â€Å"make and sell† strategy is extremely short-sighted and today, in order to succeed, companies need to follow a â€Å"sense and respond† strategy. Organisations should not put in all their efforts to find the right customers for their products, but the focus should be on finding the right products for your customers (Solomon, 2006, p. 370).   More importantly, in order to find right products for your customers, you first need to have a thorough understanding of the needs and wants of your customers. Only when businesses have the proper knowledge about the buying patterns of their consumers, they can sustain their revenues and ensure that they rank high in terms of customer satisfaction.

Holocaust and Jewish-Christian Relations Essay Example | Topics and Well Written Essays - 1750 words

Holocaust and Jewish-Christian Relations - Essay Example The continued anti-Semitic feelings of the Church stem from Christian teachings based on interpretations of the New Testament that have also contributed to the Holocaust and the persecution of Jews in Europe over the centuries. In 1814, Jews in the Papal States were locked into cramped ghettos at night, were forbidden to practice law or medicine, to hold public office or to hire Christian servants. Meanwhile elsewhere in Europe, Jews were increasingly free to live as they wanted. These practices were the inspiration for the racial laws enacted by the Nazis and the Italian Fascists in the 1930's. After the fall of the Papal States in 1870, the Church's hostility towards the Jews began to take an even more disturbing form. No longer simply loathed as unbelievers, the Jews became hated symbols of secular modernity. With varying degrees of enthusiasm the German Catholic Church sympathized with, if not actually supported the Nazis. Their views on communism, socialism, liberalism and freemasonry were similar to those of the Nazis. Though these Church leaders were concerned with some aspects of the National Socialist regime, they did virtually nothing to stem the growing tide of anti-Semitism. Some of them even agreed with the Nazi ideals to "endeavor to maintain the purity of the German blood and German race" and to fight the Jews' "hegemony in finance, the destructive influence of the Jews in religion, morality, literature and art, and political and social life." (The Catholic Church and the Holocaust, pg 23). Hitler was inaugurated as Chancellor of Germany on January 30 1933 with 52% of the votes. To make constitutional changes, the National Socialists needed two thirds of the votes. Therefore Hitler felt compelled to appease the Catholics and made a series of promises and concessions to German Catholicism. On March 23 he released a statement assuring the Christian churches of his resolve to work for peaceful relations between the church and the state. After Hitler gained power the German Catholic leaders adjusted to the Nazi regime and most church leaders enthusiastically supported the domestic and foreign policies of the Fhrer during most of the Nationalist Socialist era. Some thought that the anti-Jewish laws were in fact beneficial as they eliminated Jewish influences considered harmful to Christian society. On the 20th of July 1933 the Concordat between the Vatican and the Third Reich was signed. It was a major step towards legitimizing the Hitler regime and sealed the subordination of German Catholics to the Nazi program. Therefore on June 1 all German Catholic bishops issued a letter withdrawing earlier prohibitions against membership of the Nazi party and encouraged the faithful to be loyal and obedient to the new program. They looked upon the National Socialist regime as another anti-communist authoritarian system, not recognizing Hitler's totalitarian ambitions. On March 24, Hitler acquired the support of the Catholic Cen tre Party for passage of the Enabling Act, under which Hitler could enact ordinary legislation by decree. This right was extended a year after

Industry Best Practices Research Paper Example | Topics and Well Written Essays - 750 words

Industry Best Practices - Research Paper Example More devices are being used today than were ever before. This has made protecting network while providing access very difficult and expensive in the industry. It is important to ensure that local user access is very tightly secured today while remote user access is just as simple and sound as local. Given the use of devices and technology today, all users are remote while all end points are unsafe. The user demand will increase in the coming years and demand access to business resources from any location will also increase. The future is gearing up towards a universal access control model, one that inverts the network. In this the protection will be more focused towards application resources. In universal access control, the entire access network field is level. In this setting, no user, device or location is given preference or trusted blindly. The focal point of such an access control field are its information resources. These include the applications, the data and the services. Th us in all its benefits and advantages, the biggest advantage of universal access control is that it ensures all resources are available easily at any point and at any location. However, universal access control is just made available. It Is not made universally accessible as one of the best practices in the industry. The IT department of any telecommunication company needs to come up with a strategy to establish and sustain universal access control. Universal access control has made protection of devices, data and resources more easy. With the growing evolution of laptops and mobile traditional networks cant be protected completely by IT. Thus the most dangerous and notorious attacks on the networks come from local users than from remote users. Thus implementation of universal access control ensures protection from these attacks. It is important for IT managers to assume that any user and device as a potential risk point. Implementation of universal access control has become a criti cal norm in the industry. IT managers must now assume that any user and device is a potential risk point. It does not matter if the user is gaining access remotely or by directly plugging into the LAN. Thus universal access control in a remote connectivity environment, serves to provide the following three important objectives: (REMOTE CONNECTIVITY) 1. Provision of adequate security: The security system should ensure that users are validated with passwords to protect network attached resources from unauthorized access. The greater the number of levels of security provided, the more secure the network resources and information would become. 2. Easy administration: The security systems should be easily accessible, easy to use and most be protected from unwanted tampering by other users. 3. Transparency: Users can attempt to implement circumvent security methods which are difficult to use. So the universal access control model implemented should ensure logging in from both the work sta tion attached to corporate LAN as well from home office. Implementation of universal access control is costly. It takes heavy costs for IT, infrastructure and other costs have escalated sharply and heavily. Thus the implementation of universal access control is a costly procedure. . Works Cited REMOTE CONNECTIVITY. (n.d.). Retrieved 1 14, 2012, from Sonic Wall:

Demon and Fact Faustus Essay Example for Free

Demon and Fact Faustus Essay Mephistopheles varies greatly in his attitude towards Faustus, sometimes seemingly offering support and guidance while others acting in a dismissive, even disdainful manner. Throughout, Faustus is manipulated into fulfilling Mephistopheles own goals, yet the bewitching fiend succeeds in giving him the belief that he wants to do these things himself whether or not he is being guided, albeit rather forcefully, there. Nonetheless it remains to be seen if this is a reflection of the deceitfulness from the devils servant or rather the weakness and arrogance shown by Faustus. Faustus appears vulnerable and naà ¯ve upon conjuring for the first time, pathetic fallacy adding to the sombre mood, as gloomy shadow(s) overcast the scene, obscuring what is about to happen, leaving the audience in the dark and instilling a sense of terror. Therefore when Mephistopheles appears as a devil it is presumably through fear that Faustus describes him as too ugly such is the heightened sense of tension and feeling of the sublime he experiences. As opposed to reacting to Faustus needs Mephistopheles immediately gains control and begins surreptitiously asserting his dominance over him, taking advantage of the fact Faustus is clearly out of his depth, and resorting to imperatives, commanding Mephistopheles to speak! hinting that desperation is starting to creep in. Throughout the play it appears as though Mephistopheles is praying on Faustus weaknesses, identifying his aspiring pride as a pressure point and luring him towards the idea of becoming the sole king of all the earth. Once overcome with the thought of being a great emperor Faustus is obviously convinced that selling his soul is the best option he has and appears to disregard any rational logic, allowing Mephistopheles to sit back only issuing short replies like I will in return to the overly ambitious notions filling Faustus egotistical head. Faustus lack of control is only furthered when his own appetite gets the better of him leading to Mephistopheles threatening to go back to hell forcing Faustus to implore with him not to leave furthermore signalling his reliance on him to actually carry out all his frivolous desires. The compromise of being offered greater things proves too much for Faustus as  passion overcomes reason, which Mephistopheles is keen to distance them from, crea ting stark opposition and providing further evidence that he is willing to manipulate Faustus through his vulnerabilities, regardless of what emotions this will invoke in the mere mortal himself. In addition to promise bringing whirlwinds, tempests, thunder and lightning under the control of Faustus, Mephistopheles also immediately senses whenever there is slight doubt in his subject, quickly bombarding him with fantasises to delight his mind and turn his attention away from any concept of repentance. This eagerness to persistently tempt Faustus towards hell every time he wavers slightly suggests a driven character, supported through his own claims that he would do anything to obtain his soul no matter the cost, showcasing a lack of care or sympathy towards the difficult situation Faustus finds himself in. This only serves to further the level of deception and pretence when Mephistopheles calls on Faustus to stab thine arm courageously resorting to flattery to get his own way, knowing that Faustus ego will easily succumb to being complimented and raised above others. However in direct contrast, Mephistopheles shows hes not afraid to resort to intimidation, reporting hell hath no limits such is the reach of the devil, one should know not to cross him as under the heavens the lines blur and the liminal becomes ever more apparent, this bold claim undoubtedly a shocking one in front of a contemporary audience wherein religion was distinct in its boundaries hell and heaven two entirely different entities. After a relatively straight forward process of persuasion Mephistopheles gains Faustus soul, leading to an apparent change in attitude from Mephistopheles more bold in his tactics he openly denies Faustus his wishes, instead questioning his stupidity and chastising him by warning him to talk not of a wife but rather concentrate on aspects of life he himself deems relevant. Faustus pitiful cry at the end of scene 5 suggests that already he realises the drastic mistake hes made and that thou art deceived! by the dishonest Mephistopheles, leaving the audience to feel slight sadness for the misplaced trust he possessed. Nevertheless while this seems tragic one cannot avoid the suggestion that Faustus was only guided down a path he  desired all along and that he convinces himself to be resolute and show willing to commit the most heinous of crimes such as offer luke-warm blood of new-born babies an awful taboo that highlights just how far he will go in order to quench his thirst for power and fame. In turn, this advocates Mephistopheles as more of a bystander than initially thought and while he is unequivocally determined in gaining more souls to enlarge his kingdom, he remains open about this throughout, instead of being sly and secretive. Therefore it can be considered that Faustus is in no position to call Mephistopheles a bewitching fiend such are the failings of his own character. He is the one who condemns himself through his over ambition at becoming a conjuror laureate and arrogance in believing that he has tamed Mephistopheles and made him obedient. Whereas Mephistopheles only points him in the right direction and technically always remains under his command, bringing him a hot whore for a wife, while unsatisfactory is still fulfilling the parameters of Faustus self-indulgent wish. Despite this obedience towards his supposed master, Mephistopheles can definitely be considered a bewitching fiend due to his ability to lure Faustus into making the decisions that Mephistopheles himself wanted and the drive he holds in forcing the deal through to the end. Furthermore his lack of concern towards his own conjuror is revealing, joking tut I warrant thee in reaction to Faustus recognition he has done wrong, displaying both a lack of remorse and also a smugness that he has succeeded in accomplishing Lucifers plan.

Oscar Wilde Earnest

Oscar Wilde Earnest Trivial Comedy for Serious People: Oscar Wildes The Importance of Being Earnest â€Å"Since we know The Importance of Being Earnest is a trivial play for serious people, our task as serious people is not to be content to say its funny, but to be careful when describing the fun† (Sale 479). First staged in February 1895 at the St. James Theatre, people packed the theater to see Oscar Wildes new play, The Importance of Being Earnest. The play â€Å"was an immediate hit† (Greenblatt and M.H. Abrams 2221). It was a promising time as Wildes plays had been the talk of the town for the past several years. Generally, Wildes plays were â€Å"serious even when trying to evoke comedy; his previous plays ranged from social satire and criticism (Lady Windermeres Fan), to themes that defied propriety and incited some moral indignation (Salome)† (Barnet xxix). In reply to criticism [surrounding Lady Windermeres Fan,] printed in the St. James Gazette of February 26, 1892, Wilde wrote a letter to the editor published on February 27th, under the heading â€Å"Mr. Oscar Wilde Explains†(Mason 390). In this letter, Wilde claimed â€Å"that he did not want the play to be viewed as ‘a mere question of pantomime and clowning, but that ‘he was interested in the piece as a psychological study† (Mason 390). His â€Å"tendency was to make his people ‘real, and then to take his audience through the looking-glass into a world which seemed to reflect modern life† (Raby 159). This new play, The Importance of Being Earnest, therefore, revealed a novel side of Wilde not exposed before. One of his contemporary critics, H. G. Wells, said â€Å"that it was much harder to listen to nonsense then to talk it, but not if it is good nonsense†¦.and this is very good nonsense† (Beckson 187). Hamilton Fyfe, on the other hand, found it â€Å"slight in structure, devoid in purpose† nevertheless â€Å"extraordinarily funny† (Beckson 187). â€Å"One critic failed to find it delightful; curiously this was Wildes fellow playwright from Ireland, Bernard Shaw†(Greenblatt and M.H. Abrams 2221). Although he claimed he did find it amusing, â€Å"George Bernard Shaw said that it leaves me with a sense of having wasted my evening† (Beckson 221). He even poked fun at those who praised the sheer nonsense of Wilde, remarking that â€Å"if the public ever becomes intelligent enough to know when it is really enjoying itself and when it is not, there will be an end of farcical comedy† (Beckson 221-222). Since George Bernard Shaw had a reputation for being a harsh critic, this criticism was characteristic of him. After reading the play, one might even agree with Shaws review. However, the play does have an understandable plot (â€Å"a gross anachronism,† according to Shaw (Beckson 221). The main character, Jack Worthing, is courting the affections of Gwendolen Fairfax, but is impeded by her mother, Lady Bracknell, who opposes the match (Greenblatt and M.H. Abrams 2229-2231). This part of the plot is serious enough. Wilde then adds a comical aspect: Jack has been introducing himself as Ernest while in town, and when back at his country estate he refers to a â€Å"younger brother† named Ernest (Greenblatt and M. H. Abrams 2223). While Wilde tries to inject a sense of seriousness into the comedy, he allows his plot twists to develop into the ridiculous. For example, the case of Miss Prisms losing an infant is nonchalantly explained as an absent minded switch between a book and a baby; the baby being placed in a handbag and the book in the perambulator (Greenblatt and M. H. Abrams 2261). There is also Algernons behavior and his imaginary friend called â€Å"Bunbury†¦which he invented as an invaluable permanent invalid in order that he might be able to go down into the country whenever he chooses† (Greenblatt and M. H. Abrams 2226), eventually Bunbury simply explodes. As ridiculous as Wilde made his plots, is the way he resolved them: Algernons way of killing off Bunbury was to calmly say that he â€Å"was quite exploded† (Greenblatt and M. H. Abrams 2256). When pressed for a better answer, Algernon simply explains that the doctor found that Bunbury was going to die and he expired right then and there. Gwendolens (and for that matter Cecilys) outrage after discovering the truth about Ernest is won back by the ridiculous attempt by Jack to christen himself Ernest. And the hard to believe predicament of Miss Prism and the lost baby eventually resolved Jacks impediment with Gwendolen. Very often when offered questionable storylines, one can expect relief from the moral of the story or the play, which the author might try to instill. The search, in this case, would be in vain. Algernon never gets his due over his continued deceit in Bunburying, and Jack Worthing is redeemed by the discovery of his being â€Å"Ernest all along. Jacks confession that â€Å"it is a terrible thing for a man to find out suddenly that all his life he has been speaking nothing but the truth†(Greenblatt and M. H. Abrams 2263) is simply accepted and forgiven. None of the characters get chastised for their bad behavior or prejudice. So, one is left to think that Wilde, in not condemning these actions, absolutely agrees with them. Therefore it might be considered that the plot is only a prop for Wildes more implicit messages, hidden within his side notes, his characters, and their situations. The message may not be understood by looking at the play as a whole; but in its parts. The gems hidden within the play are the commentaries of Wilde on topics such as medicine, relationships and social norms, with â€Å"considerable insight on the human condition, in particular issues of class, gender, sexuality, and identity† (P.P.F 288:538). He places these commentaries either as asides in the dialogue or in the intricacy by which a scene is played out. For example, Algernons skepticism regarding Jacks proposal to Gwendolen echoes the social dilemma, â€Å"girls never marry the men they flirt with†¦girls dont think it right†¦it accounts for the extraordinary number of bachelors that one sees all over the place† (Greenblatt and M. H. Abrams 2224). As for the dialogue of the two young ladies toward s each other (they will call each other a lot of things before they become friends); Wilde portrays the younger gal as naively idealistic, while portraying the other as an impractical romantic. They are represented as fickle, although Gwendolens attitude towards Cecily ranges from quite friendly to jealous rivalry and then to faithful friend (all in one scene). At the same time, Lady Bracknells impression of Cecily goes from the unthinkable to the idea that â€Å"[Cecily] has distinct social possibilities,† and as such would make a suitable member of London High Society (Greenblatt and M. H. Abrams 2258). While most of Wildes contemporaries were thrilled at the â€Å"nonsense† of the play, Shaw had expected a serious comedy by the playwright. Instead he saw it as having no structure and a real disappointment. The play does begin to make sense though, when we look away from the perspective of the critic and into the authors mind. If we accept that the plot is a prop, which Wilde used to throw abuse and amusement at his audience, we can then conclude that the play was meant as one big commentary on sensibilities, on society, and on theater. Furthermore, if we look at Wildes own problems at the time of the plays fame, we might understand Wilde. In the scene where Lady Bracknell is interviewing Jack, and then reacting to Jacks helpless admission that he has lost his parents, Lady Bracknell states that â€Å"losing both parents seem an act of carelessness† (Greenblatt and M. H. Abrams 2232), and adds that to rectify the situation he should â€Å"make a definite effort to produce at any rate one parent, of either sex, before the season is quite over† (Greenblatt and M. H. Abrams 2233). As absurd as this may seem, it does have a purpose: Lady Bracknell represents Victorian High Society. Because of this, she is ready to condemn based on ones birth or unfortunate circumstance; yet she makes a complete turnaround in her disapproval of Cecily once she realizes that the girl has good ancestry (namely, her father is rich) (Greenblatt and M.H. Abrams 2257). The absurdity of Jack posing as Ernest mirrors the life of the playwright himself. Oscar Wilde, at this time, had begun to scandalize London with his lifestyle and had been largely condemned as a homosexual. Jack Worthing explains that the pressures of leading a â€Å"high moral life† in the country does not provide him with the happiness he needs; rather, that happiness is found in Ernest whose reputation is entirely opposite of Jacks (Greenblatt and M.H. Abrams 2226). In the same way, perhaps Wilde feels somehow trapped in the need to conform to Londons High Society standards. The lack of a decent plot is an attack of the sensibilities of the audience to a serious play. Oscar Wilde once explained â€Å"that the play has an underlying philosophy: ‘that we should treat all the trivial things of life seriously, and all the serious things of life with sincere and studied triviality† (Greenblatt and M. H. Abrams 2222). The whole point was not the progression of the story, but the progression of the absurdity: starting with the truth of â€Å"Ernest†, then the nonsense of â€Å"Bunburying†, until the play escalates to the ridiculous in Miss Prism. His characters crude commentaries, which seemed to offend, were meant to offend; if anything, none of it needed to be taken seriously. The play is an exercise of triviality. George Bernard Shaw couldnt see past the nonsense of Wilde. The Importance of Being Earnest was actually quite an accomplishment. Wilde worked hard writing and rewriting the script until he felt he had the perfect combination of wit and humor shrouded in seriousness. It was absolute nonsense, yet it was a masterpiece of nonsense. There is a lesson to be learned here. Something serious need not be treated to death as serious; it can be allowed some form of triviality. These few lines say it best: Jack: â€Å"I am sick to death of cleverness†¦ The thing has become an absolute public nuisance. I wish to goodness we had a few fools left.† Algernon: â€Å"We have.† Jack: â€Å"I should extremely like to meet them. What do they talk about?† Algernon: â€Å"The fools? Oh! About the clever people, of course!† (Greenblatt and M. H. Abrams 2234). Works Cited Barnet, Sylvan. Introduction. The Importance of Being Earnest and Other Plays By Oscar Wilde. New York: Penguin Books, 1985. Beckson, Karl, Ed. Oscar Wilde: The Critical Heritage. London: Routledge, 1997. Greenblatt, Stephen, and M.H. Abrams, Eds. The Norton Anthology of English Literature. 8th ed. New York, USA: W.W. Norton Company, Inc, 2006. Mason, Stuart. Bibliography of Oscar Wilde. Edinburgh: Riverside Press Limited, 1908. Reprinted, New York: Haskell House Pub, 2007. P.P.F. The Importance of Being Earnest.Contemporary Review. 288.1683 (Winter 2006): 538-539. Retrieved April 3, 2008. www.liberty.edu. Academic Search Premier. http:/​/​search.ebscohost.com.ezproxy.liberty.edu:2048/​login.aspx?direct=truedb=aphAN=23913109site=ehost-live Raby, Peter, Ed. The Cambridge Companion to Oscar Wilde. Cambridge: Cambridge University Press, 1997. Sale, Roger. Being Earnest. Hudson Review 56:3 (Autumn 2003): 475-484. Retrieved April 3, 2008. www.liberty.edu. Academic Search Premier. http:/​/​search.ebscohost.com.ezproxy.libety.edu:2048/​login.aspx?direct=truedb=aphAN=11262215site=ehost-live

Argumentative Essay: Women Should Not Be Allowed To Go Topless In Publi

Argumentative Essay: Should Women Be Allowed To Go Topless in Public   Ã‚  Ã‚  Ã‚  Ã‚  In the summer of 1996 Gwen Jacobs enjoyed a topless summer stroll during which she was seen by a local O.P.P officer, was apprehended and subsequently charged with indecent exposure. Gwen Jacobs pleaded not guilty in court and won the right to go topless in Ontario. This incident brought up an excellent question: should women be allowed to go topless on public beaches and in other public areas? The answer is strictly no, women should not be allowed to go topless anywhere outside of their own home.   Ã‚  Ã‚  Ã‚  Ã‚  One of the many reasons why I believe that women should not be allowed to go topless is with respect to the safety of women. Men and boys have, in recent years, been using short, tight, skirts and shirts as an excuse for rape or date rape. Men have said that the girl was wearing a tight shirt and short skirt and it was obvious that she was easy and wanted the attention. This statement leads me to my next point. The average human being upon first contact with a stranger bases his initial impression of that person solely on the person's appearance. This is only natural as the only thing that we know about this stranger is what we see of them the first time we meet. We all are aware of the sayings "Preppy","Jockish","Skater","Sluty" etc. This final saying, â€Å"Sluty† is interpreted by 90 percent of North Americans as a tight skirt and tight tank top which happens to be the usual ensembl... Argumentative Essay: Women Should Not Be Allowed To Go Topless In Publi Argumentative Essay: Should Women Be Allowed To Go Topless in Public   Ã‚  Ã‚  Ã‚  Ã‚  In the summer of 1996 Gwen Jacobs enjoyed a topless summer stroll during which she was seen by a local O.P.P officer, was apprehended and subsequently charged with indecent exposure. Gwen Jacobs pleaded not guilty in court and won the right to go topless in Ontario. This incident brought up an excellent question: should women be allowed to go topless on public beaches and in other public areas? The answer is strictly no, women should not be allowed to go topless anywhere outside of their own home.   Ã‚  Ã‚  Ã‚  Ã‚  One of the many reasons why I believe that women should not be allowed to go topless is with respect to the safety of women. Men and boys have, in recent years, been using short, tight, skirts and shirts as an excuse for rape or date rape. Men have said that the girl was wearing a tight shirt and short skirt and it was obvious that she was easy and wanted the attention. This statement leads me to my next point. The average human being upon first contact with a stranger bases his initial impression of that person solely on the person's appearance. This is only natural as the only thing that we know about this stranger is what we see of them the first time we meet. We all are aware of the sayings "Preppy","Jockish","Skater","Sluty" etc. This final saying, â€Å"Sluty† is interpreted by 90 percent of North Americans as a tight skirt and tight tank top which happens to be the usual ensembl...

Slaughterhouse Five Essay -- essays research papers

Thesis: Because he was unable to find comfort from human cruelty in common human institutions, Billy Pilgrim turns to the Tralfalmadorian concept of time.   Ã‚  Ã‚  Ã‚  Ã‚  Billy Pilgrim has been through many cruelties in his life. As a child his own father was cruel to him. They had gone to the Y.M.C.A. to teach Billy how to swim. A horrible, traumatic, event that would stay with Billy for the rest of his life. â€Å"Little Billy was terrified, because his father had said Billy was going to learn to swim by the method of sink-or –swim. His father was going to throw Billy into the deep end, and Billy was going to damn well swim†(43). Roland Wear was a very cruel man as well. He even to it as far as to try and kill Billy by kicking him in the spine. The only reason he had to kick Billy in the spine was because some organization Roland had in his mind about he, and the other two scouts being the â€Å"Three Musketeers†. In Roland’s mind, Billy had broken them up, he had severed the connection between the greatest fighting force in the army. â€Å"Weary drew back his right boot aimed a kick at the spine, at the tube which had so many of Billy’s important wires in it. Weary was going to break that tube†(51). A horrible and saddening event that even the U.S. A. would hide for twenty-three years from the people of its own nation. The bombing of Dresden was the major cruelty for the simple reason that it killed so many innocent people with there being no military around. One of the most beautiful cities in the world to see devastated by war. â€Å"There were hundreds of corpse mines operating by and by. They didn’t even smell bad at first, were wax museums. But then the bodies rotted and liquefied, and the stink was like roses and mustard gas†(214). Such horrible tragedies how could Billy ever even come close to being able to cope with them all? Something must keep Billy sane.   Ã‚  Ã‚  Ã‚  Ã‚  The failure to comfort Billy through human institutions, is how humanity has failed to try and comfort those less fortunate. Billy’s daughter, who is trying to comfort him constantly, does not do a very good job for the fact that she puts down every single thing that Billy will say about Tralfalmadoriane. If family should help comfort humans then why would Billy’s daughter yell at him so often? Family is supposed to be understanding and sensitive to each other’s proble... ...madorian concept of time and has finally achieved the peace he has so long needed. â€Å"It was all right, said Billy. Everything is all right and everybody has to do exactly what he does. I learned that on Tralfalmadore†(198). As he was giving his speech in Chicago, Billy knew he would die that day by the end of his speech. This showed how much he had accepted what the Tralfalmadorian’s had taught to him. â€Å"It is time for your to go home to your wives and children, and it is time for me to be dead for a little while-and then live again.†(142). Billy’s belief in the Tralfalmadorian concept of time not only gives him peace of mind, but a courage that he will not fear death because he will still live in memories therefore not being dead at all.   Ã‚  Ã‚  Ã‚  Ã‚  The only way Billy could keep from going insane from the nagging question of â€Å"why†, was to turn to the Tralfalmadorian concept of time. Billy now has the answers to any of the â€Å"why† questions he has ever asked. This makes life more free and comforting to many people since they may now have a guilt free mind. â€Å"Now he closes his speech as he closes every speech- with these words: farewell, hello, farewell, hello†(142).

Book Report On The Outsiders Essay -- Essays Papers

Book Report On The Outsiders Character Analysis: Ponyboy Curtis - Ponyboy is a fourteen-year-old member of a gang called the Greasers. His parents died in a car accident, so he lives alone with his two older brothers, Darry and Soda. He is a good student and athlete, but most people at school consider him a vagrant like his Greaser friends. Sodapop Curtis - Soda is Pony's handsome, charming older brother. He dropped out of school to work at a gas station, and does not share his brothers' interest in studying and sports. Darrel Curtis - The oldest of the Curtis boys, Darry is also the acknowledged leader of the Greasers. Johnny Cade - Johnny is Pony's closest friend and the gang's pet. They are especially protective of him since he is smaller than the rest, his father beats him, and he is afraid to walk the streets alone after being attacked by a group of Socs. Cherry Valance - Cherry is from the richer part of town and associates mainly with the Socs, but she befriends Pony and the other Greasers and gives them information about the Socs. Bob Gardner - Bob is Cherry's boyfriend. Johnny murders Bob to stop him from killing Pony. Dallas Winston - A member of the Greasers, Dally has spent time in prison. He helps Johnny and Pony by telling them to go to Jay Mountain to hide out and by giving them money. Two-Bit Mathews - The Greasers' oldest member. He acts like a mentor or mascot to the Greasers. Steve Randle - Soda's best friend and anoth...

How Cavemen Lived

How cavemen lived By: Ausha Champ Here are a few of the reasons cavemen wrote on the walls of there caves. One is how to kill or catch certain pray. So they could have the meat for pray and hide for quilt. The way to tell how many people in there crew died. They would trace there hand and color it in brown or black and trace the other hand in white. The color represents the living and the white represents the dead. Hares a good question, Why do cavemen draw animals on the wall of their caves? Hares the answer, they were inspired by the animals and the drew pictures to tell stories about them.Did you know that a fool hand meant positiveness? And a hand with the thumb, pinkie, and ring finger meant negativeness. The way you can find this out is go to google and type in the stone age. I have been wondering this whole time what did cavemen do if they broke a bone. What they did is they would pop it back into place and rape hide around it. Then they would not walk anywhere if it was a leg , and would not move their arm, if it was the arm that was broken. Did you know that cavemen had a lot more sicknesses then use? So if they got sick they wanted to stay away from others, so they didn’t get any one else sick.And yes it was that serious, and no I am not going crazy. Do you think cavemen were anymore health then use today, because of their diets? Actually we are more health, because our food it actually processed. You see cavemen didn’t have any processed food, unlike we do today . They did not have the technology to have processed food. Did cavemen have shoes? Well I don’t know for sure, but im pretty sure they would be smart enough to protect their feet, cavemen weren’t dumb. So that is what I found on cavemen, but I will fine out more in my social study book.

Marketing mix in a business

Paraded Sahara Part 1 (a) The marketing mix is a strategy tool used to formulate a plan for product development and promotions in a business. Examining the mix for the company Bottle Green may help Simon Speers, Company Owner, see the strengths and weaknesses of the business whilst considering its growth potential. The four core elements of marketing mix are product, place, price and promotion.Products: A range of cordial drinks, mostly elderflower but has a growing range including flavors such as, ginger and lemongrass, Cox's apple and Victoria plum. The product is tangible and has a core benefit of quenching thirst. The quality, brand name and packaging may also be a benefit to a consumer who considers their image and how others perceive them. The product life cycle as many others will go through the five phases; development, introduction, growth, maturity and decline. This is why it is important for the company to have new products lined up in order to boost sales.Place: Bottle Gr een distributes to and sells products in supermarkets, Waitress being he single biggest customer, also to tea rooms and small outlets. The company also exports to Sweden and Canada at present. Bottle Greens distribution is out-sourced, this may be a benefit as having another company deal with the logistical area of the business could save time and enable that time to be focused on a more valuable area, such as promotions. Price: Bottle Green Cordial drink is priced Just under E, I assume this is a cost based price.Simon Speers describes the bottle as ‘chic' and hopes for it to be on the dinner tables of the nations middle class. With this premium rand image and quality product it has a competitive price when comparing it to other rival brands. For example, the sparkling soft drink produced by company Seller is currently priced at E. 25 for a mall bottle and Bottle Greens price for a similar product is E. 39 for a mall bottle. Promotion: Bottle Green has a good brand image and has built up brand awareness amongst customers.Not only does the business have a great social media profile, it also sends out samples and recipes to TV chefs who are key influencer in the public eye. Jamie Oliver and Delia Smith being two TV hefts who have given positive feedback and influenced sales to rise. Another area I would like to focus on is purchasing. The bulk of Bottle Greens elderflower comes from the company farm in Clotheshorse and the rest is imported from Hungary. Sugar forms the basis of the cordial drink and this is a problem for Speers.Currently purchasing sugar at Euro-sugar price which is higher than world-sugar price by approximately 2% per tone. At present the business is purchasing at a fixed price but any movement in the wrong direction on the foreign exchange markets will mean further expense for Bottle Green. Part 1 (b) Expert Jeanine Woodcock, managing partner at Bottle Green has some suggestions which mainly focus on promotions of the business. Engaging with customers through the social media profile where customers can discuss stories in reference to the products was one suggestion.This will encourage existing and new customers to advertise the business via word of mouth and the internet. By doing this alongside another of Woodcocks suggestions, researching current customer interests and behavioral patterns, Bottle Green will have a deeper understanding of its statistics and core demographic. This will enable the business to see its strengths and weaknesses in promotions and take action where necessary. The expert also suggests sponsoring a typically British unique and authentic event. This could potentially engage more customers and raise brand awareness which should in turn increase sales.Another expert Joe Whiteouts, deputy director at Bottle Green makes suggestions that focus on product, place and promotion. One suggestion was elderflower capsules that could be added to water and be sold where water based drinks are prepared, for example, offices that use water dispensers. This product development will enable the business to target a new market with a unique new product. Another suggestion was to target the vending machine market, this would put the product in a new place where it would compete with the competition of other soft drink retailers.The final suggestion was to supply schools with recipes in May and June when elderflower is in blossom. The idea that this campaign could be competition based would give potential customers an incentive to engage with the product. It was also suggested that the idea could be pitched as a new healthier alternative to the normal range, this would allow the business to branch out into yet another area of the market. These suggestions could possibly raise brand awareness and bring new customers which would in turn bring more revenue.The business would also have new products in the market beginning a new life cycle. Part 1 (c) The weaknesses I can see in Bottle Greens marketing mix are a lack of product range, the high purchase cost of sugar and the lack of promotion. Firstly I would take the advice of the expert Joe Whiteouts and introduce a new product and a healthier alternative range. This would bring interest from new areas in the market and potentially increase sales. Secondly I would work on the current promotional schemes, I would take the advice of both experts when it comes to promoting the business.Using the social media profile is possibly the quickest, most efficient way to advertise and promote the company in a finance friendly manner. Thirdly sponsoring events and school campaigns are also good ideas, not only British events and British schools but also International events and schools to encourage the potential growth overseas. Fourthly I would branch out and advertise on TV, this is a age opportunity to reach out to millions of potential customers. Finally I would do extensive research on sugar suppliers and try to find a cheape r alternative, this could save the company money and also increase gross profit.I would achieve these goals by working with specific areas in the business such as, the product development team, purchasing team, marketing and promotions team and also the two experts to create new products with a marketing strategy to launch the business into its next level. If all the suggestions were carried out and successful I believe that with rotgut development, increased brand awareness and promotional advertising the business would be in a better financial position and potential growth not only in the I-J but also overseas would look encouraging.

Life of Quaid E Azam

ACCF/AHA Pocket Guideline Adapted from the 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy November 2011 Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons  © 2011 by the American College of Cardiology Foundation and the American Heart Association, Inc.The following material was adapted from the 2011 ACCF/AHA Guidelines for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy (J Am Coll Cardiol 2011;XX:XX–XX). This pocket guideline is available on the World Wide Web sites of the American College of Cardiology (www. cardiosource. org) and the American Heart Association (my. americanheart. org). For copies of this document, please contact Elsevier Inc. Reprint Department, e-mail: [ema il  protected] com; phone: 212-633-3813; fax: 212-633-3820.Permissions: Multiple copies, modification, alteration, enhancement, and/ ordistribution of this document are not permitted without the express permission of the American College of Cardiology Foundation. Please contact Elsevier’s permission department at [email  protected] com. Contents 1. Introduction †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 3 2. Clinical Definition †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦ 6 3. Genetic Testing Strategies/Family Screening †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 4. Genotype-Positive/Phenotype-Negative Patients †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 9 5. Echocardiography †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 10 6. Stress Testing †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 14 7. Cardiac Magnetic Resonance †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 15 8. Detection of Concomitant Coronary Disease †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 17 9. Asymptomatic Patients †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 19 10.Pharmacologic Management†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 21 11. Invasive Therapies †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 26 12. Pacing †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 29 13. Sudden Cardiac Death Risk Stratification †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 30 14. Selection of Patients for Implantable Cardioverter-Defibrillators †¦ 32 15. Participation in Competitive or Recreational Sports and Physical Activity †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 6 16. Management of Atrial Fibrillation †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 38 17. Pregnancy/Delivery †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 41 2 1. Introduction The impetus for the guidelines is based on an appreciation of the frequency of this clinical entity and a realization that many aspects of clinical management, including the use of diagnostic modalities, genetic testing, utilization of implantable cardioverter-defibrillators (ICDs), and therapies for refractory symptoms lack consensus.The discussion and recommendations about the various diagnostic modalities apply to patients with established HCM and to a variable extent to patients with a high index of suspicion of the disease. Classification of Recommendations The ACCF/AHA classifications of recommendations and levels of evidence are utilized, and described in more detail in Table 1. 3 Applying Classification of Recommendations and LevelRecommendations and Level of Evidence Table 1. Applying Classification of of Evidence Table 1. Applying Classification of Recommendations and Level of Evidence S i z e Class I Benefit >>> Risk f T r e a T m eSni T ee f ffe c T e a T z o Tr Class IIb Class IIa Benefit >>> Risk Benefit Risk Additional studies with broad Additional studies with objectives objectives needed focused needed; additional registryreasonable to perIt Is data would be helpful Class IIa Class I Benefit >> RiskRisk Benefit >>> Additional studies with Procedure/Treatment focused objectives needed should be performed/ Procedure/Treatment should be performed/ administered It administered Is reasonable to perform procedure/administer treatment n Recommendation favor n Recommendation in thatProcedure/Treatment form procedure/administer may be ConsIdered treatment n n Rec ommendation Recommendation’s eSTimaTe of cerTainTy (PreciSion) of TreaTmenT effecT a populations d* ived from multiple zed clinical trials analyses Recommendation that level a procedure or treatment Multiple populations is useful/effective evaluated* n Sufficient evidence from Data randomized multiple multiplederived from trials randomized clinical trials or meta-analyses or meta-analyses n of procedure or procedure treatment treatment is useful/effective being useful/effective n Sufficient evidence from n Some conflicting evidence n favor usefulness/efficacy less of treatment or procedure well established being useful/effective conflicting evidence evidence from multiple from multiple randomized randomized trials or trials or meta-analyses meta-analyses in favor of treatment or procedure usefulness/efficacy less being useful/effective well established conflicting evidence from single evidence from single randomized trial randomized trial oror nonrandomized studies nonrandomi zed studies in favor usefulness/efficacy less of treatment or procedure well established being useful/effective opinion, case studies, or opinion, case studies, standard of care care or standard of may/might be considered is reasonable may/might be reasonable can be useful/effective/beneficial usefulness/effectiveness is is probably recommended unknown/unclear/uncertain or indicated or not well established n n Some Greater multiple randomized trials from multiple randomized or or meta-analyses trialsmeta-analyses b populations d* ived from a ndomized trial ndomized studiesRecommendation that level b procedure or treatment Limited populations is useful/effective evaluated* n Evidence from single Data derived or randomized trialfrom a single randomized trial nonrandomized studies or nonrandomized studies n n Recommendation in that n Recommendation favor n n Recommendation Recommendation’s of procedure or procedure treatment treatment being useful/effective is useful/effective n Some conflicting single n Evidence from n n Some Greater evidence from trial or randomized single randomized trial or nonrandomized studies nonrandomized studies n Recommendation favor n Recommendation in that C ited populations d* sensus opinion ts, case studies, ard of careRecommendation that level C procedure or treatment is Very limited populations useful/effective evaluated* n Only expert opinion, case Only consensus opinion studies, or standard of care of experts, case studies, or standard of care n n n Recommendation Recommendation’s of procedure or procedure is treatment treatment useful/effective being useful/effective n Only expert expert n Only divergingopinion, case studies, or studies, opinion, casestandard of care or standard of care is reasonable should can be useful/effective/beneficial is recommended is probably recommended is indicated oris useful/effective/beneficial indicated n n Only diverging expert Only diverging expert d phrases for commendations shou ld Suggested phrases for writing recommendations is recommended is ndicated is useful/effective/beneficial s treatment/strategy A is Comparative recommended/indicated in effectiveness phrases†  preference to treatment B treatment/strategy A is probably treatment/strategy A is recommended/indicated in in recommended/indicated preference to to treatment B preference treatment B it is reasonableshould be chosen treatment A to choose treatment A over treatment B over treatment B treatment/strategy A is probably recommended/indicated in preference to treatment B it is reasonable to choose treatment A over treatment B ive ess phrases†  4 treatment A should be chosen over treatment B e T menT e ffe c T A recommendation with Level of Evidence B or CClass IIIIIb Benefit Class No orBenefit > Risk Class III Harm Procedure/ Additional studies with broad test treatment objectives needed; additional Cor III: Not No Proven be helpful noregistry data would Benefit benefit Helpful Class II I No Benefit or Class III Harm Procedure/ test Cor III: Not no benefit Helpful Cor III: harm treatment No Proven Benefit does not imply that the recommendation is weak. Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials. Although randomized trials are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective. Procedure/Treatment Cor III: Excess Cost Harmful harm be w/o Benefit to Patients may ConsIdered or Harmful n n Recommendation’s Recommendation that Excess Cost Harmful w/o Benefit to Patients or Harmful Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as sex, age, history of diabetes, history of prior myocardial infarction, history of heart failure, and prior aspirin use. †  For comparative effectiveness recommendations (Class I and IIa; Level of Evidence A and B only), studies that support the use of comparator verbs should involve direct comparisons of the treatments or strategies being evaluated. n procedure or treatment is usefulness/efficacy less not useful/effective and may well established be harmful conflicting n Greater n evidence from multiple Sufficient evidence fromRecommendation that procedure or treatment is not useful/effective and may be harmful Sufficient evidence from multiple randomized trials or meta-analyses Recommendation that procedure or treatment is not useful/effective and may be harmful Evidence from single randomized trial or nonrandomized studies Recommendation that procedure or treatment is not useful/effective and may be harmful Only expert opinion, case studies, or standard of care COR III: Harm potentially harmful causes harm associated with excess morbidity/mortality should not be performed/ be done administered/ other n multiple randomizedor randomized trials trials or meta-analyses meta-analyses n n Recommendation’s Recommendatio n that n sefulness/efficacy less procedure or treatment is well established not useful/effective and may be harmful conflicting n Greater n evidence from single Evidence from single randomized trial randomized trial oror nonrandomized studies nonrandomized studies n Recommendation’s Recommendation that usefulness/efficacy less procedure or treatment is well established not useful/effective and may n Only diverging expert be harmful opinion, case studies, or n Only expert opinion, case standard of care studies, or standard of care n n n n COR III: COR III: may/might be considered Nomay/might be reasonable Benefit Harm usefulness/effectiveness is is not potentially unknown/unclear/uncertain recommended harmful or indicated not well established harm is not causes associated with excess morbidity/mortality should not be done COR III: No Benefit is not recommended is not indicated should not be performed/ be done administered/ is not useful/ other beneficial/ is not useful/ effect ive bene? cial/ effective should not be done s not useful/ beneficial/ effective 5 2. Clinical Definition The generally accepted definition of hypertrophic cardiomyopathy (HCM), is a disease state characterized by unexplained left ventricular (LV) hypertrophy associated with nondilated ventricular chambers in the absence of another cardiac or systemic disease that itself would be capable of producing the magnitude of hypertrophy evident in a given patient. Clinically, HCM is usually recognized by maximal LV wall thickness ? 15 mm, with wall thickness of 13 to 14 mm considered borderline, particularly in the presence of other compelling information (e. g. , family history of HCM), based on echocardiography.In terms of LV wall-thickness measurements, the literature has been largely focused on echocardiography, although cardiovascular magnetic resonance (CMR) is now used with increasing frequency in HCM. In the case of children, increased LV wall thickness is defined as wall thickness ? 2 standard deviations above the mean (z score ? 2) for age, sex, or body size. However, it should be underscored that in principle, any degree of wall thickness is compatible with the presence of the HCM genetic substrate and that an emerging subgroup within the broad clinical spectrum is composed of family members with disease-causing sarcomere mutations but without evidence of the disease phenotype (i. e. , LV hypertrophy). 6 3. Genetic Testing Strategies/Family Screening Class I 1.Evaluation of familial inheritance and genetic counseling is recommended as part of the assessment of patients with HCM. (Level of Evidence: B) 2. Patients who undergo genetic testing should also undergo counseling by someone knowledgeable in the genetics of cardiovascular disease so that results and their clinical significance can be appropriately reviewed with the patient. (Level of Evidence: B) 3. Screening (clinical, with or without genetic testing) is recommended in first-degree relatives of pati ents with HCM. (Level of Evidence: B) 4. Genetic testing for HCM and other genetic causes of unexplained cardiac hypertrophy is recommended in patients with an typical clinical presentation of HCM or when another genetic condition is suspected to be the cause. (Level of Evidence: B) 7 Class IIa 1. Genetic testing is reasonable in the index patient to facilitate the identification of first-degree family members at risk for developing HCM. (Level of Evidence: B) Class IIb 1. The usefulness of genetic testing in the assessment of risk of sudden cardiac death (SCD) in HCM is uncertain. (Level of Evidence: B) Class III: 1. Genetic testing is not indicated in relatives when pathogenic mutation. (Level of Evidence: B) 2. Ongoing clinical screening is not indicated in genotype-negative relatives in families with HCM. Level of Evidence: B) No Benefit the index patient does not have a definitive 8 4. Genotype-Positive/Phenotype-Negative Patients Class I 1. In individuals with pathogenic mutat ions who do not express the HCM phenotype, it is recommended to perform serial electrocardiogram, transthoracic echocardiogram (TTE), and clinical assessment at periodic intervals (12 to 18 months in children and adolescents and about every 5 years in adults), based on the patient’s age and change in clinical status. (Level of Evidence: B) 9 5. Echocardiography Class I 1. A TTE is recommended in the initial evaluation of all patients with suspected HCM. (Level of Evidence: B) 2.A TTE is recommended as a component of the screening algorithm for family members of patients with HCM unless the family member is genotype negative in a family with known definitive mutations. (Level of Evidence: B) 3. Periodic (12 to 18 months) TTE screening is recommended for children of patients with HCM, starting by age 12 or earlier if a growth spurt or signs of puberty are evident and/or when there are plans for engaging in intense competitive sports or there is a family history of SCD. (Level o f Evidence: C) 4. Repeat TTE is recommended for the evaluation of patients with HCM with a change in clinical status or new cardiovascular event. (Level of Evidence: B) 5. A transesophageal echocardiogram (TEE) is recommended for the intraoperative guidance of surgical myectomy. (Level of Evidence: B) 10 6.TTE or TEE with intracoronary contrast injection of the candidate’s septal perforator(s) is recommended for the intraprocedural guidance of alcohol septal ablation. (Level of Evidence: B) 7. TTE should be used to evaluate the effects of surgical myectomy or alcohol septal ablation for obstructive HCM. (Level of Evidence: C) Class IIa 1. TTE studies performed every 1 to 2 years can be useful in the serial evaluation of symptomatically stable patients with HCM to assess the degree of myocardial hypertrophy, dynamic obstruction, and myocardial function. (Level of Evidence: C) 2. Exercise TTE can be useful in the detection and quantification of dynamic left ventricular outflow tract (LVOT) obstruction in the absence of resting outflow tract obstruction in patients with HCM. (Level of Evidence: B) 11 3.TEE can be useful if TTE is inconclusive for clinical decision making about medical therapy and in situations such as planning for myectomy, exclusion of subaortic membrane or mitral regurgitation secondary to structural abnormalities of the mitral valve apparatus, or in assessment for the feasibility of alcohol septal ablation. (Level of Evidence: C) 4. TTE combined with the injection of an intravenous contrast agent is reasonable if the diagnosis of apical HCM or apical infarction or severity of hypertrophy is in doubt, particularly when other imaging modalities such as CMR are not readily available, not diagnostic, or contraindicated. (Level of Evidence: C) 5.Serial TTE studies are reasonable for clinically unaffected patients who have a first-degree relative with HCM when genetic status is unknown. Such follow-up may be considered every 12 to 18 months f or children or adolescents from high-risk families and every 5 years for adult family members. (Level of Evidence: C) 12 Class III: 1. TTE studies should not be performed more HCM when it is unlikely that any changes have occurred that would have an impact on clinical decision making. (Level of Evidence: C) 2. Routine TEE and/or contrast echocardiography is not recommended when TTE images are diagnostic of HCM and/or there is no suspicion of fixed obstruction or intrinsic mitral valve pathology. (Level of Evidence: C)No Benefit frequently than every 12 months in patients with 13 6. Stress Testing Class IIa 1. Treadmill exercise testing is reasonable to determine functional capacity and response to therapy in patients with HCM. (Level of Evidence: C) 2. Treadmill testing with monitoring of an electrocardiogram and blood pressure is reasonable for SCD risk stratification in patients with HCM. (Level of Evidence: B) 3. In patients with HCM who do not have a resting peak instantaneous g radient of greater than or equal to 50 mm Hg, exercise echocardiography is reasonable for the detection and quantification of exercise-induced dynamic LVOT obstruction. (Level of Evidence: B) 14 7. Cardiac Magnetic Resonance Class I 1.CMR imaging is indicated in patients with suspected HCM when echocardiography is inconclusive for diagnosis. (Level of Evidence: B) 2. CMR imaging is indicated in patients with known HCM when additional information that may have an impact on management or decision making regarding invasive management, such as magnitude and distribution of hypertrophy or anatomy of the mitral valve apparatus or papillary muscles, is not adequately defined with echocardiography. (Level of Evidence: B) Class IIa 1. CMR imaging is reasonable in patients with HCM to define apical hypertrophy and/or aneurysm if echocardiography is inconclusive. (Level of Evidence: B) 15 Class IIb 1.In selected patients with known HCM, when SCD risk stratification is inconclusive after docume ntation of the conventional risk factors, CMR imaging with assessment of late gadolinium enhancement may be considered in resolving clinical decision making. (Level of Evidence: C) 2. CMR imaging may be considered in patients with LV hypertrophy and the suspicion of alternative diagnoses to HCM, including cardiac amyloidosis, Fabry disease, and genetic phenocopies such as LAMP2 cardiomyopathy. (Level of Evidence: C) 16 8. Detection of Concomitant Coronary Disease Class I 1. Coronary arteriography (invasive or computed tomographic imaging) is indicated in patients with HCM with chest discomfort who have an intermediate to high likelihood of coronary artery disease (CAD) when the identification of concomitant CAD will change management strategies. (Level of Evidence: C) Class IIa 1.Assessment of coronary anatomy with computed tomographic angiography is reasonable for patients with HCM with chest discomfort and a low likelihood of CAD to assess for possible concomitant CAD. (Level of E vidence: C) 2. Assessment of ischemia or perfusion abnormalities suggestive of CAD with single-photon emission computed tomography or positron emission tomography myocardial perfusion imaging (because of excellent negative predictive value) is reasonable in patients with HCM with chest discomfort and a low likelihood of CAD to rule out possible concomitant CAD. (Level of Evidence: C) 17 Class III: 1. Routine single-photon emission computed echocardiography is not indicated for detection of â€Å"silent† CAD-related ischemia in patients with HCM who are asymptomatic. (Level of Evidence: C) 2.Assessment for the presence of blunted flow reserve (microvascular ischemia) using quantitative myocardial blood flow measurements by positron emission tomography is not indicated for the assessment of prognosis in patients with HCM. (Level of Evidence: C) No Benefit tomography myocardial perfussion imaging or stress 18 9. Asymptomatic Patients Class I 1. For patients with HCM, it is recom mended that comorbidities that may contribute to cardiovascular disease (e. g. , hypertension, diabetes, hyperlipidemia, obesity) be treated in compliance with relevant existing guidelines. (Level of Evidence: C) Class IIa 1. Low-intensity aerobic exercise is reasonable as part of a healthy lifestyle for patients with HCM. (Level of Evidence: C) Class IIb 1.The usefulness of beta blockade and calcium channel blockers to alter clinical outcome is not well established for the management of asymptomatic patients with HCM with or without obstruction. (Level of Evidence: C) Class III: Harm 1. Septal reduction therapy should not be performed for asymptomatic adult and pediatric patients with HCM with normal effort tolerance regardless of the severity of obstruction. (Level of Evidence: C) 2. In patients with HCM with resting or provocable outflow tract obstruction, regardless of symptom status, pure vasodilators and high-dose diuretics are potentially harmful. (Level of Evidence: C) 19 Fi gure 1. Treatment Algorithm HCM PatientsACE indicates angiotensin-converting enzyme; ARB, angiotensin receptor blocker; DM, diabetes mellitus; EF, ejection fraction; GL, guidelines; HCM, hypertrophic cardiomyopathy; HTN, hypertension; and LV, left ventricular. Treat comorbidities according to GL [HTN, Lipids, DM] Obstructive Physiology No Heart Failure Symptoms or Angina No Yes Yes Avoid vasodilator therapy and highdose diuretics Systolic Function Annual clinical evaluation No Heart Failure Symptoms or Angina LV EF 50 mm Hg) for whom standard medical therapy has failed. (Level of Evidence: C) 4.When surgery is contraindicated or the risk is considered unacceptable because of serious comorbidities or advanced age, alcohol septal ablation, when performed in experienced centers, can be beneficial in eligible adult patients with HCM with LVOT obstruction and severe drug-refractory symptoms (usually New York Heart Association functional classes III or IV). (Level of Evidence: B) 26 Class IIb 1. Alcohol septal ablation, when performed in experienced centers, may be considered as an alternative to surgical myectomy for eligible adult patients with HCM with severe drug-refractory symptoms and LVOT obstruction when, after a balanced and thorough discussion, the patient expresses a preference for septal ablation. (Level of Evidence: B) 2. The effectiveness of alcohol septal ablation is uncertain in patients with HCM with marked (i. e. , >30 mm) septal hypertrophy, and therefore the procedure is generally discouraged in such patients. (Level of Evidence: C) Class III: Harm 1.Septal reduction therapy should not be done for adult patients with HCM who are asymptomatic with normal exercise tolerance or whose symptoms are controlled or minimized on optimal medical therapy. (Level of Evidence: C) 2. Septal reduction therapy should not be done unless performed as part of a program dedicated to the longitudinal and multidisciplinary care of patients with HCM. (Level of Evidence : C) 27 3. Mitral valve replacement for relief of LVOT obstruction should not be performed in patients with HCM in whom septal reduction therapy is an option. (Level of Evidence: C) 4. Alcohol septal ablation should not be done in patients with HCM with concomitant disease that independently warrants surgical correction (e. g. coronary artery bypass grafting for CAD, mitral valve repair for ruptured chordae) in whom surgical myectomy can be performed as part of the operation. (Level of Evidence: C) 5. Alcohol septal ablation should not be done in patients with HCM who are less than 21 years of age and is discouraged in adults less than 40 years of age if myectomy is a viable option. (Level of Evidence: C) 28 12. Pacing Class IIa 1. In patients with HCM who have had a dualchamber device implanted for non-HCM indications, it is reasonable to consider a trial of dual-chamber atrial-ventricular pacing (from the right ventricular apex) for the relief of symptoms attributable to LVOT obst ruction. (Level of Evidence: B) Class IIb 1.Permanent pacing may be considered in medically refractory symptomatic patients with obstructive HCM who are suboptimal candidates for septal reduction therapy. (Level of Evidence: B) Class III: 1. Permanent pacemaker implantation for the performed in patients with HCM who are asymptomatic or whose symptoms are medically controlled. (Level of Evidence: C) 2. Permanent pacemaker implantation should not be performed as a first-line therapy to relieve symptoms in medically refractory symptomatic patients with HCM and LVOT obstruction in patients who are candidates for septal reduction. (Level of Evidence: B) No Benefit purpose of reducing gradient should not be 29 13. Sudden Cardiac Death Risk Stratification Class I 1.All patients with HCM should undergo comprehensive SCD risk stratification at initial evaluation to determine the presence of: (Level of Evidence: B) a. A personal history for ventricular fibrillation, sustained ventricular tach ycardia, or SCD events, including appropriate ICD therapy for ventricular tachyarrhythmias. * b. A family history for SCD events, including appropriate ICD therapy for ventricular tachyarrhythmias. * c. Unexplained syncope. d. Documented nonsustained ventricular tachycardia (NSVT) defined as 3 or more beats at greater than or equal to120 bpm on ambulatory (Holter) electrocardiogram. e. Maximal LV wall thickness greater than or equal to 30 mm. Appropriate ICD discharge is defined as ICD therapy triggered by VT or ventricular fibrillation, documented by stored intracardiac electrogram or cycle-length data, in conjunction with the patient’s symptoms immediately before and after device discharge. 30 Class IIa 1. It is reasonable to assess blood pressure response during exercise as part of SCD risk stratification in patients with HCM. (Level of Evidence: B) 2. SCD risk stratification is reasonable on a periodic basis (every 12 to 24 months) for patients with HCM who have not under gone ICD implantation but would otherwise be eligible in the event that risk factors are identified (12 to 24 months). (Level of Evidence: C)Class IIb 1. The usefulness of the following potential SCD risk modifiers is unclear but might be considered in selected patients with HCM for whom risk remains borderline after documentation of conventional risk factors: a. CMR imaging with late gadolinium enhacement. (Level of Evidence: C) b. Double and compound mutations (i. e. , >1). (Level of Evidence: C) c. Marked LVOT obstruction. (Level of Evidence: B) Class III: Harm 1. Invasive electrophysiologic testing as routine SCD risk stratification in patients with HCM should not be performed. (Level of Evidence: C) 31 14. Selection of Patients for Implantable Cardioverter-Defibrillators Class I 1.The decision to place an ICD in patients with HCM should include application of individual clinical judgment, as well as a thorough discussion of the strength of evidence, benefits, and risks to allow the informed patient’s active participation in decision making. (Level of Evidence: C) 2. ICD placement is recommended for patients with HCM with prior documented cardiac arrest, ventricular fibrillation, or hemodynamically significant ventricular tachycardia. (Level of Evidence: B) Class IIa 1. It is reasonable to recommend an ICD for patients with HCM with: a. Sudden death presumably caused by HCM in 1 or more first-degree relatives. (Level of Evidence: C) b. A maximum LV wall thickness greater than or equal to 30 mm. (Level of Evidence: C) c. One or more recent, unexplained syncopal episodes. (Level of Evidence: C) 2.An ICD can be useful in select patients with NSVT (particularly those 30 mm or Recent unexplained syncope No Yes ICD reasonable Nonsustained VT or Abnormal BP response Yes Other SCD Risk Modifiers* Present? Yes No ICD can be useful Legend Class I Class IIa No ICD not recommended Class IIb Class III Role of ICD uncertainRegardless of the level of recommendatio n put forth in these guidelines, the decision for placement of an ICD must involve prudent application of individual clinical judgment, thorough discussions of the strength of evidence, the benefits, and the risks (including but not limited to inappropriate discharges, lead and procedural complications) to allow active participation of the fully informed patient in ultimate decision making. BP indicates blood pressure; ICD, implantable cardioverter-defibrillator; LV, left ventricular; SCD, sudden cardiac death; SD, sudden death; and VT, ventricular tachycardia. 35 15. Participation in Competitive or Recreational Sports and Physical ActivityClass IIa 1. It is reasonable for patients with HCM to participate in low-intensity competitive sports (e. g. , golf and bowling). (Level of Evidence: C) 2. It is reasonable for patients with HCM to participate in a range of recreational sporting activities as outlined in Table 2. (Level of Evidence: C) Class III: Harm 1. Patients with HCM should not participate in intense competitive sports regardless of age, sex, race, presence or absence of LVOT obstruction, prior septal reduction therapy, or implantation of a cardioverterdefibrillator for high-risk status. (Level of Evidence: C) 36 Table 2. Recommendations for the Acceptability of Recreational Noncompetitive) Sports Activities and Exercise in Patients With HCM* Intensity Level High Basketball (full court) Basketball (half court) Body building†¡ Gymnastics Ice hockey†¡ Racquetball/squash Rock climbing†¡ Running (sprinting) Skiing Soccer Tennis (singles) Touch (flag) football Windsurfing § Moderate Baseball/softball Biking Modest hiking Motorcycling†¡ Jogging Sailing § Surfing § Swimming (laps) § Tennis (doubles) Treadmill/stationary bicycle Weightlifting (free weights)†¡|| Hiking 2 4 4 3 3 3 2 5 4 5 1 3 (downhill)†¡ Skiing (cross-country) 0 0 1 2 0 0 1 0 2 2 0 0 1 1 Eligibility Scale for HCM†  Intensity Level Low Bowling Golf Hor seback riding†¡ Scuba diving § Skating ¶ Snorkeling § Weights (nonfree weights) Brisk walking 5 5 3 0 5 5 4 5 Eligibility Scale for HCM†  *Recreational sports are categorized according to high, moderate, and low levels of exercise and graded on a relative scale (from 0 to 5) for eligibility, with 0 to 1 indicating generally not advised or strongly discouraged; 4 to 5, probably permitted; and 2 to 3, intermediate and to be assessed clinically on an individual basis. The designations of high, moderate, and low levels of exercise are equivalent to an estimated >6, 4 to 6, and