The secret language of leadership - Free Essay Example

Sample details Pages: 35 Words: 10501 Downloads: 3 Date added: 2017/06/26 Category Statistics Essay Did you like this example? Selected in 2000 as one of the worlds ten most admired knowledge leader, Steve Denning is an award winner for the books  «The secret language of leadership » and  «the leaders guide to storytelling ». He studied law and psychology in Sydney University and then went to Oxford in the UK for a law postgraduate degree. Don’t waste time! Our writers will create an original "The secret language of leadership" essay for you Create order He worked in organization in the US, Europe, Asia and Australia and was until 2000 the program director Knowledge Management at the World Bank. In the book the Secret Language of Leadership, the steps that have to be achieved to become a successful leader are to get the attention, to stimulate desire, to reinforce the reason and to continue the conversation. To reach those, a leader has to use six enablers that will be describing in our analysis of the language of Leadership: key enablers. rticulating a clear, inspiring goal Stephen Denning starts his explanation of the key enablers of the language of Leadership by a quote o George Bernard Shaw: This is the true joy in life, the being used for a purpose recognized by yourself as a mighty one; the being thoroughly worn out before you are thrown on the scrap heap; the being a force of Nature instead of a feverish selfish little clod of ailments and grievances complaining that the world will not devote itself to making you happy. This quote shows us the importance we give on the recognition of the actions we can do or the goal we can reach. We will now analyze how important it is to articulate a clear, inspiring goal. Stephen Denning illustrate the chapter, Articulating a clear, inspiring goal, of his book; with the example of the company Apple. Steve Jobs the creator of Apple had created chaos in his company because even if he is a brilliant person he was not an inexperience chairman. A new CEO took his place in 1983, John Sculley, who was a star manager of other big companies as Pepsi. Even if Sculley did a good job on stabilizing the corporation and rationnalized the products, the Apple staff was no supporting him. Sculley wanted to implement a shift in Apple life by producing low cost computers like Dell, but the staff was not interested in becoming just another computer company. They wanted to follow Steve Jobs goal of creating cool, innovative electronic products, a purpose that for themselves was worthwhile in itself. John Sculley was forced out in 1993, his instrumental goals were not embraced and he was not successful on inspiring Apple staff to pursue new goals energetically and enthusiastically. What the staff wanted was to pursue Apple original purpose, which was more seductive for them as they came into this company for those values. Michael Spindler, Sculleys successors met the same fate. Steve Jobs came back as the CEO of Apple, and he didnt try to change the company purpose, which he settled many years before. We now know the success of Apple, Steve Jobs became a great CEO and he spread the world with his initiate focus, which was designing cool, innovative electronic products. Apple is a success story and Steve Jobs is often associate to this success, even when he has medical trouble it has an important impact on Apple stock exchange. Steve Jobs is so link to Apple that every launching of his product and every keynote he does make a huge buzz. In my opinion and especially in the market of new technologies when a company his created with a new concept, a brand new idea, a new way to work and projection in the future; the people who mean to work for those values are so convince that it is what you have to reach that they wont consider any other proposition. Sculley and Spindler did not take into consideration what was Apple staff considerations and first goals; it is why we ask them to quit the company. It is complicated to change the main purpose of a business and the common goals and ideas of a whole staff when there are extremely committed to it. Before making changes in a company you have to define a clear vision and history of what people working in are sensitive and committed to. 1. Articulating a Worthwhile purpose In this part, Stephen Denning set up the problematic of the importance of enduring enthusiasm. He is wondering why Steve Jobs could generate enduring enthusiasm while John Sculley couldnt. Stephen Denning take the example of two kids playing piano, one child loves it, its a joy for her to play, it fills her life with meaning and she wins prizes. Her joy of playing is even more important that the prizes or recognition she could get. An other child is forced by her parents to play, she has a natural aptitude for music but do not enjoy it so much. Those two girls have a different view on this activity, the first one feels energized and enthusiastic and the second one is bored. Stephen Denning link this example with the practice of sharing knowledge in the organization, which is called knowledge management. Some people within the organization commit their working lives to making the best knowledge available to those who need it. They are honest and open to others. The source of their own personal growth is from the knowledge they spread within the organization, the benefits for them is the inherent value of sharing knowledge itself. Some people are practicing knowledge management on their own, it is to bring more money into the company, but for those who want to share their knowledge, they will find reward in the essential fact that the knowledge will be share. Stephen Denning says: A principal difference between these two different ways of viewing an activity is that when the activity generates sustained enthusiasm, the activity is being pursued for its own sake, not merely to achieve some instrumental or external good such as money, status, prestige, power, or winning. The perceived inherent worth of the activity being undertaken is foundational. For Stephen Denning the enthusiasm toward an activity is important, because if you are enthusiastic for an activity, you will be for the own sake of this activity and not for some other instrumental goals. I totally agree with this vision, as I consider than even if you can be successful for an activity you dont really like, you wont have the same interest and implication to that activity that if youre really enthusiastic about it. When you are a leader your are face to certain situation that if you are not enthusiastic about what you are doing it will be difficult for you to find solutions or it will take you more time to do it, or you will not act you should do. The enthusiasm you could have for an activity can have influence on the people you are working with. The have feelings and can perceive if you are running for instrumental goals or if you find happiness on the own sake of an activity. It is an element to recognize basic leaders to outstanding ones. In some situation, Stephen Denning take the example of prisoners in a concentration camps, people can find psychic energy to create meaning for their lives. The people who are able to find inherent value in whatever they are doing are sometimes called autotelic personalities: they have the capacity to be intrinsically motivated by almost any activity. It is a great advantage of being able to find value in what you are doing and to be motivated in whatever you do, but I am sceptical on the degree of enthusiasm of those people. I agree in the fact that you can motivate yourself for some activities that you are not really into it, but I think their might be a difference in the level of implication and enthusiasm for activities that really fit to you and you personality and vision that the one which are not. Stephen Denning define the characteristics of activities that can generate sustained enthusiasm: The participants in the activity can see themselves making progress toward something that is good for its own sake, additional effort is a joy and not a burden. The participants experience their own personal growth and development as part of the activity. A balance between ability level and challengeà ¢Ã¢â€š ¬Ã¢â‚¬ the activity is neither too easy nor too difficultà ¢Ã¢â€š ¬Ã¢â‚¬ is also conducive to enthusiasm. The participants see themselves as contributing to, raising the sights of, and enhancing the efforts of other people pursuing the same activity. Ideally, the activity should bring some positive instrumental benefits: income, status, prestige. But even without that, it should at least be without negative instrumental effects. If those four elements are in place, there are chances that enthusiasm can be sustained. We can also notice that the primacy of goals pursued for their own sake in transformational leadership does not mean that instrumental benefits are unimportant. In practice, instrumental benefits reinforce the pursuit of goals for their own sake. Instrumental goals are complementary to enthusiasm and the pursued of goals by their own sake. But you have to remember that even if instrumental benefits are important, if you placed them first, enthusiasm is likely to die. You always have to consider the inherent value of the activity. For Stephen Denning: One central aspect of the language of transformational leadership is therefore to articulate goals and activities in terms that can be viewed by participants as worthwhile in themselves, not merely pursued because they lead to instrumental benefits. This is a fundamental quote that resume the importance of articulating a clear, inspiring goal. Those facts are true for leaders, but it is also true for corporations, they are most inspiring when they pursue large goals that are worthwhile in themselves. In this book, we find the example of Toyota, their goal is to: to enrich society through the building of cars and trucks. Also the example of Johnson Johnson who defines the companys responsibilities as first, to the consumers and medical professionals using its products, second, to employees and managers, third to the communities where its people work and live, and fourth and last, to its stockholders. Or Costco, their goal is to provide its members quality goods at low markups. Transformational leaders present their goals as larger than any particular task or organization or time-bound objective. Stephen Denning take the example in politics: Thus Abraham Lincoln can be assassinated, but his vision of a nation pursuing a new birth of freedom lives on. John F. Kennedy can be shot, but his vision of changing race relations in the United States is implemented by his successor. Martin Luther King Jr. can be murdered, but a whole nation continues the work that he started. It is true that Goals that are articulated as worthwhile in themselves enhance the possibility of sustained enthusiasm, and hence the possibility of transformational leadership. But, articulating the goal as worthwhile in itself doesnt mean that listeners will necessarily see it in this way. Enthusiasm and finding reward in the activity your are pursuing is important, you find more energy and capabilities of reaching your goals and you know that when an activity is pursued for its own sake, the activity never ends. You are so convinced of the meaning and the importance of the activity that you want to reach a level of excellence, the activity will have no limits. It is what give us excitement when we are doing something we are convinced to do. In my opinion to be a good leader you should look for those feelings and excitement in an activity that will fulfill you needs. Or if you want to become a good leader it is the way you have to perceive an activity, you have to tend to those attempt. We are now going to see the importance of setting priorities among goals. 2. Setting Priorities Among Goals Leader fails a lot because they dont have a clear and inspiring goal or have too many of them. Leadership is such a demanding activity that any one individual can probably pursue no more than a couple of significant change ideas at any one time. It is essential to set priorities. Selecting a goal, or at most several goals, and then persevering is a requirement for success as a transformational leader. Stephen Denning take the example of Ronal Reagan, who was a single mindedness leader and politician. He success was mainly based on a relatively small number of goals : defeating the Soviet Union and reducing taxes and the size of government. What I learn for the chapter tow of the part two of The secret language of Leadership, is the importance of commitment and enthusiasm toward an activity in order to embrace inspiring goals that will be define clearly and focus on some domains, in order to make the activity a success. The leaders own story Committing to the goal Stephen Denning starts this third chapter by pointing out the fact that Abraham Lincoln did not begin his presidency as a transformational leader. By definition, transformational leadership is a process that changes and transforms individuals. It is often associated with ethics and involves long-term goals. Transformational leadership focuses on the process by which the leader engages with followers, and together create a connection that raises each of them to higher levels of motivation and morality. A transformational leader must be attentive to follower needs and motivation, and tries to help followers reach their full potential. It requires long term strategic planning, clear objectives, a clear vision, the efficiency of systems and processes According to B.M. Bass, one of the leading theorists on transformational leadership, the leader transforms and motivates followers by: making them more aware of the importance of task outcomes, inducing them to transcend their own self-interest for the sake of the organization or team, and activating their higher order needs. Transformational leadership is concerned both with the performance of followers as well as developing them to their full potential. What make Stephen Denning says that Abraham Lincoln did not begin his presidency as a transformational leader is that he was explicit in declaring that he had no intent to abolish slavery to his earlier speeches. Its explicit goal was to preserve the Union at that time, which mad sense as there was no consensus for abolishing slavery. But soon, in 1862, nearly 2 years after the beginning of his presidency, he came to the view that the Union could not be preserved without abolishing slavery. Stephen Denning says: Privately, he continued to argue that his goal remained the pragmatic one of preserving the Union. But publicly, Lincoln became a leader in a moral cause. In December 1862 Abraham Lincoln made a speech to the Congress: We say we are for the Union. The world will not forget that we say this. We know how to save the Union. The world knows we do know how to save it. Weà ¢Ã¢â€š ¬Ã¢â‚¬ even we hereà ¢Ã¢â€š ¬Ã¢â‚¬ hold the power, and bear the responsibility. In giving freedom to the slave, we assure freedom to the freeà ¢Ã¢â€š ¬Ã¢â‚¬ honorable alike in what we give, and what we preserve. We shall nobly save, or meanly lose, the last best hope of earth. Other means may succeed; this could not fail. The way is plain, peaceful, generous, justà ¢Ã¢â€š ¬Ã¢â‚¬ a way which, if followed, the world will forever applaud, and God must forever bless. This speech symbolize the moment when Lincoln became a transformational leader, he justified his action on instrumental and legal grounds. This new vision, based on moral grounds, Lincoln showed that it was something worthwhile in itself. With this changes Lincoln is proclaiming a new Union who want to restrain slavery, who will fulfill the promise of liberty. We can say that Lincoln is a transformational leader after this participation in the Congress in December 1862 because he stimulates people to want to do something different, inspiring them to higher levels of aspiration. Abraham Lincoln gives a new vision of what the United States should sand for: government of the people, by the people, for the people Stephen Denning came to the point of studying politicians as leaders. 1. Politicians as Leaders We often think of our politicians as leaders. But they are more oriented on the acquisition and retention of political office rather than being worried about people moral values and inspiring them to change. But if they do care, they usually survive in the world of politics. A successful politicians is one who is willing to fight, to attack the establish order, who is flexible. And who is able to preserve a public image of being honest, compassionate, moral and devout. Stephen Denning notice that: Retaining power is principally about listening to the electorate. If you want to get elected, learn to speak, said Tom Daschle, former Democratic leader in the U.S. Senate. If you want to stay elected, learn to listen. It is difficult to understand the commitment to change of politicians and also ambiguous, because you are not 100% sure of what drive them to the commitment of their goals. Stephen Denning says that we should not be surprised of the lack of leadership in politics because nothing in the terminology of politics suggests that the people are electing leaders. Also that politicians have qualities like containing conflicts, guiding forces of change by giving direction, value and purpose but that it is not necessarily the qualities of a transformational leader. I agree with the fact that politicians have qualities and that it is not the sign of a transformational leader. But when you choose to elect a politician, you would like him to manage your country and maybe to make yourself more aware of the importance of task outcomes, for your own self-interest, you might want his politician to be concern of developing the population to its full potential. But it is that in reality that does not happen that much, or will we know it and we would live in a perfect world or close to the excellence ! 2. CEOs as Leaders Stephen Denning takes the example of Alan Klapmeier in Cirrus Design, a manufacturer of private aircraft. Alan wanted to introduce a new innovation that would change the industry, but its board of directors stopped him because they just completes a market research highlighting that this product elicited the least interest. Later Klapmeier convinced his board of directors, the innovation was introduced and it became a success. The decisive issue for the board of directors was not if the innovation was worthwhile but it was the institutional preoccupation. Stephen Denning says: If a firm can focus its efforts on activities valuable in themselves where it has, or can develop, an edge over its competitors, social responsibility can become not a drag on the firms profitability but rather a strategic business opportunity. Companies can do well while doing good. He also highlight the fact that is easier to pursue an inherently worthwhile purpose in a privately held corporation rather than in a publicly held corporation as their business tend to be faire-weather corporate citizens, they are under continuing pressure to grow and do whatever is profitable. Furthermore, pursuing goals that are both worthwhile and profitable doesnt remove the inherent tensions between the pursuit of worthwhile activities and the goal of enhancing the bottom line. We can see that it is not easy for a CEO to be a leader, it depends of the environment, the context; it is why a leader as to be flexible and can adapt easily to the environment. We can also say that in publicly own companies they have the same tools as private own companies so they can try harder to pursue an inherently worthwhile purpose by develop a challenging and attractive vision, together with the employees and translate it to actions, express confidence, decisiveness and optimism about the vision and its implementation, realize the vision through small planned steps for its full implementation. But we also have to balances with the fact that objectives are not the same in private and publicly own companies. Speaking to the CEO (NB: people of power will be called CEO) Leadership is here approached through change. The main question rose by the author is How to communicate disruptive new ideas to people with great power. This implies the question of the HOW of course, which is one of the Management science and research main concerns but there is also here a dimension not that often developed, its the communication with people having power. We often hear how to be a leader and get your team and N-1 to do things but it is not that often that the target of power people (CEO) is approached. The key idea expressed here is understanding. The author emphasis on the human part of every individual and on the importance of the context. He thinks the person as an individual but part of a global scheme. To lead correctly you have to explore deeper and learn about personal individual. What are their preferences, hopes, manners, fears The idea here is to understand how people work inside, what trigger them. Because if you can understand the deeper needs of an individual you cant then easily figure out the proper way to communicate with him. You have then greater chances for him to listen to you and then to believe you. 1. Garry Williams and Robert Miller theory The author then develops a theory by Gary Williams and Robert Miller. They have agreed on 3 main leaders categories (80%): the charismatic, the skeptics and the followers, and they. then talk about thinkers and controllers (20%) Leaders needs: For charismatic: the boldness of idea should be featured For skeptical: need to hear the message from a person he trusts For risk averse follower: need to be reassured other people do it do Controller and thinkers: need details Trust Issue: The question of trust is developed. They distinguish here in the game of trust two different parties: the people in the inner circle of trust of the leader and the others. Inner Circle Not yet trusted Has the CEOs attention Sponsors the interaction Can be perceived as an opponent Can be perceived as irrelevant If so wont be listened to When aware of that, the challenges are easier to identify. The problem is here to focus on the CEOs interests and to make him believe in the idea you want to present to him by making it a part of himself. Committing to change The author uses here a powerful expression Commitment mind, body and soul. He explains here that to him the only way for a leader to succeed is to commit fully to an objective. The leader is here expected to see intensively even obsessively, to feel it. Being committed 100% is crucial for the leaders effectiveness, but the real problem is not to get him to convince the other but to get him passionate about the goal and get it to become a part of him. Because if strongly and intimately convinced he will be able to take the goal/company or team to a higher level. The leaders feelings stressed out? Feelings are often considered in Leadership theories, how to connect with people to make them do what is needed for the common goal (often the company)? But what I think is extremely interesting here is the consideration made to the leaders feelings. The question is not how to deal with the teams feelings but to analyze what thrive the leaders and how they handle their emotions. The Author here develops a little paragraph on how stressful it can be for a leader to become a leader. The two mains reasons to this stress would be : Steve Denning then points out the famous and classical world Leaders such as Gandhi, Martin Luther King Jr. and Kennedy who so intimately convinced had to pay the price of their life for their causes. To conclude this discussion I found important to highlight the phrase p79 telling that its an opportunity to lift their game to a new level because to me it sums up very well the basic structure of leadership that is to say the dimension of a vision. 2. Howell Raines leadership tale Steve Denning choose to introduce this chapter with a story: The Howell Rainess leadership tale. He tells us more about Howell Raines, former executive editor of the New York Times and the kind of leader he is and how he lived and tried to implement is change strategy. To sum up, Raines wanted the times to be the first on the news, with bigger and more original stories covered by what he called overwhelming force. He was familiar with the firm and the staff and had strong backing from his boss. One of the first thing is did was to use his right of fire and hire to create the dream team he had in mind. He did implemented change and got the Times to win a Pulitzer but after 19 months he was dismissed because of one of his reporter accused of plagiarism. The underlying reason was a bit different though, he was told to have lost the newsroom. What happened here is that despite his vision and that he strongly believed in what he intended to implement, he had failed to win the hearts and minds of his staff. He did not listened to his people enough and was perceived as very intimidating and aggressive. He did not succeed in taking other with him in his change strategy mainly because he underestimated his change strategy and its interaction with the staff. New audience: The author here develops the concept of audience evolution. Communication and management as we know it now is pretty recent in human history. Once upon a time people were not considering work like they are now. They had no specific expectations except earning money and would not even think work as a way of making them feel better, important and individually considered. There are 3 notions I will highlight that I think are crucial to understand this change of audience expectations: Quest for happiness: Nowadays we are in what I call the endless happiness quest, everyone wants and have to be happy by any means, and it of course includes work. People have more skills, are more educated and therefore expect more. They want something in return. New relation to authority figures: Another important thing that changes a lot the way the audience is acting is that we nowadays have a new relation towards authority, in private spheres (Family with your parents) and public spheres (at work with your boss). This is very important to keep in mind to understand why the audience acts in a certain way and what it expects. Expansion of diversity: We are dealing with more and more differences between people: gender, ethnicity, nationality, religion, life style, age group and geographical location Understand that new audience: The problem is that dealing with different people means that you wont reach them with the same tools. What is the common point to every single individual? We are humans. And what is common to every human being? Emotions. Whatever we do, wherever we come from we are driven by emotions, whether we try to hide them or we work with them we are all emotional. This is what the leader has to use: Emotions. He has to keep in mind that we are all different, have different goals, ambitions, perspectives and needs but a way to get us to understand the other and get involve in change or in a project is to use our emotions, the one that thrives us to go to another level. The author emphasis a 2 dimensions individual with a surface and a deeper world. To make something of someone you have to go to the deeper world, and for this you have first to get to know the individual personal story. They question. They explore. They intuit. They wander. They mingle. They live in it. They listen. They watch. Its a matter of imaginatively reaching out and getting inside the subjective world of the people who need to change and getting a sense of what it is like living in that world, so that the leaders feel its logic and power and order and compelling harmony Finding and encouraging New leaders Steve Denning develops an idea that I find particularly interesting it is that leaders cant work alone. No matter how charismatic and how committed he is to his vision an idea he will need the others to make change happen. He speaks about middle hierarchy and calls them evangelizers. He then makes a parallel with Raines story and how he failed involving his staff in his change strategy. He ends that chapter with the concept of Narrative intelligence required for understanding the story of the change idea and the audiences story. 3.Steve Denning vision of leadership Why Do People Change Their Minds? Stephen Denning explains us that there are 3 ways for people to change their mind: by actual experience, by observed experience, and by symbolic learning. Actual Experience: The way we are living and experiencing things around us can change the way we think about them, mostly because of the feelings we have when experiencing those things. When you feel a strong emotion doing something, you trend to pay attention to it and to remember it more easily and longer than when you dont feel anything. Observed Experience: Actual experience is not the only way to learn from experiences, observing events can have the same emotional effect as real-life experiencing. In the public arena, 9/11 changed the way many people viewed terrorism. Symbolic Learning: Most of the time the learning of an idea communicated symbolically is not as powerful as an experience but it can have similar physiological reactions. In the author case, the combination of direct experience, observed experience, and symbolic learning led to his spending a large part of his life devoted to international development. 1. Changing minds through direct or observed learning: The more immediately people are involved in an actual or observed experience, the more meaningful the learning will be, and the more impact they will have. Direct or observed learning in a business environment can be: acting, conversations, visits, role-playing, simulations, prototyping, training, Advantages of experiential learning (direct or observed): Emotions are involved Participants make up their own opinion (durability of the change) Experiential learning is more effective than passive learning Limits of experiential learning: Leaders dont always have the power to change peoples actual experiences Most of the leaders falls on the use of language as a way to change peoples mind 2. Persuading people to change through language Methods of persuading people change their minds Abstract Narrative Direct and explicit Appeal to reason through detailed evidence and arguments Narratives in which the object is to have the listener live the story as fully and movingly as possible Indirect and implicit Appeals to intuition, through cues, signs, heuristics and manipulative tricks Narratives in which the object is to stimulate a new story in the mind of the listener Stephen Denning founds 4 different type of language that can be use to change people mind: Giving people abstract reasons Giving people indirect rules of thumb as to why they should change Involving people directly in a story Inducing people themselves to generate a new story Leaders are a key component in the art of influencing others and make them change their mind. Leadership depends on a lot of dimensions: the leader himself, the follower, the situation and any combination of these factors. Not only the leader can use language to influence his peers, but also emotions, rewards, charisma, 2.1 Abstract Appeals to Reason: To obtain the best results, emotion should be kept out: rational processing must be unencumbered by passion. As Stephen Denning said, give people reasons and they will do whatever you say. Advantages of the approach: It is honest It is open It isnt manipulative It ties in with the idea that human beings should be rational in their decision-making. Limits of reason method: When it comes to inspiring enduring enthusiasm for changing behavior, it is worse than ineffective It can be counterproductive. Research shows that when people are presented with reasons to change their behavior in a fundamental way, they become more entrenched in their current viewpoint, not less. This type of leadership can be related to the cognitive resources theory; in fact, the cognitive resources theory is a situational model that deals with the cognitive abilities of the leader. The context and the inter-personal relationship arent really taken in consideration and only the experience and the knowledge of the leader are important. It is because the leader knows what he is talking about that followers are able to trust him and to be leaded. Because this theory doesnt pay attention to circumstances and environment it cant be studied any further. In fact it has been proved that situation and context are as important as the trait personality of the leaders and the followers it is why it is important to go beyond the simple do what I asked you to do leadership behavior. Appeals to Intuition: It is obvious that logical reason isnt the only way (and the most common) used by people to make a choice. They are mainly base on intuitive thinking. Some of the reasons are because it is fast, automatic, effortless, associative, natural, and often barely conscious. In this case, efficiency of the decision-making process is more important than its accuracy. If we were to try to apply conscious reasoning to every decision we had to make, we would never get out of bed in the morning, let alone get anything done. Intuition operates by using more rapid pathways based on context and similarity rather than the conscious use of logic and evidence. It efficiently incorporates emotions and feelings. Intuition, suffused with emotion, points out things we should quickly focus on in order to take action. It guides attention and keeps us focused on things to do and things to avoid. For example in a business environment you can be subject to such approach when your boss tells you: Do this and youll get a bonus, or Do that and your career is over. These types of discussions dont invite people to examine the reasons why this makes sense or that doesnt: instead, they aim to invoke an intuitive decision to do what the system rewards and avoid what the system punishes. Advantages of the approach: It requires little effort from participants Effective for low involvement issues Limits of the method: Vulnerability to cognitive biases Extensive financial resources or power to put in place the relevant cues and rules of thumb Better for establishing attitudes in the first place than for changing behavior When managers offer quid pro quos in exchange for compliance, they may run out of quids to offer for the quos Risk of an incentive treadmill Generate pushback and cynicism The best role for appeals to intuition may be a limited one, as a support for other communication tools. This type of leadership is called transactional leadership, as said previously it can be effective in certain situation, but most of the time, it fails to motivate followers to perform beyond their basic job requirement. In this type of leadership, the leader has all the power and controls the relationship with the followers. This is not a healthy way to manage people and it doesnt give good results in a long-term basis. 2.2 Narrative Direct narrative: Direct Narrative arguments convince one of their truths, stories of their lifelikeness. Jerome Bruner, Actual Minds, Possible Worlds We can see in the day-to-day life that we make most of our decisions through narrative rather than careful intellectual effort. We cannot decide what to do until we decide what story or stories we see ourselves as living. So logically, if we want to change the way people act, we need to change their stories. But how does a story persuade people to act? The narrative immerses the listeners as fully as possible in the story. The listeners are mentally transported from the real world to the narrative world that the storyteller is telling them. The story operates like real experience so as to influence attitudes through emotions and feelings as if the listener was living the story for real. The more absorbing the story, the more effective it is. Advantages of the approach: It is carried by the natural affinity of human beings for stories Stories tend to be more interesting, fresh, and entertaining than abstract argument Stories are flexible Stories trend to diverse groups Limits of the method: It is time consuming to tell a story that fully transports the listener Need for substantial financial resources, coordination with multiple storytellers, and exercise of power Indirect narrative: The idea presented by Stephen Denning is that it is important to give some freedom to the listener in his way to hear a story. In fact, if the story is deliberately crafted to be less absorbing, the listeners will not only hear the story, he will also hear his own silent voices within, as his minds ponder the implications of an analogous story for his own life. The distinction between direct and indirect narratives is important. They involve two fundamentally different mechanisms for getting results. In the direct narrative: the emphasis is on absorbing listeners in the richly told story of the storyteller, mentally transporting them to another world. In the indirect narrative: the emphasis is on stimulating a new story in the minds of the listeners. Its the listeners story thats key. The distinction between direct and indirect narrative parallels the distinction between abstract reasons and intuition. Indirect narrative is a principal route by which transformational leaders stimulate desire for change. When Al Gores movie, An Inconvenient Truth, tells the story of the success in repairing the hole in the ozone layer by concerted international actions; he doesnt try to tell a well-told story. He doesnt try to immerse the listeners in the sights and sounds and smells of what was going on when people were taking steps to fix the hole in the ozone layer. His story doesnt transport listeners to that different world. Instead, his telling of that story is minimalist in style. His story may nevertheless succeed if it sparks a new story in the mind of the listener: We solved the problem of the hole in the ozone layer, so maybe we can solve the problem of global warming! Advantages of the approach: Quick and powerful Can generate long term change free of cynicism Change with energy, gusto and enthusiasm Limits of the method: It doesnt work on everyone It requires a certain amount of narrative intelligence 3. To resume: Experiential methods are more likely to be effective than non-experiential methods, because the emotional imprint of a live experience is usually more pronounced than that of a virtual experience by way of language. Narratives are more likely to be effective than abstract communications, because this is how human beings think and make decisions, and because it simulates the emotional significance of experiential learning. Indirect methods are more likely to be effective than direct methods, because indirect methods leave it up to the audience to make up their own minds rather than having opinions forced upon them. The Leader as Storyteller What has been demonstrated so far is that all leaders need narrative intelligence. They have to know how to craft and perform a story, with good judgment as to what kind of effect it would have on the audience. Narrative intelligence can be even more effective when its principles are made explicit, because then other people can learn how to use it. 1. The Central Role of Narrative Intelligence Yet theres something profoundly counterintuitive about the whole idea of narrative intelligence. We would all like to believe that its substance that convinces, that analytic understanding must surely be more effective than any mere story, particularly a rudimentary story without rhetorical flourishes. Its hard to accept that something as primitive and old-fashioned as a bland narrative can be more powerful than analysis in the sophisticated business world of the twenty-first century. What is even more challenging, though, is how far the idea of narrative intelligence may extend. What if storytelling was not only one communication tool among many but also a criterion for judging the effectiveness of all forms of communication directed toward action? The concept of multiple intelligences was put forward in 1983 by Howard Gardner in Frames of Mind: The Theory of Multiple Intelligences. Several type of intelligences has been identified so far: linguistic, logical-mathematical, spatial, bodily-kinesthetic, musical, interpersonal, and intrapersonal, the naturalistic intelligence, and the emotional intelligence. None of these intelligences cover whats involved in narrative intelligence, that is to say, an understanding of and a capacity to navigate through a world of interacting narratives. But what exactly does Stephen Denning mean by narrative intelligence? Its about understanding the world in narrative terms and grasping the pervasive role of narratives in all aspects of human existence. It concerns knowing the different components and dimensions of narratives. Its being familiar with the different patterns of stories that exist and knowing which narrative patterns are likely to have what effect in which situation. Its knowing how to overcome the fundamental attribution error and understand the audiences story. Its having the capacity to anticipate the dynamic factors that will determine how the audience will react to a new story. Its being able to judge whether a new story is likely to be generated in the mind of any particular audience by any particular communication tool. Telling truthful stories The will to truth which will still tempt us to many a venture, that famous truthfulness of which all philosophers so far have spoken with respectà ¢Ã¢â€š ¬Ã¢â‚¬  what questions has this will to truth not laid before us! What strange, wicked, questionable questions! Friedrich Nietzsche 1. Truthfulness in the Marketplace In collaborative activities, truthfulness is a normal condition: deceptiveness, or being less than forthcoming, is aberrational. Competitive situations are different. In The Liars Tale, Jeremy Campbell reminds us that throughout nature, deceptiveness and nondisclosure are the norm in competitive situations. Deception, dissembling, feints, and bluffs are the name of the game. Since transformational leadership is in essence a collaborative activity, the relevant model is the collaborative one. In leadership, truthfulness and integrity are essential. Lack of forthrightness or deliberate shading of the truth is devastating to trust and credibility. Even an apparent lack of openness, can be disastrous. The marketplace presents interesting issues for transformational leadership since it inevitably comprises a mix of collaboration and competition. In the marketplace, the tension between competition and collaboration is always in play. The dilemmas can be acute for individuals. The answer to those questions is both obvious and difficult. Its obvious in the sense that if the objective is transformational leadership, to achieve the enduring enthusiasm of customers, truthfulness is crucial. Leaders have no choice: truth is their currency. Shading the truth may yield benefits in the short run and even result in a quick killing in the sense of a sale and a profit, but it also risks a killing in a different sense, that is, the death of trust. The practices of deception, shading the truth, less-than-full disclosure, and the manipulative weapons of influence dont constitute a long-term basis for generating enduring enthusiasm for a product, a service, a brand, or an organization. To be a transformational leader and inspire enduring enthusiasm, theres really no choice: truth telling is foundational. In the world of branding, the temptation to shade the truth is even stronger, especially now that companies have discovered how consumers can develop strong relationships with their brands in an anthropological sense, despite the lack of any real distinctiveness of the underlying products or services. Although this approach of saying whatever you can get away with may have short-run gains, in terms of long-term trust and enduring enthusiasm, it is a frequently trod path to disaster. Doing the right thing pays off. Storytellers who trick consumers get caught. They become inconsistent and sooner or later they get punished. Transformational leaders use their followers emotions to make them change their mind. This can be done regardless to any ethics and moral value. Transformational leaders can be very influent over their followers who are often respectful and trustful to them. Sadly not all leaders are good people, and some of them may have narcissistic behaviors, thriving tendencies on power and manipulation. Furthermore, some followers can be emotionally dependent to their leaders. It exists a theory of the dark side of charisma (describes by Yukl), that explains that for every example of a positive transformational leadership behavior, there are also some sad example of negative transformational leaders demonstrating charismatic qualities. For example Mahatma Ghandi is of course know for his impressive charismatic leader qualities in a good way, while Charles Manson or The Rev Jim Jones both are example of leaders from the dark side charisma leadership. Transactional leaders are more focusing on results and performance, transformational leaders prefers ethics and values. In short, these two approaches to leadership have different moral dimensions. Transformational leaders can manipulate their followers in ways that are more negative than positive for them. I read in an article[1] where it was explain that 3 scientific: Sanders, Hopkins and Geroy proposed an extension to both theories with what they called the transcendental leadership theory. Their article suggests that there are 3 type of leadership level: the transactional, the transformational, and the transcendental, and they suggest that a leaders development has to be associated with these levels of leadership accomplishment. This model in opposition to traditional leadership theories indicates that leadership is best understood if we take into consideration the leaders internal concern. They in fact tried to bring spirituality out of the box and to weave it twist into new way of thinking of leadership. Through charisma, individualized consideration, intellectual stimulation and inspirational motivation, transformational leaders have great potential to promote performance beyond expectations and to effect enormous changes within individuals and organizations. Nevertheless, the transformational leadership seems to be seen as a coherent leadership style adapted to our time even if we saw some dramatic example of what can be done on the same of charisma, risks exist particularly using idealized influence. The transformation of individual and organization has to be paired with moral and integrity concern and responsibilities. 2. Authentically Communicating Distinctiveness Being a leader in the marketplace imply to make a commitment to truth and authenticity. So, the company must not communicate on an authenticity that didnt really exist. If the company has no distinctiveness, it need to find or create one before communicate on it. The company cannot, for being a good leader, lie on a potential distinctiveness. Companies need to fix the firm inside before going outside We can identify three ways of communicating distinctiveness in an authentic way. The story of the firm itself: you can talk about where the company come from, what values it has, how it grew Southwest Airlines is a story of people living life to the fullest, with humor and a sense of fun, being free to roam about the country because the airline makes it affordable to do so by providing cheap, reliable, entertaining flights to popular destinations This way of communicating distinctiveness is closely linked to the character of its founder. However, we can criticized this approach because you can have good companies that are good leaders but without a good story behind it. In the case of a merge or acquisition, the story of the company can be sort of deleted. The value and story of the company can also evolve with the time and the trends so they have to be careful on what they communicate. If a company defend a value since many years, and for different reasons, it has to move away from this value, the company will have to adapt its communication. The story of the products and services: you can just communicate on the distinctiveness of the products or services. However, the problem is a distrust atmosphere in the marketplace that makes hard to tell credible stories about products or services. Customers have difficulties to believe that what the company said is true. Consequently, the solution can be to lean on customers for broadcasting this message. Consumers who trust the products and services will be messengers of the company. In this case, you dont need any advertisements. Google is a highly valued and valuable company, not because of its clever advertisements, but because hundreds of millions of people find its software pleasant and easy to use, and they are happy to tell their friends and colleagues about it People will trust more their friends and families than the company, so this message will be better received and believed. This phenomenon could happen thanks to the word of mouth but also thanks to the Internet, blogs and social networks However, for expecting that customers became evangelists of the brand, they have to be really satisfied by the products and services. And for this, it means that the company has a special relationship with its consumers with values like constancy and integrity. As a limit of this solution, we can say that, here, the company needs to have already built a relationship with its consumers. It cannot come and expect to have some brand evangelists. The story of the client: for any brand, there is a certain type of person who loves this brand. If you know the story of this person, it can resonate and turn the brand into an icon When Volkswagen presented itself as a company that made cars for iconoclasts in the 1960s and 1970s, it was hugely successful Thanks to this, the consumer can recognize himself to the brand he consumed and it will increase its brand loyalty. There is the apparition of implication and its like the consumer is part of the brand and the company. This solution is less obvious than the previous solutions. It can be difficult to really perceive what kind of person is the consumer. Moreover, the company risks losing consumers that are not exactly the kind of person that the company described. 3. From Sales Pitch to Trusted Partnership Considering the importance of trust for a company, a lot of them are now aspiring to become reliable collaborators with their consumers. Thus, these companies prefer to receive positive consideration than achieve immediately sales. Consumers are looking for advice and dialogue about issues of common concern. Thats what Stephen Denning called moving from sales pitch to trusted partnership. For this, companies have to really understand what is involved in the phenomenon of trust. Social scientists have discovered that trust is created by different collaborative behaviors. They took, in particular, the example of scientific community where there is a spirit of generosity. Participants make their contributions and they take their chances as to whether or when they will get anything back in return In this type of community, behaviors are respected because they lead to trust, scientists are transparently honest. We can observe the same phenomenon in the pharmaceutical industry, because of all the laws and regulations that border this market. Risks are quantified and made explicit to doctors and consumers at the time of purchase The last industry mentioned here is the software market. Here, products are tested for effectiveness but bugs are considering as normal and they are repaired with successive versions of the software. Users are sometimes more interested in getting timely updates of software than in avoiding risks from flawed product releases Nevertheless, in this market, the level of trust generated is unlikely to be high. There is some miscommunication to the consumers and software is rarely withdrawn from the market when there are some issues. Leaning on these examples, Stephen Denning give us recommendations on how to behave for building a trusted relationship: Showing real concern for the interest of counterparts: you have to be interested in the problems of the people you are dealing with Revealing vulnerability:we can say that you have to show as a human person with your strengths and notably your weaknesses. Sharing something of value early on: like you bring something to a friend when you go to his house, you need to bring something to your partner. Meshing with what has gone before: here, its the importance of listening and sharing with your partner. Instead of just giving, you can receive feedbacks from your partner. Willingness to learn: this is linked with the previous item, you have to be ready to listen what the partner wants to say. You are not here just to talk and express what you think. Generally, going towards a trusted partner behavior will be a significant change for companies. For staffs that wont be ready for the transition, thats where good quality of leadership will be involved. As a general critic to this part, we can say that Stephen Denning went to much in details for the examples of specific market and less in the advantages and drawbacks of sales pitch and trusted partnership. 4. Truthfulness in the March to War For illustrating the transformational leadership, Stephen Denning choose to talk about politics. Especially, by giving the example of how to convince people that launching a war against another country is legitimate and useful. Politicians usually have to demonize the enemy, exaggerate the offences it has caused, minimize the difficulties that will occur in the prosecution of the war, and exaggerate the benefits that will ensue Through the examples of the First World War, where the entire range of modern media were used to deploy propaganda, and of the Vietnam War, where they used misleading military rationales to frighten the American people, Stephen Denning showed us that the leadership in this case can really lead to a huge transformation of the opinion and way of thinking. He ended this part by the case of the Iraq war. This war was launched, lean upon a set of stories that turned out to be false. Consequently, we should be careful for verifying the stories used by politicians to persuade us into a war of choice. Here, we see the bad aspect of storytelling. With more time and examination of risk, it can help to verify the stories. As a limit of this comparison between war decision and transformational leadership, we can say that according to the context, the arguments given can be less powerful and impactful. To conclude this chapter, which talked about the importance of truthfulness, we can say that it has become a really important item for a company and for the durability of good relationship with its partners (consumers, clients, suppliers). Truthfulness is not just a quality of the mind. It must be reflected in the entire person and reflected in the body language of the leader Thats what Stephen Denning is going to talk about in the following chapter. Leadership presence What is leadership presence? Is it something mysterious or magical? How did great leaders come to possess it? Were they born with it? Can it be learned? Even without answering to these questions, Stephen Denning already said that it is unavoidable if you want to be listened, to get respect, to be taken seriously and to be a leader. In the book Leadership presence of Belle Linda Halpern and Kathy Lubar define it as the ability to connect authentically with the thoughts and feelings of others. With this, we can add to have a clear goal and being aware of your own story. But, in this chapter, he chooses to focus on something else: the body language. It can infer immediately on what it is said. The calm assertiveness of real leadership implies energy, but energy has been harnessed, energy that offers no direct threat to the audience. The idea of calm assertiveness is used for talking about the control of our own fears and desires. It helped us to show that we are here for the audience and available to listen and interact with them. To implement this idea, there are only some basics to establish presence. 1. And What Are Those Basics? Basics elements that are quoted here, for a good body language, are: Eye contact: the highway on which the interaction takes place. You symbolize that you are ready to interact with everyone who is there. Throw away your notes: you have to delete this obstacle between you and the audience. You also have to be fully present and not only a reader. Get out from behind podium: its also an obstacle between you and the audience. They can think that you are hiding yourself. Open body stance: with square shoulders, calm and total focus on audience, you will signify that you are there for the audience. Use gesture: with this, you are saying that its not only your mind that is here, but all your body. It can add images to your word and showing energy and enthusiasm. But, in any case, they should reflect calm assertiveness. Plant your feet: if you must move, does it toward the audience but not side to side across the scene. These few simple principles are essential to create a good impact on the audience for a leader. In this part, Stephen Denning is detailing a lot of simple principle that you have to implement for starting to be a good leader. This little practical actions are really useful but it is important to underline that they are not enough. 2. Practice, Practice, Practice We lost time for preparing what we are going to say instead of working on how we are going to say it. Macolm Ladwell points out, we all want to believe that the key to having impact on someone lies with the inherent quality of the ideas we present. In fact, the way we decide to present our ideas can totally influence what we are going to say and how is going to be received by the audience. According to Stephen Denning, thanks to the calm assertiveness, everything you can say can become wonderful! The important is to bring into harmony body, emotion and thought. The key for succeeds into that is only to practice a lot. We can measure a kind of success when the leaders succeed to speak the language of leadership from the heart. The listeners will recognize good intent and help rectify any defects in performance skills by hearing what was meant to be said. 3. Do Leaders Need Charisma? We dont have to confuse body language of Leadership and Charisma. For him, Charisma is not at all an essential element of leadership. The born leader and colourful charismatic person are only legend. A lot of good leaders havent any charisma at the beginning. By the example of Gandhi, he showed us that the charisma means nothing for being a good leader. And, moreover, his final charisma was not the reason but the result of his success. It was only after he had success in influencing people that people began to think of Gandhi as having Charisma Consequently, we can say that charisma is more a consequence of leadership than a cause of it. In this part, Stephen Denning is really explaining in detail the story of Gandhi. It gives a good overview of how a good leader can have no charisma from the beginning. However, it will have been interesting to have another examples to see how charisma can influence (or not) a good leadership. 4. Can Leaders Use Written Stories Here, he wants to talk a little about the uses of written communication. For him, it is not really reluctant because there is no presence and interaction with the audience. To engage these kinds of audiences with strange, new, transformational ideas, I have two words of advice: be there! Nowadays, to read a book takes time and people needs to be motivated for reading a book. Thats where storytelling can help to motivate people to read. So, you need to meet your audience and motivate them for reading written communications. Finally, in this part on written communication, Stephen Denning is really going quickly without talking about the impact that can have these types of communication. It is not only a question of time or motivation. It is also a question of choice and willing to discover more described way of communication. 5. Should Leaders Use PowerPoint? Stephen Denning ended this chapter by talking about the importance of the support during a presentation. Nowadays, the most used tool is the PowerPoint. However, for many people this tool can be really boring and destroy a good presentation. But, he wants to highlight the important rules that you have to follow for making a good PowerPoint support to your presentation. The medium encourages the speaker to use theatrical tricks to keep the audiences attention. It can be an effective performance. But it is less likely that the message sticks as well as one that combines words with images. With this piece of advice on how to build a good PowerPoint presentation, Stephen Denning keep on giving practical advices that can be really useful. Again, these advices are not enough to become a good leader but they are still good to read. Finally in this chapter, we have seen, through really practical tools and information, the importance of body language in a good trusted partnership. For succeed a transformational leadership, you need also to insure a good leadership presence. This presence is notably made by the right body language. Parallel with other main leadership theories: I will highlight some concepts of some other leadership theories that are I think correlated to Steve Denning leadership conception. The Secret Language of Leadership 3 [1] Transformational Leadership: Characteristics and Criticisms by Iain Hay (https://www.leadingtoday.org/weleadinlearning/transformationalleadership.htm)

Taking a Look at Organizational Changes - 1435 Words

Organizational Changes Understanding human behavior is vital in the organization in which I work. I work as a supply sergeant for a military police unit, the 233D Military Police Company. The managers and leaders in this organization face many challenges. Throughout the last ten weeks we have gained a plethora of knowledge from the text book, ORGB, by Debra Nelson and James Quick in regards to human behavior in organizations, formal and informal organizations, organizational commitment, influential tactic, goal setting, leadership style, conflict management style, empowerment, performance appraisal, and change management, and several other subjects regarding organizations, management, and anything or one that may affect it. Leadership Styles The leadership styles that best suits the Officer’s and Non-Commissioned Officer’s in my unit is a combination of autocratic and democratic styles. 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Diagnosis On Stomach Cancer Survival Health And Social Care Essay Free Essays

Stomach Cancer is one of the 20 most common malignant neoplastic diseases in the UK. Survival from tummy malignant neoplastic disease has been increasing in the past 30 old ages, nevertheless at that place remains to be survival differences between different socio-economic categories. The endurance in more disadvantaged categories has remained lower than endurance from the more flush categories ( this difference is known as the want spread ) and more so important in males. We will write a custom essay sample on Diagnosis On Stomach Cancer Survival Health And Social Care Essay or any similar topic only for you Order Now Methods: A complete dataset of 70370 malignant neoplastic disease patients that was formed from the malignant neoplastic disease register dataset and merged with Hospital Episode Statistics ( HES ) dataset. The extra jeopardy patterning attack was used ; utilizing the construct of flexible parametric patterning with restricted three-dimensional splines was used to predict net endurance from tummy malignant neoplastic disease. Consequences: The net endurance was found to differ between different want classs, where cyberspace endurance was lower in the most disadvantaged category and the highest in the most flush category. The net endurance was found to be higher in females than males and was found to be about twice every bit much in patients who had surgery. Decision: It was found that although net endurance about doubled in patients who had surgery, the want spread still remained. However farther analysis which include phase and class of malignant neoplastic disease would assist in placing whether this want spread is in fact important after taking into history such variables. Table of Contentss Care Form 53 Glossary DCO – Death Certificate Merely EHR – Excess Hazard Ratio FP – Fractional Polynomial GOR – Government Office Region HES – Hospital Episode Statisticss IMD – Index of Multiple Deprivation MAR – Missing At Random MI – Multiple Imputation TVC – Time changing constituent DF – Degrees of freedom ONS – Office of National Statistics HES – Hospital Episode Statisticss AIC – Akaike information standard BIC – Bayesian information standard 1 Introduction 1.1 Biology and Symptoms of Stomach Cancer Cancer is a disease which causes unnatural growing of cells which start to split and reproduce uncontrollably and in some instances these cells can metastasise. This growing in cells occurs many old ages before the malignant neoplastic disease can be detected. The cancerous cells lose legion indispensable control systems due to mutant in the cistrons of normal cells. When human cells reproduce, mutant can go on by opportunity, nevertheless a figure of different mutants occur before malignant neoplastic disease cells are formed. There are three cistrons which can do malignant neoplastic disease cells ; transforming genes ( besides known as ‘cancer cistrons ‘ which are unnatural and do the cells to multiply or duplicate ) , tumour suppresser cistrons ( cistrons which stop the cells multiplying nevertheless if damaged halt working hence cells become cancerous ) and DNA fix cistrons ( cistrons which repair other damaged cistrons nevertheless if damaged so mutants can non be repaired and therefore when the cell multiplies and divides it copies the mutants ) . ( 1 ) Stomach malignant neoplastic disease is the malignant neoplastic disease that occurs in the tummy and is besides known as stomachic malignant neoplastic disease. There are a figure of different types of tummy malignant neoplastic diseases. The most common type of tummy malignant neoplastic disease is known as glandular cancer of the tummy which starts in the secretory organ cells of the tummy liner, the secretory organ cells so produce stomach fluids and mucous secretion. Other types of tummy malignant neoplastic disease include ; Squamous cell malignant neoplastic diseases ; formed in the squamous cells ( skin cells that are between the secretory organ cells which form the tummy liner ) ( 2 ) . Lymphoma of the tummy ; really rare and is a different type of malignant neoplastic disease in which white blood cells ( lymph cells ) become cancerous cells and can non assist support the organic structure like normal white blood cells ( 2 ) . Gastrointestinal tummy tumor ( GIST ) ; a rare tumor which grows from the cells of the connective tissue which uphold the variety meats of the digestive ( GI ) piece of land and can be both cancerous and non-cancerous ) ( 2 ) . Neuroendocrine tumor ; are rare tumour which grows in the tissues that produce endocrines in the digestive system and can be cancerous and non-cancerous ( 2 ) . The early symptoms of tummy malignant neoplastic disease are non-specific and include dyspepsia, sourness and belch, experiencing full Oklahoman and hence ensuing in loss of weight, shed blooding in the tummy which can do anemia and hence doing fatigue and paler tegument. Other symptoms include purging, blood coagulums, hurting in the upper venters or hurting under the chest bone and trouble in get downing. Symptoms of the advanced phase of the malignant neoplastic disease, include blood in the stool and development of fluid in the venters ( 3 ) . There are no testing programme for tummy malignant neoplastic disease in the UK, nevertheless tummy malignant neoplastic disease is the most common malignant neoplastic disease in Japan and hence a showing programme is used which involves a Ba repast x-ray followed by endoscopy. 1.2 Stomach Cancer Incidence, Survival A ; Mortality Cancer is a cardinal wellness issue in the UK, where a one-fourth of all deceases are due to malignant neoplastic disease and one in three people develop malignant neoplastic disease at any point in their lives. Cancer is more common in older people where more than 75 % of deceases occur in people over 65, nevertheless it can develop at any age. The incidence rate of malignant neoplastic disease has increased by 20 % in males and 40 % in females since the mid-1970 ‘s ( 4 ) . Stomach malignant neoplastic disease was found to be the 9th most common malignant neoplastic disease amongst work forces and the 14th most common amongst adult females in the UK in 2008 ( 5 ) . Around 7610 new instances of tummy malignant neoplastic disease were diagnosed in the UK in 2008, 4923 instances among work forces and 2687 in adult females with an overall incident rate of 8.6 per 100,000 individuals. In Britain the incidence rates for both males and females have more than halved ; from about 30 per 100,000 in 1975-1977 to about 13 per 100,000 in 2006-2008 in males, and from about 14 per 100,000 in 1975-1977 to about 5 per 100,000 in 2006-2008 ( 5 ) . The rate increased quickly for people above 60 old ages to about 140 per 100,000 in work forces and 67 per 100,000 in adult females aged 85 and over in 2008 ( 5 ) . Survival from tummy malignant neoplastic disease progressively progressed in patients diagnosed in 1996-1999 compared to patients diagnosed in 1971-1975, peculiarly due to quicker and earlier sensing and diagnosing, and betterment in intervention ( 6 ) . In England and Wales ; the one twelvemonth endurance more than doubled in patients diagnosed in 1996-1999 compared to 1971-1975. The 5 twelvemonth endurance were about three times higher in patients diagnosed in 1996-1999 compared to patients diagnosed in 1971-1975 ( 6 ) . The mortality rate of tummy malignant neoplastic disease decreased by about 70 % in both males and females over the last 30 old ages in the UK. The tendency of mortality was similar to the tendency of incidence as the mortality rate was found to be higher in males than females across the UK in 2008 ( 7 ) . The different types of intervention for tummy malignant neoplastic disease include surgery, radiation therapy, chemotherapy and biological therapy. Combinations of the interventions are besides normally used such as chemotherapy and surgery in state of affairss where it is non possible to take a localized malignant neoplastic disease wholly as it has spread and hence chemotherapy is used to first shrivel the malignant neoplastic disease plenty to surgically take it ( 8 ) . 1.3 Hazard Factors More than 70 % of all tummy malignant neoplastic disease instances are diagnosed in developing states ( 9 ) . Older people, males and people belonging to the most disadvantaged socio-economic position have a higher hazard of tummy malignant neoplastic disease ( 10 ) . Other hazard factors include ; smoke, intoxicant, weight, household history, exposure to radiation, business and Helicobacter Pylori ( 10 ) . Helicobacter Pylori is a bacterial infection that has higher prevalence in developing states and in people who have a low socio-economic position. In a survey of instances in 2010, it was found that 32 % of tummy malignant neoplastic disease instances were associated with infection of the bacteria. In other surveies it has besides been found that get rid ofing Helicobacter pylori may help in forestalling tummy malignant neoplastic disease ( 10 ) . There is uncertainness about the association of holding tummy malignant neoplastic disease and an unhealthy diet. A few surveies have found that a higher consumption of fruits and veggies is associated with cut downing the hazard of tummy malignant neoplastic disease, nevertheless other surveies such as the EPIC survey found that a Mediterranean diet reduces the hazard of tummy malignant neoplastic disease. Another survey found that pickled veggies increase the hazard of tummy malignant neoplastic disease in Nipponese and Koreans ( 10 ) . Family history of tummy malignant neoplastic disease increases the hazard of acquiring the disease, nevertheless some of this addition may be environmental, as some surveies showed grounds of increased hazard in partners of patients ( 10 ) . The EPIC survey found that physical activity reduced the hazard of tummy malignant neoplastic disease and have a protective consequence, nevertheless other surveies provide no grounds of such and hence farther research needs to be carried out to supply important grounds ( 10 ) . 1.4 Socio-economic Inequality The endurance between want classs varies well for tummy malignant neoplastic disease ; with flush patients holding higher endurance rates compared to strip patients as shown from a figure of surveies worldwide. Mitry et Al. ( 11 ) analysed tummy malignant neoplastic disease informations from England and Wales malignant neoplastic disease registers and found a statistically important ‘deprivation spread ‘ ( i.e. the difference in endurance between flush and disadvantaged categories of patients ) in survival analysis in work forces diagnosed between1986-1999. Another survey carried out in the Netherlands found that the hazard of deceasing was lower after seting for possible confounders in flush patients compared to deprived patients ( 12 ) . A survey in Japan besides looked at the association between socio-economic position and tummy malignant neoplastic disease endurance by analyzing the endurance of patients by their business. There was grounds of disparity in endurance b y business after seting for possible confounders and this was chiefly due to ulterior diagnosing of tummy malignant neoplastic disease amongst the lower businesss ( 13 ) . The want spread in endurance has widened for male patients diagnosed in the 1996-1999 compared to those diagnosed in 1986-1990. Mitry et Al. ( 11 ) showed that the want spread for both annual endurance and five-year endurance has widened steadily and significantly from 1986 to 1999 for tummy malignant neoplastic disease and that that the want spread in work forces is likely to go on broadening. In England There were grounds of socioeconomic inequality in tummy malignant neoplastic disease incidence, it was reported that incidence remained unchanged in the flush groups, nevertheless incidence decreased by 31 % in deprived work forces and by 47 % in disadvantaged adult females higher in West Midlands, England between 1986-2000 ( 14 ) . Many suggestions were put frontward to explicate the beginning of the want spread in malignant neoplastic disease endurance, and three chief factors were suggested ; phase of diagnosing, biological features of the malignant neoplastic disease, host factors and consequence of intervention, psychosocial factors, and intervention received, medical expertness and malignant neoplastic disease showing ( 15 ) . 1.5 Aims A ; Aims The net ( comparative ) endurance in a population of malignant neoplastic disease patients is their endurance from the malignant neoplastic disease of involvement in the absence of other causes of decease. The comparing of net endurance in the UK by want class suggests a important broadening want spread in males ( 11 ) . The purpose of this undertaking is to look into whether the widening want spread in work forces was due to work forces in the deprived group non profiting from healing surgery. The phase at diagnosing will besides be studied to look into the possibility of deprived work forces diagnosed at a ulterior phase compared to affluent work forces. Datas from the eight regional malignant neoplastic disease Registries of England over the period 1997-2006 will be examined. This dataset will be linked to the Hospital Episode Statistics from which information on intervention will be derived, to analyze survival tendencies and estimate net endurance of patients with tummy malignant neoplastic disease after seting for sex, age, want spread, intervention and phase of disease at diagnosing. Net endurance will be estimated utilizing an extra jeopardy theoretical account. From the extra jeopardy theoretical account, all cause mortality will be modelled as the amount of the extra ( cancer-related ) mortality jeopardy and the expected ( background ) mortality. Net endurance will hence be calculated as the ratio of the observed ( all cause ) endurance to the expected ( background ) endurance. The background mortality/survival will be defined utilizing life tabular arraies from the general population. The life tabular arraies will be merged utilizing age, sex, twelvemonth of issue, GOR ( Government Office Regions ) and want class to the malignant neoplastic disease dataset. Net endurance by want class will foremost be estimated to find if there is any grounds of socio-economic inequality in malignant neoplastic disease endurance in the analysed period 1997-2006. An analysis will so be carried out, seting for confounders such as age, sex, intervention, and phase of malignant neoplastic disease. 2 Materials and methods This chapter will supply description of the informations used in the undertaking and the statistical methods applied to predict net endurance from tummy malignant neoplastic disease by want category. The construct of flexible parametric patterning with restricted three-dimensional splines will be used to take into history differences in mortality by age, sex and intervention are discussed in item. All statistical analysis was carried out utilizing STATA 12.1 ( 16 ) . 2.1 Datas The UK is known to hold the most extensive/complete malignant neoplastic disease enrollment systems in the universe ( 17 ) . Presently there are eight malignant neoplastic disease registers in England. The malignant neoplastic disease registers in England collect information on clinical informations such as phase and type of malignant neoplastic disease, decease certifications which are forwarded by the Office of National Statistics ( ONS ) and demographic information such as day of the month of birth, day of the month of diagnosing, sex ( 18 ) . Information such as the malignant neoplastic disease class, phase and intervention are largely uncomplete. furthermore information on infirmary admittances and co-morbidity is frequently unavailable. Further information on malignant neoplastic disease patients can be obtained from the Hospital Episode Statistics ( HES ) . The HES is a database apparatus to include informations and information on all admittances in NHS infirmaries since 1989. Since 2003, the HES database has besides included and stored information on outpatients. The information in the HES are extracted from clinical instance notes. clinical instance notes include more elaborate descriptions of the clinical informations such as class and phase of malignant neoplastic disease at diagnosing, intervention received and co-morbidity. The malignant neoplastic disease register and HES database can be merged ( 19 ) utilizing the patients NHS figure and cardinal information day of the month of birth. Once the malignant neoplastic disease register and the HES database are combined, an independent cheque on the quality of the information is carried out every bit good as betterment in the completeness of the informations aggregation ( 19 ) . The patients acknowledged through decease certifications are followed up by their enrollment officers from their several regional malignant neoplastic disease registers to happen out the topographic point of intervention and therefore the patients ‘ infirmary A ; instance notes. However this is non equal for some patients as they may non hold been provided any secondary attention ( hospitalization/clinics ) and therefore these patients are referred as decease certification merely ( DCO ) ( 20, 21 ) . Analysiss will be carried out on anon. informations from the eight malignant neoplastic disease registers in England on tummy malignant neoplastic disease diagnosed during 1997-2006. The patients identified suited for the analyses were merged in progress with their several patient records from the HES database from which information on intervention was extracted. Demographic information which included day of the month of birth, sex, Government Office Region ( GOR ) , day of the month of malignant neoplastic disease diagnosing and morphology were given for each patient. Information on the abode ZIP code at diagnosing and critical position ( dead, alive or emigrated ) were found from the Office of National Statistics for each patient. However as there was no information available the socio-economic position of each malignant neoplastic disease patient, utilizing the ZIP code ; the abode at diagnosing of each malignant neoplastic disease patients was identified and hence a want mark based on the abode was allocated to each patient. Five want classs ( from 1 ‘most affluent ‘ to 5 ‘most deprived ‘ ) were classified utilizing the income sphere mark of the 2004 Index of Multiple want ( IMD2004 ) and each patient was hence assigned to their several class based on their want mark. The IMD is based on everyday administrative informations of the 34,378 Lower Super-Output Areas ( LSOAs ) in England. Carstairs index ( 22 ) was the index used antecedently. Comparing the IMD mark to the Carstairs mark, the IMD is based on a smaller geographical country and is non based the nose count informations and therefore can be updated on a regular basis without transporting out a new nose count. The IMD is normally updated every 3-4 old ages. 2.2 Statistical Methods 2.2.1 Relative Survival and Excess Mortality Net endurance can be used to mensurate malignant neoplastic disease mortality straight. It can besides be used to mensurate extra mortality of malignant neoplastic disease patients compared to the general population. Net endurance can be estimated utilizing cause specific or extra mortality. Net endurance utilizing the cause-specific attack can be used by measuring the cause of each decease, merely the deceases attributed to the malignant neoplastic disease are considered and all other causes of deceases are censored. The major disadvantage is that there is a strong dependance on the quality of decease records. Cause-specific endurance can be used to mensurate malignant neoplastic disease mortality straight and uses inside informations of all deceases, nevertheless the cause of decease in this instance is malignant neoplastic disease and is used in the malignant neoplastic disease mortality. This method requires the cause of decease to be accurate and exactly specified, nevertheless the cause of decease is non given in most instances. Indirect deceases such as deceases due to route accidents or deceases due to side-effects of medications/treatment alongside deceases due to malignant neoplastic disease are hard to sort. Furthermore, different diagnosticians will specify cause of decease otherwise depending on the state of affairs at clip of decease hence cause of decease may non be right defined. There are two methods of appraisal of the cause specific attack are Kaplan-Meier method and the Acturial method. Excess mortality is a method which accounts for malignant neoplastic disease mortality straight and indirectly without necessitating an accurate and precise specification of the cause of decease ( 23 ) . The extra mortality is derived as the difference in the ascertained mortality ( mortality due to all causes ) and expected mortality ( mortality due to non-cancer-related causes ) . Both extra mortality methods estimation malignant neoplastic disease mortality after seting for background mortality from assorted other causes and hence presumptively should give similar values. In world nevertheless this depends on how suitably premises are fulfilled for each several method, chiefly accurately documenting and stipulating the cause of decease for the cause-specific method and the truth of gauging the expected mortality for the extra mortality method ( 23 ) . Excess mortality is classified mathematically utilizing the jeopardy map at clip since diagnosing as. The jeopardy map is equal to the amount of the extra jeopardy due to stomach malignant neoplastic disease diagnosing and the expected jeopardy ( sometimes known as the baseline jeopardy, estimated utilizing external informations from the general population ) where is the covariates vector ( 24 ) . Equation ( 1 ) Net endurance ( Relative endurance ) is the survival corresponding to extra mortality, and is derived as the ratio of the ascertained endurance of the malignant neoplastic disease patients to the expected endurance estimated from the general population utilizing life tabular arraies. Equation ( 1 ) may therefore equivalently be written in footings of net/relative endurance as Equation ( 2 ) where and are the cumulative observed and expected endurance severally. The relation between the jeopardy map and expected jeopardy and cumulative observed and expected endurance severally, is given by and, and the net/relative endurance is so given as. ( 24 ) The jeopardy is assumed to be piecewise changeless over of follow-up clip ( changeless over little clip intervals ) in pattern and hence a short period such as a twelvemonth or less might be used at the start of the followup. If a longer period is used so the changeless jeopardy premise is violated and clip since diagnosing is non automatically adjusted for and is hence the uninterrupted map may be modelled as a measure map. A new covariate vector is derived by adding the covariate vector with the index variables where the index variables are generated for all intervals apart from the mention interval. A multiplicative map of the covariates in the signifier of is assumed to be the extra jeopardy and therefore equation ( 1 ) becomes Equation ( 3 ) or instead Equation ( 4 ) where the parametric quantity estimates when exponentiated can be inferred as extra jeopardy ratios ( EHRs ) . The jeopardies are assumed to be relative implicitly in equation ( 3 ) . By Introducing interaction footings of the follow-up clip and covariates in the theoretical account can be used for patterning non-proportional jeopardies. Excess mortality can be estimated utilizing assorted different methods, Different methods exist for gauging extra mortality, either utilizing a full likeliness attack ( 25 ) , or based on sorted informations incorporating one observation for each life table interval within a generalised additive theoretical account ( 25, 26 ) . Life tabular arraies provide information on endurance and give the chance of decease in the general population stratified by age, calendar twelvemonth, sex, want and authorities office part ( GOR ) . The life tabular arraies in England are based on the nose count informations and are hence updated every 10 old ages to demo alterations in life anticipation. In the analysis carried out for this undertaking the life tabular array used is stratified by sex, age, GOR, twelvemonth of issue, and IMD quintile. The Life tabular arraies from 1981-2010 were used. Life tabular arraies are based on mortality in the general population, which include the mortality due to stomach malignant neoplastic disease, but because decease due to malignant neoplastic disease is little compared to the general population, it does non impact net/relative endurance estimations in pattern Ederee et Al. ( 27 ) . The stpm2 bid in STATA was used to foretell comparative endurance. The timescale and failure were declared utilizing the stset bid, and the clip beginning for the analysis was taken to be the day of the month of diagnosing of each topic. The timescale was calculated in old ages and the extra mortality was modelled as the primary result of involvement as suggested in ( 23 ) . 2.2.2 Splines Frequently complex non-linear effects from uninterrupted variables e.g. age are modelled in arrested development theoretical accounts. There are many improved methods of patterning complex and non-linear effects. Splines is an easy manner of including an explanatory variable in a smooth non-linear manner. Mathematical maps which are sections of multinomials and joined together at points called knots are known as splines. To do the spline smooth, A figure of restraints which include limitations on the mathematical derived functions of the spline map are applied between next multinomial sections so that the curve is smooth at the knot. In general, splines can be generated utilizing multinomials of any grade. However three-dimensional splines are frequently used, in which each section can be written as a three-dimensional multinomial as three-dimensional multinomials normally model most curves right and are computationally easy to obtain. The smoothness status for a three-dimensional spline means that the spline map is uninterrupted i.e. the first and 2nd derived functions are uninterrupted everyplace and there are no leaps or interruptions in the spline. A three-dimensional spline with K knots may be derived mathematically in footings of K+4 parametric quantities in general as ( 28 ) : where the notation classifies the incline map, where if, and if and the knots are at places severally. Cubic splines behave ill at the dress suits when fitted to informations is less and the spline map may be susceptible to extreme value. A subset of three-dimensional splines where the spline map is additive before the first knot and after the last knot are known as restricted splines ( 28 ) . A restricted three-dimensional spline can be specified by K-1 parametric quantities for K figure of knots which is 5 less than a general three-dimensional spline. where the is defined as: With a logarithmically transformed clip variable, restricted splines are normally used to pattern the extra jeopardy. Knots can be anyplace on the log-outcome clip distribution, where the boundary knots at the first and last log-outcome clip. 2.2.3 Flexible Parametric Survival Models Royston and Parmar ( 29 ) foremost introduced flexible parametric theoretical accounts in the position of censored endurance informations. This method of patterning informations gave more flexibleness to the form of the jeopardy map in comparing to other parametric theoretical accounts e.g. the Weibull theoretical account for which the signifiers of the jeopardy map are limited. The flexible parametric theoretical accounts do non necessitate numerical incorporation and hence a cardinal advantage of such theoretical accounts is comparatively fast calculations. ( 30 ) The Cox theoretical account is the most common method of covering with censored informations, nevertheless flexible parametric theoretical accounts can cover with non-proportional jeopardies more expeditiously. In flexible parametric endurance theoretical accounts, clip is treated as a uninterrupted variable and hence unlike piecewise approaches the demand of dividing the time-scale is non needed ( 24, 26 ) . The big Numberss of excess parametric quantities which are required to be created so that time-dependent effects are incorporated in the piecewise attack are hence non required in this modeling attack and hence this reduces the computational clip and uses less computing machine memory particularly for big datasets. Alteration of the flexible parametric theoretical accounts have since been done for comparative endurance theoretical accounts ( 30, 31 ) A parametric theoretical account is defined as a theoretical account which can be identified in footings of a fixed set of parametric quantities ( , , †¦ ) . Restricted three-dimensional splines are fitted to the estimations of the log baseline jeopardy in a flexible parametric net/relative endurance theoretical account ( 30 ) . Equation ( 6 ) Transforming to the endurance graduated table Equation ( 7 ) where is the restricted three-dimensional spline map of with knots, and is the cumulative overall jeopardy. The log-likelihood map is obtained utilizing equation ( 6 ) and numerical methods are used to gauge the parametric quantities which give upper limit likeliness utilizing equation. Thus the endurance and hazard maps can be analytically estimated. 2.2.4 Evitable Deaths A manner of infering extra hazard ratios is by ciphering evitable deceases ( 32-34 ) . The figure of evitable deceases is the figure of deceases due to stomach malignant neoplastic disease which could be avoided if the net endurance in all socio-economic classs would be the same as that of the most flush class after seting for the different features of each class. The expected figure of deceases due to all causes amongst a specific group of patients utilizing equation ( 2 ) is: where N is the size of the population, is the expected endurance at clip T and is the net endurance of the concerned group at clip T. In the general population, the predicted figure of all-cause deceases in a matched group is: . The premise of net endurance being the same as in a population being compared to is made ( in this instance the least disadvantaged ( flush ) category ) to deduce evitable deceases. The figure of evitable deceases are calculated by deducting the predicted figure of deceases due to all causes given the new comparative endurance from the predicted figure of deceases due to all causes given the original comparative endurance. The figure of â€Å" evitable † deceases represents postponed deceases which will happen subsequently and hence are really variable with the follow-up clip. 2.3 Statistical Analysis To transport out the statistical analysis, informations were examined to vouch it ‘s dependability. Consistency cheques were besides carried to do certain informations was placed in the needed scopes. Datas from the Hospital Episode Statistics ( HES ) database were merged with the malignant neoplastic disease register informations, and information on intervention was obtained. patients whose records could non be matched to the HES database were excluded. Patients who had losing informations on variables such as GOR or IMD mark ( used to deduce want classs ) , which were used in unifying with the general population life tabular array to gauge the net endurance were besides excluded from the analysis. The patient distributions were examined by the chief explanatory variables on the information. To happen differences in want class, cross-tabulations of other variables ( such as intervention, GOR and malignant neoplastic disease registers etc. ) by want category were carried out. Net endurance by want category was estimated utilizing a flexible parametric theoretical account. This theoretical account did non affect any variables with losing informations and the stpm2 bid in STATA was used to cipher predicted net endurance. Expected chances of decease were estimated by unifying the life tabular arraies stratified by age, sex, want and GOR and twelvemonth of issue, to the malignant neoplastic disease dataset ( formed of HES merged with the malignant neoplastic disease register informations ) . The method of flexible parametric theoretical accounts utilizing restricted three-dimensional splines was used, as this method was computationally less ambitious and less clip consuming and a more accurate method of analysis. Using flexible parametric patterning with splines, interaction footings were fitted in the theoretical account. As extra mortality was predicted to differ non-linearly with age, hence interaction footings for age with splines were besides introduced. To prove the rightness of this method of analysis, both in footings of the procedure of utilizing splines and besides presenting the interaction footings of the theoretical account. Net endurance for up to 10 old ages was estimated and predicted by want category, seting for sex, intervention and age group. A new variable dividing the age with 5 splines was so created and used to do dummy variables for the restricted three-dimensional age splines variables. A restricted three-dimensional spline with 5 knots was used. To let for non-proportionality in the extra jeopardy for both twelvemonth ( twelvemonth of diagnosing ) spline and age spline variables, dummy variables for the interaction between both variables were generated. A figure of flexible parametric theoretical accounts were fitted for males and females individually. The first theoretical account was fitted with want and chief confounders such as the age splines and twelvemonth ( twelvemonth of diagnosing ) splines. A 2nd theoretical account with interactions between age splines and twelvemonth ( twelvemonth of diagnosing ) splines every bit good as utilizing all the variables from the first theoretical account. The 3rd theoretical account was fitted by including intervention ( as the association between intervention and want class was to be examined particularly in patients who had surgery ) in the best adjustment theoretical account out of the first two theoretical accounts. The theoretical accounts were re-fitted with clip changing effects with age merely and so with both age and clip of diagnosing. These theoretical accounts were compared for the best of tantrum utilizing the likeliness ratio trial. To happen out which grades of freedom ( DF ) for the baseline jeopardy produced the better adjustment theoretical account, the best adjustment theoretical account without the clip changing effects was fitted with 1 to 5 DF and so compared utilizing Akaike information standard ( AIC ) and Bayesian information standard ( BIC ) . The best fitting theoretical account with the DF for the baseline jeopardy was chosen to be the 1 with the smallest AIC and BIC. The same method was used to make up one’s mind which DF for the varying effects was best used for the best fitting clip changing effects theoretical account. The scrutiny of evitable deceases was carried out to gauge and foretell the figure of evitable deceases at 1 and 5 old ages if endurance was the same in all want classs as the most flush class. 3 Consequences 3.1 Description of the malignant neoplastic disease register informations For the analyses to be carried out, a sum of 70,370 patients who were diagnosed with tummy malignant neoplastic disease during the period of 1997-2006, and were linked to the HES database. From the entire figure of patients, 1729 ( 2.46 % ) patients were registered via their decease certification merely ( DCO ) or had zero endurance ( day of the month of decease was the same as the day of the month of diagnosing ) . Zero endurances were included in the analysis by adding one twenty-four hours to the day of the month of decease, as excepting them would overrate the endurance, nevertheless it is known that DCOs seldom have a confirmed day of the month of diagnosing ( 21 ) . Of the entire figure of tummy malignant neoplastic disease patients, 45,580 ( 64.77 % ) were work forces and 24,790 ( 35.23 % ) of the patients were adult females. Table shows the figure of tummy malignant neoplastic disease instances by GOR. The largest absolute figure of tummy malignant neoplastic disease patients was in the North-West part and the smallest being in the North East part. Table: Proportion of tummy malignant neoplastic disease patients by Government Office Region Government office part Number ( % ) of patients North East ( A ) 5,157 ( 7.33 ) North West ( B ) 11,615 ( 16.51 ) Yorkshire and The Humber ( D ) 8,710 ( 12.38 ) East Midlands ( E ) 6,278 ( 8.92 ) West Midlands ( F ) 8,461 ( 12.02 ) East of England ( G ) 7,027 ( 9.99 ) London ( H ) 7,508 ( 10.67 ) South East ( J ) 8,878 ( 12.62 ) South West ( K ) 6,736 ( 9.57 ) The proportion of males to females and average age of tummy malignant neoplastic disease diagnosing were similar across all want categories, the highest mean age at diagnosing in the in-between want class ( 73.3 old ages ) and the lowest amongst the most disadvantaged group and the flush group ( 72.4 old ages ) , nevertheless this difference in mean age at diagnosing was non that large amongst want categories. The spread for age amongst all want categories was found to be similar due to the lopsidedness and standard divergence. The proportions of topics coming from each GOR by want category differed mostly. Figure: Percentage of patients by want categoryA clear monotonically increasing form was found in the per centum of people by want category, where there was a lower per centum of patients from the flush category and a higher per centum of patients from the disadvantaged category as shown in Figure 1. Figure: Percentage of patients having no intervention A tendency was seen in intervention. Figure 2 shows that the most disadvantaged group were less likely to have any signifier of intervention. The tendency in the per centum of patients having any intervention including surgery was found to back up the consequences from Figure 2, where the per centum of patients from flush to the most disadvantaged were 34.63 % , 34.30 % , 33.74 % , 33.02 % and 32.79 % severally. Table: Distribution of patients by Sexual activity Males Females Entire Variables Nitrogen % Nitrogen % Nitrogen % 45,580 64.77 24,790 35.23 70370 100 Age group ( old ages ) 15-44 1,020 2.24 706 2.85 1,726 2.45 45-54 2,760 6.06 1,072 4.32 3,832 5.45 55-64 7,277 15.97 2,663 10.74 9,940 14.13 65-74 14,990 32.89 6,087 24.55 21,077 29.95 75-84 14,992 32.89 9,031 36.43 24,023 34.14 85-100 4,541 9.96 5,231 21.10 9,772 13.89 Want 1-least deprived 7,033 15.43 3,497 14.11 10,530 14.96 2 8,169 17.92 4,226 17.05 12,395 17.61 3 9,241 20.27 5,160 20.81 14,401 20.46 4 10,399 22.81 5,723 23.09 16,122 22.91 5-most deprived 10,738 23.56 6,184 24.95 16,922 24.05 Treatment Surgery merely 7,718 16.93 4,347 17.54 12,065 17.15 Chemo merely 6,266 13.75 2,114 8.53 8,380 11.91 Radio merely 233 0.51 112 0.45 345 0.49 Surgery, wireless 135 0.30 77 0.31 212 0.30 Surgery, chemo 1,688 3.70 731 2.95 2,419 3.44 Chemo, wireless 114 0.25 37 0.15 151 0.21 Surgery, chemo, wireless 45 0.10 13 0.05 58 0.08 No intervention 29,381 64.46 17,359 70.02 46,740 66.42 Site C160 13,932 30.57 4,520 18.23 18,452 26.22 C161 643 1.41 290 1.17 933 1.33 C162 1,133 2.49 600 2.42 1,733 2.46 C163 2,276 4.99 1,746 7.04 4,022 5.72 C164 1,059 2.32 812 3.28 1,871 2.66 C165 3,268 7.17 1,688 6.81 4,956 7.04 C166 1,227 2.69 686 2.77 1,913 2.72 C168 460 1.01 250 1.01 710 1.01 C169 21,582 47.35 14,198 57.27 35,780 50.85 Government Office Region ( GOR ) A 3,223 7.07 1,934 7.80 5,157 7.33 Bacillus 7,367 16.16 4,248 17.14 11,615 16.51 Calciferol 5,466 11.99 3,244 13.09 8,710 12.38 Tocopherol 4,182 9.18 2,096 8.46 6,278 8.92 F 5,669 12.44 2,792 11.26 8,461 12.02 Gram 4,746 10.41 2,281 9.20 7,027 9.99 Hydrogen 4,745 10.41 2,763 11.15 7,508 10.67 Joule 5,802 12.73 3,076 12.41 8,878 12.62 K 4,380 9.61 2,356 9.50 6,736 9.57 Cancer Registry North A ; York 7,455 16.36 4,431 17.87 11,886 16.89 Trent 5,277 11.58 2,799 11.29 8,076 11.48 East Anglia 3,148 6.91 1,474 5.95 4,622 6.57 Thames 9,368 20.55 5,202 20.98 14,570 20.70 Oxford 1,815 3.98 1,002 4.04 2,817 4.00 South A ; West 5,876 12.89 3,063 12.36 8,939 12.70 West Midlands 5,975 12.43 2,790 11.25 8,456 12.02 North West A ; Mersey 6,975 15.30 4,029 4.029 11,004 15.64 From Table 2, it can be clearly seen that the proportion of males and females were similar in the two youngest age group classs, nevertheless the proportion of males was more in the in-between two classs and the proportion of females was more in the oldest two classs. The distribution of the proportion of males and females was similar for all want, intervention, GOR and malignant neoplastic disease register classs. The proportion of males was about twice every bit many as females for site C160 and the proportion of females was more compared to males for site C169, nevertheless the proportion of males and females were similar for all other sites. A important factor in finding endurance is intervention, hence a trial was carried out to see if there was any difference between want classs in the proportion having any intervention compared to those non having intervention, and in the proportion having intervention affecting surgery compared to those undergoing no surgical intervention. Two logistic arrested development theoretical accounts were hence carried out, one for the proportion having any intervention and the other for the proportion having surgical intervention by want class, seting for age and twelvemonth of diagnosing, individually for males and females. After seting for confounder, the odds of acquiring any intervention for females in the most disadvantaged class were 0.88 times less than in the flush class ( p-value 0.009 ) . There was no difference in the odds of intervention in males between want classs. After seting for confounders, the odds having surgical intervention in males from the more disadvantaged classs was 1.18 times more than in the flush class ( p-value lt ; 0.001 ) and no difference in the odds of having surgical intervention in females between want classs. The average age at diagnosing was 72.92 old ages. The mean overall follow-up clip of 1.57 old ages as shown in table 3. The per centum of patients who died by the terminal of the follow-up period was found to be 91.64 % of patients. Table 3 shows the average follow-up clip ( the norm clip until stomach malignant neoplastic disease patients are dead or censored ) and the per centum of those who died stratified by age group, want category and intervention. A really little difference was found in both overall mean follow-up clip and the proportion dead by the terminal of followup between males and females. The average follow-up clip was longer and the proportion of patients deceasing by the terminal of the followup was lower in younger topics. The average follow-up clip was longer and the proportion of patients deceasing was lower in the patients belonging to the most flush class, with both results demoing an diminishing tendency by diminishing want category. The average follow-up clip of patients having surgery, with either or both radiation therapy and chemotherapy, was longer than those patients who did non have surgery and the proportion death by the terminal of followup was smaller. This was chiefly due to the fact that chemotherapy and radiation therapy interventions were carried out on patients at the ulterior phases of the malignant neoplastic disease, whereas surgery was carried out earlier phase, nevertheless this may propose that patients who underwent surgery had a better endurance. Variable Average followup ( old ages ) % dead by the terminal of followup Male Female Overall Male Female Overall 1.58 1.56 1.57 91.74 91.45 91.64 Age group ( old ages ) 15-44 2.63 2.95 2.76 80.39 74.50 77.98 45-54 2.47 2.55 2.49 83.62 80.78 82.83 55-64 2.25 2.51 2.32 85.83 82.58 84.96 65-74 1.76 1.99 1.83 90.43 97.93 89.70 75-84 1.13 1.29 1.19 95.96 94.59 95.44 85-100 0.62 0.64 0.63 99.10 99.14 99.12 Want 1-least deprived 1.76 1.80 1.77 89.95 89.33 89.74 2 1.65 1.58 1.63 91.46 90.91 91.27 3 1.56 1.52 1.54 92.14 91.98 92.08 4 1.48 1.50 1.49 92.36 91.94 92.22 5-most deprived 1.53 1.48 1.51 92.18 92.12 92.16 Treatment Surgery merely 3.41 3.70 3.52 77.52 74.76 76.53 Chemo merely 1.58 1.48 1.55 94.14 94.80 94.31 Radio merely 1.70 1.40 1.60 90.56 91.07 90.72 Surgery, wireless 3.82 4.67 4.13 76.30 61.04 70.75 Surgery, chemo 3.26 3.25 3.26 81.46 80.85 81.27 Chemo, wireless 1.84 2.02 1.89 92.11 89.19 91.39 Surgery, chemo, wireless 3.13 3.27 3.16 86.67 84.62 86.21 No intervention 0.99 0.94 0.97 95.64 95.82 95.71 Table 3: Average follow-up clip and % of patients who were recorded as holding died by the terminal of the follow-up period by sex 3.2 Consequences from the more complex analysis The simple flexible parametric theoretical account was fitted with want, age splines and twelvemonth splines variables. The grades of freedom for the baseline jeopardy were chosen utilizing the AIC and BIC consequences from Table 4. Table 4: Degrees of freedom for Baseline jeopardy and their AIC/BIC Baseline Hazard DF Model DF AIC BIC Male 1 16 92327.50 92467.13 2 17 87329.59 87477.95 3 18 86419.88 86576.97 4 19 86097.21 86263.03 5 20 85890.83 86065.38 Female 1 16 44135.45 44265.34 2 17 41201.07 41339.08 3 18 40783.54 40929.67 4 19 40686.45 40840.69 5 20 40568.31 40730.67 From Table 4, it can clearly be seen that the theoretical accounts fitted with 5 grades of freedom for the baseline jeopardy give the smallest AIC and BIC for both males and females and hence provide a better tantrum for the theoretical account. Although it seems best to utilize 5 DF for the baseline jeopardy, 3 DF will be used as the theoretical accounts with 5 DF are computationally intensive when clip changing effects are included. Table 5: Net endurance by want class at 1, 5 and 10 old ages unadjusted for intervention for males and females individually Net endurance Males Females 1-year endurance Most flush 0.36 0.38 2 0.34 0.35 3 0.33 0.34 4 0.32 0.33 Most disadvantaged 0.32 0.33 5-year endurance Most flush 0.16 0.19 2 0.14 0.16 3 0.13 0.16 4 0.12 0.15 Most disadvantaged 0.12 0.15 10-year endurance Most flush 0.12 0.15 2 0.10 0.12 3 0.10 0.12 4 0.09 0.11 Most disadvantaged 0.09 0.11 Consequences from the estimation of cyberspace endurance up to 1, 5, and 10 old ages after diagnosing, unadjusted for intervention, are shown in Figures 3-8 for males and females individually, and showed that there was a suggestion of a additive tendency across the want groups. Between the five want groups, 1-year predicted net endurance ranged from 0.32 to 0.36 for males and 0.33 to 0.38 for females. The 5-year predicted net endurance ranged from 0.12 to 0.16 for males and 0.15 to 0.19 in females. The 10- twelvemonth predicted net endurance ranged from 0.09 and 0.12 for males and 0.11 to 0.15 for females ( Table 5 ) . In general, the predicted cyberspace endurance scope had a somewhat higher lower limit and upper limit for females than males bespeaking that the predicted cyberspace endurance was overall better/higher in females than males. The estimated difference in endurance was 0.04 in males and 0.05 in females between the most flush and the most disadvantaged groups at one twelvemonth after diagnosing. At five old ages after diagnosing the estimated difference in endurance between the two groups was the same for males but decreased to 0.04 for females. A clear additive tendency was seen between one and five old ages after diagnosing. The tendency between the least disadvantaged and most disadvantaged classs remained up to ten old ages after diagnosing, although at ten old ages the endurance of the two most disadvantaged classs was the same. Table 6: Excess jeopardy ratio ( EHR ) of decease, adjusted for age and twelvemonth of diagnosing for males and females individually without seting for intervention and clip varying effects for patients diagnosed with tummy malignant neoplastic disease during 1997-2006 in England Males Females EHR P-value 95 % CI EHR P-value 95 % CI Want 1-Least deprived Baseline – – Baseline – – 2 1.046 0.014 ( 1.009, 1.084 ) 1.072 0.006 ( 1.020, 1.128 ) 3 1.076 lt ; 0.001 ( 1.039, 1.114 ) 1.082 0.001 ( 1.031, 1.136 ) 4 1.117 lt ; 0.001 ( 1.079, 1.155 ) 1.118 lt ; 0.001 ( 1.066, 1.172 ) 5-most deprived 1.142 lt ; 0.001 ( 1.103, 1.181 ) 1.143 lt ; 0.001 ( 1.091, 1.197 ) Splines 1 3.389 lt ; 0.001 ( 3.349, 3.428 ) 3.383 lt ; 0.001 ( 3.331, 3.436 ) 2 1.242 lt ; 0.001 ( 1.230, 1.254 ) 1.262 lt ; 0.001 ( 1.246, 1.278 ) 3 1.107 lt ; 0.001 ( 1.101, 1.113 ) 1.098 lt ; 0.001 ( 1.090, 1.106 ) Table 6 shows a comparing of the consequences of the flexible theoretical accounts for males and females individually. Comparing the consequences of males and females, the extra jeopardy ratio ( EHR ) of decease by want class was higher in general for females, although both analyses gave a additive tendency in EHR by want. For both males and females, the EHR of decease by want was statistically important indicating that the EHR differed for each want class compared to the most flush class. Therefore more disadvantaged groups had a higher extra mortality due to malignant neoplastic disease compared to the less disadvantaged groups. Age and twelvemonth of diagnosing were modelled as a non-linear effects, and were important in for the first three age splines for both males and females and were important for twelvemonth spline 1 and 4 in males and twelvemonth splines 1 A ; 2 in females. Figure: Internet endurance up to 1 twelvemonth after diagnosing, by want class at diagnosing for males diagnosed with tummy malignant neoplastic disease during 1997-2006 in England. Figure: Internet endurance up to 1 twelvemonth after diagnosing, by want class at diagnosing for females diagnosed with tummy malignant neoplastic disease during 1997-2006 in England. Figure: Internet endurance up to 5 old ages after diagnosing, by want class at diagnosing for males diagnosed with tummy malignant neoplastic disease during 1997-2006 in England. Figure: Internet endurance up to 5 old ages after diagnosing, by want class at diagnosing for females diagnosed with tummy malignant neoplastic disease during 1997-2006 in England. Figure: Internet endurance up to 10 old ages after diagnosing, by want class at diagnosing for males diagnosed with tummy malignant neoplastic disease during 1997-2006 in England. Figure: Relative endurance up to 10 old ages after diagnosing, by want class at diagnosing for females diagnosed with tummy malignant neoplastic disease during 1997-2006 in England. Table 7: Degrees of freedom for Time Varying Component ( TVC ) and their AIC/BIC with baseline jeopardy of 3 DF. TVC DF Model DF AIC BIC Male 1 23 86047.89 86248.62 2 28 86035.85 86280.22 4 38 85727.08 86058.72 5 43 85660.87 86036.14 Female 1 23 40628.06 40814.77 2 28 40590.59 40817.9 4 38 40504.96 40813.45 5 43 40515.35 40864.43 The flexible parametric theoretical account was fitted with want, age splines and twelvemonth splines variables and age splines as the clip changing consequence. The grades of freedom for the baseline jeopardy were chosen utilizing the AIC and BIC consequences from Table 4. From Table 7, it can clearly be seen that the theoretical account fitted for males with 5 DF for the clip variable consequence gives the smallest AIC and BIC, nevertheless the theoretical account fitted for females with 4 DF has the smallest AIC and BIC. Therefore either 4 DF or 5 DF can be used run the analysis for the clip changing effects and intervention. Further analysis was carried out utilizing 4 DF. Table 8: Adjusted extra jeopardy ratio ( EHR ) of decease for males and females individually seting for intervention and clip changing effects of age and twelvemonth of diagnosing for patients diagnosed with tummy malignant neoplastic disease during 1997-2006 in England Males Females EHR P-value 95 % CI EHR P-value 95 % CI Want 1-Least deprived Baseline – – Baseline – – 2 1.080 lt ; 0.001 ( 1.042, 1.120 ) 1.056 0.036 ( 1.004, 1.110 ) 3 1.111 lt ; 0.001 ( 1.073, 1.150 ) 1.095 lt ; 0.001 ( 1.043, 1.149 ) 4 1.167 lt ; 0.001 ( 1.128, 1.208 ) 1.124 lt ; 0.001 ( 1.072,1.179 ) 5-most deprived 1.195 lt ; 0.001 ( 1.155, 1.236 ) 1.162 lt ; 0.001 ( 1.109, 1.217 ) Splines 1 3.639 lt ; 0.001 ( 3.593, 3.686 ) 3.783 lt ; 0.001 ( 3.709, 3.859 ) 2 1.219 lt ; 0.001 ( 1.206, 1.232 ) 1.243 lt ; 0.001 ( 1.223, 1.264 ) 3 1.100 lt ; 0.001 ( 1.093, 1.108 ) 1.112 lt ; 0.001 ( 1.102, 1.122 ) Treatment No Surgery Baseline – – Baseline – – Surgery 0.327 lt ; 0.001 ( 0.317, 0.337 ) 0.311 lt ; 0.001 ( 0.298, 0.325 ) No Chemo Baseline – – Baseline – – Chemo 0.732 lt ; 0.001 ( 0.711, 0.754 ) 0.826 lt ; 0.001 ( 0.788, 0.865 ) No Radio Baseline – – Baseline – – Radio 0.755 lt ; 0.001 ( 0.679, 0.839 ) 0.764 0.001 ( 0.653, 0.894 ) Age splines Age spline1 1.304 lt ; 0.001 ( 1.285, 1.323 ) 1.295 lt ; 0.001 ( 1.269, 1.322 ) Age spline 2 0.945 lt ; 0.001 ( 0.931, 0.959 ) 0.938 lt ; 0.001 ( 0.922, 0.956 ) Age spline 3 1.014 0.063 ( 0.999, 1.028 ) 1.019 0.048 ( 1.000, 1.039 ) Age spline 4 0.993 0.286 ( 0.980, 1.006 ) 0.980 0.028 ( 0.963, 0.998 ) Age spline 5 0.987 0.044 ( 0.975, 1.000 ) 0.999 0.896 ( 0.985, 1.014 ) Year of diagnosing splines Year spline1 0.923 lt ; 0.001 ( 0.912, 0.935 ) 0.929 lt ; 0.001 ( 0.914, 0.944 ) Year spline 2 1.016 0.012 ( 1.003, 1.028 ) 1.005 0.567 ( 0.989, 1.021 ) Year spline 3 0.988 0.041 ( 0.976, 0.999 ) 0.996 0.622 ( 0.980, 1.012 ) Year spline 4 1.025 lt ; 0.001 ( 1.013, 1.038 ) 1.012 0.140 ( 0.996, 1.029 ) Year spline 5 1.003 0.630 ( 0.991, 1.015 ) 1.005 0.592 ( 0.988, 1.021 ) Table 8 shows a comparing of the consequences of the clip changing effects theoretical account seting for want, age at diagnosing, twelvemonth of diagnosing and intervention for males and females individually. Comparing the consequences from the male analysis with the female, the extra jeopardy ratio ( EHR ) for decease by want was lower in females in general, although both analyses gave a additive tendency in EHR by want. Comparing the EHR for both analyses to consequences from Table 6, it is clear that the EHR is lower when intervention and clip changing effects such as age and twelvemonth of diagnosing are taken into history. There was besides lessening in EHR for any intervention compared to no intervention ; nevertheless there was a big lessening in EHR of surgery compared to no surgery for both males and females. In both analyses, intervention with surgery was associated with increased net endurance compared to non-surgical intervention or no intervention. Age and twelvemonth of diagnosing were modelled as a time-dependent non-linear consequence, and were important for peculiar splines in both theoretical accounts. The additive tendency in want category remained and became more important, since the EHR in want classs for both males and females differed in comparing to the most flush group at the 5 % significance degree, as in the instance of the simpler analyses. Therefore more disadvantaged groups had a higher extra mortality due to malignant neoplastic disease compared to the less disadvantaged groups. The deficiency of an interaction term between want classs and splines in the concluding theoretical account suggests that the difference in comparative endurance between want groups did non alteration over the clip period of the survey. Figure: Internet endurance up to 1 twelvemonth after diagnosing, by want class at diagnosing for males seting for intervention and clip changing effects and diagnosed during 1997-2006 in England. Figure: Internet endurance up to 1 twelvemonth after diagnosing, by want class at diagnosing for females seting for intervention and clip changing effects and diagnosed during 1997-2006 in England. Figure: Internet endurance up to 5 old ages after diagnosing, by want class at diagnosing for males seting for intervention and clip changing effects and diagnosed during 1997-2006 in England. Figure: Internet endurance up to 5 old ages after diagnosing, by want class at diagnosing for females seting for intervention and clip changing effects and diagnosed during 1997-2006 in England. Figure: Internet endurance up to 10 old ages after diagnosing, by want class at diagnosing for males seting for intervention and clip changing effects and diagnosed during 1997-2006 in England. Figure: Internet endurance up to 10 old ages after diagnosing, by want class at diagnosing for females seting for intervention and clip changing effects and diagnosed during 1997-2006 in England. Figure: Internet endurance up to 10 old ages after diagnosing, by want class at diagnosing for males who had intervention affecting surgery, seting for clip changing effects and diagnosed during 1997-2006 in England. Figure: Internet endurance up to 10 old ages after diagnosing, by want class at diagnosing for males who had intervention affecting surgery, seting for clip changing effects and diagnosed during 1997-2006 in England. Table 9: Net endurance by want class at 1, 5 and 10 old ages adjusted for intervention and surgery for males and females individually. Males Females Net endurance Net endurance from tummy surgery Net endurance Net endurance from tummy surgery 1-year endurance Most flush 0.37 0.65 0.36 0.67 2 0.34 0.63 0.34 0.65 3 0.33 0.62 0.33 0.64 4 0.32 0.61 0.32 0.63 Most disadvantaged 0.31 0.60 0.32 0.63 5-year endurance Most flush 0.16 0.42 0.17 0.46 2 0.14 0.39 0.16 0.44 3 0.14 0.38 0.15 0.42 4 0.13 0.37 0.14 0.42 Most disadvantaged 0.13 0.36 0.14 0.41 10-year endurance Most flush 0.12 0.36 0.13 0.40 2 0.11 0.32 0.12 0.37 3 0.10 0.32 0.11 0.36 4 0.10 0.30 0.11 0.35 Most disadvantaged 0.10 0.30 0.11 0.35 Consequences from the estimation of cyberspace endurance up to 1, 5 and 10 old ages after diagnosing, adjusted for intervention and clip changing affects, are shown in Figures 9-14 for males and females individually, and showed that there was a sug How to cite Diagnosis On Stomach Cancer Survival Health And Social Care Essay, Essay examples