American lifestyle Essay Example for Free

American lifestyle Essay In your opinion what are the two most significant characteristics of modernist literature? Use any TWO texts from the course to substantiate and illustrate your argument. In my opinion, the two most significant characteristics of modernist literature are the pessimistic view of modern society or modern doubt, expressed through alienation and fragmentation, and the technique of stream of consciousness. In this essay I will discuss these characteristics and several important texts to illustrate my argument. Gertrude Steins work is a perfect example of fragmentation, or rather in her case, literary cubism. In art, cubism means showing multiple perspectives, taking a form and breaking it down to rebuild it on canvas (analytical cubism) or taking materials to create a sort of collage (synthetic cubism). In modernist literature the same process occurs: people, feelings, locations are fragmented, only bits and pieces are described instead of the whole picture. As Picasso said: I paint objects as I think them, not as I see them. Stein was inspired by modernist artists such as Picasso, and wrote a series of literary portraits, including one on Picasso. She defended the representational nature of Cubism and believed that through the distortion, repetition and altering of a subject one could get a resemblance of human perception. The love song of J. Alfred Prufrock is a good example of both alienation and fragmentation. Both Prufrock and his world are fragmented. He cannot really connect with the women he sees, the conversations he hears, the city he walks through, or the mermaids he hears. The descriptions of the women he meets are not realistic, but fragmented, the poem never visualizes the woman with whom Prufrock imagines an encounter except in fragments: Arms that are braceleted and white and bare Arms that lie along a table, or wrap about a shawl. But not only the women and his environment are described in fragments, Prufrock himself is growing old, fading in a fragmented way: I shall wear the bottoms of my trousers rolled. / Shall I part my hair behind? Do I dare to eat a peach? Even his voice is a fragmentation of voices past and present ( Dante, Shakespeare) that somehow harmonize. The fragmentation in the poem the worries, the interruptions, the repetitions all sum up his relation to the world. The images are used to convey meaning, coherence can be established from the ruins of fragments. Prufrocks thoughts may perhaps move from one to another, but they do so in a way that mimics our thought process. He moves from one doubt to another, and his seemingly random observations are rooted in his past and his insecurities, just like ours are. This poems fragmentation to some extent serves to display Prufrocks indecisive, second-guessing, and pessimistic nature, but it more importantly reflects the fears and uncertainties we all posses. Moreover, Prufrocks question Do I dare//Disturb the universe? mirrors his insecurity and anxiety about his social standing. From the fragmented images provided by Eliot we come away with a coherent analysis of Prufrocks character. He is the typical modern man, and his fragmented and often unsure voice is proof of it. The other issue raised by this poem is the modernist feeling of alienation. Prufrock alienates his emotions from those around him. He is scared to show the real him for fear of being rejected or alone. He cannot connect with people on an emotional level. There will be time, there will be time to prepare a face to meet the faces that you meet. In this particular quote Prufrock tells us how he is not himself, but someone people want him to be. Prufrock experiences feelings of exclusion and alienation from the modern world and industrialised society, which becomes clear in his low self-esteem and his inability to form relationships, and makes him worry about what people think of him. He even claims he should have been a pair of ragged claws Scuttling across the floors of silent seas and feels pinned and wriggling on the wall when people scrutinise him. With the lack of self-confidence, his alienation grows stronger. The quote: Do I dare? is repeated often throughout the poem. He asks himself time after time whether he should be himself or the person other expect him to be. Because of his alienation Prufrock feels unable to act on his desires, since he feels that people will automatically reject him. This can be seen as a reflection of the fast-paced modern American lifestyle, with people feeling trapped and unable to connect with other people and to society. Another example of the alienation evident in modernist literature is Heart of Darkness. Modernist writers often present the world as desolate, and Conrads Heart of Darkness is no exception. As Marlow describes: My isolation amongst all these men with whom I had no point of contact, the oily and languid sea, the uniform sombreness of the coast, seemed to keep me away from the truth of things, within the toil of a mournful and senseless delusion (p.30)

An Ethnographic Study on Children’s Culture :: Sociology, Childhood, Culture

Children spend most of their time in institutions such as schools, learning, in order to provide themselves with the education they need to make their dreams come true. Children view these institutions as a space for sociability where they can form bonds with others, outside their families, as they create and spread their own distinctive culture (McDonnell 26). As a reading buddy at Brooksview Middle School, the knowledge I acquired while there was fascinating as it allowed me to reflect upon my own experiences and relate it to what we were learning in the course. Observing firsthand and note taking allows a researcher to examine the practices of children’s culture more efficiently and this is what I spent most of my Monday afternoon’s doing. Although these institutions are there to help children succeed, they also deny them access to their own culture which may prohibit them from becoming â€Å"fully human† (Friere 28). Viewing childhood as a culture allows one to understand why children view culture so differently from adults (McDonnell 22). At institutions such as Brooksview, children are denied access on a number of things and are assumed to be incapable of making their own rational decisions. Due to the institution’s location, the teachers and principle are extremely strict with the children on how they should act, giving them standards which may deny children from accessing their own culture. This influences these children to act in certain ways, ways in which they believe the society wants them to act. This is shown one day when I attended an assembly regarding the failing rate of the grade sixes. Throughout the assembly, the principle was educating the children on how they should behave in school which led him to his point that the cause of the failing rate (60%) was because of the â€Å"coloured† kids (Appendix, Day 6). This is similar to the experiment that is being tested on Octavian in the novel Octavian Nothing Traitor to the Nation. Due to Brooksview’s location and Octavian’s skin colour, people will presume that black people will fail, especially in practices such as education. â€Å"†¦ African is, by nature, (a) shiftless and (b) rebellious, requiring constant supervision to remain productive†¦ You have done us a wonderful service, through your failure.† (Anderson 337). This possibly will affect a child’s approach within their society as it may alter their perspective on how they should act rather than how they want to act; changing for the sake of others.

Caste System in India and Social Status Essay

What night is donned upon my nation, lord? â€Å"Atleast she has an employment guarantee.† â€Å"Even if the employment is manual scavenging† â€Å"Someone will do it, why not she† â€Å"She is a little child. She also has a right to education and decent livelihood.† Ah! I then realized what void argument have I given. Who will provide them education and what will it fetch them? â€Å"She is anyway having two meals.† And yes so true is that. Food is much more important than dignity. Even if they are maltreated it is their destiny. The concept of destiny has always remained a puzzle to me. And this destiny is based on the social status of their parents. Yesterday there was a shraaddh ceremony in my village. It is organised to worship, to acknowledge our ancestors. Therefore I made a rare visit to my village. While serving the food I saw two little girls, wearing tattered clothes and with unkempt hairs. On enquiring I came to know that they belonged to scheduled caste. One of my cousins told me that they are engaged in cleaning others’ excreta manually. I could not believe it. They were barely 5-6 years old. I was astonished at the fact that how agreeingly they had given in to the social discrimination. I gave them a sympathetic look but they didn’t react. They didn’t care about by compassion, they just wanted food. My sympathy would not satisfy their hunger and hunger is the m ost prominent feeling they have. They don’t need dignity or education which will not bring them food. They don’t care if they have to clean gutters or do manual scavenging. They are not aware of their rights under Article 15, Article 17, Article 21A or Article 24 and they don’t give a damn to it. I wonder if the twinkling of stars ever reach their eyes. The time running on our wrists seems frozen in their eyes. How hopeless seem their eyes! They don’t question anyone. But once you see them it is impossible to escape (Tears fill my eyes). I wish the oppressor would also look at them once. We have made their life so blunt. Its a crime, I tell you people, it is a crime to kill even the hope of hopes. And then they talk about religion. What religion? Whose caste and cultures? Is God only of the rich and powerful? Do the oppressed have no God? A sin it is. I speculated if they were also acknowledging their ancestors these days. What will they thank them for? Poverty and gloom is their inheritance and ignominy their heritage. Even after spending their entire life doing these odd jobs they gain nothing and remain trapped in this vicious circle. Nothing changes and generations after generations exhaust their life in it. Will someone come to their rescue? When I went to serve them meal I was precautioned many times by my kins to be very careful about keeping the utensils substantially far to keep them (obviously utensils) â€Å"clean†. Even after continually encountering social seclusion they remained undeterred. â€Å"You should be grateful and proud that you are born in human race, in a hindu family and that too in a BRAHMIN family.† According to my family being born in a BRAHMIN family was the biggest achievement of my life. But after seeing what I had lately seen these declarations seem so hollow. I feel pity, I feel guilty for being a brahmin. Where is humanity, God? â€Å"What night is donned upon my country, lord?† Night which gets darker with the sunrise (as its the time to make the world cleaner and their life dirtier). Now the question arises is that how will it change? And more importantly who will bring the change? The more I try to find the answers the more disheartened I am. Who will provide an answer? Politicians- Though the law considers all the people equal but law-keepers don’t. If the casteism and thus untouchability ends, how will their shops run? How will they gain votes by dividing the society? They would not let this stigma end. Education- Even if they go to schools they will be discriminated and secluded. That learning has no meaning which leaves them despondent and unemployed. There is no use of education unless it is free and practical. Bureaucrats- Most of the officials are ignorant and indifferent towards these people though many people from their community are obtaining significant positions. They do little or nothing to improve the condition of these people. Government policies- It is well-known that policies are never rightly implemented in India. Reservation is a fine example. The prosperous are the beneficiaries whereas the poor remain poor and needy remain needy. Common people- It is the foremost responsibility of privileged castes to be humane. I often think if really there is some God we would be punished, our life can’t be so perfect (though it really is not). I would like to summarise my message as FEAR NONE BUT GOD. However I often doubt the presence of God. I really can’t follow a religion which renders people hopeless and suppress their rights. My conscience is my God. And for the unprivileged sections, â€Å"God helps those who help themselves.† So be courageous, be aware and send your children to schools rather than to clean gutters as it is not only about them but even the fore coming generations. Education is much more important than a little more money. I won’t end it on a sad note. The morning of this dark night will definitely come. I urge the people in power to visit these people and see how they have given up the hope to rise, how the dogmas of caste has ran down to their veins. And I request the advantaged sections to restudy the vedas and let these people choose. Make humanity your religion. And do remember that you are not following the Brahmin rules, so don’t push them back. I challenge you to beg for living before pressurising the oppressed to do this inhuman work. Rise! O rise! Before you fall. Let the positivity penetrate into their skin and get to their blood. Let them live before they die. Provide them opportunities to learn the magic of words. Give them a fair chance to realise their potential and talents and choose their work so that Ambedkar becomes their soul and they his shadow. â€Å"†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦This division of labour is not spontaneous; it is not based on natural aptitudes. Social and individual efficiency requires us to develop the capacity of an individual to the point of competency to choose and to make his own career. This principle is violated in the Caste System, in so far as it involves an attempt to appoint tasks to individuals in advance—selected not on the basis of trained original capacities, but on that of the social status of the parents†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..† – B.R. Ambedkar

Case Study(Whole Foods) - 1481 Words

1.) The Whole Foods strategy seeks to provide products of the best quality to its customers by maintaining high standards that the farmers, organic growers must match. The strategy also involves providing best tasting food and foods that are fresh, wholesome and safe to eat. It also involves promoting organically grown foods to exercise their influence on the people and the industry. Customers are the most important stakeholders responsible for the growth of Whole Foods Market, thus satisfying their needs and meeting their every possible demand is key behind the success of this company. Inviting store environments and retail innovation also enhances this. Their strategy involves working efficiently with its vendors, team members and†¦show more content†¦Return on Shareholder’s Equity= (Profits after taxes/Total Equity) 2004 2005 2006 2007 (3,864,950-2,523,816/3,864,950) (4,701,289-3,052,184/4,701,289) (5,607,376-3,647,734/5,607,376) (6,591,773-4,295,170/6,591,773) = .34699 or .35% = .35 % =. 35 % = .35% 2.NP= .033 % = .050% = .036% = .027% 3. N/A N/A (49+8,606/2,042,996) = .004 (24,781+736,087/3,213,128) = .023 4. N/A N/A (203,828/2,042,996) = .099% (182,740/3,213,128) = .056% After analyzing some of the important financial ratios of the company it seems that the Gross Profit is consistent throughout the years 2003-2007 remaining at 35%, however the net profit margin displays another story it has decreased significantly from 2005-2006(.050-.036 %) and from 2006-2007(.036-.027%). The net profit dropped 2.3 % in two years, which is not alarming but the management should look into the reasons behind the decline. The debt-to-equity ratio is used to evaluate borrowing capability and the amount of debt in the company. Usually ratios above 1.0 indicate excessive debt, in the case of Whole Foods Market the ratio has gone up from 2006-2007 (.004-.023), which indicated an increase in the amount of borrowings. The ratio is nowhere close to one, which indicates credit worthiness of Whole Foods Market and their ability to pay back debt. The return on shareholders equity hasShow MoreRelatedWhole Foods Case Study1568 Words   |  7 PagesNick Zawisa Strategic Management September 23, 2010 Case Study: Whole Foods Market Since 1980, Whole Foods Markets has grown from a small local store in Austin, Texas, to the largest retail chain of natural and organic foods in the United States. Whole Foods has been leading the natural and organic foods movement across the United States, working to gain acceptance among the growing number of consumers interested in eating healthier foods. The company has built a reputation for being selectiveRead MoreCase Study Whole Foods1155 Words   |  5 PagesCase Study assignment 1. What are the chief elements of the strategy that Whole Foods Market is pursuing? Fresh natural and organic foods and products with no preservatives or artificial ingredients. Promote healthier eating/lifestyle and increasing consumer knowledge/education of food safety, environment and how pesticides affect the land as well as the human body. 2. Is the strategy well matched to recent developments and conditions in the natural and organic foods segment of the food retailingRead MoreWhole Foods Case Study2408 Words   |  10 PagesCase Analysis Whole Foods Market in 2010: Vision, Core Values, and Strategy By: Katie Hollar Baker College Online Case Analysis Whole Foods Market in 2010: Vision, Core Values, and Strategy Overview Whole Foods Market was established in Austin, Texas in 1980 as a natural and health food supermarket, and it has since become the world’s largest supermarket chain in organic and natural foods. Whole Foods Market had 289 stores located in Canada, Great Britain, and predominantly in theRead MoreWhole foods case study Essay870 Words   |  4 PagesNovember 27, 2013 HRM 598 Case Study Introduction Whole Foods Market, Inc. is the largest chain of natural foods supermarkets operating in the United States. Whole Foods has six core values that drive its company and they include; selling the highest quality natural and organic products, satisfying and delighting customers, supporting their Team Members (Whole Food Employees) happiness and growth, creating wealth through profits and growth, caring about the communities and our environment, creatingRead MoreEssay on Case Study-Whole Foods1284 Words   |  6 Pages1. Whole Foods creates a narrow market niche by catering to the special needs and tastes of the consumer, thus, creating a differentiation-based advantage over competitors. By taking actions to acquire Wild Oats, Whole Foods has gained the competitive edge in the marketplace. 2. Recent developments and conditions in the natural and organic food industry can put a strain on the vision and strategy that John Mackey first set out to accomplish. However, part of a good business strategy is toRead MoreWhole Foods Inc Case Study1200 Words   |  5 PagesIntroduction Industry Overview The Whole Foods Inc was founded in 1980 by john Mackey, from a local supermarket store on safe grocery. Since then, it has grown into the world’s largest retail store all kinds of organic and natural foods. As of 2004, the annual sales were recorded as $8 billion. It has approximately 264 stores in the USA, 6 in Canada and 5 in the United Kingdom (Thomson, 2010). The headquarters are located on an 80,000 square feet flagship store in Austin, Texas. Over the yearsRead MoreCase Study : Whole Foods Market1370 Words   |  6 Pages Performance Mangement-4013 Assignment Title: Whole Foods Market Report by: Kiranpal Mann Student #: c0645417 Date: 1st March 2016 Table of contentsRead MoreWhole Foods Case Study Essay1324 Words   |  6 PagesWhole Foods Markets is a retailer of natural and organic foods. The company was founded by current CEO John Mackey who partnered with Craig Weller and Mark Skiles to merge their two natural food stores, Saferway and Clarkville Natural Grocery, resulting in the opening of the original Whole Foods Market on September 20, 1980. They had a 12,500 square foot store manned by 19 staff members. With a passion this industry, Mackey devised great visions, values, and strategies to take Whole Foods MarketsRead MoreWhole Foods Market Inc. Case Study Essay1200 Words   |  5 PagesAccording to the Whole Foods Market Inc. case, study shows that Whole Foods Market is an American supermarket chain exclusively featuring foods without artificial preservatives, colors, flavors, sweeteners, and hydrogenated fats. It is the United States first certified organic grocer, which mean s it ensures, to National Organic Program standards, organic integrity of the heterogeneous products from the time they reach stores until they are placed in a shopping cart. Whole Foods Market Inc. openedRead MoreWhole Foods Operations Management Case Study1794 Words   |  8 PagesWhole Foods Operations Management Case Study Assignment With the launch of the 365 brand, Whole Foods is hoping to target and bring in a younger, more hipster demographic of customers. Their hopes are that these younger, more price sensitive shoppers will grow with the brand, become accustomed to the organic, GMO-free selection, and will transition into customers of the regular, more expensive, Whole Foods stores as they grow in their careers and begin making more money. The most important challenge

Brave New World And The Island - 898 Words

Imagine a perfect world where everything is controlled; your job, your everyday life, even your thoughts. You would never have to think about anything ever again, but Aldous Huxley, the writer of Brave New World and Michael Bay, the director of The Island, both attempt to depict the dangers of this â€Å"utopia†. Although Brave New World and The Island both successfully communicate satire, Brave New World is better at eliciting people to think and change. In both Brave New World and The Island, one aspect that communicates satire is the lack of individual thought. For example, in both, everyone in the community has predetermined jobs. In Huxley’s novel, everyone is assigned a job based on their caste level; in Bay’s film, people automatically learn a job to advance society after being cloned. This shows the degree of a government’s control over the population. The societies represented here closely resemble totalitarianism, â€Å"[a] form of government that subordinates all aspects of its citizens lives to the authority of the state, with a single charismatic leader as the ultimate authority† (Merriam-Webster.com). Because nearly everything is designated to people or enforced strictly, people do not think for themselves. Although this creates a stable society, it also creates a mindless society. For example, on page 28, the Director of Hatchery and Conditioning comments on listening to hypnopaedic phrases, saying, â€Å"they’ll have that repeated forty or fifty times more before theyShow MoreRelatedThe Island and Brave New World1430 Words   |  6 PagesShort introduction to the movie: The movie â€Å"The Island† takes place in the year 2019, where rich people can buy a â€Å"life-insurance† in form of a clone. The clones live separately under the earth in an old military site, where they have no acces to the real world. They have been told that they are the only survivors of a catastrophy that contaminated the whole world. They live separately under the observation of Dr. Merrick, the unscrupulous chief of the organisation. The clones are used for theirRead MoreA Brave New World and Island by Aldous Huxley1037 Words   |  4 Pagesdid not show his emotions or even believe in mourning over the dead. The visible proof is that of his wife dying of breast cancer and then a year later he marries another woman with no problem. This comes full circle and relates to both Brave New World and Island, where death is not an issue since it is controlled in some way. In addition, Aldous also had a tendency to use psychedelic while writing his books, there was a feeling that he admired while on these drugs. No one really knows what he feltRead MoreThe Island Of Dr. Moreau, Wells And Aldous Huxley s Brave New World1492 Words   |  6 Pageslaws holds the danger to eliminate individuality and ultimately requires humans to assimilate to a new standard without error and within the bounds of scientific advancement. In H.G. Wells’ novel The Island of Dr. Moreau, Wells argues the influence technology has on human nature and the power it holds when conducted without law. Similarly, Aldous Huxley presents a dystopia in his novel Brave New World, which is intended to be conceived as paradise —under the grounds that each citizen is guaranteedRead MoreEthical And Logical Stand Point On Future Humanity1528 Words   |  7 PagesThroughout our course of the DHC Integrated Learning, the terminology used can help one determine whether or not the tw o worlds that Huxley and Wells have presented are an ethical and logical stand point on future humanity. In Brave New World, they are creating gametes in dishes and growing â€Å"perfect† humans that are genetically modified to serve society in a certain way, in a certain class system. Once children are born they go through a conditioning process that gives them psychological ideas inRead MoreEverything Is Good in Moderation769 Words   |  4 PagesIn Aldous Huxley’s 1931 novel, Brave New World, satire is achieved through symbolism and biblical references. Sarcasm also plays a major role in this novel’s satire. Brave New World contains examples of self-gratification and self-sacrifice that occur in the New World society. Huxley’s novel describes a society in which people have pills to wash their problems away, Henry Ford is their god, and humans are created in a lab rather than naturally. The savage part of the story is filled with self-flagellationRead MoreWilliam Shakespeare s Brave New World925 Words   |  4 PagesThroughout the novel, Brave New World, the author, Aldous Huxley strategically incorporates various Shakespearean allusions into his story. The most distinguished allusion throughout the entirety of the novel is to a quote from The Tempest, a play about a sorcerer and his daughter that live together on a remote island. The quote from The Tempest, in which Brave New World derives its name, â€Å"O, wonder!/How many goodly creatures are there here!/How beauteous mankind is! O brave new world,/That has such peopleRead More Essay on Bravery in The Tempest823 Words   |  4 Pagesand performs different capacities erratically.   A denotative definition from the 15th century, according to the Merriam-Webster Collegiate Dictionary (10 ed.), portrays brave as meaning, [from Old Italian and Spanish, meaning courageous, wild; probably from Latin, meaning barbarous].   The dictionary then defines brave as a.   having courage: dauntless b.   making fine show: colorful, c. excellent, splendid.  Ã‚  Ã‚   All of these distinct definitions find their capacity in The Tempest.   ProsperoRead MoreMain Characters In Brave New World1036 Words   |  5 PagesAldous Huxley wrote the book Brave New World, which was originally published in 1932. Throughout the story, many characters are introduced but some of the main characters are the Director of the Hatcheries and Conditioning (Known as Tomakin and D.H.C.), Lenina Crowne, Bernard Marx, Henry Foster, Mustapha Mond, and John the Savage. At the beginning of the book, D.H.C. is taking student on a tour of the Central London Hatchery and Conditioning Centre, while he e xplains the conditioning process andRead MoreThe Brave New World, By Aldous Huxley And 1984 By George Orwell1680 Words   |  7 Pagescompares the two dystopian societies of Brave New World by Aldous Huxley and 1984 by George Orwell. He suggests that â€Å"Orwell feared that what we hate will ruin us. Huxley feared that what we love will ruin us† (Postman). The Party of 1984 maintained control of the people by keeping them under constant surveillance, whereas the government of Brave New World kept the citizens so happy, they never felt threatened enough to put up a fight. 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E-Procurement in Global Supply Chain Management - 2798 Words

E-procurement in global supply chain management Introduction From 1990s, due to the economic globalization and the increased competitive pressures, lots of firms increase their focus on integrated supply chain management to gain a competitive advantage. Effective supply chain can facilitate a firm to be more competitive not only by reducing the purchasing costs but also improving the competitive dimensions of quality, dependability, flexibility, and innovation. Nowadays with globalization, global supply chain management is becoming a very important issue for most of businesses. The main reasons of this trend are procurement cost reduction, purchasing risks control, and revenues increasing. For instance, companies may set up overseas†¦show more content†¦That is to say, using e-commerce not only can increase services level to keep customers, but also make profits more than before. Nowadays, there are many companies using e-logistics and e-procurement for customers, because those will be an optimal way to extend and increase business processes in supply chain management and also those are real value methods to attract more customers than before. Therefore, e-commerce can create a lot of additional values in the company in order to maximize its chances of success. There are three main things in e-commerce: information, Internet and technology. Information Improving the use of information is the important thing in e-commerce because more-accurate, up-to-date information about customer demanded allows products to be delivered in the right way in order to decrease cost and increase efficiency (2001, Lee and Seungjin). So, a company should prioritize internal system first, because the company should complete internal for controlling its information and business. 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FALSE 3. Net market places are growing at a faster rate than private industrial networks. ANS. TRUE 4. E-distributors typically operate in vertical markets. ANS. FALSE 5. Exchanges tend to be biased toward the seller even though they are independently owned and presumably neutral. ANS. FALSE 6. 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In addition, the complexity of international logistics systems in many sectors has grown as a result of increasing product variations and d ifferentiation. Another factor is that many companies are concentrating on their core skills and are reducing their vertical integration. The efficient management of the resulting global flows of goods has boosted both the businessRead MorePorters Five Forces Value Chain1396 Words   |  6 PagesDay #2 Porter’s Strategic Models: The Five forces and the Value Chain CIS Department Professor Duane Truex III The Information Systems Strategy Triangle Business Strategy Organizational Design Strategy ICT/Information Strategy Professor Truex E-CommercePrinciples 1 HOW CAN INFORMATION RESOURCES BE USED STRATEGICALLY? 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Epidural Catheterization In Cardiac Surgery Health And Social Care Essay Free Essays

Introduction: Risk-benefit-ratio rating of extradural haematomas due to catheter arrangement in patients undergoing cardiac surgery is still controversial. The intent of this survey is to update to 2012 the per centum of catheter-related extradural haematoma hazard in cardiac surgery. Methods: Bracco and Hemmerling 2007 hazard appraisal was updated by seeking all reported instances of extradural arrangement for cardiac surgery, in web and in literature, from April 2007 to September 2012. We will write a custom essay sample on Epidural Catheterization In Cardiac Surgery Health And Social Care Essay or any similar topic only for you Order Now Hazards of other medical and non-medical activities were retrieved from recent reappraisals or national statistic studies. Consequences: Hazard of catheter-related extradural haematoma is 1/5,493, with a 95 % CI of 1/970 to 1/31,114. It is similar to the hazard in the general surgery population of 1/6,628 ( 95 % CI 1/1,170 to 1/37,552 ) . Decisions: Hazard of catheter-related extradural haematoma should be considered acceptable, since it is comparable to the hazard of deceasing in a auto accident, which is a jeopardy widely accepted. Its usage should be encouraged, because extradural improves recovery in patients undergoing cardiac surgery. Introduction In cardiac surgery, the extradural anesthesia/analgesia technique has been performed for many old ages [ 1 ] ; however, its usage is frequently limited by the fright of increased hazard of extradural haematoma associated with anticoagulation therapy. The risk-benefit ratio of medical processs needs to be known in order to do the best pick in routinely clinical pattern. In peculiar, it is of import to better look into the hazard benefit-ratio of extradural catheter in cardiac surgery, since it is a controversial and strongly debated pattern. In a recent reappraisal [ 2 ] , Royse showed the benefits and hazards related to high pectoral extradural anaesthesia, and he concludes that amp ; acirc ; ˆ?epidural usage in cardiac surgery is no more unsafe than in non cardiac surgery A ; acirc ; ˆA? . Previously, Bracco and Hemmerling estimated hazard of catheter-related extradural haematoma, seeking databases from 1966 to March 2007 [ 3 ] . The deliberate hazard was 1 extradural haematoma out of 12,000 extradural catheterisation reported in literature. The purpose of this survey is to update to 2012 the per centum of catheter-related extradural haematoma hazard in cardiac surgery. Method Medline, SciSearch Embase, Google and Google Scholar were searched to choose publications showing patients undergoing cardiac surgery who received extradural anesthesia/analgesia. The hunt standards were ( ( ( ( extradural anaesthesia ) OR extradural catheter ) OR locoregional anaesthesia ) OR extradural ) AND ( ( ( ( cardiac surgery ) OR coronary arteria beltway grafting ) OR aortal valve surgery ) OR mitral valve surgery ) . Databases were explored from April 2007 to September 2012. The compiled publication list includes: conference abstracts, randomized control tests, retrospective and prospective surveies, and meta-analysis. The figure of patients undergoing cardiac surgery who received extradural catheterisation was retrieved ; attending was paid to non number patients twice. After that, the entire figure of instances ( denominator ) was calculated summing instances from April 2007 to September 2012 with instances from 1966 to March 2007 ; the latters were already included in th e appraisal hazard done by Bracco and Hemmerling [ 3 ] . The numerator was calculated adding instances of extradural haematoma after extradural catheterisation in cardiac surgery, occurred from 1966 to 2012. The hazard of catheter-related extradural haematoma was compared with several different hazards, such as: the hazard of catheter-related extradural haematoma in non cardiac surgery, the hazard of chest or prostate malignant neoplastic disease, and the hazard of route traffic hurt. The per centums of hazard used for comparing were extrapolated from big tests, meta-analysis or national statistics studies. As already done by Bracco and Hemmerling, the Wilson method [ 4 ] was used to cipher 95 % reversible assurance interval ( CI ) of a individual proportion. The comparing between 2 proportions was done utilizing the same method [ 5 ] . Consequence In 2012, the hazard of catheter-related extradural haematoma in cardiac surgery is 3 instances out of 16,477 patients, or 1/5,493, with a 95 % CI of 1/970 to 1/31,114. From April 2007 to 2012, around 4,477 patients having merely extradural or extradural plus GA and undergoing cardiac surgery were found. This population besides includes some paediatric patients. Kind of surgery and figure of patients are shown in table 1. We summed our consequences with the one estimated by Bracco and Hemmerling ; hence, the denominator is 16,477 ( 12,000 + 4,477 ) . Merely two instances of catheter-related extradural haematoma are described in literature from April 2007 to 2012. The first one occurred in 2010 and is reported by the UK Medical Protection Society [ 6 ] . A 70-year-old adult female had to undergo alteration surgery after 6 old ages since she received a ternary coronary arteria beltway. The twenty-four hours of surgery extradural catheter was placed without incident, and so GA was induced. The twenty-four hours after surgery, in the forenoon, the patient showed initial neurological symptoms, noticed by a nurse. However, her spinal column was examined through a CT scan merely hours subsequently, after neurological scrutiny revealed an intense motor and centripetal bilaterally block at the T6 degree. A big haematoma in the extradural infinite was clearly seeable ; hence, an exigency laminectomy and emptying of haematoma were performed. This patient remained paraplegic. The 2nd instance of catheter-related extradural haematoma happened in 2011 [ 7 ] . On the twenty-four hours of surgery, after GA initiation an extradural catheter was placed. The patient was a 55-year-old adult male scheduled for mitral valve replacing and tricuspid annulate plasty, who had stopped warfarin 7 yearss earlier surgery. Preoperative blood test revealed a normal curdling profile and normal thrombocyte count. A flaccid paraplegia appeared 16 hours after the terminal of surgery ; at that clip his curdling profile was altered and he had besides thrombocytopenia. An exigency magnetic resonance imagination showed an extradural haematoma at the T5-T6 degree, hence a laminectomy, within 6 hours since symptoms onset, was instantly performed to take the haematoma. This patient had a good overall recovery, and presented merely a little dysuria 6 months after laminectomy. Bracco and Hemmerling identified merely one instance of catheter-related extradural haematoma occurred in 1995 and subsequently reported in 2004 [ 8 ] ; hence, this instance adds up to the 2 antecedently described, so the numerator for the hazard assessment up to 2012 is represented by 3 instances. Several instances of neurological complications happening in patients with an extradural catheter placed for cardiac surgery are described in literature. Arora et Al. reported a instance of pneumocephalus after extradural anaesthesia [ 9 ] . The patient was a 68-year-old hypertensive, diabetic and corpulent male admitted for a coronary arteria beltway surgery ( CABG ) . He had a moderate clogging pneumonic disease, so extradural anaesthesia was proposed, obtaining informed consent. After uneventful extradural catheter interpolation, the trial dosage was administered ( 2ml of 2 % Lidocaine ) . Immediately, the patient reported a terrible concern, and so generalized tonic clonic ictuss developed. The patient gained consciousness 10 proceedingss subsequently, after ictuss were controlled. The magnetic resonance imagination showed air in the basal cisterns and subarachnoid infinites. The patient got a full recovery and underwent surgery 2 yearss subsequently. Writers concluded that the c omplications were due to the puncture of the dura mater. The hazard of catheter-related extradural haematoma in cardiac surgery is comparable to the hazard of extradural haematoma after regional techniques for general surgery [ 10, 11 ] . Volk et Al. estimated an incidence of spinal haematoma of 1: 6,628 in general surgical population, in Germany, from 2008 to 2009. We calculated a comparative hazard decrease of 17 % prefering general surgery ( non important ) . The US mortality for bosom disease ( deaths per population ) [ 12 ] is 10 times higher the hazard of extradural haematoma after extradural anesthesia/analgesia for cardiac surgery. The hazard of catheter-related extradural haematoma in cardiac surgery is 100 times lower than both the incidence of acute nephritic failure after CABG [ 13 ] , and the incidence of sternal lesion infection after CABG [ 14 ] . The hazard of catheter-related extradural haematoma in cardiac surgery is besides a 1,000 times lower than the frequence of ordering mistakes in infirmaries ( errors/admissions ) [ 15 ] . Patients undergoing cardiac surgery with an extradural catheter in topographic point have a hazard to develop an extradural haematoma comparable to the hazard of developing chest malignant neoplastic disease ( women/year ) or prostatic malignant neoplastic disease ( men/year ) [ 16 ] , and to the hazard of deceasing by accident ( deaths/population ) [ 17 ] [ Fig.1 ] . Discussion Knowing the hazard per centum related to medical processs is really of import in clinical pattern ; it permits to correctly measure the risk-benefit ratio and to explicate patients all is needed, in order to obtain an informed consent before executing processs. Two recent meta-analysis have shown, one time once more, that the usage of epidural over general anaesthesia in patients undergoing cardiac surgery improves recovery by diminishing: the incidence of acute nephritic failure, the incidence of postoperative supraventricular arrhythmias, the clip on mechanical airing and respiratory complications [ 18, 19 ] . Therefore, extradural anaesthesia is an of import intercession in the multimodal scheme that anesthesiologists actuate in order to vouch the best quality attention. Furthermore, wake up cardiac surgery is a new minimally invasive anaesthesia technique, and it is a cherished option for bad patients with terrible COPD ; because avoiding cannulation and mechanical airing is necessary to cut down the hazard of decease [ 20-25 ] . This survey demonstrates that the hazard of catheter related extradural haematoma in cardiac surgery is non zero, but it is a hazard that we consider to be acceptable, since it is comparable to the hazard of deceasing in a auto accident [ 26 ] , which is an jeopardy normally accepted [ Fig. 1 ] . Restrictions of the current hazard analysis are related to our determination of non sing differences among the surveies we used as beginning. Different times of catheter arrangement, different perioperative heparinization protocols and different puncture degrees are non taken into history. The increased hazard, compared to the 2007 appraisal by Bracco and Hemmerling, we believe is due to a lessening in the figure of instances we used to find the denominator, and non to a existent addition in instances of catheter-related extradural haematoma. We used as denominator the figure of patients who received an extradural catheterisation to undergo cardiac surgery. It is our sentiment, that the instances reported in literature in recent old ages are merely a little proportion of the figure of extradural catheter arrangement really performed. Furthermore, the attending paid to epidural-related jobs has increased over clip, and accordingly, the demand to describe incorrect events increased. In literature, instances of self-generated extradural haematoma without an extradural catheter after cardiac surgery are besides described. For case, Hayashi et Al. [ 27 ] reported about a 71-year-old adult females, who underwent mitral valve plasty with CPB. The surgery lasted around 4 hours uneventfully, and she was non antecedently treated with anticoagulant therapy neither with extradural. One hr after surgery, paraplegia was apparent, an extradural haematoma compacting spinal cord at the C7-T4 degree was revealed through magnetic resonance imagination. A conservative attack was chosen because the paraplegia was non progressive. The writers stated that the extradural haematoma etiology was non apparent. The adult female had good overall result. In decision, measuring the risk-benefit ratio of utilizing pectoral extradural anaesthesia in cardiac surgery should be easier, thank to this update hazard appraisal. How to cite Epidural Catheterization In Cardiac Surgery Health And Social Care Essay, Essay examples