Comparing the Fate of Oedipus and Phaedra Essay - 2321 Words

Oedipus destruction was foretold to his father and mother, Laius and Jocasta, when he was born. It was told to him again when he was a young Corinthian prince, to which he ran from home (I heard all that and ran 876). Tiresias tells it to him again during the passage of the Oedipus Rex. The destiny of Oedipus has been laid down, unalterable from the moment he was created. He was fated to marry his mother and kill his father. Phaedra is not controlled by fate. She is possessed by a frivolous deity (the goddess anger has landed on your head p142), stung by her lack of praise and with a grudge against Phaedras stepson Hippolytus. Thus it is the goddess, Aphrodite, that causes Phaedra to fall in love with the young Athenian†¦show more content†¦It is Oedipus pride that he can escape the fate wound by the gods at all by running from it. He instead runs straight into it. If he had remained with his adopted parents then his disastrous corruption would not have been brought upon The bes and the House of Laius. It is his pride that drives his yearning for self-knowledge. He must see it all, must see the truth at last, despite the appeals by his wife for him to stop (if you love your own life, call off this search! My suffering is enough 1163). There was no requirement for him to reveal his own incestuous crimes but his pride led to him doing so. It is his own character that leads him to carry out his own fate. During the Oedipus Rex, no gods appear on stage, unlike the Hippolytus. This is because there is no divine motivator behind the scenes. Whilst we feel their presence and they are frequently referred to (Apollo - he ordained my agonies 1468), this is a tale of men and their own actions. Phaedra on the other hand is a very different character. When we first see her, she is in a swoon, carried on a stretcher by servants. Though we begin to think of her as a weak, womanly character (I have lost control of my limbs p135), it soon becomes clear that she is possessed. Not only did we see the calculating Aphrodite a couple of scenes earlier plotting this supernatural affliction (my scheming caused a terrible longing to

Comparison the Value Proposition of - 4681 Words

Comparison the Value Proposition of Dell and Hewlett-Packard Table of Contents IntroductionÂ…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…...Â….4 Part OneÂ…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â….4 1.0 Analyse the value proposition of Dell and Hewlett-PackardÂ…Â…Â…Â…Â…Â…Â…Â…...4 1.1 Mission analysisÂ…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â….Â…5 1.2 Market definitionÂ…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…5 1.3 Market SegmentationÂ…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â….6 1.4 Market AttractivenessÂ…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â….6 1.5 Differentiating capabilities and Strategic positionÂ…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â….7 1.6 Marketing assetsÂ…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â….8 1.6.1 Customer LoyaltyÂ…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…..8 1.6.2 Demand ManagementÂ…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…9 1.7 BrandsÂ…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â….9 2.0 Evaluation of Dell and†¦show more content†¦In comparison, HP operates in seven segments: Imaging and Printing, Personal Systems, Enterprise Systems, HP Services, HP Financial Services, Software and Corporate Investments and their principal activity is to provide solutions and services to individual consumers and businesses. 1.4 Market Attractiveness Market Attractiveness is the degree to which in opportunity fits with our goals and capabilities whereas market position reveals how well we can do in this market or segment. (Piercy 2002) Dell is recognised for their products, true low-margin, high-asset-turn business that is much more concentrated on turning out a wide range of system desktop PCs, notebooks, etc. Figure 2 Market attractiveness and position (Source: Piercy 2002 p434) High Low Strong Market Position Weak In contrast, HP has a very valuable printer business that Dell does not have in their PC maker. The reason that printers are so profitable is because demand of ink and other necessities. In the PC market HP could not afford to Dells price margin as they need to spend on their marketing and physical supplies. 1.5 Differentiating capabilities and Strategic position According to Piercy, differentiating capabilities is put togetherShow MoreRelatedRubbertech Case Study1581 Words   |  7 PagesRubbertech is a Thai company, targeting the Thailand first will be an easier transition from a relationship building perspective; they will not need to devote time or resources toward breaking cultural barriers, and can focus on promoting their value proposition. Additionally, Rubbertech has no direct competitors, except manual labor and an Indian company with burgeoning technology that is akin to the RTP (Eisenstein 2006). While the Indian company is in the research and development phase, RubbertechRead MoreSocial Identity : An Individual s Preexisting Association With The Successful Other. Essay1504 Words   |  7 Pagesdifferences brought about by these two dimensions, Feitosa et al. (2012) presented five propositions that predict how individuals would differ in the structure of their social identities based on their culture’s characteristics as defined by the previous dimensions. These predictions are discussed below individually, with the original propositions examined through how further research has supported or challenged them. Proposition 1: Individuals from collectivist cultures are more affectively involved in theirRead MoreValue Proposition775 Words   |  4 PagesValue Proposition Your value proposition can equip you with the following benefits to your business: * Create a strong differential between you and your competitors * Increase not only the quantity but the quality of prospective leads * Gain market share in your targeted segments * Assist you in enhancing tools that will help you close more business * Improve your operation efficiency iPod vs. Other MP3 Players - As early as 1996 MP3 players were available to the public forRead MoreQuestions On Value Propositions Delivery Value Essay1743 Words   |  7 PagesDiscussion of how value propositions delivery value in different aspects Background and concept definition The term value proposition was first mentioned by Michael Lanning and Edward Michaels in a 1988 staff paper, they think value proposition has a function of delivering value in a business. A clear and simple statement of the benefit and price which firm can provide to its customer. However, the rapid development of business management, there are some argues of this term, and the concept is changingRead MoreSelecting an Overall Positioning Strategy1252 Words   |  6 PagesThe full positioning of a brand is called the brand’s value proposition—the full mix of benefits on which a brand is differentiated and positioned. It is the answer to the customer’s question â€Å"Why should I buy your brand?† Volvo’s value proposition hinges on safety but also includes reliability, roominess, and styling, all for a price that is higher than average but seems fair for this mix of benefits. The figure shows possible value propositions on which a company might position its products. In theRead MoreDigital Marketing Web Analysis Report1369 Words   |  6 Pagesorganized and portrayed. This however varies in comparison to Kogan.com website as its usability is complex and has a general view of untrustworthiness which is a major concern for e-commerce. According to Gonzales et. Al, (2015), this situation is a main course for alarm since trust is important in e-commerce. Both companies are analyzed and individual web analysis criteria included to highlight the strength and weaknesses of the two websites. The comparison table is also included which indicates thatRead Morerecorded future case study1519 Words   |  7 Pagesand national defense are interested in the idea of getting a better understanding of the future while analyzing data from the past on the Internet. As a consequence, the potential market segment is strongly associated with Recorded Future’s value proposition and core technology. ï  ¬ Customer Selection At present, The main services in RF is the financial institutions, competitor analysis and government intelligence agencies including USA Department of Denfense. Because they have great demandRead MoreSwot Analysis Of Zynga1368 Words   |  6 Pagesentertainment during leisure time, such as television. Zynga’s competitive position follows a broad, integrated strategy, as its product has both low-cost and differentiated elements. Zynga’s value proposition focuses on providing value by offering users a social, casual, and low-cost entertainment product. Zynga’s value chain demonstrates how it provides a product that emphasizes social and shared user experiences. Zynga invests in first-rate technology to provide its customer with mostly real-time, liveRead MoreAmazons Value Chain Analysis1620 Words   |  7 PagesValue Chain Analysis In the 1990s, Amazon (Amazon.com) introduced a new business model for entrepreneurs choosing to use the Web as its place of business rather than the traditional brick and mortar companies. Amazon’s e-business and e-commerce business models generated significant revenue for the company and resulted in creating an effective and sustainable competitive advantage for the online retailer. â€Å"Amazon was one of the early movers to recognize the opportunity in both e-commerce and cloudRead MoreZaras Case Study1373 Words   |  6 Pages1. What is Zara’s value Proposition? How does it differ from its Competitors? â€Å"Zara has pioneered leading-edge fashion clothes for budget minded young adults through a tightly integrated vertical structure that cuts delivery time between a garment’s design and retail delivery to under three weeks (against the industry norm of three to six months)† (Grant, 2010, p.212) According to Clayton Christensen in order to process you Value Proposition you must look at the following (Harvard Business

Coming to God free essay sample

Interacting with piers can result in good behaviors or bad. It depends on who you place yourself around and what kind of morals your friends have. The best way to make good friends is having things in common with people, and sharing the same types of characteristics that each of you have. One thing to remember about being with others is to be yourself and remember your morals. I have had quite a few experiences of not agreeing with my friends, I think everyone has had that problem before. So the question is, what do you do? Well you can answer that in many different ways. It depends on what the argument topic is about. For example, when I was in ninth grade my friends and I had lots of different beliefs about lots of different things. I believed in Jesus Christ and that He died on the cross for our sins and saved us all from eternity in hell. We will write a custom essay sample on Coming to God or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Most of my friends agreed with me, except for one. Now this girl’s name is Zoey and she had been one of my best friends for a long time. It was somewhat hard to be her friend though because she did not believe in Jesus Christ. In the Bible it tells us to reach out to unbelievers and try and draw them closer to God by sharing the gospel with them, and that is what I tried to do. Zoey had been raised a lot different from me though, she had never gone to church, or read the Bible, whereas I had been to church and read the Bible my whole life. I understood where she was coming from by not wanting to have anything to do with God because it was a very new thing to her and it might be kind of scary at first, but I really did want her to come to Him so one day I invited her to go to a Wednesday night church with me. On Wednesday night my church has a youth program and a lot of teenagers went. It was a lot different from church because even though we sang and the pastor preached, it w as not necessarily taken as serious as church on a Sunday morning because you were around all your friends. Zoey seemed to be kind of in an uncomfortable position at first, but once we all went in and started singing she started to feel more relaxed. My pastor prayed for us and started teaching. He knows that a lot of us bring new kids with us to the church so he always makes sure to say something about how Jesus died for us and rose again. Now to Zoey, that was all fake and did not seem believable to her, so she kind of shook her head and laughed. As soon as he got into the real message though I could see her starting to take an interest in what he was saying. The pastor usually only preaches on Wednesday nights because he is very good with kids and using words to get their attention where as a Sunday morning church pastor might just read straight from the Bible and might come off as a little boring. At the end of church Zoey asked if we could go again next week and of course I sai d yes. She was starting to believe which made me feel great. I felt as if I had done something right and now Zoey might become a Christian. It all shows that even though we had our differences at first, it was right of me not to give up and let our friendship go because now Zoey is still a good friend of mine, and she truly believes in God and all He has done for us. I always remember that life lesson anytime I go anywhere some one might not be a believer in Christ, because now I know that anyone can believe in Him. That is His power that he gives us to tell others about Him, and help save each other from sin.

Socialist Party of America free essay sample

White, author of Fire in the Ashes: Europe in Mid-century (1953) wrote, Socialism is the belief and the hope that by proper use of government power, men can be rescued from their helplessness in the wild cycling cruelty of depression and boom. Progress of socialism The Socialist Party in America was born and grew dramatically between 1900 and 1912. Under the charismatic leadership of Eugene V. Debs in 1912, 160 councilmen, 145 aldermen, one congressman, and 56 mayors, including Milwaukee, Wisconsin, Berkeley, California, and Schenectady, New York, were elected as Socialists. At the time, Socialists published 300 newspapers, including the Appeal of Reason, which was a Kansas-based publication with 700,000 subscribers. Membership in the Socialist Party totaled 125,000. Debs imprisoned Debs converted to socialism while serving Jail time for his part in the Pullman Strike n 1897, and began to edit the Appeal to Reason publication. From 1900 to 1920, he ran for president on the Socialist ticket while increasing membership to the Socialist Party tenfold. We will write a custom essay sample on Socialist Party of America or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Although Debs insisted he was a Marxist, he spoke more about poverty and injustice than typical socialist concerns about the class struggle and the dictatorship of the proletariat (Marx). In 1912, Debs received 900,000 votes, which was six percent of the presidential votes cast that year, principally for his stand against America s involvement in World War l. Debs appealed to blue collar workers hungry for improved working conditions and higher wages, but also such intellectuals as authors Jack London and Upton Sinclair. Debs campaign poster Prominently with President Theodore Roosevelt and through the 20th centurys first years, the Progressive Movement came into view with its belief in the perfectability of man, and in an open society where mankind was neither chained to the past nor condemned to a deterministic future; one which people were capable of changing their condition for better or worse. The Socialist Party was included within the Progressive Movement. The party dealt with American problems in an American manner. Unlike the Communist Party, the For example, socialists and other progressives campaigned at the local level for municipal ownership of waterworks, gas and electric plants, and made good progress in such endeavors. In 1911, there were 18 Socialist candidates for mayor, and they nearly won the Cleveland, Ohio, and Los Angeles, California, mayoral races. In 1905, Upton Sinclair founded the Intercollegiate Socialist Society, which soon had chapters in the leading universities. Lively young men and women discussed the New Gospel according to St. Marx. Universities were considered to be favorable ground for progressive thought. Following the election of 1912, Socialist Party membership began to decline as some members cast their vote for Woodrow Wilson. Others were expelled, such as the Industrial Workers of the World, of which Debs and labor organizer Mother Mary Harris Jones had once been members. The IWW had been organized in 1905, grew into a radical, direct-action wing of American socialism by 1910, and had up to 100,000 workers by 1915.

A Right to a Diverse Life Essays - Pluralism, Christianity, Religion

A Right to a Diverse Life Patriarch Bartholomew's assessment that pluralism is important in today's multicultural society is accurate because religion s hould not be forced upon anyone. This assessme nt aims to create an environment where peace and diversity can be protected. Patriarch Bartholomew argues that in order to achieve his goal of promoting diversity , we must first take a step back and reevaluate ourselves ; how we as Christians treat other religious groups . Christians decry Communism for being anti-religious when a more accurate assessment would be that it was anti-pluralist. There was a belief system in the Soviet Union: known as Marxism. Anything that was different from that belief system (ie: all religions) was violently suppressed. Belarus is one of the nations formerly under Communist rule. During that time, a fanatical, absolutist, government refused to allow any forms of pluralism to flourish. This becomes more than a question of which ideolo gy is correct, but t his was a violation of human rights. Under Communism no respect was shown to the beliefs of people. This is deplo rable to those of us who hold that all people are living icons of Christ . How then is modern day Belarus, a so-called Orthodox country that should hold this same belief in the inherent dignity of every human person, justifying its suppression of pluralism? It does not matter if the "religion" is militant atheism or Ortho dox Christianity, no religion should ever be forced upon anyone. The U.S. is an example of a pluralist society, but even here it is not perfect. An average American classroom is very diverse. There are usually students from a wide variety of religious backgrounds such as Christian, Jewish, Muslim, Buddhist, and even atheists. There is still a concern in some areas with mixing religions, yet this is how our nation came together. The colonists came to this land in order to escape religious persecution. Would we really want that same persecution to occur here? Sadly, this is already the case. What happened to America being a melting pot- a shining example of pluralism for the world to follow? Recent spikes in Islamophobia certainly tell a different story. Even here, among different denominations of Christianity, pluralism is sometimes blatantly disrespected. Despite recent movements towards embracing diversity, Protestantism is still the most common and accepted religion in this country. My own high school experience was one of a lack of tolerance. I felt oppressed being the only Orthodox person in a predominantly Born-Again Christian environment. I was in the minority of the school and people harshly tried to get me to convert. Being Greek Orthodox was not really an option. Growing up we are instilled with the morals and traditions of our families and religion. If one day that was stripped away from us who would we be? Our identity would be in a way gone, and the way of live will be altered to fit those in power. In a Non-denominational church service, there is little to no similarities to the Orthodox faith service. Orthodoxy is about tradition and structure, while Born-again Christians are not as structured and are more lose' with their services. As a student enrolled at this school I had to partake in the weekly chapel services. Growing up in the Greek Orthodox Church I was very uncomfortable observing, yet alone participating in their form of worship. One example of this would be during our Spiritual emphasis week, an annual celebration of praise and worship. As Orthodox Christians we show our respect and faith to God through the sign of the cross. At my school, they do not make the sign of the cross, but have other ways to show respect to the Lord. During a point in the service I made my cross and a teacher approached me and asked to speak with me after service. The problem they said, was that they wanted me to participate in the service there way.' Meaning hands in the air praising the Lord and singing alone to their worship songs. If I can be suppressed in a tiny school on Long island, imagine what an entire nation and religious group felt like. The problem

Tips for avoiding negativity at work

Tips for avoiding negativity at work Even if you generally like your job, work is still work. Day after day of clocking in makes it easy to get bogged down with everything you don’t like. It certainly doesn’t help if your workplace is full of coworkers who make a habit of complaining. That said, negativity never made anybody more successful or productive. It can even prove to be a toxic and destructive force that can really impact your performance and career.   Rather than joining the chorus of complainers, try to be the person who walks into the room and lights it up! Here’s how.Stop bad thoughts before they ruin your day.Learning to recognize negative thoughts when you first have them is the first step. As soon as you feel a complaint rise up, take a second. Pause. Resist the urge to let the annoyance wash over you and choose to move on to more productive things instead. Once you gain a little distance from your initial negativity, you’ll see what waste of time and energy it is.Practice, in this case, makes perfect- it’s not easy to take that extra beat to shake off your annoyance. Once you get into the habit, however, ignoring it will become second nature.Change the way you speak.Do you find yourself using a lot of negatives in your speech? Maybe you tend to speak in absolutes: These lunch meetings are always awful. This guy’s work is never on time. Try easing up on those black-or-white sentiments, leaving room for hope of improvement. Don’t write off someone or something- assume there’s room for improvement and give people the benefit of the doubt. Everyone’s just trying to get through the day.Take action.If you’re all doom and gloom but are doing nothing to change your current situation, you don’t really have room to complain- at least not all the time. Take an active part in your life. Go talk to the person who’s annoying you. Go ahead and get that really annoying project finished so it is off your desk. Do something productive instead of simmering in your own mud.Give up on reading minds.Do you (mis)interpret everything people do or say in order to feel worse about it? If someone hasn’t responded to your networking request or Facebook message, do you automatically assume they don’t like you? Or if someone praises your work, is your first reaction that they’re just saying that to make you feel better? You shouldn’t take things so personally, and you definitely can’t read minds. So stop trying. You’re only causing yourself unnecessary pain.Try on some new shoes.If you only ever consider the world or any particular situation, from your perspective, then you might get stuck in certain negative thought patterns. If you’re angry or frustrated or annoyed try looking at the situation from a different angle. People act a certain way for a reason, and nailing down that reason can help you look at annoyances from a practical viewpoint.  You mig ht not find that you totally understand or forgive every person, but you will find that you waste much less of your day being grumpy about it.Be nice.If you are the kindest version of yourself (even when you are about to burst with grumpiness), good vibes will flow your way. First, treat yourself well- do nice things to brighten your day and change your outlook to something more positive. But also make sure to throw in a few random acts of kindness to people around you. It will make you feel better about the world and it will brighten someone else’s day. Everybody wins.

Explication of a Poem Essay Example | Topics and Well Written Essays - 750 words

Explication of a Poem - Essay Example The main idea of the poem is that the poet sees night as freedom, not daytime, which is unconventional. arms wide In the face of the sun, Dance! Whirl! Whirl! Till the quick day is done. Rest at pale evening... A tall, slim tree... Night coming tenderly Black like me† (Hughes, 2010). The idea is that the narrator would like to whirl and spin in this kinesthetic manner, and is therefore crying out a wish that is in vain. The still image of the tree is a kinesthetic contrast to the dance. These very visual symbols also have metaphorical meaning in the poem as black people and white people. The idea is that the poet narrator is visually breaking through the conventions of using light and bright to mean good, and darkness to mean evil, and asking the reader to empathize with night. In terms of simile, as noted above, the narrator identifies themselves with night as well as a tree. â€Å"To fling my arms wide In some place of the sun, To whirl and to dance Till the white day is done. Then rest at cool evening Beneath a tall tree While night comes on gently, Dark like me- That is my dream!† (Hughes, 2010). The main simile is of the dark. as the sun and the night, or night and daytime. Langston Hughes answers the main question with more questions, because this is a Socratic method of seeking the answers. In terms of whether his views are political and societal, if one cannot say that the author has both intents, the result would be towards societal rather than political, since there are no names named, or parties advocated, in Hughes’ work. There were also other powerful societal critics, who did not explicitly involve politics in her writing, but instead pointed towards social concerns. There are many similarities and differences between the works. Overall, both hope to achieve the goal of societal critique. The most

Education Law Essay Example | Topics and Well Written Essays - 500 words

Education Law - Essay Example The significance of the case is to show that school authorities should ensure that the off-campus rules they implement need clear wording, applied and interpreted for students who do not understand them. The case is an excellent example for school authority officials and for students showing what happens in instances when school rules get breached. The student was not suspended from carrying out other school activities and functions, but got suspended from the baseball team as punishment for being in possession of alcohol. The violation of school rules warrants different punishments. However, certain factors have to be considered before enforcing such punishments. The first factor is the seriousness of the offense. Other factors such as the student’s age, the student’s code adopted by the board, the attitude and how often the student commits the offense are also important to assess. Lastly, the other two factors include requirements of chapter 37 of the education code and the potential effect that the student’s misconduct has on the school environment. The first concept is that the state has to take action (Lesson 3). For example, a teacher from a private school who gets fired without getting a notice from the school’s board of team members has the right to complain for contractual breach. In such an instance the school becomes liable for a lawsuit because it violates its own policies. The second concept is that the person must have been dispossessed of his or her property or liberty by the state for the court to accept that there has been a violation of due process. In this case, the state is liable for violation of due process because of breaching the contract formed between it and the person. The third concept is that the nature of due process is dependent on how severe the problem is in a case. In a case where a person has killed another person and gets sentenced to life imprisonment or death penalty, the state is liable for

Resource Concerns Research Paper Example | Topics and Well Written Essays - 750 words

Resource Concerns - Research Paper Example Resources as a Concern in Global Strategy Customers expect value for money when purchasing a product. The manufacturer has to ensure that the customer is delivered the greatest value for money while keeping base costs as low as possible. Globally, consumers tend to behave differently as per their geographical, cultural or other tastes. In certain cases, it is possible to substitute local solutions for customers but in other situations it is imperative to use original resources. The custom furniture manufacturing business under consideration is able to sell its products given their novel form. Such a form can only be maintained when using resources that were being used by the parent manufacturing plants located in the United States. However, it must be considered that importing such resources from the United States would cost heavily and carries the additional risk of making the products uncompetitive in an already competitive market. Resources of Concern in China China is a large buy ing and selling paradise for both consumers and manufacturers. Given that China produces a large number of manufactured products, it is highly likely that a number of critical resources might be available in China. However, certain specialized resources might not be available and might have to be outsourced from the United States before they can be manufactured locally in China. The custom furniture business relies in large part on the use of wood (Han, Wen, & Kant, 2009) as well as other construction materials such as wrought iron, stainless steel and novelty plastics. As far as materials such as wrought iron and stainless steel are concerned, China has an ample cheap supply of these materials. However, when the issue of woods and novelty plastics is considered, the situation is altogether different. Although China has an ample supply of wood but Chinese woods such as mahogany, oak wood or birch cannot be expected to provide the same output as local woods (Chunquan, Taylor, & Guoqi ang, 2004). Chinese focus lies more towards the production of synthetic boards to create furniture while custom furniture requires original wood for the exquisite feel and taste (Lee, 2011). The issue with novelty plastics is similar since they would have to be outsourced from the United States. In turn these imports would cost the company heavily and there may even be certain trade barriers for novelty plastics. On another note, China would provide a number of different textiles and fabrics for use in furniture manufacturing. However, in order to keep the look and feel of the original furniture, it would be necessary to import specialized fabrics. In the longer run, it may be possible to manufacture these textiles inside China but initially it would cost the company heavily. Impact on Decision to Expand in China Even though the Chinese market may hold some entry barriers such as the need to import certain resources but a competitive business can still be afforded given that Chinese imports of furniture originating from the United States totals some 8.8% of overall furniture imports (Aspin 2000, 2009). If the concerned company begins business in China by importing certain resources from the United States, the cost of the produced furniture would be lower than that of imported furniture. The lower cost of other base inputs such as electricity and labor would help to offset the cost of imports. Moreover, in the longer

Recovery Programme For Patients Undergoing An Anterior Resection

Recovery Programme For Patients Undergoing An Anterior Resection The topic I have chosen for my project is the Enhanced Recovery Programme (ERP) for patients undergoing elective colorectal surgery, and whether this aids with early discharge from hospital. I shall discuss traditional pre and post operative assessments alongside the one used for ERP. I will also discuss each of the seventeen modals used within ERP and how when it is used collaboratively can aid with early discharge. I will also discuss any complications that arise from ERP and traditional surgery and if there is any difference to the patient. Within the conclusion, I will discuss the findings and any way of gaining additional knowledge and skills. I will undertake a comprehensive search of literature using the cinhal, pubmed databases and reading literature that is available within the university library. I will use quantitative research to analyse my data and incorporate this and any further learning into my conclusion. During the last four years of my training, I have developed a keen interest in colorectal surgery and this is something I would like to expand on when I become a qualified nurse. I have nursed a lot of patients on the Enhanced Recovery Programme, but I have never looked into this at any great length and I wanted to see if this had any benefit to the patient or even whether it truly did mean early discharge from hospital. In the early part of the 1990s, surgery underwent a drastic change it went from using long lasting anaesthetics to shorter fast acting ones. Combining the new anaesthetics and analgesic methods together with new surgical techniques, a new surgical pathway was created and this seems to have shortened the post operative recovery period. This means that patients could be taken out of main operating theatres as they didnt need as much recovery time. Minor surgical cases were moved to smaller day stay units (Apfelbaum 2002). The term for this new pathway was called fast tracking. Recovery times for patients on the fast track programme were considerably shorter in comparison to those patients that were not. Arguments were bought up to justify the use of fast track surgery such as reduce the nurses workload, reduce hospital costs and improve patient care by getting them back to their preoperative condition more quickly (Watkins 2001). The expansion of fast track meant that more surgical pro cedures were being performed as day cases. The expansion of the fast track concept to colonic surgery was pioneered by Henrik Kehlet, a surgeon of the Hvidovre University Hospital in Denmark. He stated that of 60 patients who underwent a colostomy on the fast track programme, 59 required a hospital stay of two days. In 2001 Enhanced Recovery after surgery (ERAS) group was formed, it was their job to look into the case mix, clinical management and clinical out comes of colorectal patients. What they found was that in Denmark, the length of stay was considerably shorter than Edinburgh, Sweden and Norway who were practicing care that is more traditional. The length of stay within Denmark was 2 days and the other 4 had an average stay of between 7-9 days (Nygren 2005). With the experiences of Denmark in mind, ERAS group developed a new evidence based concept that was holistic in its approach. There are 17 key elements to the Enhanced Recovery Programme (ERP) (appendix1). The 17 elements can be divided into 3 facets Preoperative, Intraoperative and Post operative. Each one of these facets is evidence based and only when they are used collaboratively in elective surgery do they produce a paradigm shift on how we manage our patients. The concept of ERP is to increase patient satisfaction and decrease patient complications. A patient preparing for traditional open bowel surgery used to be prepared in pre-operative assessment for a stay in hospital of around 14 days (Rickard et al 2004); Enhanced recovery patients are being prepared for a stay in hospital of 5 days (Elwood 2008). What ERAS did was to discover that there is a gap between evidence and practice, one of the consistent findings in health service research was what should be done according to scientific evidence and best clinical practice (Bodenheimer 1999). Improving the quality of care increases the amount of patients that are seen each year. This is because the right things are being done in a timely and organised fashion. Preoperative The effectiveness of the Enhanced Recovery Programme (ERP) depends on changing the patients outlook on their hospital stay. Encourage patients to believe that a shorter stay in hospital is a viable option. Department of Health (2009) states that the enhanced recovery uses evidence based interventions both pre and post operative. It is well established that stress levels rise when faced with the prospect of surgery but this concept has recently been challenged by Fearon K (2005a) in which he suggests that elements of the stress response can be reduced or even eliminated with the application of modern anaesthetic, analgesic and metabolic support. The ERP relies heavily on a multi professional approach involving all members equally. Tradition was that doctors gave the pre assessment teaching. But due to time constraints on the consultants, this was often rushed due to the amount of other patients that needed to be seen and not all patients questions were answered. The introduction of nurse specialist pre assessment clinics helped alleviate some of the pressure, and the atmosphere was more relaxed and the nurses understanding of the programme made it easier for patients to follow (Crenshaw, Winslow 2002). It is essential that all patients are well prepared for the operation, not just for a check on their physical condition but also their psychological needs. Looking after the patients psychological needs is an important part of the enhanced recovery programme as it helps reduce the stress of surgery. Patients are counselled on the important parts of the enhanced recovery programme such as early mobilisation and diet resumption. Screening for malnutrition will also take place at this appointment it should include weight, height and the body mass index should be calculated and any unintentional weight loss should be calculated use of the malnutrition universal screening tool (MUST) should be used (appendix 2). It is also reasonable to discuss discharge at this point. A patient being diagnosed with any disease is hard enough to deal with but then to be told you need an operation. Obtaining consent is a vital component to the success of the programme. Gaining consent is more than signing a bit of paper (Department of health 2009). Consent must be given freely and without coercion. All the facts must be given about the treatment and any risks should be discussed. The core ethical principle according to royal college of nursing (2004) is respect for the individuals rights. Gaining consent is a legal requirement. As a nurse the NMC (2008) states that, we are accountable for our own actions so we must ensure consent is obtained before any procedure is carried out. Some patients may not wish to know all the facts if this is the case the consultant in charge of the patients care should document this in the patients medical records, and all healthcare professionals should adhere to this. Patients are encouraged to bring in their own clothes so they are not sitting around in bed all day. Patients with disabilities or who may require more help are also identified at this visit. It is explained in the pre assessment what is expected of the patient after surgery. Clarke (2005) suggest that only forty two per cent of day surgery patients in the UK are currently offered a pre-assessment visit, within my own personal experience a pre assessment appointment is well advised, as this gives the patient time to ask any questions and alleviate any last minute fears. This part of the ERP has not changed from the preoperative counselling for traditional surgery. The preoperative assessment is a critical component of ERP as it gives patients autonomy over their own care. One of the main principles of the enhanced recovery care is that bowel preparation is avoided as this can cause dehydration and electrolyte imbalance particularly in the older patient (Burch, J.2009) a point that is also raised by Holte (2004a) he also goes on to state that bowel prep can also be very stressful. The trust that I am placed only one of the consultants uses bowel preparation usually in the form of an enema as these help prevent post operative constipation and contamination of the surgical area by faeces and is only ever used if a stoma formation is not required. Bowel preparation is still used for traditional surgery with oral sodium phosphate being the most convenient method. However concerns were raised that by not giving bowel preparation this could cause problems post operatively, but these fears have not surfaced (Holte et al 2004b). A recent study by Guenaga (2005) suggested that giving oral bowel preparation can cause anastomotic leaks, and may cause wound infect ions and possibly death. Nil by mouth after midnight originated in 1946 when reports suggested that a higher risk of pulmonary aspiration existed among patients that had general anaesthesia that had not fasted. Reassessment of this tradition began in the 1980s where numerous studies failed to demonstrate that fasting ensured that the stomach would be empty (Crenshaw, Winslow 2002). Also noted was patients that had prolonged fasting would complain of headaches, dehydration, hypovalemia and hypoglycaemia. As a result, in 1999 American Society of Anaesthesiology developed guidelines that support a more liberal preoperative fasting protocol. The original belief of nil by mouth (NBM) from midnight before surgery is still widely adopted for some surgical procedures and is still applied to some elective cases (Maltby 2006).Consumption of oral fluids up to 2 hours prior to surgery is known to reduce post operative vomiting without any adverse effects, contrasting with patients that are starved normally prior to surgery (Khoyratty, Bhavik, Ravichandran 2010).There are several elements of the programme that are important, one element is the careful use of fluids, traditional surgery uses too much (Burch 2009). It is documented that hyperglycaemia increases diabetic complications, in a study by Nygren et al (1999) also found that patients that werent Diabetic had the same amount of glucose within their blood work as patients with type2 diabetes. Patients on the enhanced recovery programme are given two clear carbohydrate drinks to take: 800mls is taken the night before surgery, 400mls is to take with breakfast (Grover 2010) this reduces the preoperative thirst and hunger but it also reduces post operative insulin resistance, therefore patients are in a better anabolic state to benefit from post operative nutrition, The Carbohydrate drink consists of 12.6g of complex carbohydrate in the form of Maltodextrin Nygren et-al (2006). Having these carbohydrate drinks is the equivalent of having 2 roast dinners. A patient on a morning list must not eat after midnight but can have clear fluids until 3am. In contrast, consumption of an appropriate mixture composed of water, minerals and carbohydrates offers some protection against surgical trauma in terms of metabolic status, cardiac function and psychosomatic status. Oral intake shortly before surgery does not increase gastric residual volume and was not associated with any risk of as piration. For normally nourished patients restoration of gastrointestinal (GI) function is one of the primary goals of post operative care. A recent study by Khoyratty, Bhavik, Ravichandran (2010) found that many of their patients voluntarily fasted longer than was given in the written instructions this is not advisable as this can cause post operative complications and can delay the healing process. This was also noted by others (Baril Portman 2007). Food and drink is a basic need and is needed to sustain life and aid with the healing process. A patient will routinely have a catheter inserted on the operating table and close monitoring of Urine output is vital, minimum output per hour is usually 35mls if it reduces then the team should be called because understanding fluid management is vital for the ERP to work. Intravenous fluid will have been prescribed avoiding normal saline and ideally stopping after 24hours (Billyard et al 2007). Fluid balance charts are vital as 60% of a males body weight and 55% of a females body weight is made up of water and electrolytes; one third of this fluid is extracellular (ECF) and two thirds intracellular (ICF). A reduction of 5% in total will result in thirst and thus considered to be mild dehydration (Welch 2010). Inadequate fluid intake or fluid loss can also cause dehydration. Patients who have had major abdominal surgery will have some fluid loss. With reference to preoperative and post operative patients Intravenous fluid on traditional surgical patients were given 3.5 to 5l of intravenous fluid on the day of surgery (Tambyraja et al 2004) however recent studies have found that providing no more fluid than is necessary to maintain fluid balance (for example a patients body weight), as this reduces post operative complications thus reducing a patients stay in hospital (Brandstrup et al 2006).For more traditional surgery the patient would normally be on restricted oral intake but this is not the case with ERP so monitoring intake is vitally important. Poor urine production can lead to renal failure and electrolyte imbalance. Monitoring fluid balance is important because as nurses we need to carefully monitor a patients input and output, as poor monitoring can lead to poor outcomes. The hourly catheter bag is changed to a leg bag on day 1 after the operation to make it easier for the patient to mobilise but strict fluid balance must be maintained (Burch J 2009). This should include stoma output if a patient has had a stoma. The catheter is usually removed on day 2 post operatively as long as there are no post operative complications and strict out put is still monitored. While fluid balance charts are a good and useful tool for monitoring fluid balance they are only as accurate as the data recorded on them, another good way of monitoring fluid loss or gain is to weigh a patient, as 1000mls is equivalent of 1kg any rapid weight gain can be directly related to a change in fluid status. The detrimental effects of fluid imbalance can be life threatening, therefore the importance of strict monitoring and accurate recording can not be stressed enough. Nursing staff of all levels should strive to complete fluid balance charts as fully and as accurately as possible. Traditional surgery required starving a patient the day before surgery. When a patient returned from theatre they were not allowed to eat until the Surgeon could hear normal bowel sounds and sometimes this may not happen for 4-5 days post operatively. So a patient could be starved of anything to eat and drink for as long as a week. A patient undergoing colorectal surgery may already be malnourished and the complications following surgery are greatly increased. Malnutrition can affect every tissue, muscle and organ within our bodies it can also have an affect on our psycho-social welfare (Todorovik 2003). National Institute for Clinical Excellence (2006) state in their nutritional support in adults that malnutrition is usually caused by physical factors. A recent study into nil by mouth versus early feeding found that of 837 patients that met with inclusion criteria found that early feeding reduced the risk of any type of infection although the risk of vomiting was increased (Lewis, e t al 2001). Patients on the programme are encouraged to drink and eat straightaway if they feel like it. Usually sips of water are offered and if tolerated they are offered nutritional supplements to drink, usually one about an hour after surgery, if this is tolerated then another will be given and left for the patient to drink at leisure (Fearon 2005b), Billyard (2007) contradicts this and states: the patient should drink at least 2L including three nutrition drinks on returning to the ward. Once a patient can tolerate fluids without vomiting or feeling nauseous, they can progress on to solid foods usually something light. A concern for surgeons was post operative ileus (POI). POI is a well recognised consequence of any abdominal surgery and is frequently experienced by patients, Leir (2007) states that it is not a life threatening complication but is a costly post operative complication. POI is defined as a transient impairment of intestinal motility after abdominal surgery (Han-Geurtz et al, 2007).There are many factors that have shown to increase its progression such as Local intestinal inflammation Anaesthetic Agents Over hydration Post operative analgesia(opiates) Reduced mobility. POI along with nausea and vomiting are the most common complication. POI can be minimised with the use of epidurals. Scoop et al (2006) stated: that mid-thoracic epidural is considered the pinnacle of the enhanced recovery programme. Although it is possible to use Patient Controlled Analgesia (PCA), Morphine can increase the risk of vomiting it can also cause the bowels normal peristaltic movement to temporarily paralyse. Recent research in to POI and the different approaches to treatment found by giving a patient chewing as a form of Sham feeding (making the body think it was eating) helped with gut motility. Schuster et al (2006) found that gum was an inexpensive and of some benefit after colostomy formation. Five randomised trials of chewing gum to restore the natural gut motility found that patients who were chewing gum passed flatus 24% earlier and had bowel movement 33% earlier, which shows a significant and positive conclusion of early discharge which on average 17.6% earlier than those that did not have the chewing gum (Chan and Law 2007). POI is usually diagnosed with symptoms of nausea and vomiting along with abdominal distension, pain and the failure to pass flatus or faeces. Parnaby et al (2009) found although flatus and faeces were passed earlier in patients who chewed gum it did not have any bearing on early discharge or post operative complications. If tachycardia is present then other causes should be excluded. The treatment for POI is inserting a nasogastric tube (NG) although one is inserted during the intubation process during surgery it is removed as soon as the surgeon has finished operating because there is good evidence to suggest that leaving a NGT in place can cause pneumonia (Cheatham et al 1995). Once a diagnosis of POI has been made, all oral intake should discontinue, and the patient should be removed from the programme and the traditional approach should commence. Patients are encouraged to take regular anti emetics to aid the patient with early return of oral intake the trust that I work cyclizine is the anti emetic of choice. Post operative pain is always a concern this is why Professor Kehlet designed the ERP because he believed every patient deserved to have a pain free recovery. For patients to understand pain nurses need to be able to educate the patient. Biggs (2009) states that less than 1% of university education is spent on pain and the effects of pain. It is vital that nurses have an understanding of pain physiology in order to educate our patients and in turn increase patients knowledge and reduce anxiety, increasing patient satisfaction. Regular pain assessments should be maintained at rest and on movement by a competent nurse (DH2009). It is stated by Vickers et al (2009) that pain should be classed as the Fifth Vital sign. In postoperative patients on ERP, it is vital that nurses monitor pain because pain can reduce a patients motivation for all the other parts of ERP. Concerns have arisen about the use of thoracic epidurals as the analgesia of choice due to immobility and urinary retention, but if inserted high enough in a thoracic position it is possible to mobilise safely and with fewer side effects such as constipation, this means that opiates which have an adverse effect on the bowel can be avoided and again this can facilitate to an earlier discharge. 1 gram of paracetamol is given 4 times a day and is given in conjunction with PCA or epidural, this is also part of multimodal approach. Also, the afferent nerves are blocked resulting in less stress response less gut paralysis and a decreased risk of pulmonary complications (Jorgenson et al 2000). The epidural dose is reduced 48 hours after surgery, and once epidural is running at 2mls per hour then a trial without epidural should commence and pain reassessed after 1 hour if minimal or no pain then commence co codomol 30/500 every 6 hours and oral Non Steroidal Anti Inflammatory Drug (NSAID) diclofenac 50mg every 8 hours (British National Formulary, 2009) with this in mind the consultant can prescribe a mild laxative for patents as this will avoid constipation although this is not the case where stoma formation occurs. Alternatively, at the anaesthetists request oral paracetamol 1g 6 hourly may be given also diclofenac 50mgs 8 hourly and 10-20 mgs of Oxynorm every 2-4 hourly. As a nurse I am aware of the importance of pain management within the ERP because psychologically a patient in pain will not feel like eating, or mobilising so keeping on top of pain by using trust pain charts and ensuring that pain relief is delivered on time helps reduce anxiety. In theory, there is not hing stopping nurses from giving paracetamol or co-codamol every 4 hours during the day as making the patient comfortable will aid sleep meaning that paracetamol or co-codamol will not be needed between midnight and six in the morning, it also means that extra pain relief may not be needed thus reducing post operative complications. On saying all of this post operative pain is believed to be at its worst directly after surgery and the intensity is expected to diminish over time (Buyukilmaz et-al 2010), the World Health Organisation analgesic ladder (2007) is used in reverse for surgical patients. on return from surgery patients, initial observations should be taken by the trained nurse so she has a baseline to work with. All further observations should be meticulously maintained as per any hospital policy. The use of Bair huggers during surgery has reduced the incidence if hypothermia during the operation it is important to maintain a constant core temperature as it was found that all of the anaesthetics used during operations caused hypothermia also there are several non pharmacological reasons that warrant the use of Bair huggers for example shaving the surgical site (Sessler and Akca 2002). Wound infection is a serious and costly complication. During colorectal surgery, the incidence of wound infections increases to 10%. Ikeda et al state that all incidences of wound infections occur during the first two hours of any surgical procedure. The primary connection between hypothermia and surgical site infection (SSI) is vasoconstriction because of a decrease in tissue oxygenation and if a patient is immunosuppressed which most colorectal patients are this can also cause SSI. Blood loss during surgery can increase the risk of SSI due to blood transfusions during surgery. On return to the ward from recovery the nurse in charge of the patient must ensure that the wound site is checked for bleeding and check the dressing for any sign of strike through the nurse would expect to see some excess on the dressing but it should be regularly monitored so any problems can be found early. Port sites where a patient has had laparoscopic surgery should be checked. When a stoma has been formed, the nurse should look at the site making sure it is pink/red in colour and it is warm and there is no excessive bleeding. Wound infections can delay discharge so any problems should be found early reported to the patients team and the correct antibiotics can be prescribed early and may only delay discharge by 2-3 days. Anti thrombotic prophylaxis is a must within colorectal surgery; treatment is usually commenced the evening following surgery and continued on a small maintenance dose of 40mg of enoxaprim (Dylan 2010) until the patient has regained full mobility. There are no further advantages in general surgery for extended use of enoxaprim but there are advantages for patients undergoing orthopaedic surgery. Associated use of low dose heparin and continuous use of epidural analgesia is open for discussion as there have been reported cases mainly in the United States of epidural haematomas (Tryba 1998). A patient undergoing stoma formation under ERP pathway can have their discharge delayed due to teaching, on how to care for the stoma. Although pre-operative teaching does occur, the reality often does not sink in until after the operation. The stoma nurse specialist will see the patient on the day after the operation. The patient returns with a clear see through bag so nursing staff can see when t he stoma becomes active. Teaching begins at the bedside where the patient may only want to observe the proceedings, but all of the time the stoma nurse actively encourages the patient to take note of the proceedings. Psychologically the patient may need lots of reassurance as to them this is not natural (Rust 2007). A patient with a stoma should plan for a stay in hospital between 5 -10 days and it usually takes this long for a patient to be able to manage their stoma. To become self caring with a stoma is the patients biggest psychological battle (Bekkers et-al1996). So on my understanding of the research available stoma formation does infact delay discharge by four days depending on the patient and his/her ability to manage. Patients are not always proactive recipients of care (Ellwood 2008). Early Mobilisation is important to reduce complications such as chest infections. Chest infection rates have dropped from 4% to less than 2% this is because patients are not laying in bed for days. Bed rest not only increases insulin resistance it also decreases muscle tone and in addition, there is an increased risk of thromboembolism. On the ward, the physiotherapist has a book which nurses can refer patients and patients should be seen on day 1 following surgery. Patients are encouraged to sit in the chair for two hours on the day of surgery to encourage deep breathing (Francis 2008). A care plan should be formulated with a specific mobilisation plan incorporated. It is essential that a patient should be nursed in an environment that encourages early mobilisation. Anti embolic stockings are also prescribed. The stockings facilitate venous return from the lower extremities. They also provide venous thrombosis. As nurses, we should make sure the patient is lying down as this allows the veins to relax. The stockings should be removed at least once a shift, so that the nurse can inspect the patients legs and feet for any signs of redness as the skin around the heel can break down very quickly. Encourage leg exercises every hour during the day. Muscle contractions compress the veins, preventing a clot. Contractions also promote arterial blood flow. The introduction of the enhanced recovery nurse has been invaluable not only for the patients but also for staff. The role of the ERP nurse (ERPN) is fundamental to the programme as she/he co-ordinates patient care from the beginning. The ERPN works freely within the colorectal team seeing patients in clinics. He/She helps the patient through their hospital admission reinforcing the goals and liaising with hospital ward staff. ERPN works closely within the surgical team, colorectal cancer team and stoma nurses. The biggest challenge for the ERPN was changing the practice of nursing staff on the wards repeated teaching sessions with all new nurses and doctors with regular feedback and all new updates to the programme (Elwood 2008). Unfortunately, within the trust I am placed the already busy colorectal cancer team initiate all of the teaching, ERP has become a large part of the daily schedule within the trust that a need for an ERP nurse is deemed necessary and funding for the post has become available. Although regular care pathways and protocols are in place, an integrated care pathway was drafted but due to increased pressure from our consultants the document was abandoned, and deemed unworkable but after reviewing the evidence it seems to be used within most other trusts that incorporate the ERP as part of their surgical planning. Nursing interventions within the ERP can influence the out come so it is important that the nurse looking after the patient has the most up to date knowledge and skills and able to detect when a patients condition deteriorates. Another useful tool is a patient diary so that the patient can keep a record of when they got up so the patient is aware of when they can get back into bed. On the first day of surgery, the Patient should aim for 2 hours and then 6 hours until discharge (Fearon et al 2005). Patients are encouraged to walk 60 meters from day one post operatively. To enable continuity of care nurses need to consider the clients needs for assistance within the home. Discharge planning begins even before the patient comes into hospital; the process is usually started at pre admission clinic. The nurse will take a full social history; this is obtained so nursing staff on the ward are aware of any social problems. Fearon et al (2005c) stated that patients are fit for discharge after the following criteria has been met Have good pain control with oral analgesia Are eating solid food and no Intravenous Fluids Are independent with all ADLs And willing to go home All patients should be discharged with an information leaflet including a telephone number of the ward in case they have any problems. In some of the trusts, an enhanced recovery nurse specialist post has been created and on discharge, the ERPN will telephone the patients on the programme at home to allay any fears and to check that there are no post operative complications. a telephone helpline has been set up at one London hospital so that patients can have direct contact with someone during out of hours and they are hoping that this will reduce the amount of AE admissions. The ward I worked on would refer all patients on the ERP to the district nurse with first visit being on the day of discharge, making sure that the referral form states that the patient is currently on ERP. Patients can telephone the ward if problems occur within the first 24 hours. Because patients on ERP are discharged earlier, this means that potentially serious complications can occur at home for example ana stomotic leaks (King et al 2006). Therefore, it is important that patients have a port of call once they are home and within the community setting. The need for support at discharge is also unlikely, compared to a patient who has traditional open surgery Readmission rates for patients on ERP shows that from 1998-2008 334 patients of which 99 (30%) were on ERP and 235 were not (Larsson et-al 2010). The 99 on ERP tolerated soft diet approximately 2.5 days earlier than those not on ERP and were discharged at least 2 days earlier from hospital. Recent research done by 2 Doctors searching the colorectal cancer data base for the trust found; ERP has reduced the length of stay by 3 to 5 with no change in mortality or readmission, the best results came from a gynaecology ward where the nursing staff followed the ERP care pathway in its entirety. Conclusion Traditional Perioperative procedures and prac

Peer Effects and Alcohol Use among College Students, by M. Kremer and D. Levy, :: Peer Pressure Essays

Kremer and Levy (2008) analyze to what degree college students who consume alcohol influence their peers. College students could affect their peers’ alcohol consumption, which in turn may lead to damaging effects. For example, peers could potentially disrupt classrooms, be exposed to disease, and lower their grade point average, start binge drinking, abuse illegal drugs, and even die. These affects may generate multiplier effects in the future. Earlier studies have examined this issue of alcohol consumption and the negative peer effects among college students. Sacerdote (2001) examines peer effects in universities. He finds evidence that supports this theory that students whose roommates reported high beer consumption were more likely to replicate the same behavior. Kremer and Levy (2003) noted that peers who had a roommate that drank could potentially increase the peer’s preference for alcohol consumption. The Cooperative Institutional Research Program’s (CIRP’s) Entering Student Survey demonstrated GPA’s declining in peers whose roommates drank alcohol frequently, especially those who had in high school. The survey classified males as being especially sensitive to peer influences. Empirical data presented by Wechsler, Lee, Kuo & Lee (2000) show that alcohol use and abuse reported by 40% of university students had been binge drinking at least once within the past two weeks and it was concluded that alcohol use, and more specifically binge drinking, is a social influence by peers. There are various economic theories presented in this article. For example, in the context of academic achievement, the assumptions made are that peers could affect others’ preferences, as seeing their friends consume alcohol also stimulates the desire in the other student to consume alcohol. Many theoretical models assume that students’ academic achievements are a linear function of their peer’s ability to influence their behavior as well. The theories presented consist of peers’ effects on the influence of preferences, leading to lower academic achievement because the student’s study is disrupted. The assumption that students who are frequent drinkers being roomed with another frequent drinker would increase their alcohol consumption and possibly lead to binge drinking based on variables, preferences model, and theoretical models which assume the student’s academic outcomes are a linear function of their peer influence, and multiplier effe cts. Kremer and Levy find from the empirical works that some individuals are more vulnerable than others in the influence to increase alcohol consumption. The increase in alcohol consumption is more commonly linked to the desire for social acceptability.

Stylistic Analysis of Ragtime Essays and Term Papers

The global environment protection Our earth is our home, so if we want to protect our home we should protect our environment from harmful effects of human activity. Some of these activities cause pollution. Pollution now is a very important problem. Some of these problem are : the ozone holes, global warming (or green-house effect), acid rain †¦ The ozone layer is a layer of gases which stop harmful solar radiation protecting the earth. Recent research shows that there is a hole in part of the ozone layer which is caused by smoke from factories, car exhaust fumes, aerosol cans ‘cause they contain CFC.Global warming is an increase in world temperature caused by the release of carbon. Such precipitation as acid rain contains dangerous chemicals, this is caused by smoke from factories. Another problem is poisons in foods. Farmer soften spray chemicals in crops to safe them from pests. These chemicals are called pesticides. Scientists have found that pesticides often end up in our food and they can cause health problems – especially for kids. The marine life or in other words ocean biota are in danger. They are filled with poison : industrial, chemical, nuclear waste.Every ten minutes one species of animal, plant or insect dies out for ever. The biodiversity is reduced to minimum, the extinction of animals and plants is a real problems nowadays and if nothing is done our earth will die in about 30 years from now. We face an ecological catastrophe. The humanity abuses nature. So what can we do to avoid the environmental degradation ? There must be more rainforests,  «green » belts on our planet, we should plant more trees, we should not waste resources but try save them, we also must make smoke from factories and car’s fumes more clean, we must not dump industrial waste to seas and rivers †¦Now people are beginning to realize that ecological disaster is not somebody else’s. They make different organization, whose aim is conse rvation. For example, â€Å" GREEN PEACE † , â€Å"FRIEND OF THE EARTH † and others. Everyday millions people from all over the world do everything to diminish harmful influence of human production on the global vegetation, mineral resources and animal kingdom, and they need for our help. Everyone must take part in it, to save our planet clean and prosperous. It`s a pressing necessity to change the character of interaction between man and nature, just to make our future better. Stylistic Analysis of Ragtime Essays and Term Papers The global environment protection Our earth is our home, so if we want to protect our home we should protect our environment from harmful effects of human activity. Some of these activities cause pollution. Pollution now is a very important problem. Some of these problem are : the ozone holes, global warming (or green-house effect), acid rain †¦ The ozone layer is a layer of gases which stop harmful solar radiation protecting the earth. Recent research shows that there is a hole in part of the ozone layer which is caused by smoke from factories, car exhaust fumes, aerosol cans ‘cause they contain CFC.Global warming is an increase in world temperature caused by the release of carbon. Such precipitation as acid rain contains dangerous chemicals, this is caused by smoke from factories. Another problem is poisons in foods. Farmer soften spray chemicals in crops to safe them from pests. These chemicals are called pesticides. Scientists have found that pesticides often end up in our food and they can cause health problems – especially for kids. The marine life or in other words ocean biota are in danger. They are filled with poison : industrial, chemical, nuclear waste.Every ten minutes one species of animal, plant or insect dies out for ever. The biodiversity is reduced to minimum, the extinction of animals and plants is a real problems nowadays and if nothing is done our earth will die in about 30 years from now. We face an ecological catastrophe. The humanity abuses nature. So what can we do to avoid the environmental degradation ? There must be more rainforests,  «green » belts on our planet, we should plant more trees, we should not waste resources but try save them, we also must make smoke from factories and car’s fumes more clean, we must not dump industrial waste to seas and rivers †¦Now people are beginning to realize that ecological disaster is not somebody else’s. They make different organization, whose aim is conse rvation. For example, â€Å" GREEN PEACE † , â€Å"FRIEND OF THE EARTH † and others. Everyday millions people from all over the world do everything to diminish harmful influence of human production on the global vegetation, mineral resources and animal kingdom, and they need for our help. Everyone must take part in it, to save our planet clean and prosperous. It`s a pressing necessity to change the character of interaction between man and nature, just to make our future better.

Beer and Brandy essays

Beer and Brandy essays Parody is defined as a literary or musical work in which the style of an author or work is closely imitated for comic effect or in ridicule. The elements of parody are apparent throughout many of the episodes of The Simpsons. The episode that I thought showed the best elements of parody, when contrasted to a movie is the episode called, Bart of Darkness which parodies the Alfred Hitchcock movie Rear Window. The similarities I will examine are the setting, and the similarities of the female characters. I believe that though seen by many as a low humor cartoon, The Simpsons incorporates many aspects of high humor as well. This is achieved through the parodying of a classic film such as Rear Window. As the movie Rear Window begins it shows the thermostat, to give the impression that it is a incredibly hot summer day. Because of the heat, most of the people keep their windows and blinds up to help manage the hot temperatures, and this leaves everyones personal lives open for any voyeur to intrude upon. With nothing better to do within the small confinements of his one room apartment than sit around with a broken leg, Mr. Jefferies sits at his window and becomes familiar with his neighbors daily routines, and activities. The setting in The Simpsons episode is set up in a similar, but more humorous way. In the Simpsons episode the heat is established be scenes such as Homer in the kitchen with a tent built around the refrigerator to make a cooler area for him and Bart. Nonetheless it is depicted as an incredibly hot day. It is because of the heat, that the Simpsons get a pool, and the pool is responsible for Barts broken leg. After Bart breaks his leg, he is confined to a very sm all room, with nothing to do, but be nosey. Bart looks at everyone outside, from his window, in the very same manner that Mr. Jefferies does in his apartment. Bart, like Mr. Jefferies,...

Dissertation Paper

Dissertation Paper Dissertation Paper Dissertation Paper University students sometimes feel lost and frustrated when they face the necessity of writing a dissertation paper. Really, this task is a complicated one; it takes a lot of time and effort to write a dissertation. Anyway, you have no other way out except of start work. Do not give up, as you are well prepared to take the challenge. In this paper you will find some useful tips on how to start work. Choose your topic According to the Asian saying, the first step is half of the way. For you this first step, choosing your topic, is genuinely important. It depends on your choice whether your work will be interesting for you or boring, whether it will be easy or difficult to find data for your dissertation paper, and, finally, whether the staff will be willing to help you. You will perhaps need to have some preliminary reading around your topic before you make your choice. But do not waste your time, it is no use skipping from one topic to another. When you think th at you have found what you need, consult the staff. It is very important to find a supervisor, having a deep knowledge of the subject, who will be willing to help you. Make a rough timetable of your work It might be not very easy to plan the work on your dissertation paper, which will last for months. Students sometimes rush to start their work, but they do not know where to go. That is why they may, for example, spend lots of time gathering evidence, but they will be extremely short of time when it comes to bibliography. Still, it is better to prepare your timetable at the very beginning of your work, as it will protect you from sleepless nights before the final deadline. Consult your supervisor You know that your dissertation paper is assigned to you to provide you with the opportunity to develop your intellectual skills. Some students think that they can work absolutely independently. Others just do not know how to cope with this task and do not do anything. Both of them ar e wrong, as avoiding the supervisor is a very big mistake. If you want your dissertation paper to bring you the highest possible mark, consult your supervisor whenever you need professional help. Well, we hope that creating a dissertation paper will be the most interesting and fruitful experience in your studies.

War on Terror Essay Example | Topics and Well Written Essays - 750 words - 1

War on Terror - Essay Example and all of the countries it trades with. The federal government, in what some might term a ‘knee-jerk’ reaction to the attack, declared a ‘war on terror’ to justify the military initiative de jour and the spending of unprecedented amounts of money on questionable programs and ventures in an effort to ‘provide security’ to its citizens. The terrorist attacks of Sept. 11 were on U.S. soil but resulted in severe repercussions regarding not just national economy. On that day and for about a year and a half prior, the major economies of the world were teetering on the edge of at least recession conditions and many were close to a full-scale depression. The attacks prevented any perceived or real economic upturns that were predicted given the factors present at that time. The event destroyed lives and property, increased government spending at a time when the country could ill afford the excessive expenditures and squelched corporate and consumer confidence which further slowed the economy and hindered the recovery efforts. The events lasted over a period of a couple of hours but its affects are still being felt all over the world. The heightened insecurity regarding terrorist acts and its effects on the economy worldwide continues to give worry to investors and businesses which only serve to further cripple the economi es of most countries. The attacks of Sept. 11 also had an instantaneous negative economic influence on the financial and corporate sectors worldwide. Many companies either closed or scaled back which caused an increase of unemployment and a resulting decrease of the tax base. This lack of consumer, corporate and government monetary resources was not good news for countries that depend upon exporting products to the U.S. for economic stability such as the Asian ports located in Thailand and Singapore. Regions of the world that

Biology Essay on Diabetes Example | Topics and Well Written Essays - 2500 words

Biology on Diabetes - Essay Example According to Hsieh et. al. (2005 quoted in Morhan et. al. n.d., p. 15), various organs like the kidney and liver showed some lowered levels of mtDNA 8-OHdG when the rats were treated with rice bran oil. It showed that the oil may have certain properties that would be helpful to diabetics. Another study coming from Molnar et al. (n.d. as cited in Morhan et. al. n.d., p. 15) suggested that circulatory system illness and diabetes can be caused by angiotensin-converting enzyme gene insertion and deletion polymorphism. Those who have allele D may experience a heightened oxidative stress. It then leads to the injury of endothelium. Oxidative stress is then detected by the presence of albuminuria. Albuminaria may have some linkage with type 2 diabetes as what was investigated by Molnar et al. (n.d. cited in Morhan et. al. n.d.). With the significant level of fructosamine in the blood, they need insulin and more medicines for combating hypertension than people with the genotype II. Fructosam in is then the substance resulting from the joining of fruit sugar and amine through chemical reaction and releasing water in the process. That substance is used as a detector of the blood sugar level and identify whether an individual has the tendency to have diabetes or not (Lavin 2009, p. 697). It was then proven by the study that patients with allele D have bad metabolic activity and exhibit cell damage development due to oxidative stress. The connection then between the treatment method and the genotype and hypertension treatment had small significance (Morhan et al. n.d., p. 16). Hypertension is then the drastic increase in the blood pressure that passes through the blood vessels and result to tearing of the walls of the vessels. Its complications are heart attack, kidney failure and stroke (Cohen 2004, p. 9). The amount of fructosamin in the bodies of the patients was then affected by inhibitors as its presence reduced the amount while its absence allowed the prevalence of be yond the normal level of fructosamin seen in the body. The study concluded with the patients having resistance to taken insulin led to a degrading state of metabolism that resulted to oxidative stress (Morhan et. al. n.d., p. 16). The study showed how certain genes affect the condition of diabetics. Going on with the oxidative stress, it becomes a complication of diabetes once superoxide has been made in excess through the existence of hyperglycaemia. It happens in detail as such overproduction of superoxide leads to higher levels of nitric oxide creating strong oxidants that hastens the appearance of complications from diabetes. The same method also causes damages to the inner linings of the blood vessels for diabetic patients (Morhan et. al. n.d., p. 17). Hyperglycemia then is the condition of having high concentration of glucose in the blood as a result of not having much insulin in the body to regulate the blood sugar levels. It may progress slowly or may come out abruptly that may pose serious complications. When it goes out of control, it has the ability to dehydrate the person and experience severe chemical imbalance in his body. It is then usually related to diabetes

Homeland Security Essay Example | Topics and Well Written Essays - 1500 words

Homeland Security - Essay Example The suddenness of the attacks on September 11, 2001, and the manner in which America was caught off guard, would shape our perception of the war on terror and frame America's response. Previous wars had unfolded methodically in the public's eye, such as the extended debate that preceded the Civil War. However, the War on Terror had no such incubation period to give the American public time to orient themselves to the new face of war. America was thrust into war "without any troops or plans in place to confront this particular enemy. Just as important, it occurred in a context of public indifference to or ignorance of the threat posed by terrorists" (Callahan, Dubnick, and Olshfski 555). The US had made few, if any, plans to deal with a terrorist arrack on US soil, and the discussion of terrorism was largely restricted to the law enforcement, investigators, and prosecutors that had confronted domestic terrorism such as the Unabomber and the attack on the Murrah Federal Building (Calla han, Dubnick, and Olshfski 555). The Congress took aggressive action and on October 4, 2001 introduced HR 3026 "To establish an Office of Homeland Security within the Executive Office of the President to lead, oversee, and coordinate a comprehensive national homeland security strategy to safeguard the Nation" (HR 3026). On November 25, 2002 George Bush signed into law PL 107-296, the Homeland Security Act of 2002, which established the Department of Homeland Security (Gressle CRS-2, CRS-6). ... The Department of Homeland Security (DHS) would consolidate intelligence efforts, provide for broad powers of investigation, and limit specific legal standards in regards to terrorism. The Homeland Security Act and the formation of the DHS gave the government sweeping new powers to patrol the US borders and took a more liberal approach toward domestic surveillance. The DHS was formed to consolidate intelligence and investigations when "The establishment of the Department of Homeland Security brought under one authority 22 federal entities with vital roles to play in protecting our Nation and preventing terrorist attacks within the United States (The National Security Strategy). Border patrol and customs has been especially challenged with 500 million people crossing our borders each year, and 21,000 containers entering the US through 350 commercial ports of entry every day (Bodenheimer). Bender reports that, "The Secure Border Initiative, costing more than $2 billion this year alone, is a major effort to increase Customs and Border Protection personnel, introduce detection technologies, and construct a fence along the border with Mexico". The DHS has also placed sp ecific priority on the increased use of 'tamper-evident' containers, biometric identification technology, and radiation, chemical, and biological threat detection equipment (Bodenheimer). In addition, there has been an increased level of domestic intelligence activity designed to weed out suspected terrorist cells. Marrin describes these increased efforts as: Additional controversial domestic intelligence programs include the Justice Department's proposed Operation TIPS for public reporting of suspicious activity, the modification of

Sherlock Holmes Essay Essay Example for Free

Sherlock Holmes Essay Essay Arthur Conan Doyle has written a number of short stories about a fictional character called Sherlock Holmes and his trusted work mate Dr. Watson. Together they solve mysteries using the art of the reasoner and imaginative thinking. I have recently been studying the adventure of the speckled band among other short stories. Holmes is portrayed as an intelligent crime solver, with quick thinking skills and a sharp mind. We find straight away in the story that Dr. Watson and Holmes are good friends as Holmes wakes Watson up early especially because he thinks he would want to learn about the case right from the start. Holmes has an eye for detail, which we realise near the beginning of the story as he can clearly describe how the woman travelled to meet him, by the half return ticket and mud splatters on her jacket. The crime is a murder; set it the mansion belonging Dr. Grimesby Roylott in Stoke Moran. Dr. Roylott was in great debt and rented out most of his property to gypsies. He was a very lonely, bitter, miserable man. The murder is described by the victims sister, Helen Stoner, she saw her sister just before she died and experienced some of the strange things that happened to her sister on the night of her death, afraid and worried she turned to Holmes for his help. There are many suspects in this story, such as the gypsies, or the animals that the doctor kept in the grounds. But the prime suspect in this scenario was the doctor himself, he had the motive, if his daughters should marry then the money from their mothers will, would go to them. Therefore if they were to die before they got married the doctor would keep the money. It is an unusual murder because the room in which it took place was locked, with the windows closed and metal bars put there. On visiting the scene Holmes finds some peculiar abnormalities with the room, there is a bell- pull, which isnt fixed to a bell, just the ceiling. Also the bed is nailed to the floor and there is an air vent between this room and the doctors. Holmes also looked in the doctors room and found a bowl of milk on top of a safe also a small dog lead hung on the corner of the bed and tied to make a loop of whipcord. Holmes finds these clues using the art of the reasoner and his imaginative thinking, to work out how the previous murder happened and when the next was about to happen. Holmes also uses the art of the reasoner in another short story- Silver blaze, where the prize racing horse is stolen and its owner beaten to death in Kings Pyland, Holmes works out that it cant have been anyone other than John Straker or his wife, as no-one else could have made it so that curried mutton was the dinner for the stable boys, so as to hide the taste of the sleeping drug put in it. So that Straker could take the horse out of the stable at night, in order to harm the horse and fix the race. The murder weapon was an Indian snake; the doctor kept it in a safe, but whenever one of his daughters was to be married, he would let it out. It would make its way through the air vent; down the dummy bell- pull and onto the bed to kill whatever was lying bellow it. It was then called back with a whistle, to the doctors room and put back in the safe. The red herring in this story could be the cheetah and the baboon, as they could have come into the house and killed the girl, also the gypsies as there were some around at the time of the murder, and the before the victim died she said the speckled band which could have meant the spotted scarves they are often found wearing and a band of gypsies. The tension is built up when Holmes and Watson stay in Helen Stoners room to find out what killed her sister and could possibly kill her. As they sit in darkness listening to the night sounds outside, waiting for what they dont know at this stage, then Holmes realises that a snake has just entered the room and scares it off with a light. The twist in the tale is right at the end, when, because the snake is scared back through the ventilator, it gets confused and bites Dr. Roylott. So his greedy and malicious plan backfires, and he is killed. I chose to write about this story because I think that it has a lot of good points to describe, and it is a great, gripping story. Show preview only The above preview is unformatted text This student written piece of work is one of many that can be found in our GCSE Arthur Conan Doyle section.

A Computerized World :: essays research papers fc

COMPUTERS A Computerized World Computers play an important role in this modern society. All people around the world are forced the â€Å"computer age† nowadays. Since the first computer was made in the late 1950s, which I heard that was came from the Chinese Abacus, the technology has developed extremely. Computers are everywhere and control a great deal of our living environment. More and more areas are being taken over by the computer. Not able to use a computer is a serious handicap with ramifications in all areas of life. Therefore, if people do not know computers or do not know how to use them it means that they are not prepared for the future. They will fall behind our advancing society. Computers have been applied to industry, agriculture, political affairs, economy, military, science and many other fields; it is becoming more and more important. It is reason why I feel; I need to know more about computers such as why computer is useful, history of computer, and Internet. COMPUTERS ARE USEFUL IN OUR LIFE Nowadays, no matter what the professions, a mainstay of the companies prefers to hire employees who basically need to know how to operate computers. â€Å"Knowledge of computers† has become a basic requirement in job descriptions. As computers are capable of handling large amounts of data in a very short time, they are well suited for word processing. For instance, medical officers use computer to record patients’ data for finding them easier and more conveniently. Banks also use computers to store information for consumers to know their account conveniently and orderly, etc. The government agencies are the one who use computers most because they need to record confidential data, for instance, the military, and the U.S Census Bureau, etc. The business also use computer password system in the companies that to avoid other companies’ stealing their business secrets. Therefore, the secret data will not let out to other countries or companies. Since a small diskette can contain much more data than a written page, and it takes less place, I think it will not be too long all the paper-archives are replaced by magnetic tapes and diskettes. It is possible to get the American telephone book on just one diskette. HISTORY OF COMPUTERS   Ã‚  Ã‚  Ã‚  Ã‚  About two hundred years before, the word â€Å"computer† started to appear in the dictionary. Some people even did not know what is a computer. However, most of the people today not just knowing what is a computer, but understand how to use a computer.

Worlds of History by Kevin Reilly :: essays research papers

Worlds of History by Kevin Reilly Response to: From Hominids to Human Beings, From Nisa: The Life and Words of a !Kung Woman, Women and the Agricultural Revolution, From Hammurabi’s Code, From the Upanishads: Karma and Reincarnation, and From the Upanishads: Brahman and Atman   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Societies of today are very different from the first civilizations. Pre-historic cultures depended on the cooperation of its people to live. Today, however, everyone is dependent on money. Even though the main focus of each story was distinctly different, they all had a similar view on society. They all felt that cooperation was essential to the survival of their community. From Hominids to Human Beings revealed how the people of pre-historic civilizations interacted. Pre-historic man was a forager, a hunter-gatherer. They traveled in bands of about twenty-five people and used only transient camps. â€Å"The band, not the nuclear family was the principal social unit.† (Matossian, pg 13). Every member of the band worked together to obtain food. The adults taught the children to be responsive to others needs and share the food with the group. Frans de Waal, a researcher at the Yerkes Primate Research Center in Atlanta, Georgia, traced this behavior back to chimpanzees. â€Å"Chimpanzee groups consist of caring, sharing individuals who form self-policing networks† (pg 13). Despite this fact, chimps share food only when it is to their advantage and cheat whenever they can get away with it. When the cheaters are identified, food is withheld in the next windfall. Nisa, from From Nisa: The Life and Words of a !Kung Woman, feels extremely jealous of her newborn brother, Kumsa, and often makes him cry. Nisa felt she wasn’t being paid enough attention to and deprived her brother of milk by nursing. Nisa leaves to live with her grandmother after being berated several times for stealing. She thought that was what her mother wanted, but when she returned her parents told her they wanted her to be with them. â€Å"Yes, even your mother wanted you and missed you.† (Shostak, pg 28).   Ã‚  Ã‚  Ã‚  Ã‚   Later in the story, Nisa’s father arranges a marriage. At that time women were married when they were still young girls. As a result, they were often scared of their husbands and a woman would sleep between the newly married couple. A woman named Nukha layed between Nisa and Bo to show her that she had nothing to be afraid of. Nukha and Bo would bump in Nisa while making love, but Nisa didn’t say anything. Worlds of History by Kevin Reilly :: essays research papers Worlds of History by Kevin Reilly Response to: From Hominids to Human Beings, From Nisa: The Life and Words of a !Kung Woman, Women and the Agricultural Revolution, From Hammurabi’s Code, From the Upanishads: Karma and Reincarnation, and From the Upanishads: Brahman and Atman   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Societies of today are very different from the first civilizations. Pre-historic cultures depended on the cooperation of its people to live. Today, however, everyone is dependent on money. Even though the main focus of each story was distinctly different, they all had a similar view on society. They all felt that cooperation was essential to the survival of their community. From Hominids to Human Beings revealed how the people of pre-historic civilizations interacted. Pre-historic man was a forager, a hunter-gatherer. They traveled in bands of about twenty-five people and used only transient camps. â€Å"The band, not the nuclear family was the principal social unit.† (Matossian, pg 13). Every member of the band worked together to obtain food. The adults taught the children to be responsive to others needs and share the food with the group. Frans de Waal, a researcher at the Yerkes Primate Research Center in Atlanta, Georgia, traced this behavior back to chimpanzees. â€Å"Chimpanzee groups consist of caring, sharing individuals who form self-policing networks† (pg 13). Despite this fact, chimps share food only when it is to their advantage and cheat whenever they can get away with it. When the cheaters are identified, food is withheld in the next windfall. Nisa, from From Nisa: The Life and Words of a !Kung Woman, feels extremely jealous of her newborn brother, Kumsa, and often makes him cry. Nisa felt she wasn’t being paid enough attention to and deprived her brother of milk by nursing. Nisa leaves to live with her grandmother after being berated several times for stealing. She thought that was what her mother wanted, but when she returned her parents told her they wanted her to be with them. â€Å"Yes, even your mother wanted you and missed you.† (Shostak, pg 28).   Ã‚  Ã‚  Ã‚  Ã‚   Later in the story, Nisa’s father arranges a marriage. At that time women were married when they were still young girls. As a result, they were often scared of their husbands and a woman would sleep between the newly married couple. A woman named Nukha layed between Nisa and Bo to show her that she had nothing to be afraid of. Nukha and Bo would bump in Nisa while making love, but Nisa didn’t say anything.

Doing Business in Japan Essay

1) A large Japanese firm makes important decision by a so-called â€Å"nemawashi† consulting system which requires all internal stakeholders to review and sign the final decision. Research the concept online and compare the advantages and disadvantages of this decision making versus the vertical U.S. system. Describe specific situations when â€Å"nemawashi† could be advantageous and disadvantageous. The culture of the Japanese is to live in harmony with nature and others and they do this by avoiding debates and clashing positions by using a decision making system called Nemawashi. They value interpersonal connectedness and consensus which is the exact opposite of how Americans think and respond. This idea was developed in 1950 when American statistics professor, W. Edwards Deming, trained Japanese leadership staff in Science and Engineering on quality control techniques. David O’Gorman (2012) wrote, The techniques Deming introduced were very compatible with the cultural value of harmony. For example, Deming had 14 key principles for quality improvement. One principle is to â€Å"Break down the barriers between departments.† Deming’s perspective on teamwork, and his other teachings on quality improvement, fit perfectly with Japan’s cultural values of harmony and consensus. Nemawashi gets its meaning from a horticulture terminology meaning â€Å"wrapping around the roots.† When transplanting a tree from one place to another, preparing the root ball by wrapping it with fabric material and acclimatizing it to its new location before transplanting would make that tree grow healthier and stronger in its new environment. (Sakai, 2012) In practice, it means that the groundwork for a new proposal must be carefully prepared in advance if it is expected to take root, survive and prosper. (O’Gorman, 2012). Japanese managers are significantly more relationship-oriented and hierarchical than their U.S. counterparts, preferring consensus building, collectivist decision making, and risk avoidance. (FitzGerald, 2014) By informally communicating ideas to stakeholders, any issues planned for discussion in the larger meeting that might prove to be controversial are hashed out ahead of time so that they don’t create embarrassing snags. Any new ideas or proposals that are going  to be presented can be floated in the pre-meeting, in order to avoid any surpr ises during the main meeting. (Kopp, 2010) To avoid conflict and saving face, many of the discussions of an idea are done informally with all stakeholders prior to the actual formal meeting. There are advantages and disadvantages of this decision making style. The advantages of Nemawashi are: Nemawashi is a more disciplined business practice Nemawashi eliminates the element of surprise Nemawashi eliminates the likelihood of â€Å"whoever screams the loudest† getting their way Nemawashi eliminates ego and aligns interests to a common goal, focusing on the problem at hand with more input across the team or organization (Gordy, 2013). Consensus-building The disadvantages of Nemawashi are: It is time consuming Is not well suited to generating the innovated products and services that Japan needs to compete globally in the future. It suppresses innovative ideas. The nemawashi-ringi process can allow good ideas to wither and die. (O’Gorman, 2012). People are worried that decisions are sometimes made behind the scenes, instead of out in the open. It is therefore seen as an undemocratic process. (Abe, 2014). Those who hold a minority view do not express it to preserve harmony. Furthermore, decisions are flexible and open to change. As a result, decisions are vague, rarely written down, allowing various parties to implement the decision differently. (Anderson, 2009). An example where Nemawashi can best be implemented occurs when a decision does not have to be reached immediately. Japanese use it effectively when they are trying to improve a product such as Toyota. They have time to research, analyze, mull over, and share with all of the stakeholders and can flush out any inconsistencies or challenges prior to making the final decision. An example where Nemawashi is not advantageous is when a decision needs to be made rather quickly or when trying to be innovative. Because nemawashi is time-consuming, if there was a sudden decision that needed to be made, individuals who use this method of decision making would have difficulty getting everyone on board and in agreement in such a short amount of time. It may take months, perhaps years, for an idea  to work its way through the nemwashi-ringi process and be implemented. In the past, this did not pose much of a problem. But in today’s rapidly changing global environment there are increasing demands on companies to make faster decisions just to maintain their competitive position. (O’Gorman, 2012). An example of innovative products can be an idea such as the iPhone or self-driving tr ansportation. 2) Imagine that you are to welcome a Japanese delegation in your home-country. The delegation represents a potential business partner for your firm. Describe how you would prepare for the meeting and how you would decrease intercultural communication apprehension on both sides. I am welcoming a Japanese delegation in my home-country and because I am not ethnocentric, I have researched the Japanese culture and understand that they value hierarchy, status, social ranking, interpersonal relationships and nature. Japanese are polite, sensitive and have good manners and so it will be important to demonstrate those qualities, but not make an assumption because they possess these qualities that they will do business with my organization. I must prepare months in advance for the meeting because Japanese do not like to be taken by surprise. Japanese value commitment, dedication, excellent service, quality and reliability. I would send the itinerary to the Japanese delegation in advance along with any necessary paperwork for their review along with pictures of the executive members of the organization and their ranking. The professional portfolio would detail how long our organization has been in existence and our ranking in our industry. We would have researched their organization and identified their executives as well as their salaryman with whom we are engaging to do business. At the airport, a team of individuals would meet them and acknowledge the most senior member first on down to the salaryman. A business card held by both hands would be given to each one as each of us bow the formal bow and say ‘Watashi no namae wa Jones desu’. Although you do not need to become word-perfect Japanese speaker, many Japanese people really do appreciate foreigners who make the effort to learn at least a few Japanese words and business phrases. (Web) We would receive their business card and immediately study the card and place it carefully in our business card portfolio. We then would follow the itinerary explicitly. Instead of  taking them straight to the office, we would have tickets for the professional baseball team in our region in the loge with food and delicacies of their liking. Matsuzaki (2014) as a summer scholar states that Japanese people love sports, especially baseball. After the game, each delegate would receive a baseball hat with the team logo and a baseball shirt. After the game, a walk through the company and introduction to any senior managers would be done. We would go over our goals and objectives and discuss our portfolio in detail sharing information of how with an expanded business in Japan everyone could have a substantial profit. The most important thing to remember in dealing with the Japanese is to take a passive attitude and listen very carefully to those words that are spoken as well as those not spoken. Soft sell and use facts like â€Å"we sold over a million sets last year† rather than biased information such as â€Å"we’re better than them.† Be very careful not to overstate your case. Any kind of smooth talker or talking too much can rub the wrong way. It is much better to say too little than to say too much. ( Matsuzaki, 2014) Afterwards, at an upscale restaurant we would have an uchiage, (drinking party) which is a tradition Japanese have done after the end of a business transaction. Each business partner would be advised as to drink in moderation and if they do not drink, politely provide an excuse as to why they are not imbibing. The delegation would later be escorted to their hotel and in the morning escorted to the next planned event or to the airport by our executives with a parting gift of a company pen from Tiffany’s. 3) Access JETHRO’s website and other e-Global resources and describe the complexities of setting a Japanese representative office. What are the advantages and disadvantages when compared to other forms of business establishments in Japan? There are many complexities when setting up a representative office in Japan. According to Japan Management Consulting the Representative Office needs to have a Representative resident of Japan. The Representative Office needs to prove the reality of its existence by showing: a lease for office space in its own name a utility bill in the Representative Office name copy of the contract between the representative and the foreign country The Representative of the Representative Office needs to prove its good standing  with Social Insurance, Tax and Legal authorities by providing documents such as: registration with the local ward office â€Å"Juminhyo† registration with Social Insurance, typically a copy of Pension Book is needed proof of payment of resident tax and national tax and also individual enterprise tax if she/he was self-employed. The representative office also need to register with relevant tax office to report and pay the tax withheld on employees salary. (Japan Management Consult, 2011) The advantage of creating a Representative Office in Japan is to be able to carry marketing survey and information gathering activity in Japan before starting a full scale operation, without having to support the burden of full size company and especially keeping a Japan Yen General Ledger and paying taxes. The Representative Office can employ people in Japan and does not need to be registered with legal authorities like the Legal Affairs Bureau. The only registration needed is with tax office for payment of emplyees withheld income taxes. A representative office is often used by companies that wish to employ people in Japan for support activity or before starting a full scale activity. (Japan Management Consult, 2011) The disadvantage of a Representative Office is that it cannot engage in any for profit transactions that would raise Japan’s tax liability. It is only there to gauge the atmosphere of the environment through surveys and assessments. References Abe, Namiko. (2014). About.com Japanese Language. Nemawashi. Retrieved from: http://japanese.about.com/library/weekly/aa080597.htm Anderson, R.V. (Mar/Apr 2009) Management World. The Online Journal for Certified Managers. Japanese and American Management: A Contrast of Styles. Retrieved from http://cob.jmu.edu/icpm/management_world/CMartMar09.pdf FitzGerald, L.A. (2014). Module 2: One World Many Cultures. In Jones International University, BC 607: Leading from a Global Perspective. Retrieved from http://courses.jonesinternational.edu/display.jkg?courseSectionId=33756&uid=105453&tpl=frameset Gordy, Bill. (Dec 11, 2013). The Solutions Group Inc. Implementing the Japanese Business Practice of Nemawashi. Retrieved from www.thesolutionsgroupinc.com/implementing-the-japanese-business-practice-of-nemawashi/ Japan Management Consulting (2005-2011)