Na Essay Example | Topics and Well Written Essays - 250 words - 3

Na - Essay Example Many children mimic the television ads and would wish that their body conformation be the same to some popular celebrities in the advertisements they encounter daily in the social media, television, and the internet (Jennifer Siebel Newsom). In order to save the coming generation from various health issues related to underweight models it is recommended that underweight modeling be banned as a way of promoting good health among young adults and celebrities. According to recent news posted in the daily mail, Israel introduced a law in 2013 to burn ultra-skinny models as a way of fighting anorexia (Reynolds). Most women have refused to believe that they can get old and have engaged in facial make up in order to look good. In addition to this, some have been forced to enter into difficult diets that end up destroying their natural looks. It is no wonder that one out of 200 American women is suffering from anorexia just for beauty (Lauren Langman and Devorah K). On the other hand, one third of adults in the US are suffering from obesity due to misleading concepts of beauty from the advertisements. My opinion is that advertisements are doing more harm than good for the women to an extent that women are forced to change their diets to suit the advertisers and the social media. Reynolds, Emma. Underweight models BANNED in Israel to fight anorexia: New law forces women in ads to stay healthy (and faked images have to be identified too). 2 January 2013. 2014

Culture of Madness Essay Example for Free

Culture of Madness Essay Schizophrenia is a mental disorder that enables individuals to engage in unruly behavior. It is a mental disorder that makes individuals deviate from social norms. In the years between 1920s and 1950s, schizophrenia was a general condition that was manifested by emotional disharmony and impacted negatively on the abilities of the white people with regard to thinking and feeling. Research article authors of psychiatric journals described schizophrenia patients as native-born-Americans of white European ancestry. Such patients were termed by psychiatric authors as harmless and instead needed psychotherapeutic care. In 1960s, schizophrenia was described as illness manifested by rage. Research articles asserted that it was a condition that afflicted the Negro men who were hostile and aggressive. These Negroes protested for their civil rights. The protests were organized by black power, black panthers, nation of Islam or other activist group. I disagree with the view that schizophrenia has got popular cultural expression. It is merely a mental disorder that is not influenced by either race or culture. According to Metzl in 1960s, schizophrenia patients were the Negro men, who were described as aggressive and hostile. In the real sense, the black Americans who were oppressed were not hostile neither did they act ragely. They raised their voices to be heard by Americans for a change of lifestyle, from oppression to freedom. In so doing, the black Americans were fighting for their rights as equal human beings since they wanted to be treated with equality. As discussed by Metzl, schizophrenia was associated with racism, thus biased. It was considered to be a disease of the black Americans since they expressed their feelings due to pressure exerted on them. They were out to fight for the state of affairs between the Americans and the Black Americans. Schizophrenia is feared in the current moment. Schizophrenia patients can act unruly in a given surrounding. These patients act to satisfy only their desires not considering the effect of their deeds on other people. They can behave in a way that interferes with other people’s daily life. For example, if the illness drives them to violent behavior, other people will leave what they were doing and deal with them first. Any activity that they engage in, they do it with all their strength and thus can be destructive and fierce. b) According to psychiatrists, schizophrenia is a biological mental illness expressed through defined symptoms like delusions whereby the patient thinks of invisibilities and acts according to his/her thoughts. It is also expressed through hallucinations where by the patient builds castles in the air and imagines that it is real life. The patients as well have disorganized speech whereby they mix issues which do not relate at all. They express catatonic behavior which is a disorganized behavior in a given environment, for instance relieving oneself in the open. Such symptoms are manifested in ways that are specific to the surrounding, assumptions and values of the schizophrenic individual. For instance, a schizophrenic individual can behave unruly in the midst of other people. He can violently attack a group of people for no good reason and cause alarm. This is because the patient is not able to control him/herself due to lack of mental coordination. He/she thus attracts attention of people who may be in the middle of serious events. A schizophrenic patient usually makes undesired assumptions particularly in a group of people. Whenever they see other people talk or laugh, they always think that they are being laughed at because of their condition. They can therefore attack them and end up harming them for no reason. Some usually assume that it’s their duty to perform any role anywhere. For example, some schizophrenic patients assume that it is their duty to clean every environment they are in. They therefore end up collecting wastes everywhere they go. Most schizophrenic patients think that a group of people behave in a certain manner to hurt them or because they want to go against their wishes intentionally. They are in a condition which cannot allow them to reason with the surrounding. They instead act negatively. For example, if a schizophrenic patient is always violent, the people around him and who knows his/her condition may decide to tie him or her with some ropes or lock the person in a house for some time. If he or she happens to see some people hold such ropes in another incident, he/she may try to get hold of the ropes as he/she thinks that he/she will still be tied up. On the contrary, this may not be case. As a matter of fact, the ropes might be for a different purpose. c) Symptoms of schizophrenia can be harmless if at all the assumptions; values and norms in the current setting are changed. This can only be achieved if there is freedom in all aspects of life of schizophrenic individuals. For instance, it can be assumed that, if one is talking to himself or herself, he or she is probably talking to the ancestors and should be allowed to do so. It can as well be assumed that if one behaves unruly, he/she is expressing some burning issues within him/herself. Therefore, with this kind of assumptions, nobody would criticize schizophrenic individuals and subsequently, they would have all the freedom they require to express themselves. Schizophrenia cannot cause any distress if the patients are given freedom of speech. For example, a schizophrenic person should not be shut down if he mixes ideas in a discussion. He should be understood the way he is and given time to express himself. In so doing, he will not feel neglected or weak in one way or another. Some may behave in a schizophrenic manner out of a bad experience they have had before. For example, one can become schizophrenic after a divorce or death of his/her partner. Within this context, such people need understanding and a shoulder to lean on so as to counteract the effects of what they are going through. Schizophrenic’s behavior should be termed normal in a surrounding so as not to cause distress. For example, some religions like Islam allow wife battery. Therefore when wife battery cases are encountered in a family with a schizophrenic husband, they are considered to be normal behavior. 2. Conceptual Tools Evans-Pritchard, E. E. (1987). â€Å"The Notion of Witchcraft explains Unfortunate Events,† Witchcraft, Oracles and Magic among the Azande. Oxford: Clarendon Press. a) Constitution is in the making of man. It entails a set of laws or norms that are involved in structuring, creating and defining limits of power or authority possessed by government. A constitution is used to give states identify since all states that have got constitutions are referred to as constitutional states. In the context of phenomena, constitution is the process of using a category to create or come up with knowledge or perceptions about something. A description is very different from constitution in that whereas a description is the concerned with defining an item, constitution is creation of ideas, thoughts or shapes. Constitution is used to define the structuring or production process of anything. In the context of culture, the outcome of culture or that which is attributed to culture is considered as a product of the constitution process. On the other hand, definition of the meaning of culture and what it entails is termed as description. A distinction between constitution and description is realized in the description of witchcraft within the Zande community by Evans-Pritchard, 1987. The physiological state of a person that is linked to witchcraft is a mere description of the activity. On the other hand, a constitution is what will yield or be generated from witchcraft. Witchcraft from the wording itself is a mere description of some kind of psychic acts. However, constitution is what is synthesized from this act or from the notion itself. The reason why Evans-Pritchard has made this distinction is to show reality in the light of witchcraft within the Zande community. The Azande are so glued into linking everything with witchcraft; therefore, the writer tries to show distinction between reality and witchcraft by giving an elaborate distinction between description and constitution of categories. This way, he tries to change the notion of Azande from thinking that every mysterious thing that happens is due to witchcraft. In the context of reality and the internal knower, symbols and language are used to describe culture. The shift towards seeing categories as generative is seen through activities which are as a result of certain categories. A category is composed of certain elements with some common characteristics. It is the common characteristics that enable the categories to become active and achieve a certain goal. In the Zande community for example, witchcraft has been described as a psychic act. On the other hand, it has been solely associated with constituting unfortunate events among men. The objective description in this case is that witchcraft is associated with one’s physiological state. Evans-Pritchard believes that the physiological state used to describe witchcraft is nothing more than a passage of food through the small intestines. It is this objective definition of witchcraft that seems to be embedded in the shift of witchcraft from an objective description to a generative category. The generative nature of witchcraft is seen in its role to explain occurrence of unfortunate events as well as in regulating the conduct of people. b) The shift from describing to being generative lies in the fact that, description is the initial process used to come up with a category. Once a certain category of people or items is formed, they are used to generate and produce an intended outcome. Alternatively, they are linked to the generation of certain results. This way, the change in framework from descriptive to generative is enhanced. When this framework changes, explaining the history of a category shifts as well. This occurs in that, instead of giving the history of a category with respect to description, the generated outcome of the category is used to explain its history. In the Zande community, witchcraft is attributed to physiological factors. Consequently, it is associated with generating mysterious negative effects on man. However, with time, the association of categories such as witchcraft, with mysterious negativity derives a different meaning and there is need to shift the explanation. In the Zande community, witchcraft is considered to be generative in every aspect of the Azandes’ lives. Each and every mysterious occurrence in the lives of the Zande community is considered to be linked to witchcraft. Several claims are made with regard to witchcraft. For instance, among the Azandes, when blight attack groundnuts in the field, this is attributed to witchcraft. Also, if women tirelessly bail water from a pool and only manage to draw a few minuscule fish, witchcraft is said to be responsible for this mysterious occurrence. If a wife, contrary to other days, is unresponsive and gloomy, it is said that witchcraft is the cause. Evans-Pritchard has compared the occurrence of misfortunes in the Zande community to the occurrence of misfortunes among the African people. He has gone further to show that the Azande attribute witchcraft to a chain of causation for conditions which when looked at closely, relate a person to natural occurrences. Therefore, if the occurrence of events were to be understood in a more realistic manner, the explanation of generative categories would have to change. Evans-Pritchard has showed how this would be done. In all those circumstances where witchcraft was seen as the cause of misfortunes, it was during that particular moment that witchcraft was seen as the cause of the misfortune. This is perceived to mean that witchcraft is not solely responsible for every kind of bad luck. Therefore, the explanation would shift from a generalized understanding to a more specific one. Witchcraft, according to the people of Azande, is used to explain the occurrence of coincidence which causes harm to man. c) The shift from description to seeing categories as generative provides a way to think about rationality, irrationality or their interrelation. To examine this, the paper will look at the belief held by the people on what and who is associated with witchcraft. From a rationale point of view, this is just a timeless category without any basis or governing principle. The community of Zande can be termed as an irrational group because of the way they attribute witchcraft to occurrences which, a normal and ordinary person would attribute to natural calamity or mere coincidence. The Azande did not practice any rationality in as far as existence of phenomena is concerned. They do not believe in the existence of phenomena, much less mystical causation. They hold the view that witchcraft is the cause for that which happens mysteriously. The irrationality of the Azande is manifested by the fact that they cannot accept that things can occur through mere coincidence. They have used witchcraft to explain the occurrence of mysterious events. This is irrational of them as there are no facts to back up their ideology. The mere fact that witchcraft is a psychic act could also mean that it is attributed to some positive occurrences. However, this is not so as only the negative aspect of occurrences is linked to witchcraft. On the other hand, the Azande have applied some rationale in as far as why some things do happen. For example, the Azande are very much aware that termites eat up the support of a granary thus can fall or collapse at any moment. This is a show that the Azande think rationally. However, irrationality comes in when they relate witchcraft to the collapse of a granary in the presence of people. The Azande do apply rational thinking to explain occurrences but when a negative outcome is impacted on man, this is linked to witchcraft despite the fact that it may not necessarily be the case. This is the interrelation between rationality and irrationality within the category of witchcraft among the Azande.

Competition in the coffee industry

Competition in the coffee industry INTRODUCTION Today we stand witness to a new coffee era, one made up of Caffe Lattes, Espresso Macchiatos, Cappuccinos and Frappuccinos. Specialty Coffee is here to stay and no one will be more eager to tell you that than Howard Schultz, CEO of Starbucks, the worlds largest specialty coffee bar. The study of Starbucks Corporation leads one on a multifaceted journey through an organizations insinuation into a culture, its dominance of a market and its creation of a brand synonymous with loyalty, integrity and longevity. Ever since it first spread through the Moslem world in the sixteenth century, coffee has played a pivotal role in society by providing meeting places for intellectuals from all sides of life to converge. As coffee was slowly introduced to the European world it was recognized for both its sociability and its taste. Soon Coffee houses were prevalent throughout Europe and were the natural locations for political, literary and societal debate. It crossed the Atlantic Ocean in the mid-seventeenth century and replaced beer as New York Citys favorite morning drink. Starbucks Corporation is an international coffee and coffeehouse chain based in Seattle, Washington, United States. Starbucks is the largest coffeehouse company in the world, with 16,635 stores in 49 countries, including 11,068 (6,764 Company Owned, 4,304 Franchised) in the United States, followed by nearly 1,000 in Canada and more than 800 in Japan. Starbucks sells drip brewed coffee, espresso-based hot drinks, other hot and cold drinks, snacks, and items such as mugs and coffee beans. Through the Starbucks Entertainment division and Hear Music brand, the company also markets books, music, and film. Many of the companys products are seasonal or specific to the locality of the store. Starbucks-brand ice cream and coffee are also offered at grocery stores. Michael E. Porter provided a framework that models an industry as being influenced by five forces. The strategic business manager seeking to develop an edge over rival firms can use this model to better understand the industry context in which the firm operates. Porters Five Forces of Competitive Position: Industry Rivalry The dynamics of the industry rivalry within the specialty coffee industry has changed dramatically since 1987. Unlike the early days of the specialty coffee industry when Starbucks competed primarily against other small-scale specialty coffee retailers they now compete against companies of varying sizes and different exposures to specialty coffee. Starbucks competes with a variety of smaller scale specialty coffee shops, mostly concentrated in different regions of the country. All of these specialty coffee chains are differentiated from Starbucks in one way or another. Coffee Bean competes with Starbucks. They are similar to Starbucks in their attempt to create a third-place but distinguish themselves by creating an entirely different atmosphere. Where Starbucks strives to create an upscale European atmosphere, Coffee Bean tries to implement a more American feel to their coffee houses. Often they will use knotty pine cabinetry, numerous fireplaces and soft seating. Also they offer a barrage of magazines and newspapers as well as the guarantee of speedy service and free refills. In addition, they offer free WiFi, drive through accessibility and meeting rooms for rent. Through their subsidiary VKI technologies, they have become the world leader in the design, manufacture and distribution of coffee making equipment and related products. In addition to these smaller scale specialty coffee companies, Starbucks must now compete against two of the largest companies in the fast food industry who have recently entered the specialty coffee segment. The first of these competitors is Dunkin Donuts, who claims to be the worlds largest coffee and baked goods chain. Currently, Dunkin Donuts operates about 5,500 franchises around the United States, 80 stores in Canada and 1,850 throughout the rest of the world. In the past couple years the franchise has put enormous emphasis on their coffee beverages. They serve coffee beverages in an assortment of types and styles including espresso, cappuccino and latte. They also serve their coffee in an assortment of flavors including French Vanilla, hazelnut, cinnamon and numerous others. The largest industry rival currently facing Starbucks is the McDonalds restaurant fast food chain. McDonalds originated from a single San Bernardino, California hamburger stand, which opened in 1948, and has turned into what is now the worlds largest restaurant chain with over 14,000 restaurants in the United States alone. The key to McDonalds success has been the consistent quality standards they achieve for their food, coupled with their quick service and low prices. 10 years ago Starbucks and McDonalds were at complete opposite ends of the spectrum in the restaurant industry. However, McDonalds, encouraged by the success of its upgraded drip coffee, began testing numerous drinks sold under the name McCafe. Starbucks meanwhile, with its rapid expansion, was adding drive-through windows and numerous breakfast sandwiches, similar to the Egg McMuffins served at McDonalds, to their stores. These measures have drawn the two companies closer together as competitors due to an encroachment into the demographic consumer base made by each company. In summary, the current impact of the industry rivalry force created by the competition between specialty coffee retailers is very high, especially as contrasted to what it was at the time of Starbucks rapid expansion twenty years ago. The growth of the industry has slowed while the number of competitors within the industry has increased. Both of these factors, in addition to Dunkin Donuts and McDonalds high strategic stakes in the specialty coffee industry, have caused this change from weak to strong industry rivalry. Potential for New Entrants Another of the five forces in Porters model, which has changed significantly since the late 80s when we analyze the current environment in which Starbucks competes, is the potential for new entrants. As stated earlier, the primary deterrents to entry in the specialty coffee industry are the various barriers to entry. The economies of scale within the specialty coffee industry have increased as the size of the top players has increased. Companies such as Dunkin Donuts and McDonalds have national distribution channels through which they can transport their specialty coffee at a relatively low cost compared to potential new entrants who have no such developed distribution systems. These larger companies are also able to economize on their accounting operations and marketing budgets by facilitating their specialty coffee operations from the same department as for all segments of their businesses. Finally, these larger corporations are also able to reap economies of scale through their purchasing by negotiating long term contracts with coffee farmers and purchasing coffee beans in bulk quantities at discount prices. There is numerous cost disadvantages imposed on new entrants that are independent of the economies of scale considerations. As the industry matures, the ability to access distribution channels and select from the highest quality coffee beans has becoming increasingly difficult. Most of the favorable store locations within the larger metropolitan areas have already been occupied by current competitors within the specialty coffee industry. Additionally, many companies now have proprietary product technology involved in the production of their specialty coffee as well as lower per unit costs due to an experience curve. Product differentiation within the specialty coffee industry has moved away from the purely objective and defined traits such as the taste of the coffee, convenience of the stores and prices charged. The industry has progressed toward more subjective traits such as the ambience of the store, the social responsibility of the company and brand identification. Many companies have gained very loyal customer bases stemming from their past advertisements, customer service, objective product differentiations and early entry into the industry. All of this makes it more difficult for new entrants to gain a solid customer base. From the analysis above, it can be ascertained that the barriers to entry in the specialty coffee industry have increased substantially. As a consequence, the potential threat of new entrants has gone down. Since, the industry does not have large capital requirements, smaller specialty coffee shops are still prevalent throughout the United States and the potential for more of them to enter the industry is still present. However, these new entrants can be disregarded given the unlikely nature of their concerted expansion and the inconsequential effects they have singly on the overall demand in the consumer market. Substitute Products The force created by substitute products in the specialty coffee industry has decreased. Many companies that presented the specialty coffee industry with a threat in the form of substitute products have actually entered the industry and now compete directly by offering their own premium coffee selections. The primary substitute products still posing a threat to the specialty coffee industry are the caffeinated soft drinks offered by Pepsi and Coca-Cola. However, even these substitute products pose little threat to the premium coffee industry. In the past five years, studies done on the percentage of meals or snacks that included a carbonated soft drink as opposed to coffee have shown a reversal in consumer preference. Coffee has gradually gained preference over carbonated soft drinks. This is mostly attributed to the health concerns associated with carbonated soft drinks and the new evidence showing coffee as a relatively healthy alternative. Supplier Bargaining Power With the extensive growth in the specialty coffee industry, supplier bargaining power has changed in numerous ways. In 1987, when the first Starbucks was conceived, the farmers from whom Starbucks purchased its premium coffee beans were numerous, small and unconnected to one another. Currently, many of the farmers who sell to Starbucks and other premium coffee chains are united by an initiative known as fair trade certified coffee, which was organized by TransFair USA. Under this initiative, companies such as Starbucks are given the opportunity to advertise their coffee as being fair trade certified if they purchase from coffee suppliers that are democratically owned cooperatives. This initiative was designed to ensure that the coffee farmers would be compensated fairly for their crops. Their increased unity under this initiative worked as a positive externality by increasing their ability to exert bargaining power over their buyers. The fair trade coffee certification is looked at by consumers in their decision of where to purchase their premium coffee. Thus, although the farmers are still numerous and small they are now connected through the initiative launched by TransFair USA and act in some respects like one large entity. Although the farmers of premium Arabica beans are still in constant competition with the substitute Robusta coffee bean growers, their bargaining power is not significantly diminished by this threat due to the unlikelihood of a big premium coffee retailer adopting the substitution. When Starbucks first began purchasing premium Arabica coffee beans in the late 1980s, they executed purchases incrementally throughout the year. Currently, they lock their coffee suppliers into long-term contracts to dilute potential price volatility. These contracts have stipulations within them which place a financial burden on the coffee suppliers if they choose to supply a different company. By creating these switching costs for the premium coffee suppliers, Starbucks has diminished their ability to play one buyer against another, which decreases their bargaining power. A last component to the analysis of supplier bargaining power within the current specialty coffee industry environment is the threat of forward integration. Technically, the farmers can forward integrate by setting up smaller coffee shops and brewing their own batches. This is, however, extremely unlikely and has yet to occur. When comparing the bargaining power of suppliers today in the specialty coffee industry to the bargaining power of suppliers during the late 1980s, it is apparent that suppliers are more powerful today. The increased unity among the coffee farmers, decreased significance of specialty coffee retailers purchases as a proportion of premium coffee bean sales and increased importance placed on high quality coffee beans by the purchasers have all acted to increase the bargaining power of the supplier group. Although Starbucks has locked some of the coffee suppliers into long-term contracts not all suppliers are affected; thus, the supplier bargaining power is only ma rginally diminished by that tactic. Bargaining Power of Buyers The last component of Michael Porters five forces analysis to be applied to the modern specialty coffee industry is the force created by the bargaining power of buyers. The primary buyers in the specialty coffee industry remain individual consumers, who neither engage in concerted behavior nor individually purchase in large volumes relative to the total sales of a corporation such as Starbucks. Unlike the late 1980s, however, there are a few buyers who purchase in large volumes. These large buyers are typically other multinational corporations who choose to serve Starbucks brewed coffee in their offices. However, the effects of losing one of these buyers to a competitor would not be detrimental to a company with a large sales volume such as Starbucks. Neither the individual consumers nor the multinational corporations who purchase specialty coffee commit a significant fraction of their resources to these purchases. This makes the buyers less sensitive to price fluctuations and gives the players within the specialty coffee industry more control over pricing. This acts to decrease the bargaining power of both the buyer groups. The expansion of the specialty coffee industry created a wider array of competitors who offered high quality specialty coffee. This made it much harder for the players in the specialty coffee industry to differentiate themselves through quality and turned quality into the industry standard. In addition to the increasing quality standardization which specialty coffee has undergone, the buyers face no switching costs and have an enormous selection of retailers from whom they can buy. The buyers of specialty coffee do pose a credible threat of backward integration. This threat can be carried out if a buyer chooses to start a mom and pop specialty coffee store in close proximity to an established specialty coffee store. Same-store sales are roughly 20% lower in Starbucks stores located within a two block vicinity of mom-and-pop specialty coffee stores. The ability of buyers to backward integrate is enhanced by the availability of all information regarding the demand, market pricing, and supplier costs in the specialty coffee industry through sources such as the World Wide Web. With full information, the buyer is in a better position to ensure that they pay a favorable price and receive an appropriate level of quality from the product. The amount of bargaining power that can be exerted by the buyers within the specialty coffee industry has increased as a result of the availability of information regarding market variables. This along with the other previously discussed changes to the dynamics of buyer bargaining power has increased its overall magnitude from the level it was at in the late 1980s. Limitations of Porters Five Force Model Porters model is a effective tool used to identify whether new products, services or businesses have the potential to be profitable. However it can also be very illuminating when used to understand the balance of power in other situations. Porter argues that five forces determine the profitability of an industry. At the heart of industry are rivals and their competitive strategies linked to, for example, pricing or advertising; but, he contends, it is important to look beyond ones immediate competitors as there are other determines of profitability. Specifically, there might be competition from substitutes products or services. These alternatives may be perceived as substitutes by buyers even though they are part of a different industry. An example would be plastic bottles, cans and glass bottle for packaging coffee for Starbucks. There may also be potential threat of new entrants, although some competitors will see this as an opportunity to strengthen their position in the market by ensuring, as far as they can, customer loyalty. Finally, it is important to appreciate that Starbucks purchase from suppliers and sell to buyers. If they are powerful they are in a position to bargain profits away through reduced margins, by forcing either cost increases or price decreases. This relates to the strategic option of vertical integration, when Starbucks acquires, or mergers with, a supplier or customer and thereby gains greater control over the chain of activities which leads from basic materials through to final consumption. It is important to be aware that this model has further limitations in todays market environment; as it assumes relatively static market structures. Based originally on the economic situation in the eighties with its strong competition and relatively stable market structures, it is not able to take into account new business models and the dynamism of the industries, such as technological innovations and dynamic market entrants from start-ups that will completely change business models within short times. For instance, coffee and soft drinks is often considered as being highly competitive. The industry structure is constantly being revolutionized by innovation that indicates Five Forces model being of limited value since it represents no more than snapshots of a moving picture. Therefore, it is not advisable to develop a strategy solely on the basis of Porters models Haberberg and Rieple, but to examine it in addition to other strategic frameworks of SWOT and PEST analysis. Nevertheless, that does not mean that Porters theories became invalid. What needs to be done is to adopt the model with the knowledge of their limitations and to use them as a part of a larger framework of management tools, techniques and theories. This approach, however, is advisable for the application of every business model. CONCLUSION Any company must seek to understand the nature of its competitive environment if it is to be successful in achieving its objectives and in establishing appropriate strategies. If a company fully understands the nature of the Porters five forces, and particularly appreciates which one is the most important, it will be in a stronger position to defend itself against any threats and to influence the forces with its strategy. The situation is fluid, and the nature and relative power of the forces will change. Consequently, the need to monitor and stay aware is continuous. Some issues during the implementation of these Five Forces are crucially important for organizations to build long-term business strategy and sustaining competitive advantages rather than simply list the forces. Successful use of the Porter Model Analysis includes identifying the sources of competition, the strength and likelihood of that competition existing, and strategic recommendations for the action a company should take to in order to develop barriers to competition. Having applied Michael Porters five forces model to the specialty coffee environment which confronted Starbucks in 2007, a conclusion can be logically derived regarding how the proportional effects of each force on the competition within the specialty coffee industry has changed since 1987. Specifically, the force created by industry rivalry has gone from one grounded in strategies of differentiation and focus while discouraging price wars to an extremely competitive environment where differentiation is increasingly difficult and price wars are looming. The strength of the force imposed by the potential for new entrants has decreased as a result of more formidable barriers to entry. The bargaining power of both suppliers and buyers has increased as a result of increased unity among the suppliers and the accessibility of information to the buyers. The threat of substitutes is still insignificant given the continued declining sales of carbonated soft drinks compared to coffee and speci fically specialty coffee.

Wiliiam Shockley-Autobiography :: essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   William Shockley was born on February 13, 1910 in London, England. He is most famously noted for winning the Nobel Prize in physics in 1956. He won this for being the co-inventor of the transistor with John Bardeen and Walter Houser Brattain. Shockley’s parents were both Americans. His father, William Hillman Shockley, was a mining engineer born in Massachusetts. His mother, Mary Bradford, was a federal deputy surveyor of mineral lands. They returned to America when William was just a baby. They both were very encouraging for his love and passion for science, as well as his neighbor who was a professor of physics at Stanford. He got his B. Sc. Degree at the California Institute of Technology in 1932. Four years later he got his PhD from the Massachusetts Institute of Technology (MIT). He wrote his doctoral thesis on the energy band structure of sodium chloride. The title of this thesis was â€Å"Calculation of Electron Wave Functions in Sodium Chloride Crystals.†   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   After graduating from MIT, he went straight into work at Bell Laboratory. He did most of his research in solid state physics, especially vacuum tubes. Most of his theoretical advances led the company to conquer their goal of using electronic switches for telephone exchanges instead of the mechanical switches there were using at the time. Some of the other research he did was on energy bands in solids, order and disorder in alloys, self-diffusion of copper, experiments on photoelectrons in silver chloride, experiment and theory on ferromagnetic domains, and different topics in transistor physics. He also did operations research on individual productivity and the statistics of salary in research laboratories.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   From 1940-1945 Shockley worked on military projects from World War II. He was Research Director of the Anti-submarine Warfare Operations Research Group. After this he served as Expert Consultant in the office of the Secretary for War. He was particularly working on refining radar systems. As soon as the war was over, he went back doing solid-state research, investigating semiconductors.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Once Shockley returned to Bell Labs in New Jersey, he immediately joined a research group headed by Dr. C. J. Davisson. His group consisted of Bardeen and Brattain. Most of the time, he left them and worked alone. He would drop in on them occasionally to check up on their work. With Shockley’s idea of using field effects and applying the quantum theory to the development of semiconductors, Bardeen and Brattain succeeded in creating a point-contact transistor.

Introduction to Counselling Essay

   Definition of a Counsellor Counselling is about to give help rather than advice, advice frequently means telling people what they should or ought to do, and this has no place in counselling. Counsellors look at what is possible, but do not tell clients what they should do. That would be the counsellor taking control rather than the client gaining control. The primary difference between counselling and other forms of helping is the way in which the counsellor listens. A counsellor should always be factual within their notes, you should always take notes after a session while fresh on your mind, taking notes in a session can cause clients to maybe feel worried or nervous on what you’re putting down and also keep you interested and proven to be listening. The difference between advice, guidance and counselling Advice: Mainly a one-way exchange, giving an opinion, making a judgement, making a recommendation =Persuasive. Guidance: Mainly a one-way exchange, showing the way, educating, influencing, instructing =Encouraging. Skills of a counsellor Every person who uses counselling skills is designated a counsellor. We can distinguish two broad groups of people who use counselling skills, people who are called counsellors who engage in counselling as a distinct occupation and others who use counselling skills as part of their other skills. They would be temporarily in the role, for example we go to our doctor for something medical or a psychiatrist for something spiritually wrong these establish a helping relationship. What they offer is not counselling however they use counselling skills, they may also be trained counsellors so the dividing line is not clear cut. The difference is that the person knows when counselling is taking place and has agreed to it. Other skills you pick up on when counselling are: * Respecting personal space * keeping legs uncrossed and sitting relaxed * Being open with body language, * Bringing your body in to talk is being interested and sitting back shows you’re interested and engaged. * Memory is the key. * Try not to talk with hands or sit on them. * Clothing can be casual but formal depending on where you work * Setting a good first impression is important * Keep facial expressions to a minimum show expression but limit to how much. * Eye contact should be minimal keep eyes moving around the face * Think about distractions before your client arrives * Keep your client informed on what we’re going to do and not do. * Being agreeable and willing to be there, and most importantly helping your client to get back on track. Values of counselling and psychotherapy Values inform principals. They represent the important way of expressing a general ethical commitment that becomes more precisely defined and action-orientated when expressed as a principal. At all times counsellors must show a commitment to: Respecting human rights and dignity Protecting the safety of clients Insuring the integrity of practitioner/client relationships Enhancing the quality of professional knowledge and its application Alleviating personal distress and suffering Fostering a sense of self that is meaningful to the person(s) concerned Increasing personal effectiveness Enhancing the quality of relationships between people Appreciating the variety of human experience between people Striving for the fair and adequate provision of counselling and psychotherapy services Ethical principles of counselling and psychotherapy Principles direct attention to important ethical responsibilities, there are six ethical principles that are used which also help on making decisions when looking over them, they are as follows: * Being trustworthy – honouring the trust placed in the practitioner, he’s to building good understanding and helps your client being able to open up if the trust is there. * Autonomy – respect for the clients to be self-governing, this is important to allow and help our client to gain their ability to be self-directing. * Beneficence – a commitment to promoting the clients well-being, always acting in the best interests of the client based on professional assessment. * Non-maleficence – a commitment to avoiding harm to the client, do not take advantage of the client at their most vulnerable part in their life i.e. sexual, financial, emotional or any other form of client exploitation. * Justice – the fair and impartial treatment of all clients and the provision of adequate services, a commitment to fairness requires the ability to appreciate differences between people and to be committed to equality of opportunity, and avoiding discrimination against people or groups contrary to their legitimate personal or social characteristics. * Self-respect – fostering the practitioner’s self-knowledge and care for self, seeking counselling or therapy and other opportunities for personal development as required. The practitioner’s personal moral qualities are of the utmost importance to clients. Personal moral qualities The practitioner’s personal moral qualities are of the utmost importance to clients. Many of the personal qualities considered important in the provision of services have an ethical or moral component and therefore considered as virtues or good personal qualities. It is inappropriate to prescribe that all practitioners possess these qualities, since it is fundamental that these personal qualities are deeply rooted in the person concerned and developed out of personal commitment rather than the requirement of an external authority. Personal qualities to which counsellors and psychotherapists are strongly encouraged to aspire include: Empathy: The ability to communicate understanding of another person’s experience from that person’s perspective. Understand and letting them know that you understand Sincerity: a personal commitment to consistency between what is professed and what is done. Being honest, saying something and meaning it. Being able to be sincere and li sten to your client rather than talking. Integrity: commitment to being moral in dealings with others,  personal straightforwardness, honesty and coherence. Trust is very important. Resilience: the capacity to work with the client’s concerns without being personally diminished. Being able to hear what your client is saying to you and being able to stay there and not feeling the need to leave or cry with your client because of their story you are hearing, being able to hold your own. Respect: showing appropriate esteem to others and their understanding of themselves. Appropriate esteem and understanding themselves, respect that the person respects themselves. Not judging why they got to that point and help them understand why they got to this point. Humility: the ability to assess accurately and acknowledge one’s own strengths and weaknesses. Believing your good at something, work towards not feeling that you’re put down and low. Competence: the effective deployment of the skills and knowledge needed to do what is required. Keep improving skills, knowing you know what you are doing but you can build on it. Fairness: t he consistent application of appropriate criteria to inform decisions and actions. Knowing your able to meet your clients’ needs and if not discuss you could refer them to someone else, also about being fair to self, make sure your always being fair to your clients in the decisions you make. Wisdom: possession of sound judgement that informs practice. Sound judgement, understanding boundaries. Courage: the capacity to act in spite of known fears, risks and uncertainty. To be able to sit and listen to your client’s story, having the courage to be honest to your client. Non-verbal communication Awareness of non-verbal communication between the listener and the talker; we try to be aware of how we use our own bodies and how the talker uses their body to communicate. * Eye contact – keep eye contact minimal and moving around the face. * Facial expression – show expression but be limiting to how much you show. * Body posture – keep legs uncrossed and body straight, keep body language open. * Body movement – bring your body out to show you’re interested and bring body in when you’re really taking in what your client is saying. * Head nodding – is a strong thing to do shows your listening. * Proximity/position of chairs – positioning of the chairs is important as not to be directed in front of each other. Why we use this skill? * To show talker that the listener is paying attention. * To try to communicate that the listener is present. * To create a warm environment. * To encourage the talker to open up. * To begin to build a trusting relationship. Minimal encouragers Minimal encouragers are a form of verbal communication. They are brief sentences or a single word. Examples include: * ‘Go on’ * ‘Tell me more’ * ‘And’ * ‘Because’ * ‘Mmm†¦Ã¢â‚¬ ¦.’ * ‘Ah ha’ * ‘Oh’ Using some of your minimal encouragers will help to keep your client talking and prompt them to continue in there story. * To show the talker that the listener is paying attention. * To communicate that the listener is present. * To encourage the talker to continue their story. Reflecting A reflection is offering back what the talker has said but it includes the feeling that the listener thinks was communicated. Feelings might be contained in the words the talker is using or feelings might also show themselves in how the talker presents i.e. looking sad or showing that they are angry. Why we use this skill? * To check or show that the listener has understood. Gives client confidence that the listener is actually paying attention in what the client is saying * To help the talker become aware of their feelings. Gives the client the option of discovering what they are actually feeling for themselves. * To work closer in the relationship. Gaining your clients trust to build a relationship. * To create a sense of intimacy. As your allowing your client to hear what they are saying and showing that the feeling you may be providing them with helps them to know you are truly listening to them. Paraphrasing Paraphrasing is to offer back in a few words what the talker has said in order to check understanding and communicate your attention. Paraphrasing can be good to help your client to hear what they have said and they know you have heard what they have said. Helps to show you are trying to understand what your client is saying. Why we use this skill? †¢To give the talker an opportunity to hear back what they are saying. As it can be very helpful for your client to hear back what they have said. †¢To check or show that the listener has understood. It also gives your client confidence that you have listened and heard what they have to say. †¢To invite further exploration of the talker’s story. It helps your client maybe feel more confident and open to talk more freely. Example: Talker: It’s been a rough week. I’ve done nothing but argue with my partner, the house has been burgled, there’s bad news from the hospital†¦at least I got a win on the scratch-card. Listener 1: You got a win on the scratch-card Listener 2: It’s been a rough week. Listener 3: You’ve been arguing with your partner †¢What do you think of the different listener’s responses? I think listener 2 is a much better response to what the client has said as leaves the story open for the client to decide where they want to go next. †¢What do the responses say about the listener’s points of view? Listener 1) is very in appropriate as quite a few bad things gone on for your client. Listener 2) leaves it open for your client to choose what to talk about Listener 3) is also a good thing to say but doesn’t give the client a chance really to decide what they would prefer to talk about. * What other responses can you think of? Maybe number 2) but also ask client to describe maybe the worst part about the week? Summarising A summary is an overview of what the talker has been talking about during the session. A summary can be used during the session as well as to end the session. Think about the main points of a session and say it back to your client. Summarising really helps letting your client know you are really listening and heard what they have said. Knowing if a silence is that your client is thinking, or gone quiet as maybe a bit lost so you could recap what your client has told you. Re capping can help to start your client talking again. Near the end of a session say to your client you have a few minutes left so let’s summarise and the pick out points, once relayed back ask your client if they would like to add anything else. Why we use this skill? * To communicate that the listener has heard and understood the content of the session. * To gather important points together. * To help the talker decide which points they want to talk about in more detail. * To help the talker if they are stuck, going round in circles, confused or if the session needs moving forward. Counselling Contract †¢Place, time, dates †¢Number of sessions †¢Confidentiality and limitations †¢Supervision and note taking †¢Model of counselling used †¢Fees and cancellation arrangements †¢Out of session contact Having a contract helps your client to know what’s expected of them, also what is going to happen. Confidentiality and limitations Offering confidentiality is part of a counsellor’s contract with their clients but there are limits to this at which point further action will be needed. What are the limits? †¢At risk – a person, who is deemed to be at risk to self or others, so could be talking about harming his self or others. †¢Children – any child at risk of abuse, maybe a partner hurting or abusing the child. †¢Vulnerable persons – vulnerable people at risk of abuse, by client or there partner. †¢Terrorism Act – there is a terrorism hotline number, for instance if someone said they were taking a bomb to the mall ECT. †¢If working for an agency you would follow their guidelines around confidentiality. If at any time you hear you client talk about any of the limits you have discussed, you need to make your client aware that you have to break the confidentiality. Other limits include: †¢Supervision – client material discussed with a supervisor, although this could be discussed with clients permission about their case but not mention there name. †¢Note-keeping – brief and factual notes made after each session, as a client has the rights to ask for their notes to see.

Mandatory Civil Service

Mandatory Civil Service Every person should be entitled to protection and provision by his or her nation. There is no single person brought up as a citizen of this country who can claim that he or she owes nothing to this nation. Just as every adult is nurtured in this country, it would be right if something were given in return to the mother country as a gesture of respect for duty.Advertising We will write a custom essay sample on Mandatory Civil Service specifically for you for only $16.05 $11/page Learn More According to General MacArthur, â€Å"Duty, honor and country: Those three things determine what one ought to be, what one can be, and what one will be.† (MacArthur 2). It is impossible to pay back the generosity of the country in equal measure, but a gesture of gratitude can help foster a sense of duty and obligation in every citizen. In this essence, it is appropriate that every young person in the country engages in an activity in service of the nation. Barak Obam a said, â€Å"We cannot continue to rely only on our military in order to achieve the national security objectives that we’ve set. We’ve got to have a civilian national security force that’s just as powerful, just as strong, just as well-funded.† (qtd. in Elliot 5). Those were president Obama’s words to American people in July. It is also important to mention that the particular service is only appropriate when the person involved is young. It is easier for anyone to manage such a service when responsibilities are few. This service goes further to increase the labor power of the people in the country. For their civil service, the young citizens will get remuneration and compensation for their constructive contribution to the nation. In that case, it is necessary to serve the nation as a citizen if one has no apparent duty in any other sector of the economy. This call comes rather as an obligation than as a statutory requirement. For many years, som e young people have been trying to avoid fulfilling their responsibilities, leaving a few willing individuals to work on their behalf. There are those who work in the civil service as a way of paying the community back. Others are forced to engage in country service for years due to some circumstances rather than their own will. This is particularly true for those youth who have deprived backgrounds. Youth coming from poor families have to work since there is no other support coming from the government or their parents. Others are rich enough not to engage in a service of any kind since they regard it humiliating to serve the nation. This kind of attitude is detrimental to the development of our society. Therefore, we must instill a sense of duty and obligation in every young citizen of this country. This policy could be a better solution to problems affecting many youths in this country. Currently, this country is the greatest consumers of narcotics. The consumption can be attribut ed to the idle young people who have a lot of free time and money, which they may have obtained from their parents or even from illegal activity. This decadence and the lack of any sense of responsibility are likely to lead this country to many problems in future since at that particular time, the current youth will be at the helm of the country.Advertising Looking for essay on public administration? Let's see if we can help you! Get your first paper with 15% OFF Learn More This action presents an opportunity for the people of this country to solve the perpetual problem of labor. If all young people work in the civil service for a short time, this will ease the burden of labor off the working population. We are more likely to experience labor problems and complaints in future. We can take advantage of the young population to increase the productivity of this country. This program is not only aimed at engaging young people in socially important activities util izing their abilities, but it is also an opportunity to train young people on the basic requirements of dealing with various situations in life. People in their teenage years have energy but lack skill to use their skills for a constructive purpose (Smolla 119). No responsible person would like to be idle and unproductive. Thus, since we consider our youth well-meaning, it would be better to engage them in a productive activity. This idea can be seen to violate the principles of liberty. However, it is important to note that the youth undertaking the mandatory civil service will not be kept in service longer than the required time. The duration which one will work in the civil service is also limited. This shows that the program is not meant to exploit the young people for any reason but to train them on the right approach to life. It is also an important program for their country. In fact, this strategy benefits the youth more than any other group in the country. It is, therefore, imperative that the young people themselves support this plan. It is not our intention to impose unwanted duties on the youth. Some places, such as Thailand, have seen the success of this policy on a smaller scale (Smolla 115). South Korea, one of the fastest developing economies in the world, has also implemented this policy (Cho 189). According to all the future benefits of the program, it is possible to make this great idea real and advantageous to this country. Cho, Kuk. Conscientious Objection to Military Service in Korea. Oregon Review of Internal Law 9.2 (2007): 181-108. Print. Elliot, Brenda J. SecDef’s â€Å"Soft Power†: Civilian Expeditionary Workforce RBO. 28 May 2012. Web.Advertising We will write a custom essay sample on Mandatory Civil Service specifically for you for only $16.05 $11/page Learn More MacArthur, Douglas. General MacArthurs Thayer Award Speech Duty, Honor, Country (1962). Department of Defense Pamphlet GEN-1A, US Government Printing Office, 1964. Web. Smolla, Rodney. Community Service Programs. Law and Contemporary Problems 62.4 (2011): 112-124. Print.

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buy custom Bodybuilding and Health in Athletes essay In athletics, the most important aspect of training schedule remains diet. Eating right things increases an athletes ability to train, not forgetting effectiveness. Carbohydrates, fat, protein and sugars are the core food groups that offer the body an adequate supply of energy. The right percentages of these nutrients in an athletes diet should be: 40% of carbohydrates like whole cereals, bread, potatoes and pasta, 40% of fruits and vegetables, 10% of proteins like fish and meat, finally 10% of fat which can be from milk and all dairy products. Currently, sports supplements are available on the market and many athletes have embraced their use because they have believed that they enhance their diet. Most athletes experience drastic changes in their bodies after taking these supplements, therefore, it is advisable that one consults a legal dietician or health officer before using any supplement. When most people hear about bodybuilding supplements, they quickly think of steroids that puff up peoples muscles in one night. This should not be the belief because supplements play a vital role in health and in enhancing performance in fitness exercises and weight training sports. The setback comes about in finding out the sfe ones to use and the right amount to be taken to in order to attain the intended result. Protein and creatine are among the most vital sport supplements available on the market today. Let us simply look at each of these two. Protein Protein supplement is a powder that usually contains: whey protein, vitamins and other nutrients. Whey is very useful to the body because it is easily absorbed. It is better than Soya or egg products and it is most efficient when taken as a solution; for example it can be dissolved in water or milk and taken before going to bed, in the morning and after exercise. It can also be consumed after exercise. Bodybuilders often take it before and after exercising and sometimes in place of normal meals. Protein is very essential for efficient growth and repair of muscle tissue; this being a reason as to why protein supplementation is very essential for athletes, especially bodybuilders to enhance their body mass. Creatine Creatine is an organic acid in the body that helps in supplying the muscles with energy. Most scientists have discovered that creatine reduces recovery time and mental fatigue, improves brain function, and increases energy, strength and muscle mass. CCreatine has an advantage over other supplements and even steroids because plenty of it can acquired in plenty from normal foods like beef and fish. Creatine is popularly used by body builders and rugby players .Creatine levels in the body are easily exhausted if the body is highly active and the body normally takes a long time to recover them. It is for that reason that creatine supplements are recommended for athletes to keep creatine in good levels for their muscles to withstand constant hard work. A percentage of the public have raised doubts over the effectiveness of creatine supplements in relation to performance but a great number of researchers have proved beyond doubt that it does meet the desired goal. However, the effects of this supplement vary in different athletes and this is the explanation as to why some are dubious and others are satisfied users. It is not obvious that creatine supplement works out well for everyone. In most cases, creatine makes the body unable to effectively breakdown large amounts of active ingredients. Intake of higher amounts of carbohydrate supplements in majority helps in creatine absorption. The side effects of creatine supplements are nausea and muscle cramps and to avoid these one must take a lot of fluids. Buy custom Bodybuilding and Health in Athletes essay

The Federal Reserve System Coursework Example

The Federal Reserve System Coursework Example The Federal Reserve System Coursework – Coursework Example The Federal Reserve System The structure of the Federal Reserve Banks and Board of GovernorsThe structure of the Federal Reserve Banks is a complete one. There are twelve districts where the Federal Reserve Banks are administered with the view of devolving power. Such a system also enables for satisfactory management of the Federal Reserve Banks payment system. The board of governors of each Federal Reserve Bank is constituted of three bankers and three business leaders. Three of the board members are government appointees, and this composition is designed with a view to demonstrating a different perspective in matters pertinent to decision making within the banks. It also helps the government by keeping an eye on issues that are related to decision making. The action of the board of governors and the operations of the banks are governed by laws to forestall any cases of irregularity. One of the recommendations is to improve on marketplace and technological developments such as elect ronic banking. This will help in coping with the increased competition that has been experienced by the private sector (United States, 1996).Independence of the Federal Reserve SystemThe Federal Reserve System ought to be independent of any political influence when undertaking to implement and design its monetary policy. Essentially speaking, economic decisions and measures cannot be left in the hands of the political elite such as the President and the US Congress. For economic development to be spurred and its effects to trickle down to the common man, highly educated and specialized economists who exude substantial experience must be engaged. This will guarantee sound decision making and creation of monetary policies that benefit the common man through extensive research and periodical economic evaluation and analysis.ReferencesTop of FormUnited States. (1996). Federal Reserve System: Current and future challenges require systemwide attention : report to congressional requesters. Washington, D.C: The Office. Bottom of FormTop of FormTop of Form

Women's role in Hinduisim and Judaism Essay Example | Topics and Well Written Essays - 2000 words

Women's role in Hinduisim and Judaism - Essay Example This work intends to look into the role of women in Hinduism and Judaism. In order to understand what views the religions hold, the work primarily focuses on religious texts rather than contemporary social reality. This is so because what is practiced in the society is often slightly different from what is prescribed. Admittedly, Hinduism and Judaism are much older than many other religions. (Tuyizere 66). A look into the position of women in Hindu religion will provide the researcher with a number of contradicting views because while women enjoy equal status with men in some places, cultures, and texts, they seem to face many restrictions in some other cases. The reason may be that Hinduism is not a single religion, but is a union of various religions possessing considerably different views. Anyway, Vedas and Upanishads are considered as the basic tenets of Hinduism, and hence, the research on any subject in Hinduism should begin there. To begin with, a look into Vedas shows that a daughter is considered inferior to a son. To illustrate, Rig Veda presents the reader with a number of prayers for the birth of sons (Rig Veda I.91.20; III.1.23). These brave and religious sons are considered important because a son is necessary to perform religious rites to the ancestors. Thus, without a son, salvation of ancestors becomes a difficult task (Rig Veda V.85.25). As a result of this position, there is a degree of uneasiness associated with the birth of a girl child (Atharva Veda. VIII. 6. 25). Similarly, a look into Atharva Veda shows various charms and rituals in order to ensure the birth of a son (Atharva Veda VIII.6). Despite these differences, one can find references indicating equal position enjoyed by boys and girls in the Vedic society. For example, Atharva Veda (XI.5.18) shows that girls spent their early years in Brahmacharya ashram

Leadership & Ethics Essay Example | Topics and Well Written Essays - 250 words

Leadership & Ethics - Essay Example Gandhi experimented by majoring on the weakest points of humanity. This problem on belief of the soul could not work. According to Gandhi, he could not explain his weaknesses to draw an answer from the likes of Lord Wavell or Hitler (Jagdeep S. et al, pp 979). Another weakness of Gandhi was evident between him and Kasturbai the wife. Gandhi forced his wife to do what opposed her internalized values. Gandhi portrayed the same coercion in relating to his children. This at times made Gandhi to oppose his notion of being non-violent. As women had been longed nurtured with role to embrace self sacrifice this element of being nonviolent proved violent. Gandhi possessed an element of repression and authoritarian. Gandhi never spoke to his son as he choose a different religion and went against his believes. Furthermore, Gandhi fell in love with her secretary and hence forcing her to fast and shave off. This was a sign of weakness. From this point of view there is no sense in being sexually attracted to one another if there exist violence and hang

Hugh Hefner Essay Example | Topics and Well Written Essays - 2500 words

Hugh Hefner - Essay Example Launched in 1953, the magazine's objective was centered on explicit sexuality. Playboy Enterprises (2000) Hefner has been known as the vanguard power behind this prolific company. However it is also evident that his lifestyle has been marred by marital scandals, which have resulted into various separations that have led to impeccable divorces. His innovative strategies have witnessed an incredible achievement of the Play boy Magazine and their fabulous life at large. Hefner is perhaps the first magazine to become rise and led a celebrity lifestyle. He was once arrested in Chicago in 1963, Illinois for being in possession of indecent photos of one of the movie actress Jayne Mansfield. By 1971 he developed a famous Playboy castle in Los Angeles. He also served in the U.S Army in WW11 after graduating Steinmetz. Peter Gregory (2005). Heffner was coupled with the indecisions for identifying the brand name; he was torn between Stag Party and Play boy. But through a collective reflected that hinged on the fabulous lifestyle and the exorbitant celebrity kind of a culture, Play boy had to outrun every suggestive brand name. Hefner's vision was centered on elevating the Play boy magazine to enjoy and champion the popular rule as the people's favorite series in America and even on global dimensions. Most of his competitors include esquire a magazine company that he worked with before, Merrion D.S (1997). Hefner is trying to create his Company had to contemplate about the trademark symbol, at first he thought a smoking jacket would do, but unfortunately he received an objection from the Stag Magazine lawyer that warned his against infringement. Playboy Enterprises (2000) while relaxing with his wife and colleagues, his wife suggested the Playboy thing; the rabbit drawing was likewise introduced on the second cover of th e page that reflected the beauty and glory of chic eyes if not a bikini knot. Jennifer White (2003) Although Hefner's wife at first thought that this Playboy acronym wouldn't hit the markets, the incorporation of the Rabbit symbol and the name blended to become a world famous. But owing to the financial constraints during his first experiences with the company, Hefner had to look out for a state of the deceptive art to promote his magazine. But since the 3-D and comic books were so myriad and popular at the same time, Hefner did a nude pictorial in a 3-D, inscribing those little glasses in every issue although expensive it was, at that time. I discovered that the Marilyn Monroe calendar-which everyone had heard about but nobody had seen-was owned by the John Baumgarth Calendar Co. out on the West Side of Chicago, very close to where I had grown up. But he thought of Marilyn Monroe, a Hollywood celebrity, and immediate conceived the potential of Monroe's nude photograph on his first issue. Playboy Enterprises (2000) Marilyn Monroe was the centerfold in the first issue of his playboy Magazine n December 1953. This issue featured as the only one to name its playmate 'Sweetheart of the Month'. In 1965 issue, playboy Magazine featured the first African-American centerfold. Peter Gregory (2005). Genesis to Opulence Playboy's sensational hit on the market was evident that time Hefner imported a nude photograph of actress Marilyn Monroe that he purchased. Since at this time Monroe was a star with the Hollywood moviemakers, so Hefner employed strategy of using his photography to

CALIFORNIA HISTORY Essay Example | Topics and Well Written Essays - 1250 words

CALIFORNIA HISTORY - Essay Example The gold rush saw the influx of people into the region, and the Native Americans found they were under pressure in their home. The native populations decreased at an alarming rate due to the destruction of natural resources. In the process of mining gold, water resources were damaged and the fish which the natives fed on died. Other game such as deers which were a source of food also left because of the increasing human population. Under this strain, the native population moved deeper into the forest areas as their numbers diminished. In 1911, however, a man belonging to this tribe emerged from the Mount Lassen region. Since he did not have a name the anthropologists named him Ishi. He was the last man of the Yana tribe. The story of Ishi is fundamental in the history of California since it gives the roots of the people in that region. It has, however, been said that retelling of the story by anthropologists such as Theodora are attempts to elicit sympathy for the Native American pop ulation. The Native American tribes that have since gone extinct are described as ignoble savages. They are believed to have had no art, religion, technology or government that warranted them to be called a culture. They are thought by some people to have been unworthy inhabitants of California region since they did not develop the natural resources of the place. This, in my opinion, is a mistaken view of the Native American. ... Culture takes into account the ability to learn. When Ishi came into contact with civilization, he was able to be integrated. He learnt their behavioural patterns, and started to act like one of them. This shows that these natives had the ability to learn. The only difference is that what he had to learn in his society was different from the things he could learn from the civilized world. Ishi was a man of Stone Age culture but that made him no less of a human being. The customs of the Yana separated males and females. At a tender age they were cared for by their mothers but at the age of ten, the separation was implemented. Boys and girls were then neither allowed to sleep, or play together. The boys left with their fathers or any other male relative so as to learn the necessary skills. This differentiation based on gender roles makes the Yana a society that understood what sex roles meant. This was a vital feature of their culture. The separation of the sexes was to the extent that male and female dialects of the language were different (Kroeber and Kroeber). Life and death was sacred to these people as evidenced by the practices they kept. When someone died, they were burnt and the remains buried under a rock. This marked the grave, and kept the animals away from the bones. This practice of burning the dead is still practiced in today’s society. The reasons are different though for this. They had their own way of acknowledging life and death. They realized the different genders and assigned societal roles along the same lines. Claiming that these people did not have aspects of life that warranted them to be a culture is a mistaken view. Art varies from society to the next. The Yahi community had a different kind of Art

Major Corporation Assignment Example | Topics and Well Written Essays - 500 words

Major Corporation - Assignment Example Wal-mart Corporation has managed to maintain corporate responsibility as a form of philanthropic effort by enhancing close relationship among all its stakeholders. Moreover, the corporation has managed to maintain social responsibility as a way of developing its success. The corporation has managed to enact its business practices according to the set legal and ethical values. For example, Wal-mart has always been able to maintain a clean name all over the years that it has been operation. The corporation has also been able to engage in corporate social responsibility (Kneer, 2009). This means that Wal-mart appreciates its customers and the community by engaging in various development activities for the well-being of the society. In order to achieve the best within the competitive business sector in America, Wal-mart has also managed to enact a number of core values. One of the core values include offering respect for all individuals associated with the company daily operations (Kneer, 2009). This means that the corporation offers respect to all its employees through employing the appropriate leadership. The other core value that the corporation has managed to employ in its business operations is offering the best service to customers (Kneer, 2009). Each customer in Wal-mart is plays a significance role in enabling the corporation to meet its profit goals. Therefore, the corporation maintains a strong relationship with all its customers by treating them well and equally. The other core value that Wal-mart has been employing in its operations is striving for excellence (Kneer, 2009). This means that the corporation’s goal has always been being the best in the competitive market through providing better services to all its potential customers (Kneer, 2009). Wal-mart Corporation has also played a significant to enhance core competence through

Operations and Information Management Essay Example | Topics and Well Written Essays - 2250 words

Operations and Information Management - Essay Example This was a significant and big expansion by the retail shop moving towards becoming a huge retail chain in the country having its stores across in all the main places. MobUlike also had its two stores in Italy which gave the chance to Smartz to spread its business even in Europe. Through this report using various theories and aspects the importance of usage of new IT strategies like ecommerce in the business expansion and its benefits are been seen and understood. Along with this the importance of information management system for a company in its process improvement is been studied which gives a clear understanding over what and how IT system helps in growth of a particular company. The particular retail chain Smartz sells smartphones and its accessories. This company is looking to grow its chain widely across the country and trying to reach every customer by providing the best facility and good products and a good price. The company owner has looked to take up packaged software’s from commercial vendors to interconnect the whole process of Smatrz, MobUlike and also the end consumers in all aspects. The acquisition of MobUlike by Smartz is a big change in the business process for the company. The company is looking to take up the process of ecommerce to reach the end consumer which is a big step towards the growth as the ecommerce usage in the country has grown a lot and that to at a rapid pace (Doyle, 2001, pp.34-45). Business process management is basically the process involved in management of the overall business in an efficient way as per the requirements of the client or the customer to achieve the customer satisfaction by fulfilling their needs and wants. In this case the owner Imran needs to manage the process of both Smartz and MobUlike and integrate them along with launching the ecommerce process (Golden, 2005, pp. 65-72). The It systems in both the companies are different as a result the integration of

CALIFORNIA HISTORY Essay Example | Topics and Well Written Essays - 1250 words

CALIFORNIA HISTORY - Essay Example The gold rush saw the influx of people into the region, and the Native Americans found they were under pressure in their home. The native populations decreased at an alarming rate due to the destruction of natural resources. In the process of mining gold, water resources were damaged and the fish which the natives fed on died. Other game such as deers which were a source of food also left because of the increasing human population. Under this strain, the native population moved deeper into the forest areas as their numbers diminished. In 1911, however, a man belonging to this tribe emerged from the Mount Lassen region. Since he did not have a name the anthropologists named him Ishi. He was the last man of the Yana tribe. The story of Ishi is fundamental in the history of California since it gives the roots of the people in that region. It has, however, been said that retelling of the story by anthropologists such as Theodora are attempts to elicit sympathy for the Native American pop ulation. The Native American tribes that have since gone extinct are described as ignoble savages. They are believed to have had no art, religion, technology or government that warranted them to be called a culture. They are thought by some people to have been unworthy inhabitants of California region since they did not develop the natural resources of the place. This, in my opinion, is a mistaken view of the Native American. ... Culture takes into account the ability to learn. When Ishi came into contact with civilization, he was able to be integrated. He learnt their behavioural patterns, and started to act like one of them. This shows that these natives had the ability to learn. The only difference is that what he had to learn in his society was different from the things he could learn from the civilized world. Ishi was a man of Stone Age culture but that made him no less of a human being. The customs of the Yana separated males and females. At a tender age they were cared for by their mothers but at the age of ten, the separation was implemented. Boys and girls were then neither allowed to sleep, or play together. The boys left with their fathers or any other male relative so as to learn the necessary skills. This differentiation based on gender roles makes the Yana a society that understood what sex roles meant. This was a vital feature of their culture. The separation of the sexes was to the extent that male and female dialects of the language were different (Kroeber and Kroeber). Life and death was sacred to these people as evidenced by the practices they kept. When someone died, they were burnt and the remains buried under a rock. This marked the grave, and kept the animals away from the bones. This practice of burning the dead is still practiced in today’s society. The reasons are different though for this. They had their own way of acknowledging life and death. They realized the different genders and assigned societal roles along the same lines. Claiming that these people did not have aspects of life that warranted them to be a culture is a mistaken view. Art varies from society to the next. The Yahi community had a different kind of Art

Operations and Information Management Essay Example | Topics and Well Written Essays - 2250 words

Operations and Information Management - Essay Example This was a significant and big expansion by the retail shop moving towards becoming a huge retail chain in the country having its stores across in all the main places. MobUlike also had its two stores in Italy which gave the chance to Smartz to spread its business even in Europe. Through this report using various theories and aspects the importance of usage of new IT strategies like ecommerce in the business expansion and its benefits are been seen and understood. Along with this the importance of information management system for a company in its process improvement is been studied which gives a clear understanding over what and how IT system helps in growth of a particular company. The particular retail chain Smartz sells smartphones and its accessories. This company is looking to grow its chain widely across the country and trying to reach every customer by providing the best facility and good products and a good price. The company owner has looked to take up packaged software’s from commercial vendors to interconnect the whole process of Smatrz, MobUlike and also the end consumers in all aspects. The acquisition of MobUlike by Smartz is a big change in the business process for the company. The company is looking to take up the process of ecommerce to reach the end consumer which is a big step towards the growth as the ecommerce usage in the country has grown a lot and that to at a rapid pace (Doyle, 2001, pp.34-45). Business process management is basically the process involved in management of the overall business in an efficient way as per the requirements of the client or the customer to achieve the customer satisfaction by fulfilling their needs and wants. In this case the owner Imran needs to manage the process of both Smartz and MobUlike and integrate them along with launching the ecommerce process (Golden, 2005, pp. 65-72). The It systems in both the companies are different as a result the integration of

How far do the values of Kino Essay Example for Free

How far do the values of Kino Essay A. The Novelette, The Pearl was written by John Steinbeck in 1944. Steinbeck is a magnificent author who uses dramatic, narrative and musical themes all together . e. g. the song of evil and the song of family to convey his idea effectively. He is able to attain an effect on the reader without lengthy details on emotions, places etc. All his novels are set in Salinas Valley and the main themes of his novels are on man versus nature and how man abuses it. Drama, visual effects and music all blend together in Steinbecks novel making it an all time classic. The Pearl is the story about Kino (Main character Mexican pearl diver) who is the leader of his tribe. In the story he goes on to finding a pearl, which affects him greatly. The pearl of the world gives him dreams of wealth and prosperity but all this changes when things dont turn out the way he planned them to. The pearl gives him suffering and brings out the evil in man. At the beginning of the novel we see the Mexicans oneness with nature as they made songs about it which brought them happiness. The fisherfolks lives were very simple as they lived in poverty and yet they enjoyed the fruits of nature. They lived in brush houses and ate simple food like hot corn-cake. Their sense of unity in the family is shown as they hardly communicate through words because they know what and how one another thinks. (Page 10)- They had spoken once, but there is not need for speech if it is only a habit anyway. Songs were important in their culture as they linked everything to music. The tribe was so closely united and were always ready to help each other. We see this when all the neighbors assist Kino when he takes Coyotito to the doctor for the scorpion bite as a child was a most important thing in life. Another example of closeness is when the tribe goes with Kino to sell the pearl as it a historic event as one of their members are going to get a lot of money. This all shows the loyalty of the neighbors. The tribe is superstitious and at the same time religious, as it is shown to us when Juana prays and chants magic at the same time when seeing the scorpion. They had experience in treating the dangers of nature . e. g. scorpion bites. Both Kino and Juana are superstitious and this is evident when they find the pearl of the world, they hid excitement and the pageant Gods were angry at them. The only thing that made the tribe unhappy was the whites treatment towards them which they thought was unjust. The whites brought fear and distrust . e. g. the way the doctor looks after and treats the rich rather than the poor. The poor lived in brush houses while the rich lived in stone and plaster houses. The whites poison the minds of the tribe as they are victims of ignorance and illiteracy. They were made to believe that their remedies were inferior to those of the white when in most cases they were not. The corrupted values of the whites are seen when the doctor misuses his skills and knowledge to make the baby sick instead of curing him. There is also ill-treatment of the beggars; we see this when they dont help Kino in finding a doctor and they feel it is a source of entertainment when a fisherman comes for help in the city. Eg:(When Kino wants to find a doctor for his son as he got bitten by a scorpion, and instead of the beggars helping Kino finding one, they made fun of him) The irony is that the beggars have no dignity compared to the fishermen who work for a living. When the tribe found the pearl they never thought of riches, only things that will help them where as compared to the whites they only thought of riches and themselves e. g. the doctor was fond of rich silk and expensive clothes compared to the fisher folks who just wore rags. Here a sense of irony is shown as the fisher folks are the whites main source of income and despite this, they still feel disgusted by the fisher folks. The priest was also a disgrace to religion as he too only thought about himself and riches as they wanted materialistic things. We also see how the whites treat their culture as to be very inferior and at the same time exploit them because the tribe is illiterate. Kino represents all the men in the tribe, he was the head of the family and showed the superiority of men e. g. when he eats first in his family and makes decisions. He is a protective father. This is evident when we see him confront the three trackers and when he tries to save his son from the scorpion bite. We see how the pearl changes him from a dependable, hard working man to a man who wants power. The main thing of a man is to have a canoe, as it was a sign of life. The tribe was of fishermen and they depend on canoe to fish in. Here we see Kinos loyalty to the family and family possessions as we see how he valued his canoe which he got from his grandfather-(Kinos grandfather had brought it from Nayarit, and he had given it to Kinos father, and so it had come to Kino) This is how the canoe is passed down from generation to generation.. A canoe was passed down from ancestors and without one they wouldnt be able to get married as it would be hard to support a family. The canoe was a symbol of livelihood, prosperity, independence and survival. Many things were passed down from generations such as Pearl diving, fishing and use of seaweed for remedies. Kinos life is focused on his family whom he loved a lot. His love for Juana is shown when he wants the pearl to help them in getting married. The closeness and the sense of brotherly unity between Kino and his brother Tomas, they gain from the values of their forefathers, as we see how Tomas advises him about the pearl and also helps Kino when the pearl brings bad luck to him. Kino shows his care for the races when he wants the pearl to bring prosperity to the tribe rather than to himself alone we see how he wants education for his son as with education they wouldnt be victims to the whites, he wants his son to spread knowledge and understanding to his tribe in the future through the things he learned. Kino is a skilled fighter where his response to danger is fierce and quick. It is a primitive instinct of the tribe. He is known as a noble savage; he is uncorrupted by a false coating of civilization that we see through the behavior and character of the doctor, priest and the pearl trader. The primitive violent reaction is shown when he attacks the thief that comes and robs him and when he murders one of the attackers in self-defense. When Kino finds a big hole in his canoe there is anger and deep sorrow as without a canoe a man is helpless. He is like a machine when he flees from the attacker to high ground like an instinct of an animal. There is stubborn courage in Kino; he displays a tragic courage for he is a man opposing all the forces against him. We see Kino is a man constant struggle against any prison that binds him. We see at the end of the story Kinos emotion when he loses his son and everything he owns because of the evil pearl and so a result he throws the pearl where it belongs. The situation of Kino could have happened to anyone in the tribe as all he imagined was that everyone would share his joy, but he was wrong. Juana represents all the females in the tribe as a womans character was obedient and respected. Her femininity was shown when she waits for Kino to finish eating and then she would start eating. She respected her husband by making him choose decisions. Juana is an ideal partner for Kino like her instincts when she wants to throw the pearl, and by showing unquestionable loyalty by wanting to stay with Kino and refuses to leave him even though it meant life or death for her and her baby. She shows strength when Kino is weakened by the evil of the pearl. Because of this action Kino draws strength to her loyalty. When Kino said to Juana I am a man he meant that he was half insane and half god and she knew in her womans soul that the forces of nature and society would crush him in the end, yet she needed such a man. Sometimes the female makes decisions for the men as a desperate measure like when she tells Kino to throw away the pearl. Both Kino and Juana were superstitious when finding the pearl and hence both of them suffered from the evil it brought as their simplicity and gullibility made them unaware about the pearls poison and the pain it brought as they suffered a terrible loss and were neglected by society. The dream Kino conjured from its shiny surface was to bring sorrow and death, as too much good luck gave them something bad at the end. But at last he had learnt his lesson and throws the pearl back into the sea where it belongs. There is always a limit to which you can make use of something. Once you begin to abuse it you pay the consequences and this is what happened. Culture is a very important aspect of life as not only is it a symbol/identity but it is also something which no body can take away from you as it becomes part of you. Every culture has its own occasions, celebrations, beliefs, dress etc. In The Pearl John Steinbeck used Kino and Juana very specifically to portray the importance of culture and the way things go about in a particular culture. Eg: the way the canoe was passed down from generation to generation etc.

Difficult Intubation And Post Tonsillectomy Bleeding

Difficult Intubation And Post Tonsillectomy Bleeding A six year old boy with Downs syndrome is on his way to the childrens hospital by ambulance with post-tonsillectomy bleeding. He underwent adeno-tonsillectomy because of recurrent tonsillitis and enlarged adenoids under general anesthesia the day before, some 22 hours ago. Despite being overweight at 37 kilograms and enlarged adenoids he did not suffer from sleep apnea. Prior to his original surgery, the child was uncooperative necessitating an inhalation induction with some struggling. Venous access was difficult even post induction requiring several attempts, and finally being achieved in the left saphenous vein at the ankle. Because of possible atlanto-occipital instability associated with Downs syndrome, laryngoscopy was performed with C-spine precautions. Direct laryngoscopy presented a Grade 3 view due to an enlarged tongue. Bag-mask-ventilation with an oro-pharyngeal airway was easy throughout the preintubation phase. Indirect laryngoscopy using the GlideScopeÂÂ ® revealed a Grade 1 view followed by the placement of a styletted, uncuffed 5 mm ID oral RAE tube. Adeno-tonsillectomy was performed i n the usual fashion and the child was discharged home after an uneventful 20 hour overnight observation period. Apparently, while momentarily unattended at home, the boy ate a hard tea biscuit. The child immediately experienced a sharp pain and an intra oral bleeding started. The emergency physician on duty is confronted with an overweight boy, sitting on a stretcher and spitting blood frequently into a kidney basin. The child is in moderate distress with the following vital signs (HR 152, BP 97/57). The child will not tolerate nasal prong oxygen and the pulse oximeter reading is 94% on room air. Auscultation of the chest is clear. Examination of the mouth reveals brisk bleeding in the right tonsillar bed. An attempt to start an intravenous line in the right saphenous vein is not successful, but blood is obtained for a CBC, coagulation parameters and a cross match for blood. The child is then transferred to the operating room. 45.2 INTRODUCTION: 45.2.1 What is the incidence, Morbidity and Mortality of pediatric post-tonsillectomy bleeding? Tonsillectomy is one of the most frequently performed surgical procedures in children. Rates in children aged 0-14 vary considerably within and between countries. In 1998, they varied from 19 per 10,000 children in Canada to 118 per 10,000 in Northern Ireland, so a very common procedure in both countries (1). The most common post-tonsillectomy complications include postoperative nausea and vomiting and pain. Dehydration may occur in children due to delayed and poor oral intake, nausea and fever. Delayed post-operative bleeding is the most significant complication and though uncommon, is not rare (2). Many estimates of the incidence of post-tonsillectomy bleeding exist in the literature varying widely from 0 to 11.5 percent (3). Typically, however, the rate ranges between 2.9 and 3.4% (4). Mortality rates are rarely reported in the literature. Two large studies reported 0 out of 15,996, and 1 out of 16,381 tonsillectomies in 1979 and 1970 (5). On the other hand, there are many published case reports. Sixty-seven percent of post-adeno-tonsillectomy bleeding originates in the tonsillar fossa and 27% in the nasopharynx. There are two major time frames for post operative bleeding. Most often, the bleeding occurs within the first 24 hours after surgery (primary bleeding) (5). Primary bleeding is generally related to surgical technique, and incidence is declining. Twenty five percent of all post tonsillectomy hemorrhage occurs after 24 hours. This secondary bleeding is not related to surgical technique, is rare and of unchanged prevalence over the years (5). It is mainly observed between the 5th and 10th postoperative day, although it may occur at any time (6). Infection of the tonsillar bed with clot sloughing is believed to be the major cause of secondary bleeding. It tends to occur more commonly in older pediatric patients, because the indication for tonsillectomy in this age group is usually related to recurrent infections rather than airway obstruction, the most common indication in the younger pediatric age group.(5). Since tonsillectomy is usually performed to improve the quality of life in otherwise healthy, young children, any death is unacceptable. 45.3 PATIENT EVALUATION: 45.3.1 What are the initial clinical steps one should take in the patient with post-tonsillectomy bleeding? The diagnosis of post-tonsillectomy bleeding is usually made by a quick history. Parents or patients will mention right away the previous surgery. Differential diagnosis is blunt or sharp trauma to the oropharynx. Rare cases are bleeding tumors of the oropharynx, like hemangioma. The child will present with fresh blood in the mouth and frequent swallowing of blood. Nausea with or without emesis of fresh blood is common. Newer and more potent antiemetic medications may mask or suppress vomiting. Therefore, the amount of blood swallowed may be underestimated. It is not uncommon for children to have been bleeding silently for a prolonged period of time with extensive blood loss. The child is often restless, diaphoretic and pale. The vital signs may show an increased heart rate, because of pain and hypovolemia. In awake children, hypotension following blood loss is a very late sign and then indicates significant hypovolemia. Intravenous access must be established as soon as possible followed by initial volume resuscitation with crystalloid or colloid solutions or. A blood sample for baseline hematocrit or hemoglobin is necessary as well as for blood type and cross match. An intra oral examination will show blood and blood clots. A bleeding source may be seen in the tonsillar bed. Bleeding from the tonsillar bed may initially be controlled using pharyngeal packs and cautery. But children with post tonsillectomy bleeding should be taken back to the operating room for exploration and surgical hemostasis. Repeated attempts to stop bleeding on the ward or in the emergency department should be avoided, except if exsanguination is imminent. A questionnaire of children undergoing tonsillectomy with or without postoperative bleeding showed an increased incidence of post-traumatic stress disorder if the children with bleeding were treated on the ward compared to children without bleeding or if the bleeding was treated in the operating room (7). 45.4 AIRWAY MANAGEMENT 45.4.1 How is the airway usually managed in post-tonsillectomy bleeding? Large volumes of blood may be swallowed, and blood or blood clots are often present in the oral cavity of these children. Despite the fact that the aspiration of blood is not similar in severity to aspiration of gastric acid, it remains an undesirable occurrence. In addition to hypovolemia, patients with post tonsillectomy bleeding present two major problems: Aspiration: These patients must be considered to have a full stomach and are at an increased risk of aspiration. Difficult airway: Blood and blood clots may impair visualization to the vocal cords. In addition swelling of the oropharynx may have occurred because of surgery or infection. This may lead to a changed laryngeal anatomy. Because of the risk of aspiration, a mask induction maintaining spontaneous breathing is not desirable and a rapid sequence induction should be considered. The efficacy and use of cricoid pressure, especially in children is currently controversial. It is noteworthy that cricoid pressure can distort the laryngeal anatomy and worsen the view of the larynx. In addition, it can induce vomiting in the partially anesthetized patient. The blood and blood clots in the oropharynx can impair vision during laryngoscopy or cause plugging of the endotracheal tube. A working suction apparatus is lifesaving and must be prepared in duplicate. One should be a large bore, rigid surgical suction and the other mounted with a flexible endotracheal suction catheter. If one becomes blocked with a blood clot, another is readily available. If large amounts of clot are present, it may be necessary during the initial laryngoscopy to manually remove them with a finger or gauze. A Magill forceps should be available to grab clots deeper in the pharynx, recognizing that these clots may be too fragile to be grasped and removed from the oral cavity using the Forceps. A past history of difficult laryngoscopy is helpful, although this never precludes preparations for a difficult and failed airway. Different sized curved and straight blades as well as a flex tip blade (McCoy laryngoscope) should be readily available. Different sized cuffed endotracheal tubes, with one size up and down of the calculated size must be prepared. They should be preloaded with a well lubricated intubating stylet, as is standard for a rapid sequence induction. A tracheal introducer (Bougie) may be helpful in the presence of a grade 3 view. If the epiglottis is visible, but no laryngeal entrance can be appreciated, a stroke of chest compression may help find the glottic opening by creating air bubbles. The pediatric lightwand represents an elegant technique for intubation in the case of a glottic view obscured by secretions or blood. The extremely bright light can shine easily through blood and blood clots. However experience is necessary when using this device. Indirect laryngoscopy using the video-laryngoscope (GlideScopeÂÂ ® or the AirtraqÂÂ ®) can be difficult. Blood and secretions may block the optical lenses and impair the view to the vocal cords. The lens in the AirtraqÂÂ ® with its position between the lightsource on one side and the guide channel for the endotracheal tube on the other side might be more protected than the lens of the GlideScopeÂÂ ®. Case reports or studies, however, have not been published in this regard. The laryngeal mask plays an accepted role as an alternative airway device in managing the difficult pediatric airway (see Chapter 42). It is used frequently in primary adeno-tonsillectomies. It can be placed quickly and can be used as a conduit for a flexible bronchoscope to guide intubation if required. On the positive side, a laryngeal mask may briefly tamponade the bleeding site, and therefore protect the airway and the optical lens of the bronchoscope. Though, on the other hand, it may not provide sufficient airway protection in situations with increased risk of aspiration like post tonsillectomy bleeding. A case report recently described the successful use of a laryngeal mask for a failed intubation in a post tonsillectomy bleed (8). The use of a flexible bronchoscope alone is not recommended in cases of oropharyngeal bleeding. Experts recommend that the practitioner should rely on the alternative techniques with which they have the most experience and skill. Preparation for the unexpected is essential. An experienced otolaryngologist or other qualified rigid laryngoscopist/bronchoscopist should be in the OR for all of these cases. If direct laryngoscopy fails, a rigid device wielded by the otolaryngologist may just be successful. An appropriately sized, lubricated and tested rigid laryngoscope/bronchoscope connected to a light source and suction must be readily available at the head of the child. Preparation for a surgical airway is also essential (e.g. tracheotomy tray opened and ready). To reduce the risk of postoperative nausea and vomiting the stomach content of the child should be suctioned using an orogastric tube at the end of the procedure, recognizing that this does not guarantee an empty stomach as much of the blood may be clotted. 45.4.2 What are the airway management options for this patient? This patient presents several issues regarding anesthesia induction and airway management: high risk of aspiration difficult intravenous access suspected atlanto-occipital instability known difficult direct laryngoscopy with easy facemask ventilation expected difficult view of the larynx due to blood and secretions Several options for the anesthetic and airway management of this child need to be weighed and considered in light of their risks and benefits: Intravenous induction versus inhalation induction without IV access: This child is undergoing a second surgical procedure within 24 hours. Due to the frightening emergency situation, pain, bleeding and his mental impairment he is distressed and uncooperative. While a smooth inhalation induction with a facemask was preferred for his first surgery, a stomach potentially full of blood mitigates against this approach and for a rapid sequence induction to minimize the duration of an unprotected airway. One might even hope for a rapid venous access following a mask induction to permit medication administration but we know in this case that is not likely. Anesthesia induction with cervical spine precautions versus no C-spine precautions: Downs syndrome is associated with atlanto-occipital instability in up to 20% of cases. It can occur in children as young as 4 years of age. The large head of the Downs child coupled with this atlanto-occipital instability places them at increased risk for cervical spine injury during anesthetic induction. Radiographic findings of cervical spinal instability in Downs syndrome remain controversial. Lateral radiographs of the neck in flexion and extension do not reliably detect atlanto-occipital instability. Due to impaired cognition and anxiety, positioning of the patient can be difficult. Old lateral neck radiographs are not available for this child. Due to the emergency situation, a current neck radiograph is not possible. Therefore cervical spine precautions should be performed. Extreme neck extension should be avoided in this child. Awake tracheotomy versus anesthesia induction with attempted laryngoscopy: The fact that this child has a known difficult direct laryngoscopy together with a documented Grade 3 view favors an awake tracheotomy under local anesthesia. This approach would maintain a protected airway at all times. Awake tracheotomy in adults and children are challenging. Optimal surgical positioning with neck extension is crucial for successful procedure. It is not expected, that this child will tolerate this procedure. This fact, together with the required c-spine precautions would exclude an awake tracheotomy as an option for this child. The plan is to perform an intravenous rapid sequence induction employing indirect laryngoscopy to place an endotracheal tube. Preparations for rigid laryngoscopy are in place and the surgeon is prepared to embark immediately with a surgical airway (in this case a triple set up). 45.4.3 How should you prepare for this case? Following the failed attempt to start an intravenous line in the emergency department, the child was brought to the operating room. As previously outlined, venous access is crucial for induction and fluid resuscitation. Placement of a central line in the awake child is a possible option. For internal jugular vein access, the head may need to be rotated with increased risk associated with the presumed atlanto-occipital instability. The subclavian approach has the risk of a pneumothorax. An ultrasound guided femoral vein approach is an alternative. On the other hand, several studies have shown that an intraosseos cannula can be placed within 60 seconds and that this line provides an excellent access for the administration of medications and fluids. Because of the risks associated with central line placement, the child was prepared for an intraosseous cannula. The right leg was prepped with antiseptic solution, and local anesthetic injected at the tibial plateau. An intraosseous canula was placed without incident. A normal saline solution flowed freely permitting the administration of 20ml.kg-1 bodyweight. Atropine 0.1 mg IV was administered to reduce additional secretions and mitigate vagal responses secondary to laryngoscopy. The usual monitors were applied (pulse oximetry, noninvasive blood pressure and EKG). The surgeon was prepared as was his equipment; the rescue airway cart was in the room. 45.4.4 Management of this child Concurrent with the placement of the intraosseous canula, the child was prepared for a rapid sequence induction. The child was denotrogenated with 100% FiO2 for 3 minutes employing a facemask that was reasonably tolerated with much cajoling. Considering the possibility of significant hypovolemia a 50/50 mix of Ketamine and Propofol (ketofol) was selected for induction and Succinylcholine for neuromuscular blockade. Cricoid pressure during induction was not applied to avoid stimulating vomiting in the already agitated child. It was applied after the child was deeply anesthetized. As soon as the child was deeply asleep and paralyzed, the mouth was suctioned easily and several clots were removed with the Magill Forceps. Again the brisk bleeding from the right tonsillar bed was noted. Since the previous direct laryngoscopy showed a Grade 3 view, a repeated direct laryngoscopy was not attempted. Because the oral cavity seemed to be free of clot, it was decided to proceed with indirect laryngoscopy with the GlidescopeÂÂ ®. Unfortunately, blood obscured the lens and following a prolonged laryngoscopy the attempt to intubate was abandoned. Oxygen saturations fell from 100% to 94% and despite the risk of aspiration, mask ventilation was begun and cricoid pressure was maintained.The saturations recovered nicely. At this point, faced with a failed intubation, rather than a failed airway it was decided to insert a ProSealÂÂ ® laryngeal mask. The oral cavity was once again suctioned with a rigid catheter under direct laryngoscopy and a number 3.0 ProsealÂÂ ® laryngeal mask was easily placed. No air leak was noted and pressure controlled ventilation with a pressure limit of 15 cm H2O was started. A number 5.5 uncuffed endotracheal tube was loaded on a pediatric flexible bronchoscope. Using the LMA ProSealÂÂ ® as a conduit, the bronchoscope was advanced into the trachea. Blood and secretions where present in the LMA and in the trachea but did not obscure the view through the bronchoscope. The ETT was placed easily. With a small air leak at 20 cm H2O airway pressure, it was decided not to change the ETT over a pediatric Cook airway exchanger to a cuffed ETT. Since the LMA did not obscure the surgeons view, it was decided to leave the LMA in place and remove it together with the endo tracheal tube at the end of the procedure after emerge of anesthesia. With a secured airway, the ENT surgeon cauterized the tonsillar bed, and the bleeding artery could be ligated. At the end of the procedure, a large bore nasogastric tube was placed through the suction port of the ProsealÂÂ ® laryngeal mask and the stomach suctioned. The child was taken to the pediatric ICU where he was extubated fully awake one hour later. 45.5 OTHER CONSIDERATIONS 45.5 1 What is the current thinking with respect to the surgical management of post-tonsillectomy bleeding? Life threatening post-tonsillectomy bleeding requires an aggressive approach to surgical management. Initially pressure on the bleeding tonsillar fossa with a clamped gauze or the index finger may give sufficient time to start an intravenous line for blood work and cross match, and to provide for fluid resuscitation or blood transfusion if indicated. If intraoperative localization of the bleeding source is time consuming and local treatment is ineffective, ligation of the external carotid artery at an early stage may be required. Aberrant arterial blood supply to the tonsillar region deriving from the internal carotid artery or the carotid bulb may be present. In cases such as these, packing of the pharynx and angiographic embolization of the feeding artery may be necessary(9). 45.5.2 Are there specific measures that one ought to employ to reduce the postoperative morbidity and mortality of patients following tonsillectomy? The focus on post-tonsillectomy bleeding is on preventive measures, both by the surgeon and the anesthesia practitioner. Tonsillectomy technique: In comparison to the cold knife technique, hot techniques employing bipolar diathermy or coblation tonsillectomy are associated with an increased rate of secondary bleeding (4, 9). The duration, frequency and surgical extent of these techniques are linked to the amount of damage to the surrounding tissue. This damage leads to deeper zones of local necrosis which is vulnerable to bacteria- and enzyme-containing saliva, and therefore at increased risk of secondary bleeding (4, 5). Effects of postoperative, nonsteroidal, antiinflammatory drugs: Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit platelet cyclo-oxygenase (COX). A recent meta-analysis showed an increased risk of re-operation for hemostasis post-tonsillectomy if conventional NSAIDs such as ketorolac, ibuprofen or ketoprofen were used for postoperative pain control in children (10). On the other hand ketorolac has been proven to be an effective treatment for post tonsillectomy pain, and as a non-opioid delivers an intraoperative opioid sparing effect and leads to a reduction in postoperative respiratory depression, nausea and vomiting. A most recent meta-analysis did not find an altered number of perioperative bleeding events in patients given an NSAID (11). Still, the use of these drugs should be discussed with the surgeon and used with precautions. Effects of dexamethasone for postoperative nausea and vomiting (PONV): Postoperative nausea and vomiting increases the risk of primary hemorrhage and unexpected postoperative hospital admission. Dexamethasone has antiemetic properties in the perioperative setting. However, dexamethasone may inhibit wound healing, attenuate the inflammatory response to local infection and as a result perhaps increase the risk of postoperative bleeding. A recent study in children undergoing tonsillectomy and administered dexamethasone was prematurely terminated because of an increased bleeding rate (12). Similar to NSAIDs, the use of dexamethasone should be discussed with the surgeon und used with caution. Tonsillectomy as outpatient surgery: Traditionally, tonsillectomy has been associated with a hospital inpatient admission. Economic imperatives have pushed hospitals to perform tonsillectomies as outpatient day surgery procedures. The evidence has shown that this can be safely performed with the following exceptions: age under 3 years medical disorders that increase anesthetic and surgical risk craniofacial abnormalities abnormal coagulation, with or without an identifiable bleeding disorder obstructive sleep apnea acute peritonsillar abscess family conditions that prevent easy and rapid return to a medical facility Patients should always be observed for a minimum of 6 hours. They should be able to tolerate oral fluids and be pain free of prior to discharge. As an alternative to hospital admission, a 23 hour overnight observation period can be considered. 45.6 SUMMARY Post-tonsillectomy bleeding is a rare event, which occurs most often within 24 hours following tonsillectomy. However, it may be delayed for up to 14 days postoperatively. The amount and severity of bleeding along with the need to ensure patient comfort and a still surgical field most often make operative revision under general anesthesia necessary. The insidious and continuous nature of the bleeding may lead to significant hypovolemia which is often difficult to assess. Blood work and cross match as well as preoperative intravenous access with fluid resuscitation are crucial in the management of these children. Aspiration and a difficult airway are ever-present risks during the induction of anesthesia in these patients. Rapid sequence induction with direct laryngoscopy and endotracheal intubation is the accepted first choice in the management of these children. An array of pediatric airway management devices need to be immediately available. Blood and secretions can obscure the laryngeal view and can make some devices more useful than others. A surgeon experienced in rigid broncoscopy and establishment of a surgical airway must be present during anesthesia induction. Cautious use of nonsteroidal inflammatory drugs and steroids is advocated. Any death related to a tonsillectomy is a unacceptable bleeding in otherwise healthy children.