Monday, December 30, 2019
The Raven And Ulalume By Edgar Allan Poe - 3442 Words
Adverse Effect of Death on the Lives of Those Left Behind: Alliteration and Repetition Discussed in Edgar Allan Poeââ¬â¢s The Raven and Ulalume Were I called on to define the term ââ¬ËArt,ââ¬â¢ Poe once wrote, I should call it ââ¬Ëthe reproduction of what the Senses perceive in Nature through the veil of the Soul.ââ¬â¢ The intense grief that is felt after losing a loved one can often result in despair and irrationality, but in some of Poeââ¬â¢s poetry it has resulted in the severe mental collapse of the narrator. In The Raven and Ulalume by Edgar Allan Poe, the adverse effects following the loss of a loved one are demonstrated through the use of alliteration and repetition. Edgar Allan Poe, born in Boston, Massachusetts on January 19, 1809, became acquainted with loss at a very young age following the death of his mother and the later loss of a famous sequence of beloved women to illness. In 1811, after his mother, Elizabeth Arnold Poeââ¬â¢s death, Poe was orphaned at the age of two. He was taken into the home of John Allan, a successful business man also believed to be his godfather, and his wife. After moving to England for a brief period with the Allenââ¬â¢s, Poe and his foster parents returned home to Virginia in 1820. Poe attended several private schools and upon his high school graduation, enrolled in the University of Virginia followed by the U.S. Military Academy, but did not graduate from either. After being influenced by Romantic Poets, Poe developed a passion for writing. He began aShow MoreRelatedEdgar Allan Poe, An American Writer, Editor And Literacy Critic1297 Words à |à 6 Pages Edgar Allan Poe, an American writer, editor and li teracy critic, also known for his dark, deranged poetry. Poe was born in Boston, Massachusetts on January 19th, 1809 and passed away at the early age of 40, on October 7, 1849. In adolescence, he was abandoned by his father at the age of 2, a year after his mother died and Poe was left orphaned. John and Frances Allan soon took in Poe, they never fully adopted him but he was treated as if he was their own. As Poe was starting post-secondary schoolRead MoreThe Death Of A Beautiful Woman By Edgar Allan Poe Essay2251 Words à |à 10 PagesIn several, if not all, works of Edgar Allan Poe, there is a not so subtle theme that is found. One of the death and beauty. How is the death of a young woman romanticized within selected works of Edgar Allan Poe? In such works as ââ¬Å"Lenoreâ⬠, ââ¬Å"Ulalumeâ⬠, popular ââ¬Å"Annabel Leeâ⬠, ââ¬Å"The Ravenâ⬠, and short story ââ¬Å"The Oval Painterâ⬠,the ââ¬Å"death of a beautiful womanâ⬠theme is prevalent and s trongly noted within context, word choice, and imagery. In the eyes of Edgar Allan poe, death, especially that of a womanRead MoreAnalysis Of Edgar Allan Poe s The Raven1232 Words à |à 5 Pages Edgar Allan Poe: The Raven Literature is a very powerful tool that is used to make a huge impact on society or in someoneââ¬â¢s perspective. As complex as the world, literature can appear in many forms using unique vernacular that expresses human endeavors. In some cases, social reform is Transcendentalism is an American literary, philosophical movement, promoting the idea of independent progress. The central idea is the optimistic viewpoint of humanity. People, men and women equally, have knowledgeRead MoreEssay about edgar allan poe557 Words à |à 3 Pages Edgar Allan Poe Edgar Allan Poe was born on January 19, 1809 in Boston, Massachusetts. He was the son of two poor touring actors, Elizabeth Arnold Poe and David Poe Jr. The Poes traveled around to many different theaters, playing many different roles. While his mother was a well-known actor, his father was not, and was usually drunk during performances. David Poe abandoned his family when Edgar was about two and the rest of the Poe family left for Richmond, Virginia. Edgarââ¬â¢s mother died of tuberculosisRead More Edgar Allan Poe Essay504 Words à |à 3 Pages Edgar Allan Poe Edgar Allan Poe began his career as a poet, and collected or corrected poems throughout his career. A quality of enjoyable sounds can be found in poems that readers also consider serious. However, these elements can also exist with themes that are more typical of the Romantic Movement, such as dreams and nightmares Poe handled this through images designed to show undecided states of awareness represented as lakes, seas, waves, and vapors. Nearly all Poes criticism on poetry wasRead MoreEdgar Allan Poe : The Father Of Gothic Literature1393 Words à |à 6 PagesNovember 3, 2017 Edgar Allan Poe Studies say that Edgar Allan Poe was the father of gothic literature. As an American writer and critic, he went through the struggles of living in poverty, having a drinking and gambling problem, and being judge based on his decisions. He was best known as an author of gothic fiction. He had a life of misfortune and indigence. Edgar Allan Poe was born on January 19,1809 in Boston, Massachusetts to two striving actors, David Poe Jr. and Elizabeth Arnold Poe. Some studiesRead MoreEdgar Allan Poe s Life Filled With Sorrow And Pain892 Words à |à 4 PagesThesis: Edgar Allan Poe led a life filled with sorrow and pain. His works tend to reflect his lifestyle by incorporating darker elements in the usage of his characters. Edgar Allan Poe was born January 19, 1809 to two actors, David Poe Jr. and Elizabeth Arnold Hopkins Poe. He was born in Boston. Before he was three years old, his father abandoned him, his brother (William Poe), and his sister (Rosalie Poe). Shortly after this, his mother died, leaving the three children orphaned. Poe moved to BostonRead More The Mystery of Edgar Allan Poe Essay1499 Words à |à 6 PagesThe Mystery of Edgar Allan Poe What was the mystery of Edgar Allan Poe? Why was he so special? He was special because he helped change poetry by giving it different focuses. Through looking at Edgar Allan Poes life, we will understand what motivated him to write what he did, what the meaning was behind these works, and how this changed poetry. Before Edgar Allan Poe, the common belief was that poetry should be about Truth, and that it should impart some morals. Poe disagreed, and stronglyRead MoreThe Works Of A Depressed Man Essay1830 Words à |à 8 PagesPoe: The Works of a Depressed Man In this paper, will analyze the works of the great poet Edgar Allen Poe. My focus of this analysis will be his theme and how it related to his life. The poems I will be analyzing are Annabel Lee, The Raven, and Spirts of the dead to show the themes of Poeââ¬â¢s works. My analysis will show how Poe used the tragic events of his life as well as a few of the good things that happened to ultimately inspire themes of death, depression, and despair as well as some other minorRead MoreEdgar Allan Poe s All The Senses, And The Symbolic Expression Of Emotion1139 Words à |à 5 PagesToday, Edgar Allan Poe is one of the most revered American authors as many consider him the inventor of the detective fiction genre and an influence on the development of the poetic movement of Symbolism, which favored ââ¬Å"the derangement of all the sensesâ⬠and the symbolic expression of emotion. However, Poe spent most of his life struggling as a full time writer. This is mostly attributed to the fac t that he could not stay sober whenever he had a steady job. Poeââ¬â¢s battle with alcoholism led to the
Sunday, December 22, 2019
The American Way to Boost Self-Esteem Essay - 1281 Words
The American Way to Boost Self-Esteem So youre suffering from low self-esteem, lacking in self-confidence, and not excited about your less-than-perfect body. No problem! Its nothing a new haircut, wardrobe change, or visit to the gym cant solve, right? Not any more, apparently. Gone are the days when body image problems are solved through friends, exercise, or counseling. Gone too is the era of au naturel and unaltered body parts. More and more people these days, especially women, are turning to the operating table to conquer battles over self-image. With images of Janet Jacksons breasts, Britney Spears tummy, and J. Los booty filling television screens and invading magazine stands across the country, its noâ⬠¦show more contentâ⬠¦Whatever happened to the notion that beauty is not skin deep, but comes from within? The media and pop culture in this country have distorted the vision of beauty. Through images and television shows, they have twisted a message of loving your body for what it is by promoting plastic surgery as an answer to all your problems. We are all influenced by the pressure to fit in, to succeed, and to please in our daily lives. But portrayals of plastic surgery in the media have sent the message that any road bump or obstacle through life can be solved through a simple nip and tuck. Nervous about getting that new managing job? No sweat, a rhinoplasty will do the trick. Want to impress that boy youve had a crush on all year? Just stop by your nearest plastic surgeon for a breast enlargement. Feeling a little depressed lately? Consider some liposuction to boost your mood. As economic conditions improve for the average citizen, more people can afford to worry about their looks. A shift in cultural values has led to an increasing demand for plastic surgery as well as plastic surgery reality shows on television. Whether to improve their chances of getting a job or to diminish signs of natural aging, more and more people are following the leads of participants onShow MoreRelatedDance Is The Expression Of Man1552 Words à |à 7 Pageshow dance can free a human being. By stating that dance is the expression of man, and that dance may reveal something or some wonderful thing a human can be Martha ultimately reveals only a small aspect of the full benefits of dance. Dance avails self-esteem by the social, mental, and physical benefits it has to offer. The history of dance is filled with many unique events that all have played a great role towards shaping its foundations. Whether it was choreographers who created multiple differentRead MoreThe Psychological Effects of Going Through Cosmetic Surgery1486 Words à |à 6 PagesAccording to the American Society of Plastic Surgeons in the United States 14.6million cosmetic surgery procedures were performed in 2012. Cosmetic procedures range from skin rejuvenation to cleft palate repair. The most popular age range of cosmetic surgeries performed is 40 to 54 years old. Most of us are self conscious about how we will appear in the future. Our self conscious feelings towards our body image affects us psychologically and psychosocially by our own body-self image, sexual relationshipsRead MoreExercise Benefits Essay1237 Words à |à 5 Pagesgood? At its most basic, exercise is any type of physical exertion we perform in an effort to improve our health, shape our bodies, and boost performanc e (Waehner, Web). Adults, men and women, and teens both benefit from exercise and physical activity in many different ways. Exercise should play a key role in everyoneââ¬â¢s daily life, not only does it boost self esteem, it also improves mental health and helps prevent depression, heart disease, cardiovascular disease, Type II Diabetes, and, as alwaysRead MoreOutside Beauty And Staying Forever Young1238 Words à |à 5 Pagesundoubtedly comes from the need to replicate their favorite celebrities. Other causes for plastic or cosmetic surgery come from low self-esteem issues, sexual satisfaction and the need to be accepted as beautiful. For Instance, in 2000 more than 6.3 million women went under the knife by surgeons certified by the American Board of Plastic Surgery, says the American Society of Plastic Surgeons statistics. The five most popular invasive surgical procedures for women in 2000 were liposuction, eyelidRead MoreThe Self Image Of Young Adults1396 Words à |à 6 PagesFor many, many decades Americans have suffered from self-image because of inner conflicts causing very low self-esteem issues. Many of these conflicting identity issues play into these severe inflictions with one s self. Teens and young adults have a troubled existence of feeling incompetent, unloved, unworthy and leaving them unable to fit into the crowd because of their body image leaving an imprint of a certain way to look. As Early as age five, children have been brainwashed with secular televisionRead MoreThe Problem Of Self Esteem976 Words à |à 4 PagesMost people face self esteem problems at different levels. At some point in li fe people face this problem without realizing it. In the essay The Trouble with Self-Esteem written by Lauren Slater starts of by demonstrating a test. Self esteem test that determines whether you have a high self-esteem or low self-esteem. The question to be answered however is; what is the value and meaning of self-esteem? The trouble with self-esteem is that not everyone approaches it properly, taking a test or doingRead MoreSelf Esteem By Carol Craig1090 Words à |à 5 PagesSelf-Esteem can be harmful and make people very self centered, but others lack confidence and need a boost of self-esteem. Self-esteem is a very important factor in various reasons that happens in peopleââ¬â¢s daily life. With no type of thought people donââ¬â¢t think or take self-esteem with importance without realizing that self-esteem is a huge thing that us humans depend for our daily activities. Some shifts that have happened toward self- esteem over the past few decades were the fact that many p eopleRead MoreDoes Social Media Cause Psychological Problems ?1487 Words à |à 6 Pagescommunities, digital storytelling and scrapbooking, and data, content, image and video sharing, podcast portals, and collective intelligence. All of these forms makes majority of individuals keep up with technology and be a part of the information hi-way. Since social media website becomes part of the majority of individualââ¬â¢s life, there is an enormous amount of studies that has been made to identify the benefit of utilizing social media. An example of this study is the one made by Maurizio Mauri, PhRead MoreThe Effects Of Negative Body Image1668 Words à |à 7 PagesBody image is the way one sees oneself and how one imagines how one looks .(7)Having a positive body image means that, most of the time one sees oneself accurately,one feels comfortable in oneââ¬â¢s body and one feels good about how one looks.(7)In todayââ¬â¢s time Americans are vain in oneââ¬â¢s appearance,meaning we feel having a thin body we are more accomplished, successful and beautiful. Growing up in a time where appearance is everything to an individual can easily make a young girl self-conscious of herRead MorePersonal Grooming Marketing1488 Words à |à 6 Pagesof health and style that affects their self-esteem. Most in this group have a sports or music celebrity they admire which defines for them what it means to be a man. The message of a scrawny or an overweight male with poor grooming models what is undesirable in a male. A man with style will have our personal care products clearly showing him to be a well-groomed, healthy and high self-esteem male. Our personal care products will boost our consumerââ¬â¢s self-esteem by improving their looks, having them
Saturday, December 14, 2019
Is the Global Warming Real Free Essays
Global warming has becoming an increasingly important issue in our environmentally conscious society as it is a problem affecting every aspect of the environment and the living beings everywhere on this planet. Yet, it is quite controversial as to its nature, cause, and the effects it will bring along in the future. The average temperature of the earthââ¬â¢s surface has risen by 0. We will write a custom essay sample on Is the Global Warming Real? or any similar topic only for you Order Now 8 degree Celsius since 1880. The International Panel on Climate Change (the IPCC), based on the work of hundreds of scientists in more than 100 countries, has concluded in its 2007 report that this current planetary warming is mainly caused by human activities, such as the burning of fossil fuels, deforestation, and agriculture. (The IPCC 2007 Synthesis Report) These activities have greatly increased atmospheric concentration of greenhouse gases, especially carbon dioxide (CO2), methane (CH4), and nitrous oxide (N2O). These greenhouse gases are naturally occurred and essential for life on earth as they trap the sunââ¬â¢s heat and keep the earth warm. If these gases were removed from the atmosphere, the earthââ¬â¢s temperature would plummet to -18 Celsius, far too cold to sustain our current ecosystem. However, humans are causing massive increase in these greenhouse gas emissions, enhancing their heat- trapping ability. As a result, the temperature is rising higher and higher. Pidwimy, 2006) Scientists have also found that CO2 is the most important greenhouse gas which is responsible for 55% of the current warming. The atmospheric concentration of CO2 increased from 280 parts per million (ppm) in 1750 to 379 ppm in 2005. The principal reason for this mounting CO2 levels is the use of fossil fuels and changes in land use: the burning of oil, gasoline, and coal for running cars, factories, and generating electricity, and the cutting down of forests to make way for farming, housing and other dev elopment. Emissions from fossil fuel combustion contribute about 65% of the additional CO2 added to the atmosphere. (Pidwimy, 2006) The worldââ¬â¢s biggest fossil fuel consumers are the United States, China, and the European Union. ( Damassa, 2006) Deforestation contributes 25% the CO2 emissions. Sir Nicholas Stern says the destruction of the rainforests of the Amazon, the Congo basin and Indonesia will in the next four years alone add more CO2 into the atmosphere than every flight in the history of aviation to at least 2025. According to the audited figures from 2003, deforestation is releasing two billion tons of CO2 into the atmosphere every year. (Howden, 2007) If these activities continue, the atmospheric CO2 concentration will be double the pre-industrial levels during this century that will raise the global temperatures by around 2?C to 5?C. (Pearce, 2008, P1) Chlorofluorocarbons are man-made greenhouse gases which accounts for 25% of the current warming. Chlorofluorocarbons have the strongest heat-trapping ability among all the greenhouse gases per molecule. However, the atmospheric concentration of these gases is low so they are not as damaging to the climate as CO2. Many nations have reduced their production and use of these man-made chemicals in response to Reports of the development of ozone holes over the North and South Poles and the general decrease in global stratospheric ozone levels over the last 20 years, thus the concentration of these gases may soon begin to decline. (Pidwimy, 2006) Other two important contributors to global warming are methane and nitrous oxide. Comparing figures from 2005 with pre-industrialised levels (measurements taken in 1750), methane increased from around 715 parts per billion (ppb) to 1774 ppb and nitrous oxide increased from 270 ppb to 319 ppb. (The IPCC Synthesis Report 2007) the main sources for the extra methane now found in the atmosphere are agriculture (rice cultivation, grazing animals) and fossil fuel use (coal mining, and oil and gas extraction). Nitrous oxide is released into atmosphere from the loss of the forests, the cutting down forests for agricultural fields, and the use of fertilizers for plants growth. Pidwimy, 2006) The impacts of this man-made warming lie not only, or even primarily, in the temperature rise. It says in the IPCC Synthesis Report 2007, Discernible human influences extend beyond average temperature to other aspects of climate, including temperature extremes and wind patterns. Anthropogenic warming over the last three decades has likely had a discernible influence at the global scale on observed changes in many physical and biological systems. There are many other effects that have occurred due to global warming, e. g. the melting of ice and snow cover, rising global average sea level, increase in intensity and frequency of extreme weather events (heat weaves, heavy precipitation, tropical cyclone activity). (The IPCC Synthesis Report 2007) 41 Scientists are predicting that global warming will produce a lot of negative consequences. According to the IPCC, the global average temperature will rise 0. 2 per decade for the next two decades if the greenhouse gas missions are at or above the current rate and this warming will cause further damage to the global climate system during the 21 century than those observed during the 20 century. (the IPCC 2007 Synthesis Report) The sea level is expected to rise between 7 and 23 inches (18 to 59 centimetres) due to thermal expansion and melting ice on land by the end of this century. By 2080s, many millions more People than today in coastal areas, especially in heavily populated and low-lying mega deltas of Asia and Africa will be at great risk every year due to sea level rise. the IPCC 2007 Synthesis Report) it is estimated that there are more than 180 countries having populations in low-lying costal areas, 70% of which have urban areas of more than 5 million people that are at risk, including Tokyo; New York; Mumbai, India; Shanghai, China; Jakarta, Indonesia; and Dhaka, Bangladesh. (Wagner, 2007)126 Global warming will pose threats to peopleââ¬â¢s health: More frequent and severe heat waves will cause more heat stroke and other heat-related illnesses and death. The elderly and the young are the most susceptible to these effects; air pollution worsened by global warming will lead to more respiratory and cardiovascular diseases, such as asthma and cardiac disarryhthmia; Thanks to global warming, malaria-carrying mosquitoes are spreading to cooler places too, where there has never been this disease before, such as South Korea and the highlands of Papua New Guinea; (Weiss, Pam, 2008) And a group of 12 diseases called Deadly Dozen have been found to spread due to the warming temperature, e. g. Avian ââ¬ËFlu, Cholera, Plague, Ebola and Tuberculosis. (Simmons) Global warming will add significantly to the worldââ¬â¢s water shortage problem as it increases the severity of droughts, foods, and cyclone, all of which reducing the water supply and destroying the quality of water. Wong Poh Poh, a professor at the National University of Singapore, says that the U. N. Intergovernmental Panel on Climate Change has found that 2 billion people will not have access to adequate drinking water by 2050 and 1. 2 billion more people will be under the threat of severe water shortage by 2080. NG, 2008)86 Many of the worldââ¬â¢s species could be on the verge of extinction due to global warming. According to the IPCC 2007 report, that 20- 30 % of the worldââ¬â¢s species would become extinct if global average temperature rises additional 1. 5 to 2. 5?C (relative to 1980-1990) and 40-70% would be expected if the increase in temperature exceeds 3. 5?C. (the IPCC 2007 Synthesis Report) Ho wever, there are some scientists who are sceptical about this man-made global warming theory. According to these sceptics, Climate change is a natural process and is not caused by man. The world has experienced warmer and colder periods in the past without any external cause so a minor rise (less than a degree) in global average temperature is normal. Explains Richard L. Lindzen, a professor of meteorology at the Massachusetts Institute of Technology, ââ¬Å"the motions of the massive oceans where heat is moved between deep layers and the surface provides variability on time scales from years to centuries. Recent work â⬠¦suggests that this variability is enough to account for all climate change since the 19 Century. â⬠Lindzen asserts that the warming in the tropics around an altitude of about 9 km should be 2. times greater than the surface warming but the measurements show that warming at these levels is only about ? of the surface warming. This means the greenhouse effect only contributes to about one third of the surface warming and not all of this really small warming is caused by man. (Lindzen, 2009) Global warming sceptics also argue that computer models which predict the future climate are not reliable. According to S. Fred Singer, an atmospheric physicist at George Mason University, these computer models can not calculate all the important parameters around the globe therefore are unable to predict the future climate. Singer says, ââ¬Å"If you only calculate temperature, winds, and so on at intervals of 200 miles, then you cannot depict clouds, or even cloud systems, which are much smaller. So until the models have a good enough resolution to be capable of depicting clouds, itââ¬â¢s very difficult to put much faith in them. â⬠Singer also claims that these models do not agree with each other in predicting the temperature rise for a doubling CO2 levels. Some predict a warming of 5 degrees Centigrade while others predict one degree. ( How to cite Is the Global Warming Real?, Papers
Friday, December 6, 2019
Competitive Strategy of Alphapharm and Estia Health -myassignmenthelp
Question: Discuss about theCompetitive Strategy of Alphapharm and Estia Health. Answer: Industry: Pharmaceutical The pharmaceutical industry in Australia has witnessed an increasing competitive market in the recent years. This is due to the technological advancements witnessed in the world of medical sciences. Further, the increasing inspection from payers, the community and the regulatory bodies have also compelled the pharma industries to rethink their strategies and policies in order to survive. It is however, also true that the industry in Australia has witnessed great boon over the past few decades as investors beyond the country are also showing interest in the industry. In a recent survey by PwC, it was revealed that 45% of the people related to this industry consider the m-health and e-health are the potential competitive advantages that will benefit the industry in future. Company: Alphapharm Overview A generic drug manufacturing company based in Australia, Alphapharm is owned by the Mylan Pharmaceuticals of United States (Mylan.com.au, 2018). The company manufactures a variety of generic drugs that is exported to more than fifty countries across the globe. The company started operating in Australia in the year 1982 and has been among the top three pharma companies in the country. In fact, as per the reports of the Australian governments industry data, it is the biggest drug manufacturing and selling Company in the country with 20% share in the market (Industry.gov.au, 2018). Competitive strategy The company forms its strategies based on its three most important stakeholders that include the doctors, the pharmacists and the consumers. One of Alphapharms biggest strategies is its compliance with the policy of generic substitution (Mylan.com.au, 2018). The company is probably the only in Australia that supplies generic medicines to the people and upholds generic substitution. It follows the simple strategy to benefit all three of its stakeholders as mentioned. In case of the doctors, the company has a separate force that gives every detail about the generic substitution to the doctors thus helping them adapt to adopt this revolutionary idea. With regards to the pharmacists, Alphapharm delivers numerous value-added services to the pharmacies and that makes it the only company to do so. Lastly, the company has a separate and unqie strategy for its consumers. To being with, it is the only pharma company that advertises on all forms of media, be it television, print, radio or the s ocial media. The success of its competitive strategy is evident from its positioning in the ASX list of top pharma companies in the country. In addition, the acquisitions made by the company over the last few years including the latest in Mumbai, India prove its success. Industry: Aged care The aged care industry in Australia is abounding with opportunities for companies to cash in and do business. The need for this industry in Australia is rising each year as the countrys population is ageing. Many implications of this fact concern the Australian economy and its society. The government is aware of this fact and has made provisions for the systematic planning of providing home care and residential care for the aged population. However, the industry continues to waver in trajectories unchartered as the aged care providers face innumerable challenges as well as opportunities. Company: Estia Health Overview Estia Health (EHE) is an aged care provider based in Australia. It operates in places like Victoria, New South Wales, South Australia and Queensland. Established in 2005 as Estia, EHE specializes in providing residential services to the aged population that include everyday living, wellbeing and lifestyle, nutritious food and clinical healthcare (Estiahealth.com.au, 2018). The company performed significantly well in the financial year 2016 generating over 440 million dollars in revenues. It is currently headed by Norah Barlow as the Chief Executive Officer (CEO). It boasts of 69 facilities across 5,782 places. The company aims to expand its business in the coming years as the market opportunity for the industry continues to grow. Competitive strategy The main strategy of EHE is to acquire as many places as possible to expand its business and continue to provide quality services to the aged people. In its 2016 report, the company elaborated its plans of acquisition. It made a strategy to own 500 to 100 single sites across Australia in the coming year. Further, the company has strategized to acquire one medium and large sized firm within the period that ensures the accomplishment of its expansion strategy. In addition, it plans to modify more than 300 Brownfield and around 1000 Greenfields to open new branches. As part of its acquisition strategy, EHE struck deals with four leading aged care providers in Australia in 2016 and was successful. The company acquired Kennedy Healthcare in February that expanded its operating places by 21% (Theage.com.au, 2018). It led to the company boasting an addition of nearly 500 beds for its customers across the country, which was well above the forecast predicted by many experts. However, the acquisitions did not make much difference to the share prices as the company had expected. Therefore, it can be stated that the companys competitive strategy of acquisition has been largely successful in helping its expansion but it was not effective in raising its share value. Industry: Child Care The childcare sector in Australia is a booming industry that continues to provide investors with great opportunities to do business. This has in fact resulted in the rapidly increasing number of childcare providers within the country despite the presence of numerous other companies. In the 2017 financial year, the industry saw purchase of 76% of land for childcare centers. However, the industry faced a wavered flow of sales volumes in the past year with sales going down to 5.84% (Smh.com.au, 2018). Experts believe that despite the industrys declining figures, it continues to grow owing to increasing support from the government and the rise in peoples participation. Company: G8 Education Overview G8 education provides education facilities and quality care to children across Australia and Singapore. Based in Australia, the company was founded in 2007 with the mission to be the leading contributor of educational developmental child care facilities in Australasia (G8education.edu.au, 2018). Gary Carroll is the CEO of the company who was appointed the role in January 2017. In 2017, the company generated revenue of close to 800 million dollars that was about 20 million more than the previous year. In addition, it owned 516 centers across Australasia with more than 9,000 employees serving there (G8education.edu.au, 2018). Competitive strategy As part of its competitive business strategy, G8 focuses on acquisition, quality care and education, employees and community. The focus for this assignment however, is the companys strategy on quality care and education. With a view to increase its business within Australasia, G8 looks to aim at investing more in educational and care facilities to be provided to the children. In the year 2015, the company spent around 9 million dollars on bettering its childcare facilities within all its centers (Theaustralian.com.au, 2018). Further, the company looks to increase its workforce in order to attain the best team of expert educators. With a view to raise its stake, G8 also aims to make new partners. This would ensure a strong workforce thus raising the quality of care and education. Very recently, the company came into partnership with the Swinburne University of Technology that aims to give G8 employees the chance to earn a degree through the universitys training program (Swinburne.edu.au, 2018) This strategy has faired remarkably well for the company because parents have been given increased assurance that the education and care of their children are in the right hands. With a workforce adept in early childhood learning, it surely would help the company be ahead of the race in the coming years as well. It needs mentioning that G8 Education is one of Australias top childcare providers. References: Estia Health. (2018). Corporate profile. [online] Available at: https://www.estiahealth.com.au/investor-centre/corporate-profile [Accessed 13 Apr. 2018]. Estiahealth.com.au (2018). DELIVERING ON FY2020 STRATEGY, Estia Health (EHE). [online] Estiahealth.com.au. Available at: https://www.estiahealth.com.au/assets/media/files/Delivering%20on%20FY2020%20strategy(2).pdf [Accessed 13 Apr. 2018]. G8education.edu.au (2018). Company Overview - G8 Education. [online] G8 Education. Available at: https://g8education.edu.au/about-us/company-overview/ [Accessed 13 Apr. 2018]. G8education.edu.au (2018). G8 Education Investor Presentation. [online] G8education.edu.au. Available at: https://g8education.edu.au/wp-content/uploads/2013/09/260416-SGD-Bond-Roadshow-Investor-Presentation.pdf [Accessed 13 Apr. 2018]. Industry.gov.au (2018). Australian Pharmaceuticals Industry Data Card 2013. [online] Industry.gov.au. Available at: https://industry.gov.au/industry/IndustrySectors/PharmaceuticalsandHealthTechnologies/Pharmaceuticals/Pages/PharmaceuticalsIndustryDataCard.aspx [Accessed 13 Apr. 2018]. Mylan.com.au (2018). Mylan Seeing Is Believing. [online] Mylan.com.au. Available at: https://www.mylan.com.au/ [Accessed 13 Apr. 2018]. Mylan.com.au (2018). Mylan to Acquire Famy Care Businesses to Create a Leading Women's Health Care Franchise. [online] Mylan.com.au. Available at: https://www.mylan.com.au/en-au/news/press-releases/2015/123276 [Accessed 13 Apr. 2018]. Smh.com.au (2018). Australia's childcare sector grows up. [online] The Sydney Morning Herald. Available at: https://www.smh.com.au/business/companies/australias-childcare-sector-grows-up-20171116-gzmqht.html [Accessed 13 Apr. 2018]. Swinburne.edu.au (2018). New partnership aims to raise early childhood education workforce quality. [online] Swinburne.edu.au. Available at: https://www.swinburne.edu.au/news/latest-news/2018/02/new-partnership-aims-to-raise-early-childhood-education-workforce-quality.php [Accessed 13 Apr. 2018]. Theage.com.au (2018). Roll-up strategy sees Estia Health shake off weak debut. [online] The Age. Available at: https://www.theage.com.au/business/investments/rollup-strategy-sees-estia-health-shake-off-weak-debut-20150730-ginwqt.html [Accessed 13 Apr. 2018]. Theaustralian.com.au (2018). Value Investor: Lessons from G8 Education. [online] Theaustralian.com.au. Available at: https://www.theaustralian.com.au/business/business-spectator/value-investor-lessons-from-g8-education/news-story/dc080db0e7b12df0c95a08a5deb216cb [Accessed 13 Apr. 2018].
Thursday, November 28, 2019
Antigone When Pride Leads to Ruins Essay Example
Antigone: When Pride Leads to Ruins Paper Kelley Booth Humanities: Classical Greek Rome Critical Paper #1 09 October 2011 When Pride Leads to Ruins Antigone, a play about corruption, political context, and bravery, shows how the different perspectives on values and conflict between the characters can lead to destruction and death. Antigone is a great tragedy between family members that illustrates the characters true purposes and personas on what they believe is right and wrong in their society. It explains how Antigone and Creon battle a theoretical war dealing with the controversy of the Greek ideals and values. The classic tragedy allows readers to see the values and conflicts in the play about social, political, and religious matter. In that day and time, ancient Greeks believed that women were nothing but objects, and they were only to be seen and not to be heard. Antigone reveals that is not always the case and that women have a right to say and stand up for what they believe in. Antigone was written by Sophocles, who demonstrates different views of political and religious principles of Antigone and Creon, along with conflict of blood relationships and honor in the fight for what is right. We will write a custom essay sample on Antigone: When Pride Leads to Ruins specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Antigone: When Pride Leads to Ruins specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Antigone: When Pride Leads to Ruins specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Antigone reveals bravery in a political, social and religious sense with the support of the characters values and beliefs. Antigone, the main character, is faced with a major decision in following her religious beliefs, or the law of her uncle, Creon (temporarily the king of Thebes). Creonââ¬â¢s law is put in place when he prohibits the burial of Polyneices, Antigones brother of flesh and blood, and if anyone attempts to bury him, the sentence for disobeying the king will be death. Antigone sees how wrong Creon is and ââ¬Å"appeals not only to the bond of kindred blood but also to the unwritten law, sanctioned by the gods, that the dead must be given proper burial- a religious principleâ⬠(Fagles 40). On the other hand, Creon believes that the gods and religion are on his side because he ââ¬Å"finds it unthinkable that these gods should demand the burial of a traitor to the city who came with a foreign army at his backâ⬠(Fagles 40). The opening of Antigone shows the real essence of what they play is about because it shows the conflicting laims of Antigone, whose character is based on religious principles; and Creon, who is based off of political principles. Creonââ¬â¢s political decision of making Polyneices burial forbidden was not only his pride due his title of king, but the ââ¬Å"denial of burial in their homeland to traitors, real or supposed, was not unknown in Greeceâ⬠(Fagles 40). His political ruling of Antigones brother was ultim ately a rightful law that has been done before in the time of the ancient Greeks because the kingdom of Thebes was ran by many sets of rules and laws. In Antigones mind the right thing to do is to organize a proper burial for her brother, but in the eyes of the law that is not allowed. Antigone, the religious portion in the play, chooses a ââ¬Å"heavenly approach, as opposed to the mundane road that Creon chose to followâ⬠because she ââ¬Å"feels that Creon is disregarding the laws of heaven through his edictâ⬠(Studyworld). By her choosing this heavenly approach, her main beliefs are entirely different from Creonââ¬â¢s because she had different views of political principles and she supports the gods and laws of heaven. Antigone was a very loyal, dedicated, and trustworthy woman towards her family, but ââ¬Å"a private code of conduct; in the context of the fifth-century Athens challenges the authority of the city-state and defense of a blood relationship had strong political overtonesâ⬠(Fagles 39). Her political aspect of the situation is emphasized greatly when she shows her loyalty compared to Creon: ââ¬Å"whoever places a friend/ above the good of his own country, he is nothing. And when he realizes later that this is in fact the issue between him and his niece, he reconfirms her death sentenceâ⬠¦Ã¢â¬ (Fagles 39-40). The conflict that is at stake is Antigones devotion to her family, and Creonââ¬â¢s opposing argument that state should come first. Antigone never stopped believing that Creon was wrong about the unlawful act of her very own brotherââ¬â¢s burial. Her strong beliefs of having a religious ceremony for her brother were strong, so she went behind Creonââ¬â¢s back and had a rightful burial for her brother, Polyneices, without the help of her unreliable sister Ismene. Surprisingly when Antigone asks her sister to help her in disobeying Creon, Ismene did not want to participate in anything that will defy her city because she had no strength for that (Fagles 63). Outraged, Antigone found bravery on a new level because she would die for her own flesh and blood. She states, ââ¬Å"I will bury him myselfâ⬠¦if I die in the act, that death will be a glory. I will lie with the one I love and loved by him-ââ¬Å"(Fagles 63). Furthermore, she did not want to hide from her defying King Creon, her uncle, like Ismene did; she wanted everyone to know that Creon was doing wrong in the society, and if showing her honest beliefs might get her killed, so be it. His cruelty as King sets in when he ultimately led Antigone to her death. Although Antigone went through much turmoil, she never stopped believing and defending what she thought was right. She defended her beliefs along with humiliating and manipulating Creon when he condemned her to death by implying, ââ¬Å"Give me glory! What great glory could I win/ than to give my own brother a decent burial? / they would praise me too if their lips werenââ¬â¢t locked in fearâ⬠(Fagles 84). She emphasized true accusations to Creon to call ââ¬Å"his opinions and decisions weak and unjustâ⬠and ââ¬Å"also emphasizesâ⬠¦that Creonââ¬â¢s decision to capture Antigone was his own, and was not backed up by the majority of the peopleâ⬠because they were too scared to speak up (Studyworld). Ultimately, Creon was abusing his powers and legitimacy as King of Thebes by doing what was right for him, and not using his power for good. In Sophocles plays, ââ¬Å"he explores time and again the destinies of human beings who refuse to recognize the limits imposed on the individual while men and gods, go to death or triumph, magnificently defiant to the lastâ⬠(Fagles 51). This explains Creonââ¬â¢s selfishness and his pride into ruling a city on his own terms, no matter the limits; and how Antigone goes to such lengths in showing her loyalty and religious beliefs toward her brother, Polyneices. Also, Sophocles demonstrates pride through Creon by describing ââ¬Å"the type of pride that allows men to create laws that substitute for divine principlesâ⬠(Antigone Themes). With this kind of pride that Creon withholds in himself, it ends in ââ¬Å"a disastrous failure, both as head of a family and head of state, an offender against heaven and a man without family or friends, without the respect of his fellow-citizensâ⬠(Fagles 52). There is also a sense that Sophocles input his feelings and emotions in the words of the Chorus Leader. Throughout the play, the chorus leader tries to emphasize to Creon the right direction, especially when Creon finally agrees with Chorus Leader to free Antigone from the rocky vault by convincing him using his better judgment (Fagles 116-117). The ancient Greek civilization was based off of rules, law, and order; and not off of religious persuasions. The Greek civilization would agree with Creon and his illicit laws, and consider them by explaining, ââ¬Å"in times of crisis, the supreme loyalty of the citizen is to the state and itââ¬â¢s duly constituted authoritiesâ⬠(Fagles 38). This could explain why Sophocles wanted to show the Greek civilization that it is okay to stand up for what you believe in, like Antigone did. Not only standing up for what you believe in, but also showing your honesty towards your family and friends by helping them out in the time of need. Despite Antigone and Creon having both to deal with conflict, the play subsides with the sense of making choices even if others do not agree. The strong tragedy states a separation between traditional religion and politics between Antigone and Creon because it ultimately shared a link to how Greek civilization perceived their society. I believe that the sagacity of a person of the Greek civilization has a sense of judgment on them if they stand up for what they believe in because they are following the rule of manââ¬â¢s law, not their hearts. In addition, I believe that Sophocles is stating through this play that no man is superior, wiser, or more authoritative than the Gods because the people of the Greek civilization only depended and worshipped the Gods. In this case, Antigone defying Creon, the law, was acceptable because the Godââ¬â¢s law comes before all else. Overall, Sophocles gave a means of respecting ones authority, but also having the right of individual freedom to reject societyââ¬â¢s infringement. Works Cited Antigone by Sophocles. Studyworldworld: Studyworld Guides, Research Papers, Book Reports, Essays. Web. 13 Oct. 2011. http://www. Studyworldworld. com/basementpapers/papers/stack35_6. html. Antigone Themes | Antigone ThemesSaver. Studyworld Guides Essay Editing | Antigone ThemesSaver. Web. 13 Oct. 2011. http://www. Antigone Themessaver. com/antigone/Studyworld-guide/major-themes/. Sophocles, Robert Fagles, Bernard MacGregor Walker. Knox, and Sophocles. The Three Theban Plays: Antigone, Oedipus th e King, Oedipus at Colonus. New York, NY: Penguin, 1987. Print.
Monday, November 25, 2019
Financial Analysis of Samsung Essays
Financial Analysis of Samsung Essays Financial Analysis of Samsung Paper Financial Analysis of Samsung Paper reaching $ 110. 2 billion , compared with Intels $ 860 million higher than the market value , as the worlds largest semiconductor manufacturer revenue . Samsung Electronics , according to statistics released on the October 4th 2013 , in the third quarter ( July to September ) sales of 59 trillion won ( about 337 billion Yuan ) , operating profit amounted to 10. 1 trillion won ( about ARM 575 billion) , this value was even higher than the record 5. 98 percent in the second quarter. Thus , the profits of Samsung Electronics has been single-season record highs for two consecutive quarters. 3. 2. 2 Marketing Samsung has nearly 20 kinds of products in the global market share to get the first, ranking first in global enterprises. U. S. Market research firm Strategy Analytics recently released report, the second quarter of the global smart hone shipments grew 47% , reaching a record 229. 4 million , of which 76 million sales of Samsung Electronics , the market share expanded to 33. 1 % and Apples share was 13. 6%, phone sales in the second quarter of 31. 2 million . The data also show that the first half of this year, Samsung Electronics turnover of 1 10. 33 trillion won (U. S. $ 99. 3 billion ) , an increase of 19% ; operating profit of 18. 31 trillion won (U. S. $ 16. 5 billion ) , an increase of 51%. Samsung Electronics stakeholders also said that with the second half of the season will go into IT products , Samsung Electronics will continue to increase n the second half performance , parts department based on the competitiveness of high value-added products and specialty products , is also expected to bring more profits for the company . 3. 3 Core Competencies 3. 3. 1 Innovation Speaking of Samsung resplendence, almost every manager or ordinary employee will refer to the well-known remarks by Junk-He Lee, the chairman of Samsung Group, Except wife and children, all the things have to change. In 1 993, Junk;He Lee conducted the New Management program. Through continuous indoctrination of the consciousness of crisis and the concept hat only those who change can possibly survive, Samsung core business begun to change from mass imitation production to independent brand development based on digital technology. During its course to become a world-class company, Samsung has never stopp ed innovation and transformation. In 2001 in order to cope with the fast-changing information age, the program of Digital Management was carried out. In 2002, Samsung implemented the Wow Product System in order to maintain its leading position through the development Profit Operations Inbound Logistics Outbound Logistics Marketing and Sales Service Samsung type industrial ark use high-end technologies offer unique and thoughtful service work in marketing guiding principle Multinational company system all over the world set up strong marketing team and extensive marketing relationships massive and high quality skill training strong capability chances for personal development Administration HARM Technology Development Procurement of a series of high-tech. Innovation now has become part of Samsung spirit and culture and has become the driving force of Samsung firm and continuous transformation. 3. 3. 2 Triangle Management Structure Samsung Group creates a triangle management structure in the New Management program aiming at the integration of knowledge capital. In such a structure, CEO Junk-he Lee is at the vertex of a triangle. Another point is the structural adjustment department itself. The third triangle point is the Chief Executive Group. CEO at the vertex is in charge of guiding management direction and deploying strategic target, leading his workers struggling to create products. Structural adjustment department not only assists President to carry out the strategic decisions but also acts as the role of monitor in charge of regulating a few branches of the operation. Chief Executive Group is responsible for carrying out specific strategic plan regarding to how to develop the actual business activities. Triangle Management Structure increases Samsung market competitiveness, considered as Samsung management work milestone. Because of this structure,management responsibility is strengthened and management efficiency also improved. 3. 33 Human Resource program In order to be better in the 21st century, Samsung strengthens human resources management system, building up South Koreans biggest talent bribery to promote the operations sustainable development. Additionally, Samsung pursues the principle of people first, always believing that enterprise success lies in the quality of employees. Samsung divide technology into four terms: basic technology, advanced technology, core technology and future technology.
Thursday, November 21, 2019
Applewood auto group Coursework Example | Topics and Well Written Essays - 1000 words
Applewood auto group - Coursework Example The range for profits was calculated as a difference between the maximum and the minimum profit for each location. The results are presented in the table below. The last row presents the results for all sold vehicles (Black, 2012:52). 2. a. To construct the histogram for the profits, the Data Analysis toolkit is used. The option ââ¬Å"Histogramâ⬠permits to create the table and the graph for the distribution of profits (Anderson, Sweeney and Williams, 2014:106-180). b. The results show that the data is normally distributed with the small sqewness. The most frequently obtained profit is between $ 1,800 and $ 2,000. The rarest profits are within the range between $ 294 and $ 900. The profits of more than $ 3,100 are also very rare. More than 70 % of profits are within the range of $ 1,200 and $ 2,800. 3. a. To build the boxplot for variable age, the option ââ¬Å"Histogramâ⬠in the Excel Data Analysis Toolkit can be used (Anderson, Sweeney and Williams, 2014:106-180). The results are given in the table and in the graph below. The boxplot shows that the variable age is normally distributed. The mean and the median are almost equal. The average age of the buyer is 46 years. The most of the buyers are in the age between 33 and 60 years. The youngest buyer has 21 year and the oldest buyer is 73 years old. b. The data on the graph does not support the idea that the older buyers purchase cars on which the higher profits can be earned. It is seen from the scatterplot that buyers purchasing vehicles on which the high profits can be earned are in every age group. The scatterplot does not show the presence of the relationship between the age of the buyer and the earned profit. c. The option ââ¬Å"Add Trend Lineâ⬠in Excel can be used to get the trend line and the coefficient of determination. The coefficient of determination R2 is equal 0.0684. The correlation coefficient is the square root of the coefficient of determination R = 0.2615. The results
Wednesday, November 20, 2019
Virtual learning environments Essay Example | Topics and Well Written Essays - 2500 words
Virtual learning environments - Essay Example However, the long run is equally important, because the students are being prepared for it. This is where losses are experienced. To the administrator, the environment may shorten the processes. However, to some others, pressure is experienced in this kind of an environment. While at it, the way forward is to improve the environment so that there is efficiency in the learning environment. Table of Contents Understanding the Virtual Learning Environment 5 The Virtual Learning Environment as a Walled Garden 7 Conclusion 12 Introduction Technology has in many ways changed everyoneââ¬â¢s lifestyle. According to Brown & Adler, (2008, p.16-32) the approach people have to life and the means in which given tasks are accomplished has completely changed. The education system has experienced this change, by the introduction of the concept of virtual learning environment. Virtual Learning Environment is a learning experience where students use the web to access academic resources for example class work, various tests, homework among others (Friedman 2005, p.123-125). It is also referred to as Learning Management System When Virtual Learning Environment was first introduced in the learning institution in 1990ââ¬â¢s, a wave of pessimism met the concept (Bush & Mott 2009, p.3-20). Lecturers doubted their ability to use the environment. Students on the other hand were limited on the resources necessary to facilitate the environment (Friedman 2005, p.123-125). The concept looked as though it was something that would enable the teachers to evade administration processes. It looked like something in the mirage, probably to be conceived in the minds of many generations to come. However, Sener (1996, p.19-23) explains that technology has a way of making anything attainable, due to its dynamic nature. There are two forms in which virtual learning environment can take place (Gillmor 2006, p. 1-5). Firstly, it can take the form of synchronous learning. In this case, the teacher gives classes live from the web through tools such as power point videos or chatting. Both the teachers and the students are able to interact as they share their views on a given topic. The second aspect of virtual learning environment is that of asynchronous learning. This is also referred to as self spaced method of learning (Holden 1994, p.70-71). The students here are given a chance to act independently, and do the normal class-work. They are also expected to meet certain deadlines, which require commitment to the given tasks. New and better concepts are introduced everyday into the virtual learning environments to attain efficiency and effectiveness in the targeted areas (Friedman 2005, p.123-125). The idea is not limited to a certain location, or done in a specific way. Rather, the idea is flexible, allowing many students to access the information they need in their studies. There is also a shift from the centralization of the concept from the professional teacher. Today, the concept allows for interaction between students and their teachers, and amongst the fellow students. Several tools are used by teachers and students in the web learning. These include: social networks, blogs, wikis, and media sharing among others. Virtual learning environment was first fully embraced in the universities. The concept today has evolved to include all learning
Monday, November 18, 2019
Sexual Attraction Essay Example | Topics and Well Written Essays - 2750 words
Sexual Attraction - Essay Example Therefore on our biological level sexual attraction is a display of reproductive abilities; on psychological level we want to support that spiritual bond among individuals and reveal our emotions; in sociological frames sexual attraction is caused by cultural, legal and other aspects of our lives; from the point of view of philosophy, sexual attraction has prints of all the aspects of inner and outer worlds. Different societies have different mechanisms and criteria of sexual attraction. Historical and cultural backgrounds of our lives create stereotypes of what good and bad is, what sexual and what is not â⬠¦ A complex bundle of personal preferences, experiences, genetic information, moral values of the society determine what is sexually attractive for any individual. First and most common idea is that sexual attraction should be considered in terms of physical appearance of a person. Whether this statement right or not, weââ¬â¢ll consider in this section. Furthermore it is relevant to give a brief overview of historical roots of sexual attraction if any. Thus in prehistoric age a woman with broad shoulders, big belly and flabby breasts considered to be sexually attractive (Buss, 1994). The epoch of Renaissance renovated this tendency and this image followed its existence. Nevertheless itââ¬â¢s hard to imagine that modern society could accept this image as an attractive one. Nowadays in order to be sexually attractive, a modern woman should be tall, slim, have good-looking face, proportional breasts and full lips. Following this criterion, we can conclude that sexual attraction is differentiated on a visual level. But female sexual image discussed above can be transformed in accordance with subjective attitude and imagination of an individual. Another question appears at this point: who is the individual deciding what is sexually attractive and what is
Friday, November 15, 2019
Surgical Treatment Method of Isthmic Spondylolisthesis
Surgical Treatment Method of Isthmic Spondylolisthesis Comparison of Two and Three Vertebral Segment Posterolateral Fusion in the Treatment of Isthmic Spondylolisthesis Serkan BILGIC, Omer ERSEN, Tolga EGE, Kenan KOCA, Selahattin OZYUREK, Safak EKINCI, Erbil OGUZ, Ali SEHIRLIOGLU ABSTRACT Background Optimal surgical treatment method of isthmic spondylolisthesis remains unclear. Complications can be invited while saving a segment for lumbar motion. Objective The aim of this retrospective study was to determine the effect of the number of fusion levels on the clinical results of adult isthmic spondylolisthesis patients who had undergone posterior instrumentation and PLF. Patients and Methods This retrospective study comprised 37 (20 male, 17 female) patients with isthmic spondylolisthesis who had undergone posterior instrumentation and PLF (Postero-lateral fusion) between January 2005 and May 2011. Pre and post-operative radiological evaluation was made by anteroposterior, lateral, oblique and lateral flexion-extension x-rays. Preoperative spondylolisthesis slippage grading was evaluated according to the Meyerding classification from the preoperative radiographs. Results The mean age of the patients was 36.4à ± 9.2 years and the mean follow-up period was 34.3 months. Two-level fusion was applied to 22 patients and single-level fusion was applied to 15 patients. Decompression was performed on 7 patients in the two-level fusion group and on 6 patients in the single-level fusion group. There were no neurological complication after surgery in either group. No union complications were seen in the two-level PLF group but in the single-level PLF group, screw loosening occurred in 3 patients and screw breakage in 1 due to the pseudoarthrosis. These four patients were revised with two-level PLF. Conclusions This study has demonstrated that two-level posterior instrumentation and PLF with local bone grafts and DBM have significantly better clinical and radiological results than single-level surgery. To avoid potential complications of PLIF, two-level PLF can be an alternative treatment option. Key words:Istmic spondylolisthesis, Posterior lumbar interbody fusion, Fixation Background Lumbar spondylolisthesis is present in about 5% to 6% of the population with various etiopathogenesis. Due to its variant pathological anatomy, the radiological appearance, age and clinical aspect of the patients are different on diagnosis. It generally starts as spondylolysis, a bilateral pars fatigue fracture and becomes spondylolisthesis with a slip of a vertebra over the adjacent one. As the slip increases, disc degeneration and pain starts (1-3). Although conservative treatment is the first treatment option, surgery for symptomatic spondylolisthesis in adults has been found to have better clinical results than conservative treatment choices (3, 4). However, it remains unclear which surgical strategy should be adopted, as there is limited scientific evidence on which to base an optimal treatment method. Discussions on spondylolisthesis treatment have generally focussed on reduction, fusion levels, graft choices, and surgical techniques (5-7). One of the most preferred surgical treatment options for spondylolisthesis is posterior transpedicular instrumentation of the relevant segments and posterolateral fusion (PLF) (5, 7). However, it is still a matter of controversy in literature as to how many levels should be fused and instrumented. Objectives The aim of this retrospective study was to determine the effect of the number of fusion levels on the clinical results of adult isthmic spondylolisthesis patients who had undergone posterior instrumentation and PLF. Materials and Methods This retrospective study comprised 37 (20 male, 17 female) patients with isthmic spondylolisthesis who had undergone posterior instrumentation and PLF between January 2005 and May 2011. Patients with spondylolisthesis other than Type 2 according to the Wiltse classification were excluded from the study. Pre and post-operative radiological evaluation was made by anteroposterior, lateral, oblique and lateral flexion-extension x-rays. Preoperative spondylolisthesis slippage grading was evaluated according to the Meyerding classification from the preoperative radiographs. The decompression decision was made preoperatively according to magnetic resonance imaging (MRI) and patients preoperative neurological evaluation. Preoperative and postoperative neurological status, duration of surgery, number of fused and instrumented levels, total blood loss and complications were evaluated from the clinical database. For clinical evaluation of surgical outcomes, the Oswestry Disability Index (ODI) a nd Visual Analog Scale (VAS) applied at the final follow-up were used. 3.1 Surgical procedure: Exposure was obtained from the spinous processes to the transverse processes bilaterally throughout segments planned for fusion. Under fluoroscopic control, 6.5 mm pedicle screws were placed by free-hand technique. No reduction manoeuvre was used. Decompression of the segments, which had been determined by preoperative MRI and clinical examination was performed for the patients with neurological deficit. In all cases PLF was performed. In the area planned for fusion, the spinous processes were resected, peeled off from soft tissues and used for grafting with demineralized bone matrix. Patients were mobilized with a soft brace on the first postoperative day and the brace was continued for 3 months. (Figure 1, 2) 3.2 Statistical analysis We used the SPSS software package (version 15.0, SPSS, Chicago, IL) and expressed categorical variables as percentages and continuous variables as meanà ± standard deviation (SD) or median (quartiles). Kolmogorov-Smirnov test was used to evaluate whether the distribution of continuous variables was normal. For parameters that showed normal distribution we used the paired sample t test and for parameters that did not show normal distribution the Mann-Whitney U-test was used. Chi-square test was used to analyze categorical variables. Statistical significance was set at p Results All patients had a history of at least 3 months of lumbar pain due to the spondylolisthesis, which had proved to be resistant to conservative treatment. The mean age of the patients was 36.4à ± 9.2 years and the mean follow-up period was 34.3 months. Low-grade isthmic spondylolisthesis was present at L5-S1 level in 23 patients, at L4-5 level in 13 patients and at L3-4 level in 1 patient. Two-level fusion was applied to 22 patients and single-level fusion was applied to 15 patients. Decompression was performed on 7 patients in the two-level fusion group and on 6 patients in the single-level fusion group. There were no neurological complications after surgery in either group. Mean duration of surgery for single-level and two-level surgery was 160 minutes and 190 minutes (160-240), and average blood loss was 285 ml and 390 ml respectively. There were no differences between the two groups in terms of demographic properties (Table 1). One of the patients in the two-level PLF group had superficial infection and was treated with debridement and antibiotheraphy. No union complications were seen in the two-level PLF group but in the single-level PLF group, screw loosening occurred in 3 patients and screw breakage in 1 due to the pseudoarthrosis. These four patients were revised with two-level PLF. (Figure 3) ODI scores from the final follow-up were 12.2à ±6.2 in the single-level PLF group, and 9.2 à ± 6.4 in the two-level PLF group (p=0,035). VAS scores were 3.2à ±1.7 in the single-level PLF group and 2.9à ±1.6 in the two-level PLF group (p=0.043). The ODI and VAS scores of the patients revised with two- level PLF were excluded from the clinical evaluation. Discussion Lumbar spondylolysthesis has several etiopathogenetic factors as was shown by Marchetti and Bartolozzi giving rise to variations in pathological anatomy, radiological findings, age and clinical symptoms of the patients on diagnosis. When conservative treatment options fail, surgery becomes the next step. Although there have been a large number of studies on spondylolisthesis, there is no clear evidence for a single superior treatment option. Anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF) and PLF with/without instrumentation are the most widely accepted surgical methods. Whilst PLF with instrumentation is the most preferred treatment for most authors, there is no scientific evidence showing that PLF is disadvantageous compared to PLIF or circumferential fusion (8-11) even though the major theoretical advantage of PLIF and circumferential fusion seems to have resulted in improved outcomes compared with PLF. Ekman et al (12) found that the type of fusi on, whether PLIF or PLF, did not affect the outcome of surgical treatment of adult isthmic spondylolisthesis over a two year follow-up period. Furthermore, PLIF is a more invasive, technically more difficult method requiring a longer operative time, which may result in increased blood loss and higher complication rates (12, 13). Similarly, Kim et al. could not demonstrate any difference between ALIF and PLF with instrumentation (11). Although circumferential fusion was reported as significantly better than PLF at 6 months and 1 year in a study by Swan, no difference was determined at two years (14). In a systematic review of 29 high quality studies, Jacobs and al. found no difference between different fusion techniques (15). In the current study the treatment choice was PLF with instrumentation which is a relatively easy method with a shorter operating time and lower blood loss compared to other techniques in literature. When performing PLF, slip reduction can be achieved during the same procedure. The advantages of slip reduction include improved spine biomechanics, better nerve root decompression and a better opportunity for fusion by relieving tension and shear forces (5). Although the major disadvantage of slip reduction is increased risk of neurological injury, there have been numerous studies evaluating slip reduction for adult low grade spondylolisthesis (14, 16-18). In the current study, slip reduction was not performed to avoid the possibility of potential neurological damage and as all the cases had low grade isthmic spondylolisthesis. To protect one more mobile segment, some authors have preferred single-level postero-lateral instrumentation and fusion instead of two-level (6, 13, 15). However, there is no scientific proof to help determine the number of fusion levels and this decision is based on the surgeonââ¬â¢s empirical experience. In a prospective study by Inage et al, two-level fusion with local bone grafts was shown to cause increased pseudoarthrosis (6). Similarly in a study by Deguchi et al, single-level fusions showed an 82% fusion rate, and two-level fusions, a 74% rate radiologically (19). Higher fusion rates in the two-level fusion group were achieved with rigid spinal implants. The clinical success of that study correlated with the radiological fusion rates. Contrary to the information in literature, local bone grafts mixed with demineralized bone matrix (DBM) were used in the current study to achieve union for both groups and no union problem was seen in the two-level fusion group. Pseudoarthros is was observed in four cases in the one -level fusion group. Although some authors have reported incongruity between the clinical results of spondylolisthesis patients and union rates, VAS and ODI are the most reliable clinical tests to evaluate spondylolythesis (9, 10, 20). The results of the current study reveal that two-level posterior instrumentation with PLF has better results than single-level surgery according to VAS and ODI. This study has some limitations. Firstly, the retrospective design did not allow for uniformity of the groups. The number of patients was also limited to achieve generalized results. Although the pedicle screws were all 6.5 mm in size, they were not all from the same manufacturer, so implant problems were disregarded. In conclusion, this study has demonstrated that two-level posterior instrumentation and PLF with local bone grafts and DBM have significantly better clinical and radiological results than single-level surgery. To avoid potential complications of PLIF, two-level PLF can be an alternative treatment option. References 1.Floman Y. Progression of lumbosacral isthmic spondylolisthesis in adults. Spine. 2000;25(3):342-7. 2.Fredrickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP. The natural history of spondylolysis and spondylolisthesis. The Journal of bone and joint surgery American volume. 1984;66(5):699-707. 3.Osterman K, Schlenzka D, Poussa M, Seitsalo S, Virta L. Isthmic spondylolisthesis in symptomatic and asymptomatic subjects, epidemiology, and natural history with special reference to disk abnormality and mode of treatment. Clinical orthopaedics and related research. 1993(297):65-70. 4.Moller H, Hedlund R. Surgery versus conservative management in adult isthmic spondylolisthesisa prospective randomized study: part 1. Spine. 2000;25(13):1711-5. 5.Floman Y, Millgram MA, Ashkenazi E, Smorgick Y, Rand N. Instrumented slip reduction and fusion for painful unstable isthmic spondylolisthesis in adults. Journal of spinal disorders techniques. 2008;21(7):477-83. 6.Inage K, Ohtori S, Koshi T, Suzuki M, Takaso M, Yamashita M, et al. One, two-, and three-level instrumented posterolateral fusion of the lumbar spine with a local bone graft: a prospective study with a 2-year follow-up. Spine. 2011;36(17):1392-6. 7.Zagra A, Giudici F, Minoia L, Corriero AS, Zagra L. Long-term results of pediculo-body fixation and posterolateral fusion for lumbar spondylolisthesis. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2009;18 Suppl 1:151-5. 8.Bernhardt M, Swartz DE, Clothiaux PL, Crowell RR, White AA, 3rd. Posterolateral lumbar and lumbosacral fusion with and without pedicle screw internal fixation. Clinical orthopaedics and related research. 1992(284):109-15. 9.Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT. 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine. 1997;22(24):2807-12. 10.Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. The Journal of bone and joint surgery American volume. 1991;73(6):802-8. 11.Kim NH, Lee JW. Anterior interbody fusion versus posterolateral fusion with transpedicular fixation for isthmic spondylolisthesis in adults. A comparison of clinical results. Spine. 1999;24(8):812-6; discussion 7. 12.Ekman P, Moller H, Tullberg T, Neumann P, Hedlund R. Posterior lumbar interbody fusion versus posterolateral fusion in adult isthmic spondylolisthesis. Spine. 2007;32(20):2178-83. 13.Madan S, Boeree NR. Outcome of posterior lumbar interbody fusion versus posterolateral fusion for spondylolytic spondylolisthesis. Spine. 2002;27(14):1536-42. 14.Swan J, Hurwitz E, Malek F, van den Haak E, Cheng I, Alamin T, et al. Surgical treatment for unstable low-grade isthmic spondylolisthesis in adults: a prospective controlled study of posterior instrumented fusion compared with combined anterior-posterior fusion. The spine journal : official journal of the North American Spine Society. 2006;6(6):606-14. 15.Jacobs WC, Vreeling A, De Kleuver M. Fusion for low-grade adult isthmic spondylolisthesis: a systematic review of the literature. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2006;15(4):391-402. 16.Sears W. Posterior lumbar interbody fusion for lytic spondylolisthesis: restoration of sagittal balance using insert-and-rotate interbody spacers. The spine journal : official journal of the North American Spine Society. 2005;5(2):161-9. 17.Spruit M, van Jonbergen JP, de Kleuver M. A concise follow-up of a previous report: posterior reduction and anterior lumbar interbody fusion in symptomatic low-grade adult isthmic spondylolisthesis. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2005;14(9):828-32. 18.Suk SI, Lee CK, Kim WJ, Lee JH, Cho KJ, Kim HG. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine. 1997;22(2):210-9; discussion 9-20. 19.Deguchi M, Rapoff AJ, Zdeblick TA. Posterolateral fusion for isthmic spondylolisthesis in adults: analysis of fusion rate and clinical results. Journal of spinal disorders. 1998;11(6):459-64. 20.Ohtori S, Suzuki M, Koshi T, Takaso M, Yamashita M, Yamauchi K, et al. Single-level instrumented posterolateral fusion of the lumbar spine with a local bone graft versus an iliac crest bone graft: a prospective, randomized study with a 2-year follow-up. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2011;20(4):635-9. Tables Table 1. Paramaters of groups during surgery 1
Wednesday, November 13, 2019
Essay on Narrator and Point of View in Yellow Wallpaper and Story of an
Narrator and Point of View in The Yellow Wallpaper and The Story of an Hourà à à Both Gilman's and Chopin's stories are, in effect, stories of women who feel "trapped" by the men in their lives. Gilman uses first person narration to reveal a woman's "creeping" loss of reality to her readers, while Chopin allows us to experience the joy Louise Mallard felt upon hearing of her husband's death through third person narration. Interestingly, neither story would have been able to reveal either woman's psyche to impact the reader as successfully as both did had their individual narrations been attempted through another form. In "The Yellow Wallpaper," Gilman's point of view is expressed through first person narration, which provides her readers with brief glimpses into the other characters' perception of her and her perceptions of them (which essentially enlightens readers), as well as the main character's active dissemination of what is occurring in her mind. First person narration can at times be considered biased or naive within the context of their perceptions and projections of other characters. Not so with the woman in "The Yellow Wallpaper." She seems to offer an almost unbiased perspective of husband John, which the reader notes from the beginning as she goes back and forth from justifying his attitude and behavior towards her--"Dear John! He loves me dearly, and hates to have me sick" (324)--to eventually becoming mistrustful of him: "The fact is I am getting a little afraid of John" (326). One ends up viewing John as completely oblivious yet superior in his lackadaisical attitude and treatment of his wife. Therefore one has little sympathy for John in the end (which I believe is also intended), when he finally realize... ...r V. Roberts and Henry E. Jacobs. Upper Saddle River, New Jersey: Prentice-Hall Inc. Simon Schuster/ A Viacom Company, 1998. 542-553. Gilman, Charlotte Perkins. "Why I Wrote 'The Yellow Wallpaper'" Ed. Catherine Lavender; The College of Staten Island of the City University of New York, Fall Semester, Oct. 1997. (25 Jan 1999)à à http://www.library.csi.cuny.edu/dept/history/lavender/whyyw.html McChristie, Pat. "Women Need to Work" Copyright: 1998. Cyberwoman (30 Jan 1999) http://www.cyberparent.com/women/needwork.htm Wyatt, Neal "Biography of Kate Chopin" English 384: Women Writers. Ed. Ann M. Woodlief Copyright: 1998, Virginia Commonwealth University. (26 Jan. 1999) http://www.vcu.edu/engweb/eng384/katebio.htm "Why are Women Leaving Marriage in Droves?" Marriage. Copyright: 1998. Cyberwoman (30 Jan 1999) http://www.cyberparent.com/women/marriage1.htm
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