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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