The Absolute True Diary of a Part Time Indian

One thing Arnold does not do is complain. Even though he was â€Å"born with water on the brain†, gigantic feet, ten more teeth then normal, stutter and a lisp, Arnold still doesn't complain though. Just because he does not complain does not mean he loves the life he was given. Junior still thinks life would have been much easier if he was white. He tends to put himself down quit often. Alexie Sherman illustrates what differences there are between the Indians and the white people. Indians covered their private parts with their tiny hands† (Alexie 11). Saying that Indians have tiny hands indicates that the whites had bigger hands therefore meaning that they were more powerful and/or superior over the whites. Another thing Alexie Sherman shows the readers is that Arnold has very low self-esteem because he's used to people calling him retarded so often that he starts to believe he really is. And then you'd be wondering why you're reading a story written by uch a retard† (Alexie 4). It shows that Arnold doesn't have that much confidence in himself and he believes Indians are treated the way they are because they deserve to be. Alexie Sherman is saying that Indians don't be live that white people are truly better then Indians. â€Å"Some Indians think you become white if you try to make your life better, if you become successful† (Alexie 131). This shows how Indians have lost all hope for themselves and that's probably why they don't even ry to make their lives better, because no matter what they do they still aren't as good as the Indians. Some of the Spokane Indians believe if one Indian becomes successful then he is no longer an Indian but instead a white. In conclusion Alexie Sherman uses alot of metaphor does/says many things to express how the Spokane Indians feel about themselves and how they have low self-esteem. And because of this many Indians think they can't get anywhere far in life.

Management and Leadership at Cvs Caremark

Management and Leadership at CVS Caremark Michell McGill MGT/330 September 10th, 2012 Ed Robinson CVS Caremark is the largest pharmacy health care provider in the United States with integrated offerings across the entire spectrum of Pharmacy Care. CVS Caremark is a market leader in mail-order pharmacy, retail pharmacy, specialty pharmacy, and retail clinics and is a leading provider of Medicare Part D Prescription Drug Plans.As one of the country’s largest pharmacy benefits managers (PBM’s) CVS Caremark provides access to a network of more than 65,000 pharmacies, including more than 7,3000 CVS/pharmacy stores that provide unparallel services and capabilities(â€Å"Recruiter contact information,† 2012). The size and components of the company CVS Caremark has implemented a leadership team comprised of talented and diverse leaders who’s abilities makes the company a leader among retail and specialty pharmacies in the United States.CVS Caremark divides the com pany into a Business Unit that consists of MinuteClinic, Pharmacy Benefit Management and Retail Pharmacy. Leadership, defined as influencing individual and group activities toward goal achievement. Executive leadership is a key component to the success of CVS Caremark. CVS Caremark fill many of their Executive Leadership opportunities from within, colleagues are offered development plans and encourage open dialog with colleagues and managers.Regular training and leadership development programs ensure that talent can be promoted from within the company. CVS Caremark employs Senior Executive Teams and department and line executives these positions are responsible for support and to work with teams that manage most of the major staff support functions (â€Å"Recruiter contact information,†2012). Management is described as the process of working with people and resources to accomplish organizational goals. At CVS Caremark there are several types of managers in the retail stores.T here are district store managers, district pharmacy managers, store managers, shift managers, photo lab supervisors, pharmacy managers, lead pharmacy teach, minute clinic manager and each manager report to the store managers. The distribution center employs more managers as well as other departments. Roles and Responsibilities MinuteClinic are managed by nurse practitioner who offer services to treat minor health issues such as strep throat, and ear, eye, sinus, bladder, and bronchial infections. Others convince of the minute clinic is the ability to have several common vaccinations, flu shots, hepatitis A and B, tetanus, and pneumonia.The benefit to the customer is there are no appointment necessary and the practitioner specialist can diagnose and treat and write prescriptions, which can be filled immediately in the store pharmacy with little or no waiting. Other convient services are camp, sports, and college physicals on a daily walk in, no appointment necessary. Pharmacy Benefit Management is another business unit that assists the customers with managing their benefit, filing prescription by mail and in the retail setting. The services offered help the customer file insurance and fill his or her prescriptions.Services such as ready fill and 90 day supply of maintenance medications like blood pressure, asthma medication, birth control, etc. can be automatically refilled every month or 90 days according to their insurance plan. The benefit to the customs is that they do not have to file their insurance and be reimbursed by the insurance company. The prescriptions can be automatically refilled every month or every 90 days. CVS/pharmacy retail division is America’s leading retail pharmacy with more than 7,300 CVS/pharmacy and Longs Drug stores .Many of CVS/ pharmacies are open 24 hours, which is always a benefit to the customer who may have a late night trip to the ER. CVS/pharmacy offer personalized expertise, in the retail stores and online at CVS. co m. This is a benefit to the elderly patients, they do not have to remember to call in their prescriptions, and they get a coursity phone call if the prescriptions are not picked up within two days after the fill. As people are living longer today the elderly many times do not have help maintaining their drugs or other needs and at time the responsibility can become overwhelming.Customers enjoy the convince to speak with a pharmacist about minor issues with their health or medications. Cot to cost every CVS/pharmacy offer prescription medications related health care products and other health products, such as first aid products, crutches, walkers for the elderly, bed pan, etc. There are 600 in-store minute clinics with more to come by 2016. The front store offer a wide variety of popular beauty supplies, health, and personal care brands, well stocked convince foods and a photo lab with one hour services and many other photo needs, seasonal aisle, and gift ideas and a large supply of cards for every occasions.CVS Caremark is in the United States, the company is launching a Spanish version of Caremark. com. CVS Caremark planes precipitations have access to most comprehensive Spanish-language Web site in PBM industry. The services provided will be the same services as English-speaking customers. While CVS Caremark offers great services and benefits to their employees, turnover can be a problem, due to some factors that stand out, According to Sam Walton of Wal-mart, â€Å"If you want to know where the problem is ask the front line†.The employees at CVS have several issues that if corrected the employees may be happier and offer better customer service. One issue is with the work environment, in retail pharmacy employees work an eight-hour shift and many days there is no breaks, no lunch, and many times no bathroom breaks. When dealing with customers who are sick and not feeling well, and all they want is to get their medicines and go home. The employees nee d to have a break from the crazy fast pace of the frontline. This would take care of the bathroom problem.While the management does not tell employees not to take a break, they also do not make taking break easy. As for a lunch break, employees can have food in the store but many times some stores may fill 800 to a 1,000 prescriptions a day. This leaves little time to eat or anything else. If employees had a break and a little time to eat, service with a smile, is more likely. Another employee issue is the work schedule, no set schedules are , most store employees including managers are required to work two- day shifts and two evening or night shifts and every other weekend.If the store is open 24 hours the last shift get off around 11:00 p. m. . . The 24- hour stores never close for anything, rain sleet or snow. If CVS Caremark would look at these couple of problems the service would improve, the customers would be happier. Customers can at times wait 30 minutes to an hour for thei r prescriptions. Employee who are exhausted and hungry and need to go to the restroom are less likely to provide great customer service. CVS Caremark management is always looking for ways to improve their service at the store level.There are weekly phone conferences for the management team, the pharmacist, the technicians, and the minutecilnic, and retail front store. To discuss the monthly service goals and what need to be completed to improve the service for the months to come. The district managers need to be in the store more often and the management need to take better care of their employees on a daily bases and management will see a change in customer service scores. References: Recruiter contact information. (2012). Retrieved from http://info. cvscaremark. com

Cultural Anthropology

Culture is a well organized unity divided into two fundamental aspects – a body of artifacts and a system of customs – Mammalians. â€Å"Humans cannot eat, breathe, defecate, mate, reproduce, sit, move about, sleep or Ill down without following or expressing some aspect of their society culture. Our cultures grow, expand, and evolve. It is their nature. † – Marvin Harris. The culture of a people is an ensemble of texts, themselves ensembles, which the anthropologist strains to read over the shoulders of those to whom they properly belong. † Geezer, Balinese Cockfight (p. 2). â€Å"Man is an animal suspended in webs of significance he himself has spun. I take culture to be those webs, and the analysis of it to be therefore not an experimental science in search of law but an interpretative one in search of meaning. † Greet, Interpretation of Cultures (p. 5). â€Å"People do not realize how greatly culture Influences their behavior until they co me across other ways of doing things. † â€Å"Culture is learned behavior. † A person is not born with a culture. Culture is universal. Every human being possesses it by virtue of their biological state. Cultural Anthropology) Is Inherently pluralistic, seeking a framework In which the distinctive perspectives of each culture world can be appreciated. † â€Å"[Cultural practices are meaningful actions that occur routinely in everyday life, are widely shared by members of the group, and carry with them normative expectations about how things should be done† (Gooding, Miller and Sessile, 1995). â€Å"A collective name for all behavior patterns socially acquired and socially transmitted groups. † Dictionary of Sociology and Related Sciences. Culture is a civilization†¦ s that complex whole which includes knowledge, belief, art, morals, custom, and any other capabilities and habits acquired by man (sic. ) as a member of society. † – Edw ard Taylor â€Å"Culture embraces all the manifestations of social habits of a community, the reactions of the individual as affected by the habits of the group in which he lives, and the product of human activities as determined by these habits. † -Franz Boas. Coloratura Anthropology focuses on how language, customs, and culture in general develop.Cultural Anthropologists compare and contrast the vast range of cultures with the popes of better understanding â€Å"the diversity of human behavior, and ultimately to develop a science of human behavior. † – Fried,J. Cultural Anthropology. What is traditional (or folk) culture? â€Å"Traditional culture is the habitual behaviors or thoughts of any given social group, and there is not only the chance of customary behaviors occurring; customary behaviors are expected and generally required by members of the society (Smith- Seymour, 1986).Folk culture is a model of the peasant community characterized by economic self- efficiency, intimate social ties, the strong role of ritual and tradition, and the relative isolation from urban centers. The concept of folk culture is that it represents an attempt to characterize the values and social structure of traditional, rural communities existing within complex societies. What methods do they use to study culture? Fieldwork: visiting and living among a particular people.Mapping, inventories, census, behavior protocols, questionnaires, projective tests, collecting genealogies, kinship terminologies, oral traditions, recording cases, and racing networks† (Hunter and Whiten, 1976). In order to study these cultures, ethnographers had to become part of them. Live with the people for extended periods of time. To study different groups of people, the scientists had to become immersed in their study. One important qualification that anthropologists should possess is a strong awareness of their won culture.Although it is necessary for Anthropologists to be a s culture tendencies in order to comprehend another's culture. Therefore, absolute objectivity, which would require that the Anthropologist have biases, and in research exult no culture at all, should be given up in favor of a relative objectivity based on the characteristics of one's own culture. The Anthropologist is forced to include himself and his own way of life in his subject matter.In order to study others, and to study culture in general, the Anthropologist uses his own culture. What is material culture? Culture involves much more than behavioral traits; it includes all produced artifacts – tools, art, books and texts, etc. â€Å"Probably no other country in the world has such high regard for material culture as the United States. â€Å"Cultural materialism is a type of analysis that looks at ecology and economics for explanation of cultural beliefs and practices.It tries to explain cultural habits in terms of basic needs. ‘A cultural materialist view of hist ory looks for relationships between the use of new technologies, population booms, the material improvement of life, and the collapse of civilization† (fisher, 1986). What is cultural diffusion? â€Å"The worldwide tendency of human populations to share and pool creative efforts which are in origin locally known and used. † -David Hunter. Cultural Anthropology Construct a model of cross-cultural misunderstanding, using the information presented by Lee in this article. There are many cross-cultural misunderstandings including language barriers, the way people speak and interpret words, as well as actions performed. /ontah experienced these cross-cultural misunderstandings in the remotest corners of the Kalahari Desert, while living by the Bushman. Every year the people would slaughter an ox and feast and dance in celebration during Christmas time./ontah decided to buy the biggest ox he could find; he was proud of it until the ! Kung people started ridiculing his kill by saying that it was too thin to feed all of the people. They continued to say that Christmas would be a disaster, and that they would all go to bed hungry. This troubled /ontah because he was sure that he had a fat ox, but many men assured him it was only big boned. He searched for a replacement but could not find it.On the day of Christmas, they cut into the ox, and /ontah w as saying how big and fat the ox is and how the people must be out of their minds. The ! Kung started laughing and /ontah could not understand why. He soon found out that the whole time they had been tricking him in believing that his ox was worthless, when they were actually excited to eat it on Christmas. 3. Why do you think the ! Kung ridicule and denigrate people who have been successful hunters or who have provided them with a Christmas ox?Why do Americans expect people to be grateful to receive gifts? The ! Kung like to fool each other to make sure that their people don’t become arrogant. When one man â€Å"brings home the bacon,† then he starts to believe that he is the big man of the group and will boast of his superiority. Eventually, his pride could cause him to kill other people. Therefore, the people treated /ontah the same way they would treat any other Bushman, especially because /ontah provides tobacco to the people.The Bushman had good intentions by hid ing the true meaning of their actions and words, even though it did not make sense to /ontah. It was part of their tradition, which is different from American tradition; in America, most people are taught to be grateful for any gift they receive and not to complain. For example, â€Å"you get what you get, and you don’t throw a fit† is a common saying repeated to children at school. This story shows that the reasoning behind an action may have different meanings in separate cultures.

Chinatown Essay Example | Topics and Well Written Essays - 1000 words - 1

Chinatown - Essay Example However, since the economy of America got destabilized, the labor force of China became a danger to the conventional community. Racial bias and tyrannical administration brought the Chinese people from the area of gold mines to the refuge of the locality that came to be recognized as Chinatown. It is the sole ethnic cluster in the account of the United States that have been particularly deprived of entry into the nation, the Chinese people were forbidden by law to give evidence in court, to vote, to possess property, to get married to non-Chinese, to get employed in institutional agencies and to have families to join them. The survival and success of Chinatown relied to a great extent on the family unit and neighborhood compassionate clusters which served as social and political support frameworks to the new-entrants. The associates strove to convene the essential requirements of the group of people, and represented an integrated say in the struggle against prejudiced legislation pro cedure. "CHINATOWN"  presents a informative perception towards how a cluster of people have been restricted culturally, linguistically, economically and geographically throughout aggressive times and how it has grown today to turn out to be a courageous, proud and vibrant society for the â€Å"Chinese Americans† and the â€Å"greater New York†, which is known to be in Chinese as â€Å"Dai Fao† (Big City). (Joe, 1995) Today’s Chinatown Today Chinatown has turned into a distinctive neighborhood characterized by its inhabitants, its organizations and its olden times that accounts for a story of welcome, refusal and recognition. The buildings built according to the Chinese-style and the constricted busy roads provide Chinatown its identity. Beyond the golden storefronts various tenements full of aged people and fresh immigrants stressed with issues caused by years of elimination and unfairness, health problems, substandard housing and unemployment, could be found all over the city. Central part of Chinatown itself has been restricted by its competence to develop, today no longer acts as the key housing region for the Chinese population of the New York. Numerous people have settled out of the packed Chinatown to the Sunset and Richmond regions. During the year 1977, the Chinese Community Housing Corporation and the Chinatown Resource Center commenced a wide-ranging development plan determined to discover way outs for the changes in the patterns of land use. From the time of 1895 the citizens of the Chinese American community coalition has struggled in opposition to disenfranchisement of the dwellers of the Chinese origin and supported a good amount of community assignments. Population, employment and industry In the Census of 1980 it can be found that 84.5% (for a total of 124,372) of the New York region's Chinese population lived in the New York City, and the greater part of the Chinese people of the New York City are comparatively de nser in 3 counties namely the New York County (41.9 %), Queens County (31.8 %) and Kings County (21.0 %). Moreover 73 % of the Chinese people of the New York County used to reside in fourteen census bands in the Lower East Manhattan. The Chinese migrants, above all the new immigrants, have a tendency to look for

The Importance of Advertising in Marketing Essay

The Importance of Advertising in Marketing - Essay Example Advertising is one of the corporate communication forms used by organizations or firms to encourage, persuade, or influence the audience towards their products. Advertising in most cases creates a perception of the products or services of an organization. Through advertisements, firms are able to reach out to consumers. Nonetheless, there have been serious debates on how advertisements as a form of corporate communication affect gender. Taking a view of the women, advertising has had different perceptions of women. Despite the numerous research studies on advertising gender images of women have spurred so many debates and interest, there is need to conduct a more in-depth analysis of the same. This qualitative research study aims to identify whether advertising gender images of women reinforces or challenges female gender stereotypes. The research uses literature review to create an in-depth analysis of the topic. Methodology chapter provides an overview of how the research study was conducted whilst the findings and discussion provide the understanding of the obtained data. Lastly, a concluding remark provides a summary of the main points of the study. The marketing and particularly the presence of consumption appeared in England in the era of post civil war. The consumption behaviors in England did benefit from the free wage labor force to produce commodities (Bocock, 1993). The important cultural heritage of Puritanism was a powerful part of the cultures of England, Scotland, and Wales in addition to a selection of similar cultures that was transferred to North America and Australasia. British Puritanism has exhibited some values that viewed spending money on clothes for men and children as a luxury; this has extended to not spending money on expensive meals.  However, British values to some extent have encouraged spending money on building houses and furnishing them without paying much detail to decorations.

Retailers Essay Example | Topics and Well Written Essays - 250 words

Retailers - Essay Example : 1). The Giant Coca-Cola Bottle on Nanjing Road magazine ad is a particular example of trying to penetrate another type of audience, which the company has not entered in the past. It is a common rationale for big and small retailers to gain more market share and bigger income by coming up with advertisements that can draw consumer attention to their respective products (Making Sense of Advertisements- What is the Ad Trying to Do?: 1). While most of the advertisements by Coca-Cola, Pepsi and Dr. Pepper have achieved the goals they were created for, some magazine ads by the said companies however were not effective; like the Coca-Cola â€Å"Surfer† Advertisement, the Coca-Cola â€Å"Lemon† Advertisement, the Pepsi â€Å"Lemon Twist† Advertisement, the Pepsi â€Å"Climbing† Advertisement, the Dr. Pepper Iron Man 2 Cans and the Dr. Pepper Free 20oz. at Murphy USA Advertisement. The Coca-Cola â€Å"Surfer† and â€Å"Lemon† Advertisements lack col or and the designs were mediocre; not enough to have an impact to inspire interest. On the other hand, the Pepsi â€Å"Lemon Twist† and â€Å"Climbing† advertisements are both gross and mind-boggling respectively. Such ads make the consumer wonder unnecessarily what the ads mean in connection with the product. The Dr. Pepper Iron Man 2 Cans and Free 20oz.

Training and Mentoring Essay Example | Topics and Well Written Essays - 750 words

Training and Mentoring - Essay Example They should be provided with all the information they need to execute those jobs (Anonymous, 1998). Thus it is inevitable that an organization welcomes and seeks out the value-added benefits resulting from training. According to Rosner, (1999) "training can be a great investment and training can be a waste of money." Of course, training can prove a waste of money if it does not deliver the goods. The key is to recognize the problems attributing to deficiencies in training and then assure that the correct training is imparted (Gupta 1999). Without the correct training, employees can be the organization's major liability. But if they are trained well, they can become an asset (Bartram and Gibson, 2000). Rosner (1999, p.43) states, "The most effective programs train workers in new behaviors and then train managers to support employees as they apply learning daily". Thus, if the training imparted has to be counted, then it should match directly to the requirements of the organization and people in it. One device that can be used is to accomplish this in the 'Training Needs Assessment.' The element of training that is chosen as mentoring which got its name after Mentor, Odysseus' family's sage counsellor in Greek mythology, has got increasing notice in recent years. A mentor is one who has accomplished career success and counsels and guides another for the purpose of helping him/her attain like success. An organization should always have research supervisors who can be mentors; they have the liability to discuss with and counsel a trainee on vistas of his/her work and professional development. The trainee can also find additional mentors informally or the organization may designate them. They are very significant in the complete experience of the trainee and may add to research output as well. In addition to determining what the employees have to learn, and providing them with mentors, the broad range of training delivery methods these days calls for the determination of the best learning method for the employees. Some of the general delivery methods are Instructor-Led Classroom training, Computer Based Training, Web Based Training, One-on-One, and Self-Study Guides. 2. How will these concepts impact you personally and professionally The concepts of training methods given in the passage if applied will enable an employee to be self disciplined and will inspire him to become motivated. The proposed training method will boost the overall personality of the employee. Awareness accrued from the practical training and experimentation as to what to do when and where will increase the self confidence of the employee and will enhance his or her potentiality in managing different situations in the personal life as well as professional environment. The conceptual training if imparted in proper order will increase the self esteem and morale of the employee. Also, it will amplify his professional output and will standardize the interaction process between the customer and himself or with the management. The training mode will become instrumental to create a new outlook in the employee to have harmonious approach in the workplace. The recognition of one's talent throughout the training will satisfy his ego which will make hi m productive. Moreover, it will bring in proper awareness to the latest technologies and information systems. It will also endorse an urge in building up new strategies to bring in

Gender in Organizations Essay Example | Topics and Well Written Essays - 2500 words

Gender in Organizations - Essay Example As a result, women remain different from men in that they put in more time and effort at the workplace and do more unpaid housework than their male partners. This is the main point raised by Ilene Philipson (2002) and David Schweingruber (2007), whose papers were selected as the two centerpieces of research for this essay because they capture the essence of the topic we want to discuss: that is, gender equality as it unfolds at work and at home today remains meaningless for the most part because of what both Philipson and Schweingruber call the "second shift," with Phillipson adding another factor called "familism." The first part of the main body discusses the dynamics of these two factors as to how they effectively distort the meaning of gender equality in the workplace. To illustrate the point, the last part of the essay's body looks into an actual case study of a married woman doing second shift work, tying this up to conditions in New Zealand, which is currently headed by a woma n president and where the women's movement is going great guns. ... Second Shift & Familism The dramatic increase in the labor force participation of women gave rise to the perception that we have finally entered an era that puts men and women on equal footing and makes no distinction between their sex and interests (Philipson, 2002). Women now hold jobs previously confined to men, such that there are now women police and soldiers, pilots, miners and even steel mill workers. Research since the 1960s shows that women's time spent on housework has been cut by nearly half while men doubled their time (Mickelson, et al., 2006). However, a closer look reveals that married women continue to suffer from gender inequality in the amount of work they do both at the workplace and at the house. In households with two wage earners, the women who enter the labor force continue to do more housework than men (Schweingruber, 2007). Women suffer from the same disadvantage at their paid job outside the home largely because of the mothering instinct that they bring to the workplace and creates special problems for their claim to gender equality (Fletcher, 2002). Even as a wage gap between working women and men persists, there is also a "leisure gap" between them at home (Bartley, et al., 2005). This crack in the otherwise greatly improved gender relations is traced to the "second shift" phenomenon, which is described by Philipson (2002) as the two work shifts of women: their unpaid job at home and paid job outside. Schweingruber (2007) defines the condition in more or less the same terms, relating it to the load of housework that married women perform on top of their shift of work outside the home. An important aspect of the second shift phenomenon is the way women develop an emotional attachment to their jobs and

Law of Trusts Essay Example | Topics and Well Written Essays - 2500 words

Law of Trusts - Essay Example Since the repeal of the Preamble, the law has progressed on the back of judicial decisions arrived at in the light of the Preamble. The traditional definition of such trusts came from Commissioners for Special Purposes of Income Tax v Pemsel (1891), which divided charitable trusts into four categories: trusts for 'Relief of Poverty', for 'Advancement of Education', for 'Advancement of Religion' and, trusts for 'Purposes Beneficial to the Community'. Trusts for the advancement of education, includes conventional education and training. Thus trusts for schools, colleges, universities and other institutions of learning are valid. But this head extends to any mode of acquiring useful knowledge from literary learning to scientific researches etc. In the case of Re Shaw (1957) it was held that a gift by George Bernard Shaw in his will for research of a forty letter alphabet and translation of one of his plays into it was not charitable. It is arguable whether the same result would have been reached under the principle laid down in the later case of Re Hopkins (1965). It concerned a gift to Francis Bacon Society to be used to find manuscripts proving that the plays of Shakespeare were written by Francis Bacon. The gift was held charitable. The result of research must also enter the public ... Therefore research carried out by companies and kept for their exclusive commercial use is not charitable. Although far from the concerns of the Preamble, trusts for animal welfare such as that of the preservation of wildlife through animal sanctuaries have been held to be charitable, this has been due to a change in the general approach that was adopted by the courts in the mid-nineteenth century, where charities of this kind were likely to be held to be a failure because of various reasons. Trusts for animals would be charitable if they 'tend to promote and encourage kindness towards animals and to stimulate humane and generous sentiments in man towards lower animals': Re Wedgewood. However in Re Grove Grady (1929), the Court of Appeal held that a gift for an animal sanctuary which specifically excluded humans so that the animals would not be molested was not charitable, for such a gift produced no public benefit. If it is found that the charitable purpose would be a failure because the means for its implementation as chosen by the testator are either impractical or impossible to carry out then the doctrine of cy-pres or ss13 and 14 of the Charities Act 1993, can be applied so that it would not fail. The cy-pres doctrine allows the courts to direct that the trust property be applied to a purpose as close as possible to the one intended by the settler. Cy-pres can save charitable trusts from failure at the outset or from subsequent failure when carrying out the purpose becomes impossible or impractical. The doctrine only applies to a purpose which already counts as a charitable purpose. In order for the courts to re-direct trust money intended for charitable purposes, the courts must find that the donor

Customer Perception on advertising Article Example | Topics and Well Written Essays - 1000 words

Customer Perception on advertising - Article Example This essay "Perception and Consumer Actions" outlines the effect of the advertising on the customers and how the consumers should be treated through analyzing four different articles. The first article which will be analyzed is titled, â€Å"The Effect of Consumer Perception of Store Attributes on Apparel Store Preferences† reveals the fact that four distinct variables with respect to store preference: type of clothing in stock, outside store appearance, shopping hours, and advertising. Interestingly, the overall level of impact that these attributes had on store preference varied more widely between stores than researchers at first expected (Paulins and Geistfeld 380). This leads the researcher to infer that different expectations could be a primary motivator that helps to further define and constrain these â€Å"secondary† perceptions. Oftentimes, when analysts seek to draw inference upon a specific topic, they already assume that what is being measured is necessarily the primarily important metric. Due to the fact that the reserachers of this particular article approached the issue aware of the fact that other motivations and impacts could have paved the way for the perceptions to be measured in a certain way, this research approach bears a great deal of strength in seeking to define the entire process of consumer perception. A secondary article that will be analyzed and discussed within this brief analysis is that of one entitled â€Å"Advertised versus unexpected next purchase coupons: consumer satisfaction, perceptions of value, and fairness†.

Managing for Results Essay Example | Topics and Well Written Essays - 2500 words

Managing for Results - Essay Example The officer in command was Captain William Bligh and Fletcher Christian was second in command. Some countrymen are pressed into serving the English navy for this voyage of about 2 years. After having faced various hardships put forth by the sea and the Captain in command, alike, they reached Tahiti and obtained the breadfruit plants during their six month stay on the island. However, shortly after leaving Tahiti, Christian leads a mutiny against Captain Bligh in revolt of his atrocities on the seamen. They manage to capture and cast Bligh and his loyalists in a life boat with some supplies while Christian and his loyalists return to Tahiti in the HMS Bounty. Bligh and his people make the most remarkable conduct of navigation in the history of the sea - a 3500 mile open sea voyage aboard a life boat. Bligh reaches Timor Island. He returns to Tahiti aboard another ship in search of the mutineers, lead by Fletcher Christian. Christian and a few men escape in the Bounty while several oth ers remain on the island. They are taken to England by Bligh and are tried for mutiny. Most men are executed for their crime except Roger Byam. Christen and his followers reach Pitcairn Island, where they decide to spend the rest of their lives, and burn down the Bounty so as to not be found by English searchers. ‘A story of a man who robbed his seamen, cursed them, flogged them not to punish, but to break their spirit. A story of greed and tyranny.....and of anger against it, of what it cost’ – Roger Byam during the trial (Mutiny on the Bounty, 1935) Captain William Blighs managerial abilities on the Bounty is an excellent example of how one man changed from control leadership to team unity with a change in the situation, over 2 centuries years ago. Bligh tries to enforce harsh ‘discipline’ by various means - flogging a dead seaman for striking his captain, shortening rations as per the Captains prerogative, public chastisement of Christian, Bligh accusing

Drug Companies and Ethics Essay Example for Free

Drug Companies and Ethics Essay After researching pharmaceutical companies, I quickly realized this is a very controversial topic. I’m not certain anyone in many of these companies have very many moral standards. Drug companies seemed to be very profitable from the researchers to the drug reps that deliver â€Å"gifts† and sample meds to the doctor’s offices that push their medications. Many activists will argue that drug companies put themselves before human rights. Companies violate health related human rights by prioritizing profits over peoples access to essential medications. Many large scale drug companies argue that they are proudly taking the stakeholder approach and striving to promote fair labor practices and non-discrimination in the workplace. They will also argue that the reason medication prices are so high is because of all of the research that is involved in developing a medication, while activists argue that meds are so expenisve due to the marketing they put into a drug in the first several years. I found researching the pharmaceutical companies to be very interesting. It was very hard to get past the negative controversies and debates to find anything positive about any one company. However, I finally found one company in particular, Merck Co. that has taken responsibility and turned around some negative press by developing a program that helps thousands of people. Lynch 2 Merck is one of the largest and most profitable drug companies in the world, but they have also been a leader in a donation program that helps Third World countries in Africa, South America and Yemen since the 1980’s. Merck became one of the first drug companies to become socially responsible by donating to countries that could not afford the essential medications needed to prevent a disease that caused something as severe as blindness in hundreds of people. Their medication, Mectizan, taken annually can alleviate and has ultimately eliminated this disease in some countries. Since the 80’s when Merck started this program many other drug companies have jumped on board. Companies such as Pfizer, Johnson Johnson and GlaxoSmithKline have all started taking social responsibility and are now donating through programs to these Third World countries. These companies are donating medications that our country takes for granted and that we may not need in our everyday life. Johnson Johnson donates a medication that rids their children of intestinal parasites while Pfizer donates Zithromax to eliminate trachoma. If it were not for these companies donating such large quantities of these drugs every year, millions of lives would be lost. I find it very interesting that the drug companies that many people complain about and that make millions a year in profits seem to also be able to do such wonderful things in these countries. I found many articles that complained about the CEO’s and about the terrible morals that some of these pharmaceutical companies are known for. I think that when it comes to morals and ethics people see what they want to see. Drug companies have had a bad name for many years so you don’t see a lot of positive press and articles such as the one I found. It was actually refreshing to read about the dr ug companies that donate and the lives they save. Some of us may not agree with how these companies push their drugs into our doctor offices and we may even say that they do not practice great ethics, but it seems as if these companies are at least trying to keep a â€Å"good name.† I am certain that the people in these Third World countries are very grateful to the drug companies that donate because not only are these companies saving their lives but they are also saving the lives of their children.

Business Simulation Exercise In The European Car Industry

Business Simulation Exercise In The European Car Industry The movement of pricing, vis-à  -vis the budgeted pricing is being considered next. It is seen that the budgeted pricing for A-Star was  £12,169.15 while that Plush was  £16,909.69. However over the next three periods, there have been fluctuations in the price movements as envisaged in Table 1 shown in Appendix. Thus over the period there has been an average of 6% increase in prices of A-Star and around 2% in that of Plush. These could be attributed to increases in material prices and labour which shall be taken up shortly. This could also be due to competitors increasing prices which have impacted on this business also. Forecast and Results: Production figures have been estimated at 1% of the 11.25 market share. The total market share and not the market shares as per individual age groups have been taken into account, primarily because city cars are preferred by all age groups and not restricted to any one age group. Round 1: Estimated Sales: This has been estimated by multiplying forecasted production with selling prices per unit; The Depreciation factor has not been considered, since for the first year, it is not necessary to consider cost of manufacturing fixed assets from selling prices. Bank Balance: The Companys financial strength is indicated by its bank balance. However, in this case it needs to be seen that bank balance needs to improve. Unsold stock: The question of any unsold stocks does not arise since all cars that were manufactured were sold out during the year. Gross Margin: No account of inflation has been considered during the first year of operations. Market Share: We have under produced the cars, when compared to other competitors, thus leading to lower market share. Round 2: Estimated Sales: 83% of A-Stars Production and 100% Plushs production has been fully sold out. Bank Balance: Excess of expenditure over incomes has resulted in negative bank balance. Adverse cash balance has necessitated infusion of fresh doze of bank loan. Unsold stock: There were unsold stocks of A-Star forming around 17% of production. It is hoped this would be sold during the next Round Gross Margin: the result for both was 21% but we estimated gross margin 25% for city car and 23% for medium car, so we were an unsold car for city car, which affected our gross margin actual results. Market Share: Market share needs to be improved by gaining better inroads into markets and increasing visibility and sale of cars. It could be through advertising campaigns. Forecast and Results 3: Pricing : We added two new options to care. This is to match options provided by competitors who were doing better business with these add-ons .There have been price increases in finished goods, since, due to the impact of inflation, wage bill has increased from  £425 to  £430. Production : Since there were aspects of unsold stocks, productions of cars were reduced this year although the numbers of workers were the same and the output was the same. However there was greater production. Gross Margins: : the result for city car was 25%and for medium car is 21%, but we estimated gross margin 29% for city car and 24% for medium car, so we were an unsold car for city car, which affected our gross margin actual results. Unsold stocks: Since our prices were relatively higher than that of our competitors, there were unsold stocks. Market share: All cars produced could not be sold because of high pricing. This also resulted in lower market share. Thus, selling prices needed to be brought at par with that of competitors. Sales: We increased the production, and since we produced more, we were able to sell more and gain better sales figures. Post Tax Profits: While production forecasts were lower than actual, the factory producton had not changed. Thus, more production of cars led to more materials and labour costs. Opening stocks were however not considered while calculating post tax profits. We sold lesser number of cars although we produced more, resulting in stocks, and also higher material costs. Results of Round 4: Sales: We redesigned the car options in order to remain in market- and reduced the selling prices of cars. This resulted in increase in the gross margins and medium size cars had a good market. Production: Factory output was at 60% Gross Margins: the result for city car was 15%and for medium car is 15%, but we estimated gross margin 24% for city car and 24% for medium car, so we were an unsold car for city car, which affected our gross margin actual results. Unsold Stocks: Competitors have better brand image, better market share and improved popularity Market Share: Similar to Round 3 Post Tax Profits: Error in calculating interest rates in current account and interest on loans. Summary of Financial Results : From a examination of Table 5 8 appendixed at the end of this study, it is evident that all is not going too smoothly for this auto making company. For one thing, its margins have been decreasing and even the Post Tax Profits are showing losses at the end of Round 4. This is all the more intriguing when one considers that there has been consistent increase in production over the Rounds. Thus, the most sensible thing for the company to do at this stage is to reduce production rationally and concentrate on producing only such products that are money spinners and could earn handsome profits for the company in latter years. There is no use of increasing inventory and carrying costs by producing cars that do not have a ready market, or in expectations of revenues that may not occur. Coming to market share, it may be seen that some aspects of this ratio are market driven and may not be controllable by the company. However, it is necessary that Sound Marketing Strategies need to be made that could address aspects of a sagging bottom line and reducing market share in competitive auto making markets. Non-financial results: Coming to the non-financial aspects, it is evidenced that the number of work force has increased from the initial 391 for A-Star and 475 for Plush, total of 866 employees according to the budgeted estimates. However the strength of the work force in the subsequent rounds is as shown in Table 2 in Appendix From the above, it is quite evident that there has been an excess use of work force as compared to the budgetary figures. Coming to capacity utilization while in the First and Second Round, there has been 100% capacity utilization, during the third round, it is just 65% of total. Regarding promotional activity expenses, it is evidenced that while the budgetary figure of  £60M have been maintained in the First and Second round, in the Third round this has increased to  £80M, an increase of  £20M. Present scenario in the car manufacturing scenario in Europe: It is also seen that, economic recession has severely affected the European car industry and therefore a clearer picture could only emerge if and when the recession fades away and the business economies are realised perhaps after 2010 or so. Over the past five years, there has been a slowdown in economic output across the EU. Weak growth has led to reduced consumer and business confidence. Industrial production, including the production of durable consumer goods, has declined. This has impacted severely on the car industry, given the cars status as the ultimate consumer and fashion item, as well as the importance of engineering and design in the manufacturing process. Average profit margins have declined from around 10% in the 1960s to less than 5% today, and some volume car makers are actually losing money. (EMCC Dossier on the European Automotive Industry, 2004). A business study of this kind needs to also consider economic and non-economic factors like rate of inflation, GDP, industry growth, taxation, availability of spares, etc. in order to be viable and competitive in global car markets. Segmentation and business opportunities in developing countries also needs to be seen as also the need for exploring exports in high growth areas. The non-economic factors like customer trends and preferences, road conditions and liking for the product are also major issues, especially when automakers are vying each other not only in technical competence but also in market sharing and target realization. Under such circumstances, costs, pricing, attitudes and selling stratagems all play crucial roles in determining the business opportunities and its future impact on business, especially in changing and volatile markets. The need for business projections and target setting in areas of production, sales, finance and human relations are crucial in the highly competitive auto making industry. Critical reflection on teachings: The teaching and the analyzing are interrelated they both find the guidance as the useful tool in the analysis and in the final conclusion. The learning can be successful only when the different traits and the complexities are understood properly by the guide and the knowledge can be proven beyond the boundaries. The critical reflection has the major role on the education and it is its major objective. The model of the critical reflection is shown which was put forward by meziro, for the explaining of the critical behaviour exhibited in Table 3 in Appendix The reflection is the analyzing or the forecasting of the future period by the decision making approach with the complicated and the interrelated schema. Learning as an important tool: The learning can be considered as an important tool for the analysis of the different departments in the business game and the various functions of the same. To analyze the proper functioning of the different departments are vital to know whether the business game is a success in the different trait and whether the departments suits the requirement. HR Department: The HR department is the one which deals with the people as the asset of the organization, the people related activities and the contribution by the people to the organization. It is the strategic approach to the goal settings and the functions of the management. In the study of the department is considered the strength of the employees were considered to be less than 1000, during the start up but by the growth of the company and by the innovation the strength of the employees has reached upto 4000.The study of the departments are considered by the employees turnover and the capacity of the production output by the employees in the organization. The loan facility that are acquired for the different operations and for the benefit of the employee. Professionalism of the Human Resource (HR) department is implied to be twofold implications. A professional HR practitioner has a collective professional role to play to enhance the HR occupation. (HR Department Professionalism: A Comparison Between the UK and Other European Countries, 2005). Operations Department: The operations department consists of the operations performed in the car industry, the operation starts from the purchase of the raw materials to the process and to the finished goods to the dispatching of the product is the duty of the operations department that has to be monitored. The different operation technique like the JIT and the six sigma process are done in for the efficiency of the operation department for the competitive advantage. Focused research studies that advance the theory and practice of operations management. OMR is a rigorous, double-blind peer-reviewed journal that is oriented toward fast reviews and publication of high-quality research that makes a clear contribution to the science and practice of operations management in todays global institutions. (Meredith and McMullen, n.d). Marketing department: The marketing department consists of the marketing of the manufactured cars to the customers with good promotion techniques and tactics like the offers to find the increased sales and the revenue. The main idea is to promote the product to the customer but the proper market analysis and the research has to be conducted to make the product a success.The qualitative and the quantitative research are to be conducted to have a thorough analysis for the same for finding out the demand for the product and the forecast about the market. Statistics provide traders with the detailed information needed to make focused decisions; only a complete market analysis can provide the story behind the numbers. (Market Analysis, 2010). Financial department: The financial department consists of the analysis of the financial data and the analysis of the cash flow and the fund flow of the company as the whole, the accounts personnel are to be hired as the financial controller where they have the ultimate control for the finance and the different kind of the financial aspects.The different pricing mechanism to be treated as the payback period to be made short and analysing of the different pricing ratios to be done,The fixed assets should be increased and the company turn over should be increased. The different tools are used for the analysis of the finance aspects. The commonly used ratios are the instant financial analysis, accounting ratios, and financial statement analysis tools, with industry ratios tools and accounting ratios. (My Business Analyst (MBA), 2010). If the game was played once more the performance can be improvised to much extend because the first game can lack the experience and the usage of the certain tools can be used more.The safety aspects can be considered more and the competitor analysis are to be done,The car industry can also go for the hybrid variety of cars in the industry as they are the common variety in demand ,the company also go for the variety of the alternative propulsion vehicle and electric vehicle which can add on the variety to the category of the brand. The completeness in the collection and the analysis may also have some of the inadequacy as a result of the lack of experience in the field. Business game is the practical tool to practice and understand business and its challenges, threats and opportunities. Business games help to identify oneself as the core part of the business and managing the situations. Regardless of the size of business you are in whether a large corporation, a small company, or even a home-based business effective communication skills are essential for success. (Improve your Communication Skills, 2010). The communication is very important in a business; It is the effectiveness in the company which contribute for the overall growth and the prospectus of the company and the smooth functioning of the different departments in the organization irrespective of the functions in the departments, The World of Business Communication: Every businesss aim is to gain profits. Whatever be the type of business you are in; the bottom line is that you must earn something from it. (The world of Business Communication, 2010). It is through the communication that the operations are handled effectively and efficiently. The business game is usually to improve the performance and to boost up the skills of selling, marketing and the operations. Theres a lot of confusion about team building event days. Often it is seen as an exercise to boost morale, to help workers bond better, and as a fun day out at the companys expense. (Rose, 2010). The additions for the improvement in the company are the guidance at the each of the steps for the avoiding of the mistakes and the error correction at the each level. The reference to the previous business game which are a success, The each step of the activities should be conducted in a team. The open discussion should be conducted in order to have various opinions regarding the business and the management and the brainstorming ideas from the team mates. It involves the activities to be conducted and the Free team building activities, exercises and ideas are for building teams and teamwork, corporate employee motivation, personal development, ice-breakers, energizers, and more serious learning and personal development. (Chapman, 2010). (References:The all round 1 and 3 and the graphs for the understanding of the companys performance). Team Performance: A critical evaluation of the performance of the team For every organization there will be a set of team responsible for particular activities within the organization. Team represents a set of people working together towards accomplishing a set of predetermined goals and objectives. Effective, productive teams of all types have a positive impact on bottom line results and organizational success. (Cornelius, 2006, p.1) The important works were allocated to these four members. These team members were Yi Jiang, Adnan Hasan, Shanu Jain and Fawaz Khalid Ansari. All these members have performed in such a way that this enabled the organization to achieve it goals. They altogether took the decisions related to the various operational areas. The functions allocated to each member and their roles being in a team are explained as follows; Yi Jiang  was responsible for look after the marketing department. His duty was to design the marketing research programs and to give instructions and appropriate guidance to his team members. He used to prepare slides for presentation in the team. After conducting marketing research he decides the promotion strategy that has to be implemented for their product to become successful in the market. He was having a clear idea about the European market conditions and based on those ideas he gave appropriate suggestions related to the production quantity and the percentage of market share that has to be captured by the company. He was the person who gave the idea to produce city and medium sized cars. He helped me in the operations department by deciding the quantity of products that has to be produced by the company. The company was having huge stock that was not sold in both the second and the third round. This was a great problem for the company. For solving this problem he provided an excellent idea to redesign the car. This was decided in the fourth round and the result was outstanding. Adnan Hasan was responsible to manage the finance department. He was responsible to handle all the financial operations of the company in all departments specifically the accounts department. Deciding the finance required for each activity is not an easy task and he was much capable person to give all financial instructions to the company. He has helped the operations department by stating the quantity to be produced by the firm and also provided the accurate number of human resources required for the operations department. Shanu Jain was responsible to look after the human resource department within the organization. She is a person who is very talented and highly committed towards the work. She was responsible to conduct the meetings within the organization. She prepared the agenda and the minutes of the meeting conducted between the team members from all the departments. Inorder to smoothen the team work a team charter was created by Shanu Jain Date Attendance Discussion 17-11-2009 100% Decision related to market segment and selected the design and options. 18-11-2009 100% Decision related to pricing of cars. 20-11-2009 100% Estimating the production units and sales value. 22-11-2009 100% Forecasting the profit and the cash flow and designing decision form. NX0441 Managing for Sustainable Competitive Advantage In the second round she found that the productivity of the employees has been reduced and for solving that problem she suggested to increase the wages of the worker. This resulted in an increase in the productivity among the employees and it was found in the following rounds.. The last key member is Fawaz Khalid Ansari and that is me. I was the team leader for the operation department and i was responsible to handle the operations department within the organization since I am a mechanical engineering graduate. I took the decisions related to the quantity of output to be produced by the company. I gave my complete effort to give my best to the team and thereby to the organization. With my available knowledge about the cars and the latest trends in the European market I helped the marketing department to understand the consumer behaviour with respect to the car market. I also helped my team, members to create excellent designs for the cars. I suggested an idea to purchase a single factory and give the maximum from it. As a key team member in the organization I took the decision to produce less at the first stage and this was a great help for the firm, because till round 2 the company was having many stocks that were not sold. All the activities that have to be performed by each team members are prepared in a chart and it is termed as team charter. Every team will have a particular charter and it will be in a written format. The charter typically includes a statement of mission, objectives or statement of work; background; authority, boundary conditions (scope, constraints, resources, and schedule); membership; high-level requirements or specifications, and interface responsibilities. (Project Management Training and Resources: Team Charter, 2009). I realised that the team work increases the level of motivation. This encourages members to work hard for the benefit of the team and the team is motivated because its members get their emotional and intellectual needs met by the team. (Working in Teams, 2010). The most important benefit for all the team members is that they will realise the value of a group work. In a teamwork environment, people understand and believe that thinking, planning, decisions and actions are better when done cooperatively. People recognize, and even assimilate, the belief that none of us is as good as all of us.  (Heathfield, 2010). All the decisions that are taken with respect to each department within the organization have its own significance in achieving the target of the organization. Conclusion: This is a business management game where the team members are asked to select and start a business and they have to sell the product. Various discussions have been held at different levels. It was able to learn a lot of things from this work. The participation of the team members towards a common goal was the major attraction of this game. From this game it was also able to understand how a team is working towards the predetermined goal for achieving the organizational goal. The important objective of the team members was to increase the value of the shareholder. For accomplishing this objective the team has listed out various steps that have to be followed. There is a team leader who is responsible to guide all the performance that is performed by the other team members.

Management Respiratory Distress Syndrome Infants Health And Social Care Essay

Management Respiratory Distress Syndrome Infants Health And Social Care Essay Respiratory distress syndrome (RDS) is one of the most common consequences of prematurity and a leading cause of neonatal mortality and morbidity as a result of immature lungs. RDS particularly affects neonates born before 32 weeks of gestational age but is also recognised in babies with delayed lung maturation of different aetiology i.e. maternal diabetes. Since its initial recognition there have been vast advances in understating the pathology and management of this complex syndrome. However, in order to understand the pathology behind RDS it is imperative to obtain a good foundation of normal lung maturation and physiological changes that occur in the respiratory system during the transition from fetal to neonatal life. Physiological Development and Function of the lungs During intrauterine growth, fetal lung development begins as early as 3 weeks and progresses until 2-3 years. Conventionally it is divided into 5 stages; embryonic, pseudoglandular, canalicular, saccular and finally alveolar1 (Table 1). During the embryonic stage, the lungs develop from the fetal ectoderm to form the trachea, the main bronchi, the five lobes of the lung and the major blood vessels that connect the fetal lungs to the heart; the pulmonary arteries. This is followed by the pseudo glandular stage which results in the formation of the terminal bronchioles and associated primitive alveoli. These then further divide in the Canalicular stage to form the primary alveoli and subsequently the alveolar capillary barrier. This stage also comprises the differentiation of Type 1 and 2 pneumocytes which will later go on to produce surfactant. Thus babies born after 24 weeks, have a chance of survival as the platform for basic gas exchange has begun to develop. During the saccular st age there is further differentiation of type 1 and type 2 pneumocytes and the walls of the airways, in particular the alveoli, thin to enlarge the surface area present for gaseous exchange. This is followed by the alveolar stage which occurs through the transition form fetal to neonatal life up until 2-3 years. The hallmark of this stage is alveolar formation and multiplication to augment the surface area available for gas exchange to meet the increasing respiratory demands as the infant grows. Stage Time period Structural Development Embryonic 0-7 weeks Trachea, main bronchi and five lobes of the lungs develop from the fetal ectoderm. Pulmonary arteries form and connect to heart. Pseudoglandular 7-17 weeks Formation of terminal bronchioles and alveoli Canalicular 17-27 weeks Formation of alveoli-capillary barrier and differentiation of type I and II pneumocytes Saccular 28-36 weeks Walls of airway thin for efficacious gas exchange Alveolar 36 weeks -2 years Alveolar multiplication Table 1: Stages of Lung Development Once the pulmonary epithelium develops, it begins to secret fluid into fetal lungs, the volume and rate of which is imperative for normal lung growth. Another important factor essential for normal lung development and function is the production of surfactant. At about 24 weeks of gestation the enzymes and lamellar bodies required for surfactant production and storage begin to appear 3. Thus a normal fetus age is not ready to be delivered at this stage due to surfactant deficiency. As type II pneumocytes mature between 32-36 weeks, surfactant production increases and it is stored in the lamellar bodies of these cells. Surfactant is a complex mixture of phospholipids, neutral lipids and proteins 1, 4 that has a fundamental role in maintaining the alveolar-capillary interface and reducing surface tension. It is secreted as a thin film at the liquid-air barriers to facilitate alveolar expansion and prevent end-expiratory collapse of small alveoli, especially at low alveolar volumes. A key event in the development of the lungs is the establishment of spontaneous breathing post-delivery. Prior to delivery the fetal lungs decrease lung fluid production and as the lungs mature there is simultaneous maturation of the lung lymphatic system. During labour the mechanical compression of the fetal chest forces about 1/3 of this lung fluid thus preparing the fetus for spontaneous ventilation. This will require several stimuli; including hypoxia, hypercrabia and acidosis as a results of labour5 and hypothermia and tactile stimulation. Furthermore the stress of labour stimulates chemo-receptors in the fetal aorta and carotids to trigger the respiratory centre in the medulla to commence breathing. As the fetus emerges from the birthing canal, the fetal chest re-expands creating negative airway pressure which subsequently draws air into the lungs. This again forces the lung fluid out of the alveoli and allows for adequate lung expansion. As the newborn cries there is further e xpansion and lung aeration generating positive intrathoracic pressure which maintains alveolar patency and forces any remaining fluid into the lymphatic circulation. As the neonate adapts to extra-uterine life, the normal muscles of respiration work to maintain breathing (Figure 1). In order to inhale, the diaphragm and external intercostals muscles contract to increase the size of the thorax. This generates negative air pressure in the pleura and lowers the air pressure in the lungs so that the gradient between atmospheric air and alveolar air causes air to enter into the lung of the neonate. As the neonate inhales, the elastic recoil force of the lung increases. Once inspiration ceases, the elastic recoil force of the lung causes expiration. The diaphragm and external intercostals muscles relax, the thorax returns to its pre-inspiratory volume resulting in an increase in intra-thoracic pressure. This pressure is now greater than atmospheric pressure and air moves out of the lungs producing exhalation. Figure 1: The Mechanics of breathing6 For most neonates, this transition from fetal to extra-uterine life is uneventful and completed during the first 24 hours of life. The neonate is able to establish good lung function, maintain cardiac output and thermoregulate. However, for a certain population of neonates, usually those that are born early and thus called preterm, this transition is less smooth and it is these babies that will require the support and care of the whole paediatric department. Respiratory Distress Syndrome Respiratory distress syndrome (RDS) is the most prevalent disorder of prematurity and despite a better understanding of its aetiology and pathology, RDS still accounts for significant neonatal mortality and morbidity. The incidence RDS is inversely proportional to gestational age2 such that it decreases with advancing gestational age, from about 60-80% in babies born at 26-28 weeks, to about 15-30% in babies born at 32-36 weeks 1. Risk factors for developing RDS are summarised in Table 2 and include maternal illness, complications during pregnancy and labour and neonatal complications Table 2: Risk Factors for RDS1 Respiratory distress presents early in post-natal life particularly during the phase of transition from fetal to extra-uterine life. These babies will present with signs of grunting, cyanosis, nasal flaring, intercostal and subcostal recession, increased respiratory effort, and less commonly apnoeic episodes and circulatory failure. The severity of symptoms experienced are related to the pathology of disease and it is important to identify babies at greatest risk and commence management early in order to prevent respiratory complications such as chronic lung disease (previously called bronchopulmonary dysplasia), pulmonary hypertension and in adverse cases respiratory failure and even death. Identifying normal transition and respiratory distress is largely based on evaluating the risk factors for RDS, assessing the severity of symptoms and close neonatal observation if in doubt. Babies that are born close to term or those via caesarean section may display a difficult albeit a normal transition. These babies present with transient tachypnoea of the newborn in the first few hours with respiratory rates of about 100 breaths per minute and increased oxygen requirements. Symptoms are short lived, self limiting in most cases and usually relived by oxygen. Neonates who suffer from RDS will present with worsening symptoms of longer duration, respiratory rates of 120 and increased respiratory effort with a longer requirement for oxygen. Recovery if plausible usually begins after 72 hours and is associated with decreased oxygen requirements and better functional residual capacity. Pathophysiology of Respiratory Distress Syndrome Since its initial recognition, more than 30-40 years ago, much has been elucidated about the pathophysiology of this complex syndrome. In the premature neonate, the structurally immature and surfactant deficient lung is unable to maintain the basic lung mechanics required for adequate ventilation. As aforementioned lung mechanics rely on surfactant production, alveolar multiplication and maturity for effective gas exchange, chest wall elasticity and a functionally developed diaphragm. It is therefore evident that premature neonate who lack surfactant and have structurally immature lungs will develop RDS, atelectasis and abnormal lung function. In these neonates the essential first breaths are followed by a secondary pathological cascade characterised by tissue damage, protein leakage into the alveolar space and inflammation, which may resolve or progress to BDP or chronic lung disease of prematurity (CLD)7. In neonates with RDS, end-expiration results in the collapse of alveoli due to surfactant deficiency and a subsequent reduction in the functional residual capacity (FRC). The FRC is the volume available for gaseous exchange i.e the volume of gas left in the lungs after exhalation. It is determined by an intricate balance between the collapsing and expanding forces of the chest wall and lungs7. An ideal FRC enables the best possible lung mechanics, efficient ventilation and gaseous exchange. As the FRC is reduced at end-expiration due to alveolar collapse due to high surface tension, the pressure that will be required to re-inflate the already immature lungs is increased. This in turn increases the respiratory effort needed for adequate gas exchange which presents clinically as increased respiratory rate and subcostal/intercostal recession. Moreover reaching an optimal FRC may be further impeded by both surfactant deficiency and by the preterm infants impaired ability to clear fetal lung fluid. Radiographically a chest x-ray will show the characteristic ground-glass appearance with diminished lung volumes and the cardinal features of respiratory stress, tachypnoea, nasal flaring, intercostals recession, subcostal recession, increased breathing effort and grunting will begin to manifest early on. Despite this effort to breathe, alveolar ventilation remains poor. As these areas are receiving an adequate blood supply this produces a ventilation/perfusion mismatch resulting in right to left intrapulmonary shunting1. The lungs are unable to maintain good gas exchange and blood oxygen saturation and the level of carbon dioxide begins to increase resulting in respiratory acidosis, hypoxaemia and hypercarbia. The neonate further struggles to breath and attempts to generate higher negative pleural pressures to ventilate the lungs. The ensuing acidosis further diminishes surfactant production and neonates deteriorate rapidly as blood oxygen saturations plummet. The natural progression of the disease if left untreated will lead to pulmonary oedema, right-sided heart-failure and ultimately the most devastating outcome, neonatal death. Therefore the management of these neonates requires an aggressive multi-disciplinary team approach based on the pathology of these aforementioned homeostatic mechanisms. Alongside this the basic principles of neonatology; thermoregulation, nutritional support, efficacious cardiovascular support and infection control, are all fundamental in achieving the best therapeutic goal. Ultimately the aim is to provide adequate ventilatory support, allow the lungs to heal, impede further pulmonary injury, correct hypoxaemia and acidosis and above all to keep the neonate alive. Management of RDS As aforementioned the aim of treatment is to promote lung healing and reduce further pulmonary insults. We have already established that with increasing gestational age, particularly post-32 weeks, the infant will require less aid to help it cope with the transition from fetal to neonatal life. However, before 32-weeks there is an increased propensity to develop RDS and as the neonate is unable to cope, some form of respiratory support is required. Over the past 40 years there have been numerous management therapies including ventilatory support, surfactant therapy, nitric oxide therapy and supportive therapeutics strategies amongst others. The mainstay of treatment today remains supportive and involves the use of antenatal steroids, surfactant replacement therapy, continuous positive airway pressure and mechanical ventilation, which all aim to address the pulmonary insufficiency that manifest in these individuals Antenatal Glucocorticoids Glucocorticoid receptors are expressed in the fetal lung at early gestation and as the fetus grows stimulate surfactant production post-32 weeks. Alongside receptor expression there is an increase in fetal cortisol levels at late gestation9, which coincides with lung maturation, type II pneumocyte differentiation, surfactant synthesis as well as alveolar thinning. If birth occurs before this increase in serum cortisol, the pulmonary system has not matured adequately and therefore there is an increased propensity to develop RDS. Thus a single dose of glucocorticoids such as dexamethasone or betamethasone in the antenatal period promotes lung maturation. One of the first published reviews that showed the efficacy of antenatal steroids in preterm labour was produced by Crowley in 19958. Crowley showed that steroids given in preterm labour were effective in preventing RDS and improving neonatal mortality rates. Since then several randomised controlled clinical trials have evaluated the efficacy of steroids in reducing RDS. A recent Cochrane review of 21 trials assessed the effects of antenatal corticosteroids, given to women expected to go into preterm labour, on fetal/neonatal mortality and morbidity8. The authors concluded that a single dose of antenatal steroids promoted fetal lung maturation thereby reducing the risk of RDS and the need for assisted respiratory management. The mechanisms by which glucocorticoids are thought to exert their efficacy are described below. Firstly, glucocorticoids stimulate phospholipid production. Phospholipids are a major component of endogenous surfactant and as a result augment surfactant synthesis in the biochemically immature and surfactant deficient lung 9, although the exact mechanisms by which this occurs remains to be elucidated. Secondly glucocorticoids enhance lung maturation and development. As aforementioned, in order to produce surfactant, fetal lungs must produce type II pneumocytes which will then generate lamellar bodies in which surfactant is stored. Glucocorticoids enhance this process, promoting pulmonary epithelial cell maturity and differentiation into type II pneumocytes9. Furthermore glucocorticoids cause a decrease in pulmonary interstitial tissue thereby decreasing alveolar wall thickness. A thin alveolar wall thickness facilitates efficacious gaseous exchange and will therefore assist ventilation and oxygenation of the neonate once born thus decreasing the chances of developing RDS. Another known benefit of antenatal glucocorticoids is found in reducing oxidative stress on the immature lung and prevention of pulmonary oedema9. This accumulative evidence suggests that glucocorticoids are essential for normal pulmonary development and giving a single dose to mothers at risk of preterm birth may substantially decrease the chances of the infant developing RDS. Surfactant Therapy As discussed before, endogenous surfactant has a fundamental role in maintaining the alveolar-capillary interface in order to prevent end-expiratory alveolar collapse. This is achieved by thin spread of surfactant around the alveoli which ultimately acts to reduce surface tension. The most important component of surfactant which achieves this fundamental function is a phospholipid called dipalmitoylated phopshatidylcholine (DPPC)11. DPPC also stabilises the alveoli at end expiration, further preventing alveolar collapse. Alongside DPPC the synergistic actions of surfactant proteins (SP) SP-B and SP-C also lower surface tension11. Thus a deficiency in surfactant will cause alveolar collapse, decrease pulmonary compliance, increased pulmonary vascular resistance and produce ventilation-perfusion mismatch. Hence the aim of exogenous surfactant therapy is to reverse this pathological cascade and ultimately prevent alveolar collapse thereby limiting pulmonary damage and improving ventilat ion. Since the first clinical trial assessing the use of surfactant in managing neonatal RDS by Fujiwara in the 1980s10, our understanding of the composition, structure and function of surfactant has progressed vastly. In this uncontrolled trial the chest x-rays of 10 babies diagnosed with RDS, both clinically and radiologically, showed significant improvement after exogenous modified bovine surfactant was administered with a decreased requirement for ventilation. Since then several randomised controlled trials12 have shown that surfactant therapy, alongside antenatal steroids and ventilation continues to improve neonatal morbidity and mortality. Both natural (derived from an animal source) and synthetic (manufactured chemically) surfactants are available to use in managing RDS. Meta-analysis of trials comparing the two types of surfactant have shown that natural surfactants show a more rapid response in improved lung compliance and oxygenation12 thereby reducing neonatal mortality. Furthermore natural surfactants are less sensitive to inhibition by accumulative products of lung injury such as serum proteins. Surfactants need direct delivery to lungs and usually require intubation with short periods of assisted ventilation. Traditionally two therapeutic approaches have been established in managing RDs with surfactant. The first adopts the use of surfactant prophylactically, with surfactant given immediately after birth to enable the neonate to cope with extra-uterine life. The obvious benefit of this approach is that surfactant is administered to the baby before severe RDS develops resulting in long-term pulmonary sequelae for the neonate. However this technique is invasive, as surfactant administration requires endotracheal intubation, it is expensive and furthermore it may result in the unnecessary treatment of neonates. Moreover poor intubation with failed attempts and prolonged apnoeic episodes may further damage the lungs resulting in CLD. Despite this, there is a strong body of evidence for prophylactic use of surfactant and current guidelines state that all preterm babies born befo re 27 weeks of gestation, who have not been given antenatal steroids should be intubated and given surfactant at birth7. The second therapeutic approach evaluates the role of surfactant in rescue treatment used in neonates with an established diagnosis of RDS requiring ventilation and oxygen. The advantages of rescue treatment include that it is reserved for neonates in whom RDS is confirmed and it may decrease the morbidity associated with unnecessary intubation. The obvious disadvantage is that delay in surfactant delivery may allow for irreversible lung injury to develop with decreased efficacy of surfactant administration12. Several studies have aimed to clarify the issue between prophylactic and rescue surfactant treatment. A randomised trial by Rojas et al. showed the benefits of surfactant delivery within 1h of birth in neonates born between 27-31 weeks14 with an established diagnosis of RDS who were treated with continuous positive airway pressure soon after birth. 279 infants were randomly assigned either to the treatment group (intubation, very early surfactant, extubation, and nasal continuous positive airway pressure) or the control group (nasal continuous airway pressure alone). The results of this study demonstrated that infants in the treatment group i.e. those treated with surfactant, showed a decreased need for mechanical ventilation with a decrease in the incidence of CLD and pneumothoraces. Neonatal mortality rates were similar between both groups. A meta-analysis by Soll and Morley compared the effects of prophylactic surfactant to surfactant treatment of established respiratory distress syndrome (i.e. rescue treatment) in preterm infants33. The authors analysed eight studies comparing the use of prophylactic and rescue surfactant treatment and concluded that the majority of the evidence demonstrated a decrease in the incidence of RDS when surfactant was given prophylactically. Moreover the meta-analysis showed that infants treated with prophylactic surfactant had a better clinical outcome with a reported decrease in the risk of pneumothorax, pulmonary interstitial emphysema, CLD and mortality33. As a result of such studies most neonatal units continue to practice delivery of surfactant prophylactically in preterm babies at high risk of RDS. However, some literature still debates whether there are any real advantages of prophylactic surfactant over rescue treatment. What is evident is that surfactant therapy should play a fundamental role in the management of RDS. Future trials will need to further assess the indications for surfactant therapy in treating neonatal RDS and perhaps in the management of other pulmonary insufficiency disorders that affect the neonate. Although much remains to be elucidated about the complex pulmonary surfactant system, since its introduction 25 years ago, surfactant therapy has been at the forefront of reducing RDS and its role in decreasing neonatal mortality and morbidity cannot be disputed. Mechanical ventilation Mechanical ventilations is one of the cornerstones of neonatal intensive care units and regardless of the modality used, the primary function is to maintain adequate oxygenation and ventilation. The goals of mechanical ventilation are: to establish efficacious gaseous exchange to limit pulmonary insult and CLD to reduce the respiratory effort and work of breathing of the patient To achieve these basic goals several techniques, devices and therapeutic options are available to the neonatologist that can be either invasive or non-invasive. Continuous Positive Airway Pressure The use of CPAP; continuous positive airway pressure, in the treatment of RDS was first described in the 1970s and has since been identified as a important management strategy. CPAP applies positive end expiratory pressure (PEEP) to the alveoli throughout inspiration and expiration so that the alveoli remain inflated thereby preventing collapse. The pressure required to re-inflate the lungs is reduced as partially inflated alveoli are easily to inflate than completely collapsed ones. Animal studies with premature lambs have shown the benefits of nasal CPAP over mechanical ventilation. CPAP acts to lower the markers for CLD for example granulocytes, and markers of white cell activation, increases the amount of surfactant available, improves oxygenation and lastly corrects ventilation/perfusion mismatching2, 15. Moreover CPAP produces a more regulated pattern of breathing in neonates by stabilising the chest wall and reducing thoracic distortion16. Like surfactant therapy there are two ways in which CPAP can be administered. The first method, InSUrE: intubation, surfactant and extubation, adopts a brief intubation to administer surfactant and extubation to CPAP approach and the second is the Columbia method in which babies are started on CPAP in the delivery room and are only mechanically ventilated, and intubated if the need for surfactant is established. Several studies have shown the benefit of the first approach. A study by Verder et al. randomised 68 neonates with moderate to severe RDS; 35 infants were randomised to surfactant therapy following a short period of intubation and then extubation to CPAP and 33 neonates were randomised to nasal CPAP alone. The results of this study showed that infants in the earlier group had a reduced need for ventilation; 21% in comparison to 63% in the second group16,17. Another similar trial by Haberman et al. assessed the use of surfactant with early extuabtion to CPAP and subsequently the results showed a decreased need and duration for mechanical ventilation12. Furthermore a recent Cochrane review of six studies using the InSuRE method showed that neonates with RDS treated with early surfactant therapy followed by nasal CPAP, were less likely to need mechanical ventilation and develop air leaks in comparison to neonates that were treated with the Columbia approach (i.e. early CPAP therapy foll owed by surfactant if needed)17, 18. A more recent review by the same authors further confirmed the findings of the initial review and the relative risk for developing CLD was 0.51 (95% CI 0.26-0.99) with early surfactant treatment and nasal CPAP when comparing the two methods18. The Columbia method requires the stabilisation of neonates with CPAP in the delivery room with intubation and surfactant therapy used as necessitated. This approach was adopted when retrospectives studies done by Avery et al. and later Van Marter et al. evaluated the clinical outcomes in multiple neonatal units across the US2. In both cases a lower incidence of CLD was observed in the Columbia University Hospital which adopted CPAP as a primary treatment strategy as opposed to intubation and mechanical ventilation like other units. Leading on from this Ammari et al.. evaluated the Columbia method recently. The outcomes of 261 neonates with birth weight So far the evidence base for the Columbia method has been derived from retrospective cohort studies with a lacking in RCTS and therefore a lack of stronger evidence. One RCT that had aimed to evaluate the Columbia method was the recent COIN trial by Morley. This study evaluated whether the incidence of death or BPD would be reduced by CPAP rather than intubation and ventilation shortly after birth13. 610 neonates born between 25-28 weeks were randomised to CPAP or intubation and ventilation at 5minutes after birth and surfactant was administered at the neonatologists discretion. The results of the study demonstrated that at 28 days of gestation, infants in the CPAP group had a decreased need for supplemental oxygen and fewer deaths2,13. However worrying results from this study were that approximately 46% of babies in the CPAP group went onto require intubation and had a higher rate of pneumothoraces13. There are few randomised control trials assessing the benefit of CPAP alone in managing RDS and the results of the Columbia Hospital study have been irreproducible in other centres. The mainstream use of CPAP for managing RDS remains to start CPAP in the delivery room, after intubation for surfactant treatment. There is not enough evidence to show that CPAP alone can prevent RDS and associated complications in comparison with invasive ventilation. The evidence does suggest that there is a decrease in complications with surfactant therapy and CPAP but the relationship with CLD is less transparent. At present there are two RCTs ongoing that may provide further insight into the role of CPAP in RDS when complete. The first trial is the SUPPORT study, which is randomising infants between 24-27 weeks to CPAP beginning in the delivery room with stringent criteria for subsequent intubation, or intubation with surfactant treatment within 1 h of birth with continuing mechanical ventilation2. The second is the trial by the Vermont-Oxford Network in which infants born at 26-29 weeks gestation will be randomised after 6 days into one of three groups; (1) intubation, early prophylactic surfactant, and subsequent stabilisation on mechanical ventilation; (2) intubation, early prophylactic surfactant, and rapid extubation to CPAP; and lastly (3) early stabilisation with nasal CPAP, with selective intubation and surfactant administration according to clinical guidelines2. The immediate management of the RDS neonate with CPAP remains controversial and maybe the results of these ongoing RCTS wil l provide invaluable answers to the many uncertainties surrounding this device. Nasal intermittent positive pressure ventilation Another relatively recent development in non-invasive ventilation that has evolved from NICU ventilator machines and CPAP devices is the use of NIPPV for managing RDS. Sometimes called BiPAP (for bi-level positive airway pressure), this form of non-invasive ventilation is able to provide two levels of airway pressure, without the need for intubation. BiPAP maintains positive pressure throughout respiration but with a slightly higher pressure during inspiration. By doing so BiPAP/NIPPV is able to assist neonatal breathing by: reducing the work of breathing improving tidal volume increasing blood oxygen saturation and increasing removal of CO2 thereby limiting hypoxaemia and respiratory acidosis. As the neonate inhales, the NIPPV device generates a positive pressure thereby assisting the neonates spontaneous breath and providing ventilatory support. This is at a slightly higher positive pressure. As the neonate begins to exhale, the pressure drops, but a positive airway pressure remains in the lungs to prevent alveolar collapse and thus increase gaseous exchange. NIPPV may be a potential beneficial treatment for the management of babies with RDS and has been used in NICUs since the 1980s. Recently multiple studies have aimed to evaluate the efficacy of NIPPV in stabilising neonates. A randomised controlled prospective study by Kulgeman et al.. found that NIPPV was more successful than NCPAP in the initial treatment of RDs in preterm infants19. Kulgeman and his colleagues randomised infants A further study by Sai and colleagues also established the advantages of NIPPV over CPAP in managing RDs and reducing the need for mechanical ventilation and intubation in preterm infants. In their study 76 neonates between 28-34 weeks gestation with RDs at 6h of birth were randomised either to early NIPPV (37 neonates) or early CPAP (39 neonates) after surfactant use20. Firstly they documented that the failure rate with NIPPV was less in comparison to the CPAP group (p

Social Hysteria in Shirley Jacksons The Lottery Essay example -- Shir

Social Hysteria in The Lottery Tradition is a central theme in Shirley Jackon's short story The Lottery. Images such as the black box and characters such as Old Man Warner, Mrs. Adams, and Mrs. Hutchinson display to the reader not only the tenacity with which the townspeople cling to the tradition of the lottery, but also the wavering support of it by others. In just a few pages, Jackson manages to examine the sometimes long forgotten purpose of rituals, as well as the inevitable questioning of the necessity for such customs. The black box represents virtually the only part of the original ritual that has been preserved since the lottery began. It is there not only to hold the papers that will be drawn, but also to represent to the townsfolk the tradition. The black box is constructed of pieces of the original box, a link to the time when the purpose of the lottery was clear. Most of the old custom has been forgotten: wood chips have been replaced with paper slips, and on one can remember the recital and ritual salute that had previously been part of the lottery; but the o...

The Euro :: Essays Papers

The Euro In Europe, the debut of the euro is widely hailed as the most important event affecting the international monetary landscape since the breakup of the Bretton Woods System in 1971 to 1973, or since the Bretton Woods Agreement in 1944, or maybe even since the founding of the Federal Reserve System in 1913. It has become a contest for European officials and commentators to see who can push the analogy back furthest in time. Eminences elsewhere in the world have similarly greeted the euro with high hopes and great expectations. Only in the United States has the euro been greeted with a yawn. It is not hard to see why. So far, its advent has not weakened the international financial position of the dollar; if anything the opposite has been true. The dollar has been strong against the euro rather than weak; for much of last autumn the fear was that the euro, which had started out being worth well more than a dollar, might plunge through the dreaded psychological barrier of one to one. There has been no sign of Asian and Latin American central banks replacing their dollars with euros en masse, as prominent commentators had predicted. The United States has not had to change the way it does business at Group of Seven summits, the OECD, or the IMF. Many Americans thus cannot help but feel that the euro is a tempest in a teapot. The Euro's Slow Start Perhaps Asian and Latin American central banks have been waiting to dump their dollars until the euro stabilizes. Through much of 1999 the euro was weak because the European economy was weak; governments and private investors were understandably reluctant to overweight a currency that seemed to be losing value by the day. Investors were slow to move into euros because they thought that Europe was less well prepared than the United States for Y2K. They worried about the stability of the European banking system because European banks had lent much more aggressively than their American counterparts to Indonesia, Korea, Malaysia a nd Thailand. But now that European growth is finally accelerating, the euro could strengthen, and the anticipated shift into euros at last could get under way. Perhaps governments and investors have been reluctant to embrace the euro because of a series of missteps by the European Central Bank. In the early months of 1999, ECB officials issued a series of confusing and contradictory statements, and on several occasions the ECB board's decision on whether or not to raise interest rates leaked to the press in advance of the official announcement.

Revelation Essay

Revelation The opening lines of the poem initiate the main themes; â€Å"Black bull† introduces one of the themes which are gender stereotyping. This suggests the bull is powerful, strong and very angry. Females are then introduced in the poem, â€Å"eggs and milk†. This suggests females are pale, delicate and easily broken. The poet highlights the theme of stereotypes by placing â€Å"black bull† above â€Å"eggs and milk†. This is to effectively state that the black bull is on top of eggs and milk which emphasises on the importance of gender stereotyping.The second theme is introduced which is innocence and experience, â€Å"They call him Bob – as though perhaps you could reduce a monster with the charm of a friendly name†. Tone her is cynical. The bull has been given a cheery, friendly name which is a irrelevant name for the harsh animal. The key words of the quote are â€Å"monster† and â€Å"friendly†. This is a very striki ng contrast between the idea of the name Bob being friendly, cheery and approachable, but in actual fact behind the cheery name lays a monster. The quote, â€Å"at the threshold of his outhouse†, is the turning point in the story.This is a symbolic quote that states you must go over a line before starting a new life. In the poem a young girl is standing in the area between safety and danger. The line is significant as the pause creates a series of tension building up to a sense of danger. The girl’s initial perceptions of the creature are conveyed in, â€Å"At first only black, and the hot reek of him†¦Ã¢â‚¬  The girl’s sensory impressions of the bull are that the word â€Å"black† represents danger. The words â€Å"hot reek† represents the smell and stench of the bull.Her over all sensory impression is the smell of the bulls pungent aroma that is its natural smell and the limited sight gives her a sense of the unknown danger. The poet conti nues to reference the main theme of gender stereotyping by developing it, â€Å"We was immense†, This quote highlights masculinity and power. It shows that males are bigger, more powerful and the dominate gender. The theme of innocence and experience is also developed, and the bull and the girl are compared to each other. The girl is full of fear and innocence. She is extremely intimidated by the bulls presence.The poet powerfully, reinforces the contrasting thematic dichotomies suggested in verse one. In the first instance this is done by including details in verse two which contract with details from the first verse. The poet has reinforced the theme of innocence and experience as he shows that the bull knows he is restrained. Also reinforces the theme of gender stereotyping – girl and boy. This is done as it is dark and the girl cannot see what the bull is doing, whilst the girl is unaware of this, the bull is trying to break free from where he is chained up too.The poet condenses the contrast by highlighting them in a few lines of verse two. â€Å" I had always half known he existed† Here, the poet points out that the girl had always knew the bull was there, just she had never seen the bull and didn’t want to come to terms with the reality. Verse three is effective as it shows that the girl is fearful of her encounter with the bull. The girl is terrified by the bulls presence and runs away from the farm. She runs past a group of boys.Here the writer links the bull and the boys together by the use of harsh sound effects. It is important that this link is made as it makes a direct comparison between the bulls aggression and the boys cruelty. It highlights that they both share the same characteristics. Finally, the girls attention is redirected to the parlous state of the eggs and milk, due to the flight, â€Å"scared of the eggs shattering† While she’s too busy protecting the eggs it shows the reader that females are protective towards anything precious.In the girls eyes the eggs and milk are precious, and she wants to protect them from any harm. â€Å"in case the milk should spill† The precarious position of the milk is highlighted in the small hands of a weak girl, who has been charged with the responsibility of looking after the eggs and milk. She is protecting what is important to her. The poet seems to be suggesting that her experience shows that females are scared of males and have to protect themselves from any harm. Females protect all forms of life, they are caring and sensible creatures.