The Naive Mentality of the West Essays

The Naive Mentality of the West Essays The Naive Mentality of the West Essay The Naive Mentality of the West Essay Throughout the past decade, the Arab world endured the most dreadful situations, specifically the Middle East. The consequences that resulted from the wars and terrorist attacks in the area, portrayed a negative image on the Arab families in general. Media speculations and misleading stories that segregate the Arab families from ones of different ethnicity has become a major complication for Arabs on different levels. Relocating families certainly face a harsh time but those of an Arab origin await an unlike experience. Ever since the crisis struck the region, migrating families started undergoing incomparable mistreatment. Arab Muslim families that moved to the United States were mostly affected due to the propaganda that the media had engraved in the minds of the citizens. Many Americans only needed a look at the clothing of a person to start their discrimination process. From then on everything goes downhill. â€Å"The terrorist attacks of September 11th not only brought Arabs to public attention, but also put them at risk and in danger of discrimination and prejudice. Hate crimes targeting Muslims increased by 1600% from 2000 to 2001 (CNN.com, 2002). Hate crimes against people of Middle Eastern origin or descent increased from 354 attacks in 2000 to 1501 attacks in 2001 (Oswald)†.(Isra 2012) Along with those complications many families were harassed each member in a different way. The man in the family is looked down upon at his work and he encounters a decrease in earnings. Muslim women were distinguished due to their â€Å"Hijab† which instantly revealed their ethnicity. â€Å"The Muslim women in Chicago reported having their headscarves pulled off their heads and being spat at on the street†. (Isra 2012). The Arab children had a feeling of inferiority at schools and loneliness. The language barrier and diverse cultural education made it hard for them to adapt with the circumstances and moreover the bullying they went through. Were

Between a Rock And a Hard Place Essay Example | Topics and Well Written Essays - 500 words

Between a Rock And a Hard Place - Essay Example Spillover vice is a problem in the community, with drugs and sex attracting rich white people into the area. The women consider this an insult and a hypocrisy, because rich people do not want to live in the area because of the resident blacks, although they provide the incentive for the proliferation of vice and crime in the area. Children are in particular danger, and the mothers exert extreme effort in watching their children and keeping them off the violence in the streets, and from being recruited by criminal gangs. Some have died protecting their children from armed goons. Maintaining vigilance often meant constantly staying indoors; therefore, women who find themselves in this position seldom could go to work, much less pursue a career. Their constant stress and watchfulness takes it toll on their health and the health of their children. Among those parents who had jobs, one in every four stressed that they did not have sick leaves available in order to take care of their sick children (Heymann, Earle & Egleston, 1996).

No Sweat Global Commodity Chains and Labor Rights Essay

No Sweat Global Commodity Chains and Labor Rights - Essay Example According to the recent evident, almost 25 percent of total population of the developing countries are engaged in the paid labor live in several households (Seidman, 2007). These people generally survive on equivalent to 1 US dollar per day, per person. Day-by-day, the estimation of the poor working population is increasing significantly. This essay will take a close look at various debates global commodity chains and labor rights. Discussion Labor standard is the estimated, computed and several values, such as operations per hour, assembly time, and output per unit implemented in the evaluating or forecasting labor performance. The relationship between the system of labor standard and globalized production is effectively understood within the global commodity chain concept. The global commodity chain is referred to the way in which manufacturing, sales and distribution of goods is controlled and organized across the national borders. The labor intensive manufacturing of several cons umer goods is generally characterized by the particular buyer-driven commodity chains. In these commodity chains the brand-name corporations and large retailers develop a decentralize systems of manufacturing and distribution of such goods. However, the market power significantly differs among the various players across the chain. The real production is generally subcontracted out to several small organizations that generally usually face intense market competitive conditions. Therefore, the subcontractors cannot comfortably raise the output price without risking business loss. On the other hand, brand name multinationals and retailers enjoy some significant market power degree that they can adopt to keep low prices for the products they buy or earn rents through the monopolistic brand identity development. The large retailers and brand-name manufacturers could implement their market power to improve labor standards at the production level by compensating the subcontractors to incre ase the cost. There are several limitations of the global labor standards. In spite of the implementation strategy, the limitations of several schemes along with the aspects to promote global labor standards can be recognized explicitly. Only a subset of the workforce of the world could receive any benefit if the standards were aimed to the workers who manufacture goods for export. Labors generally produce non traded services and goods cannot directly affected by several interventions such as a social cause or a standardize code of conduct. In addition to this, adoption of the expansionary macroeconomic policy can referred to be an effective strategy to improve the well being of the labors. It will help to secure the egalitarian outcome comparing to the targeted labor standards’ enforcement. Labor standards are not the appropriate policies for the well being of the workers during the period of low global economic growth rate. The concept of global labor standard is irrelevant within the context of global economic downturn and global business expansion of several firms. The government of the developing countries needs to be cautioned before developing an expansionary macroeconomic policy. It is true that, macroeconomic policies can effectively contribute to the fair improvements in the work condition. But these cannot be sufficient to address the widespread corrosion of the potential employment opportunity that has been

Biomechanics of a Sporting Movement Essay Example | Topics and Well Written Essays - 2250 words

Biomechanics of a Sporting Movement - Essay Example Biomechanics explains and describes and even predicts the mechanical side of human sports, exercises and play body movements. Biomechanics usually studies the mechanics of living things, including the forces that exerted by muscles and gravity on the animal's skeletal framework. Some examples of Biomechanics researches include the study of forces that is exerted on a bird's wings, the aerodynamics of a flying bird or insect, the beauty of a fish swimming in the water and the locomotion in animals and plants. Biomechanics of human beings falls under the study of Kinesiology. People sometimes wonder why the shark swims faster than its prey. In sports, there is a need for coaches and trainers that aid the athletes excel in their sports thru the study of biomechanics. This essay shows technically what biomechanics and how it helps the athlete win tournaments. BIOMECHANICS (Mccomb, 2004) is concerned with the application of physic's law of mechanics to living organisms just as they affect non-living things. The structural stresses of the branch of a tree and the reasons why sharks and dolphins swim faster than other fishes is an example of biomechanics study. The scientific mechanics law explains the effect that certain movements that a high jumper has on the amount and beauty of water displaced during water entry in a swimming pool contest. ... The scientific mechanics law explains the effect that certain movements that a high jumper has on the amount and beauty of water displaced during water entry in a swimming pool contest. In physics, we are taught, using the mechanics law, reasons why a piece of wood slides in such a particular way. Biomechanics (Massimino , 1997) seeks to explain the mechanical cause and effect relationship of plants, animals and human beings. Biomechanics explains and describes and even predicts the mechanical side of human sports, exercises and play body movements. Biomechanics (Greeves, 2002) usually studies the mechanics of living things, including the forces that exerted by muscles and gravity on the animal's skeletal framework. Some examples of Biomechanics (Lee, 1993) researches include the study of forces that is exerted on a bird's wings, the aerodynamics of a flying bird or insect, the beauty of a fish swimming in the water and the locomotion in animals and plants. Biomechanics of human bein gs falls under the study of Kinesiology. BIOMECHANICS OF THE SOCCER KICK. Soccer is a very popular sport around the world. The soccer game revolves around the KICK. The soccer Kick is also used in other popular sports like Rugby league and union, Australian rule Football, grid iron football, Gaelic Football, American Football and also beach volleyball. There are names given to the different soccer kicks are PLACE KICK, SOCCER -STYLE KICK, and the ROUND THE CORNER KICK. Physiology and development. Although the soccer kick lasts for only a few seconds, the intensity force and angle of the anaerobic metabolic pathway produces the kick thereby causing the ball to travel fast, slow, high, low, left or right which causes uproars and clap from the fans.Adenosine

Promoting Brand Loyalty at Abercrombie & Fitch Essay Example for Free

Promoting Brand Loyalty at Abercrombie Fitch Essay Abercrombie and Fitch is an American retailer that focuses on casual wear for consumers aged 18 to 22. It has over 300 locations in the United States, and is expanding internationally. The company also operates three offshoot brands: Abercrombie, Hollister Co., and Gilly Hicks. The company operated a post-collegiate brand, Ruehl No.925, that closed in early 2010. The company operates 1,073 stores across all four brands. The AF brand has 316 locations in the United States, four in Canada, one in London, one in Milan, one in Tokyo, one in Copenhagen, one in Madrid, one in Paris, one in Brussels, one in Dublin, and one in Hong Kong. AF stores range from 6,000 to 36,000 square feet. The company focuses on providing high-quality merchandise that compliments the casual classic American lifestyle. selling casual sportswear apparel, including knit and woven shirts, graphic t-shirts, fleece, jeans and woven pants, shorts, sweaters, outerwear, personal care products and accessories for men, women and kids under the Abercrombie Fitch, abercrombie kids, and Hollister brands. The Company determines its operating segments on the same basis that it uses to evaluate performance internally. The operating segments identified by the Company are Abercrombie Fitch, abercrombie kids, Hollister and Gilly Hicks. The operating segments have been aggregated and are reported as one reportable segment because they have similar economic characteristics and meet the required aggregation criteria. The Company believes its operating segments may be aggregated for financial reporting purposes because they are similar in each of the following areas: class of consumer, economic characteristics, nature of products, nature of production processes, and distribution methods. The Company views the customer’s in-store experience as the primary vehicle for communicating the spirit of each brand. The Company emphasizes the senses of sight, sound, smell, touch and energy by utilizing visual presentation of merchandise, in-store marketing, music, fragrances, rich fabrics and its sales associates to reinforce the aspirational lifestyles represented by the brands. The Company considers the in-store experience to be its main form of marketing. The Company emphasizes the senses to reinforce the aspirational lifestyles represented by the brands. The Company’s flagship stores represent the pinnacle of the Company’s in-store  branding efforts. The Company also engages its customers through social media and mobile commerce in ways that reinforce the aspirational lifestyle of the brands. Flagship stores and social media both attract a substantial number of international consumers, and have significantly contributed to the Company’s worldwide status as an iconic brand. The in-store marketing is designed to convey the principal elements and personality of each brand. The store design, furniture, fixtures and music are all carefully planned and coordinated to create a shopping experience that reflects the Abercrombie Fitch, abercrombie kids, Hollister or Gilly Hicks lifestyle. The Company’s sales associates and managers are a central element in creating the atmosphere of the stores. In addition to providing a high level of customer service, sales associates and managers reflect the casual, energetic and aspirational attitude of the brands. Every brand displays merchandise uniformly to ensure a consistent store experience, regardless of location. Store managers receive detailed plans designating fixture and merchandise placement to ensure coordinated execution of the Company-wide merchandising strategy. In addition, standardization of each brand’s store design and merchandise presentation enables the Company to open new stores efficiently. The Company had net sales of $2.929 billion for the fifty-two weeks ended January 30, 2010, down 15.9% from $3.484 billion for the fifty-two weeks ended January 31, 2009. Operating income for Fiscal 2009 was $117.9 million, which was down from $498.3 million in Fiscal 2008. Net income from continuing operations was $79.0 million and net income per diluted share from continuing operations was $0.89 in Fiscal 2009, compared to net income from continuing operations of $308.2 million and net income per diluted share from continuing operations of $3.45 in Fiscal 2008. Net income per diluted share from continuing operations included non-cash, store-related asset impairment charges of $0.23 and $0.06 for Fiscal 2009 and Fiscal 2008, respectively. Net cash provided by operating activities, the Company’s primary source of liquidity, was $402.2 million for Fiscal 2009. This source of cash was primarily driven by results from operations adjusted for non-cash items including depreciation and amortization and impairment charges. The Company used $175.5 million of cash for capital expenditures and had proceeds from the sale of marketable securities of $77.5 million during Fiscal 2009. The Company’s Market Share may be  Adversely Impacted at any Time by a Significant Number of Competitors. The sale of apparel and personal care products is a highly competitive business with numerous participants, including individual and chain fashion specialty stores, as well as regional and national department stores. The Company faces a variety of competitive challenges, including maintaining favorable brand recognition and effectively marketing its products to consumers in several diverse demographic markets. And sourcing merchandise efficiently and countering the aggressive promotional activities of many of the Company’s competitors without diminishing the aspirational nature of the Company’s brands and brand equity. There can be no assurance that the Company will be able to compete successfully in the future. The science of the Deal Ch.7 Genentech is a biotechnology corporation, founded in 1976 by venture capitalist Robert A. Swanson and biochemist Dr. Herbert Boyer.   Today, Genentech has the biggest market capitalization in biotech at US $88 billion, with an incredible reputation in drug development, especially in oncology, and a number of blockbuster drugs under its belt. Genentech has multiple products on the market for serious or life-threatening medical conditions. In March 2009, Genentech became a member of the Roche Group, and Genentech now serves as the headquarters for all Roche pharmaceutical operations in the United States. Accordingly, the list below includes products which were previously marketed as Roche products that are now being marketed by Genentech in the United States. Genentech’s relationship with Roche Holding began in 1990, when the Swiss company bought a 60 percent stake in Genentech for $2.1 billion. As a result of additional stock purchases and sell offs, Roche owned about 56perce nt of Genentech in 2008. The success of Genentech as a biotechnology company is indeed in no small part derived from its strategy of forming alliances with smaller companies, whose proprietary drugs and technology platforms have the potential to become blockbusters. The commercialized drug, called Tarceva, is a drug used to treat non-small cell lung cancer, pancreatic cancer and several other  types of cancer, which was released in 2004 and quickly acquired blockbuster status. It is marketed in the United States by Genentech and OSI Pharmaceuticals and elsewhere by Roche. In lung cancer, it extends life by an average of 3.3 months at a cost of CDN$95,000. Historically, this approach has brought Genentech great rewards, particularly in the field of oncology, and now the company is hoping to achieve similar success in new therapeutic areas. To support small companies with promising technologies and/or drugs in development that are at too early a stage for licensing. In this way, Genentech has developed a highly competitive approach, singling out small companies with enormous future potential and establishing mutually beneficial relationships at the earliest possible stage. A significant proportion of the Genentech pipeline has always consisted of proprietary technology platforms and drug candidates, and its brave approach to RD spending reflects this. In 2003, 24% of Genentechs revenues were directed into RD, to address the top-heavy position of its pipeline at the time. To balance resource use with the strongest likelihood of success, Genentech continuously evaluates its pipeline products in order to determine which are the most promising projects to move through the many phases of clinical testing. The pipeline includes both breakthrough innovations and new indications for existing, well understood products that may fight more than one disease or more than one form of a disease.

Minimizing Cost of Volatile Inhalational Anesthetics

Minimizing Cost of Volatile Inhalational Anesthetics P The population that will be examined are male and female patients with a physical status (PS) of I-II requiring general anesthesia for surgery, ages 20-40. I The intervention being introduced is utilizing Sevoflurane (UltaneÂÂ ®) as the inhaled anesthetic for surgeries requiring general anesthesia lasting less than one hour. C The comparison group will be those utilizing Desflurane (SupraneÂÂ ®) as the inhaled anesthetic for surgeries requiring general anesthesia lasting less than one hour. O The use of Sevoflurane for surgery cases requiring general anesthesia for less than one hour will save money for the anesthesia department rather than using Desflurane. PICO Question: Will the use of Sevoflurane rather than Desflurane in surgeries requiring general anesthesia lasting less than one hour save money for the anesthesia department? Abstract Inhalation anesthetics are used millions of times every single day in surgeries requiring general anesthesia all over the world. Cost containment is anesthesia is no longer an option, it is an absolute necessity. Anesthetic drugs account for up to 6 percent of total hospital pharmacy costs and inhalation agents comprise over twenty percent of that as a whole. One of the areas most amenable to cost reduction in the anesthesia department budget is the use and choice of inhalational anesthetic. A quantitative quasi-experimental controlled trial was developed to determine if money could be saved in the anesthesia department by utilizing Sevoflurane as the inhalational anesthetic for surgeries requiring general anesthesia less than one hour rather than Desflurane. The study chose males and females, ages twenty to forty, requiring general anesthesia at a mid-sized, urban, teaching hospital in South-Western Pennsylvania. Prices of anesthetic agents were gathered from the same facility and c alculated to determine the total cost savings that would ensue with the use of the interventional inhalation agent rather than that used by the control group. The use of Sevoflurane for two-thirds of the cases which Desflurane was used saved the institution over twenty thousand dollars. Key Words: Inhalational Anesthetics, Pharmacoeconomics, Desflurane, Sevoflurane, Anesthesia Introduction Research Problem: The cost of health services and technologies continue to increase exponentially while resources are finite. Developing effective strategies to minimize costs without compromising patient safety and quality of care are the most difficult challenges medical professionals experience.13 Inhalational anesthetics comprise twenty percent of the drug expenses in anesthesia departments. The cost of inhalational anesthetics depend on their potency, which is their minimum alveolar concentration (MAC), the minimum amount of inhalational anesthetic needed in the lungs to facilitate the absence of movement to noxious stimuli, the fresh gas flows (FGF) used to deliver the anesthetic gas, the amount of anesthetic vapor released by each milliliter of liquid, and the price of the inhalational anesthetics themselves.2,16 Inhalational anesthetics are used when general anesthesia is needed for surgery and patients do not have diseases or conditions which would preclude them from being able to utilize them (e.g. those who have malignant hyperthermia). The anesthesia provider decides which inhalational anesthetic is best for a given patient, based on their history and needs for the surgery. The problem exists when providers just use whichever anesthetic is most easily accessible at that time without minding any consideration as to the cost of the particular gas and the level of FGF they are using, which is purely a waste of money as the patient will lose heat and humidity, waste high levels of inhaled anesthetic, and demise cost containment for the anesthesia department. Statement of Purpose The purpose of this research study is to determine whether the implementation of Sevoflurane as the choice inhalation anesthetic for surgery requiring general anesthesia for procedures lasting less than one hour rather than using Desflurane will provide cost containment for the anesthesia department. Objectives/Aims The objective of this study is to provide an avenue of cost containment for the anesthesia department of a mid-sized, urban, teaching hospital and overall savings for the medical health system. This will allot more money in the department budget to be spent on technological advances, and equipment used to better develop opportunities for patient safety, the ultimate goal of all medical professionals. Review of Literature: Many studies explore different methods of cost containment in the anesthesia department. Almost all of the studies exclusively develop the notion of cost savings related to the fresh gas flows used to deliver inhalation anesthetics. Cost containment requires primarily a decrease in FGFs, but it may also be influenced by a rational use of the available halogenated agents.3 With the advances in technology and the ultra-modern anesthesia machines available, anesthesia providers should feel safe in using minimal FGFs to deliver anesthesia that would not harm their patients in any way.3 Anesthetists can directly influence healthcare costs through the patterns in which they practice, which includes reducing the FGFs chosen during inhalational anesthesia, which will directly affect the amount of inhaled anesthetic delivered to the patient and ultimately the costs which are attributable to inhaled anesthetics.10,15 Depending on breathing systems used, which are mostly semi-open today, up to ninety percent of the anesthetic gases delivered escapes into the atmosphere completely unused. By using low-flow anesthesia, most of the patients air they exhale is recycled and then returned to the patients lungs after the carbon dioxide from the exhaled air has been absorbed.15 There are also advantages of using low-flow anesthesia such as conserving the patients heat and humidity, making it less of a need to warm the patient externally, which will cut down costs on heating blankets and the like, as well as maximized the rebreathing of the exhaled anesthetic, which will cut down on the amount of gas vented into the environment,6 but there are cautions that anesthesia providers must take when using low FGFs, as titration in inhalation anesthetic is not as easily predicted. Product labeling for Sevoflurane does include a warning that patient exposure should not exceed two hours using FGF rates greater than one and less than two liters per minute.7 Also, it is not recommended at all to maintain FGFs less than one when using Sevoflurane as the patients inhalational anesthetic of choice. These recommendations are to minimize the risk of exposure of the patient to compound A which in laboratory animals, has been shown to be linked to nephrotoxicity. There are no minimum flow rate designations that exist for Desflurane.7,8 Isoflurane is less expensive than Sevoflurane and Desflurane at equal dose and the same FGFs.7 When comparing Sevoflurane with Desflurane as they are being used for surgeries lasting less than two hours, there was a ninety percent decrement time for Sevoflurane which approached the short duration of anesthesia matching that of Desflurane. However, when the duration of anesthesia increased over two hours, Sevofluranes ninety percent decrement time approached that of Isoflurane.7 The cost of inhaled anesthetic agent can be estimated by using an equation that provides the cost of anesthetic per MAC hour: Cost per MAC hour ($) = [(Conc.)(FGF rate)(Duration)(MW)(Cost per mL)] / [(2412)(D)]6 The cost of one milliliter of Isoflurane is twenty-three cents, Sevoflurane is forty-one cents, and Desflurane is eighty-three cents. Regardless of the fast onset and emergence Desflurane offers, the cost of administering Desflurane is greater than the cost of Sevoflurane at any FGF rate.10,11 The cost of inhaled anesthetic agent can be estimated by calculating the cost per MAC hour, which is the administration of inhaled anesthetic agent at 1 MAC for a one hour time interval. The cost can be calculated using the concentration percent on the anesthetic dial of gas delivered, the FGF rate chosen, the duration of the anesthetic (sixty minutes in this case), the molecular weight of the anesthetic agent (MW in grams), cost per mL of liquid agent (in dollars), a factor accounting for the molar volume of a gas at twenty-one degrees Celsius (a constant of two thousand four-hundred twelve), and the density of the agent (D in grams/mL). Cost per MAC hour ($) = [(Conc.)(FGF rate)(Duration)(MW)(Cost per mL)] / [(2412)(D)]6 The cost per MAC hour can be seen in Table 2. Desflurane is associated with a shorter recovery as is Sevoflurane, but the differences between the two in terms of patient discharge cannot be consistently shown in research studies.13 Gupta evaluated n=246 patients for recovery time after undergoing surgeries less than two hours with either Sevoflurane or Desflurane. Patients given Desflurane were able to open their eyes sixty seconds before those who received Sevoflurane, P When comparing Sevoflurane and Isoflurane for patients who are undergoing surgery for more than two hours, Gupta evaluated n=634 patients. The patients who underwent Sevoflurane were able to open their eyes sooner, P Savings of more than one hundred thousand dollars resulted from the change of using Desflurane to using Sevoflurane in the operating rooms at Montefiore Medical Center in the Bronx, New York. Traynor noted that three bottles of Desflurane are needed to maintain a level of anesthesia equal to that of one bottle of Sevoflurane, making this agent much less expensive for the hospital to utilize, with no difference in patient discharge times. Reviews of Literature indicated that patients who received Desflurane could be extubated in the operating room about two minutes sooner than the patients who received Sevoflurane; an advantage seen meaningless in the large scale of the operating room sequences.9,15 Methodology The research design chosen was a quasi-experimental study. It involved the use of an experimental group and a control group. It is important to mention that the control group was compiled from hospital anesthesia records. The study did not involve randomization as a medical facilitys computer database cannot throughput this information. Permission from a mid-sized, Southwestern Pennsylvania teaching hospital was granted and all information gathered from the facility involved no patient identifiers, including gender or age. The hospitals Institutional Review Board (IRB) was provided all details of the research study and deemed the research experiment to be exempt and permission was granted to start the study without any changes in the studys design. General anesthesia data spreadsheets were gathered from the hospital exemplifying a patient anesthesia case total for the month of July, 2012. From this information, it was determined there were a total of n0=1,459 general anesthesia cases and after careful analysis, it was found that n1=500 cases lasted less than one hour and n2=959 cases lasted equal to or more than one hour in length from the beginning of anesthesia delivery to the end of the surgical procedure, as seen in Chart 1 in Appendix A. The Southwestern Pennsylvania hospital was asked to provide their costs for Desflurane, Sevoflurane, and Isoflurane inhalation anesthetics. These prices can be seen in Table 1 of Appendix A. Utilizing the equation to calculate the amount of inhaled anesthetic used during a general surgical case in a sixty minute time duration, MAC hour costs could be calculated as seen in Table 3. The pharmacy was also asked to provide how many bottles of inhalational anesthetic are bought and used annually in their operating rooms. These results are seen in Chart 2 and calculated annual costs of the anesthetics are shown in Chart 3 in Appendix C The experimental group for the research procedure involved men and women, ages twenty to forty, with PS scores of I and II, who were undergoing general anesthesia for surgery cases lasting less than one hour. These patients were administered Sevoflurane as their inhalational anesthetic during surgery at a FGF rate of 2 liters per minute (LPM). To be sure all patients were given the same standard induction regimen, all drug doses were based on current body weight calculations. Propofol, a sedative hypnotic was given at 2 milligrams per kilogram (mg/kg). Fentanyl, an opioid analgesic was given at 5 micrograms per kilogram (mcg/kg). Midazolam, a benzodiazepine sedative was given at a standard dose of 2mg/kg. Lidocaine, a class 2 anti-arrhythmic agent was given at 1.5 mg/kg. All patients participating in the study were given their induction medications at these doses provided. In the preoperative area, all patients were given the right to participate or not participate in the research experiment as they were provided a letter of informed consent, which described completely that they would be treated no differently than any other patient and they were voluntarily consenting to participate in a research study as an individual, and in no way obligated to participate if they were unwilling to do so. Those who were not involved in the experimentation are those patients who were unwilling to consent to participate in the experiment as an individual. Those with malignant hyperthermia were excluded from the study as they could not receive volatile inhalational anesthetics. Patients who required additional narcotic for pain during surgery were excused from participation. Those with chronic kidney disease or kidney failure were also not involved in the experiment as Sevoflurane, the experimental variable could lead to kidney complications. Participants who only were given inhalational anesthetic for painful stimulation during intravenous sedation were also excluded from participation in this study. It was important to determine which inhalational anesthetic was favored most by anesthesia providers at the Southwestern Pennsylvania hospital between Sevoflurane and Desflurane for general anesthesia cases lasting less than one hour. Surveys were sent out to all members of the anesthesia team as titled Survey 1 in Appendix D. Ethics/Professionalism Ethical considerations were regarded during the completion of the study from start to finish. All information gathered from a Southwestern Pennsylvania hospital was kept in confidence and destroyed at the finish of the study by professional paper shredding services. Participant names, ages, race, nationality, and medical histories were not gathered from the hospital and were blinded from the investigator, owing to complete confidence of all those who participated during a twelve month interval. Results Results are pending until the quasi-experimental research study is completed. Discussion Volatile inhalational anesthetics account for twenty percent of pharmacy costs in the anesthesia department.10,16 By using a pharmacoeconomic model, it can be seen that careful choice of anesthetic for patients can represent a large cost containment for the anesthesia department in the hospital, without compromising patient care. All patients need to be considered a new case and may not fit into the pharmacoeconomic model because of family histories (e.g. malignant hyperthermia). However, when possible, using Sevoflurane for the choice inhalation anesthetic for general surgery cases rather than Desflurane for those lasting less than one hour can result in large cost savings for the anesthesia department. Over twenty thousand dollars could be saved if the Southwestern Pennsylvania hospital would utilize Sevoflurane over Desflurane for two-thirds of their total surgeries requiring general anesthesia for less than one hour. It is important to mention that as a professional anesthesia student, FGF commonly observed with Sevoflurane are 2 LPM and FGF with Desflurane commonly observed are 2 LPM. The nephrogenicity associated with Sevoflurane is not commonly observed when this amount of FGFs are used.7 With the use of 1 LPM FGF when using Desflurane, as there is no minimum FGF required to avoid physiological aberrance, 17,19 there is also a great cost savings maintained for the anesthesia department. Limitations There are limitations in any study when research is conducted and from this study, results are limited to a single institution and this limits its external validity as a result. Randomization was not included in this research study as a convenience sample population was used at one hospital location. The study was not extremely descriptive as patients with higher PS scores were not studied in this particular research project. This study is also missing research on older age groups, as participants age twenty to forty were included only. As all of these limitations can be seen in the experimental study, the results from this research study cannot be imposed on larger populations and therefore generalizability is poor. Future research can make these findings representable and provide for better generalization. Future Recommendations for Research In future research, randomization should be used when developing research as this will strengthen the results. Larger sample populations should be used in defined, smaller age variances to be able to impose the results on a specific group of patients. Defined surgeries should be used in sample populations to show stronger significance when looking at varied surgical procedures their results. With the inclusion of the above criteria, the research study would be experimental rather than quasi-experimental, and results could be superimposed onto given populations with much stronger data observance. Dissemination This research project will appear in the May, 2013 edition of Anesthesia and Analgesia in its entirety with all results included. There will also be one hour lectures provided on these research findings at the University of Pittsburgh at Greensburg, Robert Morris University, and St. Vincent College, times and final adjusted locations are to be announced via bulletins, which be hung in the cafeterias of each of these locations. Conclusion Inhalational anesthetics represent a significant cost for pharmaceutical costs in the anesthesia department. It is important for professional anesthesia providers to deliver cost-effective, safe anesthesia care to patients in surgery. When analyzing surgical procedures requiring general anesthesia for less than one hour, the use of Sevoflurane rather than Desflurane as the choice inhalation anesthetic in surgery can provide the anesthesia department an avenue of cost savings without compromising patient care. When Desflurane must be used for patients who cannot be administered Sevoflurane, it is important to keep in mind there is no recommendation for FGF rates, and cost savings can also be preserved by utilizing low FGFs when using Desflurane. References Weinberg L, Story D, Nam J, McNicol L. (2010). Pharmacoeconomics of volatile inhalational anaesthetic agents: an 11-year retrospective analysis. Anaesthesia and Intensive Care, 38(5), 849-854. Lockwood GC White DC (2001). Measuring the costs of inhaled anesthetics. British Journal of Anesthesia, 87(4), 559-563. Odin I, Feiss P. (2005). Low flow and economics of inhalational anaesthesia. Best Practice Research Clinical Anaesthesiology, 19(3), 399-413. Strum EM, Szenohradszki J, Kaufman W, Anthone GJ, Manz IL, Lumb PD (2004). Emergence and Recovery Characteristics of Desflurane Versus Sevoflurane in Morbidly Obese Adult Surgical Patients: A Prospective, Randomized Study. Anesthesia and Analgesia, 99, 1848-1853. Boldt J, Suttner S. (2000). Low-Flow Anesthesia: Does it have Potential Pharmacoeconomic Consequences? Pharmacoeconomics, 17(6), 585-590. Golembiewski J. (2010). Economic Considerations In the Use of Inhaled Anesthetic Agents. American Journal of Health-System Pharmacy, 67(4), 9-12. Meyer T. (2010). Managing inhaled anesthesia: Challenges from a health-system pharmacists perspective. American Journal of Health-System Pharmacy, 67(4), 4-8. Boldt J, Juan N, Kumle B, Heck M, Mund K. (1998). Economic Considerations of the Use of New Anesthetics: A comparison of Propofol, Sevoflurane, Desflurane, and Isoflurane. Anesthesia and Analgesia, 86, 504-509. Agoliati A, Dexter F, Lok J, et al. (2010). Meta-Analysis of Average and Variability of Time to Extubation Comparing Isoflurane with Desflurane or Isoflurane with Sevoflurane. Anesthesia and Analgesia, 110(5), 1433-1439. Dolk A, Cannerfelt R, Anderson RE, Jakobsson JP. (2002). Inhalation anesthesia is cost-effective for ambulatory surgery: a clinical comparison with propofol during elective knee arthroscopy. European Journal of Anesthesiology, 19(2), 88-92. Chernin EL (2004). Pharmacoeconomics of inhaled anesthetic agents: Considerations for the pharmacist. American Journal of Health-System Pharmacy, 61(4), 18-22. Beaussier M, Deriaz H, Abdelahim Z. (1998). Comparative effects of desflurane and isoflurane on recovery after long lasting anaesthesia. Canadian Journal of Anaesthesia, 45(5), 429-434. White PF. (2010). Facilitating Recovery from Anesthesia: Assessing the Costs and Benefits of Anesthetic Drugs. Anesthesia and Analgesia, 110(2), 273-275. Gupta A, Stierer T, Zuckerman R, Sakima N, Parker S, Fleisher LA (2004). Comparison of Recovery Profile After Ambulatory Anesthesia with Propofol, Isoflurane, Sevoflurane and Desflurane: A Systematic Review. Anesthesia and Analgesia, 98, 632-641. Traynor K. (2009). Inhaled anesthetics present cost-saving opportunity. American Journal of Health-System Pharmacy, 66(7), 606-607. Kapur P. (1994). Pharmacy Acquisition Costs: Responsible Choices Versus Overutilization of Costly Pharmaceuticals. Anesthesia and Analgesia, 78, 617-618. Dexter F, Bayman EO, Epstein RH (2010). Statistical Modeling of Average and Variability of Time to Extubation for Meta-Analysis Comparing Desflurane to Sevoflurane. Anesthesia and Analgesia, 110(2), 570-580. Southwestern Pennsylvania Hospital. (2012). Annual Anesthesia Data Tracking Information. Accessed 08/30/2012 with Permission from Corporate Department. Southwestern Pennsylvania Hospital. (2012). Pharmacy Records. Accessed 08/30/2012 with Permission from Corporate Department. Appendix A Table 1: Cost of Inhalational Anesthetic per a Southwestern Pennsylvania Hospital Pharmacy Records Inhalational Anesthetic Cost Per Bottle ($) Total Volume in Bottle (mL) Cost per mL of Liquid ($) Sevoflurane (Ultane) 100.82 250 0.40 Isoflurane (Forane) 9.73 100 0.09 Desflurane (Suprane) 136.37 240 0.56 Reference 19. Table 3: Calculated MAC Hour Inhalation Anesthetic Cost at a Southwestern Pennsylvania Hospital FGF Rate (L/Min) Isoflurane ($) Desflurane ($) Sevoflurane ($) 1 0.31 9.68 2.71 2 0.62 19.36 5.43 3 0.93 29.04 8.14 All estimated costs are based on duration of 60 minutes and the formula proposed by Golembiewski. Isoflurane calculations are based on concentration of 1.15%, MW of 184g, cost per mL=$0.09 and D of 1.49 g/mL Desflurane calculations are based on concentration of 6%, MW of 168g, cost per mL=$0.56, and D of 1.45g/mL Sevoflurane calculations are based on concentration of 2.0%, MW of 201g, cost per mL=$0.40, and D of 1.51g/mL Appendix B Chart 1: Total Anesthesia Cases in July, 2012: Time Intervals from a Southwestern Pennsylvania Hospital Reference 18. Table 2: Estimated Cost per MAC Hour ($) of Inhaled Anesthetic Gases: Based on FGF Rates FGF Rate (L/Min) Isoflurane ($) Desflurane ($) Sevoflurane ($) 1 0.5 12.9 6.0 2 1.0 25.9 12.1 3 1.5 38.8 18.1 All estimated costs are based on duration of 60 minutes and the formula proposed by Golembiewski. Isoflurane calculations are based on concentration of 1.15%, MW of 184g, cost per mL=$0.15 and D of 1.49 g/mL Desflurane calculations are based on concentration of 6%, MW of 168g, cost per mL=$0.96, and D of 1.45g/mL Sevoflurane calculations are based on concentration of 2.0%, MW of 201g, cost per mL=$0.90, and D of 1.51g/mL Reference 7. Appendix C Chart 2: Number of Bottles of Inhalational Anesthetic Used Annually at a Southwestern Pennsylvania Hospital Reference 19. Chart 3: Annual Expenditure on Inhalational Anesthetics at a Southwestern Pennsylvania Hospital

Lives of the Saints Essay -- Lives Saints Essays

Lives of the Saints   Ã‚  Ã‚  Ã‚  Ã‚  Lives of the Saints is a story that examines the complexities and tribulations of everyday life in a small town. Throughout the novel, we discover that even the most trustworthy and caring individuals live secret lives behind closed doors, and that the surface appearance of minor communities can be very deceptive. Some people spend their entire adult-lives trying to knock down these doors and discover the truth, but perhaps they are overlooking the key to the lock†¦ our children. Vittorio Innocente is a young boy who has not always lived up to his name. ‘My attendance at school had not been very regular-it had somehow fallen out that I’d spent much of class time wandering up to the top of Colle di Papa or down to the river with my friend Fabrizio, sharing with him the cigarettes he filched from his father. La Maestra had paid a visit to my mother one afternoon, to advise her of my truancy and vices†¦.’ (9). We find that Vitto is trying to turn around his poor school habits, and has been trying to read through a novel called Principi Matematici, but to no avail. As he sat stranded on page three of his mathematical conquest, he was overcome by a wealth of distractions. The golden sun was shining down on him that day, or so it seemed, for as he was drifting off to sleep the muffled shout of a man shattered what would appear to be his last enjoyable day; at least for a long time. Childhood can be a fragile thing. It is commonly believed that children see the world through different eyes. Everything seems fresh and interesting to them, where we become saturated with the details of our everyday lives. The eyes of Vittorio Innocente act as a safeguard, seemingly protecting him from truth and danger that he cannot see. Since the incident with the snake, Vittorio had noticed that his mother had been keeping to herself, working in the garden. However, he could not understand what was wrong with her, and could not figure out why the household seemed so empty. ‘†¦A veil seemed to have fallen between us, and for a while I had nursed this estrangement like a precious wound I could somehow turn to advantage; but the passing days brought only a growing awkwardness, as if my mother and I had suddenly become strangers, with no words now to bridge the silence between us’ (74). Vittorio’s ‘safety-goggles’ also help him when the gang of b oys inv... ...ctor to tell him of his mother’s pains, he is uninterested. â€Å"My mother wants you to come†, says the young boy. â€Å"Leave me alone†, replies the doctor in a drunken stupor. â€Å"You’re that woman’s son, aren’t you, the pregnant one who thinks she’s a princess† (221). When the doctor is finally convinced to check up on Cristina, he only makes matters worse. Upon his arrival in Vitto’s room, Cristina notices his condition and says: â€Å"You smell-like a liquor factory† (225). He takes no notice of these remarks, showing no concern for the life of the baby or Cristi. Although he manages to deliver the baby, we find that Vittorio’s mother has died during the night due to excessive bleeding. Dr. Cosabene’s ignorance has brought death and pain to a family that has been reduced to two, a young boy and his little sister.   Ã‚  Ã‚  Ã‚  Ã‚  Vitto will no longer have a normal life. He has no mother or father. He has no money, and he has nowhere to live. Consequently, he has a newborn child to look after. Where has his childhood gone? It looks as though the doctor has taken it from him, and he will never get it back. One thing remains certain†¦ Vittorio Innocente will never look through the eyes of a child again. Lives of the Saints Essay -- Lives Saints Essays Lives of the Saints   Ã‚  Ã‚  Ã‚  Ã‚  Lives of the Saints is a story that examines the complexities and tribulations of everyday life in a small town. Throughout the novel, we discover that even the most trustworthy and caring individuals live secret lives behind closed doors, and that the surface appearance of minor communities can be very deceptive. Some people spend their entire adult-lives trying to knock down these doors and discover the truth, but perhaps they are overlooking the key to the lock†¦ our children. Vittorio Innocente is a young boy who has not always lived up to his name. ‘My attendance at school had not been very regular-it had somehow fallen out that I’d spent much of class time wandering up to the top of Colle di Papa or down to the river with my friend Fabrizio, sharing with him the cigarettes he filched from his father. La Maestra had paid a visit to my mother one afternoon, to advise her of my truancy and vices†¦.’ (9). We find that Vitto is trying to turn around his poor school habits, and has been trying to read through a novel called Principi Matematici, but to no avail. As he sat stranded on page three of his mathematical conquest, he was overcome by a wealth of distractions. The golden sun was shining down on him that day, or so it seemed, for as he was drifting off to sleep the muffled shout of a man shattered what would appear to be his last enjoyable day; at least for a long time. Childhood can be a fragile thing. It is commonly believed that children see the world through different eyes. Everything seems fresh and interesting to them, where we become saturated with the details of our everyday lives. The eyes of Vittorio Innocente act as a safeguard, seemingly protecting him from truth and danger that he cannot see. Since the incident with the snake, Vittorio had noticed that his mother had been keeping to herself, working in the garden. However, he could not understand what was wrong with her, and could not figure out why the household seemed so empty. ‘†¦A veil seemed to have fallen between us, and for a while I had nursed this estrangement like a precious wound I could somehow turn to advantage; but the passing days brought only a growing awkwardness, as if my mother and I had suddenly become strangers, with no words now to bridge the silence between us’ (74). Vittorio’s ‘safety-goggles’ also help him when the gang of b oys inv... ...ctor to tell him of his mother’s pains, he is uninterested. â€Å"My mother wants you to come†, says the young boy. â€Å"Leave me alone†, replies the doctor in a drunken stupor. â€Å"You’re that woman’s son, aren’t you, the pregnant one who thinks she’s a princess† (221). When the doctor is finally convinced to check up on Cristina, he only makes matters worse. Upon his arrival in Vitto’s room, Cristina notices his condition and says: â€Å"You smell-like a liquor factory† (225). He takes no notice of these remarks, showing no concern for the life of the baby or Cristi. Although he manages to deliver the baby, we find that Vittorio’s mother has died during the night due to excessive bleeding. Dr. Cosabene’s ignorance has brought death and pain to a family that has been reduced to two, a young boy and his little sister.   Ã‚  Ã‚  Ã‚  Ã‚  Vitto will no longer have a normal life. He has no mother or father. He has no money, and he has nowhere to live. Consequently, he has a newborn child to look after. Where has his childhood gone? It looks as though the doctor has taken it from him, and he will never get it back. One thing remains certain†¦ Vittorio Innocente will never look through the eyes of a child again.