Tuesday, January 21, 2020
The Secret Diary of Lady Macbeth After receiving a letter from Macbeth Earlier today, I received a most urgent letter from Macbeth. He told me that he was accosted by three witches on the night of the battle between Scotland and Norway. They greeted him "All hail Macbeth, hail to thee, Thane of Glamis! All hail Macbeth, hail to thee, Thane of Cawdor! All hail Macbeth, that shalt be King hereafter!" Macbeth was "rapt" with what the witches had said and tried to question them further but they vanished into a haze of fog. I could see his enthusiasm from his vocabulary and could tell that he believed the witches, even though they are feared and many hundreds have been burned. He said he "burned in desire" to question them further, indicating that he was almost on fire with this knowledge that came from the "perfect'st report". Witches have metaphysical powers and "more in them than mortal knowledge". Later that day Macbeth received a message from the King saying he was to become Thane of Cawdor. He called me his "dearest partner of greatness" and plans to share the glory of the golden round with me. He sent the letter by messenger despite the danger of the contents being read by others, when it could have waited until he arrived here. Having seen Macbeth's enthusiasm, I will take my cue from him. His letters have "transported me beyond this ignorant present". I nearly told a messenger who brought news of the King coming to stay, of my thoughts and for one moment, I reacted as though Macbeth were already King, and I Queen, I must be more careful in the future. I have made the decision that Macbeth will be King, the only problem being that he is "too full of the milk of human kindness" and does not have it in him to do the unthinkable deed, at heart Macbeth is a giver and not a destroyer. I see my role as Macbeth's strengthener. I wish that I could persuade him to "catch the nearest way". To this end, I asked the evil spirits to take my womanly qualities away. I asked them to take my milk and replace it with gall. I am asking to become a poisoner instead of a nourisher. I asked for unnatural darkness so that heaven will not see and cry: "Hold, hold!" No one must see the murder, as killing the King is an unthinkable act; it is just like killing God.
Monday, January 13, 2020
Terrorism, in any form, is frowned upon by many people. However, when it is related to taking care of our environment, it could be quite controversial because environmentalism is embraced across all political spectrums. Like the right wing or left wing extremists, violent ecologists and animal rights advocates have caused some scare among people in the United States. This called ecoterrorism and some of these groups often destroy properties that they perceive beneficial to the environment and animals. As Laquer (1999) informed, the word ecoterrorism has been coined to name violent environmentalists (also called Ã¢â¬Å"greensÃ¢â¬ and other names) that push their ideologies and beliefs to the extreme. Their complaints are as just as those of Christians, Muslims, Jews, Socialists, Anarchists, and indeed most other ideologies and religions of our time, who cannot possibly be made responsible for the actions of the extremists within their ranks. However, in all these value systems, there are beliefs that, if carried to an extreme, may provide inspiration for acts of violence (p. 99). William Dyson (2000), a retired FBI agent who spent nearly 30 years working on domestic terrorism, says it is necessary to look at the way police officers classify crimes and the economic impact of violent ecological extremism to understand the full scope of ecoterrorism. Dyson contends most of the crimes are reported as localized vandalism. The significance of the total destruction is missed. Dyson says when the total economic impact of ecoterrorism is calculated, it demonstrates that the United States has been victimized by a long term terrorist campaign. In fact, in the testimony of FBI Director Louis Freeh (10 May 2001) about the terrorist threats in the United States, he classified ecoterrorism as Ã¢â¬Å"special interest terrorismÃ¢â¬ . He reasoned out that this is different Ã¢â¬Å"from traditional right-wing and left-wing terrorism in that extremist special interest groups seek to resolve specific issues, rather than effect more widespread political change. Special interest extremists continue to conduct acts of politically motivated violence to force segments of society, including, the general public, to change attitudes about issues considered important to their causesÃ¢â¬ . These Ã¢â¬Å"special interestÃ¢â¬ terrorist groups could support their belief in Ã¢â¬Å"extreme fringes of animal rights, pro-life, environmental, anti-nuclear, and other political and social movementsÃ¢â¬ . Moreover, these groups can belong animal rights and environmental movements and Ã¢â¬Å"they have turned increasingly toward vandalism and terrorist activity in attempts to further their causesÃ¢â¬ . Bryan Denson and James Long (1999) have conducted a detailed study of ecological violence. They found that damage from ecoterrorism have already reached millions of dollars. They conducted a 10-month review and considered crime only in excess of $50,000. Cases that could not be linked to environmental groups were eliminated. They found 100 cases with very few successful law enforcement investigations. According to Denson and Long (1999), most violence has taken place in the American West. From 1995 to 1999, damages totaled $28. 8 million. Crimes included raids against farms; destruction of animal research laboratories at the University of California in Davis and Michigan State University, threats to individuals, sabotage against industrial equipment and even arson. History of Ecoterrorism in the United States The history of radical ecoterrorism goes back to 1980 when a group of five militants belonging to mainstream organizations such as the Sierra Club and Friends of the Earth decided, at the end of a hike, that far more drastic action was needed in view of the imminent destruction of nature, or what remained of it. To them it seemed pointless to work within the system, and thus Earth First was born (Laquer, 1999). Many Earth First activists argue that ecotage (ecologic sabotage) Ã¢â¬Å"can actually prevent destructive activity underwayÃ¢â¬âdriving the worst Earth destroyers right out of businessÃ¢â¬â erasing their profits by slowing their work and destroying their toolsÃ¢â¬ (Taylor 1991, p. 263). Despite the fact that ecoterrorism in the US sparked in the 1980s,, two of the most influential books for ecoterrorists were published in the 1970s. These books are Robert TownsendÃ¢â¬â¢s Ecotage (1972) and Edward AbbeyÃ¢â¬â¢s The Monkey Wrench Gang (1975). Edward AbbeyÃ¢â¬â¢s novel told the story of a group of ecologists who were fed up with industrial development in the West. Abbey is an environmental activist and not a hate-filled ideologue like William Pierce. His novel is a fictional account that has inspired others. In The Monkey Wrench Gang, the heroes drive through the Western states sabotaging bulldozers, burning billboards, and damaging the property of people they deem to be destroying the environment. Incidentally, this is the same type of low-level terrorism German leftists used in the mid-1990s. ) The term Ã¢â¬Å"monkey wrenchingÃ¢â¬ has since became synonymous to ecoterrorism. Laquer (1999) thought that environment radicalism in the United States might have been connected with general political developments. The Carter administration in the 1970s initially was thought to sympathize with the aims of the ecologists, but these hopes proved false. The government neglected more forests to be put at the disposal of the timber industry. Environmentalists reacted in anger, which only increased as more deregulation occurred under President Reagan in the 1980s. The language of the radicals became more violent, as did the character of their actions. As one of the more radical thinkers maintained, the salvation of the earth required an end to civilization and to the vast majority of mankind. They saw human beings as no more important than any other member of the biological community, and with no more rights than animalsÃ¢â¬âor, indeed, than inanimate objects such as forests, rivers, and mountains. Seen in this light, they felt it had been wrong for modern medicine to combat infectious diseases, for bacteria and viruses also had rightsÃ¢â¬âas one of the ecological thinkers put it, eradicating smallpox had been immoral inasmuch as it had been an unwarranted interference with the balance of the ecosystem. Ecoterrorist Groups in the United States In the United States, the most prominent ecoterrorist groups are the Earth Liberation Front (ELF), Earth First, and the Justice Department are interested in environmental preservation. The Animal Liberation Front (ALF), Animal Rights Militia, Band of Mercy, and Paint Panthers champion animal rights. However, it is the violent groups like the ELF and ALF that advocate and engage in economic damage. The rhetorical groups, such as the Church of Euthanasia, simply border on the bizarre, advocating suicide, sodomy, and cannibalism to voluntarily eliminate the earthÃ¢â¬â¢s human population (White, 2003). In fact, FBI now ranks both ALF and ELF as the leading domestic terrorism groups that threaten United States, surpassing the Timothy McVeigh-style militia extremists who dominated the terrorism scene during much of the 1990s. James Jarboe, FBI domestic-terrorism section chief said that they estimated that the ALF/ ELF have committed more than 600 criminal acts in the United States since 1996, resulting in damages in excess of $43 million. Worse, the threat is growing because animal and environmental activists are turning increasingly toward vandalism and terrorism to further their causes (Richardson, 2002). According to Atkins (2004), ELF was originally formed by the dissident members of Earth First! in Great Britain in the early 1990s, an American version started operation in 1996 and allied with the Animal Liberation Front (ALF). The group took aim at targets it perceived as causing or promoting harm to the environment, from biotechnology research laboratories to automobile dealerships. In the US, they first made the national news with the arson of five buildings and four ski lifts in Vail, Colorado, on October 17, 1998. Environmentalists had been fighting the Vail Resorts over an area that was wintering grounds for elk and a habitat for the endangered lynx. Since 1997 the Southern Poverty Law Center has attributed ELF with dozens of terrorist attacks and $30 million in damages (p. 91). The Federal Bureau of Investigation (FBI) said the group had claimed credit for bombings and arson that had caused some $40 million in damage since the mid-1990s, when the group began its campaign in North America. Although no one had been injured in any of the bombings and fires, the FBI considered the ELF one of the most dangerous organizations in the country. Among the acts of vandalism and arson that the group had claimed responsibility for in 2001 were: Ã¢â¬ ¢ An August 21 vandalism attack on a Long Island, New York cancer research laboratory. Ã¢â¬ ¢ Coordinated June 12 vandalism attacks on five Bank of New York branches in Suffolk County, New York. Ã¢â¬ ¢ A June 10 vandalism attack on the University of IdahoÃ¢â¬â¢s biotechnology building. Ã¢â¬ ¢ A June 1 fire in Eagle Creek, Oregon, near a timber sale site in a federal forest. Two separate May 21 arson attacks, the first at a poplar tree farm in Clatskanie, Oregon, the second at the Center for Urban Horticulture at the University of Washington in Seattle. Ã¢â¬ ¢ A March 30 fire at an auto dealership in Eugene. Ã¢â¬ ¢ A January 2 fire at the offices of a lumber company in Glendale, Oregon (Ã¢â¬Å"Law Catches Up to,Ã¢â¬ 2002, p. A01). Because of ELFÃ¢â¬â¢s decentralized structure, this allowed separate cells to act independently of each other and its reliance on the Internet computer network to communicate, made it difficult to capture culprits. Typically, the group would claim responsibility for an act through its press office in Portland, Oregon Despite probes of the press office and the people who ran it, authorities had made little progress in seizing members guilty of sabotage. Knickerbocker (2005) presented salient proof that ELF has Ã¢â¬Å"guidelinesÃ¢â¬ that prove their ecoterroristic activities. These include taking Ã¢â¬Å"all necessary precautions against harming any animal, human and non-human. Ã¢â¬ But they also include a call to Ã¢â¬Å"inflict economic damage on those profiting from the destruction and exploitation of the natural environment. An ELF Ã¢â¬Å"communiqueÃ¢â¬ taking responsibility for a 2002 firebombing of a US Forest Service research station in Pennsylvania declared: Ã¢â¬Å"While innocent life will never be harmed in any action we undertake, where it is necessary, we will no longer hesitate to pick up the gun to implement justice, and provide the needed protection for our planet that decades of legal battles, pleading, protest, and economic sabotage have failed Ã¢â¬ ¦ to achieve. Ã¢â¬ Moreover, the groupÃ¢â¬â¢s website includes a 37-page how-to manual titled Ã¢â¬Å"Setting Fires With Electrical Timers. Ã¢â¬ As a cousin of ELF, the Animal Liberation Front (ALF) has been described as the most militant of the American animal rights groups. It has its roots in Great Britain where a small body of activists, the Hunt Saboteurs, opposed hunting and hunters by resorting to disruptive tactics. Two activists, Ronald Lee and Clifford Goodman, decided in 1972 to resurrect a nineteenth-century antivivisection group, the Band of Mercy. After a series of anti-hunting incidents, this group changed its tactics to direct action on animal rights issues and renamed itself the Animal Liberation Front. When the group used violence against animal research facilities, furriers, and farming, Scotland Yard classified the ALF as a terrorist organization. The ALF is organized into two segmentsÃ¢â¬âa public organization for publicity, fund-raising, and propaganda, and a covert wing of tightly organized cells of activists willing to carry out attacks on property and rescue animals. The British group has around 2,500 active members, but only about 50 members are radical enough to carry out violent attacks. Because of the success of the British ALF operations, American animal rights supporters formed a branch in the United States (Atkins, 2004, p. 0). According to ALFÃ¢â¬â¢s website, animal rights criminals have a system to publicize their activities. Like all terrorists, ecoterrorists try to create an aura of power through publicity. ALF takes it further, using the Web site as a training device. For example, tactics for raiding mink farms are given in great detail. Utilizing a four-part series, an ALF member tells readers the methods for establishing and operating a cell, procedures for obtaining funds, and directions for planning and carrying out operations. However, like all extremists, their positions are full of contradictions and virtual absurdities. For example, the Web site for the Ã¢â¬Å"we-use-no-animal-productsÃ¢â¬ ALF tells people to use leather gloves when raiding a mink farm. It also compares people who eat meat with Nazis and describes farms as concentration camps. Apparently, ALF members are unaware that Adolf Hitler was a vegetarian. Atkins (2004) reported the firebombing of the unfinished Animal Diagnostic Laboratory at the University of California at Davis on April 16, 1987, which resulted in 4. million in damages, was the most destructive operation of ALF. Representatives of the ALF never claimed responsibility for this act, but police officials have been able to uncover evidence of its involvement. Despite numerous violent operations, only two individuals, Roger Thoen and Virginia Bollinger, have been arrested and convicted for activities involving the ALF. Conclusion Ecoterrorists are uncompromising, illogical extremists just like their right-wing counterparts. A review of their ideological literature shows they use ecology as a surrogate religion (White, 2000). While not one action of ELF or ALF so far comes close to the magnitude of the attacks on the World Trade Center, the government should not ignore the threats posed by these groups. With few arrests or prosecutions have followed from the violent actions of environmentalists or animal-rights advocates, these groups may become more violent and bolder in the future. Thus, it is recommended that the US government should monitor the activities of these ecoterrorist groups and apply harsher sanctions for offenders.
Saturday, January 4, 2020
Target market/customer profile: individual or business, retail or wholesale, demographic, psychographic, geographic, socio-economic characteristics, size or needs met. The company is going to be a family own business until we see profits and have the income to expand. Once we have the income we can start to look to retail or. Wholesale. The product that we will be selling will be marketed to everywhere in the United States and world wide in the future. It doesnÃ¢â¬â¢t matter were you live you will always see someone riding his or her bike. Like I mention before everyone is attracted to motorcycles and cherish their life. The motorcycle companies are very good at coming out with new models that intrigue every type of personality no matter howÃ¢â¬ ¦show more contentÃ¢â¬ ¦People race motorcycles for a living and make a lot of money and they need the best protective equipment that money can buy to push their limits and be able to get up and do it again. One of the biggest concerns with people that want to buy a bike is their safety. They might be OK with it, but their family members might see it as a killing machine, which if used improperly it can be. ThatÃ¢â¬â¢s were we come in and give them customer or their relatives the warm feeling that if they purchase our product that they will have a greater change of coming back if in an accident. Market analysis: total market size and the share you will capture, seasonality, unique aspects There are about 200 million motorcyclist from young to late adulthood in the world and I would to provide my safety equipment to all of them. I know this will be impossible at the beginning but with dedication and the expansion of the company we can get near that number. My main focus is going to be the United States because the company will be located in California. Once out name starts to travel around from advertising and costumer to new customers I can focus on expanding to the worldwide level. Right now no one has the idea to include a small compact parachute in conjunction with full body airbag to reduce in jury to motorcyclist. By being the first and selling quality we
Friday, December 27, 2019
Burger King is one of the most successful fast food restaurants in the world. Burger King has been very effective in applying their strategic vision and mission statement to build their brand. The leadership team has positioned Burger King for a path of continued domestic and international growth, because of a strong brand recognition and quality products. Burger King uses two generic strategies to deal with competition, they are differentiation and cost leadership. Cost leadership within Burger King is essential to minimize costs. This allows Burger King to control margins and operating costs. For Burger King to offer such competitive prices, they have to reduce operating costs, but at the same time they need to provide a quality product that the customers want. Burger King also uses a differentiation strategy. A good example would be the way they grill their products and the specific techniques they use for products such as the Ã¢â¬Å"WhopperÃ¢â¬ . The marketing teams has also fo rmed slogans such as Ã¢â¬Å"Have It Your WayÃ¢â¬ and the most current slogan Ã¢â¬Å"Be Your WayÃ¢â¬ . These slogans attempt to form a differentiation pattern in the consumerÃ¢â¬â¢s minds. These marketing slogans are also used to attract new customers especially in the competitive market such as the fast food market. These techniques have allowed Burger King to reach out to new and current customers. Burger King uses a pricing strategy that is based off of their successful cost leadership techniques. This is a vital component toShow MoreRelatedBurger King s Brand Identity Essay1398 Words Ã |Ã 6 Pagesexperience with the brand. Brand Identity Burger KingÃ¢â¬â¢s brand identity relies heavily on their signature menu item the Whopper and the brandÃ¢â¬â¢s relation to the fast food giant McDonaldÃ¢â¬â¢s. According to Burger King, Ã¢â¬Å"more than 11 million guests visit BURGER KINGÃ ® restaurants around the world. And they do so because our restaurants are known for serving high-quality, great-tasting, and affordable food. Founded in 1954, BURGER KINGÃ ® is the second largest fast food hamburger chain in the world. The originalRead MoreThe Fast Food Industry Is A Multi Billion Dollar Industry1286 Words Ã |Ã 6 Pages` The fast-food industry is a multi-billion dollar industry that has generated about 200 billion U.S. dollars just in 2013 alone. This industry employs approximately four million people across the country with 83% of U.S. consumers dining at fast-food restaurants at least once a week. The word Ã¢â¬Å"fast-foodÃ¢â¬ made its addition to the Merriam-Webster dictionary during the early 1950Ã¢â¬â¢s. 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The Burger King corporation main focus is on the customers they serve and the strategies they use to continue the growth and development of their company. Burger King uses the integrated cost leadership/Differentiation business strategy. Strategies in business are instrumental for the continued growth and expansion of a company. A strategy is a set of analytic techniques that are used to influence the direction of the firm s growth in the marketplaceRead MoreDevelop Good Business Sense981 Words Ã |Ã 4 PagesDeveloping Good Business Sense Brandon M. Tate BUS/210 February 27, 2011 Gabriel Perkins Developing Good Business Sense I have chosen to compare three different fast-food restaurants for this project; StogeyÃ¢â¬â¢s, McDonaldÃ¢â¬â¢s and Burger King. I will discuss the differences in the input, operations and output stages of these companies. I will explore the various components of the OMM costs these companies have and how they affect their OMM operations. I will also discuss how companiesRead MoreCase Analysis Burger King1538 Words Ã |Ã 7 Pages Presented BY: Walid ElKateb Burger king is the second largest fast food hamburger chain in the world with more than 12,174 restaurants across 76 countries 60% of which are located in the US amp; 90% of its restaurants are franchised. By looking at the industry, we can see that Burger king is operating within the fast food hamburger (FFHR) category of the quick service restaurant in the restaurant industry. Sales for the FFHR has been growing rapidly (with a totalRead MoreBurger King International1296 Words Ã |Ã 6 PagesBurger King International MBA 6601 International Business By Wendy B. Machana Burger King International Burger King, previously known as InstaBurger King in 1954, is the worldÃ¢â¬â¢s largest flame-broiled fast food restaurant chain (Daniels, Radebaugh Sullivan, 2011). Burger Kings core competency lays in the way it cooks its burgers- by its flame broiled method as opposed to grills that fry and also the option that it offers its customers as to how they want their burgers (Ã¢â¬Å"haveRead MoreEssay about Organizational Structure- Mgt/2301127 Words Ã |Ã 5 Pagesthe organizational structures of McDonalds, Burger King, and WendyÃ¢â¬â¢s food restaurants. It will examine the comparison and contrast of the organizational structure of McDonalds with Burger King, and WendyÃ¢â¬â¢s Corporations. What functions influence McDonalds, and explains how the organizational design helps determine the structure that best suits McDonalds needs, as a business. Organizational Structure Burgers are one of the most favored junk foods people like to eat from around the world. What
Thursday, December 19, 2019
Rejecting Gender Roles in Antigone Human nature dictates that conformity is a safer choice than expressing individuality. When placed in a situation where one must either remain silent or speak their mind and face severe consequences, there is much less risk in taking the first option. Sophocles, an Athenian tragedian from the fifth century BC, confronted this theme throughout one of his most popular works: Antigone. In the play, the title character must decide if she should honor her brother and die, rather than saying nothing and leaving his dead body unburied outside the city walls. In the present day, most Americans donÃ¢â¬â¢t experience such extreme circumstances, but this battle between conformity and individuality directly reflects theÃ¢â¬ ¦show more contentÃ¢â¬ ¦Women rarely received inheritances or owned property themselves (Ã¢â¬Å"Greek AttitudesÃ¢â¬ ). Homeric women, like Penelope from The Odyssey, and Andromache from The Iliad, exemplify the expectations of wives at this time. While their main role was to produce and raise heirs, they also wove clothing and watched over their servants (Fantham 33). In the absence of PenelopeÃ¢â¬â¢s husband, Odysseus, her main objective is protecting the house and her name by rejecting suitors who, thinking Odysseus has died in battle, try to marry her (Fantham 33). PenelopeÃ¢â¬â¢s role in the household is similar to the role of women in Greece around the time in which Antigone takes place. Ismene, while loyal to her sister, still conforms to the expectation that she must abide by the laws and comply with the ones who have the power. Compared to Ismene, Antigone is a complete individualist. Her devotion to her religion and ultimately, her own morals, is what drives her to break the law without shame. After Ismene chooses not to help Antigone bury Polynices, Antigone replies, Ã¢â¬Å"IÃ¢â¬â¢ll bury him myself. And even if I die in the act, that death will be a gloryÃ¢â¬ (Sophocles 85-86). AntigoneÃ¢â¬â¢s behavior directly contradicts t he role of women at the time, as most kept to their role as a wife and mother, rarely leaving the house or challenging male authority (Ã¢â¬Å"Women in GreeceÃ¢â¬ ). Similar to how Ismene conforms to the female gender roles of Ancient Greece, Creon conforms to every quality of the ideal
Wednesday, December 11, 2019
In other words, the ERÃ¢â¬â¢s primary target group of patients is those with a sudden and unexpected need for medical services and attentions at any given time. In general, the ER must be able to provide initial diagnosis and treatment for a broad range of illnesses and injuries, some of which are more crucial than others and may require greater and immediate care. Hence, ER patients can be generally classified into two categories, which we define to be Ã¢â¬ËlightÃ¢â¬â¢ patients and Ã¢â¬ËemergencyÃ¢â¬â¢ patients. There is the issue that emergency patients should be placed under a greater priority to medical services and attention as compared to ordinary patients, who are less severely injured or ill. Given that patient arrivals follow a Poisson distribution (randomly), in order to cater to irregular service demand, the ER generally operates 24 hours around the clock comprising of both day-shift duties and night-shift duties, usually with a variable staffing level to mirror general patient volume. Therefore, due to the critical nature of the ERÃ¢â¬â¢s services whereby timeliness and efficiency are of utmost importance, there are various service protocols such as effective situational queuing models that the department must follow to fairly determine and allocate service priorities to each different patient to ensure that they receive the necessary timely medical attention. 2. 0 Problem Recognition The Revision of Emergency Duty Law 2. 1 Rationale for the revision of Emergency Duty Law In August 5th 2012, the Ministry of Health and Welfare had revised the Emergency Duty Law governing emergency rooms in the hospitals. Before the revision, the emergency room generally employed the help of residents. However, the main intent of the revision of the revision of the law is to ensure that every emergency room should have at least 1 specialist and 5 nurses on night duty. After the revision, on-duty residents now first assesses the patients, and if the patients are unable to be treated properly by the residents, they are subsequently assessed by the on-duty specialist, taking over what was usually the job of a senior resident before the law revision. It is a requirement that the names of the on-duty specialist must be posted publicly. In addition, it is also required that even the specialists who are not on night duty must assume duty if the on-duty resident requests for it (on-call). Potential suspension of license or penalty will be imposed under violation of this law. 2. 2 The Problem Two bottlenecks have been identified to appear after the emergency duty law revision. The first bottleneck appeared at the stage of assessment by duty residents because of the publicly posted name list of the on-duty specialist. Many light patients have a tendency to visit emergency room during the night because they donÃ¢â¬â¢t want to use their day hours. As previously mentioned, light patients require less urgent medical attention, so they are able to spend time to consider and be selective of the on-duty specialists when they go to the emergency room. This behavior reflects the patientsÃ¢â¬â¢ preference of choice of doctors. This resulted in an excess number of light patients seeking medical treatments on particular days, causing the first bottleneck. The second bottleneck is caused by a shortage of specialists. On-duty residents who take first examination may have a tendency to avoid difficult patients. Therefore, on-duty residents impute a heavier responsibility to on-duty specialists. Before the revision, there were three stages for treatment, but now, there are only two stages. In this case, night duty specialists who take second examinations will have to assess a large amount of patients. It is difficult to meet the required the number of duty specialists in small hospital. In Korea, most of the big main hospitals are located in the big city. In small cities or towns, there are only small hospitals. It is an issue that small hospitals often do not have enough on-duty specialists, so they have to close their emergency room. This results in the emergency patients who are in need of immediate medical attention from the small cities or towns seeking treatment from big city hospitals. This poses a critical problem whereby it takes a certain amount of precious time to shift to a big city hospital. In the case of very urgent emergency patients in small cities, it can be life threatening. 2. 3 Example In Ã¢â¬Ë Ã¢â¬â¢ which is very famous in Korea, they broadcasted an accident which was caused by the revision of the emergency duty law. Because of the new law, in Eusung in Kyong-buk, there was no emergency room. If there are emergency patients, they had to move to Andong or Sangju, which takes about 30 minutes to an hour. Evidently, Eusung covers a very large area, two times bigger than that of Seoul. In this traffic accident in Eusung, there was an old married couple that was severely hurt, but was unable to obtain medical treatment in Eusung, hence proceded to seek treatment in Andong. The journey to Andong took about 30 minutes itself, and after they finally arrived at emergency room, the woman had unfortunately passed away. 3. 0 Analysis for a Service Blueprint of ER When a patient first enters the ER, a triage is performed, whereby priorities for action in an emergency are determined. After the patient is categorized according to the seriousness of his or her illness or injury, he or she sees a doctor for the first time. Because it is mandatory for all patients to undergo registration for treatment, the patient goes to reception area and pays a fee for the medical examination. Then the patient goes through the necessary X-ray, CT, or blood tests for proper inspection. After the whole test inspection is finished, an on-duty resident in charge of diagnosis in the ER diagnoses the patientÃ¢â¬â¢s case. Since the resident is a non-specialist doctor, he or she sometimes meets difficulty in accurate medical diagnosis. Before the revision of emergency duty law, the on-duty resident hands over the case to more experienced senior residents. When the patient is still unable to be adequately treated by the senior residents, the on-duty specialist then has a responsibility to treat the patient. However, as the revision of emergency duty law came into effect, the on-duty resident now hands over the case directly to an on-duty specialist. The on-duty specialist resolves the problem and promptly sends the patient to the nurses for allocation of a hospital room. The patient will then be hospitalized for a few days. After the emergency duty law revision, the on-duty specialist suffers an increased amount of workload because there is no involvement of senior residents in ER process. What is depicted is a condensed case of ER process. The chart below records the waiting time and lead-time of each ER process as well as net average of those processes. Process| Average Waiting Headcount| Average Waiting Time| Net Average Waiting Time| Net Average Lead Time| Triage| 0. 3| 6. 25| 3. 837| 5. 254| Exam| 1. 06| 8. 46| | | Reg/Pay| 4. 02| 14. 37| | | X-ray| 6. 13| 77. 07| | | CT| 0. 98| 31. 91| | | Blood test| 0. 87| 11. 69| | | Diagnosis| 5. 61| 32. 40| | | Cooperative treatment| 2. 26| 60. 11| | | Room allocation| 4. 19| 86. 82| | | Preparation for Hospitalization| 3. 29| 77. 01| | | Reference: (2010, ) 3. 1 Blueprint of ER- Before the Revision Figure I: Blueprint of ER- Before the Revision This is a blueprint of ER before the emergency duty law revision. As you can see in the case above, the maximum number of assessment stages a patient can go through is three. They are a series of assessments done by on-duty residents, senior residents and on-duty specialists. 3. 2 Blueprint of ER- After the Revision B B A A Patients come Assessed by duty residents Triage X-ray CT Blood check Assessed by duty specialist Being treated and prescribing medicine Go home or hospitalization Diagnosis assistance Diagnosis Procedure Untreatable Treatable Patients come Assessed by duty residents Triage X-ray CT Blood check Assessed by duty specialist Being treated and prescribing medicine Go home or hospitalization Diagnosis assistance Diagnosis Procedure Untreatable Treatable Figure II: Blueprint of ER- After the Revision This is a modified blueprint after the revision. Out of the three assessment stages, second assessment by senior residents was eliminated. When an on-duty resident is unable to treat his or her patients, the on-duty specialist in then directly in charge of the treatment. For that reason, the responsibility of a duty specialist is greatly increased in ER process. Postponement of his or her performance also means that the residual processes will be also delayed. 3. 3 Bottleneck Analysis As you can see on the blueprint, after the law revision, two bottlenecks had appeared. Under the revised law, the most remarkable transition of ER system is the elimination of the senior residentsÃ¢â¬â¢ examinations, which was a stage that had existed between that of the on-duty residents and specialists. Source: Healthcare Process Patterns with Triage in the Emergency Department (2009, KORMS) The first bottleneck spot is shown at point Ã¢â¬ËAÃ¢â¬â¢ on Ã¢â¬ËFigure II: Blueprint of ER- After the RevisionÃ¢â¬â¢. At this stage, many lightly injured/sick people are coming to the ER in the night. Even though these patients are lightly injured, on-duty residents have the duty to medically examine them no matter the varying degree of medical need. This is the first step of the ER rule. However, in comparison to the unrevised law, patients then could be sent to senior residents directly. However, there are now no senior residents on duty anymore under the revised law. Thus, duty residents have the responsibility to attend to all of patients that enter the ER at the same time. Moreover, the theory of FIFO (First In, First Out) is not applicable in the ER because different patients have varying degree of medical attention needs, whereby the emergency patients should be given priority treatment. This results in a more complex queuing situation whereby there can be no confirmed estimated queue time for that of light patients. The second bottleneck occurs at the on-duty specialistsÃ¢â¬â¢ medical examinations. This is also due to the elimination of senior residents. The bottleneck is shown as point Ã¢â¬ËBÃ¢â¬â¢ in Figure II. After the first examination, should the on-duty resident be unable to treat the patients, they are sent to the on-duty specialist under the revised law. It has been identified that the service quality can also pose a problem. Certain departments, such as obstetrics, often do not have enough specialists even during the day shifts. Because at least one specialist of each department should be on night duty, these departmental specialistsÃ¢â¬â¢ night shift duty are of higher frequency as compared to that of specialists of other bigger departments. In small institutions, there are less than 2 specialists, which suggests high difficulty in allocating night duty shifts. It results in crowding of patients whereby the service demand outweighs that of service supply. This scheduling problem also leads to low quality of medical examinations during both day shifts and night shifts. In addition, it was previously mentioned that on-duty residents have strong tendency to transfer the patients to on-duty specialists. This is because the on-duty residents are generally unwilling to assume full responsibility should diagnosis go wrong with patients should they do not seek assistance from the more experienced specialists on duty. What is worse is that it is very difficult for small hospitals to hire more specialists who are willing to take night duty shifts. . 0 Solution Since the new duty law on ER has changed the service operation model dramatically, we need to find out the queuing duration for the previous service operations, current service operations under the new duty law and a few of our further suggestions. It is straightforward to develop a queuing model based on the equations such as M/M/1 of M/M/S. However since the basic characteristic of ER d oesnÃ¢â¬â¢t allow usage of the theory FIFO (First In, First Out) because of varying degrees of patient need and priority, we cannot apply a basic equation queuing model. Instead, we would use a simulation model (Extend ver. 4) FIFO that has a priority consideration function. 4. 1 Past Service Operation (Before the Emergency Duty Law Revision) Suppose each patient arrives every 4 minutes. (360 person / day) Given that the patient arrival follows an exponential distribution. Patients are categorized into 5 categories. Category 1 refers to very urgent patients, and category 5 to very light patients. Probability of each category is shown on the left picture. On-duty residents and senior residents take 5 minutes to examine the patients. And on-duty specialists take 10 minutes to examine one. We assume that all the patients just go through the duty residents to the more experienced specialists. The reason for this assumption is that many of the Korean patients do want to seek further medical treatment from the on-duty residents to that from the on-duty specialists because residents are often perceived to be less experienced and capable in comparison to the senior residents and specialists. In addition, on-duty residents have strong tendency to transfer patients to senior residents to lessen responsibility and burden. Furthermore, we assume that only 20% of the patients are sent to on-duty specialists because there are many senior residents who are sufficiently skilled. In reality, most examination processes end with medical assessment and treatment from the senior residents. Overall result of this modeling is shown below. Y axis = number of served patients X axis = time (1440 minutes = 1 day) 4. 2 Current Service Operation (After the Emergency Duty Law Revision) After the revision of the night duty law, on-duty specialists must take the second examination. There is no role for the senior residents in the examination process. All the patients go through on-duty residents and specialist to exit. Every input data in the model is same as previous one. Overall result is shown below. We can see that number of served patients had decreased dramatically after the law revision. Also, the overall queue duration had becomes longer compared to the prior one. 4. 3 Solution 1- Increasing the Number of Servers To overcome the illustrated situation after the law revision, we simply double the number of on-duty specialists. The rest of the input data still remains unchanged. Evident from the results, as a result of doubling the specialists, the number of served patients has recovered up to that of first model. Also, queue duration and volatility have improved. 4. 4 Solution 2 Adopting CP (Clinical Pathway) Before explaining the model, let us explain what the Ã¢â¬ËCPÃ¢â¬â¢ is. The definition of CP is shown below. Ã¢â¬Å"Clinical pathways, also known as care pathways, critical pathways, integrated care pathways, or care maps, are one of the main tools used to manage the quality in healthcare concerning the standardization of care processes. It has been shown that their implementation reduces the variability in clinical practice and improves outcomes. Clinical pathways promote organized and efficient patient care based on evidence-based practice. Clinical pathways optimize outcomes in the acute care and home care settings. Ã¢â¬ (Source: Wikipedia) The table above is the example of CP for acute stroke. According to the research from Korean society of nursing science, examination time was reduced from average 74. 07 minutes to 19. 27 minutes. It is more than a 73% decrease. However, this figure is specific to the example of acute stroke, so we cannot be sure that other illnesses apply the same effect when adopting CP. Therefore, we adjust the examination time by only 20%. Now, duty residents and specialists only need 4 minutes and 8 minutes respectively. Previously, they needed 5 and 10 minutes each. The result is shown below. After adopting CP, the number of served patients was increased by 25%. Also, queue duration had dramatically reduced. 5. 0 Conclusion We had established that there were bottleneck problems because of the new law imposed in the ER. To handle this problem we suggested 2 possible solutions. The result of each situation is summarized in the table below. | Mean Number of Patients Being Served | Mean Maximum Queue Duration| Before Law Revision| 287| 68. 4| After Law Revision| 143| 76. 9| Doubling The Number of Specialists| 280| 68. 5| Adopting CP (reducing examination time by 20%)| 179| 21. 6| To generate the mean of each variable, we ran the simulation for 10 times each. There were clear improvements after implementing the solutions. Both the number of served patients and the maximum queue length had improved significantly. In terms of number of patients, doubling the specialists is the best way to enhance efficiency. However in reality, hiring more specialists is sometimes impossible for many hospitals. There is shortage of specialists as well as financial distress in hospital management. Therefore, adopting the solution of CP might be a better option. Although developing CP may need a lot of time and effort, once it is developed, it does not incur more costs. In addition, hospitals are able to co-operate with each other, so they can reduce initial cost for developing specific CP. Moreover, CP could bring greater impact than increasing the number of staffs in the long run. For example, as we mentioned above, the effect of CP for acute stroke is 73% decrease in examination time. To summarize, increasing the number of doctors is the simplest and most effective solution. Adopting the CP will be the second best solution. And the most desirable action to take is adopting CP and hiring more doctors at the same time. If it is not feasible, each hospital should consider its own situation and select its own appropriate solution.
Tuesday, December 3, 2019
Ode On A Grecian Urn Ode on a Grecian Urn Summary In the first stanza, the speaker, standing before an ancient Grecian urn, addresses the urn, preoccupied with its depiction of pictures frozen in time. It is the still unravish'd bride of quietness, the foster-child of silence and slow time. He also describes the urn as a historian, which can tell a story. He wonders about the figures on the side of the urn, and asks what legend they depict, and where they are from. He looks at a picture that seems to depict a group of men pursuing a group of women, and wonders what their story could be: What mad pursuit? What struggle to escape? / What pipes and timbrels? What wild ecstasy? In the second stanza, the speaker looks at another picture on the urn, this time of a young man playing a pipe, lying with his lover beneath a glade of trees. The speaker says that the piper's unheard melody's are sweeter than mortal melodies, because they are unaffected by time. He tells the youth that, though he can never kiss his lover because he is frozen in time, he should not grieve, because her beauty will never fade. In the third stanza, he looks at the trees surrounding the lovers, and feels happy that they will never shed their leaves; he is happy for the piper because his songs will be for ever new, and happy that the love of the boy and the girl will last forever, unlike mortal love, which lapses into breathing human passion, and eventually vanishes, leaving behind only a burning forehead, and a parching tongue. In the fourth stanza, the speaker examines another picture on the urn, this one of a group of villagers leading a heifer to be sacrificed. He wonders where they are going (To what green altar, O mysterious priest...), and where they have come from. He imagines their little town, empty of all its citizens, and tells it that its streets will for evermore be silent, for those who have left it, frozen on the urn, will never return. In the final stanza, the speaker again addresses the urn itself, saying that it, like Eternity, doth tease us out of thought. He thinks that when his generation is long dead, the urn will remain, telling future generations its enigmatic lesson: Beauty is truth, truth beauty. The speaker says that that is the only thing the urn knows, and the only thing it needs to know. Form Ode on a Grecian Urn follows the same Ode-stanza structure as the Ode on Melancholy, though it varies more the rhyme scheme of the last three lines of each stanza. Each of Grecian Urn's five stanzas is ten lines long, metered in a relatively precise iambic pentameter, and divided into a two part rhyme scheme, the last three lines of which are variable. The first seven lines of each stanza follow an ABABCDE rhyme scheme, but the second occurrences of the CDE sounds do not follow the same order. In stanza one, lines seven through ten are rhymed DCE; in stanza two, CED; in stanzas three and four, CDE; and in stanza five, DCE, just as in stanza one. As in other odes (especially Autumn and Melancholy), the two-part rhyme scheme (the first part made of AB rhymes, the second of CDE rhymes) creates the sense of a two-part thematic structure as well. The first four lines of each stanza roughly define the subject of the stanza, and the last six roughly explicate or develop it. (As in other odes, this is only a general rule, true of some stanzas more than others; stanzas such as the fifth do not connect rhyme scheme and thematic structure closely at all.) Themes If the Ode to a Nightingale portrays Keats's speaker's engagement with the fluid expressiveness of music, the Ode on a Grecian Urn portrays his attempt to engage with the static immobility of sculpture. The Grecian urn, passed down through countless centuries to the time of the speaker's viewing of it, exists outside of time in the human sense--it does not age, it does not die, and indeed it is alien to all such concepts. In the speaker's meditation, this creates an intriguing paradox for the human figures carved into the side of the urn: they are free from time, but they are simultaneously frozen in time. They do not have to confront aging and death (their love is for ever young), but neither can they have experience (the youth