Research Utilization Project - Fecal Transplantation Essay Example for Free

Research Utilization Project Fecal Transplantation Essay Clostridium difficile (C-difficile) is a common bacterium that is a frequent cause of infection in the colon and effects numerous patients. Clostridium difficile increases the hospital costs associated with inpatient care, including identification of the organism as well as treatment. The most common cause of C-difficile infection is the elimination of normal intestinal flora caused by antibiotic use. Standard treatment of C-difficile infection includes the use of oral (Flagyl) and intravenous (Vancomycin) antibiotic therapy. The use of fecal transplantation to treat C-difficile infection is increasing in popularity. Research regarding fecal transplantation dates back to 1958; however, the efficacy of fecal transplant for the treatment of C-difficile are rapidly emerging with noted benefits for patients. The mere thought of presenting fecal transplantation for the treatment of a C-difficile infection is often dismissed because of limited available evidence and the concerns about using someone else’s stool to treat the infection. The necessity to educate patients with C-difficile is an additional challenge. Potential donors and recipients need to be assured of minimal risks associated with the screening and transplantation process. The ability to educate society on the results of evidence-based practice regarding the treatment of C-difficile with fecal transplantation should minimize concerns and enhance patient outcomes. The creation of a patient education programs is increasingly beneficial when multiple health care professionals and interdisciplinary teams are involved. Thus, a project objective in implementing an educational patient program for fecal transplantation is the creation of an informative brochure for potential use in the Endoscopy Department at Sharp Memorial Hospital by December 2014. The treatment regimen for initial and chronic C-difficile with fecal transplantation is inexpensive and noted as extremely effective. The articles reviewed consistently reveal efficacy rates greater than 85%. Fecal transplantation for the treatment of C-difficile continues to illicit multiple verbal and non-verbal responses and is not considered a standard of care for patients, families, communities, and hospital staff. The implementation of an informative educational brochure will minimize fears, hesitations, and reluctance for the treatment of C-difficile with fecal transplantation. The central theme of transplanting feces from a selected healthy donor to the recipient with C-difficile is often met with resistance. The fecal transplantation brochure will encompass aspects of fecal transplantation with the expectation of educating patients, families, and communities. Additionally, the brochure would enhance awareness of hospital staff providing an opportunity to educate units or departments. The application of Kurt Lewin’s change model for the implementation of an educational brochure for fecal transplantation will be employed. The current treatment modalities for C-difficile and the methods of transmission are increasingly becoming expensive for health care organizations. The financial goals of the organization are to decrease the rates of C-difficile and possibly entertain the concept of fecal transplantation. A dichotomous survey will be used to measure awareness and use of fecal transplantation for the treatment of C-difficile. The interdisciplinary team employed to create the brochure would prove beneficial in developing standardized procedures in performing fecal transplantations. The Southern California Society of Gastroenterology Nurses and Associates is an excellent venue for potentially validating and communicating the results. The two possible grant funding sources for the fecal transplantation brochure is the American Gastroenterological Association (AGA) and the American Society of Gastroenterology Nurses and Associates (SGNA). The creation and implementation of an educational brochure for patients considered for fecal transplantation would enhance community education and minimize fears in treating C-difficile with fecal transplantation. Keywords: fecal transplantation, clostridium difficile, fecal micobiota transplantation Problem Identification The traditional treatments for patients diagnosed with infections of the colon are antibiotics. However, many antibiotics kill the normal healthy bacteria of the colon. This results in an overwhelming increase in the risk for developing a C-difficile infection. Medicine. Net (2012) stated, â€Å"Patients taking antibiotics are at risk of becoming infected with C. difficile as antibiotics can disrupt the normal bacteria of the bowel, allowing C. ifficile to become established in the colon† (para. 1). The potential for implementing the use of fecal transplantations for the treatment of C-difficile among the general population is questionable. The mere thought of presenting fecal transplantation for the treatment of a C-difficile infection is often dismissed because of limited available evidence and the concerns about using someone else’s stool to treat the infect ion. Rohlke and Stollman (2012) stated, â€Å"Cure rates of 90% are being consistently reported from multiple enters. Transplantation [fecal] can be provided through a variety of methodologies, either to the lower proximal, lower distal, or upper gastrointestinal tract† (p. 403). An additional consideration is the perception of fecal transplantation within the community. The necessity to educate patients with C-difficile is an additional challenge. Potential donors and recipients need to be assured of minimal risks associated with the screening and transplantation process. Current research supports and discusses a comprehensive approach to identification and screening for potential fecal donors, donor preparation, and transplantation procedures. The procedure for donor selection and screening is comprehensive to prevent the transmission of infection. According to Hamilton, Weingarden, Sadowsky, and Khoruts (2012), â€Å"The [donor] history includes assessment of infectious risk, including identification of known risk factors for HIV and Hepatitis, current communicable diseases, and recent travel to areas of the world with a higher prevalence of diarrheal illnesses† (p. 3). In educating patients, families, and the community at large, the rigor associated with the screening process must be emphasized to reduce fear. The project objective in implementing an educational patient program for fecal transplantation is the creation of an informative brochure for potential use in the Endoscopy Department at Sharp Memorial Hospital by December 2014. The brochure will be created using a collaborative approach by employing endoscopic nursing champions. The goal is for the brochure to be patient specific and encompass appropriate information to decrease fears and answer questions associated with fecal transplantation. Additionally, the development of a patient posttest associated with the brochure will be created to evaluate the effectiveness of content delivery and adjusted accordingly to meet patient needs and desired outcomes. The proposed solution will minimize the ambiguity and fears associated with fecal transplantation for the treatment of C-difficile. Solution Description The proposed solution for teaching potential recipients and donors about fecal transplantation for the treatment of C-difficile is to diminish infection rates. By creating and implementing a comprehensive nursing educational approach patients and donors can be well informed on this innovative treatment modality. â€Å"In many areas of clinical decision making, research has demonstrated that â€Å"tried and true† practices taught in basic nursing education are not always best† (Polit Beck, 2012, p. 25). The ability to educate society on the results of evidence-based practice regarding the treatment of C-difficile with fecal transplantation should minimize concerns and enhance patient outcomes. The creation of a patient education program is increasingly beneficial when multiple health care professionals and interdisciplinary teams are involved. The importance of evidence-based practice is to ensure the evidence about fecal transplants has been collected, evaluated, and implemented to establish the best practice and approach. The main premise for patient safety is to ensure donors have been thoroughly screened to minimize the potential for the transmission of other diseases with feces. According to Rohlke and Stollman (2012) on donor selection, â€Å"There have not yet been any adverse events reported that can be conclusively or directly attributed to [fecal microbiota transplantation] FMT, and proper donor screening is essential to avoid transmitting communicable diseases from donor to recipient† (p. 406). Individuals with recurrent C-difficile infections are moderately self-educated regarding treatment modalities and are receptive to the idea of fecal transplantation. The emphasis on educating patients, families, and communities regarding fecal transplantation as the initial treatment regimen is the focus. Hospital and individual associated costs in administering antibiotic therapy for the treatment of C-difficile could be drastically reduced by using fecal transplantation as the initial therapy. Brandt (2012) stated in reply, â€Å"Do patients typically accept fecal transplantation as a treatment option? Yes †¦patients typically respond with interest, and they are generally positive about trying it and they do not typically react with disgust† (para. ). The current research base associated with fecal transplantation demonstrates high cure rates while minimizing the reoccurrence of C-difficile. Rohlke and Stollman (2012) stated, â€Å"Cure rates of 90% are being consistently reported from multiple centers† (p. 403). The review of current literature demonstrates that patient education for fecal transplantation is performed by a gastroenterologist and not the gastrointestinal (GI) nurse. Patient education provided to patients from physicians typically entails a one-way communication style. In this scenario, the gastroenterologist sends the information to the patient, and there is little discussion with the receiver. Thus, patients commonly seek out more information from the registered nurse. The ability to educate patients regarding fecal transplantation using the proposed brochure would facilitate a commonality and minimize fears. The feasibility of implementing the brochure into endoscopic departments would be perplexing and centered on nursing knowledge of fecal transplantation. Brodine and Kellogg (2013) stated, â€Å"All patients infected or colonized with C. ifficile must be educated about this bacterium, proper disease management, and transmission prevention. The nurse should use patient-centered communication—free of jargon and appropriate to the patient’s health-literacy level† (para. 13). The health care organization must employ educational programs specific to the needs of the patients and desired outcomes. â€Å"The Joint Commission recommends using the â€Å"teach-back† and â€Å"show-back† methods to educate patients; that is, ask the patient to â€Å"teach back† the information provided or demonstrate understanding by â€Å"showing† a skill†¦Ã¢â‚¬  (Brodline Kellogg, 2013, para. 3). The organizational culture at Sharp Memorial Hospital for nursing is centered on the American Nurses Credentialing Center (ANCC) Magnet Recognition Program ®. The nursing strategic plan is developed by nursing leaders with input from nursing staff based on the hospital strategic plan. Additionally, nurse leaders emphasize that innovation is a core value and part of the nursing process. Nurse leaders encourage innovation through training, resources, and role modeling (Beyond Excellence, 2013). The roposed solution of implementing patient education for fecal transplantation is supported by Sharp Memorial Hospital because it involves introducing new knowledge regarding innovative, evidence-based treatment modalities. Research Report Clostridium difficile infection remains a constant struggle for hospitals. The standard treatment regimen of antibiotics commonly results in relapses. Research on fecal transplantation is continuing to emerge as a promising alternative approach in treating chronic C-difficile infections. Numerous studies demonstrate positive outcomes with the administration of fecal transplant in the treatment of C-difficile (Rohlke Stollman, 2012). Fecal transplantation has shown through research studies to be a useful treatment for C-difficile infection via the restoration of intestinal normal flora (Brandt, 2012). The most common sign reported by patients diagnosed with C-difficile is chronic diarrhea. Johnson (2012) stated, â€Å"The administration of antibiotics can alter the balance of normal colonic flora to permit the overgrowth of pathogenic C. ifficile strains that produce toxins which cause diarrhea and associated symptoms† (para. 5). In an article published in the Alimentary Pharmacology and Therapeutics, the authors reported 17 of 22 fecal transplantations for the treatment of C-difficile were effective (Landy, Al-Hassi, MLaughlin, Walker, Nicholls, Clark, Hart, 2011). The substantiated results of the review article highlighted major differences in patients, donors, screening, methods of administration, and the definition of treatment responses (Landy et al. , 2011). The multiple factors highlighted in this review of treating C-difficile with fecal transplantation review across the spectrum using a standard approach is essential to supporting increased use of this treatment modality. Landy et al. (2011) stated, â€Å"Standardized controlled studies are necessary to ascertain the most effective treatment regimen as well as the most acceptable method of treatment† (p. 414). Grehen, Borody, Leis, Campbell, Mitchell, and Wettstein (2010) published a study, â€Å"to demonstrate the benefits of fecal biotherapy and the role of new therapeutic strategies for the treatment of gastrointestinal conditions† (p. 51). The study included 10 patients treated with fecal transplantation and monitored the progress of bacterial population of the colon pre and post transplantation for a 24 week period. Grehen et al. (2010) found the following: At intervals of 4, 8, and 24 weeks after the procedure, the bacterial populations in the patients’ fecal samples consisted predominantly of bacteria derived from the health donor samples. Comparisons of similarity at 4, 8, and 24 week samples to the donor-infused sample were made and each recipient’s baseline sample was statistically significant with Friedmen test. p. 551) Rohlke and Stollman (2012) noted that C-difficile rates continue to rise with greater intensity and severity. The treatment of C-difficile with fecal transplantation is an emerging and accepted intervention in patients with recurrent C-difficile. Rohlke and Stollman (2012) stated, â€Å"Cure rates of 90% are being consistently reported from multiple centers. Transplantation can be provided through a variety of methodologies, either to the lower proximal, lower distal, or upper gastrointestinal tract† (p. 403). The review by Rohlke and Stollman (2012) analyzed reports validating the factors of â€Å"donor selection, appropriate patient criteria, and the preparations and mechanisms of fecal microbiota transplant delivery available to clinicians and patients† (p. 403). The internal validity of the research articles reviewed demonstrates moderate samples were randomly selected. The current literature validated the need for more randomized controlled studies to determine established guidelines for the implementation of fecal transplantation. Additionally, the treatment regimen for initial and chronic C-difficile with fecal transplantation is inexpensive and noted as extremely effective. The independent variable of the effectiveness of fecal transplantation for the treatment of C-difficile remained a consistent theme. The articles reviewed consistently reveal efficacy rates greater than 85%. The external validity of the study articles revealed fecal transplantation processes are varied in the process of which patients are treated, the donor selection criteria, donor screening protocols, and the methods of delivery. The outcomes of the results reported are moderately consistent; however, the ability to generalize a standardized treatment pathway is ambiguous and larger multi-organizational and multi-disciplinary studies are essential. Rex (2012) found the following: Several studies of fecal transplantation have demonstrated high cure rates. The latest and largest to date is a retrospective case series involving 70 patients in Finland (mean age, 73; 86% outpatients). Overall, 94% of these patients had symptom resolution during the first 12 weeks after transplantation, including 32 of the 36 infected with the O27 strain of C. ifficile and all 34 of those infected with other strains. No immediate complications occurred. (para. 1) Fecal transplantation in the treatment for C-difficile has proven to be highly successful in a limited number of studies. In determining if fecal transplantation should be the standard of treatment for C-difficile infection, larger controlled studies are required. Additionally, a standard process related to donor screening, implantation techniques, transplant follow-up, and regularly documenting patient outcomes are essential in establishing standardized fecal transplantation protocols.

Analysis Of Traditional Utilitarianism

Analysis Of Traditional Utilitarianism Traditionally, utilitarianism principle holds that any action is ethically right if and only if the total outcomes of the same act are more than the outcomes produced by any other action an agent could have done in its place. According to utilitarianism only one action is right in the final analysis: the action whose net benefits are much more when compared to the ultimate benefits of other alternative possibilities. Both the foreseeable future and the immediate costs and benefits provided by each alternative to each individual need to be taken into consideration together with other indirect consequences. The purpose of this paper is to analyze the problem of measurement as one of the traditional problems of utilitarianism. An individual must determine what alternative policies or actions are there for him at any occasion, for every alternative action an individual must estimate both the direct and indirect costs as well as benefits produced by the action on every affected individual by the act on the foreseeable future. Any alternative that gives the biggest sum total of utility need to be chosen as the ethically correct course of action (Paul and Dycus 38). The advantage of utilitarianism is its ability to explain that having some certain types of actions (lying, killing and cheating) are generally wrong in a moral perspective whereas others are ethically right (telling the truth). Traditionally, utilitarians would deny that any form of action is always right or wrong. The utilitarian perspective has been used widely in economics especially in economic techniques such as cost benefit efficiency and analysis. One main set of problems with utilitarianism is centered on the difficulties met in an attempt to measure utility. If we cannot manage to have basic knowledge on which kind of activities will give us the greatest amount of utility, then it will be hard to apply the utilitarian principle. Anything considered valuable is part of the instrumental things because they pave way for other good things. On the other hand intrinsic goods are those that are desirable and independent of other benefits they can produce. Money for instance is an instrumental good while health is an intrinsic good. To effectively compare two actions, there must be some common measure of outcomes. How can one for instance measure child labor? To begin with, it must be noted that the information on the incidence of child labor are very reliable to a point where the exact comparison between the two sources of information is not possible (Weiner 155). According to Bentham, not all individuals are similar when it comes to the issue of capacity to enjoy pain and pleasures. Strength, firmness of mind, health, education lineage, climate, occupation, income, sex among many other things affect individuals sensibility to register and experience pleasures of pain. Actually, Bentham found out that social utility measurement was approximate at its best. It is useless to talk of adding quantities which afterwards after the addition will be distinct as they were before. It is a fact that one mans happiness will not be another mans happiness and a benefit to an individual will not be reflected in a totally diff erent individual. One might pretend to add 20 oranges to 20 lemonsà ¢Ã¢â€š ¬Ã‚ ¦.this addibility of different forms of happiness may appear false when rigorously considered (Rima 66). Because there was no way to measure happiness or social welfare exactly, some attempt was needed by expediency on the approximate measurement of the net balance. Mill just like Bentham found out that then unifying principle of public policy was the proportion of the good to the number. This means that there should be the greatest good for the greatest number. Mill was very concerned on the exact nature of the general rule in particular with what utilitarianism include in terms of pleasure and pain (Stuart 210). It is very hard to rely on utilitarianism as the only method of making a decision because of the need to assign values to benefits and negative consequences of our actions and compare with the positive and negative consequences that might come up as a result of other actions. It is often impossible or very difficult to measure and compare the values of some costs and benefits. How can we for instance go about assigning a value to art or life? And how can one compare the value of life with that of life, time or human dignity? In addition, can we be ever certain on all of the outcomes of our actions? Our ability to predict and measure harms and benefits as a result of certain moral rule or cause of action is dubious to say the least (Habibi 98). May be the biggest challenge with utilitarianism is that it does not consider justice. Like in the case of doctor/innocent man, such course of action can produce great benefits for the society but the truth is that the action is unjust. When a doctor decides to compromise the life of one healthy who has some organs which can save the lives of five of unhealthy patients, the act appears to be unjust but the benefit is greater. After all one life has been used bring back five other lives that would have otherwise been lost. Utilitarianism argues that it is better to lose one life and save five other lives. Mill found it hard to define whom to include in the Maximand although he managed to answer it on pragmatic perspectives. Also, Mill found it hard to define an individual not to mention social happiness. In his strongest reactions to Bentham, Mill managed to differentiate between an individuals good and happiness. The biggest happiness of the biggest number is to become our invariable guide, and the greatest happiness of living men is not of men to come; for if there is posterity, who can be our guide? Who has the capacity to prejudge our future of men living by that time and how frequent would their biggest form of happiness consist in regard to their biggest errors? (Lacey 210). Utilitarian goal was then reformulated by Mill and in the process rejected what he perceived to be a narrow and excessive definition of utility by Bentham. On his emphasis on spiritual nature, Mill managed to argue that any gain of material nature is not the final goal for any society. A broader notion of improvement and moral tone were then integrated into utilitarian goal. He maintained that utility is part of the ultimate basis for moral obligations. These dimensions had a lot of implications on the economic policy which according to Mill in the minimum terms was to suit and at best improve the publics moral character. Mill however on various occasions questioned the effectiveness of institutional changes that did not intend to bring a moral improvement and eventually not achieve lasting effects (Bay 39). Mill insisted that in utilitarianism the same amounts of happiness are equally needed whether felt by different individuals or the same individual. Mill Championed for equality and impartiality freed both popularly and the enlightened as not corollary individuals of utilitarianism but part of the very meaning of utilitarianism: a principle that is seen to be lacking actions and rationale signification, unless an individuals happiness supposed same in status is counted for precisely as much as someone elses. However, every one has equal claim to all means to happiness. The greatest happiness perception remained problematic nevertheless, because the amount of was not directly measurable as Mills put it supposed equal in degree. The anterior principle of Utilitarianism it is permitted is that the arithmetic rule is applicable to the value of happiness just like all other quantities which can be measured. Mill argued that the only measure of quantity comprised of the verdict of individuals who had encountered different quantities of pleasurable sensations. Infact on a serious point, Mill argued that pleasures differed in type and amounts; but unable to give a clear-cut means of either ranking types of pleasures or measuring total pleasure (Lueck and Allen 66). If our decisions based on morals are to take into account issue of justice, then utilitarianism apparently cannot be the only guiding principle in our decision making process. However, it can play a significant role in the process. Utilitarianism principle invites us to take into account the immediate as well as the long term outcomes of our actions. Provided its insistence on summing harms and benefits of different people, utilitarianism needs us to project our vision beyond our personal interest to avoid favoritism on people affected by our actions. On the issue of perverse pleasures, Mill managed to come up with a very strong conception of ethical values on the basis of consequences of a particular action. He defined in a clear manner the kind of consequences that would count in determining whether the action is right or wrong as pleasure and pain. All living things are trying to avoid pain and seek pleasure. Because the main aim of ethics is to come with the best world, the purpose is to maximize the total pleasure available in the world and minimize the any pain as much as possible. The creed which accepts as the basis of morals, greatest happiness principle or utility, holds that actions are proportionally right because they tend to promote happiness and proportionally wrong when the result is sadness. By happiness is purported pleasure with no pain; by sadness is intended pain and lack of pleasure (wood 100). Initially, it sounded perverse or even trivial to some individuals who believe that pleasure is usually connected to an immoral act. Mill considered pain and pleasure in their most basic stages. For instance hunger is an evil because it causes pain. Mill also pointed out that preventable death is a way of denying one pleasure hence forms part of an evil. The main moral point that Mill is trying to present is that there is need to judge the ethical value of our actions on the general consequences it has for individuals in terms of pain and pleasure. The greatest principle of happiness holds that the less pain and the more the pleasure an action causes, the better it is in moral perspective. We should therefore seek to participate in those activities and be part of policies that lead to greatest happiness.

How can we remove causes of hunger today Essay -- essays research pape

Q. How can we remove the causes of hunger in the world today? At the end of World War II public officials and scientists from all over the world predicted that, with advances in modern technology, it would be possible by the end of the century to end poverty, famine, and endemic hunger in the world. Today these optimistic projections have been replaced by hopelessness and resignation as perhaps one-fifth of the world's peoples live in absolute poverty with incomes of less than $700 a year. The United Nations estimates that around 830 million people in the world do not have adequate access to food. An estimated 24,000 people die from hunger or hunger related causes, three-fourths of which are children under the age of five. Moreover, hunger exists not only in Asia, Africa, and Latin America, but also in the richest nation on earth. Thirty-six million Americans do not have enough to eat, and the number is growing. In order to discuss eradication of hunger, we need firstly to identify some true causes. The immediate cause being improper food management; over population, lack of purchasing power, ignorance and unemployment are the issues that worsen the problem. Lot of people in this world is hungry because some people misuse and waste the world’s abundantly available food resources. The first and an obvious solution to the problem therefore is to stop this, and to distribute them among the starving population. World production of grain alone is over 1.5 billion tons, enough...

Lsd :: essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  LSD stands for Iysergic acid diethylamide. LSD is a hallucinate know to be the most powerful drug of this kind. LSD is commonly known as acid. This drug changes a person’s mental state by distorting the perception of reality to the point where at high doses hallucination occurs. Acid is derived from a fungus that grows on rye and other grains. It is semi-synthetic. It’s manufactured chemically in illicit laboratories, except for a small percent, which is produced legally for research. A very minute does can significantly alter ones perception to the point of hallucination. Hallucination is when a person hears, or sees thing that don’t really exist. LSD is the most potent hallucinate. Approximately 100 times stronger than psilocybin, and 4000 times stronger than mescaline. LSD as it is pure is a white, odorless crystalline powder that is water-soluble. But because an effective does of the drug when it is pure is almost invisible it is mixed with other substances such as sugar and packaged in capsules, tablets, solutions, or spotted on to gelatin pieces of blotting paper. Dosages Acid is normally taken orally but sometimes is inhaled or injected, but there is a big risk that you might get infections or Aids while using unsteril needles or sharing with others.   Ã‚  Ã‚  Ã‚  Ã‚  The effects of LSD depend on several factors like: -  Ã‚  Ã‚  Ã‚  Ã‚  The amount taken at one time -  Ã‚  Ã‚  Ã‚  Ã‚  The user’s past drug experience -  Ã‚  Ã‚  Ã‚  Ã‚  The manner in which it is taken -  Ã‚  Ã‚  Ã‚  Ã‚  The circumstances under which the drug is taken, place, presents of other people ect These factors are especially important with the use of acid. The effects of LSD on any user or even the same user but at different times are difficult to predict. Short-term effects   Ã‚  Ã‚  Ã‚  Ã‚  These effect will appear a few hours after usage and disappear in hours or days: Physical effects like, numbness, muscle weakness and trembling, rapid reflexes, increased blood pressure, heart rate, and temperatures, impaired motor skills and coordination, dilated pupils, nausea and sometimes seizers. Dramatic changes in perception, thought, and mood occur shortly after physical effects. These may include: - Pseudo-hallucinations that the user is aware of. -  Ã‚  Ã‚  Ã‚  Ã‚  Distorted perception of times. -  Ã‚  Ã‚  Ã‚  Ã‚  Distance -  Ã‚  Ã‚  Ã‚  Ã‚  Gravity -  Ã‚  Ã‚  Ã‚  Ã‚  The space between oneself and the environment

Use of Symbolism, Tone, and Irony in The Swimmer, by John Cheever Essay

Finding home boarded up; a sensation of coldness and unwelcoming takes over. Sudden misfortunes arise from what was once a perfect life, and the world appears upside-down. Attempts to remember what went wrong fail. Memories are unclear and time seems blurry. At one time, John Cheever found himself in this position, using alcohol to ignore his problems. John Cheever was born in Quincy, Massachusetts in 1912. In 1941, he moved to suburban Westchester and eventually became addicted to alcohol, which is a recurrent motif in many of his short stories. He died in 1982 from cancer. In his short story, "The Swimmer," an affluent man named Neddy Merrill decides to swim through all of the pools in his county to reach his own house. The neighbors welcome him at first, until a storm passes and everyone begins to regard him negatively. When he finally reaches home from his journey, he finds his house empty and boarded up. Just like the author, Ned suffered after he put aside his issues. John Cheever develops his theme that changes will inevitably come as time passes by in his short story "The Swimmer" through his use of symbolism, tone, and irony. At first glance,"The Swimmer" is literally a story about a man who swims through pools only to come home to an empty house- the symbolism makes it much more than that. One of the main symbols in "The Swimmer" is the swimming pools, which represent time periods. Halfway through the story, Ned reaches the Welchers and realises that they "had definitely gone away. [Their] pool furniture was folded, stacked, and covered with a tarpaulin" (Cheever). Unknown to Neddy, large amount of time has passed between the time he started his voyage and where he is now. Ned does not remember the Welchers' s... ...ss. Works Cited Blythe, Hal, and Charlie Sweet. "Man-Made vs. Natural Cycles: What Really Happens in 'The Swimmer..'" Studies in Short Fiction 27.3 (Summer 1990): 415-418. Rpt. in Short Story Criticism. Ed. Jelena O. Krstovic. Vol. 120. Detroit: Gale, 2009. Literature Resource Center. Web. 29 Jan. 2014. Cheever, John. The Swimmer. N.p.: Library of America, 2009. Print. Morace, Robert A. "The Swimmer: Overview." Reference Guide to Short Fiction. Ed. Noelle Watson. Detroit: St. James Press, 1994.Literature Resource Center. Web. 30 Jan. 2014. "The Swimmer." Short Story Criticism. Ed. Janet Witalec. Vol. 57. Detroit: Gale, 2003. Literature Resource Center. Web. 17 Feb. 2014. Watts, Harold H. "John Cheever: Overview." Reference Guide to American Literature. Ed. Jim Kamp. 3rd ed. Detroit: St. James Press, 1994. Literature Resource Center. Web. 18 Feb. 2014.

P&G Grooming Performance

PENETRATION RATE OF MAIN PLAYERS IN B&R MARKET In 2011, the whole B&R market penetration sunk into a sap situation, the penetration of the whole market by itself dropped from 43. 5to 41. 6(%). The penetration rate of P&G in year 2011 decreased by 8. 3% compared with that in 2010, and continued a downside trend by the first quarter of 2012 by 7. 5%. Compared with BIC, who increased 5. 8 % penetration in 2011 followed by a 10. 9% drop by 1st quarter of 2012, ENEGIZER first 1. 8% drop followed by a continuous 9. 8% drop, and other retailed brand which decreased by 9. % followed by another downturn of 9%, P&G in its B&R area did not do well in gaining potential customers during 2011. And looked more precisely in specific products of P&G, as the chart shows below, despite some badly performance products , there are still some products doing well in 2011, for example, the best performance products are PROGLIDE MANUAL and PROGLIDE POWER, which were newly trade-up in 2011 and caught the most new consumers during one year and still promise an increasing trend. G2 also did well in 2011, making an increase of 35 penetration points both in male system and male system blades.Moreover, despite the penetration decrease in male system and male system blades, MACH 3 made an increase of 5 and 33 in penetration points in male razors and disposables respectively. In contrast, FUSION series were all losing power to attract new customers, substantially, FUSION MANUAL dropped 32 penetration points in male system , 27 in male sys blades , and 14 in male razors, what’s worse than that, FUSION POWER lost nearly 40 points in male system, 34 in male sys blades and almost 69 in male razors. CONTOUR also faced a 15-point- decrease, and SENSOR 3 dropped 5 points each in male system and male system blades.Some of the products are losing attractiveness to new customers partly because the trade-up products are replacing their positions in the market, for instance, ever since BLUE 3 march ed into the market, it enjoyed a 8 points’ increase in penetration while BLUE 2 faced a responding decrease of as many as 17 penetration points in the market, therefore for these products staying still may make them sifted out, either upgrade the functions or accelerate the renewal may save those products from continuing losing customers. PENETRATION POINT IN 2011 VS YAG | MALE SYSTEM| MALE SYS BLADES| MALE RAZORS| DISPOSABLES| CONTOUR| -15| | | |G2| 35| 35| | | MACH3| -5| -5| 4| 33| SENSOR3| -16| -16| 1| -7| | | | | | FUSION| -8| -4| -9| | FUSION MANUAL| -32| -27| -14| | FUSION POWER| -40| -34| -69| | PROGLIDE MANUAL| 148| 131| 90| | PROGLIDE POWER| 93| 242| 34| | BLUE2| | | | -17| BLUE3| | | | 8| TOTAL| -7| -5| -9| -8| In 2011, P&G increased 1 point and 4 points respectively in number of purchase act and the average spending per purchase act in B&R& disposables compared with that in 2010, while ENERGIZER did not generate any changes in both measurements and BIC increased 12 points in average spending per purchase act and stayed still in purchase act volume.As we can see from the bar chart above, compared with the year before, P&G male system and male system blades both increased 2 points in number of purchase acts and 3 in average spending per purchase act(among which PROGLIDE did the best: 32 points and 34 points increase of purchase act number in male system and male sys blades, 27 point’ increase and 50 points’ increase of spending per purchase act in male system and male blades system respectively) while male disposables decreased 2 points in purchase act volume(among which G2 decrease the most: 12 points decrease) but increased 3 points spending /act(among which MACH 3 decreased 18 points while SENSOR 3 increased 12 points), and male razors did the worst performance as it dropped 2 points in purchase volume and 5 points in spending/ act, among which FUSION MANUAL did the worst(23 points decrease in spending per purchase act ).

Indiana Jones, Raiders of the Lost Ark Essay

I have chosen to evaluate a scene from Indiana Jones, Raiders of the Lost Ark where Indiana and Sallah uncover the Well of Soles where the lost ark is hidden. We open the scene at 57:03 with Indiana leading a team of diggers up a hill to the spot where they will dig for the ark. As the scene opens we hear the diegetic sounds of the diggers and commotion taking place in the background. We also hear non-diegetic music that will be referred to as the â€Å"ark theme† playing as Indiana climbs the hill and has his men start to dig for the ark. The slow and sort of creepy tone that makes up the ark theme reminds us of the continuing quest for the ark and also that the ark may very well be close by. At 58:00, the non-diegetic music briefly cuts for about four seconds but then picks up once again as Indiana turns around to whistle for his men to start digging. As the digging begins, the music picks up and gets louder and louder. The rise in the non-diegetic music builds the suspense and excitement of the scene and foreshadows the big discovery that lies ahead. At 58:26 the scene dissolves into a shot of the dig site from afar. Although the non-diegetic music ended, we pick up with the diegetic music or sound of the tune that the workers hum as they dig. We can also hear the diegetic sounds of the wind howling and we see the sun setting in the background showing us that a cold night is approaching. The coloring from the sun set gives the shot a feel that something great is about to happen yet provides a sense of mystery for those who don’t know what is to come. In this shot we cannot see a detailed view of our characters, rather just the shadows of the digging men and Indy. We are easily able to pick out Indy despite only being able to see character shadows simply because we see him put on his trademark hat which he is famous for wearing. At 58:44 the shot cuts to yet another shot of the digging site at night fall. Immediately we hear booms of thunder and strikes of lightening from an approaching storm which sets the tone of this portion of the scene. The thunder and lightning and building anticipation seem to foreshadow the discovery of the ark yet again, which we initially hink is a good thing, however, the dark and evil sounds of the storm represent bad things will eventually come from the ark and show us that in hindsight, the ark should not be disturbed. Anticipation continues to build as we hear more diegetic sounds of thunder and a spooky wind howling in the background. We see a shot of Indy and see the worried look on his face as the storm continues to approach. At 58:56 Sallah informs Indy that they hit stone and here we see an eyeline match from Indy leading to the next shot of the uncovered stone. As the workers continue to uncover the stone, the diegetic sounds continue. The lack of non-diegetic music emphasizes the roar of the thunder and helps the view focus on the big find that is about to occur. As the stone is lifted and the tomb is uncovered, we hear the diegetic sound of an animal howling in the background at 59:50. This gives the viewer a spooky feel of the tomb. At 59:55 we see and hear a stinger brought on by non-diegetic music. The thunder roars with a lightning strike which lights up the opening of the tomb which reveals a scary-looking creature with jagged teeth. As this is revealed the non-diegetic music spikes and Sallah shouts from being startled which all creates this stinger effect. The stinger also proves to be the cue that re-starts the creepy, non-diegetic music. After questioning the moving floor, at 1:00:15, the non-diegetic music spikes into a high pitch shriek, as Indy drops his torch. The non-diegetic music lowers to a creepy tone once again but then spikes into a high pitch flute sound at 1:00:22 as the camera pans over the creepy view of the snakes. The non-diegetic music continues into a low-pitch brass sound which continues to provide a creepy feel but also foreshadows the evil that lies ahead. At 1:00:42 the camera lifts back to Indy as he rolls over and delivers his famous line; â€Å"Snakes.  Why did it have to be snakes? † Sallah then crawls over to Indy and at 1:00:59, Sallah utters over the non-diegetic music, â€Å"Asps. Very dangerous. You go first! † This line then cues the diegetic sounds of a snake rattling and a loud boom of thunder which cues the end of the scene. Throughout this four minute clip, there are tons of diegetic sounds and a lot of non-diegetic music. The sounds and music play a huge roll in this scene as it builds emotion for the find of the Well of Soles yet foreshadows the danger and adventure that lies ahead in the remainder of the film.