Johnson & Johnson Global Business Environment

Johnson & Johnson: Successfully Strategizing for the Changing Global Business Environment I. Introduction Johnson & Johnson is the world's largest healthcare company. Founded in the United States in 1886, the company has been profitable for 75 straight years and currently operates 250 subsidiary companies in 57 countries. Its products fall into three segments: pharmaceuticals, with 39% of total sales; medical devices and diagnostics, with 36%; and consumer products, with 25%. Additionally, the company employs 119,200 people worldwide and sells its products in 175 countries.A truly global corporation, Johnson & Johnson has securely positioned itself to overcome the challenges its ever-changing business environment poses, as well as take advantage of the opportunities presented. With a focus primarily on Johnson & Johnson’s pharmaceutical segment, this paper seeks to explore the complex multinational environment within which the company operates as well as the opportunities and threats that the environment poses. Next, the paper will analyze Johnson & Johnson's current positioning, describing its value-chain and competitive positioning.The paper will close by evaluating how Johnson & Johnson both can seize these opportunities to realize the goals of the company. II. Analyzing the Environment In industries as competitive as pharmaceutical, medical devices and consumer goods, analyzing the environment is vital for being able to make sound strategic decisions. Since Johnson & Johnson strives to anticipate the external factors that affect its international business environment, as well as adapt to those changes, it is important that it understands the environment in which it is operating.The two sets of external forces that face the company are competitive and contextual. A. Competitive Environments – Five Forces Model Michael Porter’s five forces model provides a way of analyzing Johnson & Johnson’s competitive environment. Due to a lack of available information about the bargaining power of suppliers as it applies to Johnson & Johnson, this paper will address the four other forces: the threat of new entrants, the threat of substitutes, the bargaining power of customers, and the rivalry among industry competitors. 1. The Threat of New Entrants – High Barriers to EntryThe threat of new entrants is not of particular concern to Johnson & Johnson. Barriers to entry, especially in the industries of pharmaceuticals and medical devices, are extremely high if not unsurpassable. The world’s top pharmaceutical companies have extensive manufacturing capabilities, distribution systems, and economies of scale that have been built up over decades and would be virtually impossible for a new entrant to replicate. These top firms also have patents that protect their current products, as well as established research pipelines that ensure the continual development of new products.Also, they have strong brand names and la rge marketing budgets with which to defend them. Finally, the exceptionally high capital requirements for founding a pharmaceutical company and the sharp retaliation that new entrants could expect from the established competitors render the threat of new entrants very low. The medical device industry has similarly high barriers to entry. While entering the consumer goods market is easier, relatively, the vast number of competitors makes this industry very competitive, thus a strong brand name is vital for standing out.As the world’s most respected company according to Barron Magazine, new entrants to the consumer goods market do not pose a threat to Johnson & Johnson. 2. The Threat of Substitutes – The Rise of Generics The threat of substitutes is much more problematic than that of new entrants, especially in the pharmaceutical segment. The Food and Drug Administration (FDA) requires that generic drugs be bioequivalent to their brand name counterparts, making them seri ous substitutes. Once a patent expires, generic manufacturers are quick to reverse-engineer the formerly proprietary drugs and sell generic versions at a fraction of the cost.Virtually all the top pharmaceutical companies, Johnson & Johnson included, face an influx of upcoming patent expirations. The impending loss of sales when generic versions of the drugs inevitably become available is a serious threat to the profitability of many players in the industry. For example, Risperdal, a drug for schizophrenia made by a subsidiary of Johnson & Johnson’s called Janssen-Cilag, was a significant source of profits, with sales that totaled $3. 5 billion in 2005 and surged 21% percent in the first quarter of 2006, to $1. 2 billion.However, when the patent for Risperdal expired in December of 2007 and became available in generic form in October of 2008, the company’s revenue from pharmaceutical sales stagnated. In fact, in July of 2007, Johnson & Johnson announced plans to elimin ate up to 4,800 jobs, citing patent expirations as the main motivation to trim the workforce and thus save money. If the company does not prepare for the difficult transition between enjoying market exclusivity and losing that security as those patents expire, it will face more negative consequences. 3. The Bargaining Power of Buyers – Influence of GenericsIn the pharmaceutical industry, buyers include patients, medical doctors who prescribe drugs, pharmacists, hospital boards, insurance companies, and other health authorities. The bargaining power of patients goes hand in hand with the threat of substitutes. When drugs are patent-protected, pharmaceutical companies enjoy a monopoly where they can set prices to include high profit margins. Since there are few to no substitutes for their products during this time, customers have little choice but to pay these prices, especially if their lives depend on the drugs.However, once cheaper, generic versions of the drugs become avail able, buyers gain more power. Patients’ switching costs, an important element in determining the bargaining power of buyers, are fairly low, and price-sensitive buyers will likely switch to generic versions once available. Johnson & Johnson’s main tool in combating this problem is its strong brand name. Many customers have more trust in brand name products and are willing to pay extra for this perceived security. The other groups within buyers of pharmaceutical products, while fragmented, have more power than patients.Within the American healthcare system, insurance companies and health maintenance companies (HMOs) have considerable bargaining power, as they decide which drugs to endorse and provide. Since they have an interest in lowering costs, they exert a strong downward pressure on drug prices, partly due to the threat of the availability of generics. European governments’ national healthcare systems have a similarly high level of power, if not higher due t o strict price controls. Thus, pharmaceutical companies have a need to establish successful relationships with these groups and market towards them heavily. 4.The Degree of Rivalry – Fierce and Changing Competition Competition in the pharmaceutical industry is intense and growing in intensity. While the numerous competitors remain fairly fragmented, mergers and acquisitions have increased rivalry, as the top firms’ areas of expertise began to overlap. Rivalry is especially intense in saturated markets, such as the pain reliever segment, in which Johnson & Johnson competes with its products Tylenol and Motrin. In growing markets, innovation is a key driver of competition since pharmaceutical companies depend on â€Å"blockbuster† drugs for a large proportion of their revenue.With only one out of every 10,000 discovered drugs approved to be sold, stakes are high to find the cash cow drugs that recuperate the increasingly high costs of development. Since â€Å"me too† drugs are not as profitable, innovation drives the race to be first-to-market. While the main competitors in the pharmaceutical industry are concentrated in the United States, Europe, and Japan, an increasing number of players – especially generic drug manufacturers – are appearing in developing countries, such as China and India. These companies are driving the shift in the industry toward becoming more commoditized.Also, numerous biotech upstarts, which are smaller, more agile, and have lower overhead costs than their conglomerate competitors, are growing in power and taking market share. As the dynamics of the industry change, the established companies will find themselves facing stiff competition from all sides. B. Contextual Environment – PEST Analysis A PEST (Political, Economic, Social, and Technological) analysis is a useful tool for understanding the larger environment within which the company operates. Companies can use this tool to identify a multitude of important aspects of their environments that may impact their businesses. . Political Environment – Changing Politics and Policies First, the politics on local, regional, national, or international scales can exert strong forces on businesses. Since Johnson & Johnson operates worldwide, it must keep track of the political developments that may affect its business. For example, in the Czech Republic, health care is the subject of a major political debate. Changes in the healthcare system may affect to whom Johnson & Johnson needs to market, and with whom it needs to negotiate if the company wants its products covered by the Czech healthcare system.Also, Johnson & Johnson should be aware that the Czech Republic has a weak Parliament that will change in 2010’s elections. The company needs to anticipate which policies may shift under the new government. Finally, Johnson & Johnson should be aware that the Czech Republic will serve as president of the Council of the European Union for the first six months of 2009. This is the best time for the Johnson & Johnson branch located in the Czech Republic to lobby for any policy changes regarding the company’s interests and the business environment. 2.Economic Environment – The Crisis and the Euro The economic climate is also important for Johnson & Johnson to analyze in order to predict when its business may face challenges, as well as when it can seize an opportunity for growth. Operating in the European Union and larger European community means that Johnson & Johnson has felt the effects of the current economic crisis. Aware of the crisis, the company has been able to plan for its impact, and fortunately, the effects on Johnson & Johnson have not been severe, as medical products remain necessities even in periods of economic downturn.In respect to the Johnson & Johnson branch in the Czech Republic, the economic environment is one that quickly transitioned from a communist, plan ned economy to the free market. Though the Czech Republic has embraced free market principles since the fall of the Soviet Union, it is important that Johnson & Johnson recognize that this change was relatively recent, and certain aspects of working in the Czech Republic may still be affected by this history. Finally, discussions surrounding the use of the euro and the benefits and disadvantages of a common currency are debates that Johnson & Johnson should be aware of in this time period.While Slovakia adopted the euro in January 2009, the Czech Republic has kept its own currency. A switch to the euro in the Czech Republic could have a wide range of effects, some positive and some negative, and Johnson & Johnson should understand the implications for its business if that change occurs in the Czech Republic. For example, adopting the euro would make transactions with other countries more convenient, and Johnson & Johnson should be prepared for a possible increase in transactions or the speed in which transactions take place in order to take advantage of the opportunities this change could provide.It should also be ready for the numerous practical difficulties with tasks such as accounting that may occur with a change in currency. Keeping these economic scenarios in mind is the kind of forward-thinking that is crucial to Johnson & Johnson's success. 3. Social Environment – Aging Population and Public Health Problems There are two major social changes on the horizon that will both affect Johnson & Johnson as well as provide tremendous opportunities. The first is the aging population.The gigantic baby boomer generation, consisting of those born between 1946 and 1964, has had a huge social and economic impact on the world since its birth. This trend will continue as the generation is beginning to enter old age. The influx of senior citizens will create huge demands throughout all realms of medical care. Johnson & Johnson can expect to see increased sales ac ross all three of its segments – pharmaceuticals, medical devices and diagnostics, and consumer goods – in the coming decades, and must plan production accordingly to be able to meet the needs of this huge generation as they enter their most medically-dependent years.Additionally, in order to cater to the aging population, Johnson & Johnson is pioneering developments in preventative medicine as well as less invasive surgery techniques. Another major social change affecting Johnson & Johnson is the phenomenon of surging rates of various health problems, especially in developed societies but spreading worldwide, from obesity and diabetes to cancer and mental disorders. Though highly problematic for society, companies in medicine-related industries such as Johnson & Johnson are finding themselves with an increasing number of people to treat and cure.As a company that invests heavily in research and development, Johnson & Johnson has the opportunity to lead the way in find ing ways to address these serious public health issues. 4. Technological Environment – Promising New Fields As many pharmaceutical drug markets become saturated and the blockbuster drug strategy becomes obsolete due to the major changes occurring in the industry, innovation and breakthrough medical technologies are essential for finding blue oceans in which to compete.Predictive medicine, which entails predicting diseases based on genetics and preventing them, and personalized medicine, which involves managing a patient’s health based on his or her individual characteristics as opposed to following the more traditional â€Å"standards of care† model, are growing fields into which Johnson & Johnson can expand. The company’s strong emphasis on research and development and its leadership in the medical devices and diagnostics segment put it in an excellent position to become a frontrunner in making new discoveries in these promising new technological fields. C. Determining Threats and Opportunities 1.Threats – The Uneducated Consumer and Mergers and Acquisitions One of the biggest threats facing a company like Johnson & Johnson is the uneducated consumer. Especially within the consumer products and pharmaceuticals markets, with the increasing availability and lower cost of generic products, a key component of continued competitiveness is the discerning consumer who has preferences when it comes to treatment options. Johnson & Johnson must continually work hard to make sure that people are aware of its products and the quality that it ensures through effective branding and promotional practices, as well as consumer education.Patent expirations are also a constant concern for Johnson & Johnson as proprietary information is an integral part of sustained revenue streams. Mergers and acquisitions (M) present both potential opportunities and threats for Johnson & Johnson. The company has pursued M that have served to expand the compan y’s resources and help penetrate new and diverse markets. For example, Johnson & Johnson recently acquired Mentor Corporation in order to expand its operations in to the aesthetic and reconstructive medicine market.Also, an important new medical product called the Fibrin Pad was developed with the cooperation of three Johnson & Johnson-owned subsidiaries. These are just a couple examples of how Johnson & Johnson is able to both grow and innovate through M. On the other hand, M between other companies in the healthcare industry have the potential to upset Johnson & Johnson’s value chain and competitive advantages. Johnson & Johnson must pay close attention to the actions of rival companies in order to maintain its market-leader positions and barriers to entry against competitors. 2.Opportunities – Research, Synergies, Emerging Markets, and the Aging Population Johnson & Johnson’s greatest opportunity is found in its heavy investment in research and develop ment. This is especially important for its medical devices and diagnostics and pharmaceutical divisions. It is necessary for the company to be on the leading technological edge when it comes to medical devices to ensure that it can offer the most accurate and up-to-date machines available. As for the pharmaceutical sector, patent expiration and generic drugs demand constant innovation and addition to Johnson & Johnson’s pipeline of products for sustained success.Strong pipelines in its pharmaceutical and medical devices sectors are a major source of confidence in the company’s long-term success. With eight new late-stage compounds in the pharmaceutical sector and the introduction of several new products to new markets in the medical devices sector, Johnson & Johnson seems to be advancing its pipeline quite progressively. It also strives to be a consistently innovative company, and around 40% of its current products have been developed within the last 3-4 years. In 2008 , Johnson & Johnson spent $7. billion on research and development. The reinvestment of 11% of sales in to R, versus the industry average of 3%, demonstrates a source of competitive advantage for the company. Synergies between product branches are yet another source of opportunities for Johnson & Johnson. Through the well-coordinated efforts of its pharmaceutical and consumer products divisions, Johnson & Johnson was able to make the formerly prescribed drug Zyrtec available as an over-the-counter drug, which came to be the company’s most successful product launch in 2008.This is yet another example of how the company is able to pool its resources in order to find ways to fulfill both the needs of both its customers and stakeholders. Other opportunities for Johnson & Johnson are present in emerging markets such as Brazil, Russia, India and China. Its products are currently available to only 25% of the world’s population. However, through its decentralized management app roach and the adjustment of its products and strategies to match local needs and preferences, Johnson & Johnson is reaching an ever-increasing consumer base.One method Johnson & Johnson has been able to reach a broader consumer base through is the de-featuring of products, such simplified blood-glucose meters, which allows for access to lower-income customers and dampens the parasitic effect of cheap substitutes. One final opportunity exists in the demographic trend towards an ageing population. People are living longer, and because of this, new types of medical needs are arising all the time. Many types of medical treatments and surgeries are being developed and becoming more commonplace, such as hip replacements and plastic surgery.Patients want to be able to fix their ailments and expect a quick and uncomplicated recovery afterwards. It is up to Johnson & Johnson to develop and provide the best possible equipment and supplies to do this and fulfill the company promise of customer success. III. Establishing European and Global Opportunities A. Expansion into New Markets – Developing Countries Despite the many challenges of working in both the European and global business environments, it is clear that these environments also allow Johnson & Johnson to strengthen and continue to grow its business.With income and living standards on the rise in many European countries such as Turkey and the Czech Republic, where sales have already increased, and across the globe in developing countries like China and India, Johnson & Johnson has many opportunities to sell its products in new markets or expand more in markets it has previously penetrated. In order to take advantage of the broadening market field, Johnson & Johnson has begun to offer products that will appeal to people in less affluent nations. Its objective is clear: make products that are affordable for most of the world.To do this, Johnson & Johnson has created de-featured versions of products that can be sold at a lower price, thus becoming accessible to more patients. B. Domestic Market Defense – Competition and Mistakes While Johnson & Johnson expands to serve more customers in new markets, it must also maintain its secure position domestically. Though the consumer segment only accounts for only 25% of its total sales, the company realizes that keeping up its reputation and remaining a household name will help it as it moves into foreign markets. To put it simply, Johnson & Johnson must remain synonymous with quality, safe products.Next, Johnson & Johnson must be ready to compete with an even greater number of competitors, such as Pfizer, Merck, Novartis and Eli Lilly. Despite being the world's largest healthcare company, it still faces competition and has run into problems when it has attained the market lead, grown too confident in its product, and then lost the lead. Because Johnson & Johnson has twice lost its lead with one particular product, a heart stent, it now seems aware of this problem in its business strategy and therefore will be prepared for similar situations as it continue to penetrate new markets.IV. Analyzing Johnson & Johnson’s Current Position A. Value Chain Analysis – Synergies, Cost Reductions, and Relationships A value chain analysis of Johnson & Johnson reveals several key sources of value generation. Johnson & Johnson consists of 250 companies that operate in 57 countries worldwide. The widespread nature of its operations and decentralized management practices allow for a high degree of local autonomy and adaptation. This makes Johnson & Johnson very efficient in discovering and reacting to changing consumer demands across the globe.Also, the convergence of knowledge and information from branches across the globe gives the corporation a great advantage in the development of new products and technologies. Flexibility and detailed, location-specific knowledge coupled with heavy investments in technology, most n otably IT, are the main production-based value drivers of the corporation. They allow for timely, adaptive responses to changing needs and the ability to achieve first leader power in emerging markets. Johnson & Johnson is making progress in finding ways to reduce costs.Standardization initiatives in its pharmaceutical sector enabled the company to streamline operations and cut costs by $1. 6 billion in 2008. Cost savings are also created by means of acquisitions. For example, Johnson & Johnson’s acquisition of Pfizer Consumer Healthcare is expected to generate up to $600 billion in â€Å"cost synergies† by unifying the efforts of the two companies. Johnson & Johnson also emphasizes the importance of relationships with both its consumers and employees in its company credo.A talented and dependable workforce is important for innovation and efficiency in operations for any corporation. The company demonstrates its desire for employee welfare with healthcare services and carefully developed online resources. With an employee turnover ratio of less than 5%, Johnson & Johnson demonstrates that it is capable of attracting and retaining the right kind of people to help it remain successful. B. Competitive Positioning – Differentiation and Resource Allocation As stated in the annual report, Johnson & Johnson is a company focused on broad-based human healthcare.It offers a plethora of products throughout its pharmaceutical, medical devices and diagnostics, and consumer products divisions. These products are made in response to both local and global consumer demands, representing solutions for many different customer segments. These factors are evidence that Johnson & Johnson has chosen the competitive strategy of differentiation. Using this strategy affords Johnson & Johnson a sense of prestige and quality and this is evident in its pricing practices.However, the company does use competitive pricing strategies and is continually trying to find ways to lower costs without sacrificing quality or reputation. Johnson & Johnson is constantly seeking to expand its product portfolio across all divisions and spends large amounts of money in R&D to that end. A Johnson & Johnson representative said, â€Å"Be the first, be the best. † This is the most effective way for the company to enter new markets and secure a strong position by being the first to offer the right products in the right locations in a time efficient manner.Johnson & Johnson’s ability to perform these actions successfully is due to the sprawling nature of its subsidiaries and the amount of resources dedicated towards making sure that they all work with each other and share information. Johnson & Johnson holds a very strong competitive position versus other corporations due to the amount of its resources and depth of its operations. It is able to maintain its position as market leader in several product categories, as well as penetrate emerging markets, be cause of its ability to adapt quickly and intelligently.The company must remain vigilant, however, as complacency can result in loss of market share. V. Assessing Effectiveness and Conclusion In today’s fast-paced business environment, any firm needs to consistently reevaluate its strategic positioning, but in industries as competitive as the ones in which Johnson & Johnson competes, continual evaluation is vital for long-term success. By any quantitative measures, Johnson & Johnson is a very successful company, and the fact that it has earned a profit for 75 straight years suggests that there is a definite plan for long-term success.The company’s famous credo, known as â€Å"Our Credo† and written by former chairman Robert W. Johnson in 1943, may have a role in this success. The credo outlines Johnson & Johnson’s responsibilities to its customers, employees, communities, and finally its stockholders. It also establishes the principles that guide the comp any, from making high quality products and recognizing employees’ merit to protecting the environment and experimenting with new ideas. Johnson & Johnson’s credo has endured, unchanged, for over 65 years. While it does not explicitly state long term goals, the principles within it express the company’s intrinsic values.According to the company’s website, â€Å"Our Credo is more than just a moral compass. We believe it’s a recipe for business success. The fact that the Johnson  & Johnson is one of only a handful of companies that have flourished through more than a century of change is proof of that. † Johnson & Johnson has indeed flourished. It consistently tops the corporate reputation charts and is a role model for social responsibility. Moreover, the company is clearly prepared for the many challenges its ever-changing international business environment poses.Due to its strategic positioning and eye on the future, Johnson & Johnson will likely survive another century. REFERENCES Academic Visit to Johnson & Johnson, Prague, Czech Republic. â€Å"2008 Annual Report. † Johnson & Johnson Gassman, Oliver, Gerrit Reepmeyer and Maximilian von Zedtwitz. â€Å"Leading Pharmaceutical Innovation. † Springer â€Å"The Global Pharmaceutical Industry. † Duke University â€Å"Mental health drug market tapped out? † CNNMoney. com â€Å"Our Credo Values. † Johnson & Johnson. â€Å"Patent Expirations Behind J&J Cuts, C&T Looks Closer at Patents. † Cosmetics and Toiletries

Dc V. Heller Essay

Winter Honors Civics & Economics B-1 Case name: DC V. Heller A controversial topic came about in the year of 2008. It was concerning whether or not DC’s gun law was following along the lines of the Second Amendment Rights. A man by the name of Dick Anthony Heller was a special police officer and had gone in to register for a handgun for his home. The true underlying issue was whether or not the rights were protected under the Second Amendments which states: The right to bear arms. The uprising stipulation in the District of Columbia is that they have a state law that concerns the registration of a handgun. When looking into further depth of the law the following things must be adhered to in the stipulations of having a hand gun. It states that in order to have a registered handgun it must be â€Å"†¦unloaded and disassembled or bound by a trigger unless they are being used for lawful recreational activities or located in a place of business. â€Å"DISTRICT OF COLUMBIA v. HELLER. † n. pag. SIRS Government Reporter. Web. 24 Jan 2013. ) When the case was first taken up before it came to the Supreme Court, in the lower court system the verdict was dismissed until it was later reversed. The two court systems that herd the case before the Supreme Court were the Courts of Appeals and the district court. The arraignments for the plaintiff were; Dick Anthony Heller was dismissed for another four years until it was taken up again. In the arraignments for the Defendants â€Å"†¦DC found that the challenge to the constitution and its validity was without merit †¦Ã¢â‚¬  It seems as if they were trying to throw salt on the technicality of what the Constitution says in Amendment two and the right to bear arms. In the end what the plaintiff really wanted were his rights to be acknowledged, being that it’s in the constitution and he was a police officer at the time. As well as he wants to be able to have a gun in his house for protection as most people would want. In the lower court systems had voted against what the plaintiff had brought forth as evidence. When it was finally hear in the Supreme Court the case was ruled in favor of the plaintiff. Justice Stevens wrote majority of the decision by stating that the Second Amendment is given to everyone that is a citizen of the United States and that right can’t be taken away to a certain extent. There were concurrent opinions that were made by Justice Stevens who said if things are within our rights then we should be able to obtain them and use them to the fullest extent of our abilities. District of Columbia v. Heller a? â€Å" Case Brief Summary. † Lawnix Free Case Briefs RSS. N. p. , Fall 2008. Web. 28 Jan. 2013. ) The dissenting arguments of opinion came from Stephen Breyer, who stated that the second amendment is only for militia related ordeals and not a matter of being used as self defense. Heller at the time was a special police officer so therefore it was really questionab le on why the lower court verdict had made such a big deal out of the entire situation. The majority opinion was in favor of the plaintiff who wanted to register for a hand gun in the first place for the protection of his home. The importance of the case was that a man was being withheld his legal rights that are stated under the second amendment. It showed as well that a state law can be overturned by a higher government system. This case specifically was a major part of the Constitution because it showed a prime example of states trying to withhold the rights that we have as citizens. It brings light to the different things that certain state governments try to bring down and cover up.

How Can We Become a Good Citizens? & Ways to Be a Good Citizens

A good citizen is one who properly fulfills his or her role as a citizen. There are many opinions as to what constitutes a good citizen. Theodore Roosevelt said, â€Å"The first requisite of a good citizen in this Republic of ours is that he shall be able and willing to pull his weight. † Education is sometimes viewed as a prerequisite to good citizenship, in that it helps citizens make good decisions and deal with demagogues who would delude them. Roger Soder writes that in a democracy, where the demands of good citizenship are placed upon all, â€Å"only the common schools can provide to all the education that all need. † Science literacy is also frequently touted as a key to good citizenship. Good citizenship is sometimes viewed as requiring both intellectual skills (such ascritical thinking) and participatory skills (such as deliberating civilly, monitoring the government, building coalitions, managing conflict peacefully and fairly, and petitioning, speaking or testifying before public bodies). Henry David Thoreau wrote that men who serve the state making â€Å"no free exercise whatever of the judgment or of the moral sense†¦ are commonly esteemed good citizens. † Orit Ichilov notes that children â€Å"tend to perceive the government in the image of an ideal father that is benevolent and protective. At this stage, the good citizen is characterized as one who, through his behavior, proves himself one worthy of the love and protection of the government rather than one possessing certain political obligations and rights. Through their early school years, children usually continue to think in apolitical terms of their citizenship, expressing loyalty by their desire to remain in their country due to an attachment to its beauty, wildlife, and good people. By age twelve or thirteen, they begin referring more to political qualities, such as the nature and values of the regime. High school seniors define the good citizen primarily in political terms. Some students defin e good citizenship in terms of standing up for what one believes in. Joel Westheimer identifies the personally responsible citizen (who acts responsibly in his community, e. g. by donating blood), the participatory citizen (who is an active member of community organizations and/or improvement efforts) and the justice-oriented citizen (who critically assesses social, political, and economic structures to see beyond surface causes) as three different types of â€Å"good citizen. † Sometimes incentives prevail over desires to be a good citizen. For example, many people will avoid coming forth as witnesses in court cases because they do not want to deal with the inconvenience and red tape. Aristotle makes a distinction between the good citizen and the good man, writing, â€Å"†¦ there cannot be a single absolute excellence of the good citizen. But the good man is so called in virtue of a single absolute excellence. It is thus clear that it is possible to be a good citizen without possessing the excellence which is the quality of a good man. † Specifically, in his view, the good citizen is measured in relation to ruling and being ruled, the good man only in ruling. Some of the ambiguity is likely due to more than one Greek word being translated â€Å"good. Many organizations attempt to promote â€Å"good citizenship. † For example, the Boy Scouts of America published Scouting for Boys: A Handbook for Instruction in Good Citizenship, and theOntario Medal for Good Citizenship is given to those who are deemed to have made outstanding contributions to the well being of their communities without expectation of remuneration or reward. Another non profit or ganization, Good Citizen, has a mission to teach Americans how to be effective citizens and focuses on 100 citizen actions. Ways to be a good citizens. We can probably be a good citizen if we follow the given instructions 1. We must obey rules and regulations. 2. We must respect all nationalities. 3. Stand for the right of others. 4. We must be helpful and considerate, willing to put others first. 5. We must listens to the views of others and thinks about what they have to say. 6. We should helps people who are not in a position to help themselves. 7. A responsible citizen always respects the environment and does not damage it in anyway. 8. We must work hard as well as willing to learn new things. 9. We must be well mannered and pleasant.

Why I Am Not Going to Buy a Computer by Wendell Berry Essay

Why I Am Not Going to Buy a Computer by Wendell Berry - Essay Example As a writer, I would have to sacrifice an association that I am dependent upon and that I treasure.† However, people should not reject the new technology to use the less advanced typewriters and pencils. The current and future work-related opportunities depend on computers. The chart for â€Å"Projected STEM Job Growth 2010-2020† indicates a seventy percent increase in the jobs that will require advanced technology. People will need skills in more advanced technologies than the pencils and typewriters to work in the computer industry. For example, it will be necessary for the prospective workforce to know how to use the advanced technology to execute different tasks. In addition to the job prospects in the computer industry, the contemporary world uses computers in every aspect of life, and people of different age brackets utilize the current technology. The chart for â€Å"Daily Computer Use by Age Group† shows us that the use of new technology has increased by t wenty-five percent across all age groups. For instance, people use the modern technology such as the instant messaging service and Skype to communicate with their peers in different localities. Thus, the high use of computers indicates that the typewriters and pencils are less helpful in the current and future world.  

The Entertainment Industry Essay Example | Topics and Well Written Essays - 750 words

The Entertainment Industry - Essay Example The art cinema motivates its narratives through being real and authoritative. It shows us the real location of events as well as the real issues that we face daily. In order to change the main character of the movies, it is good to choose a character that has specific goals, well stated and is object oriented. The art of cinema is not concerned with the actions of the characters; instead, they are concerned with the reaction that they will get from people who watch the film. A better way of restructuring the art cinema would be putting emphasis on actors. This makes them feel that the welfare and role they are doing is important not only to the viewers but also to the producers, therefore, ensuring a good working relationship in the production of a movie. In ending some of the stories stated, it would be possible to change them as follows; In the art film â€Å"L’ Avventura† where character by the name Anna is lost and not found, it would be more appropriate to change t he plot and end it in a way that maybe the body is found dead in unknown place or maybe show her happily living with an unknown person. This makes the viewer know what happened to her in the end. In â€Å"a bout de soufflà ©Ã¢â‚¬  was the reason for Patricia’s betrayal of Michel remains unknown, the plot could change in a manner that she writes and leaves a note explaining why she betrayed him. Such changes will make the viewer contended after watching the film since they are fully aware of what happened rather than leaving them in suspense.

Compare the great depression and to the great recession Essay

Compare the great depression and to the great recession - Essay Example After the speculative boom of the 1920’s, Americans invested great amounts in the stock market. However, these were primarily financed through loans and almost two-third of the nominal value of stocks was represented by loans in 1929. Accelerated share prices motivated greater investment as people speculated that share prices would continue to escalate. Consequently, an economic bubble developed and the margin buying meant that investors would incur great losses if the market took a downturn. Similarly, the Great Recession resulted from speculation about mortgages and securities. It was a consequence of providing loans for homeownership to uncredit-worthy people. Mortgage loans were secured with mortgaged securities; so because of margin buying, banks were on the verge of bankruptcy when the market went into recession. Milton Friedman in his book, A Monetary History of the United States advocates that the Great depression was not a consequence of the economic cycles, tariffs o r the Wall Street Crash (Friedman and Schwartz). In fact, what thrust the country into depression was the collapse of banks and financial institutes. Apparently, the same can be said for the Great Recession. More than the actual effects of the Wall Street Crash of 1929, the psychological effects deterred investment in the capital markets. In turn, business security affects job certainty so that is why a decrease in capital investment led to a decrease in consumption. However, the Wall Street Crashes did cause bankruptcies, restriction on credit, failing businesses, rising unemployment, decreased money supply and the like. Likewise, the Great Recession led to a decline in international trade, increased unemployment, and dropping commodity prices. The chain of events from significant federal spending to tax increases only aggravated both the crises. Thus, the leaders targeted the scapegoats such as the Wall Street Bankers for the crises.

Introduction to People, Organisations and Management Assignment

Introduction to People, Organisations and Management - Assignment Example Numerous theorists of personality describe personality in different ways that reflects their relevant hypothetical inclinations. Personality is complex parameter that intrigues society as people try to explain the behaviour and conduct of others (Hogan & Roberts, 2001, 30-34). The same stratagems are experienced by psychologists in their endeavour to underscore the essence of personality. However, perhaps the most significant difference between lay men and psychologist is the fact that people often concentrate on individuals in their quest to understand personality while psychologists nevertheless employ formations of personality that are applicable to all. Additionally, the study of personality entails the evaluation of the manner in which traits of personality grow. The theory of personality in the work place underscores the significance of human personality in workplace behaviour whereby the behaviour of people at the work place is guided by their personalities. It is conceived fr om an understanding the workplaces are just social avenues in which individuals interact and share experiences, therefore much of what transpires in the workplaces regarding human relations and social behaviour stems from the distinct human personality. On a broad perspective, the hypothesis signifies the impossibility of understanding human behaviour in work places without the consideration of personality. Generally, personality is a function of models of thought, emotion and conduct which portray people as unique. Furthermore, personality emanates from within a person and is regular all over life (Larsen & Buss, 2008, 99-105). Components of personality comprise of; regularity, physical and psychological, impact on behaviour and conduct and multiple manifestation. Regularity denotes that aspect of consistency whereby an individual’s personality is often perceived through numerous events and that such conduct remains regular in diverse situations. Consequently, personality af fects physical and psychological parameters of an individual though it could also be determined by biological requirements and courses. Personality has a dynamic effect on behaviour and in most cases an individual’s personality determine their behaviour. Finally, personality manifests through different situations in which certain mannerisms remain consistent, one event or situation is not sufficient to determine personality. There are several components of personality that indicate personality and its influence to a person in different avenues of life. In fact, the components are crucial in understanding the concept of personality in detail because they expose the characteristics that signify personality. Personality is inherently relevant in understanding behaviour in the workplace because an individual’s conduct at the work place is greatly influenced by personality factors. The concept of workplace personality underscores the distinct set of behaviours and character of an employee at the work place, which have a lot to do with personal inclinations and orientations. As a result, personality is very significant in comprehending human behaviour at the workplace. Basically, all human behaviour is a function of personality since personality is the basis of character and conduct. On a broad view, workplace behaviour is a

Leadership in me Essay Example | Topics and Well Written Essays - 1000 words

Leadership in me - Essay Example A good leader develops through a continuous process of education, self-studying, training, as well as experience. Leadership styles vary, and that is why it is necessary for a person to understand and know their leadership style, and how their specific leadership affects their workplace. Leadership is influenced by various factors, and that is why it is vital to know how as well as why your style of leadership is what it is. There are numerous contributors involved when dealing with development of leadership styles within a person. According to Myers Brigg (MBTI- Myers Briggs Type Indicator), my leadership style of which is ESFP (extraverted, sensing, feeling, perceiving) is considered to be that of a personality type of which is one of the 16 types of personalities. People who have ESFP type personalities are frequently described as outgoing, spontaneous, and resourceful (Lester, 1975). ESFP has its characteristics, and the MBTI has four main areas in which it looks at preferences of personality, namely :(1) introversion versus extroversion, (2) feeling versus thinking (3) intuition versus sensing, and lastly perception versus judgment. ESFPs have a tendency of being very resourceful and practical. They prefer hands-on learning experiences and tend to hate learning from books as well as discussions based on the theory. When problem solving, they put their trust in instincts and personal abilities to solve solutions. Although they are quite reasonable as well as pragmatic, they hate structure, planning, and order. Instead, they prefer to act spontaneously, and spend less time formulating plans or schedules. ESFPs as extraverts like spending time with people and have great interpersonal skills. They are great at understanding people’s feelings and know how to respond their emotions differently (University of Saskatchewan, 2014 p. 1-2). Therefore, we can say that, ESFPs make incredible leaders and know how to mobilize, persuade,

DB marketing 10 Essay Example | Topics and Well Written Essays - 250 words

DB marketing 10 - Essay Example Higher preference is given to those individuals who have at least masters’ level of education in business administration. In order to become a sales manager an individual needs to have worked in entry level positions of the sales department such as the sales man, sales executive and should have around one to five years of experience in the same department. The pay scale of sales manager varies from the industry and the organization they work in. At an average a sales manager works for at a pay scale of more than $100,000 per year (Bls.gov, 2014). The BLS has projected that between the 10 year periods of 2012 to 2022 the job growth rate of this particular position is eight percent (Bls.gov, 2014). This position will be a great achievement in my life because I believe that I have the required knowledge, skills and abilities to work as a sales manager. I have always aimed at working in a position where my skills and traits can be used. I believe that if my skills and traits are u tilized in the position of sales manager, then I will end up experiencing job satisfaction. Secondly, I am majoring in the subject of sales and I am fully committed to learn the ins and outs of sales in order to pursue a career in the field of

Assignment ( Crappy Professor) Module 4 Example | Topics and Well Written Essays - 500 words

( Crappy Professor) Module 4 - Assignment Example In my school, there is a formal type of legitimate power exercised because there is a chain of command that we follow. For example, on top of the school organizational chart, there is the school board of directors, followed by the School administrator and the list continues to the last staff members who are janitors and security guards. Coercive power refers to the type of power exercised by using force or issuing of threats (Chapter 6 Power Point, 2015). It is illegitimate because there is use of force. Political power refers to the type of power used to control or influence a group of people. Unlike coercive power where there is use of force, political power has leaders who use their resources or knowledge to change the behavior of people. I plan to use supportive leadership, emotional detachment and authenticity to enhance authority as a future leader. Exercising supportive leadership is useful because it focuses on helping the followers or employees under my authority (Chapter 6 Power Point, 2015). As a leader practicing authenticity, I will provide the employees with an excellent example of what it means to accept individual responsibilities for my actions. Lastly, I will ensure that I am emotionally detached when it comes to dealing with organizational affairs. Expert power is the most stable since the leaders get the knowledge regarding organizational affairs based on the experts’ knowledge. It is useful because the leaders do not dwell on rumors and their own assumptions to make decisions regarding organizational affairs. Referent power is the strongest because leaders do not exert their power by making followers fearful of them (Chapter 6 Power Point, 2015). Instead, they get followers to respect and admire them. For example, leaders exerting coercive power get feared but not necessarily respected. Leaders practicing legitimate power may have the power, but it does not mean that they are admired or respected by followers. As

Jurassic Park Summary Report Essay Example for Free

Jurassic Park Summary Report Essay Jurassic Park Summary Report Jurassic Park, by Michael Crichton is a thrilling, science fiction novel. It tells the story about the cloning of dinosaurs, which are to be controlled in a theme park, however one mans greed, drove the park into devastation and destruction. I consider the plot to be complex. The novel is based upon a theme park featuring dinosaurs, which are created from prehistoric DNA. The novel begins with bizarre attacks from bird like creatures. John Hammond a wealthy, elderly man establishes this park. However, before the ark is to be opened, Hammond invites three scientists to come visit the island to approve of it. They are Alan Grant a Paleontologist, Ellie Sattler a Poleobotanist, and Ian Malcolm a Mathematician. Hammond also invites his two eager grandchildren, Tim and Lex, to come explore the park. While they are visiting they separate into groups to take a tour of the park. They depart in electric-run land cruisers. While they are examining the surroundings around them Tim and Lex notice raptors leaving on a boat to go to the mainland. Meanwhile, a rival company is paying a disgruntled employee at the park, Dennis Nedry, a million and half-dollars to steal dinosaur embryos. After Nedry has followed through with the plans the security system is shut down leaving the electricity shut off. Grant and the rest of his company are now stranded in the park. Their land cruisers break down on the perimeter of the tyrannosaurus padlock. The group is terrified to find that the fences are not electrified and that the t-rex has escaped. The t-rex attacks the vehicle with the children in it and the remainder of the people are killed r manage to escape. Grant, Lex, and Tim are unfortunately now trapped in the park together. While they are in the park they have to hide and run from many dangerous predators. Whilst trying to reach safety Grant observes eggshells. This causes him to anticipate that the dinosaurs in the park are breeding. Grant was told that this could not be possible considering the park had only female dinosaurs in it. Grant brings the eggshells with him to provide evidence that they are in fact breeding. Grant believes that when inosaurs are all of the female gender and therefore dont have any one to mate with, they are capable of randomly changing their sex. The people who survive their visit to Jurassic Park are taken off the island to safety. there are a dozen frozen embryos still in existence, the possibility still remains for more dinosaurs to be produced. The theme greed is distinctively revealed in Jurassic Park. I strongly agree with the message that Michael Crichton is trying to portray. The message itself shows that the motivation of greed does not guarantee success in life. John Hammond the owner of Jurassic Park demonstrates an excellent example of greed. Hammonds greed was motivated by his desire for wealth. This ultimately led to nor only his own desire, but many other lives were ruined and the reality of the park was destroyed. The plot was very intense; it had many events that were suspenseful though forceful. I enjoyed the plot, in general I considered it to be clear, exciting, and reasonably interesting. I thought Michael Crichton overall did a superior Job on the plot. The events I found were well structured, and generally simple to follow. I considered the plot to be believable and as I read I found myself questioning whether the cloning of dinosaurs could actually take place. I wondered if scientists had actually tried to take prehistoric DNA from mosquitoes and try to recreate prehistoric creatures. I imagine that Michael Crichton had to put a lot of consideration into creating the plot so it would make the novel become alive. I thought the novel was exhilarating and most amusing to read. I believe that Jurassic Park was extremely well written. I would absolutely recommend this novel to anyone.

Control Smoking Essay Example for Free

Control Smoking Essay Everywhere, we see people smoking where most of them are men. It has become a trend and a daily necessity to smokers. Therefore, it is very difficult to control smoking habit. However, benefit of smoking only for certain things such as increasing in economy income and chance of jobs but as for individual, it will only bring harm rather than good. Body A. Topic Sentence Most of smokers which are men have a lack of awareness about disadvantages of smoking. There are several disadvantages that can be seen from smoking, such as smoking is a cause of lung dysfunction. Supporting Point A cigarettes contains almost 600 ingredients, when burned it would produce about 6000 chemicals, where one of it is tar. The tar mostly will sticks to the cilia in our lungs and more things is it will be the cause of chronic obstructive pulmonary disease or COPD a. Specific Detail. Cilia are microscopic, hair-like structures that extend from the surface of every human. This can be found in the lungs, respiratory tract and middle ear. These cilia have a rhythmic waving, in other words, cilia will act as a broom that clean dirt in your respiratory system. b. Specific Detail COPD will affect the function of the lungs and how oxygen being delivers into the body plus it also the cause of chronic bronchitis and emphysema and involve the charge in the structure of your lung tissue and airways. Topic Sentence Moreover, cancer is also one of the contributions from smoking cigarettes. There are many statistics and organization that make research about cigarette but none of them have proven that cigarette’s a good thing. Supporting Point There are many kind of cancer from smoking habit and some of them are mouth and throat cancer. a. Supporting Detail Cigarette contains many cancer agents know as carcinogens. These carcinogens can cause mutations in mouth cells and develop a mouth cancer. b. Supporting Detail Since carcinogen is an agent of cancer that contain in cigarettes, it also can affect throat which lead to throat cancer. Moreover, the heat from burned cigarettes, also contribute in having Topic Sentence Another reason why smoking can harms the smokers because it can affect heart and blood vessel ability and yet there are many smokers who did not realise or lack of knowledge about the effect of smoking. Supporting point Smoking can change the structure of blood vessels. This can lead to the build-up of plaque that hardens and narrows the vessels, causing a disease called atherosclerosis. Atherosclerosis is a common cause of heart attacks and peripheral arterial disease (P.A.D.) a.Specific detail Atherosclerosis is a disease which is plaque builds up inside your arteries. Ingredients that contain in the cigarettes will help the build-up of the plaque. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body and also it is one of the factor of heart attacks. b.Specific detail Peripheral arterial disease (P.A.D.) also a disease in which plaque builds up in the arteries that carry blood to your head, organs, and limbs P.A.D.  usually affects the arteries in the legs. Smoking is the main risk factor for P.A.D. the smokers will have a risk of P.A.D. increases up to four times. Conclusion This are some of the bad effect by smoking cigarette which will affect your life, family and also people around you either in the past, present and future. Even though, some people may assume smoking is a good thing for them but the fact is that smoking is a bad habit that brings bad life style. Therefore we hope that every smoker in the world realise and start taking action on stopping a smoking habit because there are no benefit can be get from smoking.

Treatment Of Clostridium Difficile Infection Health And Social Care Essay

Treatment Of Clostridium Difficile Infection Health And Social Care Essay As a nurse working in acute medical ward for elderly, I work closely with patients with C. difficile infection. I have noticed the effect of C. difficile infection in elderly can be fatal. C. difficile is a gram positive anaerobic bacillus. They colonise in the oxygen deficient areas of the body. That can cause life threatening conditions, including diarrhoea, colitis and septicaemia and resulting death. C. difficile infection can cause serious illness and a significant cause of patient morbidity and mortality. It is a major cause of hospital acquired diarrhoea. C. difficile infection can cause serious illness and hospital outbreaks .It can cause significant financial burden on NHS. It is estimated that the increased length of hospital stay itself can cause an excess of around  £4,000 per patient. The number of death certificates mentioning C. difficile infection in England and Wales fell by 29% between 2007 and 2008 ,after increasing every year since records began in 1999(National Statistics,2008). According to Weston (2007), Clostridium difficile was first identified in 1935s, but until the late 1970s it was not identified as the cause of pseudo membranous colitis following antibiotic therapy. C. difficile infection is more common in elderly (over the age of 65). People who have a long stay in health care settings, those who have recently had gastrointestinal surgery and those who have a serious underlying illness that compromises their immune system are also at high risk to get C. difficile infection. In-patients are also at high risk if there are hospital outbreaks. Poor infection controls are also an important risk factor. Causes Antibiotics are considered as the most important cause for C. difficile infection. Any antibiotic can cause C. difficile infection, but Broad spectrum cephalosporins, broad spectrum penicillin and clindamycin are most frequently implicated. The second most commonly named antibiotic is Co amoxiclav (Health Protection Agency, 2008). The use of proton pump inhibitors such as lansoprazole, omeprazole and pantoprazole are also potential risk factor for C. difficile infection (Leonard et al., 2007). The disruption of normal harmless bacteria in the gut, because of antibiotic therapy also allows the C. difficile to multiply to greater number. The bacteria start to produce toxins. The antacids suppress the gastric acid secretion and as a result, C. difficile bacteria, including the spores are less likely destroyed. The reason for community associated C. difficile infection was unclear but it is become clear that the reasons for the majority of the infections are associated with antibiotic pr escriptions or hospitalisation (Wilcox et al., 2008). Transmission The transmission is through faecal-oral route. The infected patients acquire the organisms directly from other patients with diarrhoea. The route of transmission may be direct, via the hands of health care workers or via the hands of patients or via the environment. Asymptomatic people who are colonised with C. difficile are also can be able to transmit the disease. About 3% is the colonisation rate in healthy adults, but this increases to nearly 20 % in older people especially in chronic care wards. The spore form of C. difficile can survive in the environment for five months or more on hard surfaces. It is considered that the primary route of transmission of C. difficile infection via healthcare workers hand. Clinical features and pathogenesis The most important clinical feature is sudden onset of offensive smelling diarrhoea during a course of antibiotic or who had antibiotics with in the previous two months. Patients may pass soft or watery stool more than twice daily or in more severe cases more than 20 times accompanied by severe abdominal cramps (Weston, 2007). Abdominal distension, fever and dehydration may also be present in more severe cases. Unless C. difficile is diagnosed, the patients can be miss- diagnosed with irritable bowel syndrome. C. difficile infection is a major health problem worldwide that leads to increased morbidity and mortality. Healthy adults carry around 500 species of bacteria in the colon, 90% of which are harmless (Weston, 2007). C. difficile colitis results from the disruption of normal colonic flora and C. difficile colonises in the oxygen deficient areas of intestine. The spores are able to replicate and produce toxins that can lead to mucosal damage and inflammation. In a healthy adult t he normal colonic flora inhibit the growth and colonisation by C. difficile. The antibiotic therapy may disrupt the normal flora and allow the C. difficile to colonise very rapidly. After colonisation the organisms produces two protein exotoxins( Toxin A, an enterotoxin and Toxin B , a cytotoxin) in to the colonic lumen. These are responsible for diarrhoea and colitis. Toxin A binds to the receptors in the intestine and cause extensive tissue damage, inflammation and oedema. Both toxins posses cytotoxic activity against cultured cells by same mechanisms but they differ in cytotoxic potency, toxin B is generally 1000 times more potent than toxin A and to play a major role in activating inflammatory repose (Weston, 2007). Toxin B is more important than toxin A in the pathogenesis of C. difficile infection in man. According to lab test reports there are 100 different types of c difficile stains. The most recognised epidemic types is ribotype 027.The most important feature of ribotype 027 is hypertoxin production, 10 to 20 times more toxin than other stains. The C. difficile infection caused by ribotype 027 are more likely to be severe with increased complications such as renal impairment, severe colonic dilatation and sepsis (Freeman et al., 2007).The clinical features include increased severity of illness, failure to respond to antibiotics ,abdominal distension. Raised CRP and rising WCC particularly in patients who may have appeared to respond to antibiotics and deterioration in condition and appears to have higher mortality rate. Diagnosis Laboratory studies of stool sample will help to detect c difficile infection. Stool culture will help to detect the presence of difficile with toxin production. Stool enzyme immunoassay (ELISA)will detect both of the toxins ( A or B). For toxin B Stool cytotoxicity assay will be positive.Endoscopy may demonstrate ,but it is the least sensitive for diagnosing C. difficile as compared to stool assays., Sigmoidoscopy alone may not reveal any abnormality if the disease is confined to the right colon. Colonoscopy is more useful. Because of the risk of perforation Sigmoidoscopy and Colonoscopy is contraindicated in patients with colitis (Weston, 2007). Treatment The treatment of C. difficile infection depends on the severity of the illness. At my work place, the patient is closely monitored and isolated. A stool chart is maintained using Bristol Stool Chart. All antibiotics that are not required are stopped. This will help the normal bacteria to thrive again in the gut. If any patient develops C. difficile infection at my work place, we conduct a thorough investigation for the causes and we notify the antibiotic management team to review the patient. The team will review the patient in the ward (rounds Wed/Fri.) or via the phone. There will be a root cause analysis to find why the patient developed C. difficile infection? In some patients fluid and electrolyte replacement and nutrition review may also be necessary. In mild cases of C. difficile infection, patients are monitored for 48 hrs before starting antibiotics. In severe cases, antibiotics may need to be administered immediately. Metronidazole and Vancomycin are the two preliminary ant ibiotics used in the treatment of the infection (Weston, 2007). Usually a 7 to 10 day of therapy is required. Oral metronidazole 400mgs eight hourly for seven to ten days is the first line of treatment. It is contraindicated in women who are pregnant or who are breast feeding. The most recognised side effects of the metronidazole are an unpleasant metallic taste, nausea, vomiting, diarrhoea, abdominal pain, headache, pruritus, rashes, dizziness and reversible neutropenia. Vancomycin is known to cause the spread of vancomycin resistant bacteria. Vancomycin is used for severe, life threatening cases of C. difficile infection. It is also used for patients unable to tolerate metronidazole and failed treatment with metronidazole. Vancomycin is expensive. Oral vancomycin is not completely absorbed or metabolized in the gut and is excreted in the stool unchanged. This is ideal in the treatment of C. difficile infection. The recommended oral vancomycin doses for adults are either 125mg or 500mg four times daily. The use of a rectal vancomycin enema (500mg diluted in 1000ml of 0.9% sodium chloride injection) is also an alternative. A recurrence of symptomatic disease with re infection occurs in 5-20% cases. Management of repeated relapses is more difficult. The options include slow tapering of vancomycin or metronidazole over a period of six weeks and vancomycin combined with rifampicin for seven days. There are also case reports of successful treatments with intravenous immunoglobulin which contains antibodies to c difficile toxins. The studies shows oral administration of limited bacteria or yeast helps to reconstitute the gut flora and there is a potential to prevent infection.The ability of these organisms to colonize and also to prevent and treat the c.difficile is unclear. (Department Of Health, 2009). Surgery may be needed for small number of cases especially if C. difficile infection progress to fulminant colitis and perforation. Loperamide (anti diarrhoea drug) is contraindicated for C. difficile infection because this will slow down the clearing of toxic bacteria (Weston, 2007). Prevention Control Preventing the spread of C. difficile can be challenging as hospitals tend to have an increasing population of elderly, debilitated and susceptible persons, which naturally increases the number susceptible hosts within the environment. Isolation Isolation should be implemented in conjunction with the infection prevention and control measures to minimise the risk of spread to other vulnerable groups. Private room/side room is recommended, especially for patients who are fecally incontinent. Cohort symptomatic C. difficile associated disease patients only with other symptomatic C. difficile infected patients, to minimise environmental contamination. Patients with C. difficile infection may be moved to other rooms or bays when the diarrhoea ceases (no diarrhoea at least 48 hours) (Department Of Health, 2009 and Health Protection Agency, 2009). Hand washing Barrier nursing Contact precautions should be used for C. difficile infected patients with diarrhoea. Proper hand washing is essential. Alcohol-based hand gels are not effective in reducing the spread of the organism and are not recommended. Disposable gloves and aprons should be worn when caring for the patients. It is recommended that not to share the equipments between the patients. It is a good practice to inform healthcare workers and visitors that a patient is on contact precautions, such as labelling the door of the room, without disturbing patients privacy. Last year we (My work place) spent  £1,280.32 for soap, alcohol, gel and moisturiser. Environmental Cleaning The environment of a patient with C. difficile infection should be cleaned thoroughly at least twice per day. An approved hospital disinfectant-detergent should be used for all environmental cleaning. Terminal cleaning (stage cleaning) of ward area is essential after the discharge or transfer or death of a patient with C. difficile infection. (My ward) Decontamination of equipment Do not share equipments among patients to prevent cross infection. Commodes and bedpans are heavily contaminated with spores and are considered as vehicles of cross infection in C. difficile outbreaks. It is ideal that symptomatic patients have their own commodes or toilet facilities. Proper disinfection must be essential. Transfer of Patients Transfer of patients with C. difficile infection or disease to another ward, unit, or to the long term care facility must be informed prior to the transfer that the patient has C. difficile infection. Same notice must accompany transfer of patients with C. difficile infection to a long term care facility (Department Of Health, 2009). It is not necessary to have absence of diarrhoea or negative stool cultures before the transfer of a C. difficile patient to a long term care facility. On the patients discharge, we need to notify the primary care physician (My ward). Rectal Thermometers Since the outbreaks C. difficile in hospitals and long term care facilities, rectal thermometers are restricted to use. For the routine use Electronic tympanic thermometers are recommended (Department Of Health, 2009) Education Ward should conduct training programmes to the health care staff. Ensure that patient / family information leaflets are given out. Anti microbial management team It is the responsibility of the hospital trust to develop anti microbial management team. That should consist of a consultant microbiologist, pharmacist and prescriber. The trust also needs to develop restrictive antibiotic guidelines. These guidelines specifically need to address to avoid the use of broad spectrum cephalosporin, broad spectrum penicillin and clindamycin especially in elderly and minimise the use of fluroquinolones, carbapenems,that we follow in my work place. It is also a good practice to have an infection control link nurse to each and every ward. It is their responsibility to do proper training for staffs and auditing the clinical area. Outbreaks of C. difficile infection in Long Term Care Facilities An outbreak of C. difficile infection is defined as three or more cases of symptomatic C. difficile infection mainly in the same area of the hospital ward within a period of seven days. Infected patients should be placed in isolation room or cohorted. Patient(s) can be removed from precautions if there is no diarrhoea .There is no need to wait for negative stool culture to remove the patent from precautions. An education program regarding C. difficile infection and its transmission and prevention should be conducted to all health care workers. Need to highlight the use of gloves and aprons and moreover proper hand washing. The health care facility need to monitor for any significant episodes of C. difficile infection, and then need to liaise with local health department for further assistance (Walker K et al., 1993). Possible Solution Conducting education programmes and workshops for health care workers and public to increase the awareness of C. difficile infection can contribute a major role in reducing the number of C. difficile infection cases within the healthcare system. Need special attention to personal hygiene. The primary route transmission is via the hands of healthcare workers and other patients and residents. It is very important to perform proper hand washing and barrier nursing (gloves, gowns). Environmental hygiene is also very important factor in controlling C. difficile infection. Regular and proper cleaning of patient rooms with anti bacterial cleaning agents is essential as C. difficile toxins can stay in the environment for several months. Changing the way doctors prescribe antibiotic therapy is also an important strategy in control the C. difficile infection. Because C. difficile infection is always associated with the use of antibiotics, It is also recommended to have an antimicrobial management team for each hospital (Department Of Health, 2009). In cases of recurrent C. difficile infection experts agree that the non antibiotic treatment have a positive impact. The use of toxin binders neutralises the effect of toxin producing stains and to helps the intestinal flora to restore .Tolevamer, developed by Genzyme Corporation is the first non antibiotic treatment approved for C. difficile infection (www.mediscape.com). Mandatory surveillance of C. difficile infection in the United Kingdom When looking at surveillance reports, many of the hospitals in the UK have been affected with outbreaks of C. difficile.  We can see that the large increase in the number is between 2000 and 2007.It is the responsibility of the  hospitals in the UK has to measure and report to the Department of Health.  The surveillance should include the number of positive cases, number of severe infections, the number of required surgery cases and number of deaths. The surveillance of C. difficile infection is taking to get a target for 30% reduction from 2007/2008 numbers by 2010/2011.  In 2007-2008, there were 55,498 cases reported across England. In 2008-2009, the cases reported dropped to 36,095. i.e., cases dropped by 35%. Last year our target (My hospital and my community) was 180. The number of cases reported was 171, 98 of which are from hospital (7 cases from my ward).This year, the target is 155. Social, economic and political issues. C. difficile infection is expensive to the NHS. The total identifiable increased cost of C. difficile infection causes an excess of  £4000 per case. Such high costs can be used to justify expenditure on personnel and/or other control measures to reduce the incidence of this hospital-acquired infection. There are notable outbreaks of c. difficile infection worldwide since 2003.Outbreaks was reported in Montreal, Quebec and Calgary, Alberta, in Canada. Approximately 1400 cases affected, death count 36 89.A similar outbreak reported at Stoke Mandeville Hospital in the United Kingdom between 2003 and 2005, in which 33 patients died. In 2007 Maidstone and Tunbridge Wells NHS Trust was heavily criticized by the Commission, have heightened media and made public awareness. In 2009, four deaths reported at Our Lady of Lourdes Hospital in Ireland also thought to have links to Clostridium difficile infection. The prevention and control of C. difficile infection in health care settings is bec ome a global public health challenge.(Health Protection Agency 2009) Conclusion C. difficile infection is a major problem in hospitals that is associated with the use of antibiotics. C. difficile infection also recognised as one of the major health care associated infection. It is estimated that C. difficile infection affects between 40000-60000 people in the UK every year. The prevention and control of C. difficile infection is very important. The three main elements of prevention are: Need to restricted use of antibiotics; Strict isolation precautions and barrier nursing when looking after patients with diarrhoea and Through cleaning of clinical areas. Poor hand washing is known to play a key role in the spread of infection. Hand washing facilities in the hospitals such as the number of hand washing sinks and their position, and type of taps are also need to be inspected. Hand washing protocols is low in many hospitals. C. difficile infection needs treatment only if it is symptomatic. Most of the people make full recovery and in rare cases the infection can be fatal. Infection control teams need to develop education programmes to improve compliance and regular auditing. It is everybodys business to participate to prevent and control C. difficile infection with in the health care system. The health care workers need to follow the hospital infection control policy.

Madame Bovary Vs. The Awakening Essay -- Madame bovary Awakening Compa

Madame Bovary Vs. The Awakening Madame Bovary by Gustave Flaubert and The Awakening by Kate Chopin both show the life of a woman in a half-dreamy stupor, overzealously running around looking for something but not knowing what it is they are looking for. They feel immensely dissatisfied with the lives they are stuck with and find suicide to be the only alternative. The two books, Madame Bovary, written in 1857 and The Awakening, written in 1899, both have the theme of confinement and free-will, yet differ vastly with respect to the yearnings of the main characters. In addition, Edna and Emma, the protagonists of Madame Bovary and The Awakening respectively, are faced with a conflict between external oppression and their own free will, which eventually leads them to take their lives. Edna and Emma have vastly different yearnings yet similar reasons for suicide. Edna’s and Emma’s yearnings are vastly different, if not opposite. Edna yearns for an uncontrolled lifestyle because her current lifestyle leaves her feeling like a possession. She yearns to break that label; she fights to do as she wishes. Her moving into the Pigeon house, shedding of layers of restrictive clothing, and having affairs with Robert and Arobin show this feeling of confinement. Emma, on the other hand, wants to indulge in what Edna fights against; she wants to be owned and attempts to achieve self-fulfillment through romantic attachments, whereas Edna wants to break away from all attachment, especially family and society. Emma’s yearnings are shown through her affairs with Leonce and Rudolphe, her unrestricted spending of money, and through her thoughts and feelings of discontent. Emma yearned to escape the monotony of her life; she coveted sophistication, sensuality, and passion, and lapsed into extreme boredom when her life did not fit the model of what she believed it should be. Emma merged her dream world with reality without knowing it in order to survive the monotony of her existence, while ultimately destroying her. It is not her intellect, but her capacity to dream and to wish to transform the world to fit her dreams, which sets her apart from Edna. For instance, at the scene where Emma and Charles go to the La Vanbyessard’s chà ¢teau, Emma is awestruck by a fat, uncouth, upperclassman. At the head of the table, alone among the ladies, an old man sat hunched over hi... ... never really loved her. Even the moneylender played her weakness and took advantage of her. Emma realized also that her romantic idealisms could never be filled; that though a man like that may exist, she could never find him. â€Å"But if somewhere there existed a strong, handsome man with valorous, passionate and refined nature, a poet's soul in the form of an angel, a lyre with strings of bronze intoning elegiac nuptial songs to the heavens, why was it not possible that she might meet him some day? No, it would never happen!† (Flaubert 245). Emma loses all hope, and falls into a deep state of depression. â€Å"Besides, nothing was worth seeking-everything was a lie! Each smile hid a yawn of boredom, each joy a curse each pleasure its own disgust; and the sweetest kisses only left on one's lips a hopeless longing for a higher ecstasy!† (Flaubert 245). This loss of hope due to the crumbling of the foundations of her dream world and her inability to emulate the model she set for herself led to her suicide. This is similar to Edna in that Edna’s inability to achieve total independence forced her to commit suicide rather than be forced to live in such a world of tyranny and repression.

Susan DElia Speech 214: The Rhetoric of Reggae Music Spring 2002 :: essays papers

Susan D'Elia Speech 214: The Rhetoric of Reggae Music Spring 2002 Women’s Fashion in Jamaican Dancehalls â€Å"A woman has to use what she’s got to get just what she want.† -- James Brown Actress Audrey Reid does just that as the character Marcia in the Jamaican film â€Å"Dancehall Queen.† Reid plays a street vendor and single mother of two daughters struggling to give her family a better life. Poverty stricken, Marcia is forced to rely on her sugar daddy â€Å"Larry,† to feed her family and put her daughters through school. Unfortunately the price to pay is her fifteen-year-old daughter’s virginity. Appalled at how low they must stoop just to get by, Marcia decides to transform herself into a seductive dancehall girl in hopes of finding an alternative way to provide for her family. The new Marcia makes quite an impression on the men of the Kingston nightclub. When she is disguised in her dancehall costume Larry falls in love with her and showers her with expensive gifts. She is also invited to compete in a profitable dance-off against the reigning Dancehall Queen. The film ends with Marcia’s triumph, and she is awarded a large sum of money. Although this film is a highly romanticized story of a single mother rising to the title of â€Å"Dancehall Queen,† it gives an accurate portrait of the atmosphere of a Jamaican dancehall, as well as capturing the independent, strong spirit of Jamaican women. â€Å"Too many young girls in Jamaica feel trapped by dirty old men who convince them that life offers no alternatives but a future in bed with them,† explains the film’s writer and editor Suzanne Fenn. â€Å"The sub-plot in â€Å"Dancehall Queen† might be unpalatable but it’s based on a prevalent reality.† Although the film has endured some criticism, the film’s after-after party at Kingston’s Club Mirage proved that Dancehall Queen isn’t â€Å"the invention of a perverted production team in search of celluloid satisfaction. Real-life dancehall queens stroked their crotches, winded their hips and rubbed their well-oiled buttocks† (St. Hill). â€Å"Although the dancehall scene is a male dominated one, it is the female, like a queen, who reigns supreme† (www.ppreggae.com) Covering reggae history, respectively, â€Å"Reggae Songbirds† and â€Å"Dancehall Queens† offer a fairly comprehensive overview of the contributions of women in reggae. The dancehall has become a form of a message center for Jamaican people, no matter where they are within the social structure of the island.

Americas War on Drugs Essay -- Illicit Drugs

Throughout history, Americans have fought many enemies that threaten the safety of our great Nation and provided aid and resources to our partnering countries in their time of despair. However, the consequences were substantial, countless brave men and women lost their lives defending the freedom of Americans. Today American’s fight a different kind of war; it is a war without a clear enemy or end in sight. Today, America fights a War on Drugs. In the early 1970s, the War on Drugs was still relatively new and drug smuggling continued, going virtually unimpeded through the U.S. northern border (Stout 34). For over 40 years, the War on Drugs (implemented by former President Richard Nixon) had cost the United States an estimated one trillion dollars, for what is believed to be nothing more than an â€Å"objective to stomp out growing social discontent in the country† (Stout 38). However, by this time, the drug demand had increased significantly throughout the United States and many drug smugglers were beginning to create smaller organizations throughout Mexico, breaking all ties with the larger organizations. Furthermore, cash flow from drug sales wasn’t enough and other methods for obtaining quick money were used to subsidize their income, such as; kidding napping for large ransoms, prostitution and auto theft. With criminal activity escalading, President Nixon then created the Drug Enforcement Administration (DEA) in 1973 to declare an, â€Å"all-out global war on the drug menace† (Martin 226). Although, drug production and smuggling was an essential way of life for many Hispanics throughout Mexico, the United States continued to provide financial and military aid throughout decades of uncertainty. Additionally, these actions resulted ... ...s." Latin Trade (English) 17.2 (2009): 22. MasterFILE Premier. Web. 18 Apr. 2012. Campos, Isaac. "In Search Of Real Reform: Lessons From Mexico's Long History Of Drug Prohibition." NACLA Report On The Americas 44.3 (2011): 14-18. Academic Search Premier. Web. 18 Apr. 2012. Kellner, Tomas, and Francesco Pipitone. "Inside Mexico's Drug War." World Policy Journal 27.1 (2010): 29-37. Academic Search Premier. Web. 18 Apr. 2012. Martin, William. "Texas High Ways." Texas Monthly 37.10 (2009): 148. MAS Ultra - School Edition. Web. 18 Apr. 2012. Martin, William. "Texas High Ways." Texas Monthly 37.10 (2009): 148. MAS Ultra School Edition. Web. 18 Apr. 2012. Stout, Robert Joe. "Do The United States And Mexico Really Want The Drug War To Succeed?." Monthly Review: An Independent Socialist Magazine 63.8 (2012): 34. Points of View Reference Center. Web. 18 Apr. 2012.

“Divergent” by Veronica Roth Essay

Your decision in life all comes down to you and the path you choose, but just one choice can transform you. Veronica Roth created a strange dystopian world that morally depends on the choices people make in life, because their choices define who they are as people. Her futuristic world is divided into five factions that each represents something different; Abnegation (the selfless), Candor (the honest), Erudite (the intelligent), Amity (the peaceful) and Dauntless (the brave). These five factions were made up to prevent war and bring peace to the world and when they turn sixteen they get the chance to choose to leave their family, to transfer into a new faction or stay with them, but the choice all came down to them. THESIS: In the novel Divergent Veronica Roth examines how the theme of choice leads to bravery, betrayal, and greed. Body Paragraph 1: Topic sentence- Firstly the theme of choice leads to bravery, because of Tris selfish choice to leave abnegation and go into dauntless. Point:  Tris bravery in becoming a part of the dauntless is a foil to her own character, because Tris is a person of action, who has courage and is brave, but Beatrice, is the complete opposite. If Tris never made the choice to leave her faction, she would have never learned to be brave enough to overcome her fears and turn from the underdog into a hero. Bravery is represented in this book as being selfish and foolish, because the characters of the dauntless conception of bravery is acting in ridiculous life threatening situations to prove who is most daring to participate. However, bravery is truly presented as Tris goes through initiation. Not only has her choice to transfer into a different faction show her braveness but it also brought out her inner abnegation and taught her how to be selfless as well: â€Å"I believe in ordinary acts of bravery, in the coura ge that drives one person to stand up for another.† (Roth 207) Analysis: The significance of this quote is to show how Tris resembles bravery itself. Tris showed people that bravery is not just about being strong and committing acts of ruthlessness; it is about standing up for what you believe is right and being the big person in a situation when no one else is. Her choice to be brave and stand up for other people is what made her the hero in the end. Through bravery Tris was able to channel other traits in her from other factions and create a new her. Because of her willingness to be brave she was able to change herself and the way she thought. She was no longer the old Beatrice of abnegation. She turned in to the brave, courageous, strong, smart and selfless Tris of the dauntless. Any obstacle that came in her way she was able to overcome it and beat it and because of the one choice she made to decide to be brave, it made all the difference. Point 2: In addition to the above, Tris is a foil to her own character because if she had never joined the dauntless, she would have never been able to be on her way to saving the world: â€Å"I feel like someone breathed new air in my lungs. I am not abnegation. I am not dauntless. I am Divergent. And I can’t be controlled. (Roth 442) Analysis: The significance of this quote is that it shows how much Tris character changed from when she was in Abnegation to now. Being a part of the dauntless gave Tris the strength, the bravery, and the determination to get out there in the midst of it all as the world is crumbling to stand up for her own kind. If she never made the choice to change factions, she would have never had the chance to completely find herself and who she truly is, make the friends she did, and learn how to face her fears. Conclusion: In conclusion Tris bravery and strength Therefore Victoria Roth shows that through choice leads bravery, because bravery isn’t just something that happens on its own. It is the choice and the act of bravery that only you can decide to commit to and play a factor on your life. Body Paragraph: Topic sentence: Secondly the theme of choice leads to betrayal because of Tris and her brother, Caleb, choice to leave their family Point: Tris and Caleb’s betrayal is an example of pathos. Before Tris and Caleb are chosen to go up and decide on whether they will stay with their old faction or leave, their parents go to congratulate them: â€Å" My father kisses me on the head and clap Caleb on the shoulder grinning. See you soon, he says. Without a trace of doubt† (Roth 40-41) Analysis: The significance of this quote is that it shows how much hurt and betrayal they cause their father, especially, at the time. The one value that is most important about being a part of abnegation is not being selfish and to think about others. In this case Beatrice and Caleb’s choice to leave their family behind was not an act of selfishness, because they only considered themselves and not how their parents would feel. Thinking that his kids would choose to come home and stay with him and their mother, the father made a comment about how he would see them soon before the choosing ceremony started only to know minutes later that neither of his kids is coming home, and one of his kids (Caleb) are going home with the enemy- the erudite. The one choice they made that they thought would benefit them more in life ended up leading to their dishonour and betrayal of not only their family but their ex- faction. Point 2: Another act of betrayal was when one of Tris friends, Al, almost killed her out of jealousy, and insecurity. Al was supposed to be someone Tris thought she could depend on to keep her safe, trust, and ensure her that everything would be â€Å"okay† when the antagonist of the story and his crew would pick on her; but in the end he betrays her: â€Å"The soap smell is familiar. Lemon grass and sage. The same smell around Al’s bunk. A weight drops in my stomach†¦Ã¢â‚¬  â€Å"I suggest you rely on your transfer friends to protect you from now on,† he says â€Å"I thought I was†¦ I feel Al’s hands against my mouth, and a sob jolts my body forward†¦Ã¢â‚¬  â€Å"He wanted you to be the small quiet girl from Abnegation†¦ He hurt you because your strength made him feel week. No other reason† (Roth 278, 295) Analysis: The significance of this quote is that it shows you how one minute you can trust someone and the next they can easily make the choice to betray and  hurt you. Veronica Roth creates pathos for Tris, because Tris knows that she can no longer trust Al again even though they were such good friends. Al’s one choice not only hurt Tris but it also ruined their friendship, and this is one of the ways Veronica Roth shows how your one choice can define who you are as a person. Tris’ strength and ability was what caused Al to be jealous and in the end his jealousy cost him. Conclusion: Therefore, Veronica Roth created a sense of betrayal through the theme of choice, because it is another way of her showing how a specific choice can not only affect you but the other people around you. Body Paragraph 3: Topic Sentence: The theme of choice leads to war as the leader of the Erudite chooses to start a war over her own selfish reason. The factions were divided into five to prevent war and destruction from occurring in the world; but because the people of abnegation are divergent she chooses to take away many people physical and mental control to start a war and take them down: The theme of choice leads to greed because those who have power live in fear of loosing it.

The Host Chapter 12: Failed

It's impossible! You've got it wrong! Out of order! That can't be it!† I stared into the distance, sick with disbelief that was turning quickly to horror. Yesterday morning I'd eaten the last mangled Twinkie for breakfast. Yesterday afternoon I'd found the double peak and turned east again. Melanie had given me what she promised was the last formation to find. The news had made me nearly hysterical with joy. Last night, I'd drunk the last of the water. That was day four. This morning was a hazy memory of blinding sun and desperate hope. Time was running out, and I'd searched the skyline for the last milestone with a growing sense of panic. I couldn't see any place where it could fit; the long, flat line of a mesa flanked by blunt peaks on either end, like sentinels. Such a thing would take space, and the mountains to the east and north were thick with toothy points. I couldn't see where the flat mesa could be hiding between them. Midmorning-the sun was still in the east, in my eyes-I'd stopped to rest. I'd felt so weak that it frightened me. Every muscle in my body had begun to ache, but it was not from all the walking. I could feel the ache of exertion and also the ache from sleeping on the ground, and these were different from the new ache. My body was drying out, and this ache was my muscles protesting the torture of it. I knew that I couldn't keep going much longer. I'd turned my back on the east to get the sun off my face for a moment. That's when I'd seen it. The long, flat line of the mesa, unmistakable with the bordering peaks. There it was, so far away in the distant west that it seemed to shimmer above a mirage, floating, hovering over the desert like a dark cloud. Every step we'd walked had been in the wrong direction. The last marker was farther to the west than we'd come in all our journeying. â€Å"Impossible,† I whispered again. Melanie was frozen in my head, unthinking, blank, trying desperately to reject this new comprehension. I waited for her, my eyes tracing the undeniably familiar shapes, until the sudden weight of her acceptance and grief knocked me to my knees. Her silent keen of defeat echoed in my head and added one more layer to the pain. My breathing turned ragged-a soundless, tearless sobbing. The sun crept up my back; its heat soaked deep into the darkness of my hair. My shadow was a small circle beneath me when I regained control. Painstakingly, I got back on my feet. Tiny sharp rocks were embedded in the skin on my legs. I didn't bother to brush these off. I stared at the floating mesa mocking me from the west for a long, hot time. And finally, not really sure why I did it, I started walking forward. I knew only this: that it was me who moved and no one else. Melanie was so small in my brain-a tiny capsule of pain wrapped tightly in on her herself. There was no help from her. My footsteps were a slow crunch, crunch across the brittle ground. â€Å"He was just a deluded old lunatic, after all,† I murmured to myself. A strange shudder rocked my chest, and a hoarse coughing ripped its way up my throat. The stream of gravelly coughs rattled on, but it wasn't until I felt my eyes pricking for tears that couldn't come that I realized I was laughing. â€Å"There was†¦ never†¦ ever†¦ anything out here!† I gasped between spasms of hysteria. I staggered forward as though I were drunk, my footprints trailing unevenly behind me. No. Melanie uncurled from her misery to defend the faith she still clung to. I got it wrong or something. My fault. I laughed at her now. The sound was sucked away by the scorching wind. Wait, wait, she thought, trying to pull my attention from the joke of it all. You don't think†¦ I mean, do you think that maybe they tried this? Her unexpected fear caught me midlaugh. I choked on the hot air, my chest throbbing from my fit of morbid hysteria. By the time I could breathe again, all trace of my black humor was gone. Instinctively, my eyes swept the desert void, looking for some evidence that I was not the first to waste my life this way. The plain was impossibly vast, but I couldn't halt my frantic search for†¦ remains. No, of course not. Melanie was already comforting herself. Jared's too smart. He would never come out here unprepared like we did. He'd never put Jamie in danger. I'm sure you're right, I told her, wanting to believe it as much as she did. I'm sure no one else in the whole universe could be this stupid. Besides, he probably never came to look. He probably never figured it out. Wish you hadn't. My feet kept moving. I was barely aware of the action. It meant so little in the face of the distance ahead. And even if we were magically transported to the very base of the mesa, what then? I was absolutely positive there was nothing there. No one waited at the mesa to save us. â€Å"We're going to die,† I said. I was surprised that there was no fear in my rasping voice. This was just a fact like any other. The sun is hot. The desert is dry. We are going to die. Yes. She was calm, too. This, death, was easier to accept than that our efforts had been guided by insanity. â€Å"That doesn't bother you?† She thought for a moment before answering. At least I died trying. And I won. I never gave them away. I never hurt them. I did my best to find them. I tried to keep my promise†¦ I die for them. I counted nineteen steps before I could respond. Nineteen sluggish, futile crunches across the sand. â€Å"Then what am I dying for?† I wondered, the pricking feeling returning in my desiccated tear ducts. â€Å"I guess it's because I lost, then, right? Is that why?† I counted thirty-four crunches before she had an answer to my question. No, she thought slowly. It doesn't feel that way to me. I think†¦ Well, I think that maybe†¦ you're dying to be human. There was almost a smile in her thought as she heard the silly double meaning to the phrase. After all the planets and all the hosts you've left behind, you've finally found the place and the body you'd die for. I think you've found your home, Wanderer. Ten crunches. I didn't have the energy to open my lips anymore. Too bad I didn't get to stay here longer, then. I wasn't sure about her answer. Maybe she was trying to make me feel better. A sop for dragging her out here to die. She had won; she had never disappeared. My steps began to falter. My muscles screamed out to me for mercy, as if I had any means to soothe them. I think I would have stopped right there, but Melanie was, as always, tougher than I. I could feel her now, not just in my head but in my limbs. My stride lengthened; the path I made was straighter. By sheer force of will, she dragged my half-dead carcass toward the impossible goal. There was an unexpected joy to the pointless struggle. Just as I could feel her, she could feel my body. Our body, now; my weakness ceded control to her. She gloried in the freedom of moving our arms and legs forward, no matter how useless such a motion was. It was bliss simply because she could again. Even the pain of the slow death we had begun dimmed in comparison. What do you think is out there? she asked me as we marched on toward the end. What will you see, after we're dead? Nothing. The word was empty and hard and sure. There's a reason we call it the final death. The souls have no belief in an afterlife? We have so many lives. Anything more would be†¦ too much to expect. We die a little death every time we leave a host. We live again in another. When I die here, that will be the end. There was a long pause while our feet moved more and more slowly. What about you? I finally asked. Do you still believe in something more, even after all of this? My thoughts raked over her memories of the end of the human world. It seems like there are some things that can't die. In our mind, their faces were close and clear. The love we felt for Jared and Jamie did feel very permanent. In that moment, I wondered if death was strong enough to dissolve something so vital and sharp. Perhaps this love would live on with her, in some fairytale place with pearly gates. Not with me. Would it be a relief to be free of it? I wasn't sure. It felt like it was part of who I was now. We only lasted a few hours. Even Melanie's tremendous strength of mind could ask no more than that of our failing body. We could barely see. We couldn't seem to find the oxygen in the dry air we sucked in and spit back out. The pain brought rough whimpers breaking through our lips. You've never had it this bad, I teased her feebly as we staggered toward a dried stick of a tree standing a few feet taller than the low brush. We wanted to get to the thin streaks of shade before we fell. No, she agreed. Never this bad. We attained our purpose. The dead tree threw its cobwebby shadow over us, and our legs fell out from under us. We sprawled forward, never wanting the sun on our face again. Our head turned to the side on its own, searching for the burning air. We stared at the dust inches from our nose and listened to the gasping of our breath. After a time, long or short we didn't know, we closed our eyes. Our lids were red and bright inside. We couldn't feel the faint web of shade; maybe it no longer touched us. How long? I asked her. I don't know, I've never died before. An hour? More? Your guess is as good as mine. Where's a coyote when you really need one? Maybe we'll get lucky†¦ escaped claw beast or something†¦ Her thought trailed off incoherently. That was our last conversation. It was too hard to concentrate enough to form words. There was more pain than we thought there should be. All the muscles in our body rioted, cramping and spasming as they fought death. We didn't fight. We drifted and waited, our thoughts dipping in and out of memories without a pattern. While we were still lucid, we hummed ourselves a lullaby in our head. It was the one we'd used to comfort Jamie when the ground was too hard, or the air was too cold, or the fear was too great to sleep. We felt his head press into the hollow just below our shoulder and the shape of his back under our arm. And then it seemed that it was our head cradled against a broader shoulder, and a new lullaby comforted us. Our lids turned black, but not with death. Night had fallen, and this made us sad. Without the heat of day, we would probably last longer. It was dark and silent for a timeless space. Then there was a sound. It barely roused us. We weren't sure if we imagined it. Maybe it was a coyote, after all. Did we want that? We didn't know. We lost our train of thought and forgot the sound. Something shook us, pulled our numb arms, dragged at them. We couldn't form the words to wish that it would be quick now, but that was our hope. We waited for the cut of teeth. Instead, the dragging turned to pushing, and we felt our face roll toward the sky. It poured over our face-wet, cool, and impossible. It dribbled over our eyes, washing the grit from them. Our eyes fluttered, blinking against the dripping. We did not care about the grit in our eyes. Our chin arched up, desperately searching, our mouth opening and closing with blind, pathetic weakness, like a newly hatched bird. We thought we heard a sigh. And then the water flowed into our mouth, and we gulped at it and choked on it. The water vanished while we choked, and our weak hands grasped out for it. A flat, heavy thumping pounded our back until we could breathe. Our hands kept clutching the air, looking for the water. We definitely heard a sigh this time. Something pressed to our cracked lips, and the water flowed again. We guzzled, careful not to inhale it this time. Not that we cared if we choked, but we did not want the water taken away again. We drank until our belly stretched and ached. The water trickled to a stop, and we cried out hoarsely in protest. Another rim was pressed to our lips, and we gulped frantically until it was empty, too. Our stomach would explode with another mouthful, yet we blinked and tried to focus, to see if we could find more. It was too dark; we could not see a single star. And then we blinked again and realized that the darkness was much closer than the sky. A figure hovered over us, blacker than the night. There was a low sound of fabric rubbing against itself and sand shifting under a heel. The figure leaned away, and we heard a sharp rip-the sound of a zipper, deafening in the absolute stillness of the night. Like a blade, light cut into our eyes. We moaned at the pain of it, and our hand flew up to cover our closed eyes. Even behind our lids, the light was too bright. The light disappeared, and we felt the breath of the next sigh hit our face. We opened our eyes carefully, more blind than before. Whoever faced us sat very still and said nothing. We began to feel the tension of the moment, but it felt far away, outside ourself. It was hard to care about anything but the water in our belly and where we could find more. We tried to concentrate, to see what had rescued us. The first thing we could make out, after minutes of blinking and squinting, was the thick whiteness that fell from the dark face, a million splinters of pale in the night. When we grasped that this was a beard-like Santa Claus, we thought chaotically-the other pieces of the face were supplied by our memory. Everything fit into place: the big cleft-tipped nose, the wide cheekbones, the thick white brows, the eyes set deep into the wrinkled fabric of skin. Though we could see only hints of each feature, we knew how light would expose them. â€Å"Uncle Jeb,† we croaked in surprise. â€Å"You found us.† Uncle Jeb, squatting next to us, rocked back on his heels when we said his name. â€Å"Well, now,† he said, and his gruff voice brought back a hundred memories. â€Å"Well, now, here's a pickle.†