Golden Gate Bridge Suicide-Prevention Barrier Essay

Golden Gate Bridge Suicide-Prevention Barrier - Essay Example 37 people died jumping off the bridge in the year 2011. About 100 people are stopped from jumping. People who throw their lives here drown in the deep waters like the flies burn themselves throwing in the glow of light. Technically, this Gate has been hailed as an engineering marvel, and an international landmark that attracts the tourists, but its reputation is otherwise alarming. Aaron Sankin writes, â€Å"The Chronicle estimates that a minimum of 1,218 suicides have taken place on the bridge, a minimum of 19 per year--making it the single most suicide-prone location in the whole United States. Leaping from the bridge to the icy water below is usually fatal; people taking the plunge are killed 98% of the time.† (sfappeal.com †¦)For the sake of maintaining the beauty of the Bridge sacrifice of the precious lives is not the answer. Those who appreciate the engineering skills of the bridge, must exhibit some sensitivity about the number of suicides at the altar of the Brid ge. That the final solution to this problem should remain in limbo looks like a fictional account, but the 2011 suicide figures are the stark reminder to this bone-chilling issue. This is a problem for which the legal luminaries of the country should file a suit in the appropriate legal forums for the gross negligence of the concerned authorities to prevent the loss of human lives. In the absence of a system in place, deaths continue to occur. So, the Federal funding is the next option before the district authorities. At the district level, the authorities make concerted efforts and seek private donations from individuals interested in the installation of the barrier. In the absence of adequate safety barriers, The Golden Gate Bridge has turned out to be a public health hazard. Elaborating this aspect John Bateson writes, â€Å"Do you have a plan for how you’d do it? Do you have a time frame? Have you put any part of your plan into action? Suicide rarely comes in normal conversation†¦Ã¢â‚¬  (132) Most of the international tourist spots have suicide barriers. Why deny such a facility to this unique spot? I think that the district authorities must be allocated Federal Funds to the tune of $50 million. This is not a spot of local tourist delight. Tourists from all over America/world visit the bridge and thus it is a revenue-generating source as well. Further, a two-pronged strategy to prevent suicides needs to be formulated to make the entire project more human. Apart from the grant from the Federal level, the local authorities must take certain ancillary measures, for augmenting the resources on a permanent basis, for proper governance and maintenance of the Bridge. 1st Objection to the solution Physical barriers is not the final choice to eliminate all suicides. But they significantly decrease the attempts, as suicide is mostly an impulsive act, and those few minutes which give pause to the mental makeup of the individual attempting suicide will do good to save the precious life.

Factors influencing the rate of enzyme catalysed reactions Essay

Factors influencing the rate of enzyme catalysed reactions - Essay Example Role of enzyme: enzymes catalyze physiologic reactions by decreasing the activation energy level that the reactants (substrates) must reach for the reaction to occur. They cannot alter the equilibrium of a reaction but can only decrease the activation energy of the reaction thereby accelerating the reaction rate. Activation energy: it is the amount of energy that is required to raise all molecules in one mole of a compound (substrate) at a specified temperature to the transition state at the peak of the energy barrier. Free energy of activation: it is the energy barrier that prevents chemical reactions. Reactants processing enough energy to overcome the energy barrier participate in product formation .The enzyme activity is determined by the rate of an enzyme catalyzed reaction under certain defined conditions2. Reaction rate/velocity (v): it is the rate of conversion of a substrate to products per min (mol/min). The reaction rate is proportional to the concentration of reacting molecules.A + B C + D If concentration of A and B is doubled, the rate of reaction is also doubled. At equilibrium, forward reaction and backward reaction are equal, so that K1 A + B C +D K2 Forward reaction R1 = K1 [A] [B] Backward reaction R2 = K2 [C] [D] At equilibrium R1 = R2 OR K1 [A] [B] = K2 [C] [D] OR K1/K2 = [C] [D] / [A] [B] = Keq or Equilibrium constant...Each enzyme contains 2. Catalytic efficiency: enzymes are highly efficient catalysts and can catalyze million times faster than an uncatalyzed reaction .it is capable of transforming 100 to 1000 substrate molecules into products each second. Role of enzyme: enzymes catalyze physiologic reactions by decreasing the activation energy level that the reactants (substrates) must reach for the reaction to occur. They cannot alter the equilibrium of a reaction but can only decrease the activation energy of the reaction thereby accelerating the reaction rate. Activation energy: it is the amount of energy that is required to raise all molecules in one mole of a compound (substrate) at a specified temperature to the transition state at the peak of the energy barrier. Free energy of activation: it is the energy barrier that prevents chemical reactions. Reactants processing enough energy to overcome the energy barrier participate in product formation .The enzyme activity is determined by the rate of an enzyme catalyzed reaction under certain defined conditions2. 2. Substrate concentration: as substrate concentration is increased, the velocity is also correspondingly increased in initial phases but as the enzymes molecules get saturated and further increase in substrate concentration cannot make any effect in reaction velocity. 3.

Crossing Heavens Border Essay Example for Free

Crossing Heavens Border Essay After the division of Korea in World War II, North Korea introduced communism into their country aiming to create a country where everyone was equally wealthy. However, unlike the expectation, NK’s national plans didn’t work out well, and North Koreans started to suffer from political oppression and chronic food shortages. North Koreans who could not stand the situation in their home country started fleeing from North to South Korea. first broadcast in July 2007 reveals the 10 day journey of the North Korean defectors who cross several border to settle in South Korea. The journey of North Korean defectors begins in Tumen and Yalu river, the rivers defectors have to cross to reach Shenyang, a city in China. As soon as they arrive in China, North Korean defectors always have to be careful. This is because they can be caught by Chinese authorities that repatriate defectors back to their home country, where they face cruel punishments. Often, defectors temporarily settle in Shenyang to raise money before they smuggle into South. Some women defectors are even tempted into sex industries, and they often lose their opportunity to reach South Korea. Those who successfully depart Shenyang ride on an illegal bus for 10 hours that takes them to Beijing. In Beijing, group of defectors spread out themselves and melt into the crowd to avoid authority until they board a train to Kunming. On the train, the defectors hide themselves from Chinese officials’ inspection by either leaving their seat or pretending to sleep when the officials are around. After three tenth days, they arrive in Kunming. From there, they face another 8 hour drive through the mountains toward the jungle border with Laos. Even for North Korean defectors who are chastened by adversities, crossing the jungle, which takes 18 hours on foot, is strenuous. Finally, after they cross another border to Thailand from Laos, the defectors can apply for asylum at the South Korean embassy in Bangkok, and their long arduous trip ends there (Crossing Heavens Border, PBS). At the embassy, we interviewed a 23-year-old North Korean refugee Lee Ok Kyung, who was waiting for her South Korean visa to be issued. Lee recalled her memory of childhood in the North as a nightmare.â€Å"Everyone around me was struggling to find food so dying from hunger wasn’t anything new to us† she said. â€Å"My parents ran their pants off on farms day and night, but they were paid much less than the amount of work they did because all their money was sent to the supreme leader Kim Jong Il. However, no one complained about this because everyone was brainwashed that Kim was their demigod of North Korea. Unlike my neighbors, however, I knew that Kim and the high officials were deceiving us. I left North Korea because I was eager to free myself from suppression of the North Korean government. From my respect, North Korea was a heavenly country without any future or freedom. † Until now, many of North Koreans risk their lives in the hope of resettling in South Korea, a country now home to more than 23,500 defectors. However, against the refugee’s expectation, life in a new country is not easy. Many find themselves unable to cope with the faster pace of life in the South, and they are often looked down upon by their Southern neighbors. Nevertheless, North Korean refugees take such adversities lying down because they have a desperate bid for freedom that can only be acquired by crossing the border.

Minimizing Cost of Volatile Inhalational Anesthetics

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

James Joyces Araby - Setting in Araby Essay -- Joyce Dubliners Araby

Setting in James Joyce's Araby  Ã‚   In the opening paragraphs of James Joyce's short story, "Araby," the setting takes center stage to the narrator. Joyce tends carefully to the exquisite detail of personifying his setting, so that the narrator's emotions may be enhanced. To create a genuine sense of mood, and reality, Joyce uses many techniques such as first person narration, style of prose, imagery, and most of all setting. The setting of a short story is vital to the development of character. In the opening paragraph, North Richmond Street is introduced as "blind," and "quiet", yet on it rests another house which is unoccupied. The narrator states that the house is, "Detached," from the others on the street, but that, "The other houses on the street, conscious of decent lives within them, gazed at one another with brown imperturbable faces" (379). This creates an image of isolation, and uncertainty, for the one uninhabited house. The image of the lone house, lays in the shadows of the crowd of other houses who stand so remarkably calm, and collected. This enhances the image of the adolescent narrator, and perhaps foreshadows, his blind inclination towards self discovery on the road of life. The image also evokes that of the uncomfortable affect a group of peers may cast upon the isolated teen. Will steady doses of rejection and alienation drive the narrator to darker days ahead? He lives with his aunt and uncle, and there is no mention of his real parents. Whether he was abandoned, unwanted, or orphaned remains a mystery. In fact it may be that the narrator simply has no outlet through which to exercise his fragile emotions and thoughts. He has friends, but none to any degree of intimacy, his playful innocence pron... ...y perception of the reader, with the placement of the physical aspects conveying double meaning. Briefly foreshadowed, the religiousness with which he experiences his boyhood fancy, has all but abandoned and betrayed him. He recognizes the, "...silence like that which pervades a church after a service" (382). The bazaar has been emptied all the life within in it and become a cold inhospitable environment. The narrator is left again in his isolation in the middle of the bazaar, failed and dejected. He states, "Gazing up into the darkness I saw myself as a creature driven and derided by vanity; and my eyes burned with anguish and anger" (383). Perhaps it is life itself that is the religious experience worth living for, but one evolving from the inner spirit of the self in a great moment of epiphany. Works Cited: Joyce, James. â€Å"Araby†. Kirszner and Mandell 226. James Joyce's Araby - Setting in Araby Essay -- Joyce Dubliners Araby Setting in James Joyce's Araby  Ã‚   In the opening paragraphs of James Joyce's short story, "Araby," the setting takes center stage to the narrator. Joyce tends carefully to the exquisite detail of personifying his setting, so that the narrator's emotions may be enhanced. To create a genuine sense of mood, and reality, Joyce uses many techniques such as first person narration, style of prose, imagery, and most of all setting. The setting of a short story is vital to the development of character. In the opening paragraph, North Richmond Street is introduced as "blind," and "quiet", yet on it rests another house which is unoccupied. The narrator states that the house is, "Detached," from the others on the street, but that, "The other houses on the street, conscious of decent lives within them, gazed at one another with brown imperturbable faces" (379). This creates an image of isolation, and uncertainty, for the one uninhabited house. The image of the lone house, lays in the shadows of the crowd of other houses who stand so remarkably calm, and collected. This enhances the image of the adolescent narrator, and perhaps foreshadows, his blind inclination towards self discovery on the road of life. The image also evokes that of the uncomfortable affect a group of peers may cast upon the isolated teen. Will steady doses of rejection and alienation drive the narrator to darker days ahead? He lives with his aunt and uncle, and there is no mention of his real parents. Whether he was abandoned, unwanted, or orphaned remains a mystery. In fact it may be that the narrator simply has no outlet through which to exercise his fragile emotions and thoughts. He has friends, but none to any degree of intimacy, his playful innocence pron... ...y perception of the reader, with the placement of the physical aspects conveying double meaning. Briefly foreshadowed, the religiousness with which he experiences his boyhood fancy, has all but abandoned and betrayed him. He recognizes the, "...silence like that which pervades a church after a service" (382). The bazaar has been emptied all the life within in it and become a cold inhospitable environment. The narrator is left again in his isolation in the middle of the bazaar, failed and dejected. He states, "Gazing up into the darkness I saw myself as a creature driven and derided by vanity; and my eyes burned with anguish and anger" (383). Perhaps it is life itself that is the religious experience worth living for, but one evolving from the inner spirit of the self in a great moment of epiphany. Works Cited: Joyce, James. â€Å"Araby†. Kirszner and Mandell 226.

Walcotts Collected Poems and Roys The God of Small Things :: comparison compare contrast essays

Post-Colonial and Post-Modernist View of Walcott's Collected Poems and Roy's The God of Small Things      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   "Language was not so much a distinguishing sign of a soul or spirituality, which animals do not possess, as a social practice which enhanced survival of the species"-Nietzche. Nietzche reminded twentieth century intellectuals of the decisive role of language in the construction of human experience of 'reality'. With his 'perspectivism' and relativism, truth, whether artistic or scientific was seen as a social matter and a linguistic product, the displacement of one set of figures of speech by another, with knowledge the interrelations of signifiers in a field of experience made of prior interpretations. (Irving Howe, 80).    Thus in Walcott's poems and in Roy's 'The God of Small Things' modernism was further routed by inversion of ethical values as power tools for survival and exploitation, and of art as a veil over a reality describable only as wanton, godless procreation. This conception of a dynamic world of super changed energies of unimaginable force, often in violent conflict and ever-changing relations, came to resemble Freud's concept of id.    We observe, in their writings (Walcott and Roy) the apparently rational surface of consciousness hides a mass of tangled and conflicting desires, impulses and needs. The outer person is a mere papering-over of the cracks of a split and waring complex of selves driven by life and death instincts.    Walcott in his poem 'The Divided Child' writes,    There was your heaven ! The clear glaze of another life, a landscape locked in amber, the rare gleam. The dream of reason had produced its monster : a prodigy of the wrong age and colour. (Walcott 145).    According to him, language was not the transparent tool for the objective representation of a stable reality: ethics was not expressive of a discovered system of absolute values or religion other than a desire for parental protection throughout life.    He writes in his poem 'Lampfall,' And I'm elsewhere, far as I shall ever be from you whom I behold now, Dear family, dear friends, by this still glow The lantern's ring that the sea's Never extinguished Your voices curl in the shell of my ear. (Walcott 95).    When Roy was asked in an interview, 'What does it mean to be Indian?' she replied: 'Do we ask, 'What does it mean to be American or to be British?

Containerization: Cargo and Traditional Bulk Transport

What is containerization and how did the innovative use of containers transform the distribution of goods? The traditional way of transporting goods from one place to another was highly labor intensive and goods were in individual crates of different sizes and shapes and they had to be manually lifted and stowed in the holds of ships. As the time passed by, the concept of containerization emerged.Basically, Containerization is an inter-modal system of transporting the general cargo or product in lots which are too small for the traditional bulk transport system, using ISO standard containers that can be loaded and sealed intact onto  container ships,  railroad cars, planes, and trucks. The concept of containerization is considered as the key innovation in the field of logistics which has revolutionized freight handling in the twentieth century.Containerization reduces time in transit, the inventory costs and increases reliability. Such benefits are forcing the industry to make it more favorable in terms of cost, flexibility and speed. As the Internet and other new technologies and advancements are developing, it is expected to bring more innovations which will further simplify the tasks of logistics.The innovative use of containerization has transformed the distribution of goods in following ways: * Goods in lots which are too small for the traditional bulk transport can be moved using containers * It is best option for high-value and delicate cargo as it provides safety from human and natural factors * As containers are moved intact, substantial amount of time and labor cost is saved which would otherwise have incurred in loading and unloading goods * It prevents poor handling of goods that results from bulk transport systems * Containers can act as mode of storage anywhere along the transport route * Container ships provide regular service to overseas ports, thus it minimizes the waiting time * It reduces the transit time which not only offers a means of marketing for the producer that bulk systems cannot provide, but also helps to reduce the inventory costs and increases reliability. 2. What role has containerization played in the development of a global economic system? As containerization is the new way of transportation model, it’s definitely is more advanced and optimum way of shipping the goods from one place to the other.Container shipping eventually replaced the traditional â€Å"break-bulk† method of handling crates, barrels and bags, and stowing them loose in a ship's hold, a system in use since the days of the Phoenicians. The replacement of break-bulk with cargo containers dramatically reduced shipping costs, reinvigorating markets and fueling the world economy. Due to cheap transportation cost, the countries could engage themselves in a fierce export drive exploiting the technological advancements and lower labor costs which are the major basis for the industrialization. In addition to that, cheap transpor tation also helped in revolutionizing the supply chain management of the business houses.There had been some major developments like South Korea developed a very strong ship building industry centered on the new ships made possible in the development and introduction of containerization. And also, the major and biggest container ports in the world are located in Southeast Asia. Thus, the credit for the development of such ports in these areas goes to the containerization. Without which, these areas wouldn’t have been developed like they are today. Containerization makes the loading and unloading of goods from the ships to the ports easy and consumes extremely less time in comparison to that of tradition way of transportation. These are some of the major roles that containerization played in the development of the global economic system.