Organizing St. Peters Hospital

Table of Contents Introduction Differences between management and leadership The role and responsibilities of a leader The effects of globalization Conclusion Reference List Introduction St. Peter’s hospital in New York is one good example of an organization that has enhanced good management and the use of technology to improve its services. The organization’s management is structured in such a way that everything operates smoothly. Thus, there is specialization and division of labor. There is no overlap of duties by employees of different departments. Advertising We will write a custom essay sample on Organizing: St. Peter’s Hospital specifically for you for only $16.05 $11/page Learn More This is because every person who has been employed in this health facility has some aspects of professional background. For instance, the human resource department professionally undertakes on its duties in recruiting staff. Effective leadersh ip and good management have been very important in the process of running the health organization. In addition, the way in which the hospital’s management has embraced modern technology has helped in its efforts of globalization. As a result, the health facility has been able to attract many people who want to employ the services of the hospital. Differences between management and leadership One of the definitions of leadership is that it is giving new directions or giving new dreams to a team that follows the leadership. This means that the leader is the one who spearheads the implementation process of any vision or dream. On the other hand management is a control parameter that takes care of people’s resources within the team. Management controls these specific resources according to laid down policies and principles that are already in place. The two terms compliment each other since one cannot work without the other (Blanchard 2008). Leadership without management only takes care of the visions and dreams of a leader. In this situation there is no control measures necessary in the achievement of the dreams. On the other hand management without leadership is void since there is no provision of new change or new direction. Whatever happens in this situation only deals with control of the available resources, be it human or natural. Leadership must be participatory and not symbolic. This is because when a leader is taken as a symbol, they act as a figure head. This happens to the leader without taking any direction. Thus, the leader is not visionary and therefore cannot provide a new direction or a new vision to the team.Advertising Looking for essay on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More The management of St. Peter’s hospital is structured to enhance efficiency and specialization of services. The specialized work force enables high quality services to be rendered . Thus, to facilitate the management of the health facility, the management has been divided into different departments. Each department has qualified professionals that are specialized for their particular jobs. The role and responsibilities of a leader Leadership is an important aspect in any organization because leaders act as a channel through which results can be achieved. Leadership acts as a coordinating point of efforts within a group. Therefore, the leader is the figure that guides efforts in order for a group to achieve the desired results. Effective leadership is important because it helps in creating a culture of self motivation and creative thinking. Effective leadership also aligns the unidirectional focus thereby concentrating energy in a particular direction. For these reasons, motivational, strategic and management skills must be present for there to be an effective leadership strategy. Leadership also entails pushing forward relevant and dynamic ideas. It also inv olves not running away from responsibilities. There is no way a person can lead while they are away from that particular responsibility. It is also important to note that effective leadership unlocks drivers of particular processes which are hidden. An effective leader is one who takes the role of harnessing all the energy present within the team that follows them. This will help the entire group to achieve a common task due to increased efficiency that comes as a result of concentration of efforts towards a particular goal. Qualities of leadership do not change, despite the organizational changes through time. The only thing that changes is the structure of the management of the organization. This is because throughout time, there has been loss of middle management. This comes as a result of flattening of company’s structure. These reasons prompt the current organization leadership to possess greater project management skills (Snell, a. 2009).Advertising We will write a custom essay sample on Organizing: St. Peter’s Hospital specifically for you for only $16.05 $11/page Learn More The leader must therefore be visionary and inspirational so that they may know what needs to be achieved and create an image of how things ought to be (Snell, b. 2009). An effective leader must also be aware and be influential. The awareness of a leader will make them understand the abilities of each individual. A good leader must also understand their role in influencing the group that they lead. Hence an influential leader will use vision and employ the services of stakeholders in order to sway an opinion. In addition, effective leadership skills must have the aspects of trustworthiness so as to be honest and open to the team under the leader. They should also keep track of progress as a way of monitoring the targets. Taking all these factors into consideration, it can be deciphered that the role of a leader is pretty challenging (Bu ble Ivana 2007). At St. Peter’s hospital, Individuals and groups report to the higher authorities who are mainly departmental leaders. For instance, any matter concerned with recruitment of new staff is always done by the human resource department. The number of individuals under a manager is optimal to enhance the effectiveness of control. The effects of globalization Globalization is a trend can be described as having a free trade growth and investment across international borders. Globalization has resulted in integration of the international economy. Management controls specific resources according to laid down policies and principles that are already in place. The two terms compliment each other since one cannot work without the other. Positive effects of globalization include opening up of broader communication throughout the world. The opening up of communication helps in creating job opportunities. Also technological advances attribute their success to globalization . Sharing of ideas and the success of media has also been as a result of globalization. Technological input has helped to increase efficiency of professional services. The acquisition of modern machinery such as modern surgical equipment, digitization of documents, ultrasound machines and power wheelchairs has improved organization processes in the respective departments.Advertising Looking for essay on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More Conclusion Leadership is giving new directions or giving new dreams to a team that follows a leader. This means that the leader is the one who spearheads the implementation process of any vision or dream. On the other hand management is a control parameter that takes care of people’s resources within the team. Leadership is an important aspect in any organization because leaders act as a channel through which results can be achieved. Reference List Blanchard, K. (2008). Situation Leadership: Leadership Excellence: May 2008: 25, 5: ProQuest, p. 19. Buble, M Ivana, P. (2007). Interdependence between Organizational Culture and Leadership Styles: The Croatian Case. The Business Review, Cambridge: Summer 2007: 7, 1: ProQuest. Snell, B. (2009 a). Management: Leading and Collaborating in a Competitive World. Ed. 8. The Mc-Graw-Hill Companies. Chapter 4. Snell, B. b. (2009 b). Management: Leading and Collaborating in a Competitive World. Ed. 8. The Mc-Graw-Hill Companies. Chapter 1 2. This essay on Organizing: St. Peter’s Hospital was written and submitted by user Aniya W. to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Smoking Prohibited with Minors in Vehicles essays

Smoking Prohibited with Minors in Vehicles essays Smoking Prohibited with Minors in Vehicles Children do not have a choice whether or not an adult smokes while driving a vehicle. According to Chest magazine, 4.8 million American children have been diagnosed with asthma. The Centers for Disease Control in Atlanta report that in 1993, 159,000 children under the age of fifteen were hospitalized for acute asthma, and 5,300 people died. The American Lung Association states that the annual health care cost for asthma is 12.6 billion dollars. The value of reduced productivity due to loss of school days represented the largest single indirect cost related to asthma, approaching $1 billion. The National Institute of Allergy and Infectious Disease states that, More than 10 million school days are missed annually due to asthma. Annually in America, there are approximately 10.4 million physician office visits for the treatment of asthma. Approximately one-third of those visits are for patients under the age of 18, as reported in the New England Journal of Medicine. This law would be authorized by the United States Constitution, Article 1, Section 8, Clause 3...To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes. This Commerce Clause would pertain to those individuals traveling in vehicles. Added authorization is found in Article 1, Section 8, Clause 18. The necessary and proper clause would allow for the novel idea of regulating individual habits inside privately owned vehicles. In American Government and Politics Today, this clause has allowed Congress to adapt the government to changing needs and times. Enforcement of this law would be delegated to each state. Each states Department of Transportation, Highway/State Patrol would also then enforce this law. Local law/County Sheriff offices would give their support likewise. ...

How to Write a Descriptive Essay In 3 Easy Steps - BestEssay.education

How to Write a Descriptive Essay In 3 Easy Steps How to Write a Descriptive Essay In 3 Easy Steps Writing a descriptive essay is easier than it seems. If you have mastered the basics of writing an essay, the descriptive essay is something that you can master fairly easily. In fact, there are only x steps between you and a successfully completed descriptive essay. Before we go through those steps, let's answer the question, 'what is a descriptive essay?'. To use a tautology, a descriptive essay is an essay that describes something. What this means is that you will be taking an object, a person, an event, or an experience, and you will be describing that to your readers in a way that they can truly understand. Now that the definition has been established, let's review the 3  steps to writing a descriptive essay. Selecting an Essay Topic Your best topic will be one that is highly interesting to you and one that is complex enough that    you can dedicate an entire essay to describing it. In fact, the more senses that you can evoke in  your readers the better. As you evaluate potential topics, see if you can answer all of the  following questions: What would a person see? What would they hear? What would they taste? What would they smell? What would they feel? The stronger your answers to each of these questions, the more likely it is that you have found a great subject for your descriptive essay. However, it can be okay to write a descriptive essay on  a topic if it does not evoke all four senses, as long as it evokes very strong sensory and   emotional responses as you describe it. Reviewing Your Topic Students often select topics for descriptive essays that come from personal experience. This could mean that they are describing experiences they have themselves, objects the possess, or people that they know. This could also mean that they are simply trying to describe something they are truly interested in. This is a good thing, because familiarity and emotional attachment   Ã‚   makes writing a descriptive essay much easier. However, it is absolutely imperative that you spend time reviewing your topic. No matter how familiar you are, you still need to go over what you experienced, heard, or saw. This will help make the experience fresh in your mind. Use Descriptive Words to Write a Descriptive Paragraph Keep in mind that adjectives are key. The more adjectives in your essay, the more impact it is going to have on both your readers and on your instructor. So, be original and prolific in the way that you use adjectives, and also adverbs, in your essay. Remember that, 'It was a blue car   that nobody drove', is not the same as 'It was matte finished navy blue car that sat idle in my friend's garage. Now that you know how to write a descriptive essay, you should be ready to tackle your next writing assignment. However, if you are not ready, we have plenty of writers on staff to help students just like you.

Napoleons Empire

Napoleon's Empire The borders of France and the states ruled by France grew during the wars of the French Revolution and the Napoleonic Wars. On May 12th, 1804 these conquests received a new name: the Empire, ruled by a hereditary Bonaparte Emperor. The first – and in the end only – emperor was Napoleon, and at times he ruled vast swathes of the European continent: by 1810 it was easier to list the regions he didn’t dominate: Portugal, Sicily, Sardinian, Montenegro, and the British, Russian and  Ã¢â‚¬â€¹Ottoman Empires. However, while it’s easy to think of the Napoleonic Empire as one monolith, there was considerable variation within the states. The Make-Up of the Empire The empire was divided into a three-tier system. Pays Rà ©unis: this was land governed by the administration in Paris, and included the France of the natural frontiers (i.e. the Alps, the Rhine and the Pyrenees), plus states now subsumed into this government: Holland, Piedmont, Parma, the Papal States, Tuscany, the Illyrian Provinces and a lot more of Italy. Including France, this totaled 130 departments in 1811 – the peak of the empire – with forty-four million people. Pays Conquis: a set of conquered, although supposedly independent, countries which were ruled by people approved by Napoleon (largely his relatives or military commanders), designed to buffer France from attack. The nature of these states ebbed and flowed with the wars, but included the Confederation of the Rhine, Spain, Naples, the Duchy of Warsaw and parts of Italy. As Napoleon developed his empire, these came under greater control. Pays Allià ©s: The third level was fully independent states who were bought, often unwillingly, under Napoleon’s control. During the Napoleonic Wars Prussia, Austria and Russia were both enemies and unhappy allies. The Pays Rà ©unis and Pays Conquis formed the Grand Empire; in 1811, this totaled 80 million people. In addition, Napoleon redrew central Europe, and another empire ceased: the Holy Roman Empire was disbanded on August 6th, 1806, never to return. Nature of the Empire The treatment of states in the empire varied depending on how long they remained part of it, and whether they were in the Pays Rà ©unis or Pays Conquis. It’s worth pointing out that some historians reject the idea of time as a factor, and focus on regions in which pre-napoleon events inclined them to be more receptive to Napoleon’s changes. States in the Pays Rà ©unis before the Napoleonic era were fully departmentalized and saw the benefits of the revolution, with the end of ‘feudalism’ (such as it existed), plus land redistribution. States in both the Pays Rà ©unis and Pays Conquis received the Napoleonic legal Code, the Concordat, tax demands, and administration based on the French system. Napoleon also created ‘dotations’. These were areas of land seized from conquered enemies where the entire revenue was given to Napoleon’s subordinates, conceivably forever if the heirs stayed loyal. In practice they were a huge drain on the loca l economies: the Duchy of Warsaw lost 20% of revenue in dotations. Variation remained in outlying areas, and in some privileges survived through the era, unaltered by Napoleon. His introduction of his own system was less ideologically driven and more practical, and he would pragmatically accept survivals which the revolutionaries would have cut out. His driving force was to keep control. Nevertheless, we can see the early republics being transformed slowly into more centralized states as Napoleon’s reign developed and he envisioned more of a European empire. One factor in this was the success and failure of the men Napoleon had placed in charge of conquered lands – his family and officers – because they varied greatly in their loyalty, sometimes proving more interested in their new land than aiding their patron despite in most cases owing everything to him. Most of Napoleon’s clan appointments were poor local leaders, and an exasperated Napoleon sought more control. Some of Napoleon’s appointees were genuinely interested in effecting liberal reforms and being loved by their new states: Beauharnais created a stable, loyal and balanced government in Italy and was very popular. However, Napoleon prevented him from doing more, and often clashed with his other rulers: Murat and Joseph ‘failed’ with the constitution and Continental System in Naples. Louis in Holland rejected much of his brother’s demands and was ousted from power by an angry Napoleon. Spain, under the ineffectual Joseph, couldn’t really have gone more wrong. Napoleon’s Motives In public, Napoleon was able to promote his empire by stating laudatory aims. These included safeguarding the revolution against Europe’s monarchies and spreading freedom throughout oppressed nations. In practice, Napoleon was driven by other motives, although their competing nature is still debated by historians. It’s less likely that Napoleon began his career with a plan to rule Europe in a universal monarchy – a sort of Napoleon dominated empire which covered the whole continent – and more likely he evolved into wanting this as the opportunities of war brought him greater and greater success, feeding his ego and expanding his aims. However, a hunger for glory and a hunger for power – whatever power that may be - seem to have been his over-riding concerns for much of his career. Napoleon’s Demands on Empire As parts of the empire, the conquered states were expected to assist in furthering Napoleon’s aims. The cost of the new warfare, with greater armies, meant more expense than ever before, and Napoleon used the empire to for funds and troops: success funded more attempts at success. Food, equipment, goods, soldiers, and tax were all drained out by Napoleon, much of it in the form of heavy, often annual, tribute payments. Napoleon had another demand on his empire: thrones and crowns on which to place and reward his family and followers. While this form of patronage left Napoleon in control of the empire by keeping leaders tightly bound to him – although putting close supporters in power didn’t always work, such as in Spain and Sweden – it also let him keep his allies happy. Large estates were carved out of the empire both to reward and to encourage the recipients to fight to keep the empire. However, all these appointments were told to think of Napoleon and France first, and their new homes second. The Briefest of Empires The empire was created militarily and had to be enforced militarily. It survived the failures of Napoleon’s appointments only as long as Napoleon was winning to support it. Once Napoleon failed, it was swiftly able to eject him and many of the puppet leaders, although the administrations often remained intact. Historians have debated whether the empire could have lasted and whether Napoleon’s conquests if allowed to last, would have created a unified Europe still dreamt of by many. Some historians have concluded that Napoleon’s empire was a form of continental colonialism that could not have lasted. But in the aftermath, as Europe adapted, a lot of the structures Napoleon put in place survived. Of course, historians debate exactly what and how much, but new, modern administrations could be found all over Europe. The empire created, in part, more bureaucratic states, better access to the administration for the bourgeoisie, legal codes, limits on the aristocracy an d church, better tax models for the state, religious toleration and secular control in church land and roles.

Question 2 Essay Example | Topics and Well Written Essays - 2000 words

Question 2 - Essay Example This report is based on the implementation of ICT in the business strategy making process and the selected organization for analysis is Google Plc. Google is the largest market share holder of the search engine and internet browser industry (google.co.uk, 2014). With a diversified and huge product base they are among the industry leaders of the technological segment. The report will try to evaluate the process of ICT implementation by Google for business strategy development. Before the introduction of ICT in the business world, business processes focused on gaining accuracy in their strategies which slowed the response time of the business towards market changes. However, in the past two decades the increasing use of ICT in the business processes has brought in frequent changes that allowed the business houses to cope up with the changes in the market nature. Bossink (2008) stated that the basic role of ICT was to enhance the communication between a business and its stakeholders. But with continuous growth and modification in the strategy, ICT is now a dominant factor in every functional aspects of business. New technologies such as cloud computing have helped in business expansion across geographical boundaries and reduced the cost of operating overseas. Business houses can now monitor the work, gather, store and share information, synchronies their work process from a singular location in spite of travelling to all the places. Pollock (2010) stated that business operations have become more accelerated and focused with the help of ICT integration in the business. Business firms can now connect with a wider consumer base with the help of ICT technologies such as video conferencing. Furthermore, business monitoring process has also changed with advanced technologies such as cctv monitoring, employee tracking systems, etc (youtube.com, 2009). Zikmund (2008) summarized that the influence of ICT on the business process has been mainly on the

Field Research Essay Example | Topics and Well Written Essays - 750 words

Field Research - Essay Example There is no denying the fact that a majority of the top models were affiliated to a few select brands like HTC, Samsung, Apple, Nokia and Blackberry. The Smartphone available at this store evinced a range of features and applications. The Samsung Galaxy S4 happened to be a really top end phone that offered varied flexible possibilities like the option to use microSD to expand the phone memory. This model was virtually an Android powerhouse. The phone came with an eye tracking and Smart Scroll feature that allows scrolling while looking at the screen while keeping the phone a little tilted. There is a smart pause features that pauses the video being played if the user is not looking at the screen. The Air View feature allows implementing advanced functionality by holding or swiping a finger or a hand slightly over the phone. Group Play feature allows for an ad hoc sharing of files between Galaxy phones as is the case in multiplayer games and also facilitates music streaming specifical ly in Galaxy S4 phones. Truly speaking this phone came with a range of advanced features. Apple iPhone 5 also happened to be a top class phone that promised multiple advanced features. ... With its advanced wireless technology, Apple iPhone 5 connects to more networks around the world. The speed is remarkable that allows for a hassle free browsing, streaming and sharing. The phone comes with the new A6 chip that is very powerful, without taxing the battery anymore. HTC One happened to be a Smartphone that came with a range of features not available in other Smartphone. It came with a 4MP UltraPixel Camera that happened to be the best in its class. HTC One runs on Android 4.1 (jellybean) however its user interface is way apart from the regular Android user interfaces. This model has done away with the standard Android hardware button layout and the device could be readily navigated with the help of only two keys. The BlinkFeed feature is really unique as it indeed boosts content sharing, and social media integration. The phone comes with two powerful frontal speakers. The phone comes equipped with an infrared based blaster that allows it to act as an extension to the us ers’ TV. The price of the Smartphone available at this retail outlet varied from as low as $97 for the Blackberry Bold 9650 (without contract) to as high as $605 for Galaxy S4 (without contract). No wonder the price variation in the market for Smartphone is high and a consumer really gets confused as to the brand one can chose. The special thing that was noticed in case of most of the Smartphone models was that packaging and display evinced a hallmark of marketing astuteness. In most of the models the packaging happened to be sleek and was mostly intended to enhance the aesthetic appeal and to allow for easy display and stacking in the stores. In terms of the packaging, most of the brands made it a point to appear innovative and unique. In the Smartphone market there

Genetically Engineered Crops Essay Example | Topics and Well Written Essays - 2500 words

Genetically Engineered Crops - Essay Example The essay outlines the genetic engineering for agricultur. The U. S., British, and other governments that envision the biotechnology sector as the wave of the future, and as a means of augmenting their national competitiveness, have strongly supported the industry and its efforts to commercialize (and normalize) these new technologies. They have devoted considerable sums of money to biotechnology research (Gottweis 1998), taken significant strides to deregulate the industry (Wright 1994), and sought to promote the spread of U. S.-style intellectual property rights in the World Trade Organization. The U. S. government in particular has also promoted the dissemination of agricultural biotechnology in developing countries through the U. S. Agency for International Development. With so much economic and political muscle propelling them, it is not surprising that GE crops hit the ground running when they came onto the scene in the mid-1990s. But what is surprising is that the rapid growth in GE crop deployment has been matched by an equally remarkable (and perhaps historically unprecedented) proliferation of citizens' voices challenging the biotechnology industry on economic, environmental, cultural, and moral grounds. Indeed, long before transgenic crops made their way to the market, individuals and groups concerned about the dissemination of these new technologies were already questioning their safety, utility, and necessity. Advances in genetics have reached a stage where breeding schemes can now be augmented with the use of a number of technologies.

An American President and Its Political Themes Movie Review

An American President and Its Political Themes - Movie Review Example Wade for the passage of her environmental bill. The film showed that each of the Congressmen and the President himself plays a vital role in the passage of a bill whether it is beneficial to the people or not. The President in the movie along with his representative has to confer with the Congressmen to get their votes for the passage of the crime bill. According to Article II, Section I of the American Constitution, the president has the power to appoint high positions such as ambassadors and court judges but only after he has consulted with the Senate. The President has the power to make treaties with other nations but only after seeking advice and consent 2/3rds of the Senate. The constitution also stated that the President may recommend legislative measures he believed to be important in advancing the interest of the country and may veto bills from Congress but still he is subject to 2/3rds of the Congress. President Obama himself had a hard time convincing the Senate and the Con gress on the approval of the Recovery Bill or the stimulus fund. According to Herszenhorn in his article â€Å"Recovery Bill Gets Final Approval† for The New York Times, there was not a single House Republican who voted for the bill and that the bill’s passage itself was largely partisan in nature. ... fluences within their the political circle but also have the privilege to shape or destroy the future of the citizens under the guise of law and partisan loyalty. Another political theme showed in the movie is on the role of media in politics. The mass media in all its forms is very valuable to people who live a public life like the politicians and artists. The media is long known to either break or make a person’s career. In the movie, the media was seen as a tool that did both favor and misfortune to the President and his love interest. When the main antagonist in the film denounced the President and made an issue with his personal affairs, the media took the reign and published the criticisms which contributed to the rise and fall of the approval ratings. On the other hand, Sydney Ellen Wade, the love interest of the President suffered from the publicity which contributed to her loss in congress votes for the environmental bill and ended to her unemployment. Even if the med ia reports are unbiased it can change the perception of the public. Thus, it is very important that the general public should be equally proactive in determining whether the news feeds are unbiased, credible, and true. Bob Rumson, the Republican political rivalry of the President was seen in the movie to have made an effort to destroy the President’s credibility. When he discovered that the President was having an affair with Ms. Wade, she used it as a tool to create bad publicity against the President. Kaplan in her article â€Å"Perry dodges again† on CBS news revealed that GOP presidential candidate Rick Perry questioned again the citizenship of President Obama and the authenticity of his birth certificate. The issue on the authenticity of President Obama’s birth certificate was a

Recommendations for Reducing Inconsiderate Partying in the UDR Apartme Research Paper - 1

Recommendations for Reducing Inconsiderate Partying in the UDR Apartment through a A No-Inconsiderate-Partying Contract - Research Paper Example A No-Inconsiderate-Partying (NIP) contract is recommended because it can effectively and efficiently prevent and resolve insensitive parties in the UDR apartment. The contract will have a section on empathy, designation of quiet hours, a recommendation of other outlets where renters can party, and sanctions for violators, including cancellation of the lease. I also suggest a party room for every floor and enhancement of the soundproof quality of all rooms. These are more costly suggestions but they can increase profits and improve the living experience and brand equity. Hence, the most cost-efficient and effective is the No-Inconsiderate-Partying (NIP) contract that has high management and renter acceptability and sustainability. I am a recurring victim of inconsiderate partying in the UDR apartment at Domain College Park. Some of the renters here party up to 3 a.m. during weekdays. Though the apartment has students and employees renters alike, many renters are actually students since this apartment is in College Park, and this really makes it more inconceivable how they can be quite insensitive to the sleep and studying needs of other students like them. I could not always tell them to lower their noises because I am afraid of dealing with drunken adolescents and adults and because there have been times when I told them to lower their noise, which they did for a few minutes, and then they increased the noise again. I have gone to the apartment staff of the UDR apartment at Domain College Park to complain about these party noises. The staff stressed that they have a â€Å"no-party† policy and that they would remind the room’s  inhabitants about it.   These partying noises continue up to now.    Clearly, the no-party policy is not effective in deterring or resolving insensitive partiers.  Ã‚  

The Adventures of Huckleberry Finn Essay Example for Free

The Adventures of Huckleberry Finn Essay In the novel The Adventures of Huckleberry Finn, the author, Mark Twain, compares life on land to life on the river using Huck’s forbidden friendship with Jim, the risks Huck makes, and when Huck joins Tom sawyer’s gang, proving that friendship has no limits. Life on land was emotional for Huck because of the obstacles and hardships he faced. Life on the river on the other hand was a challenge because of the troubles Huck had being safe. Huck and Jim’s forbidden friendship proves that friendship has no limits through Huck seeing past the fact that Jim is black. On land when Huck found Jim for the first time in the woods, he says â€Å"..it was Miss Watson’s Jim! I bet I was glad to see him.† This shows Huck enjoys Jim’s company, White or black, he regards Jim as a type of friend. Friendship has no limits and will see past each other’s differences. The risks that Huck made for friendship proves that friendship has no limits through Huck risking his friendship with Tom to save a friendship with Jim. Huck has already been through so much with Jim on land and river, and had made a promise to stay with him till the end. So Huck was willing to risk Tom for Jim. Huck had told Tom, â€Å"I know what youll say. Youll say its dirty, low- down business; but what if it is? Im low down; and Im a-going to steal him, and I want you keep mum and not let on. Will you? Huck was being a true friend and protecting Jim, he was going to risk his old friend to save Jim. That showed how loyal Huck was to Jim and their friendship, showing that friendship really doesn’t have limits. When Huck joins Tom Sawyer’s gang he is proving that friendship has no limits by taking the oath Tom had made. On land while Tom forms his gang he says, â€Å"Everybody that wants to join has got to take an oath, and write his name in blood.† Tom takes friendship as seriously as a religion. Both Tom and Huck believe in it faithfully, it’s like a belief in a religion. It proves that friendship has no limits when a friendship is most important to both of them.

Abnormal Uterine Bleeding (UAB) In Gynaecological Practice

Abnormal Uterine Bleeding (UAB) In Gynaecological Practice INTRODUCTION Abnormal uterine bleeding (AUB) is a common complaint in gynaecological practice, represents a major proportion of out patients attendence. One, in 20 women in UK consulted their GP for menorrhagia. [1] A menstural cycle of fewer than 21 days or more than 35 days or a menstural flow of less than two days or, more than seven days is considered abnormal. [2] AUB can be categorized as excessive menstural bleeding, irregular, bleeding intermenstural including, postcoital bleeding. [3] Different terms, used to describe AUB are: oligomenorrhea (bleeding occurs at intervals of > 35 days usually caused by, prolonged follicular phase). Polymenorrhagia, (bleeding occurs at intervals of 21 days may be caused by a luteal phase defect). Menorrhagia, (bleeding occurs at normal intervals (21 to 35 days)but with heavy flow (80 ml) or duration (7 days). Menometrorrhagia, (bleeding occurs at regular, non cyclic intervals with heavy flow (80 ml). (2) Abnormal uterine bleeding, includes both DUB bleeding from structural causes. Dysfunctional bleeding can be anovulatory, which is characterized by heavy but regular periods. (I-e, menorrhagia). Structural causes include: fibroids, polyps, endometrial carcinoma pregnancy complications. Abnormal bleeding can also results from contraceptive methods. (4) In peri postmenopause women, it is essential to exclude endometrial carcinoma. In younger women, endometrial hyperplasia anatomical anomalies: such as uterine fibroids, comprise the main pathology. (5) Perimenopause is the period, 2 8 years preceding menopause 1 year after the final menses. (WHO). However, a better practical definition is, the phase preceding the onset of menopause, generally occurring around 40-50 years of age, during which the regular cycle of a women transition to a pattern of irregular cycles. (6) A variety of methods, have been used to investigate patients with AUB, such as, endometrial cytology, transvaginal ultrasound, hysteroscopy, D C and endometrial biopsy . (7) The recommendation regarding, investigation of AUB is that women, over the age of 45, should be investigated with endometrial biopsy. Frequently, this is performed as an inpatient procedure with the biopsy being obtained by uterine curettage (D C). (5)This is the most common procedure used, to evaluate the endometrial cavity of a patient with AUB. (8) However, the value of endometrial curettage is great, in the establishment of histopathologic diagnosis. (6) The operation involves a G. A often a two day stay. Originally, the procedure was thought to have a therapeutic effect or AUB, But studies have failed to support this. This procedure is performed for diagnostic purposes, to exclude endometrial malignancy. (9) REWIEW OF LITERATURE ABNORMAL UTERINE BLEEDING Abnormal uterine bleeding (AUB) is a symptom it is not a disease, but is a common debilitating condition. Dysfunction uterine bleeding (D. U. B) is the diagnosis, given to women with AUB in whom no clear etiology can be identified. [10, 11]. An approach accurate diagnosis depend on recognizing the following types: Menorrhegia: is cyclic bleeding at normal intervals, which is excessive is larger than 7 days o and amount more than 80 ml frrom normal secretory endometrium after normal ovulation is caused by conditions affecting the uterus. (10, 11) Polymenorrhea: is cyclical bleeding which is normal in amount but which occurs at too frequent intervals of Polymenorrhegia: is cyclical bleeding which is both excessive too frequent. Eg: 9/20-12/20. It implies a disturbance in the hypothalamic pituitary ovarian uterine axis. (10) Metrorrhegia: It is bleeding of any amount whch is cyclical which occur irregularly or continuously in between normal cycles. It is caused by benign or malignant growth with ulcration. (10) Dysfunctional Uterine Bleeding continuously occurs at the extreme of reproductive (adolesence perimenopausally). The abnormalities of ovarian activity may be classified as follows. Upto 90% of cases of DUB result form menstrual cycles in which ovulation does not occur (anovulation) (Dodds). The remainder of cases arise from problems associated with ovulation such as dysfunction of the corpus luteum or prolonged progesterone secretion. (12) Anovulatory Occasionally anovulatory cycles occur in all women. Upto 90% of cases of D. U. B result from menstural cycles in which ovulation does not occur(anovulation. The remainder of cases arise from problems associated with ovulation such as dysfunction of the corpus luteum or peolonged progesterone secretion. Chronic anovulation in associated with an irregular unpredictable pattern of bleeding ranging from short cycles with scanty bleeding to prolonged period of irregular heavy loss. In anovulatory cycles, the endometrium is unable to produce factors whose sysnthesis is controlled by progesterone, eg. PGF2a (Smith et al, 1982). This may account for the painless bleeding. Anovulatory bleeding may be associated with cystic glandular hyperplasia of the endometrium. This occurs in some older women also in peripubertal girl, where unopposed oestrogen secretion occurs. Endometrial hyperplasia may cause excessive bleeding, anaemia, infertility even endometrial carcinoma. (13) Ovulatory: (idiopathic bleeding) It appears that there are a number of endometrial products, which alters the degree of vadoconstriction thus may effect the volume of menstrual blood loss. In the mid 1970s, a relationship b/w prostaglandins (PG) production menorrhegia was suggested by work showing that total endometrial PG content was proportional to menstrual loss. It appears that a shift in endometrial conversion form the vasoconstrictor PGF20( to the vasodilator PGI2 occurs. Another important factor is endothelin, which is very potent vasoconstricter, produced within the endometrial vessels. Marshs group showed reduced endothelin immunostaining in the endometrium of women with monorrhegia , implicating this peptide in the pathophysiology of increased menstural blood loss. (Marsh 996) (13) Etiology of Abnormal Uterine Bleeding Before Menarche: Malignancy, trauma sexual abuse or assault are potential causes of abnormal uterine bleeding before menarche. Child bearing years: Pregnancy is the first consideration in women of childbearing age who present with AUB. Potential causes of pregnancy related bleeding includes miscarriage, ectopic pregnancy , placenta previa, abrutio placentae trophoblastic disease. Next, iatrogenic causes of AUB should be explored. Bleeding may be induced by medication, including anticogulants, selective serotonin reuptake inhibitors, antipsychotics, cortiosteriods, hormonal medication, tamoxifen (Nolvadex). Herbal substance including ginseng, ginko, soy supplement, may cause menstrual irregularities by altering estrogen levels or clotting parameters. (14), (15) Systemic Disorders: Includes thyroid, hematologic, hepatic, adrenal, pituitary, hypothalamic conditions menstural. Irregularities are associated with both hypothroidism (23. 4% of cases) hyperthyroidism (21. 5% of cases). Coagulation Disorders: Inherited coagulopathy may be the underlying cause of AUB in 18% of white women 7% of black women with menorrhagia. Others causes include polycystic ovary syndrome or diabetes mallitis present with obesity, acne, hirsutism acanthosis nigricans. Genital tract pathology may be associated with intermenstural, postcoital and heavy menstural bleeding, Any history of abnormal Papanicolaou (Pap) smear, sexually transmitted disease, gynaecologic surgery, trauma or sexual abuse should be elicited. Uterine fibroids, endometrial polyps, adenomyosis, endometrial hyperplasia and atypia and endometrial cancer should be excluded. [14, 15] Differential Diagnosis Pregnancy complications: Threatened abortion   Incomplete abortion   Ectopic pregnancy Nonuterine bleeding: Cervical ectropion/erosion   Cervical neoplasia/polyp   Cervical or vaginal trauma   Condylomata   Atrophic vaginitis   Foreign bodies Pelvic inflammatory disease (PID): Endometritis   Tuberculosis Local factors: Endometrial polyps   Endometrial neoplasia   Adenomyosis/endometriosis   Uterine myomata (fibroids)   Intrauterine device (IUD) Uterine sarcoma Coagulation disorders: Thrombocytopenia, platelet disorders   von Willebrand disease   Leukemia   Ingestion of aspirin or anticoagulants   Iatrogenic Causes: Anticoagulants Antipsychotics Corticosteroids Herbal other supplements(ginkgo, soy) Hormone replacement intrauterine devices Oral contraceptive pills Thyroid hormone replacement PATHOPHYSIOLOGY OF ABNORMAL UTERINE BLEEDING: The hallmark of normal menstrual bleeding is the final result of fluctuations in the hypothalamic-Pituitary-Adrenal-Ovarian axis leading to predictable denudation and slough of the endometrium. Hemorrhage followed by prompt hemostasis and repair causes stabilization and regrowth of the endometrium. Physiologically, constant flow levels of estrogen prime the endometrium. Normal secretion of progesterone from the corpus luteum stabilizes the endometrium, decreases vascular fragility and supports the endometrial stroma. Patients with menorrhagia typically have an imbalance of prostaglandins levels and increased fibrinolytic activity . Specifically, women with heavy bleeding often have elevated levels of plasminogen activators compared to those with normal menstruation. [16] An intact coagulation pathway is important in regulation of menstruation. Mensturation disrupts blood vessels and in the face of normal hemostasis, the injured blood vessels are rapidly repaired . Restoration of blood vessels requires successful interaction of platelets and clotting factors. Defficiency of platelets, abnormal platelet function and an intact coagulation pathway may be associated with profound changes in the menstrual ctcle. [16]. Anovulatory D. U. B is usually due to failure of the corpus luteum to sustain the developing endometrium. The decline of inhibin levels and rise in FSH levels reflect the loss of follicular activity and competence as the perimenopausal transition occurs, [16]. Ovulatory D. U. B occurs when ovulatory cycles coexist with intracavitary lesions including polyps, endometrial cancer or fibroids which cause erractic bleeding, [16]. NATURE OF ABNORMAL UTERINE BLEEDING: The studies have shown mean menstrual blood loss to be ~ 30 ml per cycle in most societies, with loss > 60-80 ml per month being associated with an increased tendency towards iron deficiency and anaemia( Hallberg ET AL, 1996 ;Code et al, 1971). An upper limit of 60 ml may be more appropriate clinically. [17]. The duration of normal menstruation also varies greatly, with an average of 5 days and the heaviest loss usually on the first 2 days(Matsumoto at al, 1962 ; Rubin and Crosignani, 1990). Duration of flow is considered abnormal when it lasts 7 days. [17]. Abnormal uterine bleeding may involve any disturbance of regularity, frequency, duration or volume of menstrual flow and the causes may be physiological, pathological or pharmacological (Fraser and Sngertekin, 2000), [17]. MECHANISM S INVOLVED IN AUB: MENORRHAGIA: Menorrhagia is caused by certain pelvic diseases. The mechanisms by which these conditions cause excessive bleeding are poorly understood, but evidence suggest that large , thin walled and fragile surface vessels underlies the menorrhagia occurring with myomata and endometrial carcinoma. This disturbed angiogenesis is most likely a consequence of unco-ordinated release of angiogenic factors from the tumor themselves(Jane and Harris, 1998), s/a VEGF, bFGF, TGF-beta( Stewart and Nowak, 1996)[17]. The mechanism of increased blood loss with copper IUCDs is thought to be due to a combination if increased cytokine- producing endometrial leukocytes ( Sheppard, 1987), increased local fibrinolytic activity and epithelial surface erosion due to contact with the device(Shaw et al, 1979_. Release of PG and activation of mast cells and macrophages may be the underlying mechanisms. [17]. A quantitative reduction in platelets s/a in autoimmune thrombocytopenia or chronic renal failure can lead to increased menstrual loss. DYSFUCTIONAL UTERINE BLEEIDNG: Dysfunctional uterine bleeding accounts for ~50% of all cases of excessive uterine bleeding, 9Barley, 1972)[17] Anovulatory Dysfuctional Uterine Bleeding: The exact mechanisms behind anovulatory bleeding are unknown(Fraser et al, 1996) but it is known that unopposed estrogen can lead to excessive endometrial proliferation and hyperplasia with increased and dilated draining veins and suppression of spiral arterioles ( Beilby et al , 1971). Large thin walled, tortuous, superficial endometrial vessels can often be demonstrated on the surface of hyperplastic endometrium(Hamou, 1985) and increased fragility is a probable contribution to increased blood loss. Unopposed estrogen has a direct effect on the uterine blood supply by reducing vascular tone (Fraser at al, 1987) and possibly an indirect effect through inhobiting vasopressin releae( Akerlund et al, 1975) leading to vasodilation and increased blood flow. Unopposed estrogen also stimulates stromal VEGF expression which may contribute to disturbed angiogenesis ( Zhang at al, 1995 ; Smith , 1998). [17]. Ovulatory Dysfunctional Uterine Bleeding: The main defect in ovulatory DUB appears to be in the control of processes involve in the regulation of the volume of blood lost during menstrual breakdown of the endometrium, primarily the processes of vasoconstriction and haemostasis. [17] Endometrial glandular and stromal estrogen and progesterone receptor levels may be increased in the late secretory phase in women suffering from DUB (Gleeson et al, 1993 )[17] There may be some role of endothelins, which increase in at the time of normal menstruation. ( Cameron et al , 1992)[17] Reduced levels of endothelins may lead to an increase in the volume of blood lost. An increase in total PG release and disappropriate rise in PGE2 have been demonstrated in ovulatory DUB (Smith et al, 1981 ). It also has been shown that there is an increase in PGE2 and PGI2 receptors predisposing to vasodilation, in women with menorrhagia ( Adelantado et al, 1988 )[17] Prevention of platelet aggregation by PGI2 release may be an important contributing factor in ovulatory DUB ( Smith et al, 1981 ) as may increased endometrial tPA content, increased local fibrinolytic activity ( Bonner et al, 1983;Casslen et al, 1996;Gleeson et al, 1993 ) and excessive endometrial heparin like activity ( Paton et al , 1980 )[17} Endometrial lysosomal enzyme activity in women with ovulatory DUB is increased, and this activity is also observed in women with menorrhagia secondary to IUCD use (Wang , 1994 ){17 ) Matrix metaloproteinases may be important in contributing to abnormal endometrial breakdown and abnormalities of menstrual bleeding ( Salamonson et al, 2000 ){17, 18 ]. Granulated stromal lymphocytes, macrophages and othe migratory leukocytes may contribute to mechanisms of excessinve loss. [18] In DUB, delayed or incomplete endometrial repair could prolog menstrual bleeding episodes, but nothing is known about such mechanisms. [18] SIGNS AND SYMPTOMS OF ABNORMAL UTERINE BLEEDING: Frequent complaint include: heavy or prolonged menstural flow, social embarrassment, diminished quality of life, sexual compromise and alteration in life style. Pain is not a common presenting symptom unless associated with passage of large blood clots. Prolonged menstrual blood loss can be associated with anaemia. Typical complains of anaemia include fatigue, unusual desire of eating starch or dirt and headaches. Severe anaemia may cause fainting, congestive cardiac failure, exercise induced fatigue, shortness of breath. Hemorrhagic shock death are rare sequelae for DUB. [16] EVALUATION OF AUB IN PERIMENOPAUSAL WOMEN: 1.  History: History focuses on identifying the type of AUB:ovulatory, anovulatory or anatomic in order to guide treatment. Ovulatory bleeding is more common, usually cyclic, and can be associated with mid cycle pain, premenstrual symptoms and dysmenorrhea. Anovulatory bleeding occurs more frequently at the axtremes of reproductive age and in obese women. It is usually irregular and often heavy. Any history of easy bruising and tendency to bleed suggests coagulopathy. History of jaundice and hepatitis gives the evidence of liver sisease. [19] 2. Physical Examination: Physical examination includes looking for evidence of systemic disease. Pelvic and bimanual examination are done to detect disease in the genital tract. Cervical cytology analysis should be current and normal and cervical and vaginal swabs should be assesses to rule out infection. [19] 3. Laboratory tests: Beta subunit human chorionic gonadotropin for pregnancy. Complete blood count with platelet count for coagulopathy LFT, PT for liver disease. TSH for hypothyroidism and hyperthyroidism. Free testosterone for ovarian or adrenal tumor. [19] 4. Assessment of the uterine cavity: The main indications for assessment of the uterine cavity is to exclude pathology, most often seen in women over 45 years of age with anovulatory cycles. [19] A wide variety of methods are available for endometrial assessment including: Ultrasonography Endometrial Biopsy Hystroscopy Dilatation and curettage Sonohysterography Hysterosalpingography 1. Ultrasonography: Ultrasonography to look for ovarian or uterine disease. Transvaginal ultrasound is 80% sensitive and 69% specific for fibroids and polyps and is superior to transabdominal ultrasound. If possible, transvaginal ultrasound should be performed on days 4-6 of the menstrual cycle. [19] 2. Endometrial Biopsy: Endometrial biopsy is a simple office procedure that can be done by family physicians, [19]despite its convenience , cost effectiveness and safety, it is a blind endometrial sampling procedure. [20]It is a useful method to exclude malignancy in perimenopausal women. The annual incidence of endometrial cancer is 19. 5 per 100, 000 women. One in 4 cases of endometrial carcinoma occurs before menopause, so biopsy should be considered for high risk premenopausal patients, even in the presence of fibroids. Endometrial biopsy produces an adequate sample more that 85% of the time and detects 87-96% of endometrial carcinoma. [19] 3. Hysteroscopy: Hysteroscopy permits direct visualization of the cercical canal and uterine cavity, enabling observation of intrauterine abnormalities. Hysteroscopy is considered an accurate gold standard in uterine cavity evaluation. Despite the lack of adequate information about the diagnostic accuracy, it is used in many studies with and without endometrial sampling as a reference standard, [21] Hysteroscopy was reported to have sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of 94. 2, 88. 8, 96. 3 and 83. 1% respectively, in predicting normal or abnormal endometrial histopathology (Garuti et al, 2001). The highest accuracy of hysteroscopy was in diagnosing endometrial polyps, where as the worst result was in estimating hyperplasia. In a recent study the sensitivity and PPV of hysteroscopy without endometrial biopsy in diagnosing endometrial carcinoma was only 58. 8 and 20. 8 % respectively (Lo and Yuyen, 2000 ). There, since the incidence of focal lesions in patients with AUB is 46-74% (Nagele et al, 1996;Pal et al, 1997 ), it seems that the most cost effective approach is to proceed with hysteroscopy complemented by endometrial biopsy, early in the assessment of AUB. [22] 4. Dilatation Curettage: Dilatation is a common surgical procedure done on women to scrape and collect the tissue from inside the uterus. Dilatation is a widening of the cervical passage. This is done using smoothy conical and tapered, graduated metal rods of various sizes and these appropriately called the dilators, which dilates the tight cervical passage slowly. Curettage is the second part of the procedure and is done to scrape the inside contents of the uterus. For this, a sharp spoon like instrument called curette is used. The procedure is usually performed under general anaesthesia. [23, 24, 25] Indications:[23, 24, 25]s Dialtation and curettage may be done as a diagnostic or a therapeutic procedure. Diagnostic: Diagnose conditions by collecting tissue samples for biopsy. To diagnose endometrial cancer. To investigate the causes of infertility. To investigate the cause of abnormal bleeding in postmenopausal women taking HRT. Therapeutic: Treat intermenstural bleeding To remove polyps in the endometrial or inner lining of the uterus. To treat irregular and heavy bleeding. To remove an embedded IUD used for contraception. To perform abortion in the early stages of pregnancy. To evacuate spontaneous abortion product. [23, 24, 25] Preoperative procedure: It is recommended that the patient take nothing by mouth, for at least 6 hours. Pain killers and antibiotics may be prescribed before the procedure. A sedative may be useful to relieve the anxirty of srgery. The genital area may be shaved and prepared for the surgery. An enema may be administered to clear the bowels. [23] Anaesthesia: General Anaesthesia: Most D Cs are done under general anaesthesia. The procedure is normally very short and the general anesthetic can be quickly reversed, with the patient going home soon afterwards. Spinal Anaesthesia: The advantage of spinal anaesthesia is that the patient is awake but at the same time does not have any sensation below the waist. It avoids all the complications of general anaesthesia. Local Anaesthesia: Occasionally, D C s are done under local anaesthesia, if the patient is not ready for general or spinal anaesthesia. [23, 25] Procedure: The vagina and cervix are cleaned with an antibacterial solution that may be iodine or alcohol based. The cervix is visualized using an instrument that is locatedin the vagina called the speculum. Lights are so adjusted to visualize the cervix so that its upper lip can be grasped with a special curved forceps called the Vulsellum. This helps both in stabilizing and bringing the cervix down towards the vaginal opening to ease with rest of the procedure. Dilatation is next done using sequential metal round tapered dilators and the opening to the uterus is gradually widened to about the size of a large pencil. Once this dilatation has been completed, the curette is inserted into the uterine cavity and is used to gently scrape the lining of the uterus. When the surgeon feels the gritty layer of cells just above the muscle of the uterus, then he/she knows that the scrapping has gone deep enough to sample the tissue adequately. This scrapping is done throughout the uterus and the tissue is sent to histopathologist. [23, 24, 25, 26] Post operative care: There may be mild abdominal discomfort after a dilatation and curettage, if pain is severe, consult a doctor. Medication should be taken as advised by doctor. Ensure to take antibiotics. Avoid the use of any contraceptive device or sexual intercourse for a week. Use sanitary napkins during this time period. If there are any signs of infection s/a fever , pain or discharge, consult the doctor immediately. [23, 24, 25] Contraindications: If a patient is too ill to undergo surgery. If the patient is unable to move her legs apart, s/a with severe arthritis in the hips. If the patient has problem with clotting mechanism of the body. [23] Complications: Complications are usually rare: Anaesthetic Complications: Reactions to anaesthetic medications. Breathing difficulties. Surgical Complications: Perforation of the uterus. Laceration of the cervix. Scarring of the endometrium. Infection of the uterus or other pelvic organs. Hemorrhage. [23, 24, 25] 5. SONOHYSTEROGRAPHY: Sonohysterography is being used more frequently for evaluation of women with many gynaecologic conditions. In 1992, it is reported the use of sonohysterography for detecting endometrial polyp in 14 of 148 infertility patients. In 13 of the women, polyps were asymptomatic. [27]This procedure is to be done by use of saline infused through a catheter into the endometrial cavity provides slight distention and separation of cavity walls, allowing the better visualization of uterine cavity. [28] Sonohysterography not only aids in diagnosis of intrauterine pathology but also in decision regarding surgical versus medical management of patients and and directs the approach and instrumentation required when surgical treatment is warranted. [28] It can be performed in any phase of cycle but the best time is during the first phase of the cycle especially when the indication is sterility or thickened endometrium at transvaginal sonography. [28] 6. HYSTEROSALPINGOGRAPHY: Hysterosalpingography requires the use of radiations and iodinated contrast material. It is expensive and provides indirect information about the uterine cavity. One can delineate fibroids and polyps but cannot comment on endometrial thickness. [28] 7. MEGNETIC RESONANCE IMAGING: Magnetic resonance imaging , an expensive modality provides excellent images of the uterus and myometrial pathology disrupting the endometrium, however, intracavitary lesions are not well demonstrated. [28] EMBRYOLOGY OF THE FEMALE GENITAL SYETEM Although genetic sex is determined at fertilization, gender is not apparent until approximately the 12th week of embryonic life. By the 6th week embryonic life, both male and female embryos start to develop the following structures on either side of the midline. :[29, 30] Genital ridge (proliferation of coelomic epithelium ) Mesonephric (wolffian )duct (lateral to the genital ridge ). Paramesonephric ( mullerian ) duct which consists of: Upper vertical part lateral to the wolffian duct. Middle horizontal part crosses in front of the wolffian duct ( both upper and middle parts form the fallopian tubes ). Lower vertical part fuses with the similar part of the opposite side to form the uteri-vaginal canal (the upper part forms the body and cervix of the uterus while the lower part forms the upper 4/5 of the vagina ). The lower 1/5 of the vagina develops from the sino-vaginal bulbs in the posterior wall of the uro-genital sinus. [29] Origin and derivatives of the Mullerian Ducts: Mullerian ducts persists, in females to develop into the fallopian tubes, the uterus and part of the vagina. [31]. Mullarian duct grows , at first it is solid, but later it becomes canalized. It deviates more and more medially till it meets its fellow of the opposite side. The septum between the two mullerian ducts disappear. The proximal parts of the mullerian ducts form the fallopian tubes, while the distal parts meet together to form the body and cervix of the uterus and the upper 4/5th of the vagina. The stroma and muscles develop from the surrounding mesoderm. The fusion of the two mullerian ducts brings together two peritoneal folds which become the broad ligaments. [29] Ovary: Development of the ovary passes into three phases: Migration of the germ cells from the yolk sac to the posterior body wall at level of 10th thoracic level to enter the genital ridge The germ cells differentiate into oogonia then primaryoocytes and become arrested until puberty. Descent of the ovary to reach the pelvis along a ligamentous cord called the gubernaculums that is attached inferiorlyot the inguinal region. The gubernaculums becomes incorporated into the uterine wall at the point of entry of the fallopian tube and persists in the adult as the ovarian ligaments and the round ligament. [29] External Genitalia: Clitoris develops from the genital tubercle (by slight elongation ). Labia minora develops from the genital folds (by remaining separate ) Labia majora develop from the genital swelings (by enlarging greatly ). Vestibule develops from the lower most part of the urogenital sinus. [29]. ANATOMY AND HISTOLOGY OF FEMALE GENITAL TRACT Uterus: The uterus is a fibromuscular organ and is a hollow and pear shaped highly vascular organ present in the pelvis between the bladder and the rectum. It is about 8 cm long and 5 am broad, within which fetal development occurs. Uterus is usually divided into a lower cervix and an upper corpus of uterine body. 1. Cervix; The cervix is narrow region at the bottom of the uterus that leads to the vagina. It has a convex round surface with a circular or slit like opening (the external os ) into the endocervical canal, ehich is approximately 2 -3 cm in length and opens proximally into the endometrial cavity at the internal os. [30, 32, 33] Histologically, the cervical mucosa generally contains both stratified squamous  epithelium (exocervix) and mucus secreting columnar epithelium (endocervix). The mucus secreting glands are confined to the endocervix. The area where the two types of epithelia meet is called the squamocolumnar junction. [30, 34]. Cervical mucus secreted by the mucosa layer of the cervical canal serves to protect against bacteria entering the uterus from the vagina . [33]. In the cervix, the stroma is firmer, more fibrous and less cellular. [34] 2. Uterine Corpus: The body of the uterus varies in size. At birth , the cervix and corpus are approximately equal in size, in the adult women, the corpus has grown to 2-3 times the size of the cervix. The uterine corpus is divided into different regions: Isthmus: where the endocervicla canal opens into the endometrial cavity. Uterine cornu: Funnel shaped area on each side of the upper uterine body receives the insertion of the fallopian tubes. Fundus: The portion of uterus above uterine cornu. [30] Histologically, the wall of the uterus consists of the following three layers: Perimetrium: It is serous membrane that covers the outside of the uterus. Myometrium: It consists of several layers of smooth muscles and imparts the bulk of the uterine wall. Contractions of these muscles during childbirth help to force the fetus out o

Definition Essay - Defining Service -- Definition Essays

Definition Essay- Defining Service Being raised in a Christian faith and family, you’re likely to hear the word â€Å"service† quite a bit. Not ever truly being interested in the denotation of this word, I always referred to the church holding services, in which were usually, programs that contain dedicated members of the church. Oxford American Dictionary says describes it as â€Å"a meeting of a congregation for worship of God, a religious ceremony. Religion being such a sensitive issue for many people, and because there are so many opinions concerning it out there, connotations for words frequently used in it are not widely talked about. Some churchgoers believe that church is the Oxford English Dictionary â€Å"a religious rite† and â€Å"active devotion to God, as through good works or prayer†. I al... Definition Essay - Defining Service -- Definition Essays Definition Essay- Defining Service Being raised in a Christian faith and family, you’re likely to hear the word â€Å"service† quite a bit. Not ever truly being interested in the denotation of this word, I always referred to the church holding services, in which were usually, programs that contain dedicated members of the church. Oxford American Dictionary says describes it as â€Å"a meeting of a congregation for worship of God, a religious ceremony. Religion being such a sensitive issue for many people, and because there are so many opinions concerning it out there, connotations for words frequently used in it are not widely talked about. Some churchgoers believe that church is the Oxford English Dictionary â€Å"a religious rite† and â€Å"active devotion to God, as through good works or prayer†. I al...

Fiscal Policy Essay -- essays papers

Fiscal Policy Supposing the status quo of the United States today states that: there is no real unemployment, the consumer price index is rising at 2 percent annually, and the federal government budget deficit, 200 billion dollars, is equal to 5 percent of the gross national product. Now, the question is how and what changes will result from fiscal and monetary policy. For example, if legislation has just passed which holds government spending constant and raises personal income taxes enough to balance the budget, then obviously the deficit would cease growing, as mentioned, along with other fluctuations of the gross national product as a whole. Because the government will stop borrowing money, it will also cut down on the spending, which will cause the economy to slow down as is illustrated by the equation: Y = C + I + G + X. In the short run people will respond to the raised taxes by decreasing their consumption, while simultaneously the marginal propensity to consume will increase because people will have less money to save. Therefore, the short run effects of this fiscal policy will force companies to lower wages, produce less, and/or lay off a portion of the work force. All the while The Fed is working up their counter cyclical monetary policy to keep deviation from the potential GDP to a minimum. The Federal Reserve Bank goes public with its goal to significantly increase the money supply. Due to rational expectations of the consumer, people might be... Fiscal Policy Essay -- essays papers Fiscal Policy Supposing the status quo of the United States today states that: there is no real unemployment, the consumer price index is rising at 2 percent annually, and the federal government budget deficit, 200 billion dollars, is equal to 5 percent of the gross national product. Now, the question is how and what changes will result from fiscal and monetary policy. For example, if legislation has just passed which holds government spending constant and raises personal income taxes enough to balance the budget, then obviously the deficit would cease growing, as mentioned, along with other fluctuations of the gross national product as a whole. Because the government will stop borrowing money, it will also cut down on the spending, which will cause the economy to slow down as is illustrated by the equation: Y = C + I + G + X. In the short run people will respond to the raised taxes by decreasing their consumption, while simultaneously the marginal propensity to consume will increase because people will have less money to save. Therefore, the short run effects of this fiscal policy will force companies to lower wages, produce less, and/or lay off a portion of the work force. All the while The Fed is working up their counter cyclical monetary policy to keep deviation from the potential GDP to a minimum. The Federal Reserve Bank goes public with its goal to significantly increase the money supply. Due to rational expectations of the consumer, people might be...

The Self in the World: the Social Context of Sylvia Plath’s Late Poems

The Self in the World: The Social Context of Sylvia Plath's Late Poems, [(essay date 1980) In the following essay, Annas offers analysis of depersonalization in Plath's poetry which, according to Annas, embodies Plath's response to oppressive modern society and her â€Å"dual consciousness of self as both subject and object. â€Å"] For surely it is time that the effect of disencouragement upon the mind of the artist should be measured, as I have seen a dairy company measure the effect of ordinary milk and Grade A milk upon the body of the rat.They set two rats in cages side by side, and of the two one was furtive, timid and small, and the other was glossy, bold and big. Now what food do we feed women as artists upon? –Virginia Woolf, A Room of One's Own The dialectical tension between self and world is the location of meaning in Sylvia Plath's late poems. Characterized by a conflict between stasis and movement, isolation and engagement, these poems are largely about what st ands in the way of the possibility of rebirth for the self.In â€Å"Totem,† she writes: â€Å"There is no terminus, only suitcases / Out of which the same self unfolds like a suit / Bald and shiny, with pockets of wishes / Notions and tickets, short circuits and folding mirrors. † While in the early poems the self was often imaged in terms of its own possibilities for transformation, in the post-Colossus poems the self is more often seen as trapped within a closed cycle. One moves–but only in a circle and continuously back to the same starting point. Rather than the self and the world, the Ariel poems record the self in the world.The self can change and develop, transform and be reborn, only if the world in which it exists does; the possibilities of the self are intimately and inextricably bound up with those of the world. Sylvia Plath's sense of entrapment, her sense that her choices are profoundly limited, is directly connected to the particular time and place in which she wrote her poetry. Betty Friedan describes the late fifties and early sixties for American women as a â€Å"comfortable concentration camp†Ã¢â‚¬â€œphysically luxurious, mentally oppressive and impoverished.The recurring metaphors of fragmentation and reification–the abstraction of the individual–in Plath's late poetry are socially and historically based. They are images of Nazi concentration camps, of â€Å"fire and bombs through the roof† (â€Å"The Applicant†), of cannons, of trains, of â€Å"wars, wars, wars† (â€Å"Daddy†). And they are images of kitchens, iceboxes, adding machines, typewriters, and the depersonalization of hospitals. The sea and the moon are still important images for Plath, but in the Ariel poems they have taken on a harsher quality. The moon, also, is merciless,† she writes in â€Å"Elm. † While a painfully acute sense of the depersonalization and fragmentation of 1950's America is cha racteristic of Ariel, three poems describe particularly well the social landscape within which the â€Å"I† of Sylvia Plath's poems is trapped: â€Å"The Applicant,† â€Å"Cut,† and â€Å"The Munich Mannequins. † â€Å"The Applicant† is explicitly a portrait of marriage in contemporary Western culture. However, the â€Å"courtship† and â€Å"wedding† in the poem represent not only male/female relations but human relations in general.That job seeking is the central metaphor in â€Å"The Applicant† suggests a close connection between the capitalist economic system, the patriarchal family structure, and the general depersonalization of human relations. Somehow all interaction between people, and especially that between men and women, given the history of the use of women as items of barter, seems here to be conditioned by the ideology of a bureaucratized market place. However this system got started, both men and women are implica ted in its perpetuation.As in many of Plath's poems, one feels in reading â€Å"The Applicant† that Plath sees herself and her imaged personae as not merely caught in–victims of–this situation, but in some sense culpable as well. In â€Å"The Applicant,† the poet is speaking directly to the reader, addressed as â€Å"you† throughout. We too are implicated, for we too are potential â€Å"applicants. † People are described as crippled and as dismembered pieces of bodies in the first stanza of â€Å"The Applicant. † Thus imagery of dehumanization begins the poem.Moreover, the pieces described here are not even flesh, but â€Å"a glass eye, false teeth or a crutch, / A brace or a hook, / Rubber breasts or a rubber crotch. † We are already so involved in a sterile and machine-dominated culture that we are likely part artifact and sterile ourselves. One is reminded not only of the imagery of other Plath poems, but also of the control ling metaphor of Ken Kesey's One Flew Over the Cuckoo's Nest, written at about the same time as â€Å"TheApplicant†Ã¢â‚¬â€œin 1962–, and Chief Bromden's conviction that those people who are integrated into society are just collections of wheels and cogs, smaller replicas of a smoothly functioning larger social machine. â€Å"The ward is a factory for the Combine,† Bromden thinks. â€Å"Something that came all twisted different is now a functioning, adjusted component, a credit to the whole outfit and a marvel to behold. Watch him sliding across the land with a welded grin . . . In stanza two of â€Å"The Applicant,† Plath describes the emptiness which characterizes the applicant and which is a variant on the roboticized activity of Kesey's Adjusted Man. Are there â€Å"stitches to show something's missing? † she asks. The applicant's hand is empty, so she provides â€Å"a hand† To fill it and willing To bring teacups and roll away headaches And do whatever you tell it Will you marry it? Throughout the poem, people are talked about as parts and surfaces. The suit introduced in stanza three is at least as alive as the hollow man and mechanical doll woman of the poem.In fact, the suit, an artifact, has more substance and certainly more durability than the person to whom it is offered â€Å"in marriage. † Ultimately, it is the suit which gives shape to the applicant where before he was shapeless, a junk heap of fragmented parts. I notice you are stark naked. How about this suit– Black and stiff, but not a bad fit. Will you marry it? It is waterproof, shatterproof, proof Against fire and bombs through the roof. Believe me, they'll bury you in it.The man in the poem is finally defined by the black suit he puts on, but the definition of the woman shows her to be even more alienated and dehumanized. While the man is a junk heap of miscellaneous parts given shape by a suit of clothes, the woman is a wind-up toy, a puppet of that black suit. She doesn't even exist unless the black suit needs and wills her to. Will you marry it? It is guaranteed To thumb shut your eyes at the end And dissolve of sorrow. We make new stock from the salt. The woman in the poem is referred to as â€Å"it. Like the man, she has no individuality, but where his suit gives him form, standing for the role he plays in a bureaucratic society, for the work he does, the only thing that gives the woman form is the institution of marriage. She does not exist before it and dissolves back into nothingness after it. In â€Å"The Applicant† there is at least an implication that something exists underneath the man's black suit; that however fragmented he is, he at least marries the suit and he at least has a choice. In contrast, the woman is the role she plays; she does not exist apart from it. Naked as paper to start,† Plath writes, But in twenty-five years she'll be silver, In fifty, gold. A living doll, everywhe re you look. It can sew, it can cook. It can talk, talk, talk. The man, the type of a standard issue corporation junior executive, is also alienated. He has freedom of choice only in comparison to the much more limited situation of the woman. That is to say, he has relative freedom of choice in direct proportion to his role as recognized worker in the economic structure of his society. This should not imply, however, that this man is in any kind of satisfying and meaningful relation to his work.The emphasis in â€Å"The Applicant† upon the man's surface–his black suit–together with the opening question of the poem (â€Å"First, are you our sort of person? â€Å") suggests that even his relationship to his work is not going to be in any sense direct or satisfying. It will be filtered first through the suit of clothes, then through the glass eye and rubber crotch before it can reach the real human being, assuming there is anything left of him. The woman in the p oem is seen as an appendage; she works, but she works in a realm outside socially recognized labor.She works for the man in the black suit. She is seen as making contact with the world only through the medium of the man, who is already twice removed. This buffering effect is exacerbated by the fact that the man is probably not engaged in work that would allow him to feel a relationship to the product of his labor. He is probably a bureaucrat of some kind, and therefore his relationship is to pieces of paper, successive and fragmented paradigms of the product (whatever it is, chamberpots or wooden tables) rather than to the product itself.And of course, the more buffered the man is, the more buffered the woman is, for in a sense her real relationship to the world of labor is that of consumer rather than producer. Therefore, her only relationship to socially acceptable production–as opposed to consumption–is through the man. In another sense, however, the woman is not a consumer, but a commodity. Certainly she is seen as a commodity in this poem, as a reward only slightly less important than his black suit, which the man receives for being â€Å"our sort of person. It can be argued that the man is to some extent also a commodity; yet just as he is in a sense more a laborer and less a consumer than the woman–at least in terms of the social recognition of his position–so in a second sense he is more a consumer and less a commodity than the woman. And when we move out from the particularly flat, paper-like image of the woman in the poem to the consciousness which speaks the poem in a tone of bitter irony, then the situation of the woman as unrecognized worker/recognized commodity becomes clearer.The man in â€Å"The Applicant,† because of the middle class bureaucratic nature of his work (one does not wear a new black suit to work in a steel mill or to handcraft a cabinet) and because of his position vis-a-vis the woman (her socia l existence depends upon his recognition), is more a member of an exploiting class than one which is exploited. There are some parts of his world, specifically those involving the woman, in which he can feel himself relatively in control and therefore able to understand his relationship to this world in a contemplative way.Thus, whatever we may think of the system he has bought into, he himself can see it as comparatively stable, a paradigm with certain static features which nevertheless allows him to move upward in an orderly fashion. Within the context of this poem, then, and within the context of the woman's relationship to the man in the black suit, she is finally both worker and commodity while he is consumer. Her position is close to that of the Marxist conception of the proletariat.Fredric Jameson, in Marxism and Form, defines the perception of external objects and events which arises naturally in the consciousness of an individual who is simultaneously worker and commodity. Even before [the worker] posits elements of the outside world as objects of his thought, he feels himself to be an object, and this initial alienation within himself takes precedence over everything else. Yet precisely in this terrible alienation lies the strength of the worker's position: his first movement is not toward knowledge of the work but toward knowledge of himself as an object, toward self-consciousness.Yet this self-consciousness, because it is initially knowledge of an object (himself, his own labor as a commodity, his life force which he is under obligation to sell), permits him more genuine knowledge of the commodity nature of the outside world than is granted to middle-class â€Å"objectivity. † For [and here Jameson quotes Georg Lukacs in The History of Class Consciousness] â€Å"his consciousness is the self-consciousness of merchandise itself . . . † This dual consciousness of self as both subject and object is characteristic of the literature of min ority and/or oppressed classes.It is characteristic of the proletarian writer in his (admittedly often dogmatic) perception of his relation to a decadent past, a dispossessed present, and a utopian future. It is characteristic of black American writers; W. E. B. Du Bois makes a statement very similar in substance to Jameson's in The Souls of Black Folk, and certainly the basic existential condition of Ellison's invisible man is his dual consciousness which only toward the end of that novel becomes a means to freedom of action rather than paralysis.It is true of contemporary women writers, of novelists like Doris Lessing, Margaret Atwood, and Rita Mae Brown, and of poets like Denise Levertov, Adrienne Rich, and Marge Piercy. In a sense, it is more characteristic of American literature than of any other major world literature, for each immigrant group, however great its desire for assimilation into the American power structure, initially possessed this dual consciousness.Finally, a di alectical perception of self as both subject and object, both worker and commodity, in relation to past and future as well as present, is characteristic of revolutionary literature, whether the revolution is political or cultural. Sylvia Plath has this dialectical awareness of self as both subject and object in particular relation to the society in which she lived. The problem for her, and perhaps the main problem of Cold War America, is in the second aspect of a dialectical consciousness–an awareness of oneself in significant relation to past and future.The first person narrator of what is probably Plath's best short story, â€Å"Johnny Panic and the Bible of Dreams,† is a clerk/typist in a psychiatric clinic, a self-described â€Å"dream connoisseur† who keeps her own personal record of all the dreams which pass through her office, and who longs to look at the oldest record book the Psychoanalytic Institute possesses. â€Å"This dream book was spanking new th e day I was born,† she says, and elsewhere makes the connection even clearer: â€Å"The clinic started thirty-three years ago–the year of my birth, oddly enough. This connection suggests the way in which Plath uses history and views herself in relation to it. The landscape of her late work is a contemporary social landscape. It goes back in time to encompass such significant historical events as the Rosenberg trial and execution–the opening chapter of The Bell Jar alludes dramatically to these events–and of course it encompasses, is perhaps obsessed with, the major historical event of Plath's time, the second world war.But social history seems to stop for Plath where her own life starts, and it is replaced at that point by a mythic timeless past populated by creatures from folk tale and classical mythology. This is not surprising, since as a woman this poet had little part in shaping history. Why should she feel any relation to it? But more crucially, the re is no imagination of the future in Sylvia Plath's work, no utopian or even antiutopian consciousness.In her poetry there is a dialectical consciousness of the self as simultaneously object and subject, but in her particular social context she was unable to develop a consciousness of herself in relation to a past and future beyond her own lifetime. This foreshortening of a historical consciousness affects in turn the dual consciousness of self in relation to itself (as subject) and in relation to the world (as object). It raises the question of how one accounts objectively for oneself. For instance, if I am involved in everything I see, can I still be objective and empirical in my perception, free from myth and language?Finally, this foreshortening of historical consciousness affects the question of whether the subject is a function of the object or vice versa. Since the two seem to have equal possibilities, this last question is never resolved. As a result, the individual feels t rapped; and in Sylvia Plath's poetry one senses a continual struggle to be reborn into some new present which causes the perceiving consciousness, when it opens its eyes, to discover that it has instead (as in â€Å"Lady Lazarus†) made a â€Å"theatrical / Comeback in broad day / To the same place, the same face, the same brute / Amused shout: ‘A miracle! † This difficulty in locating the self and the concomitant suspicion that as a result the self may be unreal are clear in poems like â€Å"Cut,† which describe the self-image of the poet as paper. The ostensible occasion of â€Å"Cut† is slicing one's finger instead of an onion; the first two stanzas of the poem describe the cut finger in minute and almost naturalistic detail. There is a suppressed hysteria here which is only discernible in the poem's curious mixture of surrealism and objectivity.The images of the poem are predominantly images of terrorism and war, immediately suggested to the poet by the sight of her bleeding finger: â€Å"out of a gap / A million soldiers run,† â€Å"Saboteur / Kamikaze man–,† and finally, â€Å"trepanne d veteran. † The metaphors of war are extensive, and, though suggested by the actual experience, they are removed from it. In the one place in the poem where the speaker mentions her own feelings as a complete entity (apart from but including her cut finger) the image is of paper. She says, O my Homunculus, I am ill. I have taken a pill to killThe thin Papery feeling. Paper often stands for the self-image of the poet in the post-Colossus poems. It is used in the title poem of Crossing the Water, where the â€Å"two black cut-paper people† appear less substantial and less real than the solidity and immensity of the natural world surrounding them. In the play Three Women, the Secretary says of the men in her office: â€Å"there was something about them like cardboard, and now I had caught it. † She se es her own infertility as directly related to her complicity in a bureaucratic, impersonal, male-dominated society.Paper is symbolic of our particular socioeconomic condition and its characteristic bureaucratic labor. It stands for insubstantiality; the paper model of something is clearly less real than the thing itself, even though in â€Å"developed† economies the machines, accoutrements, and objects appear to have vitality, purpose, and emotion, while the people are literally colorless, objectified, and atrophied. The paper self is therefore part of Plath's portrait of a depersonalized society, a bureaucracy, a paper world.In â€Å"A Life† (Crossing the Water), she writes: â€Å"A woman is dragging her shadow in a circle / About a bald hospital saucer. / It resembles the moon, or a sheet of blank paper / And appears to have suffered a private blitzkrieg. † In â€Å"Tulips† the speaker of the poem, also a hospital patient, describes herself as â€Å"fl at, ridiculous, a cut-paper shadow / Between the eye of the sun and the eyes of the tulips. † In â€Å"The Applicant,† the woman is again described as paper: â€Å"Naked as paper to start / But in twenty-five years she'll be silver, / In fifty, gold. Here in â€Å"Cut,† the â€Å"thin, / Papery feeling† juxtaposes her emotional dissociation from the wound to the horrific detail of the cut and the bloody images of conflict it suggests. It stands for her sense of depersonalization, for the separation of self from self, and is juxtaposed to that devaluation of human life which is a necessary precondition to war, the separation of society from itself. In this context, it is significant that one would take a pill to kill a feeling of substancelessness and depersonalization. Writing about American women in the 1950's, Betty Friedan asks, â€Å"Just what was the problem that had no name?What were the words women used when they tried to express it? Sometimes a w oman would say, ‘I feel empty somehow . . . incomplete. ‘ Or she would say, ‘I feel as if I don't exist. ‘ Sometimes she blotted out the feeling with a tranquilizer. † A papery world is a sterile world; this equation recurs throughout the Ariel poems. For Sylvia Plath, stasis and perfection are always associated with sterility, while fertility is associated with movement and process. The opening lines of â€Å"The Munich Mannequins† introduce this equation. Perfection is terrible,† Plath writes, â€Å"it cannot have children. / Cold as snow breath, it tamps the womb / Where the yew trees blow like hydras. † The setting of â€Å"The Munich Mannequins† is a city in winter. Often, Plath's poems have imaged winter as a time of rest preceding rebirth (â€Å"Wintering,† â€Å"Frog Autumn†), but only when the reference point is nature. The natural world is characterized in Sylvia Plath's poems by process, by the ebb and flow of months and seasons, by a continual dying and rebirth. The moon is a symbol for the monthly ebb and flow of the tides and of a woman's body.The social world, however, the world of the city, is both male defined and separated from this process. In the city, winter has more sinister connotations; it suggests death rather than hibernation. Here the cold is equated with the perfection and sterility to which the poem's opening lines refer. Perfection stands in â€Å"The Munich Mannequins† for something artificially created and part of the social world. The poem follows the male quest for perfection to its logical end–mannequins in a store window–lifeless and mindless â€Å"in their sulphur loveliness, in their smiles. The mannequins contrast with the real woman in the same way that the city contrasts with the moon. The real woman is not static but complicated: The tree of life and the tree of life Unloosing their moons, month after month, to no purpose. The blood flood is the flood of love, The absolute sacrifice However, in Munich, â€Å"morgue between Paris and Rome,† the artificial has somehow triumphed. Women have become mannequins or have been replaced by mannequins, or at least mannequins seem to have a greater reality because they are more ordered and comprehensible than real women.It is appropriate that Plath should focus on the middle class of a German city, in a country where fascism was a middle class movement and women allowed themselves to be idealized, to be perfected, to be made, essentially, into mannequins. In â€Å"The Munich Mannequins,† as in â€Å"The Applicant,† Plath points out the deadening of human beings, their disappearance and fragmentation and accretion into the objects that surround them. In â€Å"The Applicant† the woman is a paper doll; here she has been replaced by a store window dummy.In â€Å"The Applicant† all that is left of her at the end is a kind of saline solut ion; in â€Å"The Munich Mannequins† the only remaining sign of her presence is â€Å"the domesticity of these windows / The baby lace, the green-leaved confectionery. † And where the man in â€Å"The Applicant† is described in terms of his black suit, here the men are described in terms of their shoes, present in the anonymity of hotel corridors, where Hands will be opening doors and setting Down shoes for a polish of carbon Into which broad toes will go tomorrow. People accrete to their things, are absorbed into their artifacts.Finally, they lose all sense of a whole self and become atomized. Parts of them connect to their shoes, parts to their suits, parts to their lace curtains, parts to their iceboxes, and so on. There is nothing left; people have become reified and dispersed into a cluttered artificial landscape of their own production. Because the world she describes is a place created by men rather than women (since men are in control of the forces of pr oduction), Plath sees men as having ultimate culpability for this state of affairs which affects both men and women.But men have gone further than this in their desire to change and control the world around them. In â€Å"The Munich Mannequins† man has finally transformed woman into a puppet, a mannequin, something that reflects both his disgust with and his fear of women. A mannequin cannot have children, but neither does it have that messy, terrifying, and incomprehensible blood flow each month. Mannequins entirely do away with the problems of female creativity and self-determination.Trapped inside this vision, therefore, the speaker of the Ariel poems sees herself caught between nature and society, biology and intellect, Dionysus and Apollo, her self definition and the expectations of others, as between two mirrors. Discussion of the Ariel poems has often centered around Sylvia Plath's most shocking images. Yet her images of wars and concentration camps, of mass and indivi dual violence, are only the end result of an underlying depersonalization, an abdication of people to their artifacts, and an economic and social structure that equates people and objects.Like the paper doll woman in â€Å"The Applicant,† Sylvia Plath was doubly alienated from such a world, doubly objectified by it, and as a woman artist, doubly isolated within it. Isolated both from a past tradition and a present community, she found it difficult to structure new alternatives for the future. No wonder her individual quest for rebirth failed as it led her continuously in a circle back to the same self in the

A Rapidly Growing Field of Science

Nanotechnology is a rapidly growing field of science, which is particularly interesting for researchers since the early 90s of the last century has become a vital part of the modern technology. Nanomaterials are increasingly becoming a part of our regular lives (Hill and Julang, 2017). They are characterized by new characteristics that differ from those existing at the macro materials. Therefore, nanomaterials are used in innovative products and processes (Fariq et al., 2017). Recently, application of nanomaterial extensively increased, because of high demands for the production of such materials. Classically, the nanoparticles are produced by chemical and physical methods (Stark et al., 2015), as these methods are costly, toxic and non-eco-friendly, scientists are looking forward to synthesizing low cost, non-toxic, eco-friendly nanoparticles (Singh et al., 2016; Sangeetha et al., 2017). Biogenic synthesis of nanoparticles using organisms such as bacteria, fungus and plants emerged as a suitable alternative to the more complex physical and chemical synthetic procedures (Singh et al., 2016). Fungi have some advantages over other microorganisms because they are easy to handle, their nutritional requiems are simple, have a high wall-binding capacity, as well as their capabilities for the intracellular metal uptake (Bhattacharjee et al., 2017). Silver nanoparticles are among the most widely-used metals, and are used as antimicrobial agents, water treatment, textile industries, sunscreen lotions †¦etc. (Raja et al., 2012). We assume that each kind of fungi could have its own machinery to reduce the metals through a production of a group of enzymes. So, the synthesized nanoparticle by each kind of fungi could show a specific characteristic including definite shape and size that makes them effective in many applications, especially as antimicrobial agents. Therefore, the main aim of the present study depends on the wide survey of many fungal species that were isolated from Saudi habitats to investigate their potentiality to synthesize the silver-nanoparticles. The physical characteristics of the newly produced nanoparticles will be studied using accurate and fine techniques including the X-Ray Diffraction (XRD), Fourier Transform InfraRed (FT-IR) and the transition electron microscopy (TEM). The antibacterial activity of the characterized silver nanoparticles will be studied against many medically-important bacteria, especially that are involving in human diseases such as Escherichia coli, Proteus vulgaris, Staphylococcus aureus and Pseudomonas aeruginosa. The expected results of this research are the obtaining of new fungal species that have the ability to produce new AgNPs with the specific characteristic that could be used and a new antibiotic or antibacterial agents to control the bacterial infections especially those have a resistance to the classical chemical antibiotics