Should Americans have free universal health care Research Paper

Should Americans have free universal health care - Research Paper Example However, the health insurance project does not give an impression of achieving its intended purpose of providing quality health security. In the contemporary American society, health security seems to be confined to a given section of the local populace. I am a loyal retiree and an inhabitant of the United States of America. No member of my entire family is currently entitled to health insurance coverage. My health insurance coverage was, unfortunately, withdrawn when I lost my job. Nonetheless, I do admit that even when I enjoyed the privileges that come with full-time job, I never benefited from the scheme as to my expectations. Consequently, my quest for valuable health care services coerced me into conducting a research on the proposed free Universal Health Care; its legitimacy and suitability to the ordinary American population. The research paper is a detailed, analytical editorial based on a number of past research studies. INTRODUCTION The universal health care, also known as the social health protection, is a system which provides quality health coverage and financial shield to all citizens of a given country. Its key goal is to provide a significant package of financial and medical promotions to all members of the state’s populace. ... Today, scores of debates and arguments have developed in America pertaining to whether or not the Universal health coverage is morally justified. The so called Obama Care was established and approved in 2010 as an idea of the Institute of Medicine. Its principal concern is to ensure that all Americans have affordable health coverage by 2014. The Americans’ take on the current health care system Most American citizens sympathize with the fact that the present-day American healthcare system is skewed toward the concern of corporate bodies rather than independent individuals and small scale business units. The contemporary American health insurance policy employs a scheme known as pooling in which employers attached to large corporations insure their employees with health care insurances, subject to contract. However, there is usually a wide disparity between the sick and healthy as a majority of the insured employees live healthily. As a matter of facts, the said discrepancy cov ers the expenses of the sick resulting to sound premiums for the companies’ employees. Conversely, this approach is only appropriate for companies with the substantial number of employees thus creating hurdles for undersized businesses. Miniature business units find sheer intricacy in covering their employees. This is attributed to the high ratio of the hill to the healthy resulting in sky-scraping premiums. In contrast, such establishments often fail to afford the premiums hence opt out of upholding the health coverage system for their employees. As a result, most American employees in the small business sector tend to believe that the proposed free Universal health coverage will be a better deal if well implemented.

Create a dialogue between two people. Describe and critique two Essay

Create a dialogue between two people. Describe and critique two perspectives on morality - Essay Example I believe in utilitarian ethics and I would like to discuss it with you and maybe learn about your moral basis.† Steve was delighted by the topic and replied, â€Å"I have also noted our differences and attributed it to diversity. Discussing our moral values would be important to our interpersonal relationship and will improve our perspective on our environments. I believe in deontology ethics. Could you please tell me about your ethical perspective?† David: â€Å"Utilitarian ethical perspective is based on the concept maximum good to a majority of members of the society (Brooks and Dunn 183). It informs judgment on a act, whether of commission or of omission, based on effects on members of the society and therefore means that morality of an act is determined after members of the society have interacted with the act and its effects, both positive and negative have been observed. The act is then said to be unethical if realized bad effects on members of the society are m ore significant than benefits from the act. It is however considered moral if greater benefits can be derived from it and this identifies two perspectives to determining ethics in an act, the extent of effects on people and the number of people that the act affect. Utilitarianism also relates to decisions whose implementation has effects on people. Rule utilitarianism explains this by offering rules that can lead to maximum good in a society. A decision to restrict a person’s right to smoke in a public place is for example moral under utilitarian ethics because while it may infringe the smoker’s need and may be cause distress, it will be beneficial to many other people I the immediate environment through ensuring clean air and protecting the people’s lives (Kanniyakonil 65- 66).† David: â€Å"I should have been keen to note that your judgments are based on consequentialism. My ethical perspective, deontology, is however a rule based perspective to moral j udgment. The perspective associates morality with duty that is expected of people in a society and is based on social rules. It is different from your ethical perspective because it disregards consequences of an act or a decision. An act that is consistent with established rules is for example considered ethical despite its negative consequence to members of the society and an act that contradicts existing rules and obligations is considered immoral irrespective of the net benefit that in which it results. considering your example of smoking in a public place and suppose that a the society allows people to smoke in public places, then the act of smoking is considered moral regardless of the air pollution and its associated effects on people’s health (Basford and Slevin 214, Showler 21)† David: â€Å"Reliance on rules for judging decisions and actions has the benefits in fair judgment and this is contrary to the scope of your utilitarian approach that also appear to be subjective. One of my concerns with utilitarian approach to ethics is the lack of a suitable measure for benefits and harm of an act. There is no standard measure and this compromises reliability and fairness because some people may be more sensitive than others are while some may exaggerate consequences. It is also difficult to identify population segments that have been affected by an act or a decis

Grand Canyon Crash of 1956 Essay Example | Topics and Well Written Essays - 1500 words

Grand Canyon Crash of 1956 - Essay Example The agency was established to run a broad Air Traffic Control (ATC) system and to certify aircraft designs, airline training programs and maintenance. The Air Traffic Control (ATC) system is responsible for managing air traffic. It is run by the FAA with a twofold purpose: to maintain a safe separation of aircrafts flying over the US and to make aircraft traffic to move as efficiently as possible. The ATC is actually a good place in the airline industry to appreciate its systems-like structure. The ATC organizes all the flights in the country (therefore, implementing a centralized architecture for the industry) and was created based on the idea of a broad and nation-wide system of scheduled flights, which did not existed before. The ATC comprises four types of facilities: airport towers, terminal radars, en route centers and flight service stations. Airport towers look after planes while they taxi to and from runways and during take-off and landing. Terminal radars monitor flights during the climb and the descent phases of the flight. There are 236 of them in the US. The en route centers keep track of aircrafts while they are en route during the high-altitude cruise phase of the flights. Finally, flight service stations are information centers for pilots flying in and out of small cities and rural areas. A keyA key facility in overseeing the entire ATC system is the FAA's Air Traffic Control System Command Center (ATCSCC), located in Herndon, VA. It looks for situations that might create bottlenecks and setups up management plans to control the traffic into and out the troubled sectors. The goal of such a plan is to keep traffic at the trouble spots manageable for the controllers. The importance of the ATCSCC becomes clear when one acknowledges that, on average, there are 900 daily flight delays of 15 minutes or more, which cost to the airlines and customers around $5 Billion USD a year. However, the ATC model is a centralized system architecture that many argue will not be able to cope with the saturation of the airspace and the increase in traffic delays that are expected to take place in the near future. The big challenge for the industry is the design and implementation of a distributed air-flight management system that could increase the throughput of the aviation system keeping the safety levels unchanged. This approach is called Free Flight and is currently being researched by the FAA and the aviation community. Free Flight is expected to improve significantly the efficiency of the National Airspace System. With Free Flight, pilots operating under Instrument Flight rules (IFR) will be able to select the aircraft's course, speed, and altitude in real time. Today, pilots define a flight plan with the ATC, prior to take-off and have to follow the route specified in that plan. Any deviation from that route must be pre-approved by ATC. With Free Flight, pilots will be able to change route, speed and altitude to achieve the desired results, notifying the ATC. Pilot's flexibility will mainly be restricted only to ensure separation and to prevent unauthorized entry into special use airspace. The Free Flight concept is based on two airspace zones, protected and alert, the sizes of which are based on the aircraft's speed, performance characteristics, and communications, navigation, and surveillance equipment. The protected zone, the one closest to the

Reading the Text of the Photograph Essay Example | Topics and Well Written Essays - 750 words

Reading the Text of the Photograph - Essay Example The mother’s eyes are directed outside the window where she could be looking at something which caught her attention – or could just be lost in her thoughts. They both appear to be pensive as both their lips are curved downwards. Both are wearing white which glow as the sun shines on them. Two throw pillows neatly covered by a weaved pattern appear beside the mother, with one pillow directly providing cushion to her back. To their back, at the upper left portion of the photograph appears a top thin table containing picture frames which are about nine in number. There are bigger frames, numbering three, which are mounted on the wall above the thin table. Most of the background is obscured in contrast to the bright light focused on the mother and child. It is possible that this picture is taken either late morning (almost near noontime) – or immediately after lunch. The photographer could possibly be a member of the family – the father, or brother, or even a sister who wanted to capture the lazy, reposed mood of the members. It is possible that mother and child did not expect their photos to be taken, as they remain sober and melancholy. This photograph is taken inside an auditorium where two prominently seated men are close to the photographer. A total of seven men are clearly seen in this photo – all smiling. These men could be batch mates or members of an all male organization; maybe a fraternity or a professional civic organization. It is eminent that these men are viewing someone, possible a colleague or a person with great humor. There were not viewing a film as their eyes were not focused on a movie screen – but rather on someone directly in front of them. They could possibly be listening to a guest speaker or a batch mate talking about his previous experiences. The man on the right front seat was holding a snack (possible filled with peanuts) and he was seated in a slouching position

Negative Influence of Social Media Essay Example for Free

Negative Influence of Social Media Essay Today, Mass Media is notoriously known to project a negative influence on teens and society. It manipulates several aspects of our lives including, but not limited to, the choices we make about our overall physical appearance, how we perceive beauty, healthy decisions we make regarding drug and alcohol use, engaging in premarital sex, and our peer and social interactions. We emulate what the media portrays as acceptable and desirable, though it goes against the norms and values put forth from society. As we mature, our goals and values seem to change as we break from the traditional values and connect with those portrayed as cool and current, through the media and pop culture. During adolescence, one often struggles with choosing between what is right from wrong and the media often accentuates the lives of celebrities. Young children are known to emulate their role models, unconscious of the consequences that may result in their actions. The media has been proven to be detrimental to the health and lifestyle of the youth. The media has a strong impact on the appearance satisfaction of today’s youth. Young women are constantly comparing their bodies to the ones seen advertised on television commercials. Around 10 million females and 1 million males in the United States are suffering from eating disorders such as anorexia, bulimia, etc. After seeing these beautiful and flawless models on billboards and advertisements, many women are disturbed with their personal body images. This is known to be a main contributor to eating disorders around the world. Thus, the media has the effect to change ones mental set up. Beauty and Body Image in the Media† is an article that explains the negative affect the media has on young women and how they view themselves. Images of female bodies are seen in films, TV, magazines, ads, etc. These models are engraving the perfect body image into the minds’ of the youth. Women’s magazines are full of ads influencing women that if they lose weight they’ll have it all. Researchers have observed that these images of thin and airbrushed models are associated with depression, loss of self-esteem, and the development of harmful eating habits. It’s been suggested that almost half of all preadolescent girls are dissatisfied with their appearances and either diet or think about dieting. Further, 50 to 70 percent of average weight girls feel that they’re overweight and 90 percent of women are frustrated with their body images. These advertisements are not only advertising their products, but they’re also selling an entire way of life. The media promotes tan, fit, and outward physical perfection in men and women. It is not only middle-aged adults who seek cosmetic surgery to alter their appearance. Today, children also undergo cosmetic procedures. In fact, in 2005 it was reported that children under the age of 18 underwent approximately 333,000 cosmetic procedures. Some included liposuction, breast augmentation, otoplasties (ear pinnings), and rhinoplasties (nose jobs). Teenagers of both genders are trying to acquire a perfect figure rather than living a healthy lifestyle and appreciating themselves for who they truly are. The media also has a reputation for promoting unhealthy choices, such as unprotected premarital sex and drug and alcohol use. The media is sending the wrong message to young adults that taking part in these activities is okay. The article, â€Å"The Media’s Influence Undermines America’s Morals†, by Tim LaHaye contains numerous examples of how the media is detrimental to the future of the United States. AIM, Accuracy In Media, and PMRC, Parents Music Resource Center, are organizations that support government regulation of the media. They believe that the media is destroying our culture and altering our values. Moviemakers, producers, and journalists are provoking sexual immorality in our society by explicitly exposing and promoting sexual relationships. The media is even found glamorizing teen pregnancies in the MTV series, 16 and Pregnant and Teen Mom. LaHaye states that, â€Å"the media’s power is seen in its degrading influence not only on the nation’s morals, but on†¦ virtually every area of life. † Music also plays a huge role in influencing teens toward becoming sexually active and provocative. â€Å"Rock Music Has a Negative Effect on the Youth†, by Rob Lamp is another article which states that rock music is somewhat accountable for the increase in teenage pregnancies. A counselor for pregnant teenagers believes that young girls are emulating celebrities. They are buying their albums and dressing like them. Today, 30 percent of all women loose their virginity before age sixteen. Violence sexuality has also become popular in music videos and song lyrics. Rap lyrics are being criticized by child advocate groups such as the American Academy of Pediatrics, for imparting the wrong message to the youth about sex and drugs. Misogamy is a derogatory or hateful comment geared towards girls and women and a lot of rap artists tend to include misogamy in their lyrics. The  APA has determined that today’s youth actually spends more time listening to and reading to the lyrics via the Internet to their favorite music than they do watching television. This council urges parents to be vigilant when it comes to knowing what their children are listening to. Lamp also states the kind of electronic music played at raves has been associated with the use of drugs and alcohol. † The Robert Wood Johnson foundation backed a report titled â€Å"Substance Abuse: The Nations Number One Health Problem†, which shows juveniles are starting to use drugs and alcohol between the ages of 12 and 13. In fact, by eighth grade 52 percent of adolescents have used alcohol and 20 percent have used marijuana. This figure jumps to 80 percent use of alcohol and 49 percent use of marijuana by the 12th grade. A research conducted in 1997 showed that in the 200 most popular movie rentals, alcohol appears almost 93 percent of the time and illicit drugs appeared roughly 25 percent of the time. Further, of the 1,000 most popular songs, 27 percent were shown to include alcohol or drug references. These numbers have surely risen since 1997. In addition to music videos and song lyrics promoting premarital sex and drug/alcohol use, this form of media is also seen promoting violent behavior among adolescent teens. Robert Lamp also believes that â€Å"heavy metal and rap have been associated with reckless behavior and below-average academic performance†¦ heavy metal and rock music have also been associated with an increasing risk of suicide, depression, delinquency risk behavior, smoking, and conduct problems† (Neale 1). In recent years, lyrics are becoming more vulgar and inappropriate. The violence heard in rock music instigates adolescents to commit violent crimes. In Northport NY, a seventeen-year-old boy was slaughtered; the names of Ozzy Osbourne and his former band members were spray painted at the crime scene, along with many satanic symbols. Doctor Guttman, a Professor of Psychiatry at Northwestern University states that, â€Å"Rock has so often been involved in these things (violence, teen suicide, etc. ) many of us in psychiatry have had to take it more seriously. † 45 percent of about 1,200 rock music videos supervised were viewed as explicitly violent. Video games and movies also play a prominent role in promoting violence among youth. The article â€Å"Most Teens Play Violent Video Games†, by Ben Berkowitz and published in the Washington Post, states that â€Å"70 percent of American teenage boys have played the violent, but popular â€Å"Grand Theft Auto† video game, and they are more likely to have been in a fight than those who have not played. † It is clear that the violence depicted through these games are mimicked by youth who have difficulty distinguishing between fantasy and what is appropriate and acceptable in a realistic environment. Tim LaHaye gives a real life example of how the media affects certain people. In San Diego, a High School honor student watched An ABC horror movie on the life of Lizzy Borden, an infamous axe murderer in the 1890’s. After viewing this film, he decided to murder his mother, father, and sister. These examples illustrate how juvenile violence is promoted through music, video games, and movies. We live in a society that depends greatly on the media to impart information, allow for communication, and provide entertainment on a regular basis throughout our daily lives. It is vital that we are attentive and vigilant in deciding what our youth should be allowed to view and listen to, as we know there is a direct connection between what one consumes and what one in turn values, how one behaves and how one interacts in society. Too much exposure to the negative aspects of the media can be detrimental to one’s mental, emotional and physical health. The media influences how we perceive beauty, the healthful decisions we make, and how we interact socially. The negative media is harmfully transforming our ethical values of life and our outlook on society.

Tibialis Anterior Tendon Reconstructed With Plate and Screw

Tibialis Anterior Tendon Reconstructed With Plate and Screw Traumatic Ruptures On The Insertion Of The Tibialis Anterior Tendon Reconstructed With Plate And Screw Fixation Technique And Anterolateral Thigh Flap Running title: tibialis anterior tendon reconstructed with plate and screw fixation technique Haijun Mao M.D., Guangyue Xu M.D. Institution:Orthopedics, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China Abstract Objective: Traumatic ruptures of the tibialis anterior tendon are rare but can cause substantial functional deficiencies. This study aimed to evaluate the effectiveness of the reconstruction of traumatic ruptures on the insertion of the tibialis anterior tendon using plate and screw fixation technique and anterolateral thigh (ANTEROLATERAL THIGH) flaps. Methods: Eight consecutive patients with a traumatic rupture of anterior tibialis tendon on the insertion were managed from February 2008 to February 2012. The insertion was reconstructed with plate and screw fixation technique, and the tissue defects were repaired with ANTEROLATERAL THIGH free flaps. Results: All flaps survived without any complications. The average preoperative and postoperative American Orthopedic Foot and Ankle Society ankle-hind foot scores of the patients were 51 and 94.7.Good ankle dorsiflexion strength against strong resistance was observed in eight ankles postoperatively, and a substantial improvement in strength was noted compared with the preoperative examination. Conclusion: Repairing a ruptured insertion of the tibialis anterior tendon using plate and screw fixation technique and ANTEROLATERAL THIGH flaps was a reliable technique and yielded satisfactory results. Level of Evidence: Level V, retrospective case series. Key words: tibialis anterior tendon; plate and screw fixation technique;rupture Introduction Ruptures of the tibialis anterior tendon, either traumatic or atraumatic, are uncommon. Traumatic ruptures are caused by an acute trauma accompanied with osseous or soft-tissue injuries in addition to pain and weakness in dorsiflexion of the ankle[1,2]. Tibialis anterior tendon is important in ankle dorsiflexion3. Ruptures of this tendon can cause functional deficiencies. A localized pseudotumor is usually present at the anteromedial aspect of the ankle, corresponding to the retracted, ruptured tendon end. Physical examination may include loss of the contour of the tibialis anterior tendon over the ankle and the use of the extensor hallucis longus and extensor digitorum communis to dorsiflex the ankle[2]. Traumatic ruptures are usually accompanied with associated injuries. Traumatic ruptures of the tibialis anterior tendon that occur in the avascular lesion within 2cm to 3cm of the insertion make an end-to-end suture impossible because bone reattachment is necessary[1,3–6]. These ruptures are caused by accidents and result in tissue defects. Consequently, island or free flaps may be required during the repair of the tibialis anterior tendon. Clear guidelines about the treatment of these injuries are currently unavailable. Reconstruction of this tendon to restore ankle dorsiflexion and inversion includes end-to-end repair, tendon transfer, or allograft augmentation[4,7–10]. The present study describes a surgical technique using plate and screw fixation with anterolateral thigh (ANTEROLATERAL THIGH) flaps to reconstruct traumatic ruptures of the tibialis anterior tendon. Patients and Methods Eightconsecutive patients with a traumatic rupture of anterior tibialis tendon on the insertion were managed from February 2008 to February 2012. These patients comprised six males and two females with an average age of 32(range,24-46) years. Five and three ruptures involved the right and left legs, respectively. This study defines traumatic rupture as a rupture that occurred because of direct blunt trauma (e.g., accident) to the tendon accompanied by osseous or soft-tissue injuries. These blunt traumatic cases were accompanied by tissue defects, which were reconstructed with ANTEROLATERAL THIGH free flaps. Early repair (3weeks after the rupture or less) was performed for all the traumatic cases, and the average time from rupture to surgery was 1.8(range: 3days to 3weeks) weeks. Rupture of tibialis anterior tendon was diagnosed based on history and physical examination. All patients had functional complaints, includingweakness in dorsiflexion or unsteady gait, limping, and increased fatigue with walking. Physical examination included a pseudotumor at the anterior part of the ankle, loss of the normal contour of the tendon, and weak dorsiflexion of the ankle accompanied by hyperextension of all toes. Magnetic resonance imaging was performed to assess the retraction of the tendon and confirm the diagnosis. All patients were available for follow-up. A retrospective review was conducted on medical records, final patient interviews, and physical examinations at an average of 2years and 3months (range: 1year and 3months to 4years) postoperatively of all cases. Postoperative manual strength testing was performed using a 0 to 5 scale (0, no evidence of contractibility; 1 (trace), evidence of muscle contraction with no joint motion; 2 (poor), range of motion with gravity eliminated; 3 (fair), range of motion against gravity; 4 (good), range of motion against some resistance; and 5 (normal), range of motion against strong resistance. 11 The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used for preoperative and postoperative evaluation. This 100-point standard rating system is designed to compare the results of different treatment methods in patients with the same disorder. The anti-hindfoot AOFAS scores evaluate pain (50 points), function (including gait, range o f motion, and strength) (40 points), and alignment (10 points). 12 Surgical Technique All surgical cases were performed under general anesthesia in the affiliated drum tower hospital of nanjing university medical school.A small longitudinal incision was made above the superior extensor retinaculum. The extensor retinaculum was left intact if possible to avoid adhesions of the tendon.The proximal ruptured tendon end typically retracted to the inferior edge of the retinaculum or just beneath it. Debridement was performed for the proximal and distal parts of the tendon.If the tendon could be brought to its insertion, a direct tendon repair was carried out. If the tendon ends could not be approximated or if the tendon could not be apposed onto its insertion site, an interpositional tendon graft, which included plantaris tendon (two cases), extensor digitorum longus tendon (one case), and peroneus tertius tendon (one case), was used to bridge the gap and reinforce repair . An anchor is usually used in most reported literature. However, this study employed plate and screw fixation technique to repair the tibialis anterior tendon to its anatomical insertion. Direct tendon repairs were performed in four cases. The end of the tibialis anterior tendon was placed on its anatomical insertion, and then a mini-plate was pressed on it and screwed. The harvested grafts had smaller diameter than the tibialis anterior. In most patients, this tendon could be doubled, which usually resulted in a graft with a diameter of 5mm to 6mm. The ankle and foot were held in maximal dorsiflexion and maximal supination, respectively, to determine the final length of the tendon graft. One end of the grafted tendon was fixed using plate and screw fixation technique. The tendon should surround one screw to ensure a firm insertion. When the bony attachment was performed, the tendons were sutured to each other with Vicryl using the side-to-side technique. Finally, the tissue defect was repaired with free flaps. In this study, the ANTEROLATERAL THIGH was performed in all cases. Short-leg cast immobilization was used for the first 2weeks to maintain the ankle in 0Â ° of dorsiflexion. Weight bearing in the cast was allowed in the succeeding 2weeks. The duration of cast immobilization was determined in part by the surgeon’s perception of repair quality during surgery. At 6weeks postoperatively, weight bearing and full dorsiflexion were allowed. Plantar flexion was gradually increased. Results All ANTEROLATERAL THIGH flaps survived without any complications, such as necrosis and infection, except for bloated appearance. The average preoperative and postoperative AOFAS Ankle-Hind foot scores of the patients were 51 and 94.7, respectively. Active dorsiflexion was possible after 2weeks to 3weeks. Good ankle dorsiflexion strength against strong resistance was observed in eight ankles postoperatively, and a substantial improvement in strength was noted compared with the preoperative examination. All patients were able to walk without a visible limp. However, one patient had a little residual weakness in dorsiflexion in comparison to the uninjured side. On physical examination they still had5/5 strength. This caused some symptoms of fatigue or pain after prolonged walking. One patient had 4/5 strength result in a little claudication and continued hyperextension of the toes when walking. Because of the small sample size, there was no valid statistical means to compare the results. Complications arose in one patient. She developed a regional pain syndrome. At the final assessment, we considered that the adhesion of the intermediate branch of the superficial peroneal nerve may be the cause of complication. After the operation of releasing nerve, the patient reported no residual pain and walked with a normal gait. All patients were satisfied with the final result and would undergo the procedure again. Case report A 46year-old man suffered from a tissue defect and rupture on the insertion of the tibialis anterior tendon from a motor vehicle accident (Figure 1). His preoperative AOFAS Ankle-Hind foot score and ankle dorsiflexion strength were 53 and 3/5, respectively. One week later, a complete debridement was performed. We used the plate and screw technique to reconstruct the tendon insertion without tendon grafting (Figure 2). The defect was reconstructed with ANTEROLATERAL THIGH free flap. After the operation, a short-leg cast was performed. At 2weeks after the operation, the flap was stable and the wound healed well. At a 14month follow-up, the postoperative result was 95.3 and the ankle dorsiflexion strength was 5/5 (Figures 3 and 4). He was able to walk without a visible limp. Discussion Ruptures of the tibialis anterior tendon are rare but can lead to considerable functional deficiencies. Ouzounian and Anderson[10]reviewed their clinical experience with 12 patients who had tibialis anterior tendon ruptures. Two types of ruptures were identified based on clinical presentation: (1) atraumatic ruptures, which occurred in low-demand older patients who presented late with minimal dysfunction and (2) traumatic ruptures, which occurred in high-demand younger patients who presented earlier with more disabilities. The authors concluded that patients with traumatic ruptures, regardless of the time of presentation, demonstrated better function after operative intervention.13 In our studies, the average age of the patients was 32(range,24-46) years. Therefore, correct diagnosis should be performed as early as possible. Delayed diagnosis is common because of intact ankle dorsiflexion that occurs as a result of secondary function of the extensor hallucis longus and extensor digitorum communis muscles[14-17]. The diagnosis is significantly based on physical examination, accompanying by weakness of ankle dorsiflexion and a palpable defect of the subcutaneous portion of the tendon and a peseudotumor at the anterior part of the ankle. A pseudotumor usually corresponds with the retracted ruptured tendon end, which becomes entrapped at the distal extent of the superior extensor retinaculum. Ankle dorsiflexion is weaker than that in the contralateral extremity. A steppage gait is a characteristic but is not universally present. Conservative treatment with ankle-foot orthoses, bracing, and activity modification is a viable option in inactive patients. However, we speculated that even in cases with a considerable delay, a reconstruction should still be considered regardless of the age of the patients[8]. Several operative techniques have been published. Many reports recommend an end-to-end suture, but most publications report the use of other techniques because of the difficulties of obtaining an adequate suture repair[2,3,18]. In cases where tendon stumps are often retracted and undergo degenerative changes, an end-to-end suture does not provide adequate tensile strength to transmit the forces required for function. For such cases, tendon graft is needed. In recent literature, the interpositional autografts used include plantaris tendon, extensor digitorum longus, extensor hallucis brevis, and Achilles tendon[2,13,19]. We used ANTEROLATERAL THIGH flaps for the soft tissue reconstruction in these patients. The advantages of ANTEROLATERAL THIGH flaps include consistent and reliable anatomy, long pedicle, being far from the ablative site, allowing two-team approach, the feasibility to create multiple skin paddle by recruiting additional perforators, the flexibility to reconstruct composite defect with chimeric flap by recruiting different tissue types based on a single pedicle, and low donor-site morbidity. When a muscle component is required, we preferred to elevate the flap in a chimeric fashion anterolateral thigh hough elevating the flap as a musculocutaneous flap is also a viable option and may decrease the operative time[20]. A suture anchor or a bio-tenodesis screw is often used for the reconstruction of the insertion of the tibialis anterior tendon. However, this study employed the plate and screw fixation technique to reconstruct the insertion because of its several advantages. The screw can fix the tendon to the bone as point, and the plate can fix the tendon as flat. According to the physics formula of pressure(p)=force(f)/square(s), large square results in small pressure when muscle tension is constant. The plate and screw fixation technique may increase the square and decrease the pressure, thereby improving the firmness between the bone and the tendon. Two patients removed the cast a week after the operation. At the last interview, the patients had a manual strength of 5/5 and walked without a visible limp. These results indicate that the technique decreased the duration of cast immobilization compared with previously published reports. However, no valid statistical approach could be performed bec ause of the small sample size. In our future research, we will use a large sample size to validate the results statistically. The applied technique was simple and easy to follow. During our operation, we tested different directions (perpendicular, parallel, or other angles) of the plate to the tendon and the direction of the muscular contraction. We considered that placing the plate perpendicular to the tendon is relatively easy. We speculated that a share force exists between the plate and tendon if the plate is parallel to the tendon. In addition, a cutting action may be produced on the tendon after a long time. Thus, we situated the plate perpendicular to the direction of muscular contraction. This study has few limitations. First, it is retrospective and lacks a control group of nonoperatively managed patients. The results are not representative of all patients with tibialis anterior rupture; this study only included younger patients who were symptomatic. Second, the AOFAS Ankle-Hindfoot score was used as the clinical outcome measurement, which is not a validated instrument. Nevertheless, this study allows comparison of results because AOFAS Ankle-Hindfoot score is also used in other published studies. Conclusion We recommend surgical reconstruction of the traumatic ruptured tibialis anterior tendon using plate and screw fixation technique and ANTEROLATERAL THIGH flaps. This technique allows early mobilization and yields satisfactory results.

Impact Of Globalization On Fashion And Pharmaceutical Industries Economics Essay

Impact Of Globalization On Fashion And Pharmaceutical Industries Economics Essay Globalization is a broad concept and it has been defined in many ways by different authors. According to Freedman(1999 ,p 156) and Woods(2000,p78), globalization means various quantitative and qualitative developments ranging from a dramatic increase in international transactions, especially in finance, to the international and spatial reorganization of production, the global harmonization of tastes and standards, liberalization, deregulation, privatization, the arrival of new information technologies, the global diffusion of information, values, and ideas, massive population transfers, trends towards a universal world culture, the spread of a worldwide preference for democracy, and the erosion of the nation state. Globalization has different dimensions like economic, cultural, political and environmental. It has different impacts on different industries with varying intensities based on these different dimensions. In this essay, the impact of globalization on fashion and pharmaceuti cal industries are examined and compared. This is to examine the differing intensities with which globalization affects these two industries. In the next two sections, the different impacts of globalization on fashion and pharmaceutical industries are discussed separately. In the last section, the impact of globalization on both these industries is compared and conclusions are made. 2. Impact of Globalization on Fashion Industry The most important elements of fashion industry are textile, clothing or apparel and footwear industries. It also includes food, housing, music, automobiles, perfumery and beauty products. According to Davis (1992), one main distinguishing feature of fashion industry is its ability to differentiate between different social classes or otherwise called social differentiation. For example, the most fashionable items are always very expensive and can be purchased by the upper class while the middle class goes for cheaper items. This made it necessary to produce the fashionable items in cheaper price in the fashion industry to achieve the selling target (Graham et al, 2006). Globalization affects fashion industry through the production, distribution and marketing channels. One main impact of globalization is to keep the people informed and updated on each and every new trend in the fashion industry through old and new media like radio, television, newspapers, internet, mobile phones etc. Consequently, now there is a tendency for imitating Western fashion all over the world replacing the traditional clothing in each nation. For example to highlight secularism, a ban has been imposed on women wearing headscarfs in France by considering wearing headscarf as a traditional religious symbol. The government considered wearing headscarf adversely affecting the immigrants to assimilate into the Western culture, which is called cultural assimilation (Huntington, 1997). This cultural assimilation is an important impact of globalization in fashion industry. The updating of new trends in the fashion industry was based on the economies of scale approach. This is intended to obtain new trends in fashion to all markets at appropriate times and at the correct prices for reducing the total production costs. The need for reducing production costs has resulted in the tendency among the developed nations to outsource production to developing nations like China where the production will be cheaper. This has adversely affected the local business in developed nations and violates the economies of scale principle. The local industries got affected badly because of this outsourcing of production and many of them were not able to continue operating consequently. Eg: producing a brand, t-shirt in Western China where no minimum wage regulations are there instead of producing it in Australia for reducing the production cost. In this case, achieving high profit margin in Australia is very difficult compared to that in China (Purdy, 2000). Globalization has changed this phenomenon however by reducing the transportation and communication costs and thereby increasing the accessibility of people to new fashions all over the world. This has also increased the speed of production in fashion compared to the olden days. The modern communication tools like internet forums have enabled the development and spreading of new technological innovations, which has increased the effectiveness of production in all nations. Globalization has thus resulted in more exchange of ideas and information regarding the availability of textile fabrics and production, which has also resulted in a rise in the demand for products. The consequence of all these was the brand names monopolizing the fashion industry and the spread of individualistic attitude instead of post materialistic especially among the middle classes. Base on these global conditions, the trends in fashion industry were to tempt the individuals for self-improvement instead of accepting them as they are. The most visible example of this can be seen from the growing trend of becoming thin models as the ideals of female beauty. This has proved to be anatomically more correct and has several psychological and physiological impacts. However, the negative side is that this has created by the pressure among female models for becoming thin models (Collins, 1997). The merits of globalization in fashion industry can be considered as the shift in the trends among the middle class from buying outsourced products under the influence of post materialistic ideologies to buy more locally produced ones. However, the problem is that the population of middle class is seen to be decreasing compared to the other groups. In addition to these, another impact of globalization was the shift in the production from developing to developed nations to go with the principle of economies of scale mostly under the influence of new and old media all over the world. However, this cannot be considered as a favourable trend especially under the scenario of the present economic crisis (Graham et al, 2006). According to Abarnathy et al (2003), the globalization of textile and clothing industry is not a new one and its history can be traced back to even the twelfth century. According to this study, in the earlier days the globalization was concerned with movement of labour and capital across nations based on comparative factor costs and productivities for labour, capital and other inputs between nations and their impact on product costs, changes in international exchange rates, quotas and tariffs. In the present scenario, the movement of labour and capital is based on some other aspects of distribution in addition to these like lean retailing, product proliferation, onshore and offshore outsourcing. The Multi Fibre Arrangement that has been existing in the textile industry for many years ended in 2005 with the decision of all WTO members to eliminate all quotas on textiles. China after accessing WTO in 2002 became a quota free nation in the WTO in the same year. The overall picture in the fashion industry thus shows that globalization has resulted in falling transportation and communication costs .This has significantly affected the growth of the markets in the industry .The concept of lean retailing has developed combining reduced transportation and communication costs as well as new technical innovations. The main problem however with the lean retailing is that it has enhanced the pricing pressures (Abarnathy et al, 2003). As a part of globalization process, the quotas on textiles also were removed with effect from 2005. 3. Impact of Globalization on Pharmaceutical Industry In the case of pharmaceutical industry, globalization has its effect through the combination of technological and economic dimensions (SickBlog, 2009). The focus of this industry is to research, develop and distribute drugs. Globalization process affects the industry through three major segments namely production, research and development and marketing. In the present era of globalization, it is reported in many studies that big companies in the industry, which were once in their better times, are now in difficult stages mainly due to inefficient Research and Development (RD)(Dufala,2007;Pouw,2008 etc). The established companies are reported to have failed in producing new items into the market mainly due to the rising RD costs. For example, Pfizer, which was the fourth largest multinational pharmaceutical corporation in the world, is now facing very bad time with a 10-year market exclusivity granted to new drugs. Globalization has resulted in enhanced availability of information, which has changed the role of doctors (Dufala, 2007). For example, in the case of patients who have information from internet, the decisions made by doctors are found to be questionable. Thus, the enhanced availability of information has affected the value chain in pharmaceuticals. It has also made the regulatory agencies to be more cautious. Thus, globalization process has affected the marketing by shifting towards patients. As a consequence of globalization, the generic markets are reported to be growing by taking advantage of the market exclusivity of original drugs and producing in low cost places for eg: Ranbaxi and Teva. In addition to these two developments, may small biotechnology companies face problems due to the difficulty in financing the projects in these companies (Dufala, 2007). All the developments as a part of globalization process have resulted in enhancing competition in the industry while it has not increased pressures for restructuring unlike other industries. Contract Research Organizations (CROs) have prominent role because of globalization process (Shuchman, 2007). The globalization has resulted in increased mergers and acquisitions of the CROs. Examples of CRO s are Pharmaceutical Product Development (PPD), Quintiles, Parexel, Kendle and Covance. The CROs are technologically very innovative and makes se of new business concepts. Thus, it can be seen that CROs were the main actors who were able to utilize the benefits of globalization .At the same time big pharmaceutical companies were not able to do so. It is argued that globalization has improved the conditions of developing nations by improving access to medication by joining organizations like World Trade Organization (WTO). This has been enabled through compulsory licensing or by importing cheaper versions of drugs before the expiry of patents (Slick Blog, 2009). On the other hand, it is argued that the Trade Related Aspects of Intellectual Property Rights (TRIPS), which increases the scope, duration and coverage of the industrial patents of the WTO members, has marginalized the traditional knowledge of local people. Moreover, it has been argued that the growth and development of the domestic pharmaceutical companies are adversely affected by TRIPS (Pouw, 2008). However, exceptional cases are the Indian pharmaceutical companies like Ranbaxi and When Cipla, which have obtained significant growth and expanded their operations. It is also argued that globalization has adversely affected the developing nations through some other ways. In spite of the TRIPS having clause that exempts nations suffering from diseases like AIDS from patent observation, nations like America opposed this through international law suits .Thus many developing nations like South Africa were left in a difficult situation (Slick Blog, 2009). Hence, it is argued that TRIPS has supported in establishing the dominance of some big pharmaceutical companies and rising their presence worldwide (Pouw, 2008). The pharmaceutical industry has fond out the solution for this by outsourcing the production and research and development process as a part of the globalization process. These were intended to make them more cost effective in response to their rising costs. However studies have shown that these costs have been overestimated(Sampath,2005) .For example, the average cost of developing a pharmaceutical drug includes the costs of borrowing mone y to finance the RD process and the marketing costs of the product in addition to the costs of RD. This has overestimated the total RD costs. In addition to these, as a part of the globalization process, the big pharmaceutical companies are forced to perform many human trials with their new drugs before releasing them to the market. However, the main problem with this is that most consumers are reported not to be willing to participate in this process. For example, the consumers were not willing to participate in the phase three trial of Macugen, the eye disease drug by Pfizer (Shah, 2006). It is argued that the reforms as a part of the globalization process has resulted in a national ruin by the developing nations through opening of markets and through the loans provided by IMF and World Bank attached with stringent conditions (Harvey, 2005). Globalization has also affected the marketing process in pharmaceutical industry through preventing the direct to consumer marketing in most countries and promoting advertisement through global media. This type of advertisement through global media is reported to have created distorted images of health and diseases (Petryna and Kleinman, 2006).For example, the diseases like AIDS , are picturized as incurable by these advertisements which has resulted in the marginalization of many developing nations. Moreover, most of the advertisements have been related to allergic diseases rather than the real health crises. This has resulted in creating distorted images of many diseases and medicines. Overall, it is reported that the globalization process has increased the profits in pharmaceutical industry through reducing RD and production costs. This has necessitated the need for sustainable capital, which has resulted in the mergers of big pharmaceutical companies. Thus, the big pharmaceutical companies have started monopolizing the industry leaving the developing nations to be exploited for cheap labour and drug testing (Pouw, 2008,). The outsourcing process, which is supposed to offset the rising costs in the industry, is reported to have negative implications as discussed here. The public private partnerships, where the governments and big companies work together for resolving health crises, however are expected to bring many advantages for the developing nations (Bull and McNeill, 2007). 4. Conclusion In this essay, the impact of globalization on two industries the fashion industry and pharmaceutical industry are discussed. In the case of fashion industry, the globalization impacts are through the combination of cultural, technological and economic dimensions. In the case of pharmaceutical industries, the impact is through a combination of cultural and economic dimensions. In the case of both the industries, globalization has resulted in decreasing the transportation and communication costs. Moreover, it enhances the availability of information through the world media. In the case of fashion industry, these have resulted in a shift from using the outsourced products by the middle class to more locally produced items based on the economies of scale principle. This has resulted in shifting labour from developing to developed nations .Though this is intended to make the production in a more cost effective manner, it is not obtained to be favourable in the present economic condition. The impact of globalization has affected the production, distribution and marketing sides of this industry. The increased availability of information had its impact through the cultural dimension of globalization in the case of fashion industry. The positive impacts of globalization in this industry include aspects like enhancing the speed of production, reducing time lag between production and delivery and creating an individualistic approach necessitating the need for self-improvement. At the same time, negative impacts include the shifting of labour from developed to developing nations. In the case of pharmaceutical industry, the focus is on the research and development of drugs in addition to its production. Hence, globalization affects this industry through three channels production, research and development as well as marketing unlike the fashion industry. The reduction in transportation and communication costs had its economic and technological impacts. Though this has helped in reducing the production and RD costs, this had created dominance for the big pharmaceutical corporations. The enhanced availability of information made the public more aware of the adverse effects of drugs and hence made the decisions of doctors in some cases questionable .This can be considered as a positive aspect of globalization in the industry. At the same time, the enhanced communication through worldwide media has created distorted images in the minds of public regarding many diseases and the concept of health itself. Thigh the globalization process has increased the profitability of the industry; this has resulted in the monopoly of multinational giants in the industry. This has adversely affected the domestic pharmaceutical companies with only a very few exceptions. In the case of pharmaceutical industry, globalization process ahs resulted in creating prominent role for third party players like the CROs unlike the fashion industry. Many big companies who were earlier profitable got adversely affected due to the rising production and RD costs. Outsourcing which was fond as a solution to this had many negative cultural and economic effects. However, compared to the fashion industry the effects of outsourcing were not so intense in the pharmaceutical industry, which can be understood from the discussion. In the case of fashion industry, Quotas and tariffs were eliminated on textiles as a part of the decision of WTO members. In the case of pharmaceutical industries, TRIPS agreement was aimed to assist the developing nations by increasing the access to medication for developing nations. At the same time, TRIPS was obtained to leave the developing nations in difficult situation by marginalizing them in many cases. In the case of fashion industry, the globalization process has resulted in increasing competition and restructuring of the industry with a shift of labour from developing to developed nations. However, in the case of pharmaceutical industry, though globalization ahs resulted in enhanced competition, it has not resulted in the restructuring of the entire industry. Rather, it has created the emergence of the third party players, the CROs that made use of new business concepts and technological innovations. The above discussion thus shows that globalization process has affected both the fashion and pharmaceutical industries but through different intensities. The dimensions of globalization through which it affects both the industries are also little bit different. In the case of similar dimensions of globalization also, the intensities of impacts are different for both the industries depending on the nature and structure of both the industries. Globalization affects both the industries through different channels in spite of the similarities. Hence, it can be concluded that industry specific factors play important role in determining the intensity of the impact of globalization on each industry. The discussion above thus shows that industry specific studies are more relevant in examining the impact of globalization. Though globalization has both positive and negative impacts on industry performance, a generalized picture cannot be obtained in this regard. Macro studies may conceal many f actors regarding the impact of globalization as is clear from the discussion above.