The Value of Bar Mitzvah Essay -- Bar Mitzvah Speech

This is a Torah parcel that I feel spoke to my qualities in general. The segment is a piece of the Parsha Ha-Shavuah which focuses on the tale of Sarah (Abrahams spouse) having an infant at a mature age, and the subtleties around that. Remembered for the part that I’m perusing, theres accentuation that you ought to be commonly friendly towards others, and that families don’t consistently follow â€Å"Traditional† designs. Presently, let me clarify my qualities and how they fit into that Parsha: Diversion Humor is critical to me since it causes me keep a new, clear point of view and just for the most part lights up somebody's day-or my day as a rule. Likewise there's that old generalization that â€Å"Jews have such a great amount to kid about they can't stop.† So why not simply keep making kids about everything!? It unquestionably helped us overcome a portion of the difficulties that our progenitors had, and I would say, silliness can improve any circumstance. Family-To me, family is indistinguishable things from Community; another worth that has at any rate a little impact in my life. Network is family and Family is Community. I think about the Duke Lemur Center as a network of individuals who all affection doing likewise, and yet I like to consider it a family also. There’s additionally the more customary feeling of family that we as a whole think about. Mothers, Dads, Grandparents, Aunts, Uncles, Cousins, and other more distant family individuals. Devotion I picked reliability for a couple of reasons, yet for the most part the main thing I thought when I saw this was: Wouldn't it be unexpected to pick â€Å"Loyalty† as a worth, however then not remain faithful to your qualities and selection of qualities? The entire thing about dedication to individuals and things †Is keeping the conviction or whatever confidence you had in that thing or individual and adhering to ... ...ence, and the publication work my Dad helped me do on this (and nearly all that I compose today), since kid do I need it! I’d likewise prefer to express gratitude toward My Uncle for the difficult work he’s put into driving the entire thing, and being a by and large magnificent uncle. Ultimately, I’d like to completely say thanks to Ira for all the difficult work he put into helping me make this entire procedure sensible. Orchestrating the gatherings, giving me direction and bumps towards the correct course, and being the person who I can pose inquiries of and find a straight solution from. Along these lines, Ira, thank you to such an extent! Clearly I am appreciative, and I trust we can keep on becoming acquainted with one another in any event, when this is finished. What this experience has intended to me/accomplished for me...why it merited all the exertion I put into it. Works Cited Marx, Harpo. 1961. Harpo talks! [New York]: B. Geis Associates; dispersed by Random House.

Distally Based Sural Artery Flap Health And Social Care Essay

Approach: This imminent interventional overview was directed from March 2007-February 2009 at the Department of Plastic Reconstructive Surgery and Burns Unit, Liaquat University of Medical Health Sciences, Jamshoro. Test was gathered by non chance accommodation inspecting. A predesigned proforma was utilized to move up the data. SPSS 17 was utilized for informations examination. Results: Age of 35 drafted patients ‘ extended from 13-57 mature ages with Mean ±SD period of 31â ±7.7 mature ages. There were 29 guys ( 82.85 % ) and 6 females ( 17.14 % ) . All folds were endure ; incomplete tip embarrassment was found in 3 patients ( 8.57 % ) . Method of hurt was course car crash in 30 patients ( 85.71 % ) . Two youthful guys ( 5.71 % ) were with talked wheel harmed. Two patients ( 5.71 % ) had power per unit zone sore injuries. One patient ( 2.85 % ) has presented calcanium because of fire hurt. Paresthesia on sidelong limit line of pes settled on its ain inside a half year time frame in all examples, there was no neuroma arrangement. Choice: Sural arteria fold is an exceptional pick for bearing of delicate tissue imperfections of lower limb, uncommonly uncovered calcanium and malleolus because of its top notch blood gracefully and ease of open introduction. Catchphrases: lower limb Reconstruction, sural arteria, sural arteria fold, fasciocutaneous fold Presentation: Delicate tissue inclusion of lower extremities deformity is contesting to both plastic and orthopedic sawboness. Lower extremity is inclined to injury and dangers because of its area and low vascularity. In contrast to trunk, there is restricted figure of fold picks accessible for Reconstruction of lower appendage absconds. These folds ought to have the option to cover the imperfection uniquely any open bone, nervus, ligament or any major vass ; other than it ought to be anything but difficult to execute and give perpetual results to quiet. The truly clench hand recorded idea of fasciocutaneous fold was introduced in 1980 by Poten, and that came about in view of cutting edge cognizance and overview of life systems of lower especially in footings of neurovascular development, solid structure, and blood gracefully to climb and profound facia. Poten portrayed and underscored upon the capacity of fasciocutaneous fold for Reconstruction of lower leg surrenders because of their reliability and wellbeing profile. Upper and lower limbs have longitudinal scattered shallow nervousnesss and hypodermic venas. It is exhorted that fasciocutaneous folds ought to incorporate these nervousnesss and venas which help in fold perseverance and decrease the proportion of fold embarrassment and best outline of such fasciocutaneous fold is sural arteria fold which depends on normal shallow sural arteria which is a development of shallow Sural arteria. The pedicel sural fold comprises of shallow and profound facia, lesser sephanous vena, normal shallow little arteria and sural nervus, though the fold comprises of covering with hypodermic tissue and facia alongside previously mentioned neurovascular constructions.Methodology:This forthcoming interventional overview was led structure March 2007-February 2009 at the Department of Plastic Reconstructive Surgery and Burns Unit, Liaquat University of Medical Health Sciences, Jamshoro. During the overview time frame patients seeking inclusion of injury on lower members were remembered for the study in the wake of getting educated assent. A predesigned proforma was utilized to move up the information.. Patients were followed for a time of a half year. SPSS 17 was utilized for informations examination After every sterile advance the fold was raised. All patients were worked under spinal sedation. After utilization of pressure wrap, the surface markers were drawn at the sidelong limit line of Achilles ligament medicinally and along the side at the outskirt of fibular shaft. At sidelong malleolus a sidelong scratch is made, the middle scratch is made at the sidelong limit line of Achilles ligament which proceeds till the purpose of its insertion at fringe of imperfection or tubercle of calcanium. After scratch on covering and facia, the short sephanous vena is ligated and sural nervus is partitioned. Fold is than raised distally, developments of peroneal arteria are remembered for sub facial fat in the fold to ensure maximal blood flexibly. Fold is so best in class along the sidelong outskirt of Achilles ligament. Contributor side is so close mostly if fold is little in size, in any case regular surface is secured with halfway thickness covering joining. After a time of 3 hebdomads the fold is disconnected and its distal part is sewed back to its unique location.ConsequencesSural fold was done in 35 occasions. Tolerant ‘s age extended from 13-57 mature ages with Mean ±SD time of 31â ±7.7 mature ages. There were 29 guys ( 82.85 % ) and 6 females ( 17.14 % ) . Dominant part of patients were between 31-40 twelvemonth old enough Table I. All folds were endure, fractional tip embarrassment was found in 3 patients ( 8.57 % ) , and leftover portion had great suitability of full fold. Method of hurt was course car crash in main part of occasions for example 30 patients ( 85.71 % ) . Two youthful guys ( 5.71 % ) with span wheel hurt. Two patients had power for each unit territory sore sores. One patient ( 2.85 % ) has presented calcanium because of fire hurt. Paresthesia on sidelong limit line of pes settled on its ain inside a half year time frame in all cases, there was no neuroma formation.DiscussionReconstruction of lower limb imperfection are as yet a secret for fictile sawboness working in a device where microvascular medical procedure establishments are non yet accessible. The most well-known site is heel which is a weight bearing nation and is inclined to injury and different perils like power per unit region wounds. The covering over the heel is less roaming and has hapless blood gracefully. Following rehabilitat ive stepping stool a few choices have been read for delicate tissue inclusion of open heel including septo cutaneal, pivotal structure, arbitrary structure, musculus fold and free folds. Up until this point, fasciocutaneous folds are demonstrated to be an armamentarium for fictile sawboness, especially with regards to Reconstruction of lower limb deserts. Despite the fact that numerous journalists are of assessment that clinical plantar fold is the best alternative for inclusion of open heel. Anyway others are of notion that sural arteria fold offers the equivalent. Feasibility of island folds are ever faulty because of chopped down blood gracefully, another alternative for inclusion of open heel abandons is sidelong calcaneal fold which depends on sidelong calcaneal arteria, it other than contain lesser sephanous vena and sural nervus. Anyway again it has an inadequacy o fits of rage minimal size, that ‘s why it is non ever appropriate for open heel abandons especially bigger in size. Distally based opposite stream sural arteria fold is choice of pick since 1980s. it depends on middle shallow sural arteria. The blood stream is in opposite from the peroneal arteria in distal segment of leg. Little nervus other than has its ain blood vessel gracefully. These all developments anastomosis unreservedly in shallow plane. Numerous essayists have detailed that distally bases sural supply route fold as an adaptable and reliable fold for Reconstruction of lower limb imperfection. A few surveies have revealed understanding of inclusion of calcaneal and malleolus surrenders with great outcome with sural fold. The significant disadvantage of this fold is relinquish of sural nervus ; by the by surveies report that the esthesis improves over the time of clasp and same was the case in this arrangement on a 6 months development. Choice It is presumed that distally based sural arteria fold is a top notch alternative for inclusion of delicate tissue deformities of lower member, extraordinarily uncovered calcanium and malleolus because of its top of the line blood supply.Table IAge sexual orientation distributionAge scope ( mature ages )MalesNumber of patients ( % )FemalesNumber of patients ( % )10-20 6 ( 17.14 % )â€21-30 5 ( 14.28 % ) 1 ( 2.85 % ) 31-40 14 ( 40 % ) 3 ( 8.57 % ) 41-60 4 ( 14.4 % ) 2 ( 5.71 % ) Whole 29 ( 82.85 % ) 6 ( 17.14 % )Chart IMode of hurt

McCarthyism Essays - Salem Witch Trials, The Crucible, John Proctor

McCarthyism In The Crucible In The Crucible, composed by Arthur Miller, the franticness of the Salem witch preliminaries is investigated in incredible detail. There is something else entirely to the play than the witch preliminaries, however. The Crucible was created during when a comparative delirium was moving through America. A for all intents and purposes unkown representative by the name of Joseph McCarthy was pushed into notoriety when while at a talking commitment at thee Republican Women's Club of Wheeling, West Virginia he charged 205 people in the U.S. State Department of being individuals from the Communist Party (Martine 8). Dread made the American individuals surrender to the ludicrous charges brought forward by McCarthy showing similarity's to that of the Salem people group in 1692 (Carey 51). In Arthur Miller's play The Crucible, there is proof of matches between the Salem of 1692 and America of the 1950's, the American Legislature of the 1950's and its abuse of intensity, and the high court delineated in the play, utilizing its capacity to force a misinformed equity. The Crucible takes place in Salem, Massachusetts in the spring of 1692 out of a town covered with confusion. The individuals of Salem were in questionable occasions. Only a year sooner a witch in the close by town of Beverly was executed and now the witch mania had spread to their town. Befuddled, the individuals didn't have the foggiest idea who to accuse whether it be the young ladies, the negro slave, or even the Devil himself. The craziness that came about meant that the dread of singular opportunity (Miller 6). In The Crucible, mania and shrouded plans separate the social structure and afterward everybody must shield themselves from the individuals that they thought were their companions. The congregation, the lawful framework, and the harmony of the network passed on with the goal that the young ladies and their families economic wellbeing may be ensured. The way that Salem was a Puritan people group didn't improve the situation either. Puritans were an exacting religous bunch that endured no shrewd conduct. Being segregated from some other gathering of individuals with various convictions made a congregation drove Puritan culture that couldn't acknowledge a great deal of change. Any individual who was not on favorable terms with the congregation was not by any means permitted in the network (Carey 42). They trusted God chose the individuals who were to go to Paradise by a similar token however they accepted the Devil could pick his teaches additionally (Carey 43). Puritans considered anything pleasurable was spurred by what's more, came legitimately from the Devil. At the point when The Crucible was composed, the American society was compromised by socialism much like Salem was undermined by black magic (Bly 32). On September 23, 1949, President Truman announced that the Soviet Union had built up a nuclear bomb striking trepidation into the American country (Martine 8). Mill operator even recognized this dread when he stated, America had simply completed the process of battling World War II with the assistance of the Soviet Union against the Germans and now they felt compromised by them, knowing not wether they were still partners or if another war was unavoidable. The war made individuals careful about socialism. What Hitler had done was appalling. Americans dreaded this offensiveness. Thou shalt not endure a witch to live (Exodus 22:18). The puritans of Salem unquestionably put stock in witches and gaurded against them similarly as the Bible told them in this way, executing them. When an individual was denounced as a witch the best way to live was to turn around to God by atoning and uncovering names of different witches so they may atone or be vanquished (Bly 88). Judge Danforth was dedicated to the arraignment of witches. At the point when he shows up in the town of Salem, Danforth gets under way acts that achieve a malice damaging condition of tumult (Carey 15). He accepted he acquired his position straightforwardly from God, and hence carried on the witchhunt pitilessly (Bly 33). He didn't surrender effectively; when he concluded somebody was a witch he would not rest until a admission was made as is obvious in the accompanying statement: Will you confesss yourself befouled with Hell, or do you keep that dark devotion however? (Miller 111). Danforth may have had an excess of intensity additionally; being the Representative Governor of Massachusetts, Danforth had the ability to attempt, convict, and execute anybody he choose was a witch (Bly 27). While writting The Crucible, Arthur Miller decided to talk through John Proctor on of the Salem witch preliminaries casualties. Mill operator utilizes Proctor as his character that challenges the authority of the judges and their degenerate force

Leader Communication Essay - 275 Words

Leader Communication (Essay Sample) Content: Leader communicationNameInstitutionIntroductionLeaders are very prominent people in the society and their ability to win vacancies in the society relies on their ability to influence and persuade others. Persuasions and influence are attributes that can make people gain personal power and attain other things in a fast way. Leaders are top communicators. They use symbols, songs, speech, artifacts, or something else. Leaders communicate meaning. Inner leaders are said to use a very explicit kind of communication called persuasion. These leaders never use instructions, orders or policy statements, but use persuasion. The current world demands leaders not managers as managers are known to depend, order, command and fiat (Nilsson, Waldemarson, 2013). Leaders who make it today need persuasion and influence. Leaders who are able to persuade and influence makes it possible for people to act.Much more efficient in the transfer of standards and values is the use of the method of persuasion through logical argument. Leadership is a method of example and persuasion. The main aspect to persuading followers is asking them to follow the leads of the leader. Through the use of communication skills, leaders make work-community action, which is in accordance to their purposes, and ultimately the purposes shared of all (Nilsson, Waldemarson, 2013). Persuasive communication regards the interaction between the follower and the leader, which involves winning the minds of both. Persuasion involves caring, equality, and respect for the logic and ideas of those to be convinced. There are various leaders who are good at persuasion and influence. Joel Osteen is one of those leaders. An author, a preacher, a televangelist, and a senior pastor, Joel uses the power of communication to persuade people. Joel is an esteemed leader as he has chosen to use the word of God to persuade people to turn away from sin. Joel uses his services and books to persuade and influence people to be obedient and follow the truth. The ability of Joel to distinguish whats good to tell people makes him an effective and efficient ... Leader Communication Essay - 275 Words Leader Communication (Essay Sample) Content: Leader communicationNameInstitutionIntroductionLeaders are very prominent people in the society and their ability to win vacancies in the society relies on their ability to influence and persuade others. Persuasions and influence are attributes that can make people gain personal power and attain other things in a fast way. Leaders are top communicators. They use symbols, songs, speech, artifacts, or something else. Leaders communicate meaning. Inner leaders are said to use a very explicit kind of communication called persuasion. These leaders never use instructions, orders or policy statements, but use persuasion. The current world demands leaders not managers as managers are known to depend, order, command and fiat (Nilsson, Waldemarson, 2013). Leaders who make it today need persuasion and influence. Leaders who are able to persuade and influence makes it possible for people to act.Much more efficient in the transfer of standards and values is the use of the method of persuasion through logical argument. Leadership is a method of example and persuasion. The main aspect to persuading followers is asking them to follow the leads of the leader. Through the use of communication skills, leaders make work-community action, which is in accordance to their purposes, and ultimately the purposes shared of all (Nilsson, Waldemarson, 2013). Persuasive communication regards the interaction between the follower and the leader, which involves winning the minds of both. Persuasion involves caring, equality, and respect for the logic and ideas of those to be convinced. There are various leaders who are good at persuasion and influence. Joel Osteen is one of those leaders. An author, a preacher, a televangelist, and a senior pastor, Joel uses the power of communication to persuade people. Joel is an esteemed leader as he has chosen to use the word of God to persuade people to turn away from sin. Joel uses his services and books to persuade and influence people to be obedient and follow the truth. The ability of Joel to distinguish whats good to tell people makes him an effective and efficient ...

The Operations of the National Security Agency - 435 Words

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The office regularly utilizes tame approaches to gather data on remote knowledge including electronic frameworks irritating, tapping phone records, and subverting through subversive programming. Mass reconnaissance of the United States is likewise a practice utilized by Security Agency, gathering and putting away all telephone records of all American subjects. The Federal Emergency Management Agency (FEMA) is an office under the locale of the United States Department of Homeland Security. Made in 1978, the offices main role is to facilitate the reaction to any calamity that happens in the US and is excessively for the assets of neighborhood and stateShow MoreRelatedThe Surveillance Operations of the National Security Agency1946 Words   |  8 Pagestake certain actions in order to provide security from those who seek to harm its citizens. 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Career Development Plan - 2558 Words

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Business Project Plan The Forensic Accounting

Question: Describe about the Business Project Plan for The Forensic Accounting. Answer: Research background, problems and its aims The forensic accounting can be defined as the implementation of the specialized knowledge related to the accounting, auditing and investigating the economic situation of any business organization or government authority. In the recent years it is observed that the incidents of fraud in private organizations as well as in government organizations are increased (Pedneault, Silverstone, Rudewicz Sheetz, 2012). Therefore the big business organizations are proactively trying to check up the economic situation of the organization to avoid any possibility of economic fraud in the organization. There are several examples of economic frauds like the WorldCom scandal in the year 2002, to the Mossack Fonseca scandal in the recent times that caused economic loss for the business organization as well as for the governments (Imoniana, Antunes Formigoni, 2013). Therefore it can be said that the economic frauds are still an issue that needs to be addressed by both the business organization as well as government authorities. Again with the emergence of the e-commerce for doing business also increased the probability of economic frauds in both public and private sector (Rezaee, Lo, Ha Suen., 2016). Although the transactions that are performed are audited under the internal as well as the external auditors, yet there is a chance of fraud in this business processes. As opined by Othman et al. (2015) the numbers of the financial or economic frauds are increasing everyday in the whole world, the forensic accounting is getting more important for the accounting and auditing of the financial statements of the organizations. Therefore the organizations should try to implement the forensic accounting in their accounting processes in order to find out any financial crime that is happening inside the organization. Moreover the forensic accounting can provide litigation support to the organization as well as the quantifying the economic damages of the organization due to a fraud. The forensic accounting helps in investigation of the criminal activities related to the economy of the organization, resolving the partnership and stakeholder disputes related to the business. As an investigator the forensic investigator needs to be able in working under regulatory environment and with a desired degree of accuracy (Pedneault, Silverstone, Rudewicz Sheetz, 2012). Also the forensic accountant must possess the ability to reconstruct the destroyed, missing or the deceptive accountancy related information so that the actual loss in the business or the social harm can be estimated accurately depending on the different econometric models and opportunity cost scenarios. Research Questions The research attempted to address the following questions, a) How and to what degree the presence of a forensic accountant can prevent the economic fraud in the organizations. b) To what extent the existence of the external auditor can help in detection and prevention of the frauds in the business organizations as well as government organizations. References Imoniana, J. O., Antunes, M. T. P., Formigoni, H. (2013). The forensic accounting and corporate fraud.JISTEM-Journal of Information Systems and Technology Management,10(1), 119-144 Othman, R., Aris, N. A., Mardziyah, A., Zainan, N., Amin, N. M. (2015). Fraud Detection and Prevention Methods in the Malaysian Public Sector: Accountants and Internal Auditors Perceptions.Procedia Economics and Finance,28, 59-67 Pedneault, S., Silverstone, H., Rudewicz, F., Sheetz, M. (2012).Forensic accounting and fraud investigation for non-experts. John Wiley Sons. Rezaee, Z., Lo, D., Ha, M., Suen, A. (2016). Forensic Accounting Education and Practice: Insights From China.Journal of Forensic Investigative Accounting,8(1).

Persistent Pulmonary Hypertension of the Newborn (PPHN)

Abstract PPHN condition results from failure to attain a smooth transition â€Å"from fetal to extrauterine pulmonary circulation after birth†. Diagnosis of this condition can be done through various ways including; physical examinations, looking at the history, undertaking laboratory tests, using chest x-ray, undertaking hyperoxia test, and echocardiogram.Advertising We will write a custom research paper sample on Persistent Pulmonary Hypertension of the Newborn (PPHN) specifically for you for only $16.05 $11/page Learn More The signs and symptoms include; tachypnea or rapid breathing, increased heart beat rate, respiratory distress which may include signs like grunting and flaring nostrils, and cyanosis even at the time the infant is being given extra oxygen to help it in breathing and having heart murmur among others. In this paper, there has also been describing of the causes, treatment, and outcomes of PPHN condition and the role of the respi ratory therapist in dealing with this condition. Introduction PPHN condition is an outcome of failure to attain a smooth transition â€Å"from fetal to extrauterine pulmonary circulation after birth† (Bartle, Patole Rao, 2010, p.845). In most cases, pulmonary circulation experiences a noticeable drop from a high-resistance condition in the utero to a â€Å"low-resistance circuit†, within a very short period of time after birth (Mago, 2012, p.30). Such reduction in the â€Å"pulmonary vascular resistance† or what is simply referred to as PVR, gives room for the lungs to turn out to be a gas exchange body organ (Kraemer, Krijger, Reiss, Rottier, Sluiter Tibboel, 2011, p.245). This paper is going to look at the â€Å"Persistent Pulmonary Hypertension of the Newborn† condition in much detail. The paper will discuss the diagnosis of this condition, its signs and symptoms, the population affected, causes, treatment, outcomes, and the role of the respiratory t herapist. The last section of the paper will present a summary of the discussion. Diagnosis The diagnosis of the â€Å"Persistent Pulmonary Hypertension of the Newborn† condition can be confirmed by echocardiography which gives demonstration of the â€Å"right-to-left shunt with normal anatomy† (Bartle, Patole Rao, 2010, p.845).Advertising Looking for research paper on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More There is suspicion of PPHN in the newborn children who shows liability in the progressive cyanosis oxygenation condition in the initial twelve to twenty four hours of the child’s life; and in other occasions, after the first good oxygenation period. Establishing of diagnosis is carried out from the physical examinations, the history of the patient, â€Å"laboratory tests, chest x-ray, pre-ductal and post-ductal blood gases, hyperoxia test, and echocardiogram† (Natarajan, Ostrea, Uy, Villanueva-Uy, 2006, p.181). Revelation is made of either a term infant or post-term infant by the history with a perinatal asphyxia’s history or predisposing factors like persistent membrane rapturing, â€Å"oligohydramnios, maternal group B streptococcal colonization, maternal smoking, and antenatal use of NSAIDS† (Natarajan et al., 2006, p.181). The purpose of the physical examination is to help reveal the intermittent or progressive cyanosis, the variable levels of the respiratory distress and an intimately â€Å"split second heart† (Natarajan et al., 2006, p.181). There may be an audible murmur within the tricuspid or pulmonary region or sometimes in mitral area. Systematic BP maybe at the normal level or there may be exhibition of sigs of the congestive heart failure as well as low blood pressure or BP. Moreover, there may be saturations of differential oxygen with either the upper or the lower extremities resulting from deoxygenated blood shunting via duc tus arteriosus (Natarajan et al., 2006, p.181). On the other hand, considering the x-ray method, this is found to be non-specific. This may be either normal or there may be mild or moderate â€Å"parenchymal lung disease† (Natarajan et al., 2006, p.181). This form of diagnosis is mostly important in diagnosing the cause of acute deterioration among the affected children suffering from the PPHN-related conditions like; pulmonary hemorrhage among others (Nakwan, Nakwan Wannaro, 2011, p.311).Advertising We will write a custom research paper sample on Persistent Pulmonary Hypertension of the Newborn (PPHN) specifically for you for only $16.05 $11/page Learn More Diagnosing PPHN by applying echocardiographic diagnosis is carried out on the basis of demonstrating high pressures of the pulmonary artery that are usually higher than the systemic pressures, and a â€Å"right-to-left shunt† via the foramen oval and ductus arteriosus. Indicators that suggest higher levels of the pressure in the pulmonary artery are; prolonged time interval of the ventricular systole and a short â€Å"pulmonary flow velocity ratio† (Natarajan et al., 2006, p.181). A prolonged â€Å"left ventricular systolic† interval of time indicates ventricular dysfunction. Failing of the acceleration of â€Å"systolic blood flow† between the major pulmonary artery and the minor peripheral artery on the Doppler also indicates ductal shunt. Conversely, echocardiogram might be normal and â€Å"the right-to-left shunt across the ductus arteriosus or foramen may not be seen depending on the level of the pulmonary artery pressure at the time of examination† (Natarajan et al., 2006, pp.181-182). Signs and Symptoms The signs and symptoms for the PPHN condition include; tachypnea or rapid breathing, increased heart beat rate, respiratory distress which may include signs like grunting and flaring nostrils, and cyanosis even at the time the i nfant is being given extra oxygen to help it in breathing (Natarajan et al., 2006, p.181). On some occasions when the infant is being examined for PPHN, the physician may be able to hear an abnormal heart sound or what is called a â€Å"heart murmur† (Natarajan et al., 2006, p.181). Affected Population Some sections of the population are affected by PPHN, and this basically depends on the risk factors to which they may be exposed. For instance, Cornfield Delaney (2012, p.18) present a report that in a well-considered, case-control trial carried out in the U.S Army population, it was found out that babies that were delivered through cesarean section were at about five times increased risk of developing the condition of PPHN in comparison with a control population that is well-matched demographically.Advertising Looking for research paper on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More As on one hand this study encompassed nearly twelve thousand infants, it is only 20 of them that were found to have developed the PPHN condition (Cornfield Delaney, 2012, p.18). In the study, choramnionitis as well deliberated a considerably higher risk of the PPHN (Cornfield Delaney, 2012, p.18). The idea that imply that Cesarean section delivery leads to having increased risk of developing PPHN is offered support to by data that was obtained from a study conducted previously in which the delivery mode, maternal race, and â€Å"high maternal body mass index each increased the likelihood of PPHN† (Cornfield Delaney, 2012, p.18). It is also found that the risk of any woman delivering a baby that is affected by PPHN within the overall population is found to be approximately two babies among every one thousand live births (Cornfield Delaney, 2012, p.18). Causes It has been found that in otherwise fit newborn, â€Å"the cause of PPHN is usually unknown† (Cornfield Del aney, 2012, p.16). Among the researchers, there are those who hold a belief that stress among mothers while they are carrying babies in their wombs, linked to particular pregnancy complications may raise the level of the risk of having the PPHN condition. The occurrence of PPHN may take place with particular congenital conditions or diseases of babies that have some effects on the lungs (Weijerman, Van Furth, Van der Mooren, Van Weissenbruch, Rammeloo, Broers, Gemke, 2010, p.1195). The PPHN condition has as well been associated with such health conditions as hypoglycemia, anemia, birth asphyxia and severe pneumonia. Such conditions may lead to high BP within the blood vessels that subsequently, leads to the lungs to rise to the level where the blood of the infant goes on passing by lungs after delivery. In most cases, these conditions are found to be reversible and are also normally temporary. Some particular congenital conditions which contribute towards having incomplete developm ent of the lungs may as well be linked to PPHN (Cornfield Delaney, 2012, p.17). Treatment Maintaining sufficient oxygenation is the fundamental objective in PPHN management and mechanical ventilation is among treatment modalities that can be applied to realize this objective (Goissen, Ghyselen, Tourneux, Krim, Storme, Bou, Maingourd, 2008, p.437-438). Among the very early strategies within the conventional ventilator therapy was the hyperventilation to raise the level of the blood PH, facilitate the reversing of ductal shunting and inducting pulmonary vasodilatation. In comparing hyperventilation with alkali infusion, it was found out that hyperventilation brought down the level the â€Å"extracorporeal membrane oxygenation† risk (Oden Cheifetz, 2005, p.105). But on the other hand, from some study findings, it has been established that hyperventilation as well as â€Å"metabolic and respiratory alkanosis† induction in PPHN treatment, have not improved the clinical o utcome to a significant level and have been linked to â€Å"adverse neurologic sequelae† (Natarajan et al., 2006, p.183). On the other hand, pulmonary vasodilation using a number of drugs has undergone evaluation for PPHN treatment, but there has been no recommendation of any, apart from NO (Nassi, Daniotti, Agostiniani, Lombardi, Favilli, Donzelli., 2010, p.104). Some special cases of adenosine infusion have indicated improved oxygenation but have some adverse effects of â€Å"bradycardia, hypotension, and prolonged breeding time, which have precluded its clinical use† (Natarajan et al., 2006, p.183). Initially, there was utilizing of tolazoline as a â€Å"vasolidilating, ÃŽ ±-adrenergic blocking agent† (Natarajan et al., 2006, p.183). However, it facilitates inducing of histamine release and brings in adverse effects like having higher levels of gastric secretions as well as bleeding. It also leads to frequent occurrence of oliguria and systematic hypotension . On the other hand, â€Å"Extracorporeal membrane oxygenation† (ECMO) is found to be a final therapy mode among infants that has reversible cardiac or respiratory failure at a time the rest of non-invasive measures have not succeeded. This method is an improved cardiopulmonary bypass which makes sure that there is sufficient delivery of oxygen and gas exchange among the PPHN patients having or not having cardiac support. In this manner, the innate organs of the patient are rested to ensure facilitation of repair as well as to evade barotrauma and also volutrauma of the management of mechanical ventilation. Apart from PPHN, ECMO has as well been employed in â€Å"meconium aspiration syndrome, CDH, and cardiac anomalies† (Natarajan et al., 2006, p.184). Basing on the fact that ECMO is an invasive method, this method or procedure is reserved for the young children that are receiving maximum â€Å"ventilatory support† and the ones that meet Barlett standards, which is suggestive of at least eighty percent risk of incurring death. In the course of the last ten years or so, there has been a decline in the frequency of the utilization of ECMO technique because of the coming up of alternative techniques like inhaled NO or iNO (Natarajan et al., 2006, p.184). Inhaled nitric oxide or (iNO) is a technique that has been identified to be safe and very effective treatment method for PPHN in the near-term as well as term newborns (Fashaw, Hale, Lee, Rosenberg, Vaver, Waas, Werner, 2010, p.27; Hosono, Ohno, Kimoto, Shimizu, Takahashi, Harada, 2009, p.79). It has also been found out that using iNO has contributed to 3.4 percent more lives saved and a six percent rise in â€Å"average utility gained per infant (Lorch, Cnaan Barnhart, 2004, p.417). Moreover, utilization of this technique has helped to bring improvement in oxygenation and also in decreasing the need for having ECMO among term newborns having PPHN (Kinsella Abman, 1998,p.28). In the curr ent day, there has been extending of iNO utilization to the pre-term infants as being a rescue therapy among the infants having respiratory failure in spite of â€Å"surfactant replacement therapy†, and also more prevalent utilization among the infants who are less sick in an effort to bring down the level of frequency of the â€Å"chronic lung disease of the premature† (Fashaw et al., 2010, p.127). While the use of this technique becomes more and more prevalent, it remains vital to go on evaluating short-term as well as long-term outcomes for the infants (Walsh-Sukys Tyson, 2000, p.20). Outcomes The follow-up studies that were conducted previously about the infants who underwent treatment using iNO as â€Å"neonates have not found a short-term increase in medical, neurodevelopmental or behavioral problems when compared historically or concurrently with infants treated conventionally or with ECMO† (Fashaw et al., 2010, p.127). A number of studies of young child ren of up to the age of 2 years, who received treatment using iNO as neonates have been somehow encouraging concerning short-term â€Å"developmental outcomes† (Fashaw et al., 2010, p.127). In addition, the interviews conducted among parents that had children aged slightly above four years, that underwent treatment using iNO for PPHN, did not give out any findings of having increased neurologic, pulmonary, cognitive, â€Å"behavioral or neurosensory outcomes in infants treated with iNO when compared to those managed without iNO† (Fashaw et al., 2010, p.129). Even if neurodevelopmental disabilities are given different definitions depending on the study being carried out, there has been reporting of these disabilities in between ten to thirty percent of the infants having no differences pointed out where comparison was made between the infants that received treatment with iNO and a control population that received treatment for PPHN. Such numbers were as well comparable to those infants that received treatment with ECMO â€Å"followed out to 7 years of age† (Fashaw et al., 2010, p.129). Therefore, outcomes for the infants treated as being neonates for â€Å"Persistent Pulmonary Hypertension of the Newborn† tends not to be related to the â€Å"specifics of individual intensive care treatment regimens, rather to events clinically associated with PPHN such as prenatal asphyxia† (Fashaw et al., 2010, p.129). In general terms, the children that receive treatment with iNO have the same outcomes as those that receive treatment with ECMO and those that are treated with the conventional ways for the Persistent Pulmonary Hypertension of the Newborn. The Role of the Respiratory Therapist The respiratory therapist may be requested to offer supplemental oxygen and may also offer supplemental pressure to any patient who may be grunting in order to relieve the patient from some of the breathing hardships. The respiratory therapist can give th is through either the nasal CPAP or through any other more appropriate means. The therapist is then supposed to watch the infant (patient) closely for any symptoms of tiring. By making any observation of any sign of tiring, it may now become essential to apply more interventions. It is quite imperative for the therapist to watch closely this kind of patient. The respiratory rate as well as the oxygen saturation of the patient has to be constantly monitored. In case there is any deterioration in the patient, quick intervention must take place (Tibballs Chow, 2002, p.399). Summary/ Conclusion PPHN condition results from failure to attain a smooth transition â€Å"from fetal to extrauterine pulmonary circulation after birth†. The diagnosis of this condition can be carried by undertaking physical examinations, looking at the history, undertaking laboratory tests, using chest x-ray, undertaking hyperoxia test, and echocardiogram. The signs and symptoms for the PPHN condition incl ude; tachypnea or rapid breathing, increased heart beat rate, respiratory distress which may include signs like grunting and flaring nostrils, and cyanosis even at the time the infant is being given extra oxygen to help it in breathing and having heart murmur among others. It is believed that PPHN is brought about by stress among mothers while they are carrying babies in their wombs, linked to particular pregnancy complications which may raise the level of the risk of having the PPHN condition. Moreover, the occurrence of PPHN may take place with particular congenital conditions or diseases of babies that have some effects on the lungs. Considering treatment, maintaining sufficient oxygenation is the main goal in PPHN management and mechanical ventilation is among treatment modalities that can be applied to achieve the goal. ECMO has been found to be a final therapy mode among infants that has reversible cardiac or respiratory failure at a time the rest of non-invasive measures have not been successful. The technique is an improvement of the cardiopulmonary bypass which makes sure that there is sufficient delivery of oxygen and gas exchange among the PPHN patients having or not having cardiac support. But on the other, in the last few year, there has been a decline in the frequency of the utilization of ECMO technique because of the coming up of alternative techniques like inhaled NO or iNO. This new technique has been found to be very safe and very effective for treating PPHN in the near-term as well as term newborns. It has also been found out that using iNO has contributed to 3.4 percent more lives saved. Moreover, utilization of this technique has helped to bring improvement in oxygenation and also in decreasing the need for having ECMO among term newborns having PPHN. The respiratory therapist can play an important role of offering supplemental oxygen as well as providing supplemental pressure to any patient who may be grunting in order to relieve the pat ient from some of the breathing problems. The therapists also closely watches the patient in order to help carry out any interventions when need arises. References Bartle, D., Patole, S., Rao, S. (2010). Current and future therapeutic options for persistent pulmonary hypertension in the newborn. Expert Review of Cardiovascular Therapy, 8(6), 845-873. Cornfield, D., Delaney, C. (2012). Risk factors for persistent pulmonary hypertension of the newborn. Pulmonary Circulation, 2(1), 15-23. Fashaw, L., Hale, K., Lee, N. R., Rosenberg, A. A., Vaver, K. N., Waas, N., Werner, D. (2010). School-age outcomes of newborns treated for persistent pulmonary hypertension. Journal of Perinatology, 30(2), 127-139. Goissen, C. C., Ghyselen, L. L., Tourneux, P. P., Krim, G. G., Storme, L. L., Bou, P. P., Maingourd, Y. Y. (2008). Persistent pulmonary hypertension of the newborn with transposition of the great arteries: successful treatment with bosentan. European Journal Of Pediatrics, 167(4), 437-4 40 Hosono, S., Ohno, T., Kimoto, H., Shimizu, M., Takahashi, S., Harada, K. (2009). Developmental outcomes in persistent pulmonary hypertension treated with nitric oxide therapy. Pediatrics International, 51(1), 79-83. Kinsella, J. P., Abman, S. H. (1998). Inhaled nitric oxide and high frequency oscillatory ventilation in persistent pulmonary hypertension of the newborn. European Journal Of Pediatrics. Supplement, 157S28-S30. Kraemer, U., Krijger, R. D., Reiss, I., Rottier, R. J., Sluiter, I., Tibboel, D. (2011). Vascular abnormalities in human newborns with pulmonary hypertension. Expert Review of Respiratory Medicine, 5(2), 245-264. Lorch, S. A., Cnaan, A., Barnhart, K. (2004). Cost-Effectiveness of Inhaled Nitric Oxide for the Management of Persistent Pulmonary Hypertension of the Newborn. Pediatrics, 114(2), 417-426. Mago, R. (2012, August). Antidepressants and persistent pulmonary hypertension of the newborn. Psychiatric Times, 29(8), 30. Nakwan, N., Nakwan, N., Wannaro, J . (2011). Predicting mortality in infants with persistent pulmonary hypertension of the newborn with the score for neonatal acute physiology-version II (SNAP-II) in Thai neonates. Journal of Perinatal Medicine, 39(3), 311-321. Nassi, N. N., Daniotti, M. M., Agostiniani, S. S., Lombardi, E. E., Favilli, S. S., Donzelli, G. P. (2010). Sildenafil as ‘first line therapy’ in pulmonary persistent hypertension of the newborn?. Journal Of Maternal-Fetal Neonatal Medicine, 23(1),104-105. Natarajan, G., Ostrea, E. M., Jr., Uy, H. G., Villanueva-Uy, E. T. (2006). Persistent pulmonary hypertension of the newborn: pathogenesis, etiology, and management. Pediatric Drugs, 8(3), 179-188. Oden, J., Cheifetz, I. M. (2005). Neonatal Thyrotoxicosis and Persistent Pulmonary Hypertension Necessitating Extracorporeal Life Support. Pediatrics, 115(1), 105-108. Tibballs, J., Chow, C. (2002). Incidence of alveolar capillary dysplasia in severe idiopathic persistent pulmonary hypertension of the newborn. Journal Of Paediatrics Child Health, 38(4), 397-400 Walsh-Sukys, M. C., Tyson, J. E. (2000). Persistent Pulmonary Hypertension of the Newborn in the Era Before Nitric Oxide: Practice Pediatrics, 105(1), 14. Weijerman, M., Van Furth, A., Van der Mooren, M., Van Weissenbruch, M. M., Rammeloo, L., Broers, C. M., Gemke, R. J. (2010). Prevalence of congenital heart defects and persistent pulmonary hypertension of the neonate with Down syndrome. European Journal Of Pediatrics, 169(10), 1195-1199. This research paper on Persistent Pulmonary Hypertension of the Newborn (PPHN) was written and submitted by user ShaneYamada-Jones 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.

Free Essays on Absent Fathers

Absent Fathers: How it affects the kids? Absent fathers is the most abused social problem. When a kid’s father dies, there is no solution unless the mother gets remarried. When the father is alive and knows he is your father, but neglects to care for or acknowledge his kid, is what is being abused. No good comes from a life without a father. Two parents are better than one without question. If one were to believe that any good can come when you raise children without a father, my question is, why? How do you? How do you expect a kid to go out in a world from a fatherless family, and adapt into a rather masculine world? How do you believe that being raised with no father doesn’t damage a kid’s perspective of life? Do you think that a kid will get the same amount of attention, love, emotion, or interaction that he/she would in a two parent household? Do you believe that children can develop everything they need with only a mom, when another child can gain so much more from both parent figures that just a mother? Mothers and fathers obviously parents differently. If children have the combination of what mothers and father bring to parenting, they will have a fuller perspective on life and how to deal with certain situations. Mothers are affectionate, tend to be more comforting, emotional, and enforce the safety of their children. Fathers concentrate alot on discipline, raising obedient children, enforcing success, and a father figure is more physical. When little boys see how fathers treat their mothers or how their father deals with certain situations, do you think it affects them in the way they will treat people, or deal with situations in the future? When little girls see the love, and attention, and protection their father provides, they will know what to expect in a future relationship with another man (Horn). With one parent in a home the stress is overwhelming. How do they have time to fit everything in, from... Free Essays on Absent Fathers Free Essays on Absent Fathers Absent Fathers: How it affects the kids? Absent fathers is the most abused social problem. When a kid’s father dies, there is no solution unless the mother gets remarried. When the father is alive and knows he is your father, but neglects to care for or acknowledge his kid, is what is being abused. No good comes from a life without a father. Two parents are better than one without question. If one were to believe that any good can come when you raise children without a father, my question is, why? How do you? How do you expect a kid to go out in a world from a fatherless family, and adapt into a rather masculine world? How do you believe that being raised with no father doesn’t damage a kid’s perspective of life? Do you think that a kid will get the same amount of attention, love, emotion, or interaction that he/she would in a two parent household? Do you believe that children can develop everything they need with only a mom, when another child can gain so much more from both parent figures that just a mother? Mothers and fathers obviously parents differently. If children have the combination of what mothers and father bring to parenting, they will have a fuller perspective on life and how to deal with certain situations. Mothers are affectionate, tend to be more comforting, emotional, and enforce the safety of their children. Fathers concentrate alot on discipline, raising obedient children, enforcing success, and a father figure is more physical. When little boys see how fathers treat their mothers or how their father deals with certain situations, do you think it affects them in the way they will treat people, or deal with situations in the future? When little girls see the love, and attention, and protection their father provides, they will know what to expect in a future relationship with another man (Horn). With one parent in a home the stress is overwhelming. How do they have time to fit everything in, from...

Ethics Essay Example | Topics and Well Written Essays - 2000 words - 3

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Bomb Squad Guidelines - Research Paper Example ene include the establishment of a command, request for emergency services, identification of the hazards at the scene, identification of the witnesses and victims as well as the preservation of any physical evidence that may be considered as potential and transient. With these, it is possible to identify, collect, locate and preserve evidence which is valuable in order for it to undergo examination that makes it possible to produce information that is both useful and effective (Pyrek, 2010). Some of the topics that need to be updated in this book include the areas that are concerned with the collection and examination of debris from an explosion and bombing crime scene. In this sense, there was a need to improve the recognition of consistent evidence as well as the other procedures involved in handling. This also includes the area that is related to training where the amount of information possessed by an individual is supposed to be upgraded. The other area that needs to be upgraded in the book is concerned with the securing of the required resources. This can be done through reevaluation, being aware of the safety alert concerns and the establishment entry and exits paths to be used by personnel. All these practices and procedures are mainly concerned with the evaluation and assessment processes of the procedure (NIJ, 2014). These topics need to be updated because of the importance associated with the proper identification, examination and collection of forensic evidence that is highly relevant. In this way, it will make it possible to ensure the performance of more successful investigations. In this sense, this kind of revision will affect the community that deals with forensic science and the criminal community since it relates to the collection of evidence and preservation in the sense that it will encompass a wide range of areas that include most of the agencies involved in law enforcement, forensic laboratories, fire departments, government agencies and

Tesla in Automotive industry Strategy project Essay Example for Free

Tesla in Automotive industry Strategy project Essay 1. Introduction The Encyclopaedia Brittanica defined the automotive industry as all the companies and activities involved in the manufacturing of motor vehicles, including most components, such as bodies and engines; but excluding tires, batteries and fuel1. The automotive industry started with the production of what is widely considered to be the first ever automobile, the Benz Patent-Motorwagen in 1886. Although the first car was originally manufactured in Germany, in the many decades to come, the United States led the world in total automobile production until the start of the 21st century, when China took the top position. Today, China produces nearly 20 million units per year, almost double the amount of the United States. It is one of the world’s most important sectors when measured by revenue and it is a business that is still growing significantly. Last year for example, over 87 million automobiles were produced worldwide, a 3. 6% increase compared to the year before and a 43. 82% increase compared to 20032. Needless to say, the automotive industry is big business and it is very probable there are business opportunities that are yet to be exploited. Tesla Motors is an American car manufacturer that tried to exploit such a business opportunity. It’s an American company that designs and manufactures electric vehicles and electric car components3. Founded in 2003, Tesla’s goal was to lessen the world’s dependence on petroleum-based transportation and drive down the cost of electric vehicles. Moreover, Tesla’s aim is to prove that electric vehicles can be awesome as well4. This might not sound particularly unique, but Tesla Motors does have a very distinct strategy in the sense that it wants to enter the automotive market by first focusing on high-end luxury cars and sports cars. Later, when Tesla’s products and consumers acceptance have matured, they would move into the market for the middle-class consumer, which is larger but also significantly more competitive5. The idea is to establish a strong brand name at first, which will aid the company in a later stage when the decision is made to start producing lower-priced automobiles. Tesla’s first 1 http://global. britannica. com/EBchecked/topic/45050/automotive-industry 2 http://www. oic a. net/category/production-statistics/ 3 http://www. te slamotors. com/ 4 http://www. teslamotors. com/about 5 http://www. greenc arreports. com/news/1022275_msnbc-calls-ev-drivers-lunatic-fringe 3 model, the Roadster, had a base price of approximately $100. 0006. Their second car, Model S, is priced at $63. 750 including a $7. 500 tax credit. The company now has plans to launch a $30,000 small SUV the Tesla Model X 7. Eventually, Tesla wants to become a mass producer of electric vehicles and service both upper- and middle-class customers8 This discussion aims to analyze Tesla’s strategy. It is clear that Tesla has a very differentiated strategy and we will want to determine whether or not Tesla is likely to succeed in achieving its goals and become a successful enterprise. Firstly, we will take closer look at the ‘environmental’ automotive industry using Porter’s theory. Secondly, we need to closely look at Tesla’s strategy. How will Tesla try to win a respectable share of the market? As mentioned before, Tesla is a very young company and it will inevitably face fierce competition from incumbent firms. A clear plan to establish a foothold in such a market will be essential for the firm’s survival. The next step is to see if Tesla identified all relevant factors and industry forces, and if it has defined a strategy that takes all of these elements into account. It will surely need to attain a unique strategy if it wants to position itself in a key position in the market. What is it exactly that differentiates Tesla from other car manufacturers and in what way could this be beneficial for the firm? Does their strategy have a high chance of success? How can Tesla create a network of electric chargers? Before evaluating Tesla’s strategy, we must first clearly take a closer look at the company Tesla Motors itself and define the market in which the company is active. Even though they are currently operating in a smaller niche market (mid to high-end luxury cars), the plan is to eventually address the middle-class consumer and enter the ‘standard’ automobile market. This will inevitably complicate our discussion but it is essential for determining the chance of success. The paper includes a discussion on the high entry barriers that are typically associated in the automotive industry and the possible presence of strategic entry barriers raised by incumbent firms to reduce the likelihood of new entrants. We will also mention any other strategies adopted by firms in the automotive industry who want to improve their competitive position. Furthermore, the extent to which the industry is concentrated will be discussed, as well as the possible presence of strategic complements and substitutes. Moreover, Tesla will also need to take the non-market environment into consideration. Typical for the automotive sector is that it is an industry with very strict safety regulations. Tesla of course will also 6 http://jalopnik. com/5135290/tesla-increases-prices-on-already-ordered-roadsters 7 http://onpoint. wbur. org/2009/09/25/teslas-elon-musk-on-a-sub-30000-electric-car 8 http://www. marketwatch. com/ story/strategic-corporate-profile-of-tesla-motors-global-operations-2014-01-13 4 have to face the challenge of producing vehicles that respect these requirements. On top of that, the relatively recent discovery of global warming, partially caused by car emission (CO2), has led to the implementation of a series of emission standards that aim to reduce the greenhouse gasses emitted by petroleum-powered vehicles. This may not seem relevant for Tesla Motors at first since its goal is to produce electric vehicles. These regulations are however accompanied with a credit system, which means that car manufacturers that do not meet the standard are penalized and have to buy credits from other manufacturers that have a surplus of credits9. Since Tesla Motors only produces emissions-free vehicles, it has a major surplus of credits which it can sell to other car manufacturers. General Motors for example has to buy additional credits from Tesla in order to respect the regulation. This implies large transfers of wealth across car manufacturers. As a result, companies selling cars with a (too) high emission must raise prices to pay for the credits. On the other hand, the beneficiaries of these wealth transfers such as Tesla can now use the extra revenue to lower prices and take on a more competitive position in the market. All of this will of course be discussed more thoroughly in our discussion below. The paper concludes with a summary of the discussion and our prognosis regarding the future success of Tesla Motors in the automotive industry. 2. Market definition This paper only looks at models available in the US because it’s the largest electric car market, the EU is the second largest market but is much more complex because EU-countries have different legislation for electric cars. Some countries have large subsidies for electric cars and thus large market shares such as Norway, on the other hand some countries have almost no market share. The Model S is the only available model at the moment targeting the middle to high-end luxury car market. This model costs between 63. 750$(base model, 7500$ tax credit) and 125. 220 $(full option, 7500$ tax credit). 10 Because the model S is all electric, we can compare the car to slighter cheaper models because of lower long term ownership cost thanks to lower cost for electricity compared to fuel. The base model is a full-size 5 adult seat sedan powered by a fully electric 60 kW-h motor achieving 302hp. Top speed is relatively low at around 200km/h but acceleration is very good at 5. 9 seconds to 100 km/h, this is typical for an electric engine. More expensive models offer better range and performance and a warranty with unlimited kilometers on the battery for 8 years compared to 200. 000km for 8 years on the base model. 9 http://mitsloanexperts. mit. edu/californias-auto-emissions-policy-hits-a-tesla-pothole/ 10 Teslamotors. com 5 We will consider the mid to high-end luxury market containing one electric the Tesla, a couple of hybrids and a lot of traditional cars. Mid-end starts at prices of approximately 50. 000 $ with cars such as the BMW 5-serie, Audi A6 and Mercedes E-class. 11 High end stops at prices above 130. 000$. For the following analyses we will sometimes look at broader markets containing cheaper alternatives because even though these cars aren’t substitutes they are still relevant. Research show that tesla owners were most likely to previously own a Toyota prius hybrid or secondly luxury BMW and Mercedes. 12 3. Industry attractiveness and profitability In this section the overall attractiveness of the ‘environmental’ automotive industry is assessed using Porter’s influential five forces model. The term environmental indicates those vehicles that do not solely rely on the combustion of fossil fuels to power their engine. Examples are electric vehicles, hybrid vehicles or plug-in hybrid electric vehicles (PHEVs). Both the pure electric automotive industry as well as the overarching environmental automotive industry is presented, as these cannot always be seen separately. In his model, Michael Porter identifies five key competitive forces that determine the structure and profitability of a certain industry. The five forces are the bargaining power of suppliers, the bargaining power of buyers, the threat of substitutes, the threat of entry and the rivalry among existing competitors. Porter’s model enables managers, in an easy and straightforward way, to understand their industry environment and to shape their firm’s strategy accordingly. As a rule of thumb, the stronger the five forces, the lower the industry’s profit potential and hence the industry’s attractiveness to competitors. The most influential forces that have shaped and continue to shape the environmental automotive industry are discussed in the following paragraphs. A first restraint on the overall profitability of a firm is the bargaining power of its suppliers. For the environmental automotive industry the bargaining power varies among the suppliers of different components. An important component in the construction of hybrid and electric vehicles is the battery. The bargaining power of the battery companies is low as there are a lot of manufacturers present on the market. Tesla Motors, for instance, buys Li-ion cells from different manufacturers. Consequently, in the case any problems occur with a particular battery supplier, Tesla can easily switch or threaten to switch to other suppliers at low costs. Among others, Tesla works together with Daimler AG and Panasonic to develop battery packs and chargers (Boyke, Cheng, Clevers, Schroeder, Strupp, 2010). Another important component of any vehicle is the chassis. For the construction of the chassis 11 http://buyersguide. caranddriver. com 12 h%p://www. wired. com/2014/03/tesla-model-s-toyota-prius/ 6 specialized engineering skills are required. These skills can often be obtained through strategic partnerships with other car manufacturing companies. In the case of such strategic interdependence the bargaining power of the suppliers is higher than in the ‘take-it-or-leave-it’ battery case. In the past Tesla had an exclusive partnership with Lotus for the physical construction of the Roadster13. As of recently Tesla and Toyota Motor Corporation also agreed to cooperate on the development of electric vehicles, parts, the production system and engineering support14. In conclusion, however, the overall bargaining power of suppliers in the automotive industry is low. The supplier firms must contend with substitute products for sale to the industry. Tesla has more than 150 suppliers around the world, which provide over 2000 parts to Tesla. For the production of the Model S, Tesla uses a highly integrated manufacturing approach, even negotiating with suppliers to manufacture products on site to use the excess capacity. In this way, the integrated approach enables Tesla to alleviate its dependence on supplier performance (Boyke, Cheng, Clevers, Schroeder, Strupp, 2010). A second force that determines the profitability in an industry is the bargaining power of buyers. The bargaining power of buyers concerns the pressure buyers can put on the margins of producers by demanding a lower price or a higher product quality. In the environmental automotive industry the bargaining power of buyers is rather low. For Tesla in particular this is even more so. For starters, Tesla does not sell products in bulk. This means that for the consumers that purchase the finished products no real scale effects are present. Moreover, Tesla has a quite unique position on the market. Tesla is the only manufacturer on the US market that produces high-end, full electric cars that can drive autonomously for over 400 km. By employing a highly skilled, technocratic labour force and management team, Tesla has branded itself as a cutting-edge, innovative firm. They manufacture high quality electric vehicles that are very performing while being environmental-friendly and fun at the same time. The buyers of the Model S also have the possibility to entirely customize the vehicle to their taste. This creates a sense of exclusivity among the clients. Besides the B2C applications Tesla has also established a strong position in the B2B environment 15. Tesla for example licenses its patented processes and technologies to other companies. Especially in the area of battery technology 13 http://www. teslamotors. com/blog/lotus-position 14 http://www.teslamotors. com/about/press/releases/tesla-motors-and-toyota-motor-corporation- intend-work-jointly-ev-development-tm 15 http://www. slideshare. net/joseangeldf/darden-school-of-business-tesla-strategic-analysis 7 and the construction of ‘supercharging’ stations Tesla has a lot of expertise16. The proper licensing of these assets will benefit the entire environmental automotive industry as a whole. An especially important force in the electric automotive industry is the threat of substitutes from outside the given industry. Hybrid vehicles and more specifically PHEV provide a similar functionality as the full electric vehicles. Those manufacturers within these strongly related industries, which produce vehicles and services with an attractive price and performance, pose a serious threat to the established electric car manufacturers. For the Model S the most important substitutes are those mid to high-end hybrids. These vehicles offer low emissions and a good fuel economy at a similar price as the Model S. The most successful alternatives within the US automotive industry are discussed in the next chapter. In the specific price range of the Model S the threat of substitutes is still limited as Tesla is gradually positioning itself as a high-value, exclusive and environmental brand with a growing number of enthusiasts17. Nonetheless, a possible future expansion into the mid-end and low- end market segment will significantly increase the threat of substitutes. There are, however, some complementing factors that might reduce the threat of substitutes both for Tesla as well as the electric automotive industry in a whole. The scope for future development in battery technology, the presence of several tax and parking incentives for electric vehicles and the expected rise in oil prices in comparison to electricity prices might spur the attractiveness of the electric automotive industry. These market dynamics both play on the level of customers as well as producers. One possible negative factor in the realisation of potential sales is the low availability of charging and home charging facilities. However, Tesla Motors is addressing this issue by investing heavily in strategically located charging facilities and by expanding the power and endurance of the battery pack 18. Tesla’ s battery pack technology is critical to the company’ s positioning and competitive differentiation. The low cost of the battery pack allows Tesla to not only design cars with battery ranges greater than the competition but also place equal emphasis on design, performance, and energy efficiency. On the short term, the threat of new entrants in the electric US market is rather limited because of several entry barriers. The industry is characterised by high capital requirements and high sunk costs. 16 http://www. sl ate. com/articles/technolog y/technolog y/2013/05/tesla_model_s_the_electric_car_compa ny_is_a_little_bit_apple_a_little_bit. html 17 http://www. wikiwealth. com/five-forces:tesla-motors, http://www. teslamotors.com/blog-and-press- releases. 18 http://www. slideshare. net/joseangeldf/darden-school-of-business-tesla-strategic-analysis, http://www. reuters. com/article/2014/02/26/us-tesla-battery-panasonic-idUSBREA1O1MF20140226, http://www. t eslamotors. com/supercharger 8 Moreover, advanced, often patented, technologies and processes as well as a highly skilled workforce are required to successfully manufacture an electric car. The success of a firm in the industry is also largely determined by its brand image and the realisation of economies of scale19. Therefore, it is not easy for a potential new entrant to establish a foothold. This is even enhanced by the fact that the incumbent firms have a large and flexible production capacity that can be used as a retaliation device in case of entry (Boyke, Cheng, Clevers, Schroeder, Strupp, 2010). However, established vehicle manufacturers with deep pockets that have currently missed the ‘environmental train’ or disruptive innovators like Tesla Motors might overcome these entry barriers in the long run. The current competition in the US environmental automotive industry is moderate. Only a few major brands are competing. Because of the high entry barriers and the threat of substitutes not a lot of brands risk burning cash in an innovative and insecure business. However, as the sector matures and more people consider switching to an electric car this will change. In a recent report of the Electric Vehicles Initiative (EVI) a global goal of 20 million electric passenger cars, including plug-in hybrid vehicles, battery electric vehicles (BEVs) and fuel cell electric vehicles, in stock by 2020 is set forward. This is still a long way to go as the total worldwide electric vehicle stock at the end of 2012 only amounted to a large 180. 000 units. In 2012, 38. 585 PHEVs and 14. 592 BEVs were sold in the US. The cumulative stock in the US in 2012 was 71. 174 units (Clean Energy Ministerial, Electric Vehicles Initiative, International Energy Agency, 2013). In 2013 roughly 96. 000 electric vehicles were sold in the US environmental automotive industry(including hybrids)20. The three top selling brands are the Chevrolet Volt, the Nissan Leaf and the Tesla Model S. It is clear that the popularity of electric vehicles has significantly increased over the last few years. It is expected that this trend will only continue in the future as the number of models on the market increases. The share of electric cars is still only about 3,5% of the total number of cars that are sold annually in the US market21. Hence, the growth potential of the environmental automotive industry is huge, this both on a domestic as well as an international level. In conclusion of this section an assessment is made of the overall profitability of the environmental automotive industry. As previously argued, the bargaining power of suppliers and buyers is rather limited in the industry. Therefore, the vehicle manufacturers can attract more profits than their up- and downstream partners. The industry is also characterised by several entry barriers, especially on the 19 http://www. wikiwealth. com/five-forces:tesla-motors 20 http://www. greencarreports. com/news/1089443_plug-in-electric-car-sales-for-2013-almost-double- last-years 21 http://electricdrive. org/index. php? ht=d/sp/i/20952/pid/20952 9 short term. The effective prevention of possible entrants reduces the pressure on prices and allows incumbent firms to attract a significant share of the profits. The threat of substitutes is one of the most important restrictors on the profitability within the industry. Because of the similarity in functions between electric brands and hybrid brands it is important for the incumbent firms to create a positive consumer image towards their products. The growth potential of EVs is the most important driver of future profitability of the industry. Until now incumbent firms have undertaken a lot of RD initiatives in the area of battery and charging technologies. The sales numbers in the US market show that these investments are finally starting to pay-off. In the long run, with a growing global popularity of EVs, it is to be expected that also other companies will consider entering the environmental automotive industry. 4. Tesla in the market Tesla differentiates itself by producing environmental responsible cars that have all the benefits of a luxury vehicle. By equally emphasizing on speed, handling, design, comfort, and zero-emissions, Tesla creates a unique balance between performance, efficiency and aesthetics. Through the offering of this first fully electric luxury sedan car, Tesla attained a first mover advantage. Together with its ‘Silicon Valley’ culture, an approach that is innovative, competitive, and effective, Tesla achieved a solid brand name in the automotive market. (Mangram, 2012) Tesla’s battery technology is also critical to the company’s competitive advantage. With its cutting-edge battery technology, combined with essential technology research, Tesla is able to design and produce electric cars with a far greater range than its competitors. Its lithium-ion based battery, for instance, is 250 kilograms lighter compared and has a range of up to 500 kilometers. Bron ? vergeleken met wat ? But even with a supercharger a full charge is approximately one hour. Moreover the company produces many of its key parts in-house, thus making it harder for competitors to replicate. With the expansion of its own retail shops and the establishment of a network of free recharging points for its customers, Tesla keeps challenging the traditional car companies (The Economist, 2013). Tesla’s main strategy can be seen as a reflection of the innovative marketing approach Apple used for its ingenious technology. It holds that any new technology is often very expensive and wealthy customers are regularly the first to accept it. Consequently, Tesla produced its first vehicle, the Roadster, for the premium sports car consumer segment. Nowadays, with the production of the Model S Sedan, the middle to upper- middle class consumers are being targeted. Finally, by 2015 Tesla plans to produce and market an electric car available at a mass-market consumer price range (Tesla Motors, 10 2014). Although this ‘Apple Computer’s business model’ is considered to be rather exceptional in the automobile industry it helped the company to position itself as groundbreaking, self-determining, and cool. Tesla BMW Daimler AG General Motors Toyota Revenue 2 billion 60 billion 117 billion 155 billion 22 trillion Net Income -74 000 2 billion 6,4 billion 5,35 billion 962 billion Sales Growth 387% 7,2 % 3,22 % 2,08 % 18,73 % The luxury car market is highly competitive, with several incumbent companies with loyal customers. Tesla’s main competitors in the luxury car segment are BMW, General Motors, Toyota and Mercedes. While the number of any competitive electric car is still low, an increase can be expected. General Motor’s Chevrolet Volt is one of the main competing vehicles in the market. It covers a wide target market and comes at a notable lower price than Tesla’s Model S. Toyota remains the global leader when it comes to selling hybrids. Although Toyota has 4 electric cars (the Prius, the RAV4 EV, the FCHV fuel cell car, and the Scio IQ-EV), it strategically collaborates with Tesla to improve the electric car development. This alliance has been one of the main factors of Tesla’s growth as Tesla consumers can get customer service in Toyota sites (Toyota Motor Corporation, 2014). The chart compares Tesla’s main competitors on the basis of revenue, net income and sales growth. As we can see, its sales growth is overwhelming. Given that is a rather new company, it indicates its rapid expansion on the electric car market. However, Tesla’s net income remains negative. Nonetheless, the company’s share is currently being traded at 20 times its earning, and as the company continues to grow these numbers are expected to rise. According to an article by Wall Street, 43 new hybrid, electric, and fuel-cell vehicles will be produced in the US market by 2015. Moreover, the market share of alternative fuel cars will increase from 3% in 2012 to almost 5% in 2014 (Wall Street, 2013). New electric vehicle entrants and existing plug-in hybrids manufactures will continue to compete with Tesla in the near future. While the traditional car manufactures are firmly entrenched, Tesla’s competitive advantages could develop to the securing of a significant market share in the electric car market. 5. Sustainability of the competitive advantage. This chapter analyses the degree of sustainability of Tesla’s competitive advantage. First the relevant trends and developments in the automotive industry are briefly reviewed. Furthermore, the 11 predominant isolating mechanisms in force given the market position of Tesla are discussed. We argue Tesla is a textbook example of a disruptive technology. To conclude, strategy recommendations hereupon are formulated. The primordial focus of our analysis shifts in this chapter from the luxury car market to the overarching automotive industry. The rational hereof is clear-cut. On the one hand, the trend analysis for the automotive industry applies to and sufficiently covers the luxury car segment. On the other hand, Tesla continuously voices the strategy to level down through the segments. Furthermore, the majority of car manufacturers produce for multiple segments of the industry. The sustainability of Tesla’s competitive advantage thus strongly depends on the industry rather than the Model S market segment. 1. 1 Trends in the automotive industry The automotive industry is, may be argued, rather conservative. The market structure is little dynamic, without change in market leading firms for long. Furthermore, the industry evolved the past century merely through optimising the traditional ‘automobile’, with limited major breakthroughs. To illustrate, though fuel efficiency and exhaust of the combustion engine has greatly improved, working principles remain unchanged. The emergence of (electrical) alternatives that are sold commercially is only a recent phenomenon. We review three developments that will impact the automotive industry. First, the society-wide surge of environmentalism a fortiori impacts the automotive industry. A thickening body of government actions forces car manufacturers to produce cleaner cars. This both directly, through legislation (e.g. CO2 output limits for new cars), or indirectly by altering consumer behaviour through excises or tax incentives. Furthermore, consumers are increasingly environmentally conscious. Bottom-line, car sales undeniably grow more eco-friendly. Furthermore, the panoply of driver assisting technology that brakes automatically for obstacles or parks the car will be further developed. Self-driving cars may be short-term everyday reality, with Google pulling the cart. Lastly, Gen Y is argued to focus on services rather than ownership. The emergence and success of car sharing by Zipcar or Cambio illustrates this shift in mentality for the automotive industry. 1. 2 The isolating mechanisms The electric car is strongly based on the century old inventions of Serbian engineer Nikola Tesla. We nevertheless argue that the electric car is a text book disruptive technology. This technology, spearheaded by Tesla, will herewith potentially overturn the automotive industry, challenging the 12 incumbents. The early-mover advantage in this creative destruction may enable Tesla to sustain its competitive advantage. The disruptive technology concept is extensively reviewed in the of literature. We apply the framework to the Tesla case. First, the environmental movement and increasing fuel prices created momentum for alternatives of the traditional combustion engine. Both incumbent car manufacturers and many start-ups invested in research. The hydrogen car made the press as a promising technology, but proved little feasible. Eventually the electric car showed market-viable. Many innovators inter alia Fisker, failed. However, as statistics dictate tech start-up Tesla got ahead in the race at the expense of dominant car manufacturers. The 2400 Tesla Roadsters produced, sales manifestly unattractive   toincumbents, were a great success and learning opportunity for the start-up. The Tesla Model S unprecedented battery range no longer forces consumers to trade off fuel efficiency for convenience. Herewith it can shift from niche product for wealthy eco-hipsters to head on competition for the traditional luxury sedan. The Model S proves superior to its competition threefold. First, the position of the battery pack lowers the gravity centre of the car for superior handling (and creates a spacious trunk in the back and front). The electric engine also delivers instant torque, further allowing sporty driving. Furthermore, the Model S was granted a record safety score of 5,4 out of 5. Lastly, electric engines are maintenance free. Note that the electric car still offers greater potential for technological progress than the more tried and tested combustion engine. The incumbent firms are wary of this potential shift to electric for the automotive industry, note the growing number of electric cars offered. However, extensively studied, the difference in investment dynamics with nimble start-ups impedes them to appropriately and successfully commit to the disruptive technology. The sunk cost and replacement effect are strong in this case. Therefore, it is Tesla that has a head start, with Daimler and Toyota asking the new kid on the block for help. The early-mover advantage of Tesla will sustain its competitive advantage threefold. First, we consider the economies of the learning curve. The first car manufacturer to fully grasp the paradigm shift Tesla benefits hereby manifold. The design-from-scratch approach is inevitable to exploit the electric car technology to the full. The Model S is a thus a step ahead of the build-on competitors, quickly adding to Tesla’s experience with every unit sold. Furthermore, the superior battery packs are en route to continue to offer greater range and faster charging at a lower unit cost. Note that Tesla supplies its electric powertrain to Toyota and Daimler, further adding to its cumulative experience. Moreover, the strong experience gained is further protected from imitation through multiple patents. The literature further arguments the reputation for quality to be an important source of early-mover advantage for experience goods. Thus, the brand image of an electric car brand may be considered important, notwithstanding the ubiquitous possibilities for test drives. Tesla has a rock solid reputation 13 for quality, though much like Apple it has irrational haters22. To illustrate, the Tesla recall threat due to 3 car fires was resolved by an overnight software update that would slightly raise the Model S when driving on the highway. The Tesla stock price had a field day23. Furthermore, the Model S production cannot keep up with sales. Herewith, Tesla doesn’t spend a dollar on marketing. Thirdly, Tesla benefits from network effects to sustain its competitive advantage. Tesla heavily invests in the supercharger network, that quickly expanding adds to the convenience of driving an electric car station by station. For competitors it is meanwhile.