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AP and Other Stories Summary and Analysis of A P, Part 1. This story is narrated by Sammy, a young cashier at cycle, the supermarket A P. One day, three girls in essay best 80s music bathing suits stop in to buy some snacks. Sammy is family life cycle, immediately struck by a “chunky” (596) girl with a “sweet broad soft-looking can.” He is cheap write my essay ethical in multicultural, so attracted to her that he accidentally rings up a box of crackers twice, provoking the ire of the middle-aged customer who was trying to buy them. By the time Sammy calms down the irate customer, the girls are making their way towards an aisle close to his checkout slot. He notices that the girls are barefoot. None of them are particularly beautiful; he characterizes the first as chunky and “pale” and the second as “the kind of essay family life, girl that other girls think is very ‘striking’ and ‘attractive’ but never quite makes it.” However, he quickly identifies the third as their leader, noticing that she walks slightly ahead of her friends and do my energy effulgence, almost seems to be showing them how to command attention. On The Family Life! He infers that it was her idea to come to A P in the first place. He calls her the queen or, later, Queenie. Sammy notices that the straps of the help cant do my energy queen’s bathing suit have slipped off her shoulders, so there is no clothing between the top of the family life bathing suit and the top of her head.

He is in best 80s music awe of her beauty, and marvels that only an extraordinarily pretty girl could get away with walking into a grocery store with her straps down. He continues to stare at her physical features, including her long neck and her oaky hair. The other people in the store are shocked by on the cycle, the girls’ skimpy attire, as well as the fact that they are walking “against the usual traffic” (597) down the aisles. Sammy criticizes these “sheep” for looking askance at the girls but also being attracted to them. He speculates that “you could set off dynamite” (598) in an A P and the shoppers would still go about and effects warming essay, their business as usual. Nevertheless, they do seem a bit “jiggled,” with some women even turning around to look at the girls again, as if they cannot believe their eyes.

Only ten years before John Updike published “A P,” his New Yorker colleague J.D. Salinger rocked the literary establishment with his first novel, The Catcher in the Rye . There are striking similarities between Holden Caulfield, the main character of Salinger’s novel, and Updike’s narrator Sammy. Essay Family Cycle! Both hold a deep-seated contempt for cant do my efficient effulgence, authority and hypocrisy. But while Salinger’s hero is essay on the family life cycle, so self-absorbed that we never get an objective perspective on his world, Sammy is sharply perceptive, offering insights about human nature and society at large. The main action of “A P” unfolds not in the grocery store but in help essay energy Sammy’s mind.

It is not a chronicle of his ordinary day at work, but rather of his rejection of bourgeois conformity. Some critics trace Sammy’s heritage not to essay life cycle, Holden Caulfield but to cheap write ethical dilemmas, Ralph Waldo Emerson, who advocated for on the, non-conformity and moral self-reliance (Porter 1155). On Corruption D3 Xpac! In the early pages of family life, “A P,” Sammy establishes his contempt for conformity and consumerism, insinuating that the people who shop at A P are “sheep” (597) who can never be roused out of their daily routines. Do My Essay Efficient Effulgence! This critique is cemented by essay life, his detailed description of the store. Sammy locates himself “between the checkouts and the Special bins” (596) and essay best, describes the girls going up “the cat-and-dog-food-breakfast-cereal-macaroni-rice-raisins-seasonings-spreads-spaghetti-soft-drinks-crackers-and-cookies aisle” (597). This careful delineation of the story’s space suggests an underlying concern for realism despite Sammy’s lighthearted rhetorical style, which often relies on caricature. Sammy’s list of grocery items in the aisle is essay on the family, humorous, but it also indicates a deep sense of unease with the rampant consumerism in American culture. None of the foods Sammy lists are nutritious. They are all snack foods or condiments—or in the case of the pet foods, not for human consumption at all.

Rather than a necessity for survival, Updike portrays grocery shopping as a lavish exercise in self-indulgence. Essay! By buying so many unnecessary items, he suggests that people abstract themselves from their physical existence as human beings. Sammy’s sexual desire for the girls initially seems to be an antidote to this deadening consumerism. If the other shoppers have, in conforming, sacrificed their humanity, then the girls’ rebellion against social norms seems to be a refreshing dose of human vitality. This interpretation is essay family life, reinforced by their nakedness; by forgoing regular clothing and the conformity that comes with it, they embrace their fundamental human nature, and the beauty of this spectacle is stunning to simple essay, all who witness it. However, there is an on the life, alternate interpretation of the essay on corruption girls’ nudity. They are consumers just as much as the older shoppers are, and like those shoppers, they embrace unhealthy foods, looking at cookies before finally deciding to buy the herring snacks. They are conformists in their own way, with the queen leading the family life cycle other two girls who timidly “peek around [the queen’s body] and [hunch] over a little” (597). Buy College Keyboard! Although he knows nothing of essay family life cycle, their personalities and concedes that two of the girls are unattractive, Sammy still lusts after them. His sexual desire, then, is just as greedy and overindulgent as the shoppers’ desire for snack foods. Over the course of his career, Updike has sometimes been accused of essay best, misogyny (Shapiro, Roiphe).

Based on his descriptions of the essay women in the story, Sammy certainly seems to have a misogynist worldview. He insinuates that the young girls are catty exhibitionists, but the brunt of his contempt is reserved for older women. These middle-aged housewives, he suggests, are the engines of American consumerism, and he consistently belittles them, describing them as “houseslaves in pin curlers” (598). His account of the middle-aged woman at the beginning of and effects, “A P” is dehumanizing; he calls her a witch and on the cycle, compares her to a bird, calming her down by “[getting] her feathers smoothed and her goodies into a bag” (596). Essay On Corruption! Although the character’s outlook should not necessarily be extended to essay on the life, Updike himself, there are certainly grounds to criticize his treatment of women. How To Cite http://www.gradesaver.com/a-and-p-and-other-stories/study-guide/summary-a-and-p-part-1 in MLA Format. Study Guide Navigation About AP and Other Stories AP and Other Stories Summary Character List Glossary Themes Quotes and Analysis Summary And Analysis Ace in the Hole A P, Part 1 A P, Part 2 A P, Part 3 Pigeon Feathers Separating Short Easter Consumerism and the Cold War Related Links Essay Questions Quizzes - Test Yourself! Quiz 1 Quiz 2 Quiz 3 Quiz 4 Citations Related Content Study Guide Essays Q A Mini-Store John Updike Biography.

AP and cheap my essay in multicultural counselling, Other Stories Questions and Answers. The Question and Answer section for AP and Other Stories is essay on the life, a great resource to ask questions, find answers, and discuss the novel. Sammy is a nineteen-year-old cashier at the A P, a large supermarket chain. He narrates a day at the store, complaining about customers who are mean or behave like sheep. He is critical of the commercialism of modern culture.

Three. Warming Essay! Sammy thinks he experiences an epiphany for the rights of these girls but his decision to quit his job is really driven by essay family, teen angst and sexual attraction. Check out this GradeSaver link below: Study Guide for AP and Other Stories. AP and d3 xpac, Other Stories study guide contains a biography of John Updike, literature essays, quiz questions, major themes, characters, and a full summary and analysis. AP and Other Stories essays are academic essays for citation.

These papers were written primarily by students and provide critical analysis of essay on the life, AP and other short stories by John Updike.

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Pediatric Extracorporeal Membrane Oxygenation. The term extracorporeal membrane oxygenation (ECMO) was initially used to describe long-term extracorporeal support that focused on the function of oxygenation. Subsequently, in some patients, the emphasis shifted to carbon dioxide removal, and family life, the term extracorporeal carbon dioxide removal was coined. Extracorporeal support was later used for postoperative support in patients following cardiac surgery. Essay. [1] Other variations of its capabilities have been tested and used over essay family cycle, the last few years, making it an important tool in the armamentarium of life and organ support measures for clinicians. With all of on corruption d3 xpac, these uses for extracorporeal circuitry, a new term, extracorporeal life support (ECLS), has come into vogue to describe this technology.

See Acute Respiratory Distress Syndrome: A Complex Clinical Condition, a Critical Images slideshow, for more information on this life-threatening condition characterized by acute respiratory failure, hypoxemia, and pulmonary edema. The differences between ECMO and essay on the family cycle, cardiopulmonary bypass are as follows: A diagram of extracorporeal membrane oxygenation is shown below. In May 1953, Gibbon used artificial oxygenation and essay effulgence, perfusion support for the first successful open heart operation. [2] In 1954, Lillehei developed the cross-circulation technique by using slightly anesthetized adult volunteers as live cardiopulmonary bypass apparatuses during the essay on the life repair of certain congenital cardiac disorders. [3] In 1955, at the Mayo Clinic, Kirklin et al improved on Gibbon's device and successfully repaired an atrial septal defect. [4] In 1965, Rashkind and coworkers were the first to use a bubble oxygenator as support in a neonate dying of respiratory failure. Essay D3 Xpac. [5] In 1969, Dorson and colleagues reported the on the family life use of a membrane oxygenator for cardiopulmonary bypass in cheap write ethical dilemmas, infants. [6] In 1970, Baffes et al reported the successful use of extracorporeal membrane oxygenation as support in family, infants with congenital heart defects who were undergoing cardiac surgery. [7] In 1975, Bartlett et al were the first to successfully use ECMO in neonates with severe respiratory distress. [8] Patients with the term paper following 2 major neonatal diagnoses require the use of ECMO: Selection criteria for neonates include the following:

Failure to meet these criteria is a relative contraindication for essay life ECMO. Qualifying patient criteria for ECMO are applied only cause of global, when the infant has reached maximal ventilatory support of 100% oxygen (fraction of inspired oxygen [FiO 2 ] equals 1) with peak inspiratory pressures (PIP) often as high as 35 cm water. They include the alveolar-arterial gradient, the oxygenation index, and acute deterioration. The alveolar-arterial (A-a) gradient of 600-624 mm Hg for 4-12 hours at sea level may be computed as follows (where 47=partial pressure of water vapor): The oxygenation index (OI) greater than 40 in 3 of 5 postductal gas determinations obtained 30-60 minutes apart may be computed as follows (where MAP is mean airway pressure): Acute deterioration may be computed as follows: Pediatric ECMO is indicated or considered in the following situations: Today, other indications or less strict selection of patients in certain institutions have made the life use of this technology more diverse, not only in acute cardiac problems but also in primary pulmonary diseases. [9, 10, 11, 12, 13, 14] The failure to meet selection criteria discussed in Indications for Extracorporeal Membrane Oxygenation, above, is essay a relative contraindication for ECMO. Unlike the situation in neonates, when ECMO is considered in a pediatric patient, no clear set of inclusion or exclusion criteria exists.

Evaluation of on the, a pediatric patient for essay ECMO support is largely based on an assessment of the patient's condition and the institutional experience with pediatric ECMO. The extracorporeal membrane oxygenation (ECMO) apparatus consists of a blood pump with raceway tubing, a venous reservoir, a membrane oxygenator, and essay, a countercurrent heat exchanger, as shown in simple environment, the image below. The blood pump is either a simple roller pump (most common) or a constrained vortex centrifugal pump. The roller pump causes less hemolysis and is used for neonatal ECMO. The venous reservoir is used with the roller pump for neonatal ECMO. The oxygenator is responsible for essay family cycle exchanging both oxygen and carbon dioxide and is central to the successful performance of prolonged ECMO. My Essay Counselling. Three types of on the life cycle, commercial artificial lungs are available: bubble, membrane, and cause and effects of global warming, hollow-fiber devices.

The heat exchanger warms the blood using a countercurrent mechanism. Blood is exposed to life cycle warm water that circulates within metal tubing. Air bubble detectors can identify microscopic air bubbles in the arterialized blood and help cant effulgence, automatically turn off the blood pump. Arterial line filters between the essay on the life heat exchanger and the arterial cannula are used to trap air, thrombi, and other emboli. Pressure monitors, which are placed before and after the oxygenator, measure the help do my energy effulgence pressure of the circulating blood and are used to on the life cycle monitor for help efficient effulgence a dangerous rise in circuit pressure. This can occur with thrombosis of the oxygenator or occlusion of the tubing or cannulae.

Pressure monitors are critical in preventing circuit disruption in the face of distal occlusion. A continuous venous oxygen saturation monitor and temperature monitor are other important safety features. The extracorporeal membrane oxygenation (ECMO) circuit is primed with the freshest blood available. The acid-base balance and family cycle, blood gas of the primer are adjusted appropriately. Differences between venoarterial ECMO and venovenous ECMO are presented below (also see the Table). The standard ECMO procedure used in most neonatal ICUs is venoarterial bypass. In this situation, a cannula is placed through the right jugular vein into the right atrium. Best. Blood is drained to a venous reservoir located 3-4 feet below heart level. The blood is actively pumped by a roller pump through the family life cycle oxygenator, where gas exchange occurs via countercurrent flow of blood and gas. Next, the cheap write dilemmas in multicultural counselling blood is warmed to body temperature by the heat exchanger before returning to the patient through a cannula placed through the right carotid artery into the aortic arch.

Systemic anticoagulation therapy with heparin is administered throughout the bypass circuit, with frequent monitoring of activated clotting time (ACT), which should be maintained at 180-240 seconds. In venovenous bypass, a double-lumen cannula is family life placed through the right jugular vein into essay on corruption d3 xpac, the right atrium. Desaturated blood is withdrawn from the essay life cycle right atrium through the outer fenestrated venous catheter wall, and help do my energy efficient, oxygenated blood is returned through the inner lumen of the catheter and is angled to essay family cycle direct blood across the tricuspid valve. Table. Differences Between Venoarterial and of global warming essay, Venovenous Extracorporeal Membrane Oxygenation (Open Table in a new window) In certain patients with cardiac or respiratory failure who have recently undergone cardiac surgery, transthoracic cannulation of the right atrial appendage and on the family, the aortic arch can be used as an alternative to neck cannulation. Transthoracic cannulation allows left heart decompression by cannulation of the left atrium. Best. This is useful in patients with primary left heart failure.

ECMO is used temporarily while awaiting pulmonary recovery. In the classic use of neonatal ECMO, the typical ventilator settings are FiO 2 of essay on the cycle, 21-30%, peak inspiratory pressure (PIP) of 15-25 cm H 2 O, a positive end-expiratory pressure (PEEP) of 3-5 cm H 2 O, and cause and effects of global warming essay, intermittent mechanical ventilation (IMV) of 10-20 breaths per minute. Family Cycle. In some centers, a high PEEP of 12-14 cm water has been used to avoid atelectasis; this has been found to shorten the bypass time in infants. Pulmonary hygiene is strict and requires frequent positional changes, endotracheal suctioning every 4 hours depending on cheap write my essay ethical counselling, secretions, and a daily chest radiograph. Systemic perfusion and intravascular volume should be maintained.

Volume status can be assessed clinically by urine output and physical signs of perfusion and by measuring the central venous pressure and the mean arterial blood pressure. Native cardiac output can be enhanced with inotropic agents. Echocardiography should be performed to exclude any major congenital heart anomaly that may require immediate intervention other than ECMO (eg, obstructed total anomalous pulmonary venous connection). Central nervous system complications are the essay life cycle most serious and are primarily related to the degree of hypoxia and acidosis. Avoiding paralytic agents and performing regular neurologic examinations are recommended. If feasible, head ultrasonography should be performed before beginning ECMO in a neonate. Reevaluation with serial head ultrasonography may be needed on of global, a daily basis, especially after any major event. In patients with seizures or suspected seizures, aggressive treatment is recommended (eg, phenobarbital). During the essay on the family cycle first 24-48 hours on ECMO, oliguria and acute tubular necrosis associated with capillary leak and intravascular volume depletion are common because ECMO triggers an essay best, acute inflammatory-like reaction.

The diuretic phase, which usually begins within 48 hours, is often one of the earliest signs of recovery. If oliguria persists for 48-72 hours, diuretics are often required to reduce edema. When renal failure does not improve, hemofiltration or hemodialysis filters may be added to the circuit. To optimize oxygen delivery, the patient's hemoglobin should be maintained at 12-15 g/dL using packed RBCs (pRBCs). As a result of platelet consumption during ECMO, platelet transfusions are required to maintain platelet counts above 100,000/mcL. Activated clotting time (ACT) should be maintained at 180-240 seconds to avoid bleeding complications. The Extracorporeal Life Support Organization has published guidelines on anticoagulation therapy for patients receiving ECMO. [15] Strict aseptic precautions are required. [16] The presence of infection is monitored by obtaining cultures from the family life circuit at least once a week.

Based on cheap write my essay in multicultural counselling, institutional experience, the protocol frequency may vary. Other appropriate cultures (eg, fungal and essay family, viral) should be obtained as needed. Fluids, Electrolytes, and keyboard, Nutrition. Patients on on the family life, ECMO require close monitoring of cheap write my essay ethical in multicultural, fluids and electrolytes. The high-energy requirements should be met using hyperalimentation techniques. The patient's weight increases in the first 1-3 days on on the family, ECMO because of fluid retention. Clots in the circuit are the most common mechanical complication (19%). Major clots can cause oxygenator failure, consumption coagulopathy, and pulmonary or systemic emboli.

More recently, heparin-coated extracorporeal membrane oxygenation (ECMO) systems have been used to decrease the frequency of this complication. Cannula placement can cause damage to the internal jugular vein, which causes massive mediastinal bleeding. Dissection of the carotid arterial intima can lead to lethal aortic dissection. Air in the circuit can range from a few bubbles to best a complete venous air lock. This air can originate in the dislodgement of the venous cannula, a small tear in the membrane, or high partial pressure of oxygen in the blood. A large bolus of air can be fatal. Oxygenator failure is defined either as decreased oxygen or carbon dioxide transfer or as the life presence of consumptive coagulopathy. A failing membrane should be replaced immediately.

Cracks in the connectors and tube rupture have become less serious problems since the introduction of simple essay, Tygon raceway tubing. Pump malfunction may be a manifestation of inadequate venous return to essay life cycle the pump; heat exchanger malfunction can cause severe hypothermia. Failure of the entire circuit, including the oxygen source and oxygen blenders, may occur, as may failure of circuit-monitoring equipment. In cases of circuit failure, immediately clamp the venous line, open the bridge, and cheap in multicultural, clamp the essay on the family cycle arterial line to remove the buy college patient from the ECMO. Because the patient is ventilator dependent, immediately bag the patient with 100% oxygen (FiO 2 =1) or shift the patient back to pre-ECMO ventilator settings. Neurologic complications include seizures. Intracranial bleeds and on the life, infarction may be due to help essay effulgence ligation of the carotid artery and internal jugular vein, systemic heparinization, thrombocytopenia, coagulopathies, or systolic hypertension.

Hemorrhagic complications include hemorrhages and a decreased platelet count. Hemolysis and consumption coagulopathy may occur. Hemorrhage at the surgical site, at the cannula site, or into the site of a previous invasive procedure is essay cycle a frequent complication because of systemic heparinization. Intrathoracic, abdominal, or retroperitoneal hemorrhage may also occur. Decreases in the platelet count occur because of decreased production, increased consumption, sequestration, or dilution. Cardiac complications include myocardial stun, which is defined as a decrease in the left ventricular shortening fraction by more than 25% with initiation of cause and effects of global, ECMO that returns to normal after 48 hours of ECMO. In addition, hypertension is on the family cycle a dangerous complication because of the risk of hemorrhage and stroke. On Corruption D3 Xpac. Arrhythmia may occur as a result of essay family life, hypoxia and electrolyte imbalance. Symptomatic patent ductus arteriosus may occur, as well as pericardial tamponade may occur. Pneumothorax is a potential pulmonary complication, along with pulmonary hemorrhage. Oliguria is a commonly observed renal complication during the early part of ECMO; acute tubular necrosis is and effects of global warming observed in some patients and may require hemofiltration and dialysis.

A study by Zwiers et al indicated that neonates who suffer acute kidney injury in essay life cycle, association with ECMO are at increased risk for developing chronic kidney disease (CKD) and/or hypertension. In the study, 169 patients who had undergone neonatal ECMO were followed up for a median of 8.2 years. The investigators found at least one sign of CKD and/or hypertension in 54 (32%) of the buy college term paper keyboard participants, with a history of acute kidney injury being the only associated factor. The investigators also found, however, that most of the values related to chronic kidney disease (with regard to estimated glomerular filtration rate and urinary protein-to-creatinine ratio) were only marginally abnormal. [17] GI tract complications include hemorrhage, which may occur as a result of essay on the life cycle, stress, ischemia, or bleeding tendencies. Direct hyperbilirubinemia and biliary calculi may occur secondary to prolonged fasting and total parenteral nutrition (TPN), hemolysis, and diuretics.

Complications may also result from infection and sepsis, because the ECMO circuit represents a large intravascular foreign body, and my essay dilemmas counselling, frequent manipulation increases the risk of sepsis. Metabolic complications include the following: ECMO may alter serum concentration of drugs due to increased volume of distribution. Caution is essay on the family life cycle warranted when narrow therapeutic drugs are administered, and dose alterations may be necessary. Help Cant Do My Essay Effulgence. [18] Acute cardiorespiratory decompensation may result because of the following:

Weaning or Trial Period Without ECMO. In patients with a principal pre-ECMO diagnosis of essay on the family cycle, respiratory failure, a trial period without ECMO is scheduled if (1) the patient demonstrates adequate gas exchange and is on reasonable ventilatory settings and (2) the patient tolerates a pump flow of 10-20 mL/kg/min with the minimum of 200 mL/min. Variable weaning times are followed in best, patients on ECMO. In addition, the life cycle duration of treatment varies. Mortality and Morbidity Associated with ECMO. Mortality statistics of ECMO-treated patients have remained stable over the past decade. 80s Music. Predictors of death include the following: Barbaro et al investigated whether higher annual extracorporeal membrane oxygenation (ECMO) patient volume is associated with lower case-mix-adjusted hospital mortality rate. They retrospectively analyzed an international registry of essay cycle, ECMO support from 1989 to 2013.

The primary outcome was death before hospital discharge. From 1989 to 2013, 290 centers provided ECMO support to 56,222 patients (30,909 neonates, 14,725 children, and 10,588 adults). Across ECMO centers, annual ECMO mortality rates varied widely. The interquartile range was 18-50% for neonates, 25-66% for pediatrics, and 33-92% for adults. For 1989-2013, higher age group-specific ECMO volume was associated with lower odds of ECMO mortality for neonates and adults. In 2008-2013, the volume-outcome association remained statistically significant only among adults. [19] Infants who survive following ECMO have a higher rate of rehospitalization for nonpulmonary and surgical conditions. Approximately 15% of infants still require oxygen at and effects warming, 28 days after ECMO. These children have a higher rate of on the, rehospitalization for cheap my essay in multicultural pulmonary indications, particularly in the first 6 months after ECMO, and essay family life, have a slightly higher prevalence of cheap, bronchial asthma.

Difficulty in establishing full oral feeding is essay life cycle common after ECMO decannulation; feeding difficulty is reported in as many as one third of babies, even in the presence of normal suck and swallow reflexes. Somatic growth is normal in essay, infants who survive following ECMO, and essay life cycle, poor growth should be evaluated for another underlying cause. Both clinical and buy college keyboard, electroencephalographic seizure activity is reported in 20-70% of family life cycle, neonates while on ECMO. Epilepsy is warming reported in on the family cycle, 2% of patients at age 5 years. The rate of sensorineural disabilities in infants who survive following ECMO averages 6% (range, 2-18%); developmental delay occurs in 9% (range, 0-21%). Abnormal brainstem auditory-evoked response (BAER) with mild-to-moderate threshold elevation is buy college seen in 25% of essay on the life cycle, children following ECMO at discharge.

This condition usually resolves. Sensorineural hearing loss is documented after age 1 year in 80s music, 9% (range, 4-21%) of children following ECMO. Routine ophthalmic examinations during ECMO are not recommended because studies in term babies have not shown any occurrence of retinopathy. In the rare neonate with birth weight less than 2 kg in essay on the life cycle, whom ECMO is used, ophthalmic examination is essay best 80s music required prior to essay family discharge. Some degree of cortical visual impairment has been seen after posterior brain injury.

However, in the long term, visual function has been shown to essay improve. Psychosocial morbidity includes the increased frequency of social problems, academic difficulties at essay on the family cycle, school age, and higher rates of attention deficit disorder in children who received ECMO. In addition, the ECMO procedure is dramatic and highly invasive, and simple environment, families can feel isolated if no other patients are on ECMO in the same institution. At age 1 year, the stress level of the mother of an infant previously on ECMO is the essay same as the stress level in the family of a preterm infant. By age 5 years, the family stress level is the of global warming same as that of the family of a healthy child in on the life, whom ECMO was not used. Neuromotor deficits range from cant essay energy effulgence mild hypotonia to gross motor delay and spastic quadriparesis. Glass and colleagues compared the neurodevelopmental outcome of 103 neonates following ECMO and 37 neonates without ECMO at 5 age years [20] ; the mean full-scale, verbal, and performance intelligence quotient (IQ) scores of children who received ECMO treatment were within the normal range. As a group, however, the scores were significantly lower than in life cycle, children who had not had ECMO (96 vs 115). Major disability, which was defined as mental disability, motor disability, sensorineural impairment, or seizure disorder, was present in write ethical in multicultural counselling, 17 of children in essay on the, whom ECMO had been used.

Other studies have proven that the neurodevelopmental outcome of the ECMO cohort is comparable to other high-risk neonatal groups and similar to neonates with the same condition managed conventionally. Aminocaproic acid may be required to reduce bleeding during surgery. Only minimal sedation with fentanyl, midazolam, or morphine is required after stabilization. Doses of best, most inotropic medications, such as dopamine, dobutamine, and epinephrine, can usually be decreased once the cycle patient is on write my essay ethical dilemmas in multicultural counselling, extracorporeal membrane oxygenation (ECMO). Diuretics, such as furosemide (Lasix) and life cycle, chlorothiazide (Diuril), may be required for mobilization of tissue fluids. Essay On Corruption. Antacids and H2 antagonists are usually administered for GI tract bleeding.

Phenobarbital can be used if the patient has seizures. Antibiotics, such as ampicillin and cefotaxime, are used initially in on the life, the typical septicemic dosages; dosage modification may be needed, depending on the pathogen and sensitivity. The duration of cause warming, treatment will vary based on the initial diagnosis and the daily evaluation of the patient. It should be remembered that the longer the patient remains in this therapy, the more complications the patient may experience. Lowry AW, Morales DL, Graves DE, et al. Characterization of extracorporeal membrane oxygenation for pediatric cardiac arrest in the United States: analysis of the kids' inpatient database.

Pediatr Cardiol . 2013 Aug. 34(6):1422-30. [Medline]. Gibbon JH Jr. Application of a mechanical heart and on the family life cycle, lung apparatus to cardiac surgery. Minn Med . 1954 Mar. 37(3):171-85; passim. [Medline]. Lillehei CW. A personalized history of extracorporeal circulation. Trans Am Soc Artif Intern Organs . 1982. 28:5-16. [Medline]. Kirklin JW, Donald DE, Harshbarger HG, Hetzel PS, Patrick RT, Swan HJ.

Studies in extracorporeal circulation. I. Applicability of Gibbon-type pump-oxygenator to human intracardiac surgery: 40 cases. Ann Surg . 1956 Jul. 144(1):2-8. Essay Energy Effulgence. [Medline]. Rashkind WJ, Freeman A, Klein D, Toft RW. Evaluation of a disposable plastic, low volume, pumpless oxygenator as a lung substitute. J Pediatr . 1965 Jan. 66:94-102. [Medline]. Dorson W Jr, Baker E, Cohen ML, et al. A perfusion system for infants. Trans Am Soc Artif Intern Organs . 1969.

15:155-60. [Medline]. Baffes TG, Fridman JL, Bicoff JP, Whitehill JL. Extracorporeal circulation for on the family cycle support of palliative cardiac surgery in infants. Ann Thorac Surg . Cause And Effects Of Global Warming. 1970 Oct. 10(4):354-63. [Medline]. Bartlett RH, Gazzaniga AB, Jefferies MR, Huxtable RF, Haiduc NJ, Fong SW. Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in essay on the family, infancy. Trans Am Soc Artif Intern Organs . 1976. Essay 80s Music. 22:80-93. [Medline]. Smith IJ, Sidebotham DA, McGeorge AD, Dorman EB, Wilsher ML, Kolbe J. Use of extracorporeal membrane oxygenation during resection of tracheal papillomatosis.

Anesthesiology . 2009 Feb. 110(2):427-9. [Medline]. Segura S, Cambra FJ, Moreno J, et al. [ECMO: experience in paediatrics]. An Pediatr (Barc) . 2009 Jan. 70(1):12-9. [Medline]. Fisher JC, Stolar CJ, Cowles RA. Evaluating cannulation strategies used during second courses of extracorporeal membrane oxygenation in a large cohort of essay on the life cycle, pediatric patients. J Pediatr Surg . 2009 Jan. Help Do My Energy Efficient. 44(1):94-9. [Medline]. Lin YJ, Chung SY, Liang CD, et al.

Impact of on the cycle, extracorporeal membrane oxygenation support on clinical outcome of and effects of global essay, pediatric patients with acute cardiopulmonary failure: a single-center experience. Biomed J . 2013 Jan. 36(1):28-34. [Medline]. Salguero E, Gonzalez de Dios J, Garcia del Rio M, Sanchez Diaz F. [Controversies in the therapeutical management of congenital diaphragmatic hernia: update by means of evidence-based medicine]. Cir Pediatr . 2005 Oct. 18(4):170-81. [Medline]. Kattan J, Gonzalez A, Becker P, et al. Survival of newborn infants with severe respiratory failure before and after establishing an family life, extracorporeal membrane oxygenation program. Pediatr Crit Care Med . 2013 Nov. 14(9):876-83. [Medline]. [Guideline] ELSO Anticoagulation Guidelines 2014.

Extracorporeal Life Support Organization. Ethical In Multicultural Counselling. Available at http://elsonet.org/resources/guidelines. Accessed: Oct. 1, 2014. Brechot N, Luyt CE, Schmidt M, et al. Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock. Crit Care Med . 2013 Jul. 41(7):1616-26. [Medline].

Zwiers AJ, IJsselstijn H, van Rosmalen J, et al. CKD and hypertension during long-term follow-up in essay cycle, children and adolescents previously treated with extracorporeal membrane oxygenation. Buy College Paper Keyboard. Clin J Am Soc Nephrol . 2014 Dec 5. 9(12):2070-8. [Medline]. Shekar K, Roberts JA, Smith MT, Fung YL, Fraser JF. The ECMO PK Project: an incremental research approach to advance understanding of the pharmacokinetic alterations and improve patient outcomes during extracorporeal membrane oxygenation. BMC Anesthesiol . 2013 Mar 21. 13(1):7. Essay On The Cycle. [Medline]. Barbaro RP, Odetola FO, Kidwell KM, et al. Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality.

Analysis of the extracorporeal life support organization registry. Cause Of Global Essay. Am J Respir Crit Care Med . 2015 Apr 15. 191 (8):894-901. [Medline]. Glass P, Wagner AE, Papero PH, Rajasingham SR, Civitello LA, Kjaer MS. Neurodevelopmental status at age five years of neonates treated with extracorporeal membrane oxygenation. J Pediatr . 1995 Sep. 127(3):447-57. [Medline]. Contributor Information and Disclosures. Edwin Rodriguez-Cruz, MD Director, Section of essay on the family cycle, Cardiology, Department of Pediatrics, San Jorge Children’s Hospital, Puerto Rico; Private Practice in Interventional Pediatric Cardiology and pollution, Internal Medicine, Centro Pediatrico y Cardiovascular. Henry Walters, III, MD Associate Professor of Surgery, Wayne State University School of Medicine; Chief, Department of Surgery, Division of essay on the life, Cardiovascular Surgery, Children's Hospital of Michigan. Sanjeev Aggarwal, MD, MBBS Staff Physician, Department of Pediatrics, Children's Hospital of term, Michigan.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference. Mary C Mancini, MD, PhD, MMM Professor and Chief of Cardiothoracic Surgery, Department of Surgery, Louisiana State University School of Medicine in Shreveport. Stuart Berger, MD Medical Director of The Heart Center, Children's Hospital of Wisconsin; Associate Professor, Department of Pediatrics, Section of Pediatric Cardiology, Medical College of on the cycle, Wisconsin. Daniel S Schwartz, MD, FACS Medical Director of Thoracic Oncology, St Catherine of Siena Medical Center, Catholic Health Services.

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The Beauty Myth: How Images of essay on the family cycle, Beauty Are Used against Women essay. The Beauty Myth , written in 1991 by American writer, critic and political activist Naomi Wolf, became a bestseller and was regarded by The New York Times as one of the 20 th century most important books. One of the pioneers of the liberal feminism movement, Naomi Wolf described in the book her viewing of the women’s role in modern society and write in multicultural, how females are oppressed with beauty impositions in essay family the modern society. She expressed her ideas in six following sections: work, culture, religion, sex, hunger, and violence. Naomi Wolf exposes beauty myth as an organized political construct that is simple essay pollution originated by the man-dominated society in order to counteract the essay on the life cycle, feminist movement. Naomi Wolf claims that all the beauty standards that are vigorously promoted by the modern mass media and different fashion and body care industries are aimed to essay manipulate women’s consciousness by making them feel less-worth and by transferring their attention from the serious issues to the obsession with their physical appearance. It must be said that the book was written more than twenty years ago. Although lots of points implied in on the family life cycle the book are relevant to the current situation, many things have changed since 1991. Regarding this, the author may sometimes sound quite radical or uncompromising and some issues she exposes may seem to be inaccurate or a bit exaggerated. Women’s and men’s roles in the social and political life have always been classified. Since very childhood, girls and boys get general notions about behavior, clothing style and even occupation choice that are appropriate for do my essay efficient, their gender.

During the socialization period children also get ideas about the gender-based roles. They use their parents and surrounding as role models of the essay on the family life cycle, behavior they are expected to perform. The traditions and other social influences are a significant factor that directs which occupations and lifestyle may be chosen by representatives of each gender. For example, since the cheap ethical counselling, childhood boys are encouraged to study technology and take up different active sports when girls are cheered to essay on the family life cycle perform more passive activities like piano playing or studying literature. For a long time women have been referred to as the weak gender. It was related to their physical strength as well as to the intellectual capacities of women.

That is why they had limited access to cheap my essay dilemmas formal education and politics. Females were supposed to give birth to children and perform different house holding activities, while men were intended to do physically tough work. Such qualities as passivity and essay on the, domesticity were regarded as the most significant and honorable ones in any woman in the past. Women were also regarded to be more sensitive and emotionally vulnerable, that is why a man was regarded as a protector. The change of the general concept of a society led to the gender roles shifting. Best. During the last decades Western women exercise the life, same rights as men, specifically, they have a right to vote and to participate in politics. Women also get a possibility to try themselves in such fields as medicine, law, education and term keyboard, economics that were totally or partly inaccessible for them before. However, men are still viewed more powerful and strong and therefore more suitable to life cycle perform a role of a leader. Under scrutiny it appears that the vast majority of politicians and top managers are represented by males. It is mostly caused by the remnants of gender prejudices and essay best 80s music, stereotypes that were common for a men-dominated society.

Due to having more physical strength, man is believed to be an inborn leader, while woman is supposed to obey to him. It can be observed on different levels of society, for example, in a family unit or in essay family a governmental structure. In a modern Western society, family and best 80s music, house holding duties and responsibilities are usually shared by both partners and are not assigned only to a woman. But still, such routine and repetitive activities as cleaning, laundry, cooking are performed mostly by females. Women now take part in important decision making process and family problems are usually solved in a way of finding a consensus and taking into consideration both partners’ points of view. Men participate more in the process of essay life, children breeding, though women take the keyboard, largest part of on the, responsibilities related to child care. Emancipation and industrialization brought to women more opportunities. Nevertheless, Naomi Wolf claims that despite equal professional opportunities, women still do not feel free nowadays because of the beauty impositions and different kinds of prejudices concerning female gender. Of Global. Such impositions are a great challenge to the woman’s personal development and professional recognition.

It cannot be denied that every woman in the working or political world is judged not only by her qualifications, work skills and professional competence, but also by her physical appearance. Beautiful women may not be perceived seriously, while women that are regarded unattractive may be discriminated. Besides, pretty women are more likely to family life be sexually harassed in their workplace, and cause, are often seen not as victims but as provocateurs. In spite of the fact that today women are protected by law against any kind of essay on the family life cycle, discrimination that is based on a gender factor or physical appearance, different gender-based constructs may become serious obstacles for females. According to Naomi Wolf, after the female liberation movement had demolished traditional notions about the family unit and especially women’s role in the society, new requirements that demanded high standards of physical appearance were imposed on women. Recently, beauty impositions have replaced convictions related to domesticity, motherhood and passivity. And the image of an term paper, ideal housewife was replaced by the image of a skinny beauty queen.

Beauty myth incorporates inevitably into everyday life as endlessly produced “beautiful” images of how really beautiful women should look may be seen in advertisements, films and magazines. The author believes that such vigorous beauty propaganda is a reaction of man-dominated society on the feminist movement as it threatened to essay family cycle destabilize the institutions on which the patriarchal society was based. She says that all these impositions are used as an 80s music, effective device of women’s consciousness manipulation by making females obsessed with their physical appearance and preventing them from taking part in the social and political life of the country. She regards a beauty myth as a “newly invented” gender-based form of oppression and life cycle, refers it to the unrealistic and unnatural beauty standards that are imposed on women nowadays. Naomi Wolf states that Western women became obsessed with their physical appearance, age and of global essay, clothes under the pressure of the mass media, which dictates to women since their childhood how they should look. It is hard to disagree with the point that the abundance of such images may affect badly women’s self-esteem and essay on the cycle, distorts the women’s perception of themselves. Many women are prone to comparing themselves with the cheap write my essay ethical dilemmas in multicultural counselling, images of top models they see on the screen or in essay on the the magazines. As a result, females may feel depressed and less worth as they believe they are unbeautiful or different because their bodies and skin are not so perfect. She also claims that beauty myth purposes to divide women and break links between generations by making them compete with each other. Sex propaganda and term paper keyboard, using women sexuality as an effective marketing technique are other issues described in the book.

Images of pretty slim-figured girls are widely used in the advertising industry and mass media in order to strike attention of the audience. Family Life Cycle. It also motivates women to buy things via making them feel unbeautiful and outmoded and therefore forcing them to essay on corruption buy cosmetic products and fashion items that would improve their look. Life Cycle. Women are also persuaded by on corruption, the advertisements that beauty is a key to family life good life and essay environment pollution, success. Females, especially the ones that suffer from lack of confidence and low self-esteem, are prone to on the succumb to essay best 80s music such type of message and believe they may change their whole life just by changing their appearance. We can observe how the revaluation of the women’s role in the society caused the transformation of the advertisement concepts. When a woman dedicated herself to the house holding activities and was mostly regarded as a housewife, industries were oriented on life cycle the producing and promoting different items for house management. Right after women got equal rights with men and various possibilities to approve themselves in different professional domains, companies and advertisements started promoting different beauty products and services. Thanks to beauty myth propaganda, numerous cosmetic companies, fashion industries, surgery clinics, and other beauty services and companies are making million-dollar business.

Naomi Wolf rejects the gender-based belief about the male polygamy and female monogamy by using Darwin’s and other scientists’ investigations. She mentions some matriarchal Goddess religions where women were leaders, held all the paper, political and essay on the, economic power and essay on corruption, used to have more than one partner. The convictions about the female monogamy originated from the fact that female are more prone than men to building a strong emotional bond with one partner. The author also rejects the idea of modern society system that is based on the sexual selection. Still, it is difficult to object the on the cycle, fact that physical appearance and of global warming essay, age counts more for essay on the family, women than for man.

In the cant do my efficient effulgence, modern society men are mostly judged by their financial status and professional achievements, while women are evaluated by their beauty. That is life cycle why couples where a girl is much younger than a man are quite common for our society. In the help do my essay efficient, chapter about hunger Naomi Wolf describes the adverse effects that the beauty obsession may have on women’s health. Apart from psychological disorders, it may also cause physical problems. Needless to say, in an ill-inspired attempt to have a perfect look, many women resort to such radical actions as surgery and diets that are harmful to their health and result in eating disorders, fear of gaining weight, and anorexic and family, bulimic conditions. “Terror of aging” has become one more popular tendency in the advertising and cosmetic production industry. Consequently, many women have started being afraid of aging as they are convinced that becoming elder they are less attractive. Under pressure of propaganda of eternal youth women come to different methods like surgery, cosmetic products in order to buy college prevent natural process of aging. It must be said that young generation is the essay life, most vulnerable category of population as their consciousness is not stable yet, that is why young girls are prone to exurb all the information they get from essay, mass media. It is on the family well-known that teenage girls usually suffer from low self-esteem and lack of buy college, confidence during the period of transition from a little girl to a woman.

At this age their bodies are transforming and they need time to get used to it. Young girls often challenge themselves with different diets in order to lose weight and on the cycle, become as slim as girls from the TV advertisements. It often results in anorexic and best 80s music, bulimic conditions, which may have serious consequences for on the cycle, any girl’s health in general and for her future fertility abilities in particular. In The Beauty Myth Naomi Wolf is trying to best 80s music prove that today’s beauty standards are just culturally imposed physical standards that have neither historical nor biological background. Wolf’s rejection of the idea of essay family cycle, universal and changeless beauty concept is quite reasonable. Write My Essay Dilemmas In Multicultural. There are numerous evidences that beauty standards have changed throughout the centuries so that the notions about beauty and ugliness differ due to various nations or tribes. The author reasonably compares beauty to the currency system. It fluctuates similarly to changing patterns of the gold standard, which depends on different political and essay family life, economical factors. The author compares modern beauty impositions with medieval German device of torture called Iron Maiden to demonstrate how all these beauty concepts and impositions are used nowadays to immobilize women.

She claims that modern women are forced out to keep to the unique requirements of how to look and what to wear regardless their physical peculiarities and personal preferences. However, it must be said that nowadays the write ethical, new concept of natural beauty is promoted that persuade women to love them as they are. Besides, there exist different styles of outfits and looks which are oriented on different types of women. Modern women have more freedom in choosing which clothes or hairstyle to wear regarding their physical appearance peculiarities and their tastes. To conclude, gender-based roles became more flexible during the essay on the cycle, last decades.

Consequently, women got more opportunities to participate actively in the social and political life of of global, society. However, Naomi Wolf believes that all that feminism brought to women is now challenged by the new concept of beauty myth. In spite of proclaimed equal rights and recognition of the women’s intelligence and power, females are subject to rising beauty demands. According to essay on the life cycle the author, the beauty myth was generated by the men-dominated society in order to weaken females physically and mentally and to reduce their participation in the political and economical world. Although the beauty myth existed in the society before, the one that is ethical counselling promoted in modern time is much more powerful and frustrating. Family. The idea that all these beauty impositions have created some kind of buy college, pressure on women in modern society is sound, however, it is on the debatable whether it is a well-organized and intentional political construct aimed to essay immobilize women or not.

Wolf’s anger is directed against companies and industries that are promoting feminine insecurity, which is fair and essay on the family cycle, understandable given the fact that beauty obsession may have some adverse effects for both mental and my essay ethical dilemmas in multicultural counselling, psychological health.

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7 Keys to Success in the BHPH Business. Essay On The Family. Whether you are a dealer currently in the BHPH business or are just exploring the idea of getting into the BHPH business, there are seven keys to BHPH which will provide a great roadmap for success. Successful BHPH dealers have a clear understanding of the essay, amount of capital required to operate and sustain their businesses. A formal cash flow projection based on your specific business model is one of the most important steps to family life take in identifying your capital requirements. Industry statistics provided by Tom Webb of Manheim Consulting this past May showed that the year-over-year auction price of simple essay environment pollution compact cars had increased 17.7 percent and mid-size cars had increased 13.3 percent during the same period.

Webb also demonstrated that the average mileage on auction vehicles has increased substantially in the past few years, contributing to increased reconditioning expense. Based on essay family life an average acquisition cost of $5,000 with an average increase of 15.5 percent ($775) combined with an increased reconditioning cost of $200 per buy college term keyboard, vehicle, and a sales rate of 20 vehicles per month, the additional capital required annually to sustain your BHPH business would be $234,000. Did you factor the additional capital into your cash flow projection? Do you have access to the additional capital required? Access to capital is one thing; qualifying for the capital you may require is on the family, another. Cheap My Essay Ethical Dilemmas Counselling. Most companies providing capital to BHPH dealers will require that you substantiate your historical business performance in a number of key areas in order to essay on the family life qualify for capital. In most cases, the single largest expense in operating a BHPH business is the cost of vehicle inventory.

To further complicate this matter, sluggish new car sales (meaning fewer trade-ins) combined with the negative impact from the Cash for Clunkers program have made acquiring inventory one of the biggest challenges. Essay. The most successful BHPH dealers have a wide range of resources from which to acquire inventory. The largest and essay on the family life most obvious sources of inventory are wholesale auctions. Find auctions where the vehicles available for sale fit the acquisition cost of your business model. Another viable option for sourcing inventory is to help do my energy efficient effulgence develop a network of new-car dealers in your area who will agree to sell you the essay cycle, trade-ins they don’t want. These relationships take time to develop, and help essay you will have to buy junk cars along with the family cycle, vehicles you really want if you’re going to have any success with this plan. More and more BHPH dealers are reporting great success in buying vehicles from private sellers.

One of the keys to success for this plan is to simple essay environment pollution advertise boldly and prominently that you buy vehicles from the public. Finally, considering the increased cost to acquire inventory, many dealers are charging off repossessed vehicles, assigning realistic cash values, and on the life cycle reconditioning and reselling the vehicle. 3. Deal Structure. One of the most important fundamental concepts to simple essay environment understand about the BHPH business is that it is the on the life cycle, finance business, not the car business. Help Essay Energy Efficient. Although delinquency and charge-offs are facts of life in the BHPH business, successful dealers understand that it is their responsibility to make the customer successful in paying off the loan.

The degree to essay life cycle which a dealer can successfully combine the key components of deal structure (vehicle selection, down payment, weekly payment and loan term) will increase the odds of a customer successfully paying off the loan. In addition, calculating the applicant’s net-income-to-payment ratio to cause warming determine whether the customer can afford the loan payment will likely do more to increase the essay family life cycle, odds of paper successful payment of the loan than almost anything else. Finally, the customer and the customer’s down payment should be viewed separately in assessing a loan application. The temptation is to let a strong down payment drive the loan approval decision. However, loan approvals based solely on down payment are simply charge-offs waiting to happen. Essay On The Life Cycle. The objective of underwriting is to determine the buy college paper keyboard, degree of risk associated with a loan application and whether the applicant is the right customer for your loan portfolio. Take the time to verify the information provided by on the family life cycle the applicant prior to making a loan decision. Key information such as time at residence; time on essay d3 xpac job; income; residence, job, loan and essay payment histories; credit impairment; and my essay ethical in multicultural references are all critical things to essay family cycle evaluate and verify prior to making a loan decision.

Pulling a credit report on environment an applicant is done primarily to verify the honesty and accuracy of the information provided on the loan application. Many BHPH dealers also use a loan-scoring program to determine a numerical value associated with deal structure. The purpose is to assess the risk associated with the deal structure against the established guidelines of their loan approval policies. Another important fundamental concept to understand about the BHPH business is that this is the collection business, not the sales business. The most successful BHPH dealers devote a significant amount of time and energy to establishing effective policies and procedures for their collection departments. It is vital for the staff to be very consistent with handling customer delinquency and collections.

The same consistency applies to policies and procedures for repossessing a customer’s vehicle. Working with customers to essay on the life cycle keep them in cheap write ethical dilemmas in multicultural the vehicle and life making car payments during difficult times will not only create good customer relationships but also minimize repossessions. Recent developments in technology have made payment methods such as debit cards and ACH payments possible. Many BHPH dealers are implementing an online payment feature to their websites to make payments easier and more convenient for customers. 6. Repeat and Referral Business. Successful BHPH dealers rely heavily on repeat and referral business. “Organic growth,” as it is referred to, requires creating a culture at your BHPH business where customers are treated with dignity and respect. Growth of your customer portfolio also requires developing effective promotions that reward existing customers for renewing their loan, or for referring new customers to your BHPH business. Simple Pollution. Most business people understand that getting new customers is more expensive than retaining current ones. Promotional rewards such as cash, gift cards, gas cards, electronics, recreational items, reduced down payments, or forgiving a low balance on an existing loan will provide an incentive for your customers to repeat or refer customers to your business. Twenty groups, or performance groups, provide dealers with an opportunity to analyze their businesses and compare results with other non-competing BHPH dealers from across the family life cycle, country. Successful BHPH dealers understand that by analyzing their business performance, comparing ideas, sharing challenges and term keyboard discussing best practices with other dealers, they gain valuable input to guide and direct their business decisions.

BHPH is a challenging business, but it can be an extremely profitable one if it’s done correctly. Mark, Very nice article. Projecting rising costs is the number one problem I here from on the life, BHPH customers. These added expenses are actually cutting into their operations and advertising budgets by years end.

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