The story I’m going to analyze is entitled ‘The happy man’ and it was written by Somerset Maugham, a well-known English writer. He was born on 25 of January in 1874, he was an English playwright, novelist and short story writer. He was one of the most popular authors of his era. Now, I’d like to give the summary of the story. At the beginning of the story the author tells us that the narrator didn’t like to give advices. The narrator thought about life and showed his attitude to the whole life. He said that he didn’t know anything of others.
But then the narrator remembered that once he had advised well. Once a man, a total stranger, came to him and ask him for a piece of advice. He wanted to know if he would have any chance to have a job in Spain. The narrator said that if he wasn’t worried about money, he would be success. 15 years later the narrator happened to be in Servile. He had some in disposition and went to an English doctor. It turned out that this doctor was Stephens. He was happy in Spain. And thanked the narrator a lot. The method of character’s portrayed is indirect, which sometimes called dramatic.
The author didn’t comment upon the person ages, the author made them act, speak and let the reader judge for himself. The main characters of the story are the narrator and Stephens. The narrator was an intelligent, clever and bright. We can judge by his way of narration, speech. He was a doctor but didn’t practice. And first of all he was a writer. He was an experienced person, philosopher and good psychologist, because he could say for sure who the man was and what life was. He thought a lot about life and tried to understand the value of life. ‘And life is something that you can lead but once…’ He is responsible man.
Stephens was a little man, thick-set, stout. He had a round face, small dark bright eyes. He had black hair. There was nothing special in Stephens’s appearance but eyes. As we know eyes are the mirror of the soul. And judging by his bright eyes, there was some distinction in him. He was open-hearted, because he came to the strange man to ask the piece of advice. From the way he dressed ‘he was dressed in a blue suit a good deal the worse for wear. It was baggy at the knees and the pockets budget untidily’. He didn’t care what he looked like. So, he wasn’t a pragmatic person. He was emotional.
He was very excited when he came to the narrator, he had some difficulty in lighting a cigarette without letting go off the hat. He was romantic, because he wanted to live in Spain. In the beginning the readers see him as an unhappy man in England and in the end a happy man in Spain. The author used some stylistic devices to show the appearance of Stephens: cursory glance, eyes flashed, forcible ring, fleshy face etc. So, we can divide the story into 2 parts: the first is written in the form of argumentation, and the second part in the form of narration dialogs with elements of description.
The style of the author is clear. Maugham wrote from the first person, it is made the reader believe that this is a real story, and it is made the narration closer to the reader and more intimate. The style is a mixture of neutral and literary layer (poetic words: dark cloak of Destiny, paint the finger of fate). The style is full of stylistic devices. It helps the readers to get the main idea and interested what images are represented. So the author used such stylistic devices as metaphor: ‘a prisoner in solitary tower’, ‘dark cloak of Destiny’ etc.
The narrator shows the readers his attitude towards life, thinks about the value of life. Hyperbole ‘I wouldn’t exchange the life. I’ve had with that of any king in the world’ is used to show that Stephens was very happy and wasn’t concerned about material things. So, also in the story there is an inversion and repetition ‘Poor I have been and poor I always be’. Parallel syntactical constructions such as: ‘’I was, I never, I’ve never done…’, ‘there is sunshine, there is good wine…’ underline the importance of what Stephens told. The sentences in the story are rather simple and complete, the paragraphs are balanced.
Also, there are rhetorical questions with the help of them the author tries to understand what the value of life are. There are a lot of antithesis: ‘Stephens’s salary was pretty good, but his clothes where shabby’, in the beginning he was an unhappy man and in the end he was a happy one, Spain – is full of emotions, freedom, romantic, and England is conservative. Allusions: Carmen – a symbol of Spain, of freedom etc. The central idea is not stated directly in the text. Happiness is something that you can achieve only by yourself. And Stephens proved it.
Hofstede – Turkey And Germany Comparison
The article I chose was written by Roger Chambers, and I found it in what is called the Associated Content by Yahoo. It talks about Turkey and its acceptance into the European Union. The article discusses how Angela Merkel’s visit to Turkey in March, 2010, certainly did nothing to speed up the process of Turkey being accepted in the European Union. The Prime Minister wanted to nurture the idea of giving Turkey what she called a “privileged partnership” with the European Union. Even though this so called partnership may have been beneficial to both parties, Turkey didn’t accept regardless of the advantages.
The article pretty much states that for Turkey to be accepted into the European Union, it needs to be accepted by Germany. Joining the European Union requires Turkey to meet European standards in legal, social, political, and economic issues. So far Turkey has only solved one out of 35 issues of concern to the European Union. The article furthermore talks about how Turkey’s rejection to the “privileged partnership” will only lead to a continuing negotiation process that has no guarantees of success.
Turkey has a big confusion dilemma between its eastern heritage conflicting with its western lifestyle. Even though over 90% of the population is Muslim, Turkey is still considered a secular nation. Germany is considered Turkey’s largest trading partner. Approximately three million Turkish workers live in Germany. Most of these families maintain their language and heritage, opposing to the German Lifestyle. You can easily find Turkish language schools in Germany. With all these details about Turkey and Germany, one would think they might have a good relationship.
Conflicts regarding social integration and discrimination towards Turkish immigrants have been going on all around Germany. This is where Hofstede’s Dimensions come in place. Mediterranean countries such as Portugal, Spain, Italy, Greece and Turkey have the similar dimensions. These dimensions greatly conflict those Viking roots countries like Germany, Sweden, Netherlands, Austria or Switzerland. The two graphs below show the dimension for Germany and Turkey. Germany : Turkey: The first bar is referred to as the Power Distance Index (PDI). This relates to whether organizations may or may not accept hierarchy.
Countries with a high PDI, Turkey in our case, acknowledge and expect that power is distributed unequally. A good and easy example to show this hierarchy could be when it comes to family. If for example you are the smallest brother in the family, whatever the father says has to be acknowledged without any doubt. And if the father wasn’t there for any reason, the judgment or final decision goes to the biggest brother and so on. This hierarchy works the same way, not only in families, but also in business. Turkey tends to differentiate ranges on society.
This is demonstrated by their show of respect for their elder population and those of authority while Germany gives more equality to society, as you can see German has a low PDI. The second bar refers to Individualism (IDV). The higher the bar, the more anticipated an individual is to look after him/her self, the more the individual focuses on his benefits disregarding the group he is in or family. Germany and United States are in the top five of the most individualist countries where each individual looks for their own benefit rather than working as a team and receiving a mutual help and cooperation.
On the other hand Turkey has a low IDV, meaning people from birth onwards are incorporated into strong, interconnected groups, often extended families like uncles, aunts and grandparents which continue protecting each other in exchange for unquestioning loyalty. Sacrificing one’s own interest for what is better for the group is typical for a country with a low IDV like Turkey. The third bar is Masculinity (MAS). Masculinity is regarded as the distribution of roles among the genders, which is a major issue for any society.
Men and woman in Turkey have different values and aren’t as equal as the men and woman in Germany. In turkey men have their roles and women have theirs. In German it’s pretty much the exact opposite. The biggest example would be Germany’s prime minister is a female. The fourth and last bar for Turkey is the Uncertainty Avoidance Index (UAI) and it deals with a society’s tolerance for uncertainty and ambiguity. A high UAI score means a country does not deal well with uncertain situations. As Turkey is considered a Muslim country, one would predict that they would have a high UAI.
This means in order to avoid uncertain situations strict rules are applied. When it comes to business, Turks would like to get know more and engage in a business relationship with whomever they’re doing business. It is not enough to know someone’s background, history and business accomplishments to do business with them. A relationship has to be formed in order to do business. Germany has a low UAI, meaning they are flexible with rules and have an open structure related to the workforce and economy. As explained in the paragraphs above, there is a big cultural difference between Turkey and Germany.
Turkey may have developed some part of the western culture or lifestyle, but this lifestyle is similar to the Mediterranean countries. And Mediterranean countries have a culture which is in constant conflict with Scandinavian or Germanic countries. This makes negotiations much more obscure and complex between Turkey and Germany. Germany has a very strict and serious way in doing business, while Turkey has a very relaxed and traditional way. As I said before Turks want to know who they are doing business with and want to form a relationship, while Germans want to do business and only business, excluding everything else. As the requirements for Turkey to join the EU are coming from Germany, they are no doubt going to be much more demanding than if they were coming from a Mediterranean country like Portugal or Spain.
Refrence:
Chambers, Roger. (2010, April 2). Turkey and the European Union: Full member vs. “Privileged Partnership. ” Retrieved February 15, 2011, from Geert Hofstede’s Cultural Dimensions. Turkey’s cultural Dimensions. – www. geert-hofstede. com Retrieved Febuary 15,2011, from
Labor And Delivery
Labor is a physiologic process during which the products of conception (ie, the fetus, membranes, umbilical cord, and placenta) are expelled outside of the uterus. Labor is achieved with changes in the biochemical connective tissue and with gradual effacement and dilatation of the uterine cervix as a result of rhythmic uterine contractions of sufficient frequency, intensity, and duration. 1,2 Labor is a clinical diagnosis. The onset of labor is defined as regular, painful uterine contractions resulting in progressive cervical effacement and dilatation.
Cervical dilatation in the absence of uterine contraction suggests cervical insufficiency, whereas uterine contraction without cervical change does not meet the definition of labor. Stages of Labor and Epidemiology Stages of Labor Obstetricians have divided labor into 3 stages that delineate milestones in a continuous process. First stage of labor The first stage begins with regular uterine contractions and ends with complete cervical dilatation at 10 cm.
In Friedman’s landmark studies of 500 nulliparas3 , he subdivided the first stage into an early latent phase and an ensuing active phase. The latent phase begins with mild, irregular uterine contractions that soften and shorten the cervix. The contractions become progressively more rhythmic and stronger. This is followed by the active phase of labor, which usually begins at about 3-4 cm of cervical dilation and is characterized by rapid cervical dilation and descent of the presenting fetal part. The first stage of labor ends with complete cervical dilation at 10 cm.
According to Friedman, the active phase is further divided into an acceleration phase, a phase of maximum slope, and a deceleration phase. Characteristics of the average cervical dilatation curve is known as the Friedman labor curve, and a series of definitions of labor protraction and arrest were subsequently established. 4,5 However, subsequent data of modern obstetric population suggest that the rate of cervical dilatation is slower and the progression of labor may be significantly different from that suggested by the Friedman labor curve. ,7,8 Second stage of labor The second stage begins with complete cervical dilatation and ends with the delivery of the fetus.
The AmericanCollege of Obstetricians and Gynecologists (ACOG) has suggested that a prolonged second stage of labor should be considered when the second stage of labor exceeds 3 hours if regional anesthesia is administered or 2 hours in the absence of regional anesthesia for nulliparas. In multiparous women, such a diagnosis can be made if the second stage of labor exceeds 2 hours with regional anesthesia or 1 hour without it. Studies performed to examine perinatal outcomes associated with a prolonged second stage of labor revealed increased risks of operative deliveries and maternal morbidities but no differences in neonatal outcomes. 9,10,11,12 Maternal risk factors associated with a prolonged second stage include nulliparity, increasing maternal weight and/or weight gain, use of regional anesthesia, induction of labor, fetal occiput in a posterior or transverse position, and increased birthweight. 11,12,13,14 Third stage of labor.
The third stage of labor is defined by the time period between the delivery of the fetus and the delivery of the placenta and fetal membranes. During this period, uterine contraction decreases basal blood flow, which results in thickening and reduction in the surface area of the myometrium underlying the placenta with subsequent detachment of the placenta. 15 Although delivery of the placenta often requires less than 10 minutes, the duration of the third stage of labor may last as long as 30 minutes. Expectant management of the third stage of labor involves spontaneous delivery of the placenta.
Active management often involves prophylactic administration of oxytocin or other uterotonics (prostaglandins or ergot alkaloids), early cord clamping/cutting, and controlled cord traction of the umbilical cord. A systematic review of the literature that included 5 randomized controlled trials comparing active and expectant management of the third stage reports that active management shortens the duration of the third stage and is superior to expectant management with respect to blood loss/risk of postpartum hemorrhage; however, active management is associated with an increased risk of unpleasant side effects. 6 The third stage of labor is considered prolonged after 30 minutes, and active intervention, such as manual extraction of the placenta, is commonly considered. 2 Mechanism of Labor The ability of the fetus to successfully negotiate the pelvis during labor involves changes in position of its head during its passage in labor. The mechanisms of labor, also known as the cardinal movements, are described in relation to a vertex presentation, as is the case in 95% of all pregnancies.
Although labor and delivery occurs in a continuous fashion, the cardinal movements are described as 7 discrete sequences, as discussed below. 2 Engagement The widest diameter of the presenting part (with a well-flexed head, where the largest transverse diameter of the fetal occiput is the biparietal diameter) enters the maternal pelvis to a level below the plane of the pelvic inlet. On the pelvic examination, the presenting part is at 0 station, or at the level of the maternal ischial spines.
Descent. The downward passage of the presenting part through the pelvis. This occurs intermittently with contractions. The rate is greatest during the second stage of labor. Flexion As the fetal vertex descents, it encounters resistance from the bony pelvis or the soft tissues of the pelvic floor, resulting in passive flexion of the fetal occiput. The chin is brought into contact with the fetal thorax, and the presenting diameter changes from occipitofrontal (11. 0 cm) to suboccipitobregmatic (9. 5 cm) for optimal passage through the pelvis. Internal rotation
As the head descends, the presenting part, usually in the transverse position, is rotated about 45° to anteroposterior (AP) position under the symphysis. Internal rotation brings the AP diameter of the head in line with the AP diameter of the pelvic outlet. Extension With further descent and full flexion of the head, the base of the occiput comes in contact with the inferior margin of the pubic symphysis. Upward resistance from the pelvic floor and the downward forces from the uterine contractions cause the occiput to extend and rotate around the symphysis.
This is followed by the delivery of the fetus’ head. Restitution and external rotation When the fetus’ head is free of resistance, it untwists about 45° left or right, returning to its original anatomic position in relation to the body. Expulsion After the fetus’ head is delivered, further descent brings the anterior shoulder to the level of the pubic symphysis. The anterior shoulder is then rotated under the symphysis, followed by the posterior shoulder and the rest of the fetus.
Clinical History and Physical Examination. History The initial assessment of labor should include a review of the patient’s prenatal care, including confirmation of the estimated date of delivery. Focused history taking should be conducted to include information, such as the frequency and time of onset of contractions, the status of the amniotic membranes (whether spontaneous rupture of the membranes has occurred, and if so, whether the amniotic fluid is clear or meconium stained), the fetus’ movements, and the presence or absence of vaginal bleeding.
Braxton-Hicks contractions, which are often irregular and do not increase in frequency with increasing intensity, must be differentiated from true contractions. Braxton-Hicks contractions often resolve with ambulation or a change in activity. However, contractions that lead to labor tend to last longer and are more intense, leading to cervical change. True labor is defined as uterine contractions leading to cervical changes. If contractions occur without cervical changes, it is not labor. Other causes for the cramping should be diagnosed.
Gestational age is not a part of the definition of labor. In addition, Braxton-Hicks contractions occur occasionally, usually no more than 1-2 per hour, and they often occur just a few times per day. Labor contractions are persistent, they may start as infrequently as every 10-15 minutes, but they usually accelerate over time, increasing to contractions that occur every 2-3 minutes. Patients may also describe what has been called lightening, ie, physical changes felt because the fetus’ head is advancing into the pelvis. The mother may feel that her baby has become light.
As the presenting fetal part starts to drop, the shape of the mother’s abdomen may change to reflect descent of the fetus. Her breathing may be relieved because tension on the diaphragm is reduced, whereas urination may become more frequent due to the added pressure on the urinary bladder. Physical examination Physical examination should include documentation of the patient’s vital signs, the fetus’ presentation, and assessment of the fetal well-being. The frequency, duration, and intensity of uterine contractions should be assessed, particularly the abdominal and pelvic examinations in patients who present in possible labor.
Abdominal examination begins with the Leopold maneuvers described below2 : • The initial maneuver involves the examiner placing both of his or her hands on each upper quadrant of the patient’s abdomen and gently palpating the fundus with the tips of the fingers to define which fetal pole is present in the fundus. If it is the fetus’ head, it should feel hard and round. In a breech presentation, a large, nodular body is felt. • The second maneuver involves palpation in the paraumbilical regions with both hands by applying gentle but deep pressure.
The purpose is to differentiate the fetal spine (a hard, resistant structure) from its limbs (irregular, mobile small parts) to determinate the fetus’ position. • The third maneuver is suprapubic palpation by using the thumb and fingers of the dominant hand. As with the first maneuver, the examiner ascertains the fetus’ presentation and estimates its station. If the presenting part is not engaged, a movable body (usually the fetal occiput) can be felt. This maneuver also allows for an assessment of the fetal weight and of the volume of amniotic fluid. The fourth maneuver involves palpation of bilateral lower quadrants with the aim of determining if the presenting part of the fetus is engaged in the mother’s pelvis. The examiner stands facing the mother’s feet. With the tips of the first 3 fingers of both hands, the examiner exerts deep pressure in the direction of the axis of the pelvic inlet. In a cephalic presentation, the fetus’ head is considered engaged if the examiner’s hands diverge as they trace the fetus’ head into the pelvis. Pelvic examination is often performed using sterile gloves to decrease the risk of infection.
If membrane rupture is suspected, examination with a sterile speculum is performed to visually confirm pooling of amniotic fluid in the posterior fornix. The examiner also looks for fern on a dried sample of the vaginal fluid under a microscope and checks the pH of the fluid by using a nitrazine stick or litmus paper, which turns blue if the amniotic fluid is alkalotic. If frank bleeding is present, pelvic examination should be deferred until placenta previa is excluded with ultrasonography. Furthermore, the pattern of contraction and the patient’s presenting history may provide clues about placental abruption.
Digital examination of the vagina allows the clinician to determine the following: (1) the degree of cervical dilatation, which ranges from 0 cm (closed or fingertip) to 10 cm (complete or fully dilated), (2) the effacement (assessment of the cervical length, which is can be reported as a percentage of the normal 3- to 4-cm-long cervix or described as the actual cervical length); actual reporting of cervical length may decrease potential ambiguity in percent-effacement reporting, (3) the position, ie, anterior or posterior, and (4) the consistency, ie, soft or firm.
Palpation of the presenting part of the fetus allows the examiner to establish its station, by quantifying the distance of the body (-5 to +5 cm) that is presenting relative to the maternal ischial spines, where 0 station is in line with the plane of the maternal ischial spines). 2 The pelvis can also be assessed either by clinical examination (clinical pelvimetry) or radiographically (CT or MRI).
The pelvic planes include the following: • Pelvic inlet: The obstetrical conjugate is the distance between the sacral promontory and the inner pubic arch; it should measure 11. 5 cm or more. The diagonal conjugate is the distance from the undersurface of the pubic arch to sacral promontory; it is 2 cm longer than the obstetrical conjugate. The transverse diameter of the pelvic inlet measures 13. 5 cm. • Midpelvis: The midpelvis is the distance between the bony points of ischial spines, and it typically exceeds 12 cm. Pelvic outlet: The pelvic outlet is the distance between the ischial tuberosities and the pubic arch. It usually exceeds 10 cm. The shape of the mother’s pelvis can also be assessed and classified into 4 broad categories based on the descriptions of Caldwell and Moloy: gynecoid, anthropoid, android, and platypelloid. 24 Although the gynecoid and anthropoid pelvic shapes are thought to be most favorable for vaginal delivery, many women can be classified into 1 or more pelvic types, and such distinctions can be arbitrary