Competitive Strategy Essay Example for Free

Competitive Strategy Essay â€Å"Successful and unsuccessful strategies shape a company’s destiny† – R.A. Burgelman, Strategy is Destiny†¦ Competitive Strategy is the high-level strategy used by the firm to realize its business goals, and in particular, profitability, in the face of competition. We study competitive strategy within the overall context of technology firms, which operate within a so-called industry, e.g., the computer industry, the consumer electronic industry, the cellular phone industry. Each industry, ideally, serves a market, which denotes the buyers or customers of the products and services offered by the industry. The function of strategy, which has a time horizon of years, is, in general, to set the long-term direction or position of the firm, for example define the technology, product, or service that the firm intends to develop, and determine the intended market for the product or service. The function of planning, which, in general, has a time horizon of several months to years, is to translate long-term strategy into medium-term activities, e.g., the portfolio of projects that the firm should execute the time-phased planning of these projects, and resource allocation. The function of operations, which has the time-horizon of days to months, is, in general, to translate medium-term planning activities into short-term product design, development, and delivery activities such as prototyping, manufacturing, product release, and shipment. No company can follow only one strategy. For example, Johnson Johnson uses one marketing strategy for its common product such as BAND-AID Johnson’s baby products; and different marketing strategy for its High Tech healthcare products such as Vicryl Plus, antibacterial surgical sutures or NeuFlex finger joint implants. There are several different types of strategy, including competitive strategy, technology strategy, product market strategy, financial strategy, and supply-chain strategy. For a technology company to be successful all these strategies need to be aligned with each other, and with the business goals of the firm. Competitive strategy, is the highest level of strategy in the firm, and is intimately related to the mission and vision of the firm and also to setting the direction for all the other strategies in the firm. There are several schools of strategy formation: design, planning, positioning (Mintzberg, 1998). We focus on two important schools or frameworks for strategy-creation or â€Å"strategy-making† that are particularly important for high-technologycompanies. The first framework is the so-called â€Å"positioning† approach due to Porter (Porter, 1980), In this approach strategy is viewed as taking a generic position in a competitive market and which views strategy-making as an analytic process performed at the industry-market structural level (Porter, 1980) and the resulting dynamics between functional groups of players (e.g., competitors, suppliers) in the industry. The second framework analyzes strategy-making at the industry-level, company level, and intra-company level using evolutionary organization theory (Burgelman 2002). In this evolutionary organizational theory approach, each company is an organizational ecology within which strategy emerges through two basic mechanisms, external selection and internal selection. When companies start, because they are new and small ¸ the external selection mechanism dominates. As a company grows in size and becomes more established, internal selection plays an important role. Based on e volutionary organization theory, views strategy-making as an evolutionary process performed at three levels: industry-company level, company-level, and intra-company level. When these two frameworks are combined, an integrated approach to competitive strategy emerges: from industry-market level all the way to intra-company level. A unique aspect of creating competitive strategy for a company, and in particular, a high-technology company, is that the time-scales for the evolution of markets, industries, and technologies are, in general, much shorter (â€Å"faster†) compared to other industries. Therefore, the strategy frameworks of the positioning school needs to be augmented with functional maps (Clark and Wheelwright, 1993), which capture the evolution of the market, industry, and technology relevant to the company, and which can therefore be used to create strategy. The objectives of this chapter are as follows: 1. Describe the positioning framework for the creation of competitive strategy. 2. Provide an integrated competitive strategy process which is useful in developing competitive strategy in a technology company. 3. Demonstrate the application of the process of competitive strategy The objective of technology strategy (Clark and Wheelwright, 1993) is to guide the technology company in developing, acquiring, and applying technology for competitive advantage. An important part of technologystrategy is the definition of technical capabilities (e.g., advanced device design, rapid prototyping, automated assembly) that provide competitive advantage. The objective of product/market strategy is to clearly establish the following: define what differentiates the product from its competitors; identify market segments for the product, the customer needs of these segments, and the corresponding products (i.e., product lines) that will be offered to these segments; etc. An important outcome of produc t/market strategy is to define the product roadmap, including sales volume and price, necessary to realize the business goals. However, in the rapidly evolving industry and market landscape of high-technology, competitive strategy, in turn, depends on three levels of â€Å"strategy-making† as follows (Burgelman, 2002): 1. Industry-company level. At this level the firm must determine its strategic position, its core competencies, and its strategic action. 2. Company level: At this level strategy-making involves induced strategy and autonomous strategy. 3. Intra-company level: At this the internal level autonomous strategy is created. In successful companies, it is the tight coupling of strategy these three levels of strategy-making with the highest-level (i.e., industry-market level) competitive strategy that, results in successful strategic action where what the company actually does, e.g., the product lines it develops and markets, results in the realization of its business goals. It is also useful to mention two other strategies that are closely related to competitive strategy. Financial strategy in cludes issues such as capital budgeting and portfolio management, i.e., deciding on which technology and product development projects to fund in order to maximize the cumulative expected profit. Another important and related strategy is supply chain strategy (Chopra), which specifies the service, distribution, and operations functions, performed either in-house or outsourced, that the company should do well in order to successfully realize its intended competitive strategy. The â€Å"Positioning† Framework We first present a historical overview of the positioning or analytic school of strategy. Then, we develop the five forces framework (Porter, 1980) and the approach to creation of competitive strategy that is closely related to the five forces framework. We will use the personal computer industry to illustrate the approach. The positioning school of strategy which emerges from the competitive school is based on the following assumptions (Mintzberg, 1998): the marketplace is competitive strategy is a generic position in the marketplace; strategy formation is the selection of a generic position based on analysis. The underlying assumption is that industry or market structure drives position which drives the organizational structure of the firm. Matrices like the Boston Consulting Group (BCG) introduced two techniques: the growth-share matrix, and the experience curve. The growth-share matrix for a firm, developed in the early 1970s, is a 22 matrix with â€Å"growth† along one dimension, and â€Å"market share† along the other dimension. Each of these variables can take two values, â€Å"high† or â€Å"low† resulting in a 22 matrix. Therefore, the product portfolio of a firm can be decomposed into four combinations of growth and market share, each with a well defined meaning: (High growth, high market share) or â€Å"stars†, (high growth, low share) or â€Å"question marks†, (slow growth, high share) or â€Å"cash cows†, and (slow growth, low share) or â€Å"dogs†. The approach to strategy using this matrix would be to have a portfolio balanced mainly between cash cows (the stable business of the firm, e.g., â€Å"MAC† computers in the case of Apple) and stars (e.g., the iPod, in the case of Apple). The experience curve, developed in 1965-66, is based on the idea that accumulated experi ence by a firm influences costs and prices. The claim â€Å"for the experience curve was that for each cumulative doubling of experience, total costs would decline roughly 20% to 30% because of economies of scale, organizational learning, and technical innovation† (Ghemawat, 1999). In 1971, the consulting firm McKinsey came up with the GE/McKinsey nine-block matrix called the Industry Attractiveness-Business Strength matrix (Ghemawat, 1999), which plotted business strength [High, Medium, Low] along one axis, and industry attractiveness [High, Medium, Low] along the other axis. The basic idea was to divide the company into â€Å"strategic business units (SBUs)†, and then make the appropriate strategic recommendations for each SBU depending on its â€Å"location† in the matrix. The Five Forces Framework and Competitive Strategy In this framework there are two high-level stages in the creation of competitive strategy, each stage corresponding to a high-level determinant of profitability mentioned in the previous section. The first stage is the assessment of the attractiveness of the industry in which a given company is embedded based on a structural analysis of the industry. In this stage, called the five forces framework, five forces that influence industry attractiveness are identified, as well as the factors (e.g., number of competitors, size of competitors, capital requirements) that determine the intensity of each force and therefore the cumulative intensity of the five forces. The purpose of the five forces framework is to relate the degree (or intensity) of competition in a given industry, as qualitatively measured by the combined strength (or intensity) of five forces, to the attractiveness of the industry, defined as its ability to sustain profitability. Based on the structural analysis, a particula r company may be in a very attractive industry (e.g., pharmaceuticals) or in an unattractive industry (e.g., steel). However, though a firm exists in an unattractive industry, it can still be highly profitable by choosing the proper competitive position within the industry, for example, e.g., a mini-mill such as Nucor in the steel industry in the nineteen-eighties (Ghemawat). The second stage of strategy creation addresses the competitive strategy available to the firm in order to achieve a strong competitive position. Ideally, a firm would want to be in a very attractive industry (e.g., pharmaceuticals) and have a strong competitive position (e.g., large pharmaceutical firms such as Smith Klein or Glaxo) within the industry. The five forces framework for the structural analysis of an industry is as follows. First, we define the following terms used in the structural analysis of the industry: industry, market, competitors, new entrants, substitutes, buyers, and sellers. The term ind ustry denotes (1) the manufacturers (or producers) and (2) the suppliers of a primary product or service, as well as (3) the manufacturers of alternative products and services that could serve as a substitute. For example, the (conventional) personal computer (PC) industry would include PC manufacturers like Dell and Apple, suppliers of semiconductor chips like Intel and Micron, suppliers ofdisc drives like Seagate, suppliers of software such as Microsoft, etc. Substitute products could be pen-based tablet PCs or small hand-held personal digital assistants (PDAs). In the five forces framework described below, manufacturers and producers will designated as (1) competitors in the industry if they already have established products, or (2) new-entrants if they are trying to enter the industry, or (3) substitutes, if they provide alternative (substitute) products. The term market denotes the buyers (or customers) of the product or service. For example, the market for PCs would include enterprises and individual consumers. The analytical process of strategy analysis and creation can be decomposed into the following five steps. 1. Create a map of the industry in which the technology company is em bedded. There are five key sets of players that constitute the business landscape: competitors, new entrants, substitutes, suppliers, and buyers. Identify key players (companies) for each industry. 2. Perform a five forces analysis of the industry structure. The five forces that influence the intensity of competition in a particular industry, and therefore the profitability of the firms within the industry: Force 1: the degree of rivalry (or competition) between the competitors; Force 2: the threat of new entrants (or the inverse of this force, the barrier to entry); Force 3: the threat of substitutes; Force 4: Buyer Power (to demand lower prices); Force 5: Supplier Power (to increase material prices). For each force, determine the key structural determinants which affect the intensity of the force. Porter and Ghemawat provide a detailed set of the determinants for each force, some of which are given in the table below. In the last column of this table we indicate plausible values o f each force for the PC industry in the nineteen nineties. Table 1 |Force |Key Determinants |Strength of the force | |Rivalry between competitors |Concentration (number) and size of |Medium to high | | |competitors | | | |Fixed costs/value added | | | |Brand indentity | | |Barrier to entry |Economies of scale |Medium to high | | |Brand identity | | | |Capital requirements | | |Threat of substitutes |Price/Performance of substitutes |Low to medium | | |Switching costs | | |Buyer Power |Buyer concentration | | | |Buyer size (volume) |Medium to high | | |Switching costs | | |Supplier Power |Supplier concentration |Low to medium | | |Supplier size (volume) | | | |Switching costs | | In theory, one would, qualitatively determine the strength of each force, as indicated in the third column of the above table, and then determine the cumulative or combined intensity of the five forces. The collective intensity or strength of the forces will determine the structural strength of the industry, as characterized by attractiveness, or the profit potential of the industry. The profit potential is measured by the long term return on invested capital (ROIC). If the collective strength of the forces is high, as in the steel industry, then the corresponding profit potential or attractiveness is low, and vice-versa. At one extreme of this analysis is the perfectly competitive free market, where there are numerous firms alloffering very similar products that cannot be differentiated (therefore, the force of rivalry is high), entry is free (therefore, the threat of both new entrants and substitutes is high), and bargaining power of both suppliers and buyers is low. Using the PC industry of the 1990’s as an example, the qualitative values of the forces shown in the last column of the above table would lead one to conclude that the cumulative strength of the five forces was medium to high, and therefore the attractiveness of the industry, i.e., its profitability, was medium to low. The PC industry in the nineteen-nineties would therefore not be attractive to new entrants, and in fact, in the early 2000s, HP’s computer business was unprofitable, and IBM sold its computer business to Lenovo. (It is important to note that HP’s unprofitability in computer business in the early 2000s cannot be attributed solely to industry attractiveness being low, but is also due to issues associated with its acquisition of the computer company Compaq.) 3. Select a competitive positioning strategy The basic premise of Porter and Hall was that for a firm to be successful (in a market) it had to compete based on one of two sources of competitive ad vantage: cost, i.e., by providing low cost products, or differentiation, i.e., by differentiating its products from its competitors with respect to quality and performance. Porter also proposed that a firm needs to select its strategic target: either offering a product to the entire market (â€Å"market-wide†), or offering a product for a particular market segment. Using these two dimensions (source of competitive advantage, and strategic target), Porter proposed the following three generic competitive strategies: 1. Cost Leadership: offering the lowest costs products to the entire market 2. Differentiated: offering highly unique products (as perceived by the customer) to the entire market 3. Focus: offering products which serve the needs of a niche segment of the market Porter’s claim is that for a company to be successful in the industry in which it operates it must choose between one of the three generic strategies: cost leadership, differentiated, and focus. If one uses the personal computer industry in the US during the 1990’s as an example, then the competitive strategies of the major players was as follows: Dell was the low-c ost leader; HP had a differentiated strategy with high-quality products; Apple had a focus strategy, targeting a narrow marketsegment of users who whom the user-experience (look, feel, and graphical user interfaces) were extremely important; and IBM had a mixed strategy. 4. Link competitive strategy to strategic planning (Ghemawat 1999) In order for a company to derive competitive advantage (or position) within its industry, the company needs to maximize, relative to it competitors, the difference between the buyer’s willingness to pay and the costs incurred in delivering the product to the buyer. Therefore, the next step in the competitive analysis is for the company to link competitive strategy to strategic planning by analyzing all the activities involved in differentiation and cost, and, to this end, a value chain (Porter, 1985) is an extremely important tool. According to Porter, â€Å"the value chain disaggregates a firm into its strategically relevant activities in order to understand the behavior of costs and the existing and potential sources of differentiation.† A three step process for using these activities, first to analyze costs, then to analyze buyer’s willingness to pay, and finally to explore different strategic planning options to maximize the difference between willingness to pay and cost, is developed in (Ghemawat, 1999). 5. Competitive strategy needs to evolve, especially in a high-technology company where markets, industries, and technologies, are changing relatively rapidly. A good example of the evolution of competitive strategy is IBM’s strategic decisions to evolve from a product-based company in the early nineties to a services-led company at the present time. In the early nineties, when the company was in trouble, IBM closely examined its business model and strategic direction, and decided to â €Å"stay whole† by moving its focus from products and hardware to solutions. One result of this strategic shift was the creation of IBM Global Services in the mid-nineties. By the late-nineties the company moved into e-business solutions, and extended this model in the 2000’s to â€Å"business-on-demand†. One result of these shifts in strategy was IBM’s decision to exit the Personal Computer Market by selling its PC business to Lenovo. Functional Maps A functional map essentially is a time-based evolutionary map of a key metric for an important organizational function, e.g., a product performance metric map for the engineering function in a technology firm, e.g., the well-known Moore’s Law in the semiconductor industry. Since the time-scales for the evolution of markets, industries and technologies for technology companies, especially â€Å"high-tech† companies, is short compared to other industries, the creation of the appropriate functional maps is critical to strategy formation in a technology company. As an example, in the relatively short span of four decades, information technology evolved from mainframes through workstations, servers and personal computers to internet-based and mobile computing. An important feature of our approach to developing competitive strategy in a technology firm is the integrated approach to strategy for a technology company, which relates company strategy to the company’s busin ess goals, business strategy, technology strategy, and product marketing strategy. Since, markets, industries, technologies, and products for a technology company are continually evolving, an important concept that plays a vital role in the creation of strategy, and, in particular, competitive strategy, is the functional map (Clark and Wheelwright, 1993). Here are some useful â€Å"dimensions† along which to create functional maps for strategy creation: a) Evolution of the industry in which the enterprise operates (changes in technology, customer needs, competitive landscape, etc.) b) Evolution of strategy business, technology, and market of the enterprise c) Evolution of technology (including manufacturing), product platforms, and product lines of the enterprise. The processes used for technology, product, and process development within the enterprise. d) Growth (or decline) of the enterprise with respect to of market share, revenues, costs, profits, etc. e) Organizational structure of the enterprise f) Key decisions made at different stages in the life of enterprise, and the drivers for these decisions g) The interconnections and relationships between all the above dimensions A multi-dimensional functional map for Intel is given in the next section. A very simple example of how functional maps can shape strategy is in the information technology industry. A functional map of the Information Technology Industry from the 1990s to the 2000s would reveal a shift from â€Å"products† to services†. The Services business in 2007-08 is approximately $750 billion, with IBM, whose share of this market is $54 billion, being the leader. HP, whose own share in the market is $17 billion seeing this shift in the industry and the need to build competitive strength, acquired EDS, whose share of the market is $21 billion. The combined share of HP and EDS would then be $38 billion, allowing it to compete more strongly with IBM. Another simple example of the use of a functional map in creating strategy is in the software industry. In the 2000s the software market is moving from a â€Å"packaged† product to online software, where individuals can get software that is mostly free, supported by advertising. Google is using its leadership on the Web to provide online softwa re that competes with Microsoft’s packaged software. Understanding this shift from packaged to online, and the corresponding change in the revenue model from direct sales (of product) to advertising, Microsoft is aggressively entering the online advertising business. Process for developing competitive strategy in a company If we combine the positioning framework for competitive strategy due to Porter, the evolutionary organization theoretic framework due to Burgelman, and augment these with the creation of relevant functional maps, then the resulting process of developing competitive strategy in a company can be decomposed into four stages, as follows. Stage 1: Company Analysis 1. Establish the business goals and objectives (ROI, %market share, revenue, and growth aspirations). 2. Determine the technology strategy and product market strategy for the company. 3. Define the overall development goals and objectives to align business goals, technology, and market strategies. 4. Develop the functional evolutionary maps of the markets and industry in which the company is embedded. Create functional maps (time-based evolutionary maps) for technology, product market, and manufacturing strategy of the firm. These maps will be useful in the process of assessing and creating competitive strategy. Stage 2: Industry Analysis 1. Perform the structural analysis of the industry in which the company is either an active competitor, or a new entrant, or a substitute. 2. Determine the existing competitive strategy of the company within the industry. 3. Determine the relationships between the company and the other players in the industry Stage 3: Assessment and Evolution of the company’s strategy within the relevant markets and industries 1. Using the functional maps of the overall markets and industry in which the company is embedded, as well as the company specific functional maps, assess the evolution of the company’s competitive strategy. 2. Decide on what the company’s future competitive strategy should be, and the corresponding technology strategy, product market strategy, and manufacturing strategy. Glossary Autonomous Strategy (also see induced strategy). Autonomous strategy refers to actions of individuals or small groups within the company that are outside the scope of current high-level corporate strategy. While autonomous strategy is constrained by the company’s distinctive (core) competencies, it usually (1) involves new competencies that are not the focus of the firm, and (2) results in so-called â€Å"disruptive technologies† that could change the strategic direction of the firm (Burgelman, 2002). Company Structure (vertical vs. horizontal). A vertical company is one which uses only its own proprietary technologies. A horizontal company is one which (usually because of the existence of open-standards) which does not solely rely on its own proprietary technologies, but usually uses technologies and products from other suppliers. In the computer industry, traditionally, Apple is an example of a vertical company, while Dell is an example of a horizontal company. The co mputer industry, itself, moved from a vertical structure to a horizontal structure in the 1980s (Ghemawhat, 1999). Corporate Strategy (official corporate strategy). Corporate strategy is top management’s view of the basis of the company’s success. It includes distinctive (core) competencies, product-market domains, and core values (Burgelman, 2002) Industry. The term industry, e.g., the consumer electronics industry,denotes (1) the manufacturers (or producers) and (2) the suppliers of a primary product or service, as well as (3) the manufacturers of alternative products and services that could serve as a substitute (Porter, 1980). Market. The term market denotes the buyers (or customers) of the product or service. Typically markets are segmented, for example, a two-dimensional segmentation based on the types of product (product segmentation) along one axis, and the types of customers (customer segmentation) along the other axis. The market, as represented by â€Å"Buyers† is an important part of the industry analysis in Porter’s framework. Once youve established the key assets and skills necessary to succeed in this business and have defined your distinct competitive advantage, you need to communicate them in a s trategic form that will attract market share as well as defend it. Competitive strategies usually fall into these five areas: 1. Product 2. Distribution 3. Pricing 4. Promotion 5. Advertising Many of the factors leading to the formation of a strategy should already have been highlighted in previous sections, specifically in marketing strategies. Strategies primarily revolve around establishing the point of entry in the product life cycle and an endurable competitive advantage. As weve already discussed, this involves defining the elements that will set your product or service apart from your competitors or strategic groups. You need to establish this competitive advantage clearly so the reader understands not only how you will accomplish your goals, but why your strategy will work. [pic] References Burgelman, R.A., â€Å"Strategy is Destiny†, The Free Press, New York, 2002. Chopra, Sunil, and Peter Meindl, â€Å"Supply Chain Management, Strategy, Planning, and Operations†, Third Edition, Pearson Prentice-Hall, 2007. Clark, K. B., and S.C. Wheelwright, Managing New Product and Process Development, Text and Cases, The Free Press, New York, 1993. Edwards, Cliff, â€Å"Intel†, Business Week, March 8, 2004, Pages 56-64. Ghemawat, Pankaj, Strategy and the Business Landscape, Text and Cases, Addison Wesley, 1999. Mintzberg, Henry and Bruce Ahlstrand, and Joseph Lampel, Strategy Safari, The Free Press, New York, 1998 Porter, Michael, Competitive Strategy, New York, The Free Press, 1980 Porter, Michael, Competitive Advantage, The Free Press, New York, 1985 Figure 1: A strategic view of the technology firm, showing different types of strategy Revenue ($), Growth (%), Etc. Purpose of the company Financial Strategy Competitive Strategy Market Strategy Technology Strategy Business Goals †¢ Vision †¢ Mission

Management of Pain in Trigeminal Neuralgia

Management of Pain in Trigeminal Neuralgia Percutaneous management of pain in Trigeminal Neuralgia under computed tomography guidance Corersponding Author Dr. Mitesh Kumar Main Author Dr. Roy Santosham Co Authors Dr. Bhawna Dev Dr. Deepti Morais Dr. Rupesh Mandava Dr. R. Jeffrey Abstract Trigeminal Neuralgia (TN) is a brief, excruciating and perhaps the most severe pain known to man affecting the hemifacial region. It occurs mainly due to tortuous vessel compressing the trigeminal nerves, though in many cases, the exact etiology and pathogenesis remain undetermined. The first line therapeutic option for patients affected by TN is the medical line of management and patients refractory to the same, are offered various invasive procedures like balloon compression, gamma knife surgery, radiofrequency ablation, etc. In this paper, we present percutaneous management of the pain by injecting neurolytic drugs in the foramen ovale under Computed Tomography (CT) guidance as the new and promising technique of treatment in TN. Keywords Trigeminal Neuralgia, percutaneous management, CT guidance, neurolytic drugs Objective To evaluate the efficacy and safety of Computed Tomography guided percutaneous management of pain in trigeminal neuralgia using neurolytic drugs. Introduction Trigeminal Neuralgia is also known as tic douloureux, a term given to this painful disease by Nicolaus Andre in 1756 [1] . TN is a pain which typically is intense, brief, usually unilateral, recurrent shock like involving the branches of fifth cranial nerve [2]. It can be mainly classified into two types. First being, the classical TN (Type I), which is due to neurovascular compression, the most common vessel causing the same being superior cerebellar artery followed by anterior inferior cerebellar artery [3]. Second type is atypical TN (Type II), secondary to causes like trauma, tumor, multiple sclerosis or herpetic infections. The distinction between these two types is mainly based on clinical symptoms [4, 5] as Type I pain is episodic in nature whereas Type II pain is more constant. TN is often called by many as â€Å"the suicide disease† [6] as the patients who suffer from it would rather take their lives than bear the pain. The initial line of treatment for TN is medical management by drugs like Carbamazepine, Gabapentin, Oxcarbazepine among others. Patients of type I TN may also be advised microvascular decompression. Those patients who do not respond or have contraindications to the above mentioned drugs or experience no change in the intensity of the pain are called Refractory TN [7]. Such patients are advised invasive procedures like trigeminal nerve block neurolytic block, radiofrequency ablation, gamma knife surgery and balloon compression. We describe our experience in percutaneous management of pain by injecting neurolytic drugs in the foramen ovale under CT guidance in six patients, suffering from TN. Method and Materials used Pre procedural work up The pre procedural work up included clinical evaluation and thorough reading of the Magnetic Resonance Imaging (MRI) scans of all the patients to rule out any neurovascular conflict. Any patient with neurovascular conflict was considered an exclusion criterion in our study. These patients were reported taking the drugs for TN for over three months with no improvement in the pain. The pain score evaluation was done using Numeric Rating Scale [8] and Wong-Baker Faces Pain Rating Scale [9] as a baseline evaluating point to be compared to the same scoring system after the procedure. Routine investigations such as coagulation profile, liver function test, renal function test, HIV and HbsAg were done before the procedure. Numeric Rating Scale Patients rate pain on a number scale from 0-10, 0 being a depiction for no pain and 10 being the worst pain imaginable. Wong-Baker Faces Pain Rating Scale The Wong-Baker Faces Pain Rating Scale is a pain scale that was developed by Donna Wong and Connie Baker. The scale shows a series of faces ranging from a happy face at 0 (No Pain) to a crying face at 10 (Worst Pain Possible). The patient must choose the face that best describes how they are feeling. In our study, we use the Wong Bakers scale to assess the patients’ pain before and after the procedure. The neurolytic drugs and materials used in the procedure were 22 G spinal needle for block, 25 G needle for skin infiltration, 2% xylocaine , Iohexol Non ionic contrast medium, 100% alcohol, 1ml syringe and normal saline solution. The patient was put in the supine position with head placed in reverse occipitomental position (chin up and neck extended), turned 30 ° to the opposite side of the block. The foramen ovale was identified under CT guidance and a virtual track was made starting from a point which was 2-3cms lateral to the angle of mouth on the skin to foramen ovale (Figure 1). Once the trajectory of the needle and the foramen ovale was confirmed on CT scan, the skin at the point of entry was infiltrated by 2ml of 2% xylocaine using a 25G needle. Then, a 22G spinal needle was inserted at the same point and aimed in the direction of planned trajectory towards the foramen ovale (Figure 2). To prevent the needle from entering the oral cavity, a finger from inside the mouth can be used to guide the same [10]. Though, we did not apply this in any of our patients. Following this, negative aspiration was attempted to check for Cerebro Spinal Fluid (CSF) or blood aspirate. If the aspirate contained CSF or blood then the needle had to be readjusted. Then 0.5ml of mixture made from 1ml of iohexol and 2ml of 2% xylocaine was injected into the target site in order to check the spread of injectant and exact needle tip position. Once the tip of the needle touches the mandibular nerve root, the patient might complain of the exact similar pain which he/she has been suffering, thus confirming the accurate needle tip location. This injectant acts as a diagnostic block if the trigeminal ganglion is the pain generator with xylocaine providing anesthesia prior to alcohol injection. A mixture containing 3ml of 100% alcohol, 1ml of iohexol and 1 ml of saline was made. Of this 1ml of the mixture was injected into the foramen ovale (Figure 3 and 4). Post procedure check scan was performed to rule out any complication. Result Exact position of the needle tip in the foramen ovale was seen in all the six patients thus achieving 100% technical success. All these patients achieved a significant level of relief with an average pain score of two immediately after the procedure. Twenty four hours after the procedure, they rated their reduction of pain at an average pain score of one. Four out of the six patients ie Patient No. 1, 2, 4 and 6 were completely relieved of their pain with one year follow up without taking any medication. In Patient No. 3, the procedure was abandoned as during the diagnostic block, the injectant was seen tracking into CSF cistern and fourth ventricle. Patient No. 5 reported with a similar pain of TN within three months with a pain score of five, little less than the pre-procedure pain score of six. The pain was more severe in the pterygopalatine segment, hence a pterygopalatine block was carried out and the patient had a pain score of one twenty four hours after the procedure. Hence, the initial trigeminal neurolysis was partially successful in this patient. No post procedural complication was seen in any of our patients. Discussion The trigeminal nerve arises from the lateral pons at its superior to mid portion. It travels forward in posterior fossa and merges with the trigeminal ganglion in the Meckels cave. The trigeminal ganglion is located lateral to the cavernous sinus. It gives three divisions ophthalmic (V1) segment which emerges from superior orbital fissure, maxillary (V2) from foramen rotundum and mandibular (V3) from foramen ovale. The trigeminal nerve provides sensation for the face, mouth and supplies the muscles of mastication. TN mostly involves maxillary division and mandibular division of trigeminal nerve though it may also involve the ophthalmic division as well. The reported annual incidence rate of TN is about 4.5 per 100,000 persons [11] but the actual figures may be even much higher because of diagnostic challenges associated with the disease. TN is more common in females than males with a ratio of 3:2 and is usually seen after 50 years of age [11]. Trigeminal nerve block is an upcoming treatment in TN patients who are refractory to medical line of management. It relieves the pain and also reduces the side effects of drugs which are used for the treatment. Earlier studies were mainly done using x-ray or fluoroscopic guidance which had its own limitations in terms of image quality and two dimensional views. In contrast to this, CT scan provides excellent and direct visualization of foramen ovale leading to correct placement of needle [12] and thus scoring over fluoroscopy. This reduces the chances of injecting neurolytic agents at improper locations and thereby reduces the side effects. In our cases, initial check CT scan was done by injecting 1ml of iohexol to determine whether the needle is in exact location. This doubly ensured us about the location as well as the spread of injectant. This was different from previous studies done using fluoroscopy where a diagnostic block using xylocaine had to be given in order to confirm the location of the needle tip. We used a mixture of 3ml of 100% alcohol, 1ml of iohexol and 1ml of saline for trigeminal neurolysis however, Han et al stated that trigeminal nerve block with high concentration of lidocaine (10%) is capable of achieving an intermediate period of pain relief, particularly in patients with lower pain and shorter duration of pain prior to the procedure [13]. Alcohol spreads easily and should be used cautiously. The other agents which can be used but were not used in our study are phenol and glycerol. The side effects that may follow the procedure are numbness and hypoesthesia in the entire trigeminal nerve distribution. There can be abolition of corneal reflexes which can produce exposure keratitis and dryness of eyes. Improper injection of alcohol into CSF space can lead to arachnoiditis/ meningitis. CASE 1, 2, 4 and 6 These patients were suffering from trigeminal neuralgia with pain score ranging from six to eight before the procedure. All these patients have been taking carbamazepine for more than three months with no relief from pain. MRI showed no neurovascular conflict. These patients had a significant relief of pain with pain score at three months and twelve months being zero. None of these patients had to take oral medicines after the procedures. Fig 1: Site marked for needle Fig 2: Tip of the needle in foramen insertion ovale Fig 3: Dispersion of injectant in Fig 4: 3D reconstruction showing the foramen ovale needle tip in foramen ovale. Case 3 This eighty year old male came with complains of left sided trigeminal neuralgia. He had been taking carbamazepine for four months with no change in pain intensity. The procedure had to be abandoned as after injecting the diagnostic block, the injectant was seen tracking into the CSF cistern in the cerebello pontine angle and fourth ventricle (Figure 5). Fig 5: CT scan showing needle tip in the left foramen ovale Case 5 This forty seven year old female came with complains of right sided trigeminal neuralgia. She had been taking carbamazepine for three months without any relief in pain. MRI scans showed no neurovascular conflict. The procedure was successful with pain score of one immediately after and at twenty four hours after the procedure (Figure 6). However, this patient came back within three months of the procedure complaining of pain, which was more in the pterygopalatine segment. A pterygopalatine block was done with resultant pain score of one at twenty four hours after the procedure and two at nine months of the procedure. Hence, this patient showed partial response to trigeminal neurolysis carried out initially. Fig 6: CT scan showing the tip of the needle in right foramen ovale. Conclusion Percutaneous injection of alcohol, iohexol and saline mixture at the verge of foramen ovale under CT guidance is an effective and promising method to relieve pain in patients of TN refractory to medical line of management. This technique is inexpensive, cost effective and a relatively painless procedure. Being a minimally invasive technique, the chances of any infection and other post operative complications are less. Since our study involved only six patients, this technique needs to be further evaluated on a large sample size to substantiate the result of this procedure. Having said the above, we would like to emphasize that our initial experience of this procedure was quite impressing. Abbreviations TN Trigeminal Neuralgia CT Computed Tomography CSF Cerebro Spinal Fluid MRI – Magnetic Resonance Imaging References Andre ´ N. Traite ´ sur les maladies de l’ure`thre. Paris: Delaguette, 1756 Merskey H, Bogduk N. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Seattle: IASP Press; 1994. P. 59-71 Jannetta PJ. Microvascular decompression of the trigeminal nerve for tic doloreux. In: Youmans ed. Neurological surgery 4th edn. WB Saunders Co. Philadelphia. 1996: 3404-15 Cruccu G, Gronseth G, Alksne J, et al. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008; 15 (10): 1013-28 Gronseth G, Cruccu G, Alksne J, et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008; 71 (15): 1183-90 Michael D. Chan, Edward G. Shaw, Stephen B. Tatter. Radiosurgical Management of Trigeminal Neuralgia. In: editor Pollock Bruce, Intracranial Stereotactic Radiosurgery, an Issue of Neurosurgery Clinics. Elseiver Health Sciences. 2013. pp. 613-621 Cruccu G, Truini A. Refractory Trigeminal Neuralgia. Non-surgical treatment options. CNS Drugs. 2013 Feb;27(2):91-6. doi: 10.1007/s40263-012-0023-0. Hartrick CT, Kovan JP, Shapiro S (December 2003). The numeric rating scale for clinical pain measurement: a ratio measure? Pain Pract 3 (4): 310–6. doi:10.1111/j.1530-7085.2003.03034.x. PMID 17166126. Wong-Baker FACES Pain Rating Scale Foundation: Retrieved 6 December 2009. Michael J. Cousins In: trigeminal nerve block. Cousins and Bridenbaughs Neural Blockade in Clinical Anesthesia and Pain Medicine. Lippincott Williams Wilkins, 29-Mar-2012, 410 Allan B. Wolfson, Gregory W. Hendey, Louis J. Ling, Carlo L. Rosen, Jeffrey J. Schaider, Ghazala Q. Sharieff. In: Bell’s palsy and trigeminal neuralgia. Harwood-Nuss Clinical Practice of Emergency Medicine. Lippincott Williams Wilkins. June 23, 2009, 786 Và ­ctor Whizar-Lugo MD, Francisco Anzorena-Vallarino MD, Roberto Cisneros-Corral MD, Ricardo Valdez-Jeres MD, Rogelio Hernà ¡ndez-Velazco DDS. Use of Computed Tomography Guide for Trigeminal Alcohol Neurolysis. Anestesia en Mexico: Volume 20 No. 1 (January-April 2008) Han KR, Kim C, Chae YJ, Kim DW. Efficacy and safety of high concentration lidocaine for trigeminal nerve block in patients with trigeminal neuralgia. Int J Clin Pract. 2008 Feb;62 (2):248-54. Epub 2007 Nov 23.

Rejection :: essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  Someone once told me that life is not always fair; that some days are better than others are. Men do not care for this rule and we want everyday to be great, perfect and full of joy; but deep down we know it cannot be. We refuse to accept the unfairness of life though; we resist in our own unique ways to every bad thing that happens in our lives. We have been known to resist violently, lashing out at others in rage; and we have been known to bear the pain ourselves without rage and violence. Either way we find a way to deal, but dealing is not our game in life; we would rather solve the problem than to risk defeat. However, there are times and situations that cannot be solved; that judgment and result are given in one sweeping blow that can knock the wind out of our self-esteem or knock us out completely. These types of problems cannot be avoided if a male wants to have a normal and productive life. It is a matter of our approach and our dealing with the result t hat will give us a learning tool for future problems. The problem I want to ad-dress is dealing with rejection by a woman in two different stages: pre-relationship and during the relation-ship.   Ã‚  Ã‚  Ã‚  Ã‚  When I say pre-relationship I am trying to say is asking a woman out on a date. For most men this is the trickiest part of the relationship, and the most feared because of that. Men also have a portion of self-doubt in themselves when it comes to persons of the opposite sex that they find attractive. They will go through a period where they try to talk themselves out of asking a woman on a date by using the self-doubt. They will try to convince themselves that they are not good enough for the woman and therefore should not try. This is a subconscious defensive tactic to avoid rejection; because you cannot be rejected if you do not try. Self-doubt is the first snag that needs to be reckoned with before pursuing any relationship.   Ã‚  Ã‚  Ã‚  Ã‚  To overcome self-doubt you need to believe in yourself in and out. You need to show people that you are confident and believe that you are confident as well; if you cannot convince yourself, it will be ex-ponentially harder to convince others.

Mafia - Original Writing :: Papers

Mafia - Original Writing â€Å"Bang, bang, bang!† Francesco fell to the ground with a thunderous thud. His body on top of Fabio’s, who was taken out only moments earlier. Marco was the only one left; this attack has completely gone wrong. He hid behind a crate in the dark room, surrounded by five other men, all his compatriots have been killed or seriously injured. â€Å"Bang, bang† Marco shot blankly around the room; his inexperienced had just cost him dearly, those two shots gave a clear indication of his whereabouts. One of the men crept up behind him, and smashed his solar plexus with a baseball bat. Soon all five men were circling around him; an elbow struck him in the face, at this point his vision was blurred he couldn’t see clearly anymore. Shortly after the attack towards his face, he received a huge blow in the kidney area, he slowly went down. He could hear the chatter amongst the five men; he could hear their footsteps walking away from him. Marco’s once gigantic figure, lay there motionless, in too much pain to move any part of his body. Thoughts started rushing through his head, the events of the past week, has completely changed his life. A week ago, 16th July 1928, Marco Camoranesi was an ordinary man, earning average income, as a taxi driver in the busy street of New York. That night at about 1:30 in the morning, two middle-aged men entered his taxi. Marco approached them in his usual friendly way, but he soon realized that these men weren’t your ordinary New-Yorker. â€Å"Just loose those two cars behind us, you will be rewarded.† Marco was frightened, he knew that there were Mafia gangs around where he lived, but he was one of those people that thought that he was never going to see or be involved in their activities. â€Å"B†¦..but†¦Ã¢â‚¬  Marco stutters, but he had no chance to finish, as one of the men behind him put a gun on his head, â€Å"Drive!!!† Marco had no

Art, Surrealism, and the Grotesque Essay -- Exploratory Essays Researc

The term "grotesque" in art and literature, commonly refers to the juxtaposition of extreme contrasts such as horror and humor, or beauty and monstrosity, or desire and revulsion. One function of this juxtaposition of the rational and the irrational is to subdue or normalize the unknown, and thereby control it. The simultaneity of mutually exclusive emotional states, and the discomfort it might cause, inspires a Freudian analytic critical approach because of its focus on controlling repressed desires through therapeutic rationality. There are volumes of Freudian art criticism, which typically begin by calling attention to manifestations, in some work of art, of the darkest desires of the id. Perhaps in no field of art criticism does Freud's name appear more frequently than in surrealism, and for various reasons, the grotesque figures very strongly in that art movement. From the association of surrealist art and Freud, we can derive a cursory understanding of the grotesque in this breed of Modernist art: the grotesque appears as an image, the content of which might traditionally be repressed, but instead, it is expressed within the controlled confines of a work of art. The psychoanalytic critic will focus on the simultaneous attraction to and repulsion from the dream- like imagery on the surrealist canvas. Yet, this does not consider the surrealist notion of art as a liberation of the subconscious, nor does such analysis adequately incorporate the surrealist goal of political revolution. Instead, it reduces surrealist art criticism to the interpretation of dreams. This Freudian view becomes too limiting of our understanding of surrealism, the grotesque, and perhaps even of ourselves... ...d Practice of Dream Interpretation." in Freud: Therapy and Technique. ed. Philip Rieff. New York: Collier Press, 1963. pp. 205-235. Heidegger, Martin. "What is Metaphysics?" in Basic Writings, ed. David Farrell Krell. New York: Harper & Row, 1977. Plank, William. Sartre and Surrealism. Ann Arbor: Univeristy of Michigan Research Press, 1972. Sartre, Jean-Paul. Nausea. trans. Lloyd Alexander. New York: New Directions, 1964. ------- The Psychology of Imagination. trans. Bernard Frechtman. New York: Washington Square Press, 1966. ------- The Writings of Jean-Paul Sartre: A Bibliographic Life Chicago: Northwestern University Press. Interview with Claudine Chonez in Marianne, Dec. 7, 1938. ------- "What is Literature?" and Other Essays. Trans. Steven Ungar. Cambridge: Harvard University Press, 1988.

Understanding The Process Of Laundry Detergency Environmental Sciences Essay

Detergency is a procedure where dirts are removed from substrate stuffs. It ever is reviewed and researched because of its commercial importance. Washing and cleansing is a complicated procedure because it involves interactions of much physical and chemical influence. In general, rinsing procedure contains remotion by aqueous surfactant solution of ill solute thing and disintegration of drosss from fabric surfaces [ 1 ] . 2. Preliminaries Before discoursing how detergents work in rinsing procedure, we have to cognize how dirts adhere to cloths and the different types of dirts. In the present, the substrate is a fabric normally, fabricated by knitting, weaving or blending together a batch of fibres which have spun into narrations before incorporation into the fabric. Soil is something present in the matrix of the fabric but differs from the fabric fibres both in composing and form, while characteristically is of a comparable size. Dirt may be liquid or solid. If it is liquid, it must be non-volatile and non-aqueous. The liquid dirt here is termed oily dirt to separate from the solid particulate dirt. These two types of dirts may happen together: an external atom is more possible to adhere to fabrics when the latter already has liquid dirt. There are two chief differences between liquid dirt and solid dirt: form and rheological belongingss. The greasy dirt alterations shape by and large while the particulate dirt holds its initial form all the clip [ 2 ] . No affair liquid or solid, both sorts of dirt adhere to the fabric because of a effect of Van Der Waals and interrelated interactions between the dirt and the substrate. 3. Washing Procedure 3.1 Structures The most important ingredients in detergents are chemicals called wetting agents. The word aa‚ ¬Aâ€Å"surfactantaa‚ ¬A? comes from aa‚ ¬Aâ€Å"surface active agentsaa‚ ¬A? and as defined, the wetting agents are chemical signifiers which tendency to concentrate or better to adsorb at interfaces, or to organize colloidal sums in solution at really low molar concentrations. As shown in Figure 1, it is obvious to bespeak the basic demand of wetting agents is combination of hydrophilic and hydrophobic parts in molecules, i.e. amphiphilic molecules. When the wetting agents dissolved in H2O, they will prefer to hold an orientation that can minimise inauspicious interactions between hydrophobic molecular subdivisions and aqueous stage ( Figure 2 ) . Figure 1 Structure of Wetting agents Beginning: pubs.caes.uga.edu/caespubs/pubcd/B1319/B1319.html Figure 2 Wetting agents dissolved in H2O Beginning: slides of talks Therefore, there are several signifiers when wetting agents are in solutions ( Figure 3 ) . Figure 3 Different signifiers of wetting agents 3.2 Mechanism As the cardinal construction of wetting agents mentioned, the lavation procedure is easy to explicate. To do H2O wash better, surface tenseness has to be reduced so H2O can wet things more uniformly. That is exactly what a wetting agent does. The wetting agents in detergents improve H2O ‘s capableness to wet things, spread over surfaces, and ooze into soiled apparels fibres. Wetting agents do another of import occupation excessively. In the solution incorporating the wetting agents whose molecules adsorb on the surface of dirt and fabrics at the same time, the hydrophobic portion of their molecule is attracted to H2O, while the other portion is adhering to dirt and grease. Neither detergents nor soap accomplish anything except adhering to the dirt until some mechanical energy or agitation is added into the equation [ 3 ] . So the wetting agent molecules help H2O to acquire a clasp of lubricating oil, interrupt it up, and wash it off ( Figure 4 ) . Figure 4 Illustration of the particulate dirt remotion If the dirt is oily, it will scatter in solution as emulsion, while it is particulate, it disperses as suspension. 4 Components Used for wash, the detergents ever contain wetting agents, builders, enzymes, decoloring agents, and other minor additives such as optical brighteners, fabric softeners, and scattering agents [ 4 ] . Among them, wetting agents and builders are the two most of import ingredients. 4.1 Wetting agents As an abbreviation for surface active agent, wetting agents remain the most of import constituents for the development of cloth attention and place attention merchandises [ 5 ] , consisting from 15 % to 40 % of the entire detergent preparation [ 6 ] . Wetting agents used in detersive preparations can be classified into four groups harmonizing to the hydrophilic group: non-ionic detergents, nonionics, cationics, and zwitterionics. In the usage of detergent composings, alkylbenzene sulfonates, alkyl sulphates alcohol ethoxylates, kats, and betaine are popular, and biodegradable wetting agents such as APG and MES will be a development tendency in the detergent composings [ 4 ] . Nowadays, mixed active preparations are popular worldwide because they offer the advantage of good public presentation over a wider scope of wash conditions and let makers flexibleness with regard to surfactant supply and demand [ 7 ] . Besides at the same clip the commixture helps to stay mile to the tegument of custodies. 4.2 Builders A possible builder should fulfill a big figure of demands including sequestering ability, alkalinity, buffer capacity, bleach compatibility, dirt deflocculation, unwritten toxicity, skin soaking up, oculus annoyance, effects on fish and other aquatic animate beings, and other environmental and economic practicableness [ 8 ] . We use builders to take Ca2+ and Mg2+ ions in difficult H2O and in dirts, for ever wetting agents can non work efficaciously in H2O particularly in difficult H2O. And the great sum of wetting agents in the detergent preparations increases the figure of troubles and the costs of sewerage disposal. Figure 5 Structures of polydimethyl siloxanes and their derived functions [ 4 ] We have ionic, organic and polymer builders [ 4 ] . In the Attic, Sodium tripolyphosphate ( STPP ) was the most used in the yesteryear. However, for phosphates can easy do a batch of environmental jobs that later, we use organic builders such as EDTA, NTA, ODA, IDA, and so on as a replacement for STPP. But still question their clean efficaciousnesss, inauspicious ecological or toxicological influences, and the cost. Besides, we use borates and zeolites as ionic builders, and now multifunctional builder is demanded, such as superimposed crystalline silicate ( Na2Si2O5 ) which combines a high public presentation per unit mass with a high grade of multi-functionality [ 9 ] . Polymeric builders have good builder capacity but most of them are non of course biodegradable. So now a bio-based polyester co-builder, which is found to be non-toxic to aquatic life is invented [ 10 ] . 4.3 Enzymes Encapsulated enzymes have been used worldwide for 40 old ages in detergent merchandises, particularly laundry preparations, and for biodegradability and functionality at low temperatures, its importance additions [ 11 ] . Enzymes can assist to better detergence, such as peptidase, amylase, cellulase, and lipase. Alkaliphilic Bacillus strains are frequently good beginnings of alkaline extracellular enzymes to be used in detergents [ 12 ] . Before people think enzymes in detergents ever cause allergy, but now this has been changed and substituted by the recommendation of carefully use by the practician. 4.4 Bleachs We use bleaches to destruct unwanted discolorations on the cloth, and besides dyestuff in solution which causes hemorrhage. Laundry detergents typically contain percarbonate or perborate salts as bleach systems [ 13 ] . The bleach activity ever requires a suited temperature. For the energy economy and other restricts, scientists focus on new accelerators to make the same clean efficaciousness at a comparatively low temperature. However, at the same clip of decoloring discolorations, bleaches besides increase melting degree of the fabric [ 14 ] . As used in day-to-day lavation, we besides have to see the built-in toxicity and toxic by-products of decoloring additives. 4.5 Other Additives Some laundry detergents contain â€Å" optical brighteners † . These are fluorescent dyes that glow blue-white in UV visible radiation which can do yellowed cloths appear white [ 15 ] . Fabric softeners are to cut down the clash between fibres, and between fibres and the tegument. They are frequently a cationic wetting agent, which is attracted to the negatively charged substrates like proteins and many man-made cloths. Scattering capacity is a step of how a liquid stage influences a solid stage [ 16 ] . From some respects it decides the cleansing capableness. We add some scattering agents into the detergents to better the decreasing of the surface tenseness so increase the efficaciousness of detergents. 5. Development Scientists are concentrating on detergents for wash which are biodegradable, effectual, and low toxic to clamber. Biosurfactants are possible the replacements for chemical wetting agents. Compared with chemical wetting agents, they are better in biodegradability and effectivity at utmost temperature or pH and in holding lower toxicity [ 17 ] . However, it is difficult to happen a balance between the hydrolytic and the biodegradability, non merely for the wetting agents, but besides for the enzymes and other additives in the detergents [ 18 ] . Now many biosurfactants are tested for utilizing in laundry preparations, as what Mukherjee AK [ 19 ] and Srokova I [ 20 ] have done. To salvage energy and H2O, there is a tendency of concentrated detergent, and besides it is environment friendly [ 21 ] . And different new sorts of additives are added as softeners, odor-removers, antibacterial constituents, and others which can give detergents multifunction.

You Suck: A Love Story Chapter 21~22

Chapter Twenty-one Ladies and Gentlemen, Presenting the Disappointments He was the best one-handed free-throw shooter in the Bay Area, and that Christmas night he had sunk sixty-four in a row in his driveway hoop, shooting the new leather Spauldingball his dad had left under the tree for him. Sixty-seven in a row, without ever setting down or spilling his beer. His record was seventy-two, and he would have broken it, had he not been dragged off into the bushes to be slaughtered. Jeff Murray was not the smartest of the Animals, nor the most well-born, but when it came to squandering potential, he was the hands-down winner. Jeff had been a star power forward through his sophomore, junior, and senior years in high school, and he had been offered a full-boat ride to Cal, Berkeley – there had even been talk of his going pro after a couple of years in college, but Jeff had decided to impress his prom date by showing her he had enough vertical leap to clear a moving car. It was a minor misjudgment, and he would have cleared the car had he not drunk most of a case of beer before the attempt, and had the car's height not been eight inches enhanced by the light bar on the roof. The light bar just caught Jeff's left sneaker, and somersaulted him four times in the air before he landed upright in a James Brown split on the tarmac. He was pretty sure that his knee wasn't supposed to bend that way, and a team of doctors would later agree. He'd wear a brace forever and he'd never play competitive basketball again. Although he was a smokin' one-handed H.O.R.S.E. player, and he might have even been a champion if it weren't for that slaughtered-in-the-bushes thing. He liked the new leather ball, and he knew he shouldn't be using it on the asphalt, and especially this late at night, when the sound of his dribbling might disturb his neighbors. He lived in a garage apartment in Cow Hollow, and the fog was blowing in damp streams up his street, making the basketball sound lonely and ominous, so no one complained. It was Christmas – if all some poor bastard had was some hoops, then you'd have to be a special kind of heartless to call the cops on him. A car turned at the end of the street; blue halogens swept through the fog like sabers, then went out. Jeff squinted into the fog, but couldn't make out what kind of car it was, only that it had stopped a couple of doors down and it was a dark color. He turned to take his record-breaking shot, but distracted, he put a little too much backspin on the ball and it jumped out of the hoop. He ran it down at the junipers by the garage, but was only able to tip it, so that it went into the bushes. He set his beer down on the driveway and went in after it, and – well, you know†¦ Francis Evelyn Stroud answered the phone on the second ring, as she always did, as it was proper to do. â€Å"Hello.† â€Å"Hi, Mom, It's Jody. Merry Christmas.† â€Å"And to you, darling. You're calling rather late.† â€Å"I know, Mom. I was going to call earlier, but had a thing.† I was a thing, Jody thought. â€Å"A thing? Of course. Did you get the package I sent?† It would be expensive and completely inappropriate, a cashmere business suit, or something in a houndstooth or a herringbone, something worn only by matronly academics or matronly spies with stout poison-dart shoes. And Mother Stroud would have sent it to the old address. â€Å"Yes, I got it. It's lovely. I can't wait to wear it.† â€Å"I sent a leather-bound set of the complete works of Wallace Stegner,† Mother Stroud said. Fuck! Jody kicked at Tommy for making her call. He skipped out of range, waving a scolding finger at her. Of course. Stegner, the Stanford paragon. Mother was one of the first coeds to graduate from Stanford and she never missed an opportunity to point out that Jody hadn't gone there. Jody's father had also gone to Stanford. She was born to Stanford, and yet she had disgraced them by going to San Francisco State, and not finishing. â€Å"Yeah, those will be great, too. I guess they just haven't caught up with me yet.† â€Å"You've moved again?† Mrs. Stroud had lived in the same house in Carmel for thirty years. Carpet and draperies never survived more than two years, but she'd been in the same house. â€Å"Yeah, we needed a little more space. Tommy's working at home now.† â€Å"We? Then you're still with that writer boy?† Mom said ;writer; like it was a fungus. Jody scribbled on a Post-it at the counter: Note: Break Tommy's arms off. Beat him with them. â€Å"Yes. I'm still with Tommy. He's been nominated for a Fulbright. So, did you have a nice Christmas?† â€Å"It was fine. Your sister brought that man.† â€Å"Her husband, Bob, you mean?† Mother Stroud did not care for men since Jody's father had left her for a younger woman. â€Å"Well, whatever his name is.† â€Å"It's Bob, Mom. He went to school with us. You've known him since he was nine.† â€Å"Well, I had a smoked turkey delivered, and a lovely foie-gras-and-wild-mushroom appetizer.† â€Å"You had Christmas catered?† â€Å"Of course.† â€Å"Of course.† Of course. Of course. It would never occur to her that by having Christmas dinner catered, she was making other people work on Christmas. â€Å"Well, I put my present in the mail, Mom. I'd better go. Tommy's being honored at a dinner tonight because of his massive intellect.† â€Å"On Christmas?† Oh, what the fuck. â€Å"He's Jewish.† She could hear the intake of breath on the other end of the phone. This is the light version, Mom, imagine how scandalized you be if I told you he was dead and that I killed him. â€Å"You didn't tell me that.† â€Å"Sure I did. You must be losing details. Gotta go, Mom. I gotta help Tommy get his penis piercing in before the dinner. Bye.† She hung up. Tommy had been dancing naked in front of her for most of the phone call. When she hung up he stopped. â€Å"Did I mention that I worry about your ethical equilibrium?† â€Å"Said the guy who was just playing buff the scrotum with my red scarf while I was making the merry Christmas call to my mother?† â€Å"Admit it. You're a little turned on.† Dr. Drew – Drew McComber, the Ohm-budsman, the resident pharmacist and medical adviser to the Animals, was afraid of the dark. The fear had crept up on him, like a hash brownie, and coldcocked him with an inescapable paranoia after four years on the night crew at the Marina Safeway. Thing was, he awoke in the evening, to the pervasive grow lights in his garage apartment in the Marina, then drove four blocks under the streetlights to the brightly lit Safeway, then got off work in the morning when the sun was well off the horizon, to return to his grow-lit apartment, to sleep with a satin mask in place. He encountered darkness so infrequently that it seemed like a menacing stranger when he did. On Christmas night, round midnight, Drew sat among a jungle of five-foot-tall pot plants in his living room, wearing sunglasses and watching a movie on cable about the special relationship between the lady of an English manor and her chimney sweep. (Because of his work schedule, and the constant demand to stay wasted, Drew found it difficult to keep a girlfriend. Until the Animals found Blue, his sex life had been a largely solitary affair, and (sigh) apparently had become so once again.) Each time the chimney sweep's sooty hand smacked the powdered bottom of the lady of the manor, Drew grieved a little – that dusky handprint on alabaster flank falling like a shadow on his erotic soul. There was arousal, but no joy. Sad and lonely wood did tent his hemp-fiber cargo pants. Then, as if scripted by Erecto, the Generously Endowed Pizza Delivery God of Improbable Trysts, there was a knock at Drew's door. Rather than answer the door directly, Drew adjusted himself and ambled through the ganja forest to a small video screen in his kitchenette – a video peephole. He'd installed it in the days before his doctor had given him the prescription that made him a quasilegal medical marijuana grower (patient complains that reality harshes his mellow – prescribe 2 grams cannabis every three hours by inhalation, ingestion, or suppository). Sure enough, as if he had called in an order, the video screen revealed a pale but pretty blonde standing on his doorstep in a conservative blue cocktail dress and heels. She might have just come from a party or a dinner out – her hair was pinned up with tiny blue bows. She might have shown up to audition for the role of the lady of the manor. Drew keyed the intercom. â€Å"Hi. Are you sure you have the right house?† â€Å"I think so,† said the girl. â€Å"I'm looking for Drew.† She smiled into the camera. Perfect teeth. â€Å"Jeez,† Drew said, then realizing that he had said it allowed, he cleared his throat and said, â€Å"I'll be right there.† He smoothed his erection down, pushed his hair behind his ears, and in five long strides he was through the forest and at the front door. At the last second he remembered the sunglasses, pushed them up on his head, smiled broadly, and threw open the door, releasing a wide beam of ultraviolet light into the night fog. The pretty blonde dropped her smile, then screamed as she burst into flames and leapt out of the light. Drew ran out into the dark to save her. Chapter Twenty-two Being the Chronicles of Abby Normal: Pathetic Nosferatu Noobsicle Well, except for the murder, Christmas was like a slow drag over broken glass – I now truly know the ennui of passing eternity in total boredom – eating and hurling to-furky all day, stuck with Ronnie and Mom until like six, when Jared came over. His father has a fresh family with little crumb-snatcher stepsisters, so they like forget about him as soon as the squealing and presents start in the morning. He spent the whole day rewatching The Nightmare Before Christmas disc in his room and smoking cloves. His room is totally sacrosanct since he told his ‘rents that he couldn't guarantee that he wouldn't be masturbating to gay porn if anyone came in. (He's so lucky sometimes – I could stand on my head and flick the bean right there at the dinner table and my mom would be all, â€Å"Honey, Christmas is family time, we should be together† and make me finish in front of everyone.) So, we like watched The Nightmare Before Christmas disc with Mom and Ronnie until they fell asleep on the couch – then Jared and I drew some really cool tribal tattoos on Ronnie's shaved head with Magic Marker, but only like in red and black, so they look real. Then he was all, â€Å"We should go get some coffee – my aunt gave me a hundred-dollar Starbucks gift card for Christmas.† And I hate it when people brag about their Christmas presents, because it's completely shallow and materialistic. So, I was all, â€Å"Yeah, well, I'd love to, but I am now one of the chosen, so I have duties.† And he was all, â€Å"No way, you're Jewish?† And I was all, â€Å"No, I am nosferatu.† And he was all, â€Å"You are not.† And I was all, â€Å"Remember that sexylicious guy from Walgreens. It was him. Well, actually it's the Countess who brought me into the sacred circle of sanguinity.† And he was all, â€Å"You didn't even call me?† â€Å"I'm sorry, Jared, but you are of an inferior species now.† So he goes, â€Å"I know, I totally suck.† And I know he's going to go all tragico-emo on me. So I say, â€Å"Buy me a Mochaccino and I'll reveal to you our dark ways and stuff.† We leave a note saying that Jared has impregnated me and we're running off together to join a satanic cult, so my mother won't panic when she wakes up, because she's totalitarian about leaving notes. Then we head to the SOMA. But apparently, the entire fucking country shuts down on Christmas, slammed under the oppressive iron fist of the baby Jesus, so out of nine Starbucks we try, all are closed. And Jared is all, â€Å"Take me to meet them. I want to be in the dark fold, too.† And I was all, â€Å"No way, loser, your hair is totally flat.† Which it was. He only had the one spike in front, and his sculpting gel had like failed hours ago, so in his PVC raincoat, he kinda looked like a black lacquer coatrack like you see in Chinatown, but that wasn't why I couldn't take him to see the Countess and my Dark Lord. I just couldn't. I knew the Countess would freak out if she saw I was exploiting her exquisite gift to show off for a friend, so I was all, â€Å"It's very secret.† But Jared started to pout and brood at the same time, which he can totally pull off because he practices, so I started to feel like a malodorous soupà §on of mashed assholes, as Lautramont so aptly put it. (Shut up, Lily says it sounds more romantic in French.) So I let him come, but I told him he had to say outside across the street. But when we came around the corner of the Dark Lord's block, there was a guy in a yellow tracksuit standing in the middle of the street. Just standing there, with his hood up and his head down, looking like he was going to stand there forever. And he turned really slow in our direction. Jared was all, â€Å"Wanksta rappa,† in my ear, and he giggled that high-pitched little-girl giggle he does sometimes that's like violence catnip to other guys. (Which is why Jared has to carry a foot-long double-edged dagger in his boot, which he calls his Wolf-fang. Fortunately it doesn't give him any false confidence and he is still a total puss, but he likes the attention he gets when doormen take it away from him at clubs.) Anyway, I think my vampyre senses were, like, on edge, because I could just tell that this wasn't your normal hip-hop guy standing in the middle of a deserted street in a three-hundred-dollar tracksuit at midnight on Christmas night, so I grabbed Jared's arm and pulled him back around the corner. And I'm all, â€Å"Dude. Shields up. Creep. Stealth. Lowest profile.† So we peek around the corner, totally cloaked this time, and the tracksuit guy is like over by the door of the loft, and someone is coming out. It's the crusty old drunk guy with the huge shaved cat, and he has his unit out, like he's going to take a leak, which I could have gone another sixteen years without seeing. And Tracksuit grabs him like he's a rag doll and pulls his head back by the hair, and bites him on the neck. And when he does, I can see that it's not a hip-hop guy at all, but some crusty white vampyre, his fangs were like visible from space. So the huge cat guy is thrashing and screaming and spraying whiz all over the place and I can hear the huge cat hissing behind the door, and Jared grabs me by my messenger bag and starts pulling me away, down the street. So that's all I saw. And Jared was all, â€Å"Whoa.† And I was all, â€Å"Yeah.† And as soon as we got a few blocks away, I pulled out my cell and called the Countess's cell, but it went right to voice mail. So now we're at a special midnight showing of The Nightmare Before Christmas at the Metreon, drinking a huge Diet Coke to calm our nerves while we wait for a return call from my vampyre coven. (Jared forgot his inhaler and has been gasping since we saw the attack. It's so embarrassing. People are like looking, and I've moved a couple of seats over so they won't think I'm giving him a hand job or something.) I am totally overcome with dread and foreboding, and the time passes like a seeping infection on a bad eyebrow piercing. So we wait. I wish we had some pot. More later. Oh yeah, and Mom got me a green Care Bear for Christmas! I totally love it. â€Å"You're sure this is where you left it?† Jody was looking up and down the Embarcadero. There were no people out on the street – the performers and hustlers were long gone. She could hear the Bay Bridge humming in the distance, a foghorn started to low over in Alameda. A BART train burped out of a tunnel onto the street a block away, headed toward the ballpark, empty. A police cruiser turning out of Market Street strafed them with its headlights before heading past the Ferry Building toward Fisherman's Wharf. Tommy waved to the cops. â€Å"Yeah. I was right here and my watch went off. He weighed a ton. It would have taken a bunch of guys to move him.† Jody saw something shining on the bricks near her feet and crouched down to touch the source. Metal filings of some sort. She licked her finger and came up with a coating of yellowish metallic particles on her fingertip. â€Å"Unless someone cut it up.† â€Å"Who would do that? Who would cut a statue up and steal the pieces?† â€Å"Doesn't matter. Maybe thieves, maybe city workers. If someone cut that bronze shell, one of two things happened. If it was daytime, Elijah fried out here in the sun. If it was dark, he's free.† â€Å"It wasn't light, was it?† Jody shook her head. â€Å"I'm guessing no.† She saw a light pattern among the bricks a few steps away and crouched down again. There was a fine, grayish powder between the bricks. She pinched some between her fingers and shook her head. â€Å"For sure no.† â€Å"What? What is that?† She brushed her finger off on her jeans and dug into her jacket pocket. â€Å"Tommy, remember I told you that you didn't drink the whore dry because she wouldn't have been there if you had?† â€Å"Yeah.† â€Å"Well, that's because when a vampire drains someone – when we drain someone, they turn to a fine gray powder. I can't explain why, but it looks like that. Feels like that.† She pointed to the mortar lines between the bricks. Tommy knelt down and touched the powder, looked up. â€Å"How do you know that?† â€Å"You know how I know that?† â€Å"You've killed people.† She shrugged. â€Å"Just a couple. And they were sick. Terminal. They were asking for it, sort of.† â€Å"So that's why you weren't upset about the hooker?† She pulled her cell phone out of her jacket pocket, then held it behind her back and twisted back and forth looking at her feet, like a little girl being interrogated about how Mommy's lamp got broken. â€Å"Are you mad?† â€Å"I'm a little disappointed.† â€Å"Really? I'm really sorry. You would have done the same thing if you'd been there.† â€Å"I'm just disappointed that you didn't feel that you could trust me.† â€Å"You were having a hard time with your change. I didn't want to bother you.† â€Å"But it wasn't sexual or anything, right?† â€Å"Absolutely not. Purely nutritional.† She didn't think it necessary to tell him about kissing the old man. It would just confuse things. â€Å"Well, I guess it's okay, then. I guess if you had to.† He stood and she ran to him and kissed him. â€Å"I can't tell you how glad I am to have that off my chest.† â€Å"Yeah, well†¦Ã¢â‚¬  â€Å"Hang on.† She held up a finger and hit the power button on her phone. â€Å"Calling your mom to tell her she was right about your being a tramp?† â€Å"I'm calling the kid.† â€Å"Abby?† â€Å"Yeah. I need to tell her to stay away from our place. Elijah is going to start messing with us like before.† Jody watched as the little icons on her phone showed that it was searching for a signal. â€Å"But she said she wasn't coming by tonight. It's Christmas.† â€Å"I know she said that, but I think she may come by anyway.† â€Å"Why?† â€Å"Well, she has a thing for me, I think. I bit her last night.† â€Å"You bit Abby?† â€Å"Yeah. I told you, I was hurt. I needed – â€Å" â€Å"God, you're such a blood slut.† â€Å"I knew you'd be mad.† â€Å"Well, it's Abby, for fuck's sake. I'm her dark lord.† â€Å"Look, a voice mail.† Elijah Ben Sapir cast the twitching, pee-spraying alcoholic across the street, where he bounced off the metal garage door of the foundry and back out to the curb, where his head knocked the side mirror off an illegally parked Mazda. Then the vampire walked with exaggerated steps, his arms held out from his sides like a bad stage monster to try to keep the urine-sotted velour fabric of his tracksuit from contacting his skin. Although he had experienced all manner of filth and gore in his eight hundred years, and had, in fact, spent whole days hiding naked under loamy soil to escape the sun, he didn't remember being quite so put off as he was at being pissed on by his lunch. Perhaps it was that he only had one set of clothes now, and there was no luxurious yacht with a full wardrobe to retire to, or perhaps it was that he had spent the day between two urine-stained mattresses under an unconscious junkie while police searched the hotel around him. He'd just hit his limit, that's all. He'd known the desk clerk would give him up to the police, so as soon as he had gone to his room, the vampire had hidden his tracksuit in the corner of the closet, gone to mist, then slipped under the door into the next room and in between the mattress and box springs of a semiconscious junkie. He'd gone back to solid just as sunrise put him out for the day. At sundown, he was surprised at how elated he was to find the tracksuit still in the closet, after he fed off the junkie (just a sip) and snapped his neck. (Leaving more or less a greeting card to the homicide inspectors who had attacked him with the others at the yacht club.) Now his precious tracksuit was all covered in whiz and he was furious. He stalked over to where he'd thrown the bum and snatched him up by the ankle. Elijah was not tall by modern standards, but he found that if he held the bum's ankle high above his head, he could shake him sufficiently to get the job done. â€Å"You're not even her minion, are you?† Elijah banged the bum's head against the sidewalk to punctuate his question. â€Å"Please,† said the bum. â€Å"My huge cat – â€Å" Thud, thud, thud on the sidewalk. A little shake. Change, a few bills, a lighter, and a bottle of Johnny Walker rained out of the bum's pockets. â€Å"You're just her little moo cow, aren't you? I tasted her on you.† â€Å"There's a kid,† said the moo cow. â€Å"A spooky little girl. She takes care of them.† â€Å"Them?† Elijah flung the bum against the garage and proceeded to pick up the change and the bills on the sidewalk. The steel door next to the garage door opened and a burly bald man in overalls stepped out on the sidewalk, smacking a lead-tipped tire thumper on his palm. â€Å"You motherfuckers making enough noise out here?† Elijah bared his fangs and hissed at the biker, then leapt to the wall over the garage door and clung there, facedown, above the biker's head. The biker looked up at the vampire, down at the prostrate bum, then at the damaged Mazda. â€Å"Well, okay then,† he said. â€Å"I can see you fellas still have some shit to work out.† He slipped back into the foundry and slammed the door. Elijah dropped to his feet and headed up the street, not even bothering to stop to snap the moo cow's neck. How could he have been so stupid? He wasn't going to terrorize her by killing a food source. He needed to threaten her minion, just as he had with the boy. How could he have known that she'd actually betray him and choose the boy? Turn the boy? It wouldn't happen again. Amid all the anger, the hunger, and the excitement at having a purpose, Elijah Ben Sapir felt a twinge of heartache. He had begun this adventure thinking himself the puppet master; now he was all entangled in the strings. Making mistakes. No worry. He cocked his head and focused. Past the rasping breath of the moo cow, the buildings settling, the Bay Bridge humming, and a thousand hearts beating in the lofts around him, he could hear the retreating steps of the little girl and her friend.