Platos Theory of Forms Essay Example for Free

Platos Theory of Forms Essay Explain and define Plato’s theory of Forms with your personal Criticism. Plato was born in Athens on 428 BC. He was a Greek philosopher who laid foundations of western philosophy. He raised basic questions and problems of western thought, goodness and virtue, truth and knowledge, body and soul, ideal political state, and use of Literature and Arts were some of the pre dominant topics of interest to Plato. Plato devoted himself completely to philosophy. He was a student of Socrates. He was a great admirer of Socrates and he initially joined Socrates school of thought to learn philosophy. Later after the death of Socrates, he found an academy where geometry was most prominent in the curriculum along with mathematics and philosophy. He was also influenced from pre-Socratic thinkers like Heraclitus and Parmenides; who rejected physical world and said that inner is more important than believed apparent world. He was also influenced by mathematical concepts derived from Pythagoras. He learned dialectical method of following truth in order to derive a philosophy, ideas and opinions. According to Encyclopedia Britannica literally word Form means, â€Å"The external shape, appearance or configuration of an object in contradistinction to the matter of which it is composed. In Aristotelian Metaphysics, the active, determining principle of a thing as distinguished from matter, the potential principle. † (Encyclopedia Britannica, 2012) In Stanford Encyclopedia it is stated that, Plato’s term ‘eidos’ by which he identified the permanent reality that makes a thing what it is in contrast to the particulars that are finite and subject to change. The Platonic concept of form was itself derived from the Pythagorean theory that intelligible structures and not material elements, gave objects their distinctive characters. Theory of Forms states about what is real and what is not. The real is thought to be perfect whereas things which are not real are changing. Plato advocates that the world of forms is different from world of appearances. World of Forms can only be understood by philosophers and those who seek the truth. The dialogues in this theory portray knowledge as the process of leaving dark caves for going into sunlight. People who live in dark caves find their reality in shadows. These shadows are actually the symbol of the apparent world and it is just a shadow of what is real. Plato says that this world is not real; it is only the ‘world of forms’ which is real and never changes. It can be explained by many examples; for example we all try to seek knowledge but in reality what we learn is an opinion only. Likewise one thing is beautiful for someone but it can be ugly for someone else. People who have an urge to know and understand the true knowledge in the world can only touch the ‘intelligible world’. This world of objects is not independent because it depends on another real world of ‘pure forms or ideas’. Objects in this world have got their qualities from the ideal world. An object is beautiful because it takes that beauty from the ‘higher realm’. This concept of ideal Forms and forms of the world can be explained by geometry. Any square or triangle that we draw or construct is imperfect because it is ‘merely approximate the ideal triangle’. This ideal triangle has no connection with senses or reason because it is not concrete but a concept or an idea in the real world. Plato says that, the world of forms can be characterized as ‘changeless’ , ‘eternal’ and ‘real’ whereas physical world undergoes many changes and decay. The criticism on Plato’s theory of forms is that, he could not be able to draw a logical connection between ‘the realm of forms’ and ‘physical world’. According to Aristotle, this theory does not explain that how permanence and order can be attained in this world and how we can have objective knowledge of this physical world. Plato separated two worlds so distinctly that it failed to explain a former two points. The objectivity and permanence of real world does not explain this physical world hence establishes no strong connection between the two worlds. In my opinion Plato puts an argument that intellectual truth is truer than physical truth. This universe is created by God who is pure and the ultimate reality. He has no physical being but he has created a physical universe. This physical world is a copy of the real universe which only exists in the mind of creator. Similarly all horses are copies of one horse which exists at some higher land of truth. Likewise all beds are only copies of an ideal bed which lies in heaven probably. These examples are given by Plato to prove that world of forms is different from world of reality. It concludes that forms are relative and they are mere imitation of the real. The basic function of theory of forms is unification. It serves to unify ‘groups of objects or concepts’ by connecting them to a pure essence of the real world.

Investigation of Effectiveness of Clozapine

Investigation of Effectiveness of Clozapine Catarina Scott-Beaulieu Abstract: (250) Background: Clozapine is an atypical antipsychotic used for treatment-resistant schizophrenia. It is effective in treating the positive and negative symptoms of schizophrenia with a reduced chance of extrapyramidal side effects compared with other typical antipsychotics. Clozapine is known to have cardiac side effects including, but not limited to, myocarditis and cardiomyopathy. Approximately 75% of cases, of clozapine-induced myocarditis, occur within the first month of titration, highlighting the need for monitoring. Objectives: To assess the extent to which the monitoring guidelines for myocarditis, at a London mental health trust, are being followed. Method: Patients who were registered with ZTAS from June 2014 to October 2016, at the trust,  Ã‚   were identified. Data was collected based on the audit tool created from the guidelines. Using the patient notes and laboratory data, found using the trusts operating systems, data was collected and stored in the audit tool. Key findings: The monitoring standards were met for full blood count in the week prior to initiation and in week 3. No other standards were met. Conclusion: Introduction: (500-1000) Clozapine is the first atypical antipsychotic created and is used in treatment-resistant schizophrenia, which is defined as a lack of or an inadequate response to at least two antipsychotics.[1] It is a dibenzodiazepine derivative antipsychotic and interferes with dopamine binding with a strong affinity for D4-dopaminergic receptors   and 5-HT2a serotonergic receptor affinity [2], in addition it has an anticholinergic effect and antagonizes histaminergic receptors. [3, 4] Clozapine is useful in treating both the positive and negative symptoms of schizophrenia [4] and is less likely to cause extrapyramidal side effects when compared to first generation typical antipsychotics such as haloperidol[5, 6]. It has also been shown to significantly reduce the suicidal behaviors in schizophrenic patients [1, 7]. However, it is not used as a first line treatment due to its extensive side effect profile, most recognized being agranulocytosis which occurs in approximately 1% of patients in the first year of treatment [8, 9], explaining the need for regular, mandatory hematological tests for the duration of clozapine treatment. Other side effects include fever [4], metabolic effects and seizures.[4, 6, 10] Agranulocytosis, however, is not the only potentially fatal side effect of clozapine use. There is an increasing number of clozapine-related cardiac complaints reported in the literature, resulting in cardiac effects from clozapine treatment having become more recognized over the past few years. [5, 7] Whilst tachycardia is a common side effect it can be indicative of other, potentially more serious, cardiac effects such as cardiomyopathy and myocarditis. [9] Myocarditis is an inflammatory process of the myocardium, which is often of viral aetiology but may also include bacterial, fungal and drug-induced.[11, 12] The condition presents with a wide range of symptoms such as chest discomfort, flu-like symptoms and abnormal vital signs [9] and most are non-specific.[2] Reported cases of clozapine-induced myocarditis range from 0.15% to 1.2%,[5, 8, 13-15] with the highest incidence being reported in Australia, >1%. [16] Time to onset varies, but over 75% of cases occur within the first month of treatment. [12, 16-18] Endomyocardial biopsy was the gold standard for diagnosing myocarditis, but the procedure has only limited sensitivity and specificity. It was by proposed Ronaldson et al.[18] in 2011 that combining C-reactive protein (CRP) and troponin T/I would give a sensitivity for clozapine-induced myocarditis of 100%. This is a less invasive method of diagnosis, with a higher specificity and sensitivity for myocarditis and has led to the current guidelines that are in place for the monitoring of clozapine treatment. Whilst clozapine-induced myocarditis is still rare, the need for consistent monitoring within the first month of treatment is needed to ensure any possible cases are detected early, allowing for prompt treatment, increasing the chances of a better outcome for the patient.[1] This audit aims to assess the extent to which the monitoring guidelines for myocarditis, at a London mental health trust, are being followed. Assessments will explore the extent to which the recommended additional blood tests, CRP and troponin, are being completed and the extent to which the advised echocardiogram (ECG) are being followed. Additionally, it will aim to check to see if a clinician is checking the above objectives and assess the extent to which the nursing staff are asking the patients about signs and symptoms of myocarditis. Method: (500-1000) This audit was designed to investigate the extent to which the monitoring requirements, in regards to clozapine initiation and titration within the first four weeks of treatment, at a London mental health trust had been completed. The monitoring requirements audited were specific to the detection and diagnosis of myocarditis. Data collection occurred between October 2016 and February 2017. It is a baseline, retrospective audit of case notes and laboratory data. As per the Health Research Authority regulations, this audit did not require ethical approval. Audit standards and audit tool The standards used in this audit were taken from the trusts clozapine guideline, which can be found in table 3. The monitoring requirements for the detection of myocarditis involve an ECG, vital sign monitoring (pulse, blood pressure, temperature) and CRP and troponin T blood tests. These had to be completed prior to initiation and weekly for the first four weeks after initiation. It is also necessary for clinicians to verify the results of the CRP and troponin T tests, and for the nurses or clinicians to check if the patient has had any signs or symptoms of myocarditis. For the purpose of this audit, criterion 1 and 3 (table 3) will be met if the results of the investigations were documented. Criterion 2 (table 3) will be met if the clinician has made specific reference to CRP and troponin T tests in the patient notes, criterion 4 (table 3) will be met if there is specific reference to questions being asked about myocarditis symptoms. An audit tool was created using the specified mo nitoring requirements mentioned in the clozapine guideline, a template of the audit tool can be found in table x. Identifying patients to be involved in the audit Clozapine patients require regular and frequent prophylactic blood tests in order to initiate and continue treatment. As such, there is a mandatory need for patients to be registered to a clozapine monitoring service database, which collects and stores the results from the weekly blood tests. Zaponex Treatment Access System (ZTAS) is the monitoring company that was used by the trust. ZTAS provided a list of patients who were registered with them whilst under the care of the trust, from June 2014 to October 2016. This resulted in a total of n=57 patients. The patients were selected to be used in the audit after they adhered to the inclusion criteria, which are shown below. Data Collection Data was collected using various information sources at the hospital. Data on haematological tests were collected systematically from ZTAS, bloodresults.co.uk, and the trust clinical portal. ZTAS and bloodresults.co.uk offered information on the standard full blood count (FBC) monitoring that takes place weekly. The trusts clinical portal was used to collect information on other heamatological tests, CRP and troponin T; this source was also used to check any other available FBC test results. RiO, the trusts operating system, was used to collect information on the other standards being measured in this audit (criterion 2, 3 and 4)(table 3). The data collected was stored in the audit tool. ( table x) Inclusion and exclusion criteria The inclusion of the patients in the audit required them to have been registered with ZTAS at the trust between June 2014 and October 2016. It was also necessary for the patient to have started some (at least two) of the required monitoring standards prior to initiation. Prior monitoring requirements included an ECG within a maximum of 3 months prior to initiation and  Ã‚   FBC, CRP and troponin T within 10 days of the initiation date.   Vital sign monitoring such as pulse, blood pressure and temperature were included if they had been completed a maximum of 7 days before initiation. Patients were excluded from the audit if they had been transferred from another trust and were already on a controlled clozapine treatment regime. Method of data analysis Data analysis and statistical analysis was completed using Microsoft Excel 2013. Overview As stated previously, clozapine is associated with an increased risk of myocarditis, which has been fatal in some cases. Preventative monitoring measures for myocarditis are advised at this trust. Baseline troponin T, CRP and ECG should be done prior to beginning treatment and then weekly for the following first four weeks after initiation. These measures are specific in identifying myocarditis, but should also be done in concordance with standard monitoring during treatment. The standard monitoring procedures include pulse, blood pressure and temperature to be completed every other day and FBC weekly. These monitoring procedures are necessary in helping to diagnose myocarditis; symptoms of myocarditis are non-specific, but tend to indicate the presence of an infection (fever) or simulate myocardial infarction (chest pain). Nurses and practitioners are advised to question patients on the appearance of any side effects similar to myocardial infarction to help ascertain if they could h ave myocarditis. Patient demographics and study data In total, n=57 patients were reviewed. Of those, n=3 patients were excluded based upon the inclusion and exclusion criteria described in the method. Of the remaining n=54 patients, n= 6   (11.11%) patients did not initiate clozapine treatment, but n=5 were included in the audit as they had started the monitoring required prior to initiating treatment. Reasons for not initiating treatment are outlined in table 1. A total of n= 3 patients ceased clozapine treatment in week one (n=2) and during week three (n=1); one patient was persistently tachycardic, one patient refused to continue treatment and one patient was severely hypotensive. The patient group (n=53) was predominantly male 66% (n=35), 34% (n=18) were female. The mean age of patients who initiated treatment (n=48) was 34.42 years old, with the youngest patient age being 16.92 years old and the oldest being 65.21 years old. Length of treatment was calculated as the time between a patient commencing clozapine treatment and either ceasing clozapine or the end of the audit period. A total of n=10 patients were excluded from the calculation, as they either did not start treatment or the end of treatment time was not able to be calculated; reasons for exclusion are explained in table 2. The mean length of treatment was 387 days  ±268, with the shortest length of treatment being 1 day and the longest being 873 days. Of the 53 patients involved at the start of the audit, 65% (n=35) were initiated on an inpatient basis; this means the patients were initiated at the hospital, on a ward. ECG monitoring A baseline ECG had been completed in 96% (n=51)(Figure 1) of patients within 3 months prior to the commencement of clozapine. One patient refused to have an ECG prior to initiation. The percentage of patients who received ECGs decreased to 20% (n=9), 24% (n=11), 17%(n=8) and 9% (n=4) of patients for the following 4 weeks after commencement respectively. A total of 41 out of 45 (Table 4) patients did not receive an ECG in week four of clozapine titration. During week one, a patient complained of flu like symptoms and was given an ECG to rule out myocarditis; likewise, one patient during week three was given an ECG after complaining of centralized chest pain. Temperature monitoring The quantity of patients who had recorded temperatures fluctuated through-out the weeks, being highest in week two of monitoring (n=. Week four had the lowest recorded amount of temperature monitoring of all 5 weeks at patients 69% (n=31) (table 4). In week one, n=2 patients refused to have measurements taken. Pulse and blood pressure monitoring The amount of patients who did not receive BP monitoring was highest in the week prior to initiating clozapine (n=13) and in week four (n=13). The highest proportion of patients who had their blood pressures taken occurred during week one at 96% (n=44 ), with 63% (n=29) of them having their blood pressure taken once and 34% (n=15) having their blood pressure taken twice (one reading measured whilst lying or sitting and one reading measured whilst standing). Week four had the highest proportion of patients who did not have their pulse measured at 29% (n=13) (table 4). One patient was discontinued from clozapine after one day of treatment when the BP check revealed them to be extremely hypotensive, in conjunction with a rapid pulse. Full blood count monitoring FBC monitoring occurred in the highest proportion of patients throughout the monitoring period; 100%, 98%, 93%, 100% and 96% respectively. CRP and Troponin monitoring The majority (>50%) of patients did not receive CRP or troponin T blood tests throughout the duration of the monitoring period. Figure 2 shows a substantial decrease in the number of patients who had CRP tests prior to initiation (n=25) and the following weeks (n=10, n=11,n=11, n=7 respectively). A large propotion of patients (84%, n= 38) did not receive CRP blood tests during their fourth week of clozapine treatement. The number of patients who received troponin T tests were less than those who received CRP tests. Only 36%(n=19) of patients received troponin T tests prior to initiation, reducing to 26%(n=12), 20%(n=9), 15%(n=7) and 9%(n=4) in the following four weeks after initiation respectively. There were n=14 patients who had no CRP or troponin T tests throughout the entirety of the monitoring period. There were no patients who had weekly CRP and troponin T tests throughout the duration of the mointoring period. Other monitoring parameters In total, the number of patients who had their CRP and troponin checked by clinicians was less than 100% in all cases (69% (n=9), 75% (n=9), 56% (n=6) and 63% (n=5) for weeks one through four respectively).   Due to the lack of data regarding criterion 4 (table 3), there are no results available to be discussed. Summary of main findings FBC monitoring requirements were met in the week prior to monitoring and in week three. All other standards were not met in any of the five weeks. Over all, there was a better outcome seen in the week prior to initiation for most of the standards. CRP and troponin T tests were completed in less than 50% of patients throughout the five weeks measured. Likewise, excluding the week prior to initiation, less than 50% of patients received an ECG for weeks one to four. Limitations Study data was collected using patient notes and the trusts clinical portal, data was therefore reliant on the relevant health care professional entering the information onto the systems. Consequently, the lack of data could be attributed to the lack of documentation of the monitoring, as opposed to the lack of monitoring all together, especially in regards to criterion 4 (table 3). No useful results could be drawn for criterion 4 and criterion 2 may have also been significantly affected by a lack of documentation. The sample size of this audit was small (n=53), any conclusions drawn from this data may not be relevant to a larger sample size. However, in future studies, a larger sample size could be used, if this is not possible the audit could be expanded to include other trusts. Results could also be affected if the patient refused to have the relevant monitoring required, as advised in the trusts clozapine guidelines.    This audit is the first one to be completed at this trust, therefore it cannot be compared to any previous data. However, the results are being measured against set standards (table x) and can be used to compare to future audits. Results in context      Ã‚   Clozapine is highly effective in the management of treatment-resistant schizophrenia; it reduces the risk of suicidal behaviours[5, 6]and it is effective in the treatment of both the positive and negative symptoms of schizophrenia.[1] It is not widely used due to its extensive side effect profile [8], most recognised being haematological disorders, such as agranulocytosis and neutropenia which have strict monitoring protocols in place.   However, cardiac side effects of clozapine treatment have become more widely recognised over the past few years.[5] Myocarditis is an inflammatory condition of the myocardium, which is normally attributed to viral aetiology. Clozapine-induced myocarditis is a rare, but potentially fatal result of treatment. Over 75% of cases occur within the first month of treatment, making it important to monitor for myocarditis during the first four weeks of treatment.[2, 14-16] A study by Ronaldson et al.[18] developed an evidence-based monitoring tool, based on 75 cases and 94 controls for routine monitoring up to 28 days. It suggested that an ECG, CRP and troponin I/T should be completed at baseline, with routine vitals every other day. CRP and troponin I/T tests should also be repeated on days 7, 14, 21 and 28. This study proposes that combining CRP and troponin tests provides a 100% sensitivity for myocarditis. The trusts clozapine guidelines also suggest the same monitoring protocol, with the addition of an ECG every week, for the first four weeks. Individuals with schizophrenia have a 20% shorter life expectancy than that of the general population and a greater vulnerability to several illnesses (diabetes, coronary heart disease).[19] Due to the nature of the illness and the heightened health risks associated with schizophrenia and the antipsychotic medications used in its treatment, it is important to adhere to the relevant monitoring protocols. It is evident, from the results, that the proposed guidelines for the monitoring of clozapine-induced myocarditis are not being met. Likewise, a number of studies have shown a poor adherence to standards in the monitoring of antipsychotic medications.[20] Physicians may have doubts about the relevance of monitoring, or feel that it is not necessary as the incidence of myocarditis is very low; rate of incidence occur in approximately 0.15-1.2%[1, 13, 21] of patients. If we consider other medications with stringent monitoring protocols, such as insulin, due to health care professionals awareness of this medication and the implications if the standards are not met, there is often a higher standard of monitoring. There may also be an implication of cost; extensive monitoring is often expensive, making it appear to be an unnecessary expense, particularly when the chances of myocarditis occurring are very low. Health care professionals may have a lack of awareness of the need for the monitoring of myocarditis, and the implications if these are not met. The incidence of fatality due to clozapine-induced myocarditis can be as high as 50%[1], making it important to abide by the set guidelines. The monitoring guidelines are made to reduce the harm caused to patients and reduce the possibility of fatalities. However, a delayed diagnosis could result in poorer outcomes for the patients.[1] The standards allow for earlier detection and diagnosis of myocarditis, reducing the chance of poorer outcomes. The results of this audit indicate a need for an increased awareness of clozapine-induced myocarditis among health care professionals. This would improve the clinicians awareness of the need for the monitoring of myocarditis and highlight the implications if the standards are not met. A standardised questionnaire could be created to monitor the signs and symptoms of myocarditis and be used by nurses to document the results, this could be incorporated into the clinical notes. This baseline audit emphasises the need for future re-audits, to evaluate whether the standards have improved. Table 1: Reasons for not initiating treatment Number of patients (n) Consistent amber results 1 Patient changed mind/ refused 2 Previous health conditions made the patient unsuitable to start clozapine 2 Unknown 1 Total 6 Table 2: Reasons for not being included it length of treatment calculation Number of patients (n) Never initaited clozapine 6 Patient transferred to another trust 2 Patient returned to country of origin (unknown if they continued treatment) 2 Total 10 Table 3: Policy Title Clozapine Guide Trust-Wide Medication Policy Date July 2016 Local/National Local Standard Setting Criterion 1 Criterion 2 Criterion 3 Criterion 4 Criterion Full blood count, including troponin T, CRP, neutrophil and white blood cell count should be done prior to initiating clozapine and then weekly for the first four weeks. A clinician verifies the blood test results every week before treatment can be approved. An ECG is to be performed prior to clozapine commencement and every week for the first four weeks after initiation of clozapine. A nurse or physician enquires about the signs and symptoms of myocarditis weekly for the first 4 weeks of titration. Target 100% 100% 100% 100% Exceptions None None None None Table 4: Monitoring Prior to initiating (Total number of patients n=53) Week 1 (Total number of patients n=46) Week 2 (Total number of patients n=46) Week 3 (Total number of patients n=46) Week 4   (Total number of patients n=45) ECG Yes 51 (96%) 9 (20%) 11 (24%) 8 (17%) 4 (9%) No 2 (4%) 37 (80%) 35 (76%) 38 (83%) 41 (91%) Blood pressure Taken once 36 (68%) 29 (63%) 26 (56%) 25 (54%) 21 (47%) Taken twice 4 (7.5%) 15 (33%) 15 (33%) 12 (26%) 11 (24%) Not taken 13 (24.5%) 2 (4%) 5 (11%) 9 (20%) 13 (29%) Temperature Yes 39 (74%) 38 (83%) 40 (87%) 37 (80%) 31 (69%) No 14 (26%) 8 (17%) 6 (13%) 9 (20%) 13 (31%) Pulse Yes 42 (79%) 43 (93%) 41 (89%) 37 (80%) 32 (71%) No 11 (21%) 3 (7%) 5 (11%) 9 (20%) 13 (29%) FBC Yes 53 (100%) 45 (98%) 43 (93%) 46 (100%) 43 (96%) No 0 (0%) 1 (2%) 3 (7%) 0 (0%) 2 (4%) CRP Yes 25 (47%) 10 (22%) 11 (24%) 11 (24%) 7 (16%) No 28 (53%) 36 (78%) 35 (76%) 35 (76%) 38 (84%) Troponin Yes 19 (36%) 12 (26%) 9 (20%) 7 (15%) 4 (9%) No 34 (64%) 34 (74%) 37 (80%) 39 (85%) 41 (81%) References 1.Munshi, T.A., et al., Clozapine-induced myocarditis: is mandatory monitoring warranted for its early recognition? Case Rep Psychiatry, 2014. 2014: p. 513108. 2.Aboueid, L. and N. Toteja, Clozapine-Induced Myocarditis: A Case Report of an Adolescent Boy with Intellectual Disability. Case Rep Psychiatry, 2015. 2015: p. 482375. 3.Fineschi, V., et al., Sudden cardiac death due to hypersensitivity myocarditis during clozapine treatment. Int J Legal Med, 2004. 118(5): p. 307-9. 4.Bruno, V., A. Valiente-Gà ³mez, and O. Alcoverro, Clozapine and Fever: A Case of Continued Therapy With Clozapine. Clin Neuropharmacol, 2015. 38(4): p. 151-3. 5.Swart, L.E., et al., Clozapine-induced myocarditis. Schizophr Res, 2016. 174(1-3): p. 161-4. 6.Castle, D., et al., A clinical monitoring system for clozapine. Australas Psychiatry, 2006. 14(2): p. 156-68. 7.Annamraju, S., et al., Early recognition of clozapine-induced myocarditis. J Clin Psychopharmacol, 2007. 27(5): p. 479-83. 8.Murch, S., et al., Echocardiographic monitoring for clozapine cardiac toxicity: lessons from real-world experience. Australas Psychiatry, 2013. 21(3): p. 258-61. 9.Wooltorton, E., Antipsychotic clozapine (Clozaril): myocarditis and cardiovascular toxicity. CMAJ, 2002. 166(9): p. 1185-6. 10.Kar, N., S. Barreto, and R. Chandavarkar, Clozapine Monitoring in Clinical Practice: Beyond the Mandatory Requirement. Clin Psychopharmacol Neurosci, 2016. 14(4): p. 323-329. 11.Cohen, R., et al., A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder. Case Rep Cardiol, 2015. 2015: p. 283156. 12.Merrill, D.B., G.W. Dec, and D.C. Goff, Adverse cardiac effects associated with clozapine. J Clin Psychopharmacol, 2005. 25(1): p. 32-41. 13.Ronaldson, K.J., et al., Clinical course and analysis of ten fatal cases of clozapine-induced myocarditis and comparison with 66 surviving cases. Schizophrenia Research, 2011. 128(1-3): p. 161-165. 14.Haas, S.J., et al., Clozapine-Associated Myocarditis. Drug Safety, 2007. 30(1): p. 47-57. 15.Barry, A.R., J.D. Windram, and M.M. Graham, Clozapine-Associated Myocarditis: Case Report and Literature Review. Can J Hosp Pharm, 2015. 68(5): p. 427-9. 16.Ronaldson, K.J., P.B. Fitzgerald, and J.J. McNeil, Clozapine-induced myocarditis, a widely overlooked adverse reaction. Acta Psychiatr Scand, 2015. 132(4): p. 231-40.

Essay --

The United States (US) Navy has been in many battles over the years, made many improvements to their ships, and has allowed women to join the force; this is why the Navy is one of the largest branches of the military today. The Navy is a brand of the nation’s armed forces that includes warships and support ships, their crews, land bases, and many personnel. Also, many navies include an air force; some navies even have combat forces known as marines. The marines are trained to fight in the air and on land; they are some of the toughest people in the military. â€Å"On October 13, 1775, the United States Navy was formed.† (â€Å"Worldbook† 2). There was a meeting and the Continental Congress voted for the Navy to be approved. This was to help out at sea where at the time British were the major force. The Navy was initially made to cut off trades and munitions between Britain and other countries. This was an attempt to help the Americans in the war. The smaller navies of the world usually consist of warships, smaller boats like patrol boats, missile boats, and minesweepers. The main objective fo...

Intramural Sports Essay -- Essays Papers

Intramural Sports Intramurals are an organization of sports teams created for students who seek the opportunity to play sports. Those who participate in intramurals range in age, ability, and gender. These sports teams allow students to play a sport they enjoy without committing to a varsity team. Intramurals are designed for everyone to have fun but still have a competitive edge. It is easy to get involved and learn about intramurals at the University of Dayton. There are many possible ways as a student at Dayton to get involved in intramurals. Involvement in intramurals gives the chance to not only play sports that are enjoyable, but also the opportunity to meet new people and develop a relationship with them. One way that many people get involved is through people they have met or already know. For example, someone you met the other day, or a friend from high school could ask you to sign up for their team. Another popular way to get involved is through the residence hall, and play on a team with the other people in your hall. After talking to people ...

Origins of Slaves :: American America History

Origins of Slaves Treating humans as property led to unspeakable cruelties. Discuss in detail the origins and use of slaves in the Americas. "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness" (Thomas Jefferson). In my opinion the only problem with this passage from the Declaration of Independence is that it does not say, "We hold these truths to be self-evident, that all men including their race, creed, religion, or color are created equal, that they...." Thomas Jefferson's words were hypocritical. Not all men were created equal and these men were slaves. Slavery has existed throughout the United States at the time and by 1760 there were about 325,800 African slaves in North America. This was the most inhumane treatment any man could endure. The following essay shall discuss the state of slavery in North America and its economic and social consequences. Slavery in America started when the New World was first discovered. It started off when the first colonists came to the Americas and in order to survive they needed to farm the land and grow crops. Since they were not accustomed for the hot sun and were too lazy for hard labor. In order to survive they needed a large labor force to farm the lands. They tried to capture the native Indians and failed, for many reasons one of them was from smallpox, and from various diseases, which killed them. Another reason that the Europeans could not capture them was because they had been in America all their lives and they were a majority. Therefore the Europeans set out to seize African slaves. Africans were the perfect choice of slaves to farm in colonial America, because slavery had already existed in Africa. Plus Africans could endure the heat of the raging sun, since Africa and America's weather were similar. Also both African and European colonist's bodies could resist many diseases, unlike native Indians. Africans were shipped from Africa by the Europeans in what was called the Triangular Trans-Atlantic Slave Trade. This was an organized route where Europeans would travel to Africa bringing manufactured goods, capture Africans and take them to America. Eventually they would take the crops and goods and bring them back to Europe. However the Europeans had no humanity what so ever.

Plato’s Republic Essay

Plato’s Republic is a book in which Socrates, as a character, explores the nature of poetry. Although Socrates completely supports everyone’s obligation to explore various notions, (leading to his being charged with â€Å"corrupting the youth,†) the idea that poetry can be detrimental, as it may influence the minds of the youth is also proposed. This means that certain fictional readings, which would install themselves into the minds of their believers as delusions were likely to result from the reading of certain fantastic poems. In Cervantes’ Don Quixote, access to unlimited writings, however, corrupted the mind of the novel’s protagonist, who became quite crazy, as his mind became filled with ideas of the business of knights, which occurred as he read books that, according to other characters of the book, should have been banned. Plato’s Socrates was often engaged in the business of encouraging people to challenge accepted notions, and explore other ones. But poetry, when it relates fictional stories, would have had the potential to negatively influence the malleable minds of a younger audience. â€Å"Plato was concerned with the ability of a text to convince in the face of its fictionality,† Frederick de Armas wrote in Cascardi’s novel, The Cambridge Companion to Cervantes. And Plato’s concern was not without merit, when applied to the story of the man from La Mancha, who is driven insane by the fictional stories that he enjoyed. Unfortunately for Don Quixada of La Mancha, fantastic books and stories of chivalry and â€Å"knight-errantry† were permitted in Spain, and he got his hands on a great many of these stories. Miguel de Cervantes’ Don Quixote is the story of a man, who, accompanied by his loyal squire, participate in activities based on the delusions inspired by the books that he read. Don Quixote was at first a normal, honorable man, but after reading a great many books and stories about the chivalrous and challenging adventures of knights, he became of the opinion that he was indeed a knight himself, and that the stories he had read were actually incorporated into the whole world. He would produce such beliefs, based on the readings that he had scoured, that simple objects and people of the world were actually characters present in the adventures of the greatest knight who ever was, as he often thought of himself. Every belief that he had throughout the body of the book was tied to the stories of the chivalrous activities of knights that he had read. And these stories prompted him to dress in Medieval military attire (such as chain mail, accompanied by a helmet with a visor, a lance, and a shield), and partake in the activities of the extinct knights that he had read about. The books, which captivated his mind, led Don Quixote de La Mancha to believe notions as preposterous as windmills being giants, and every woman around being damsels in distress. His faithful squire, Sancho Panza was captivated by the stories that his master told him of knight-errantry, and it helped to corrupt, or make him delusional as well. The books, stories, and poetry on the subject of knight errantry were completely to blame for the downfall of Don Quixote’s mind, which in turn, dragged down that of Sancho Panza’s. But there were character from Quixotes hometown, such as his niece, housekeeper, and a man of the church who recognized that it was the fictional adventure books that caused a once respected man to go insane. His niece and housekeeper had noticed that the books were corrupting him from the start. â€Å"‘Senor Licentiate Pero Perez,’ that was the curate’s name, â€Å"some misfortune must certainly have happened to my master; for six days, both he and his horse, together with the target, lance, and armour, have been missing; as I am a sinner, it is just come into my head, and it is certainly as true as that everyone is born to die, those hellish books of knight-errantry, which he used to read with so much pleasure, have turned his brain: for, now I remember to have heard him say to himself more than once, that he longed to be a knight-errant, and stroll about in quest of adventures. May Satan and Barrabas lay hold of such legends, which have perverted one of the finest minds in all La Mancha,† the housekeeper of the illustrious knight, Don Quixote remarked after her master returned from his very first enterprise in the field of knight-errantry (Cervantes, Part 1, Chapter V). It is very straightforward, from the words of his housekeeper, that Don Quixote’s intense readings about the stories of knights and chivalry were very detrimental to his mind. Indulging in these stories over, and over, he went mad, and believed himself a universal character of the topics on which he read. Plato may have held that expression of fictional ideas had the ability to be completely detrimental to the youthful minds that absorbed various notions, and that is why (in Don Quixote) the man of the church, the barber, and Don Quixote’s niece and housekeeper set to burn (except for a few books, which they themselves prized) all of Don Quixotes library, which was filled with books on the subject of knight-errantry. In the writings of Plato, poetry had the unfortunate ability to do to young, easily-influenced people what the books of knight-errantry did to Don Quixote. This was the ability to propose delusions that would survive alongside actual beliefs which were based on true phenomena. Poets had the ability to harm the minds of the youth who indulged in their poems, just as did the writers of the chivalrous stories in Don Quixote. If it had not been for the fictional stories that Don Quixote read over and over, he would likely have not held that he himself was a character of the genre, which, at the time, was represented only in fiction. The various authors’ narrations on the fictional activities of knights were indeed what captivated the mind of Don Quixote, and caused him to go insane. Early in his adventures, his squire, Sancho Panza was bewildered by some of the delusional and fictional properties that Don Quixote extended to various environmental phenomena. His readings had him believe that a row of windmills were giants that served to hinder his own progress. â€Å" ‘Fly not, ye base and cowardly miscreants, for, he is but a single knight who attacks you,’† Don Quixote yelled at the windmills, which were, due to his mental captivation by the activities of knight-errantry, on which he had read, not windmills, but giants. This was his final warning to the giants before he charged, and rammed his lance into the propeller of a mill, shattering it, and falling to the ground, along with his trusty steed, Rocinante (Cervantes, Part I Chapter VIII). Plato’s theory, expressed in The Republic, about the detrimental and negatively influential properties of poetry are undermined in Spain at the time of the story of the knight from La Mancha. The people who collected in Don Quixote’s house, following his very first adventure (which left him immobilized, and without a weapon after he attacked a group of merchants who he perceived to be evil) were of the opinion that Plato proposes in The Republic, which is that fictional stories can be dangerous when imposed upon malleable minds, like those of the youth (or those of unstable characters, such as the prime one seen in Cervantes’ work). Although it is quite likely that the novel was composed because of its entertaining qualities, Cervantes certainly wanted to parallel the story of Don Quixote to the warnings of Plato in his views on poetry. â€Å"In this work, Plato argues that poetry inspires undesirable emotions in society and should be censored from adults and especially children for fear of lasting detrimental consequences,† Schatzie Speaks writes in her article, entitled Aristotle vs. Plato on the Dangers of Poetry. â€Å"Plato believes that since children have not yet acquired proper formation of character and knowledge of the world around them, every new experience makes a profound impact upon them. Children have no ability to know what emotions should be tempered and which should be expressed, and certain expressed emotions can have lasting consequences later in life. Plato finds it necessary to limit the types of poetry, works which he deems induce profound emotions in individuals, to protect children and future society. † Poetry, unfortunately for the knight in Cervantes’ novel, and many of those whom he encountered, was not limited, but embraced by the knight himself, and it had the very effect that Plato warned that it might. â€Å"He states that scary stories,† Speaks continues, â€Å"such as gods coming to the world in disguise and harming people, must be avoided to eliminate timidity, as such tales will induce profound fear. Furthermore, children must not be told tales detailing the horrors of death for they will then grow up to fear death and lack courage. † Plato’s critique of poetry is justified in Cervantes’ story of Don Quixote, who found himself fully subjected to the negative aspects of poetry (such as its ability to conjure up thoughts and delusions that may not actually exist). It was because fictional tails of such fantastic adventures of knights were allowed in Spain that Don Quixote was able to get his hands on these books, and fall under their spell. They inspired vast delusions in him, just as Plato said such writings could if they were not censored. Works Cited De Cervantes, Miguel. Translation by Rutherford, John. Don Quixote de la Mancha. Penguin Books, New York, 2003 De Armas, Frederick A. Cervantes and the Italian Renaissance. In Cascardi, Anthony J. The Cambridge Companion to Cervantes. Cambridge University Press, 2002. Plato. Edition by Cooper, John M. The Republic. In Plato, Complete Works. Hackett Publishing, Indiana, 1997. Speaks, Schatzie. Aristotle vs. Plato on the Dangers of Poetry. Viewed 23, July, 2009. http://hubpages. com/hub/The-Emotions-Surrouding-Poetry–Aristotle-vs-Plato

Business report on the ‘Kentucky Fried Chicken Corporation (KFC) Essay

In evaluating how well a company’s present strategy is working, a proper understanding of the company’s resource capabilities and deficiencies, its market opportunities, and the external threats to its future is essential. The really valuable part of SWOT analysis is understanding and evaluating the strengths, weaknesses, opportunities, and threats and drawing conclusions whether a firm’s business position is fundamentally healthy or unhealthy. In a nutshell, SWOT analysis is a basis for action. KFC, being one of the world’s most recognizable brands, has its own internal strengths and weaknesses and external opportunities and threats, which are identified and analyzed below. ‘Kentucky Fried Chicken Corporation (KFC) was the world’s largest chicken restaurant chain and the third largest fast-food chain in 2000’ (Krug 2001, cited in Thompson and Strickland 2003, p. C-203). The statement suggests that the brand-name image or the company reputation of KFC is very strong. Such buyer goodwill can be classified into valuable intangible assets, which is an internal strength itself giving KFC enhanced competitiveness. Also, KFC was one of the first fast-food chains to go international in the late 1950’s and was one of the world’s most recognizable brands. This means that KFC had a high degree of organizational agility in gaining wide geographic coverage and had a strong global distribution capability. Such competitive capability can be identified as KFC’s internal strength. KFC’s international strategy was to grow its company and franchise restaurant base through several high-growth markets. This suggests that the company was able to evaluate the right market opportunities available of serving additional customer groups or expanding into new geographic markets and market openings to extend the company’s brand name or reputation to new geographic areas. ‘According to the National Restaurant Association, food-service sales increased by 5.4 percent, to $358 billion, in 1999’ (Krug 2001, cited in Thompson and Strickland 2003, p. C-207). This was a result of a number of  demographic and social trends, which influenced the demand for food eaten outside of the home. The full-service and fast-food segments were expected to make up about 65 percent of total food-service industry sales in 2000. This could be identified as KFC’s external market opportunity since it could use its ability, internal strengths and resource capabilities to grow rapidly because of sharply rising demand in the fast-food industry. However, such a boom in the fast-food industry could also be identified as a potential external threat to KFC’s well-being since increasing intensity of competition among industry rivals may cause squeeze on profit margins. According to the National Restaurant Association, other food items that were growing in popularity since 1990s through 2000 included chicken, which offered and external market opportunity for KFC to expand. ‘During 1999, KFC continued to dominate the chicken segment, with sales of $4.4 billion’ (Krug 2001, cited in Thompson and Strickland 2003, p. C-210). This is because KFC’s customer base remained loyal to the KFC brand because of its unique taste. This could be identified as KFC’s distinctive competence, since KFC did the fried-chicken well in comparison to its competitors. Such uniqueness provided KFC with a competitively valuable capability, which proved to be a corner stone of every strategy. Despite its dominance, KFC was losing market share as other chicken chains such as Chick-fil-A and Boston Market increased sales at a faster rate. Such mounting competition from potent new competitors could be identified as a potential external threat to KFC’s market position. However, KFC’s leadership in the U.S. market was so extensive that it had fewer opportunities to expand its U.S. restaurant base, which again was an external threat to KFC’s future profitability and competitive well-being. The greatest concern for fast-food operators was the shortage of employees in the 16-to-24 age category since many high school and college graduates enjoyed a healthy job market. This was a result of low unemployment, since U.S. economy began to expand during early 1980s through 2000. Such environment is again an external threat for KFC’s profitability. Also, the labor costs made up about 30 percent of a fast-food chain’s total costs. Mounting competition made it difficult to increase prices, since consumers  made decisions about where to eat primarily based on price. Such labor costs and increasing intensity of competition among industry rivals which squeezed profit margins posed external threat to KFC’s profitability. However, the demographic trends offered KFC with a potential opportunity by which costs could be lowered and operations made more efficient by increasing the use of technology. ‘According to the National Restaurant Association, most restaurant operators viewed computers as their number one tool for improving efficiency’ (Krug 2001, cited in Thompson and Strickland 2003, p. C-213). Hence, computers which could improve labor scheduling, accounting and payroll can be identified as KFC’s external market opportunity which is a big factor in shaping the company’s strategy. However, higher costs and poor availability of prime real estate was one of the adverse demographic change that negatively affected profitability of such fast-food chains and hence posed an external threat. International operations carried by fast-food chains like KFC carried risks not present in domestic-only operations. Long distances posed several problems such as quality, transportation, servicing and support problems. Moreover time, culture and language differences increased operational problems. Such problems could be identified as potential threats to KFC’s international strategy, which was focused on several high growth international markets. However, rising per capita incomes worldwide and the development of the Internet, which was quickly breaking down communication and language barriers were wildly attractive market opportunities for food-chains such as KFC seeking to quickly develop global brands and a worldwide consumer base. KFC had trouble breaking into the German market during the 1970s and 1980s, however McDonald’s had a greater success penetrating the German market, because it made a number of changes to its menu and operating procedures to appeal to German tastes. This could be identified as KFC’s internal weakness since there was a lack of competitively important skills or expertise to attract new customers as rapidly as McDonald’s did. Moreover, many of KFC’s problems during the 1980s and 1990s surrounded its limited menu and inability to quickly bring new products to market, which could be identified  as KFC’s potential weakness, since it was behind its rivals such as McDonald’s in putting capabilities and strategies in place. An example of this is when KFC suffered one of its more serious setbacks on experimenting with the chicken sandwich concept when McDonald’s test-marketed its McChicken sandwich in the Louisville market. As per the circumstances, Latin America could be identified as KFC’s wildly attractive market opportunity because of the size of its markets, its common language and culture, and its geographical proximity to the United States. KFC could well evaluate the market opportunities available from Latin America and identified its own resource capabilities required to capture it, the result of which was KFC’s Latin America Strategy, which represented a classic internationalization strategy. KFC’s early entry into Latin America gave it a leadership position over McDonald’s in Mexico and the Caribbean with 438 restaurants in 2000. Mexico, in Latin America could be identified as highly attractive market opportunity for KFC because of the North American Free Trade Agreement (NAFTA), which went into effect in 1994 and created a free-trade zone between Canada, the United States, and Mexico. Other fast-food chains such as McDonald’s, Burger King, and Wendy’s were rapidly expanding into other countries in Latin America such as Venezuela, Brazil, Argentina, and Chile. Such mounting competition from potent new competitors was an external threat for KFC’s competitive well-being. Another threat came from Habib’s, Brazil’s second largest fast-food chain, which opened its first restaurant in Mexico in 2000. Another potential external threat to KFC’s well-being was the long-term value of the peso, which has depreciated at an average annual rate of 23 percent against the U.S. dollar since NAFTA went into effect. This translation risk lowered Tricon Global’s reported profits and damaged its stock price, subsequently affecting KFC’s profitability and market position. Industry and Competition Analysis An industry’s competitive conditions and overall attractiveness are big strategy determining factors. In other words, good industry and competitive  analysis is a prerequisite to good strategy making. Hence, it is very essential for a firm to evaluate whether the industry environment it is in is either attractive or unattractive to protect its future profitability. Porter’s Five Forces – A MODEL FOR INDUSTRY ANALYSIS The industry and competitive analysis used to evaluate an industry’s environment involves a process to discover what the main sources of competitive pressure are and how strong each competitive force is. Porter’s five-forces model is a powerful tool for identifying the principal competitive pressures in a market and assessing how strong and important each one is. Michael Porter provided a framework that models an industry as being influenced by five forces, which are discussed below in context to the FAST-FOOD INDUSTRY and KENTUCKY FRIED CHICKEN CORPORATION. ?a Rivalry: – If rivalry among firms in an industry is low, the industry is considered to be â€Å"attractive†, however the competitive structure of an industry is clearly â€Å"unattractive† from a profit-making standpoint if rivalry among the firms is very strong. Looking at the fast-food industry there was increasing intensity of competition among rivals. In the chicken segment, KFC was losing market share as other chicken chains such as Chick-fil-A and Boston Market increased sales at a faster rate. Many industry analysts predicted that Boston Market would challenge KFC for market leadership. Popeyes and Church’s were potent new competitors, trying to compete head-on with fried-chicken chains. McDonald’s, Burger King, and Wendy’s were rapidly expanding into other countries, which subsequently posed a threat. However, even when the rivalry among firms in the fast-food industry is very strong, the industry can be competitively attractive for KFC whose market position provides a good enough defense against competitive pressures. Moreover, to formulate a better strategy and pursue an advantage over its rivals, KFC could lower prices to gain a temporary advantage, improve product differentiation, creatively use channels of distribution, and exploit relationships with suppliers. ?a Barriers to Entry / Threat of Entry: – The competitive structure of any  industry would be identified as â€Å"unattractive† from a profit-making standpoint if low entry barriers are allowing new rivals to gain a market foothold. ‘According to the National Restaurant Association, food-service sales increased by 5.4 percent, to $358 billion, in 1999. More than 800,000 restaurants and food outlets made up the U.S. restaurant industry, which employed 11 million people’ (Krug 2001, cited in Thompson and Strickland 2003, p. C-207). Also as the U.S. market matured, many restaurants expanded into international markets as a strategy for growing sales. After McDonald’s, KFC, Burger King, and Pizza Hut, at least 35 chains had expanded into foreign countries by 2000. This suggests that the fast-food industry had relatively low entry barriers, allowing new rivals to gain a market foothold. Such low entry barriers could possibly result from common technology, easy access to distribution channels, little brand franchise, and low scale threshold. Hence, as per the above discussion, fast-food industry is clearly â€Å"unattractive†. However, it depends on the incumbent firms such as KFC to offer only passive resistance against a new entrant or aggressively defend their market positions using price cuts, increased advertising, and product improvements to give them a hard time. ?a Threat of Substitutes: – The competitive structure of an industry remains â€Å"unattractive† if competition from substitutes is strong. As a rule, ‘the lower the price of substitutes, the higher their quality and performance, and the lower the user’s switching costs, more intense is the competitive pressures posed by substitute products’ (Thompson and Strickland 2003, p. 88). There are no such substitutes in any other industry to stand in competition with the firms in fast-food industry, which is very unique. However, there are various segments in the fast-food sector of the restaurant industry, which may be identified as substitutes for each other. These segments are sandwich chains, pizza chains, family restaurants, grill buffet chains, dinner houses, chicken chains, nondinner concepts, and other chains. Usually, such chains have price cuts and improved quality and performance as a part of their strategy and since the buyers can switch to any segment of the fast-food industry easily, there are comparatively high competitive pressures among such segments. Hence, for KFC (chicken chain), the fast-food industry is not an attractive one to be in, since sandwich  chains made up the largest segment of the fast-food market and dinner houses made up the second largest and fastest-growing fast-food segment in 1999. ?a Buyer Power: – The power of buyers is the impact that customers have on a producing industry. Looking at the fast-food industry, it is more likely that the buyers (customers) can exercise considerable bargaining leverage, which again makes the competitive structure of the industry â€Å"unattractive†. This is because buyers’ costs of switching to competing brands or substitutes are relatively low in the fast-food industry. Moreover, the mushrooming availability of information on the Internet is giving added bargaining power to individuals. It is relatively easy for buyers to use the Internet to compare the different prices offered by various fast-food outlets in the industry. In a nutshell, the more information buyers have, the better bargaining position they are in. Also, the prospect of losing a brand loyal customer not easily replaced often makes a seller more willing to grant concessions of one kind or another. ?a Supplier Power: – A producing industry requires raw materials – labor, components, and other supplies, which are received from suppliers. Suppliers, if powerful, can exert an influence on the producing industry, such as selling raw materials at a high price to capture some of the industry’s profits. However, in the fast-food industry, the suppliers possibly have little or no bargaining power or leverage over rivals since the items they provide are commodities available on the open market from numerous suppliers. In fast-food industry it is relatively simple for rivals to obtain whatever is needed from any of several capable suppliers. Hence, the suppliers being able to exercise little or no bargaining power or leverage over rivals’ makes the competitive structure of the fast-food industry clearly â€Å"attractive†. As a conclusion, the collective impact of competitive forces in the fast-food industry is relatively stronger, which subsequently lowers the combined profitability of participant firms. However, even when the five competitive forces are strong, an industry can be competitively â€Å"attractive† or â€Å"favorable† to firms such as KFC whose market position and strategy provides  a good enough defense against the competitive pressures to earn above-average profits. Key Industry Success Factors Key industry success factors (KISFs) by their very nature are so important that all firms in the industry must pay close attention to them. In other words, KISFs are the prerequisites for industry success and are the rules that shape whether a company will be financially and competitively successful. Looking at the fast-food industry, there are various KISFs necessary to gain sustainable competitive advantage. Manufacturing-related KISFs for the fast-food industry would be low-cost production efficiency (to permit attractive retail pricing and ample profit margins), quality of manufacture (to provide customers with better taste in comparison to the rivals), high-labor productivity (to reduce cost since labor costs are about 30 percent of a fast-food chain’s total costs). Distribution-related KISFs would be short delivery times and having company-owned retail outlets. From the marketing point of view, clever advertising (to induce customers to buy a particular brand repeatedly), courteous customer service and attractive styling of packaging would be identified as important KISFs for fast-food industry. Skills-related KISFs would be quality control know-how and an ability to develop innovative recipes. In apparel organizing, the KISFs would be an ability to respond quickly to shifting market conditions, superior ability to use Internet and other latest technology to conduct business and managerial experience. Some other important KISFs are favorable image or reputation with buyers, convenient locations of the stores (important for food-outlets), and access to financial capital (important in newly emerging industries). Hence, the above stated key industrial success factors for the fast-food industry are cornerstones for a firm’s strategy formulation and trying to gain sustainable competitive advantage over its rivals. Company Analysis Kentucky Fried Chicken Corporation (KFC) is one of the successful fast-food chains, which was the world’s largest chicken restaurant chain and the third largest fast-food chain in 2000. KFC dominated the chicken segment, with sales of $4.4 billion in 1999 through 2000. KFC was in the lead position in the U.S. market, however had fewer opportunities to expand its U.S. restaurant base due to the entry of new rivals such as Chick-fil-A and Boston Market. Despite gains by Boston Market and Chick-fil-A, KFC’s customer base remained loyal to the KFC brand because of its unique taste, which could be identified as one of the most important resource strengths of KFC. However, KFC faced several internal problems under its various owners, which adversely affected its financial performance and competitive strength. Heublein, Inc., which was in business of producing alcoholic beverages and had a little experience in the restaurant business, acquired KFC in late 1970s. Conflicts quickly erupted between Colonel Sanders and Heublein management since the quality-control and restaurant cleanliness badly deteriorated under Heublein, Inc. By 1977, the restaurant openings had slowed down, since service quality declined under Heublein management. However, KFC did fairly well under the management of R.J. Reynolds Industries, Inc., which had little more experience in the restaurant business than Heublein. PepsiCo introduced several changes after the acquisition of KFC. Staff at KFC was reduced in order to cut costs and many KFC managers were replaced with PepsiCo managers. ‘KFC’s culture was built largely on Colonel Sander’s laid-back approach to management’ (Krug 2001, cited in Thompson and Strickland 2003, p. C-206). Employees enjoyed good job security and stability. However, PepsiCo’s culture was characterized by a much stronger emphasis on performance, which reinforced the feelings of KFC managers that they had few opportunities for promotion. As a result, a strong loyalty created among KFC employees over the years was lost. The Original Recipe Chicken allowed KFC to expand through the 1980s without significant competition from other chicken chains and thus new product  introductions was not a part of KFC’s marketing and overall business strategy. Such limited menu and inability to quickly bring new products to market made KFC face several problems during the 1980s and 1990s. However, KFC’s current strategy has been refocused. The cornerstone of its new strategy was to increase sales in individual KFC restaurants by introducing a variety of new products and menu items that appealed to a greater number of customers. Also, from the marketing point of view, KFC introduced a three-pronged distribution strategy that increased sales to a considerable level. The strategy firstly focused on building smaller restaurants in non-traditional outlets such as airports, chopping malls, universities, and hospitals. Secondly, it continued to experiment with home delivery. Third, KFC established â€Å"2-in-1† units that sold both KFC and Taco Bell (KFC/Taco Bell Express) or KFC and Pizza hut (KFC/Pizza Hut Express) products. KFC’s early entry into Latin America gave it a leadership position over several other food-chains in Mexico and the Caribbean. KFC’s Latin America Strategy was an example of a classic internationalization strategy. KFC firstly expanded into Mexico and Puerto Rico because of several external opportunities such as geographical proximity and other political and economic relations with United States. As KFC’s experience in Latin America grew, it expanded its franchise system throughout the Caribbean. Only after sustaining a leadership position in Mexico and the Caribbean did it venture into South America. However, KFC faced difficult decisions in regards to the formulation of an effective Latin American Strategy over the next 20 years, since limited resources and cash flow limited KFC’s ability to aggressively expand in all countries at the same time. Statement of alternative options Looking at the fast-food industry and the highly intensive competition prevailing, a better possible option for KFC would be to merge with other growing chicken chains such as Popeyes, Chick-fil-A, Boston Market, Church’s, and El Pollo Loco. Such merger would possibly create one of the largest chicken chains in the fast-food industry. Merging with another company would dramatically strengthen KFC’s market position and open new  opportunities for competitive advantage. In the fast-food industry, such mergers enable the companies to have much stronger technological skills, more or better competitive capabilities, a more attractive lineup of services, wider geographic coverage and greater financial resources to expand into new areas. However, it would still be essential for KFC to tailor a strategy that fits its particular strengths and weaknesses so as to hold a lead position in Latin America by operating several company-owned restaurants in the targeted countries. Recommendations Kentucky Fried Chicken Corporation, the world’s largest chicken restaurant chain and the third largest fast-food chain, has several internal weaknesses and resource deficiencies which needs to be identified and improve to gain a competitive advantage over its rivals. Moreover, today’s fast-food industry offers several external opportunities and poses potential threats to the rivals’ well-being and market position. It would be essential for the managers of KFC to identify firm’s resource strengths and weaknesses and its external opportunities and threats, which would provide a good overview of whether a firm’s business position is fundamentally healthy or unhealthy. This would further complement in formulating strategies so as to expand firm’s business activities over a wider geographic coverage. Latin America is an attractive location for investment because of the size of its markets, its common language and culture, and its geographical proximity to the United States. However, it would be difficult for KFC to penetrate the market successfully as a result of mounting competition from several competitors. It would be a wise recommendation for KFC to merge with other growing chicken chains, which would possibly fill the resource gaps and allow the new companies to do things, which KFC could not do alone. Such a merger would allow KFC to operate several franchised and company owned restaurants in the targeted countries of Latin America, which is more effective in building a significant market share in individual countries. This is because market leadership often requires a country subsidiary that actively manages both franchised and company owned restaurants. Such  strategy would also enable KFC to better control quality, service and restaurant cleanliness. REFERENCES Aaker, DA 1992, Developing business strategies, 3rd edn, Wiley, New York. Faculty of Business and Law 2003, Guide for students, 4th edn.   Perry, C 1992, Strategic management processes, Longman Cheshire, Melbourne.   Thompson, AA & Strickland, AJ 2003, Strategic management, 13th edn, McGraw-Hill, New York, NY.