A Persistant Lichen Sclerosus Case Health And Social Care Essay

Lichen sclerosus is a lymphocyte-mediated chronic inflammatory dermatitis that most normally involves the anogenital country. Treatment options include topical corticoids, tacrolismus, C dioxide optical maser extirpation and eventually vulvectomy as surgical attack. The aim of this survey is to describe a stubborn anogenital LS topic and depict the usage of V-Y promotion flap for the Reconstruction of the perineal defect after vulvectomy. Case: A relentless LS instance who was treated succesfully with surgery is reported and literature is reviewed. The patient had good tolerated the surgical process with satisfactory decorative consequences.Decision:A multidisciplinary squad work would be ideal in the direction of relentless LS instances. Surgical intervention of LS should be reserved as a last resort for patients who were furnace lining to other medical options and in the instance of a surgical effort recontruction of the vulva should be good known. Cardinal words: Lichen sclerosus, Vulvectomy, Vulvar Reconstruction..Introduction:Lichen sclerosus ( LS ) is a benign, chronic tegument disease that most normally occures in the anogenital epithelial tissue ( 1 ) . It affects both gender and kids particularly adult females in postmenopausal ages. Although the exact aetiology is still unknown, there is a strong association between LS and autoimmune upsets such as ; alopecia areata, vitiligo, thyroid upsets and diabetes mellitus ( 2 ) . Besides the autoimmune diseases in association with HLA category II antigens, hormonal factors, infective causes, and familial influence have besides been associated with LS ( 1 ) . Authoritative LS is characterized by pronounced redness, epithelial cutting and typical cuticular alterations with an visual aspect of all right â€Å" coffin nail paper † -like pursing accompanied by symptoms of pruritus, dyspareunia and dysuria ( 3,4 ) . A considerable figure of patients ( 33 % ) are symptomless but have the clinical marks of LS on physical scrutiny. The diagnosing of LS is based upon the presence of characteristic clinical manifestations, ideally with histological verification obtained from a vulvar clout biopsy. A hold in the diagnosing may originate, due to the patients ‘ embarrassment and/or reluctance of the doctor to to the full measure the symptoms every bit good as strangeness with the disease ( 5 ) . The optimum direction of LS could be achieved with a multidisciplinary attack. Surgical intervention is preferred in the instance of a post-inflammatory sequelae, phimosis or in a malignant province. Although the presence of vulval cicatrixs or the features of the defect will restrict our surgical preferance there are many surgical options proposed for the perineal Reconstruction, including local musculus and fasciocutaneous tegument flaps ( 6,7,8 ) . We are depicting a persistant lichen induration instance who was treated surgically and recontructed with V-Y promotion vulvar flaps.Case study:A 49 twelvemonth old Caucasian adult female married for 30 old ages G3, P2, A1 enduring from vulvadynia because of relentless vulvar LS for 16 old ages, admitted to our clinic. She has been having medicine with carbamezepine for ungratified leg syndrome for six old ages. She had two cesarean subdivisions and three lumbar phonograph record hernia operations in which an internal fixator was placed to the lumbar vertebras. She used to hold local cortisol, estrogen and testosterone therapies since she received her initial diagnosing. She has had vulvar alcohol injection one time and vulvar betametasone, lidocain injections and phototherapy several times. Her history revealed a vulval denervation operation to the pudental nervus with the diagnosing of vulvadynia. Furthermore she had three times simple vulvectomy and vulval Reconstruction operations. These intervention modes failed to relieve her symptoms, and sclerosing alterations of vulvar country which extends to posterior, affecting the perineum and anus. The singular findings in her pelvic scrutiny were the hyperkerotic lichen plaques spread to anus, vaginal orifis and periclitoral country ( Figure 1a ) . We observed the vaginal orifis as narrow shaped and labia majora – minora were absent. Hyperkeratotic scars were noticable on her mons pubis due to her old surgical operations and lichen plaques. In her speculum scrutiny, vagina and neck were normal in form and uterus – bilateral ovaries were normal by transvaginal ultrasound and no malignant cells were reported in her pablum smear trial. Histopathological diagnosing of the topic was confirmed with two antecedently performed consecutive vulvar biopsies that revealed characteristic cuticular wasting and cuticular hyalinisation ( homogenisation of the collagen in the upper corium ) . Our patient had relentless and worsening symptoms and we decided to execute simple vulvectomy and V-Y promotion flap for the Reconstruction of vulvar defect ( Figure 1a ) and obtained informed consent consequently. Briefly ; urinary catheterisation was needed to forestall urethral hurt and to supply plenty wound hygiene after surgery. After vulvectomy ( Figure 1b ) , we performed V form scratchs bilaterally widening to median part of the thigh without any complication ( Figure 1c ) . The scratchs were profoundly performed until the superficial genital facia to travel the flaps freely and punctilious haemostasis was done. The mobility of the cutaneal flaps are tested. Following the release of the flap, this extra block of hypodermic tissue is folded into the defect. The sidelong transverse defect which was formed when the island flap moved medially is closed horizontally, therefore giving the concluding cicatrix a horizontal â€Å" Y † form. We aproximated the hypodermic tissue with 2/0 polyglactin 910 [ Ethicon, Edinburgh, UK ] . The tegument was closed by interrupted 3/0 polyglactin 910 [ Ethicon, Edinburgh, UK ] suturas ( Figure 1d ) . We repaired the round defect above the vaginal orifis with free rotary motion flap. No drains were placed. Postoperative closing of vulvar defect was seen perfect in form. She was hospitalized for the undermentioned two yearss ( Figure 2a ) and uretral catheterisation was removed on her 2nd twenty-four hours. All the critical marks of the patient were usual without any wound infection or haematoma in the closing. In the early postoperative period, the healing of vulva was uneventful and completed after three hebdomads ( Figure 2b ) .Discussion:A assortment of names and descriptions have been used for the disease that is presently named lichen sclerosus. In 1887, Hallopeau was the first to depict the histological characteristics of the disease ( 9 ) . LS occurs at all ages but non in newborns and is rare in the first twel vemonth of life. The disease has a bimodal extremum incidence in prepubescent misss and menopausal adult females. In a survey the prevalence of lichen sclerosus in childhood was found to be 1:900. The bulk of patients consists of adult females aged between 50-70 old ages, while 5-15 % of the LS topics were kids. Lifelong surveillance of all adult females with LS is considered indispensable because of the hazard of malignant patterned advance, ( 10 ) . Although adult females with vulval LS are at increased hazard of developing invasive squamous cell malignant neoplastic disease ( SCC ) of the vulva ( 4 ) , the estimated hazard is to be less than 5 % ( 11 ) . No grounds exists that regular check-ups cut down the hazard of malignant patterned advance. Nevertheless, patients with vulval LS should be examined at least annually and localized, relentless, nonresolving lesions should be biopsied ( 4 ) . In contrast to vulvar LS extragenital LS lesions are non associated with an increased hazard of malignance ( 9,12 ) . There is non a universally recognized direction scheme for adult females with LS. It normally provides diagnostic alleviation, without needfully rectifying the implicit in upset. The intervention of LS consists of instruction and support, behavioural alteration to keep good perineal hygiene and turning away of any local thorns, medicine and surgery. Assorted conservative curative options such as, topical testosterone, topical Lipo-Lutin, topical corticoids, estrogens, retinoic acid, retinoids, vitamin A, chloroquine and a short class of systemic corticoids are wholly accepted as intervention options ( 13 ) . All published studies on the direction of LS indicate centrist to strong topical steroids as the intervention option of pick ( 12,14,15 ) . Mild to chair authority topical corticoids are besides normally used for intervention of grownup vulvar LS ( 3 ) . Recently, ace potent topical steroids were found to be an effectual intervention for this job with both short- ( 16 ) and long-run ( 17 ) efficaciousness. Topical steroid therapy is non without complications, including the possibility of wasting, contact sensitisation, tegument alterations, and secondary infection. Although there are no good studied therapies in adult females who failed to react to corticoids, Lipo-Lutin, testosterone, retinoids, topical immune system modulating agents ( tacrolismus, pimecrolimus ) and cyclosporine has been used in some randomised tests ( 4 ) . Small randomized tests showed that Lipo-Lutin and testosterone picks are less effectual than corticoids ( clobetasol ) with more side effects ( 18 ) . Treatment with an unwritten retinoid ( acitretin ) was found to be effectual in one randomised test ( 19 ) . Successful interventions with tacrolimus oinment was reported ( 20 ) but frequently discontinued due to Burnss on application sites. As presented in our instance furnace lining instances have been treated with intradermic intoxicant injections with variable consequences ( 21 ) . Another concern must be the physicological jobs that may look ( i.e. narcotic maltreatment ) in relentless LS topics due to chronic vulvar hurting. The American College of Obstetricians and Gynaecologists suggests one-year scrutinies for patients whose LS is good controlled and more frequent visits for those with ill controlled disease ( 15 ) . Surgery does non hold a cardinal function in the intervention scheme of LS and could be considered as a last resort to handle complications secondary to the LS ( 22,23 ) . Surgical intercession in LS should non be aimed at taking the disease but at deciding complications of the disease: to let go of a inhumed button, to divide fused labia, or to widen a narrowed introitus in instance of ailments about clitoric symptoms ( hurting or sexual clitoric disfunction ) ( 22 ) . Its usage is limited since scars and contractures may look after surgery. However, if surgery is the preferable intervention mode, it is of import to cognize how to retrace the vulva. Patients wish to go on their sexual life every bit shortly as possible. V-Y promotion flap is an effectual method for Reconstruction of the perineal part. This technique will supply better blood supply and nervus esthesis and will let the expanding of the vaginal orifis. The principle behind the surgical therapy is chiefly to handle those patients who did non or react ill to medical intervention and secondly to forestall the development of invasive carcinoma of the vulva ( 23 ) . Our patient had a long medical history about LS in which she had received several local therapies, phototherapy, surgical efforts and systemic medicines for 16 old ages. All intervention modes were discussed with the household and the concluding determination of the patient was surgery due to her exhaustion and better decorative outlook. Consequently, surgical intercession must be deferred until LS has been controlled with medicine or should be reserved for pull offing postinflammatory sequelae. If an excisional process ( i.e. vulvectomy ) is the preferable intervention mode, Reconstruction of the vulvar defect with V-Y promotion flap seems to be an applicable and extremely effectual surgical technique with its good decorative consequences and rapid healing after surgery.LegendsFigure 1: Pre and intraoperative images of vulvar lichen sclerosus patient. 1a ; hyperkerotic lichen plaques spread to anus, vaginal orifis and periclitoral country, 1b ; vulvectomy was performed, 1c ; V form scratchs bilaterally widening to median part of the thigh, 1d. closing of the tegument, giving the concluding cicatrix a horizontal â€Å" Y † form. Figure 2: Postoperative images of vulvar lichen sclerosus patient. 2a ; station operative 2nd twenty-four hours, 2b ; completed vulvar mending three hebdomads subsequently.

Fun Time

http://www. ehow. com/facts_5788552_benefits-open-campus-lunch_. html Budget * If students are allowed to leave campus and their parents' homes are nearby, students can save money on lunch and eat from home. Social Contact * Students may spend time with others who they may not see if the lunch was confined to on campus. Students can go out and eat with friends. Outside * If it's a great day outside, students can eat outdoors and enjoy the sun for a half-hour or so. This could lead to a fresh burst of energy and creativity.Independence * Open campus lunch allows the students to leave the premise of the school. This grants the student freedom to eat where he wants. Physical Activity * When students are allowed to leave campus, they can get out and stretch their legs a little more than if they were confined to a lunch room. http://www. masters. edu/undergrad/student-perspective/offcampuseats. aspx Line too long in the cafeteria and not a lot of change in your wallet? In need of a good q uick fix?There are several places in Santa Clarita that can satisfy your food cravings at an affordable price of $10 and under. Egg Plantation, Urbane Cafe, Chronic Tacos, La Cocina, Qdoba Mexican Grill, Corner Bakery, El Taco Llama, Saugus Cafe and Panera Bread are just a few of the delicious options to choose from. It all just depends on what type of food you are in the mood for. Don‘t know where they are located? Simply go to Yelp, Map Quest, or Google Maps and enter the destination. Here are a few off-campus favorites to whet your appetite: Breakfast ?Breakfast is offered at Egg Plantation, Corner Bakery, and Panera Bread. All have price ranges between $6-$10. These bakery cafes also offer a comfortable, friendly, fashionable place to study or hang out with friends. Egg Plantation in Newhall is home of 101 delicious omelets. Panera Bread and Corner Bakery not only offer breakfast, lunch, and dinner but free wire-less Internet as well. Way Station Coffee Shop and Eggs N Thi ngs are some mom and pop cafes that offer a wide variety of delectable breakfasts. Lunch/Dinner ? In the mood for Mexican food?Chronic Tacos (breakfast available), El Taco Llama, Qdoba Mexican Grill, and La Cocina Restaurant have good tasting lunch and dinner dishes that range anywhere from $5-10. The great thing about Qdoba is if you bring in a student ID then you are qualified for a free drink with your meal. Talk about a deal. Urbane Cafe is an excellent lunch or dinner stop that offer‘s some of the best sandwiches in Santa Clarita. Not only do you get a sandwich but a salad as well, both for $7. Just take a pick from their wide selection of sandwiches, soups, and salads. 4-Hour-Breakfast/Lunch/Dinner? If it is late and you are getting the munchies The Saugus Cafe is open 24 hours (Wednesday to Friday) with breakfast, lunch, and dinner all located within minutes from campus. Good service, friendly staff, a nice atmosphere, and affordable prices. That‘s what they all h ave in common. Just grab a friend and enjoy your meal. http://www. thetitanchronicle. com/editorials/2011/03/31/off-campus-lunches/ What if upperclassmen could have lunch off campus? That would be great news to 11th and 12th graders.It would mean upper-classmen would no longer be cooped up in school all-day; after all, this isn’t elementary school. We are young adults capable of handling the responsibility of leaving school. Set the bar high administrators, and if students decide not to come back, then consequences should be handed out. For example, if a student doesn’t come back to school, they would face suspension. Consider the age difference between the lower-class and the upper-class. Since the 11th graders and 12th graders have reached a certain level of maturity, they can handle eating lunch off campus.Upperclassmen are basically young adults and should continue to experience increased responsibilities so that they can become more productive members of our commu nity. Not everyone should enjoy off campus lunch; only students with good grades. Not only should upper-classmen have good grades, they should also have a good reputation with all administrators. Students allowed the privilege of eating off campus must be doing well in school. Just like in sports, if you have two failing grades you can’t play, well, if you have two failing grades, you can’t eat out off school grounds.School comes first for every student and needing to do well in order to eat off campus could influence some low achieving students to do better in class. There also should be record on who goes in and out of school, since keeping track of students who leave school grounds is a concern. The remedy is to have a sign in sheet. If students did not sign in and out, then suspension or other consequences would be doled out. The object is not to give students a chance to have extra free time or skip classes but to have them do something different and enjoy their s chool lunch at the same time.

Brevity in Speech and Writing

Brevity is shortness in duration and/or conciseness of expression in a  speech  or a  written text. Contrast with verbosity. Brevity is generally considered a stylistic virtue as long as its not achieved at the expense of clarity. Examples and Observations If you would be pungent, be brief; for it is with words as with sunbeams--the more they are condensed, the deeper they burn.(Robert Southey)Brevity is a great charm of eloquence.(Cicero)How brief? Well, as brief as possible but not so brief that the message doesnt get across. But messages vary so. Beat it! is short enough but very long when you reckon in the attitude that comes with it. . . . Brevity, then, depends on the message. . .Brevity, in most human communication, remains a variable governed by social relationships as much as by factual baggage. One is brief in all kinds of ways, and Poloniuss objection, This is too long, always means Too long for this person, place, and time.(Richard Lanham, Analyzing Prose, 2nd ed. Continuum, 2003)[S]ince brevity is the soul of wit,And tediousness the limbs and outward flourishes,I will be brief . . ..(Polonius in William Shakespeares Hamlet, Act 2, scene 2)There are no hard and fast rules in writing for the ear, but after more than fifty ye ars of working at it, I believe in some rough guidelines.Two of them are: short is usually better than long and dont waste words. The bank robber Willie Sutton got it right when he was asked why he robbed banks. Thats where the money is, he replied. Have you ever heard three words that convey a message better than stick em up, or Ive had it! or Im outta here? Have you ever heard anyone express himself better, faster, or more to the point than the judge who had the following exchange in his courtroom: As God is my judge, the defendant said, I am not guilty. To which the magistrate answered, Hes not! I am! You are!Now thats good writing. No unnecessary adverbs or adjectives, just telling it like it is. Dont be afraid to write the way people talk.(Don Hewitt, Tell Me a Story: Fifty Years and 60 Minutes in Television, PublicAffairs, 2001) Brevity in Presentations Edit ruthlessly. Brevity, always a virtue, is doubly so when youre trying to avoid watering down your impact. Matt Eventoff, principal of Princeton Public Speaking, in Princeton, N.J., says: This is stuff we’ve all known instinctively--anyone who’s sat in a corporate meeting over the past 20 years, with slide after slide after slide of information. It can be very powerful information, but it’s overwhelming--you don’t know what it’s saying. Are we in good shape or in bad shape? You can’t tell. When all the points of your presentation don’t back up your streamlined theme, you really risk losing people and also potentially turning them off. (Christopher Bonanos, Quit While Youre Ahead. Bloomberg Businessweek, Dec. 3-Dec. 9, 2012) Brevity and Conciseness Brevity is often used indifferently with conciseness; but when any difference is implied, then properly speaking, brevity refers to the matter, conciseness to the style. In fact, when brevity of style is spoken of, it may be considered synonymous with conciseness. Strictly speaking, however, brevity merely implies the use of few words, while conciseness implies a great deal of matter concentrated in a small space. (Elizabeth Jane Whately, A Selection of English Synonyms, 1852) Brevity and Clarity It must be recognized that it is very difficult for those giving attention to brevity also to give due care to clarity; for often we either make the language unclear for the sake of clarity or for claritys sake we have to speak at length. It is necessary, then, to be on the lookout whether the brevity is proportional, neither leaving out anything necessary nor including more than is needed. (Nicolaus the Sophist, quoted by George A. Kennedy in Progymnasmata: Greek Textbooks of Prose Composition and Rhetoric. Society of Biblical Literature, 2003) Safires Contrarian View of Brevity Every book on writing you can find these days says essentially the same thing: keep it short. Take it a bite at a time. Dispense with the adjectival frills. Put the punch in the verb and not the adverb (he added weakly). Edit, edit, edit, and avoid repetition. Less is more, spare is fair. . . Maybe we are going overboard. The burst of the business memo, the snap-and-spit of the television news bite, the mincing sentences of post-Hemingway novelists--all have led to the canonization of brevity.. Introduce it, lay it out, sum it up. The dash is dead. It is not for nothing, as the Communists say, that the hottest word in communication is briefing. (William Safire, Introduction: Watch My Style. Language Maven Strikes Again. Doubleday, 1990) The Lighter Side of Brevity People whose vision is perfect in every other respect suffer from a curious astigmatism which prevents them from recognizing a stopping point when they come to it. We suggest to some ingenious inventor that he devise a combination of time clock and trip hammer by which a dull, blunt instrument shall be liberated at the end of five minutes so that it may fall with great force, killing the after dinner speaker and amusing the spectators. (Heywood Broun, We Have With Us This Evening. Pieces of Hate and Other Enthusiasms. Charles H. Doran, 1922)[Calvin Coolidges] most celebrated trait was his taciturnity. An oft-told story, which has never been verified, is that a woman sitting next to him at dinner gushed, Mr. President, my friend bet me that I wouldnt be able to get you to say three words tonight. You lose, the president supposedly responded.(Bill Bryson, One Summer: America, 1927. Doubleday, 2013) EtymologyFrom the Latin, short

Graduation Speech Lincoln Park - 1635 Words

A place where children from grades two through eight can go and engage in fun activities such as dance, baseball, karate, and homework help is what the kids in Anaheim need. A place where children can go to â€Å"hangout† after school, do their homework and be mentored by high school teenagers, college students, and adults who have plenty of experience with working with children is extremely necessary in Anaheim. Luckily there is such a place; it’s Higher Ground Youth and Family Services. The youth in Anaheim need to stay far far away from the dangers of; gangs, drug use, juvenile hall and dropping out of school at young age. This program’s purpose is to help shape the futures of these children, help mentor them, and get them on the right path to success, whether that be going to a four year university, college, or simply just keeping them from getting into serious trouble. Higher Ground is located next to Lincoln Elementary school on Lincoln Ave. and Broadway at Lincoln Park. Lincoln Park is fairly small it is the shape of a rectangle. it has a small playground, a baseball field, and a soccer field. The soccer field grass is not so green due to the kids who practice soccer there every evening, there is not a day when the soccer boys are not out practicing. The baseball diamond is located on the opposite side of the soccer field. Here the little league baseball team practices Monday, Wednesday, and Friday. The playground is right by the entrance of the park and is locatedShow MoreRelatedThe American Travesty : The History And Evidence Behind The Veil Of Racism3348 Words   |  14 PagesNorth won the war, President Lincoln gave his Emancipation Proclamation. â€Å"On April 16, 1862, emancipationist Republicans passed a bill outlawing slavery.† Slavery had finally been eliminated and the now freed Black Americans could flourish in accordance with the Constitution, but their sufferings did not end there. 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Whatever They Told You About Who Can Write My Term Paper Is Dead Wrong...And Heres Why

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Biology 6 mark question practice Essay Example For Students

Biology 6 mark question practice Essay 86 The Brain and Mind 6 Mark Question Practice A. Neurones are specialised cells transmitting nerve impulses. There are two types of neurones; Sensory cells, which send impulses from the receptor to the central processing centre and the motor neurones, transmit impulses from the brain and spinal cord to the effector cell that will respond to the stimulus. Impulses flow along thin tubes of cytoplasm. In the sensory neurones, the cell body is located in the middle and two tubes come out of it; one from the dendrites at one end, which eceive impulses from the receptor cell, to the cell body, called the Dendron, and another from the axon terminals at the other end, which make connections with other neurones and pass the information to the CNS, to the cell body called the axon. In the motor neurones the cell body is located at the end and there isnt a Dendron tube. The Dendron and axons are covered in a fatty yellowish substance called the myelin which insulates them, stops impulses from flowing to other neurones and also peeds up the transmission of impulses. When neurones are stimulated they transmit an electrical impulse. Neurones transmit electrical impulses through the polarization inside the membrane of a neurone. This is a model answer for a 6 mark question in a Science GCSE exam. You differentiate between the two neurones if you like, and then describe the structures of the neurones and explain what each part of the neurone does, e. g what the myelin sheath does and so on.

Wal-Mart Essays (3272 words) - Walmart, Sam Walton, Cross-docking

Wal-Mart Sam Walton, a leader with an innovative vision, started his own company and made it into the leader in discount retailing that it is today. Through his savvy, and sometimes unusual, business practices, he and his associates led the company forward for thirty years. Today, four years after his death, the company is still growing steadily. Wal-Mart executives continue to rely on many of the traditional goals and philosophies that Sam's legacy left behind, while simultaneously keeping one step ahead of the ever-changing technology and methods of today's fast-paced business environment. The organization has faced, and is still facing, a significant amount of controversy over several different issues; however, none of these have done much more than scrape the exterior of this gigantic operation. The future also looks bright for Wal-Mart, especially if it is able to strike a comfortable balance between increasing its profits and recognizing its social and ethical responsibilities. Why is Wal-Mart so Successful? Is it Good Strategy or Good Strategy Implementation? -- In 1962, when Sam Walton opened the first Wal-Mart store in Rogers, Arkansas, no one could have ever predicted the enormous success this small-town merchant would have. Sam Walton's talent for discounts retailing not only made Wal-Mart the world's largest retailer, but also the world's number one retailer in sales. Indeed, Wal-Mart was named Retailer of the Decade by Discount Store News in 1989, and on several occasions has been included in Fortune's list of the 10 most admired corporations. Even with Walton's death (after a two-year battle with bone cancer) in 1992, Wal-Mart's sales continue to grow significantly. Wal-Mart is successful not only because it makes sound strategic management decisions, but also for its innovative implementation of those strategic decisions. Regarded by many as the entrepreneur of the century, Walton had a reputation for caring about his customers, his employees (or associates as he referred to them), and the community. In order to maintain its market position in the discount retail business, Wal-Mart executives continue to adhere to the management guidelines Sam developed. Walton was a man of simple tastes and took a keen interest in people. He believed in three guiding principles: 1. Customer value and service; 2. Partnership with its associates; 3. Community involvement (The Story of Wal-Mart, 1995). The word always can be seen in virtually all of Wal-Mart's literature. One of Walton's deepest beliefs was that the customer is always right, and his stores are still driven by this philosophy. When questioned about Wal-Mart's secrets of success, Walton has been quoted as saying, It has to do with our desire to exceed our customers' expectations every hour of every day (Wal-Mart Annual Report, 1994, p. 5). Walton's greatest accomplishment was his ability to empower, enrich, and train his employees (Longo, 1994). He believed in listening to employees and challenging them to come up with ideas and suggestions to make the company better. At each of the Wal-Mart stores, signs are displayed which read; Our People Make the Difference. Associates regularly make suggestions for cutting costs through their Yes We Can Sam program. The sum of the savings generated by the associates actually paid for the construction of a new store in Texas (The story of Wal-Mart, 1995). One of Wal-Mart's goals was to provide its employees with the appropriate tools to do their jobs efficiently. The technology was not used as a means of replacing existing employees, but to provide them with a means to succeed in the retail market (Thompson & Strickland, 1995). Wal-Mart's popularity can be linked to its hometown identity. Walton believed that every customer should be greeted upon entering a store, and that each store should be a reflection of the values of its customers and its community. Wal-Mart is involved in many community outreach programs and has launched several national efforts through industrial development grants. What are the Key Features of Wal-Mart's Approach to Implementing the Strategy Put Together by Sam Walton -- The key features of Wal-Mart's approach to implementing the strategy put together by Sam Walton emphasizes building solid working relationships with both suppliers and employees, being aware and taking notice of the most intricate details in store layouts and merchandising techniques, capitalizing