The Shawshank Redemption Argumentative Essay Example For Students

The Shawshank Redemption Argumentative Essay The Shawshank RedemptionThe Shawshank Redemption is a very unique movie which involves manydifferent personalities and underlying themes. The personalities of the inmatesare very interesting and when they are combined they create a very fascinatingplot which looks at prison life in a interesting and different perspective thanone normally thinks. The main characters are Andy Dufrense (Tim Robbins) andEliss Red Redding (Morgan Freeman). These characters are well complimented bythe wise and simple old man, Brooks (James Whitmore), and the evil warden. Thepersonalities of the Shawshank prison combined to form a sort of community. Onenever really thinks of a prison as such, but it seems to hold true. This movieshowed a prison not only as a place where murderers and thieves live, but as acommunity of people who have had problems and may or may not be rehabilitating. We will write a custom essay on The Shawshank Redemption Argumentative specifically for you for only $16.38 $13.9/page Order now It seems that some prisoners go in and accept what they have done and try tomake something of an already disastrous life while others give up and reallydont care if they commit other crimes (inside and outside of the prison). Butin all reality, the prison was home for the inmates and they made it into whatit was. The demeanor of the characters creates a very unique atmosphere. The story revolves around Andy who is convicted of murdering his wifeand her lover in 1946 and is sentenced to life in prison. He is sent to theShawshank prison, the state prison in Maine which is known for its harshness. At the beginning of the movie, one does not know if Andy committed thehorrible crime of murder. But what is known is that he is not ready for prisonand honestly doesnt seem like a man who would survive. His thinking going in isjust to survive and blend in. He knows that sticking out would not be good forhim. Throughout the movie, Andy undergoes several changes in his personality. But overall, he seems like a wise man who will deal with what the justice systemhas served him. He is normal on the outside but seems full of emotion. Hisemotional side is best put by the 4/14/95 issue of the San Francisco Chroniclewhich reads, Dufrense, a soft-spoken banker with emotions bubbling under thesurface. Andy is a very complex character but one can see that he holds hisfeelings inside of him and tries not to let people know how he feels. Andys friendship with Red begins in a peculiar way because neither of themhave anything in common. Andy asks for a rock hammer which Red gets for him. Red,knowing that Andy is vulnerable, gets him on the tar duty and seems to take himunder his wing. The friendship is very unique and they both are very energeticwith emotion. Bill Dupre of the News and Observer writes of their emotiontogether, This is a graceful, quiet characterization, and Robbins scenes withFreeman are wrought with depth, delicacy, and precision.This is where the opportunistic side of Andy begins to be evident. Afteroverhearing the guards talking, he almost risks his life to tell the guard thathe will help him keep the $30,000 that he inherited. This shows that Andy hadguts and that he wanted to survive. In return for his favor of helping the guard,he gets his fellow workers ice cold beers on the last day. It is ironic becausehe has quit drinking himself. Andy then begins to work in the library becausethe warden hear s of his talents in finance. This is where Andy first meetsBrooks. He use this opportunity to ask the state for more money to build alarger library. And finally, the way Andy escapes is almost genius. Knowing thathe is on the good side of the warden, he devises a very interesting andsuccessful plan of escape. .u6bca761e966b79e21206d5478911a40f , .u6bca761e966b79e21206d5478911a40f .postImageUrl , .u6bca761e966b79e21206d5478911a40f .centered-text-area { min-height: 80px; position: relative; } .u6bca761e966b79e21206d5478911a40f , .u6bca761e966b79e21206d5478911a40f:hover , .u6bca761e966b79e21206d5478911a40f:visited , .u6bca761e966b79e21206d5478911a40f:active { border:0!important; } .u6bca761e966b79e21206d5478911a40f .clearfix:after { content: ""; display: table; clear: both; } .u6bca761e966b79e21206d5478911a40f { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u6bca761e966b79e21206d5478911a40f:active , .u6bca761e966b79e21206d5478911a40f:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u6bca761e966b79e21206d5478911a40f .centered-text-area { width: 100%; position: relative ; } .u6bca761e966b79e21206d5478911a40f .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u6bca761e966b79e21206d5478911a40f .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u6bca761e966b79e21206d5478911a40f .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u6bca761e966b79e21206d5478911a40f:hover .ctaButton { background-color: #34495E!important; } .u6bca761e966b79e21206d5478911a40f .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u6bca761e966b79e21206d5478911a40f .u6bca761e966b79e21206d5478911a40f-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u6bca761e966b79e21206d5478911a40f:after { content: ""; display: block; clear: both; } READ: Fvgdf EssayOverall, Andy blends in with the prison community through the good timesand the bad (the sisters, a group of homosexual rapists). His personality is oneof a person who makes the most of what he has. But he never loses hope that hewill be free one day. Red is a very unique character in his own right. The prisons sole blackinmate, he is the man who smuggles contraband into the prison. He is also alifer and he says that he is the only man in the prison who is guilty. He hasaccepted his fate and is dealing with the prison as his life but still tries tomake his life on the inside the best he can. Red really doesnt think much aboutbeing paroled (he is rejected several times during the movie). He just takes oneday at a time. He is determined not to let the jail system get to him. Hisfriendship with Andy becomes stronger throughout the movie from when they firstmeet until Red joins Andy in Mexico. Red is a man who knows the rights andwrongs of the prison and it seems that Andy becomes his apprentice during themovie. Overall, Red is a subtle man who tries not to be noticed. His personalityis one of perseverance and he is ready to accept what the system may deal him. Talking about the warden is difficult just for the reason that he is acruel man who represents evil and unfairness in the movie. The reason the wardentakes a liking to Andy is because Andy is an accomplished accountant who canhelp him cheat the state. The opportunistic Andy takes advantage of this byreading the Bible (to impress the warden) and basically doing what he is told. This leads to the wardens demise (trusting Andy too much) and Andys escape. The personality of the warden does not change much throughout the movie. Even if he does something nice (letting Andy help fellow inmates), his solepurpose is to profit and be in charge. He shows off his power many times and inthe cruelest way. For example, his power and cruelty can be best seen when hediscovers that the young inmates testimony may free Andy. The wardens solutionis to kill the young inmate and get the matter out of the way. Losing Andy wouldbe devastating to him. The warden basically adds the bad guy dimension to themovie. The prison had people of all ages and backgrounds (non racial). Brooks is areal old timer who had been in the prison for a very long time. He exemplified aman who had just made prison his life and he was very content with his life. Henever foresaw leaving and knew this would be his life. He didnt expect anythingout of the ordinary to happen. He seems to be a lost soul not knowing what hewants or what is right for him. His death signified his confusion. The movie gives us a perspective of a prison not really shown before. Though the movie may seem unrealistic in some ways, it is very moving and makesone think deeper about who the inmates are and what they are really like. In the4/14/95 issue of the San Francisco Chronicle it reads, As preposterous as it isappealing, The Shawshank Redemption takes a straightforward, soul stirringnovel by Stephen King and turns it into a somber, bloated prison drama designedto pump you with inspiration. This inspiration is created by the actions andwords of various characters. It is actually an inspiration to the viewer toalways have hope and pursue your goals. Red said, Hope is dangerous on theinside. He was saying that having hope could drive a man crazy but in allreality he had hope in himself. This was untrue because Brooks death signifieda lack of hope. He really had no one and the inmates were his family. Leavingthe prison was devastating and he just thought nothing of life. Red was contradictory to his own words because he ended up surviving and succeeding all be causeof the hope that he had. .u6732b013a08de9c9514baadb55fa4c43 , .u6732b013a08de9c9514baadb55fa4c43 .postImageUrl , .u6732b013a08de9c9514baadb55fa4c43 .centered-text-area { min-height: 80px; position: relative; } .u6732b013a08de9c9514baadb55fa4c43 , .u6732b013a08de9c9514baadb55fa4c43:hover , .u6732b013a08de9c9514baadb55fa4c43:visited , .u6732b013a08de9c9514baadb55fa4c43:active { border:0!important; } .u6732b013a08de9c9514baadb55fa4c43 .clearfix:after { content: ""; display: table; clear: both; } .u6732b013a08de9c9514baadb55fa4c43 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u6732b013a08de9c9514baadb55fa4c43:active , .u6732b013a08de9c9514baadb55fa4c43:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u6732b013a08de9c9514baadb55fa4c43 .centered-text-area { width: 100%; position: relative ; } .u6732b013a08de9c9514baadb55fa4c43 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u6732b013a08de9c9514baadb55fa4c43 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u6732b013a08de9c9514baadb55fa4c43 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u6732b013a08de9c9514baadb55fa4c43:hover .ctaButton { background-color: #34495E!important; } .u6732b013a08de9c9514baadb55fa4c43 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u6732b013a08de9c9514baadb55fa4c43 .u6732b013a08de9c9514baadb55fa4c43-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u6732b013a08de9c9514baadb55fa4c43:after { content: ""; display: block; clear: both; } READ: Ethnographic Film EssayThe personalities of the characters create an almost unreal setting whereyou see things you may not expect to see. A community of people is what themovie is about. A community which goes through good times and bad ones. But thecharacters are what makes this film so unique and so great.

Case 2-1 Carson Container Company Essays

Case 2-1 Carson Container Company Essays Case 2-1 Carson Container Company Essay Case 2-1 Carson Container Company Essay Case Questions 1. What problems does Carson Container Company have that will affect its communications? Carson’s decentralized approach to procurement was indicative of its overall strategy toward dealing with its constituencies including employees, customers, shareholders, and communities. This decentralized strategy has affected the Carson’s communications. 2. What specific problems does Mr. Haskell have as a result of his communications to materials managers? As a result of Mr. Haskell’s communications to materials managers, over the next few days, responses came in from all but a few plants. However, over the next several weeks, the headquarters heard nothing from the plants about contracts being negotiated with suppliers. Mr. Haskell’s initiative to centralize the company’s procurement procedures was not implemented successfully, and the usual procedures for that time of year continued. 3. How would you analyse this case in terms of the expanded corporate communication strategy framework (Figure 2. 2)? The expanded corporate communication strategy framework has four important elements such as messages, organization, constituencies, and constituency responses. I would analyse this case from the 4 perspectives as the following: (a)Messages: The communication channel used by Mr. Haskell is memo and sent to 30 plant material managers. Carson as a large regional manufacturer in the United States, I think memo is not effective and strong enough to convey this important message to 30 plants. Furthermore, the decentralized and uncoordinated procurement procedures of the company has been carried for a long time, hence when Mr. Haskell intended to do a revolution, it will be more difficult. In this case, Mr. Haskell needs to put more effort on choosing the communication channel and structuring the messages’ contents. (b)Organization: The Carson and Mr. Haskell wanted to centralize the company’s procurement procedures and reduce the number of suppliers overall. The resources or Carson such as money, human resources and time needed to be considered during the implementation of the new procurement process. However, Mr. Haskell did not put consideration on the human resources and time dealing with this new procurement process. The Carson has 30 plants and many employees under procurement department; hence, it is not wise to have Mr. Haskell himself and his assistant, Patricia only to deal with the 30 plant material managers. Apparently, the human resource arrangement is not enough on this matter. Besides, the time chose to run this new procurement process was not appropriate because the time chose was the busiest period for procurement department, hence they would easily neglected the new procurement process. Therefore, the objective of the Carson and Mr. Haskell could not be achieved effectively because the company did not do appropriate arrangement on the human resource and time arrangement. (c)Constituencies: The constituencies in this case are the 30 plants material managers located in United States regionally. Hence, the attitude of the 30 managers towards this topic is relatively important. However, the results showed that the managers were too busy and they did not put much concerns on this matter. Hence, the objective of Mr. Haskell was not achieved at the end. From this we could see that Mr. Haskell did not analyse its constituencies carefully. He did not understand the material managers’ attitude and opinion towards the new procurement process. He failed in understanding and analysing the constituencies’ attitude, feelings and opinions which resulted in his failure of implementing the new procurement process. (d)Constituency responses: The constituency did not respond in the way the Carson and Mr. Haskell wished and they did not concern about the matter. The communication between Mr. Haskell and the constituencies has failed and definitely the objective was not accomplished in a desired manner. 4. What advice would you give Haskell to help solve his and Carson’s problems? I suggest Haskell to put these things into consideration in order to help solve his and Carson’s problems: (a)Constituencies and their responses: Haskell should analyse his constituencies including the primary constituencies such as the material managers and employees and also the secondary constituencies such as the suppliers. Specifically, Haskell should at least communicate with the 30 plants material managers to understand and research on their opinions and suggestion towards the new procurement method. He can do a survey or organize a video conference with all the managers to discuss about the topic. From the results of the communication, he could determine whether the new procurement method is a wise method and how he should carry out the new plan. (b)Messages: Haskell should put more efforts on delivering and structuring the message that he intended to send to all the material managers. He should choose multiple channels such as video conference, email, or intranet in order to deliver the message more effectively. A visual communication could be carried in order to increase the possibility and awareness of the constituencies. Besides, he could structure better of the message such as emphasizing the objective strongly and input some sentences that shows the much concern of the board of directors towards the new procurement process. (c)Organization: I suggest Haskell to set up a small committee who accounts for the whole research, implementation, development and evaluation of the new procurement process. This small committee should involve at least four to five professionals to keep track with the project. Hence, the new procurement procedure can be carried and improved in order to meet the objective which is to centralized the procurement procedure and reduce the number of suppliers overall. Besides, the implementation of the new policy should not be allocated at a busy or peak period of the procurement department. They should at least allow one month to each plant to execute the new procedure.

Criticism of Shakespeares play Macbeth Movie Review

Criticism of Shakespeares play Macbeth - Movie Review Example Macbeth is obviously a morality play where Shakespeare demonstrated that greed, ambition and power can corrupt a man just like what happened to Macbeth, once a loyal general of the king became a monster (figurative) when he believed the witches premonition that he will be king someday. The aplay also sent the message among its reader and audience that good will always triump over evil as Macbeth eventually fell even if he was the king of Scotland. The play was okay but I cannot say that it was terrific. Perhaps I did not appreciate the play that much due to the heaviness of Shakepeare’s language. But I like watching the play rather than reading the book because I understand the story better and it does not drag me to sleep. I thought of it as above average because there was not much technology used in the play to properly render the ghost of Banquo and the witches. They would have been a spectacular sight to behold had the production had enough budget. Shakespeare’s play is always worth doing. It raises the bar or standard of language and keeps us abreast on the beauty of the english language. The play also makes the book more interesting because in the play, the actors can vividly render the story. The plot of the story by itself also teaches a lesson that greed, ambition and power can corrupt which is a valuable lesson that students should learn in addition to appreciating the poetry of Shakespearean English.

Human resourses and communication skills Essay Example | Topics and Well Written Essays - 1000 words

Human resourses and communication skills - Essay Example This research will begin with the statement that modern improvements in information technology have provided freedom to employees to work anytime and from anywhere. This, in turn, has led to weakening of the tie between organizations and their employees. Many organizations have adopted computer- interfaced communication technology supplanting the formal hierarchical structure in coordinating and managing relationships within and between organizations. A number of organizations have been inspired by improvements in information technology and started experimenting with electronic ways of working comprising of working from satellite centres, mobile work among others. In setting up groups, there are norms that should be established with each member of the team actively participating. Attention should be paid to the content and also keenly shape and evaluate the means it employs in accomplishing goals. The team process should include the ways in which members interact, communicate with ea ch other, and communicate with employees who are not in the team and a responsibility of ensuring accomplishment of goals. Team players in an organization will include managers of different sections headed by the managing director. For an organization’s success, these people should first form a united team comprising of all the norms. For instance, a sugar-manufacturing factory in which the managing director does not treat his colleagues with respect and dignity and in which there is a lack of transparency is bound to fail. This according to norms under which a team should operate brings out the lack of proper communication between the team. A case of communication breakdown may arise in such a scenario as one in which a department requires information from another department to do its job, while the other department ignores the request or fakes an excuse. This can result into conflicts. Alternatively, the conflict can be created by giving circular responses. Such as giving u nsatisfactory response when an issue being sort has not been worked on. For example, a purchasing department requires a confirmation note from the finance department to make orders. The finance department on the contrary delays in giving the response. This slows down the processes of an organization and can lead to conflicts within. In this context, we learn that proper human resource management can be best achieved by streamlining the communication channels and ensuring that prompt responses are given to requests. It equips us with corporate wellness management skills that will help in understanding communication skills. Another aspect that could derail the operations of the organization is a lack of transparency. This should be embraced within the team as well as the employees. Employees are supposed to be genuine with each other in terms of ideas, challenges and be free to confide in the management. Managers are charged with the responsibility of opening up space thus freeing peo ple to ask anything they need without being intimidated. For instance, an employee collapses while at work simply because he/she did not have the platform to express her condition due to fear of being dismissed. Some companies have stringent measures on employee misconduct, which intimidate the employees (Condrey 2010). This poses a challenge specifically to the human resource manager whose credibility in the employees’ welfares will be doubted. In this, we learn another role of the human resource management, which is increasing the staff in an organization. Under this, the management is charged with among other things recruitment and selection of human resources, and management of a typical employment and termination situations. The strength of a proper management is invested in the energy and training its employees. A majority of firms are taking their employees for ethics training as one of the means of safeguarding the image of their firms. This should be geared towards i ncreasing the awareness of ethical conduct and familiarizing

American Companies & Globalization Essay Example | Topics and Well Written Essays - 750 words

American Companies & Globalization - Essay Example The economy of the country has experienced slow growth in the recent past in spite of being the largest single market of the world. The success of the operating organizations depends on the situation that is prevailing within the country and abroad. The multinationals are much more interested in drawing their strategies keeping into account the global perspective. The activity of foreign affiliations is indeed a complement for the key parent activities in the country in terms of employment, compensations towards workers and capital investment. In order to operate globally it is required or the organizations to expand as well as integrate the foreign activities as such activities cannot be substituted. The expansion by the U.S. parents along with the affiliates contributes to increase the productivity and also contributes to improve the standard of living of all Americans. The rising concerns for the U.S. multinationals are mainly focused on the competitiveness. The success of the mul tinationals is very important as these companies have been productive for a long time and form the pillars of economic strength. The companies are engaged in serving the fast growing markets abroad. The following figure reports the share of the private sector economic activities of U.S. that is accounted for by U.S. parents. It can be depicted from the figure above that parent companies of United States perform large shares of the productivity of America which tends to enhance the activities paving the path for high average compensation for the workers of the country. Accessing the foreign consumers is one of the drivers for the global engagements of the U.S. multinationals. The new customers can contribute in strengthening the revenues of the companies as well as the profitability of the company will witness the upward rising curve. The Statistics show a variation in the rate of GDP over the periods. One can held the evolving size of the national markets and the perspective of the consumers as the reason. When a U.S. multinational operates globally, the company can take hold of foreign currencies which they can divert into the economy of the residing country. Therefore, the economy boosts up with foreign inflow and thereby the company contributes in improving the economic structure of the country as a whole. The multinationals involved in producing goods and services are also engaged in exploration of resources and extraction. Following the policy of diversifying the products and global engagements, the U.S. multinationals are reducing the risk of crisis since a slowdown in one of the countries can be nullified by prosperity in the other. Therefore, indirectly, the economy of the country is as well enjoying a shield against the turbulences. The multinationals also contribute in increasing the exports of the country. The Balance of Payments of the country improves being the resultant. The integrated operations that the multinationals follow across borders stim ulate the exports potential of the country. Let us take the example of IBM. Even today when U.S. remains as the largest single market the company earns more than two-thirds of the total profits from abroad. A great deal of sales accrues from the exports of U.S. or the products which are produced or designed in the country. The company annually brings the economy billions of dollars from its global operations. In the last two years, the company repatriated more than 20 billion dollars

Multibacillary Leprosy (MB) Case Study

Multibacillary Leprosy (MB) Case Study 1.0 Summary of scenario and potential consequences This case is based on a 32 year old female with multibacillary leprosy(MB). Leprosy, also known as Hansens disease, is a chronic infective disease caused by acid-fast, gram-positive Mycobacterium leprae (M.leprae). Several modes of transmission have been suggested such as skin contact and sexual activities but the primary mechanism is via air by mouth and nasal discharge of untreated infected people. Leprosy can be considered in two parts in which the first milder form involves infection of superficial tissues such as skin. This indeterminate state is usually surmounted by human body eliciting sufficient immune response, with approximately 95% people being not susceptible. Nevertheless, if the body produces too high or too low a response, the second more severe form develops and progresses leaving deformities in areas such as skin, nervous system, mucosa, limbs and eyes. Thus, depending on the patients immune response, leprosy is classified by the World Health Organization(WHO) into MB in which the bodys defense system is ineffective, and paucibacillary leprosy(PB) which produces aggressive response.1 In terms of skin smear tests, MB which has large number of bacteria in skin lesion would produce positive results while PB produces negative results. Another type of classification known as Ridley-Jopling classification divides leprosy into 5 stages; tuberculoid(TT), borderline tuberculoid(BT), midborderline/borderline(BB), borderline lepromatous(BL) and lepromatous(LL) leprosy in which the latter three are the equivalent of MB. In 2009, leprosy cases were reported in 121 countries.3 Based on WHO figures, the number of new cases detected in 2008 was 249007 while the registered prevalence of leprosy worldwide at the beginning of 2009 was 213036. Although there has been a steady fall in the number of new cases detected annually, leprosy remains a global threat. In terms of signs and symptoms, those possibly encountered are numbness, nasal discharge and various kinds of lesions, macules, nodules and papules. More severe symptoms may be diffuse skin thickening, eye lesions leading to cataract, secondary infection and nerve lesions. Although leprosy can affect all people, various specific factors predispose to leprosy. Firstly, leprosy typically affects people living in tropical and subtropical climate such as Africa and South East Asia. People in endemic areas as well as the poor and marginalized community are at greater risk of contracting leprosy. In terms of age, leprosy demonstrates an age-related pattern with peak incidence in children below 10 years old and mid thirties while rarely acquired by infants.2 Besides that, men are generally more susceptible than women and genetic factors may play a role too. Despite years of incubation period, the differential diagnosis of leprosy is vital because the treatment duration is prolonged. Also, an accurate diagnosis helps in determining the appropriate and effective treatment. In vitro culture of M.leprae is not feasible given the extremely slow growth rate. Methods that can be used include skin lesion biopsy and nasal smears done using Fites acid fast tissue staining which stains the bacilli red in a blue background or using Hematoxylin and eosin stain (HE) for histological confirmation.2,4 The number of bacilli visible will denote the type of leprosy. Additionally, phenolic glycopilid-1(PGL-1) characteristic of M.leprae can be distinguished using serology techniques. Given its low mortality rate, leprosy confers debilitating repercussions nevertheless both physiologically and psychologically. Leprosy causes hypoesthesia due to impaired peripheral nerve function, muscle weakness as well as glaucoma, iridocyclitis and inflammation of the eye. As a result, patients are prone to injuries due to diminished vision, and inability to feel and control the body. The incidence of ocular problems is markedly elevated and treatment has proved to reduce prevalence of these complications as described by Gupta et al, whereby 66.3% active leprosy patients manifested ocular problems compared to cured patients at 14.3%.5 If blindness occurs, the relative death risk in blind patients compared to non-blind patients augments by 4.8fold.6 Additionally, leprosy causes clawed fingers and toes, hypopigmented skin lesions with severe ulcerations especially on feet and hands, and facial deformations. These disabilities occurs more frequently in MB patients than in PB patients,5,7 and it was suggested that MB patients have higher risk of death compared to PB patients; the average death age being 5 years younger.8 Contrasting prevalence of deformities was concluded in different studies which includes 56.97%,7 82.4%,9 84.4%,10 67%11 and these differences may be the result of improper examination technique or dissimilar grading criteria. However, the point to note here is that all studies acknowledge the severity of this disease. Apart from imposing restrictions on physical mobility, such immensely conspicuous debilities have led to a stigma linked to leprosy. Leprosy patients are often subjected to public prejudice and discrimination, leaving them significantly affected both socially and economically. Therefore, accurate diagnosis and aggressive commencement of leprosy treatment is essential to improve patients quality of life and to decrease mortality rate. 2.0 Treatment options 2.1 First line therapy The current first line therapy include dapsone, rifampicin and clofazimine. Dapsone is a bacteriostatic antibacterial active against M.leprae. Its good oral bioavailability allows its administration in tablet form. However, dapsone monotherapy is no longer used as several studies have established profound drug resistance.12,13,14 Following this, WHO recommends the use of three drugs; dapsone, rifampicin and clofazimine, administered as multiple drug therapy(MDT) for MB.1 Supporting this is a systemic evaluation by Kundu et al. which compared dapsone monotherapy to MDT and proved that MDT was significantly superior with capacity to prevent dapsone resistance.15 The current MDT dosing is dapsone 100mg and clofazimine 50mg daily self-administered, and rifampicin 600mg and clofazimine 300mg once monthly supervised. Several studies have shown that MDT is effective in eliminating leprosy with low relapse rates.16,17,18,19 For example, Georges et al. demonstrated that patients treated with MDT until bacterial clearance showed no validated relapses in the follow up period between 4 months to 5 years and 10 months.16 If adverse effects or contraindication occurs resulting in MDT termination, WHO recommends alternative regimen.20 However, it is vital to ascertain conclusively that the negative effects are due to MDT. Dapsone should be terminated immediately if patient develops adverse effects such as Dapsone Hypersensitivity Syndrome (DHS), with rifampicin and clofazimine continued at usual dosages. The use of only rifampicin and clofazimine was proven effective for dapsone intolerant patients as described by Sapkota et al.21 These patients treated for a mean duration of 15 months post-dapsone cessation showed steady decrease in mean bacteriological index(BI). Next, if rifampicin is ill-tolerated, alternative therapy comprises clofazimine 50mg, ofloxacin 400mg and minocycline 100mg daily for six months, followed by clofazimine 50mg combined with either ofloxacin 400mg or minocycline 100mg for at least 18 months; given under supervision. Ji et al showed that ofloxacin eliminated 99.99% rifampicin-resistant cells after 22 doses in two months.22 Finally if clofazimine has poor acceptability, MDT can be replaced with ROM comprising rifampicin 600mg, ofloxacin 400mg and minocycline 100mg given monthly for 24 months. In a field trial in Senegal, patients on ROM showed satisfactory progress with exceptional compliance(>99%) possibly attributed to the simpler monthly dosage.23 This combination was further advocated by S. Ura24 and Villahermosa et al25 which compared 2 years ROM treatment with MDT. The studies concluded that both therapy depicted similar advantages regarding their effect on BI, their safety and tolerability. The latter study also showed no relapse after follow ups 5 years later or more. 2.2 Second line therapy Ofloxacin and pefloxacin are broad-spectrum flouroquinolones used as second line therapy for MB. They are bactericidal acting via inhibiting enzyme DNA gyrase required in DNA replication. Patented in 1982, ofloxacin has been reported to have profound effects on leprosy. A clinical trial executed by Ji et al showed killing of more than 99.99% of viable M.leprae in skin smears inoculated into mouse foot pad, with significant clinical improvements by day 56 of therapy utilizing 400mg ofloxacin daily.26 Also, its effect was not enhanced when combined with clofazimine and dapsone. A similar study by Jianping et al which also utilized mice footpad inoculated with leprosy patients skin biopsies had analogous findings, with no M.leprae growth detected.27 These studies supports the notion that ofloxacin possesses strong bactericidal activity. Comparing pefloxacin to ofloxacin, it was found that pefloxacin was less active, requiring 150mg/kg to exert bactericidal effect compared to 50mg/kg fo r ofloxacin.22 Although minimal side effects were encountered in these studies, the short duration of therapy will not vouch for this as severe adverse reactions have been reported including tendon damage, peripheral neuropathy, cardiovascular toxicity and hepatotoxicity. Moving on, the broad spectrum minocycline is a tetracycline antibacterial which can be used in patients intolerant to dapsone or clofazimine.28 In a clinical trial by Fajardo et al, patients treated with 100mg daily minocycline for 6 months followed by WHO MDT manifested distinct clinical improvement within the first month with negative PGL-1 antigen at the end of 6 months treatment.29 However, it has been reported that minocycline induce hyperpigmentation which resulted in termination of therapy.30 This side effect ought to be considered particularly when minocycline is used to replace clofazimine. In terms of bactericidal activity, minocycline is considered more effective than clarithromycin, but significantly diminished activity compared to rifampicin. Next, clarithromycin is a bactericidal macrolide which suppresses bacterial growth by preventing its protein synthesis. A few clinical trials have shown the advantages of clarithromycin including its capability to kill M.leprae, considerable clinical improvement, patient acceptability and minor adverse effects.31,32 Daily dosage of 500mg revealed killing of 99% bacilli within 28 days and 99.9% by day 56.32 However, limited studies with clarithromycin for leprosy use have been done. Until further researches are carried out, clarithromycin remains the second line treatment for multibacillary leprosy. Since the past two decades, concerns over established dapsone resistance and increasingly emerging rifampicin resistance have set interest on use of either thioamide or clofazimine concurrently with rifampicin. However, clofazimine was chosen by WHO due to reports of hepatotoxicity when thioamides were used with rifampicin.33,34 Nevertheless, ethionamide and prothionamide are two thioamide drugs being investigated currently as monotherapy for leprosy treatment. Although mainly used for tuberculosis therapy, both drugs have been shown to exhibit significant anti-leprotic activity based on a clinical trial by Fajardo et al.35 Treatment was well tolerated for both drugs with a clinical progress of 74% and 83% respectively. Prothionamide was found to be superior to ethionamide and the overall efficacy of both drugs was similar to that of dapsone and clofazimine. However, they were less efficacious compared to rifampicin, ofloxacin, pefloxacin, minocycline and clarithromycin. They are al so more expensive than dapsone. Consequently, thioamides are generally not recommended. Finally, rifampicin and Isoprodian comprising dapsone, prothionamide and isoniazid were used in Malta Leprosy Eradication Project(MLEP).36 During the 30-year project, the leprosy prevalence steadily declined with exceptionally low degree of relapse and toxicity. It was suggested that treatment with two Isoprodian tablets daily and 600mg rifampicin tablet completely eradicated leprosy from Malta. This may well set the baseline for leprosy treatment. However, Isoprodian being not readily available became a drawback in proceeding with this therapy. Also, the MLEP posed several limitations including the confinement of the project to a relatively small area which hinders its feasibility in larger areas. Additionally, the fact that leprosy was already declining in Malta before the project commenced in 1971 raised questions over the true effect of the therapy on leprosy elimination. 3.0 Treatment recommendation and supporting evidence After discussing the treatment options available, 24 months MDT is recommended for the 32 year old female patient in this case. This decision is made based on the evidences presented previously on efficacy of MDT and also the fact that not many reliable studies have been conducted on other alternatives. The clinical pharmacological principles of each MDT drug and more evidences will be presented in this section to justify the recommendation. Firstly, dapsone is an established anti-leprotic agent acting via preventing dihyrofolic acid formation thus inhibiting nucleic acid synthesis crucial for M.leprae development. In terms of adverse effects, dapsone has been associated with side effects such as methaemoglobinamia, haemolysis, allergic rhinitis, neurophaty, aganulocytosis and DHS consisting Type 1 reversal reaction and Type 2 erythema nodosum leprosum (ENL) reaction. However, at doses used for leprosy treatment, these side effects are uncommon.37 Besides, DHS can be ameliorated with corticosteroid therapy. In order to curb resistance against dapsone, it should be used concomitantly with rifampicin and clofazimine as MDT. Also, there has been evidence of significant decline in frequency and seriousness of Type 1 and 2 reactions in patients on MDT, possibly due to rapid arrest on leprosy progression and clofazimines anti-inflammatory action.20 Next, rifampicin is an antibacterial which plays a major role in inducing rapid M.leprae cell death by inhibiting RNA polymerase involved in protein synthesis. Rifampicin has good oral bioavailability as it is readily absorbed from the gastrointestinal tract. A monthly 600mg dose is highly bactericidal and is almost as effective as rifampicin given daily as subsequent doses do not augment killing rate proportionately. Thus although rifampicin is expensive, a monthly dose contributes to its cost-effectiveness, feasibility and compliance.20 The downside of rifampicin is that adverse effects such as hepatotoxicity have been reported thus requiring frequent liver function tests and blood tests to detect liver impairment. Other common side effects include gastrointestinal disturbances, fever, headache and rashes. Also, being a liver enzyme inducer, rifampicin upregulates cytochrome P450 resulting in enhanced metabolism of many concomitantly administered hepatic cleared drugs. However, th is effect is relatively minimal due to its once monthly dosing. Furthermore, though rifampicin increases dapsone clearance rate, no changes in dose have been necessary as concluded by Pieters et al.38 Interaction with clofazimine is also not likely as rifampicin lack tendency to accumulate in tissues due to its relatively short half life (2-3 hours) compared to clofazimine (70 days). The third drug used in MDT is clofazimine which based on the MDT dosage is the most well-tolerated amongst the three drugs and is practically non-toxic.39 It is a bacteriostatic antibacterial which has predilection towards mycobacterial DNA and inhibits bacterial growth. A mere 300mg loading dose once monthly may well serve as a repository to maintain sufficient drug in the body.20 However, the downside to its use is that some 75-100% patients encounter pink colouration of the skin, but this side effect is reversible months after stopping therapy.40 Given its efficacy yet without serious adverse effects as proven by various studies and clinical trials, it would be obvious to use clofazimine as part of MDT.41,42,43 In terms of duration of MDT, the recommended duration of MDT has been constantly. WHOs previous recommendation of 24 months therapy showed high efficacy with very low relapse rate. However, in the Seventh Expert Committee(1997), the duration of MDT was shortened to 12 months.1 A study conducted by Sales et al. showed that the decline in bacillary index and occurrence of adverse reactions was analogous for both 12 and 24 months MDT.44 However, this was opposed by US National Hansen Disease Program (NHDP) which stands firm with 24 months MDT with the perspective that more vigorous and longer treatment duration generates higher efficacy with lower relapse rate.28 It also mentioned that the 12 months MDT recommended by WHO was due to cost consideration in developing countries. Besides that, based on the BNF, treatment for at least 2 years is necessary for MB.37 The fundamental objective of leprosy therapy is determined by the relapse rate and degree of disability. Having said so, many studies have showed that the relapse rate after completion of MDT for 2 years yielded either zero or very low relapse rate.45,46,47,48,49,50 These studies are parallel to a long term follow-up by Shaw et al45 which proved zero relapse using this regimen and also by a retrospective analysis conducted in China by Shen et al47 which showed that out of 2374 patients followed up for a mean of 8.27 years, five patients had relapse resulting in a relapse rate of 0.21/1000 person-years. Another basis for the 24 months MDT was the review by WHO which revealed a very low relapse rate of 0.9/10 000 person-years in analysis of more than 20,000 MB patients.49 Furthermore, Katoch et al reported that follow-up conducted between 12-44 months after MDT treatment revealed deterioration in patients who received only 12-18 months treatment and continuous improvement in those giv en 24 months therapy.51 Thus, a 24 months MDT treatment would be the wise choice for this patient. Bearing in mind that this patient is a 32 year old female who is at her child bearing age, it is paramount to ascertain if she is pregnant or lactating. Extreme caution should be undertaken if she is pregnant or lactating, taking into account risks-benefits of leprosy treatment. Several studies have demonstrated adverse effects encountered by pregnant and lactating females such as relapse, type 1 and 2 dapsone reactions and peripheral neuropathy following therapy and are thought to be due to suppression of immunity during pregnancy and breast-feeding.52,53,54However, some studies have showed that these drugs can be used safely during pregnancy.20,55 Thus, although MDT may incur risks to pregnancy and exacerbate leprosy, a well-organized health plan, frequent and regular supervision may well outweigh the risk with its potential benefits.4,54 Also, effects of MDT on lactating is very minor. Although significant amount of dapsone is found in breast milk, its risks to infants are very m inimal. In contrast, the quantity of rifampicin in milk is too small to be harmful to the baby. Likewise, only minute amounts of clofazimine are excreted through breast milk and thus far there have not been reports on severe negative effects on breast-feeding except minor skin discolouration of infant. All in all, treatment using 24 months MDT has proven highly successful with rapid conversion of disease state from infectious to being non-infectious even after the first dose. MDT remains the ultimate option due to its apparent benefits of curing and stopping transmission of leprosy, its virtually zero relapse rate, minimal side effects, ease of administration and storage, cost-effectiveness and vast clinical evidences. Additionally, patient and public education is vital to aid patient compliance and improve understanding on leprosy. In this context, health professionals carry tremendous responsibilities in giving social support and psychological rehabilitation to help patients cope with the physical and mental distress caused by the disease as well as curing the stigma of leprosy.

Uncle Toms Cabin Essay examples -- Uncle Toms Cabin Essays

Few books can truly be said to have altered the course of history, and even fewer can be said to have started an entire war. Uncle Tom's Cabin, written by Harriet Beecher Stowe, was one such novel. It is a realistic, although fictional view of slavery, that burned into the consciousness of America the images of brutal beatings and unfair slave practices. Uncle Tom's Cabin helped to turn the tide of public opinion against slavery in the 19th century. This controversial novel was initially written to question slavery and to convince people of its immorality. It was the first book that brought the problem of slavery in America to the attention of the world. It became not only a bestseller, but a social documentary of the lives of slaves. The closest parallel to the success of Uncle Tom's Cabin was Sinclair's The Jungle, but even The Jungle did not start an entire war.  Ã‚  Ã‚  Ã‚  Ã‚   The main characters in this story are Uncle Tom, Eliza and George Harris. Uncle Tom is a good man, trustworthy, a model slave. He refused to make trouble, and is accepting of an institution he cannot change. A very spiritual person, Uncle Tom tries his best to obey the Bible and to do what is right. He is the figure meant to show the good of man, and how that good was trampled by an unjust institution. Eliza is a beautiful slave owned by George Shelby, Sr., the same person who owns Tom. Eliza has a son, Harry. Eliza's husband, George Harris, lives on a nearby plantation. George is a ...