The Great Gatsby The American Dream - 927 Words

Tj Hesse Ms Labouff English 3 1 November 2017 The Poor Man’s Dream Many believe that America is the land of riches, where anyone can become rich and wealthy. This idea is known as the American Dream, a set of ideals in which freedom includes the opportunity for a successful living. However, this ethos is completely false, and is nothing more than exactly that - a dream. Throughout the award-winning work of F. Scott Fitzgerald, â€Å"The Great Gatsby†, he gathers criticism about the American Dream. He denounces the dream by shedding the light on topics such as the selfish pursuit of pleasure that always follows such attempted pursuit of the dream, the illegal ways that people attempt to undergo in order to obtain the dream, and the fact that†¦show more content†¦He will never actually join or take part in these parties, but just sits there waiting for Daisy to show up.Her voice is full of money, he said suddenly. That was it. I d never understood before. It was full of money – that was the inexhaustible charm that rose and fel l in it, the jingle of it, the cymbals song of it†¦ high in a white palace the king s daughter, the golden girl.† This quote clearly describes that he wishes to get Daisy using only his wealth and money. â€Å"He took out a pile of shirts and began throwing them, one by one, before us, shirts of sheer linen and thick silk and fine flannel, which lost their folds as they fell and covered the table in many-colored disarray. While we admired he brought more and the soft rich heap mounted higher — shirts with stripes and scrolls and plaids in coral and apple-green and lavender and faint orange, and monograms of Indian blue. Suddenly, with a strained sound, Daisy bent her head into the shirts and began to cry stormily.† This also shows that he only wants to get Daisy using his wealth, or in this case his shirts. When people talk about the American Dream, they usually describe it as coming to America, getting a job and become rich. Although being rich comes with a lot of perks such as living life without consequences and very comfortable living, it is easy to always get what is needed or to fix what doesn t needed to be fixed like when â€Å"The idea staggered me. I remembered, of course, that theShow MoreRelatedThe American Dream : The Great Gatsby Essay1568 Words   |  7 PagesThe American Dream: The Great Gatsby The Great Gatsby is a tragic love story on the surface, but its most commonly understood as a suspicious critic of the American Dream. In the novel Jay Gatsby overcomes his poor past to gain an incredible amount of money and a limited amount of social cache of in the 1920s NYC, only to be rejected by the â€Å"old money† crowd. The focus of my paper would be the pathway towards the American Dream and how it affects the person and others around. The American dreamRead MoreThe Great Gatsby and the American Dream1401 Words   |  6 PagesThe Real American Dream Since its institution, the United States has been revered as the ultimate land of ceaseless opportunity. People all around the world immigrated to America to seek quick wealth, which was predominately seen in the new Modern era. Beginning in the late 1800s to the early 1900s, the period introduced progressive ideas into society and the arts. Accompanying these ideas was a loss of faith in the American Dream and the promise America once guaranteed, especially after WorldRead MoreThe Great Gatsby and the American Dream1442 Words   |  6 PagesPursuit of Happiness. This sentiment can be considered the foundation of the American Dream, the dream that everyone has the ability to become what he or she desires to be. While many people work to attain their American dream, others believe that the dream is seemingly impossible to reach, like F. Scott Fitzgerald. Fitzgeralds The Great Gatsby examines the Jazz-Age generations search for the elusive American Dream of wealth and happiness and scrutinizes the consequences of that generationsRead MoreThe American Dream ( The Great Gatsby )1173 Words   |  5 PagesSLIDE. *POINTS TO PICTURE LIVING IN THE AMERICAN DREAM (THE GREAT GATSBY). Did anyone notice anything that caused a change in society between these two pictures? *POINTS TO SOMEONE WITH ONE OF THE ANSWERS TO THE QUIZ/QUESTION. READS OUT THE RAPID ECONOMIC BOOMING AND GREED. *NEXT SLIDE. That’s correct! During the 1920s of the Jazz Age in concurrence with the â€Å"Roaring Twenties†, America had experienced a rapid economic booming after World War I. The American society experienced an economic and politicalRead MoreThe Great Gatsby American Dream1414 Words   |  6 Pagesfilm is based on the novel by F. Scott Fitzgerald. It follows Jay Gatsby, a man who molds his life around one desire: to be reunited with Daisy Buchanan, the love he lost five years earlier. Gatsby s quest leads him from poverty to wealth, into the arms of his beloved, and eventually to death. Nick Caraway is the narrator, or storyteller, of The Great Gatsby, as well as Daisy s cousin who happens to live next door to Great Gatsby. Daisy represents the paragon of perfection. She has the aura of charmRead MoreThe Great Gatsby and the American Dream773 Words   |  3 Pagesimportant items. The American Dream is a huge achievement that everyone wants to reach. Whether people want to admi t it or not, it is a symbol all it’s self. It can be anything really, a great job, a family, white picket fence, even music or attending concerts of your favorite band. The American Dream is something that makes you so happy and what you can achieve or want achieve in your lifetime. The main AMerican Dream is money, a family, and happiness. In The Great Gatsby the american dream is a green lightRead MoreAmerican Dream In The Great Gatsby1366 Words   |  6 PagesThe American Dream has various implications for diverse individuals. For some people, the concept implies that one can accomplish his or her objectives and goals through living this dream. To others, it provides a beacon of hope, as an open door that individuals desperately desire to enter in pursuit of opportunities. The Americans after World War I, boosted by the emotions of the war, had an uncontrollable vigor about accomplishing and displaying an extravagant way of life and achieving a high socialRead MoreThe Ame rican Dream In The Great Gatsby1097 Words   |  5 PagesThe Great Gatsby The Great Gatsby by F. Scott Fitzgerald was one that was highly centralized around the American Dream. The American Dream is the belief that anyone can become successful in America if they worked hard enough. The dream did not discriminate anyone and that is why many people worked towards it. In the novel, it shows that not everyone was living the American Dream but were separated by the social classes of wealth, race, and intelligence. The 1920s in America was a roaringRead MoreThe Great Gatsby And The American Dream1771 Words   |  8 Pages 5/30/17 Of Gatsby and His Unattainable Dream The American dream is a concept that has been wielded into American literature throughout history. Projecting the contrast between the American dream and reality, F. Scott Fitzgerald incorporates his opinions, primarily based off of his experiences and tribulations in World War I, throughout his literary works.Many people believe that deplorable moral and social values have evolved from the materialistic pursuit of the American dream especially throughoutRead MoreThe Great Gatsby and the American Dream592 Words   |  2 PagesRed, white , and blue are iconic to the American culture we know of. They can show our passion, desire, and pride for our country, but you will always have you might have to give in, against what your morals tell you.In the novel The Great Gatsby by F. Scott Fitzgerald, Fitzgerald uses the colors red, blue, and white to symbolize the American dream. To accomplish the American dream you need passion and desire but you will face situations where your morals will compromised. Passion is a necessity

A Stolen Community Where Are The Victims - 1466 Words

Latavia Hawkins Ms. Whittington English IV Honors 15 April 2015 A Stolen Community: Where Are The Victims? â€Å"However you dress, wherever you go, yes means yes and no means no† -Dr. Suese. Within 48 hours of leaving home, one in three teens on the street will be lured toward prostitution. Approximately 300,000 children are at risk of being prostituted in the United States. In fact, human trafficking generates $9.5 billion yearly in the United States. The median age of entry into prostitution for a child victim in the United States is 13-14 years old. The average victim may be forced to have sex up to 20-48 times a day. Human trafficking has disgustingly shaped today’s society and has robbed us of our children and parents; It is an illegal recruitment of defenseless young teens and adults. They unwillingly transport people from place to place, country to country. Although this criminal activity violates human rights on so many levels, statistics still continue to grow and there have been so little done about it. Generally, trackers lure their victims under false pretense. Unfortunately the victims are trafficked by family members or by someone that can be trusted into having a better way of schooling, housing or even a job offer. Then unknowingly the victims voluntarily flee the country to somewhere else and become trapped by criminals. Once the potential victim has fallen for the offer then he or she is on the journey to being trafficked. OnceShow MoreRelatedCrime And Its Effects On Society1540 Words   |  7 Pagesmonetary. In today’s world, people spend a lot of money to protect themselves from becoming victims of crimes. When a serious crime happens in one community, people in that community will take the necessary precautions that they believe will prevent that crime from happening again. Depending on the severity of the crime, it can also affect people in other communities not only the people in the community where the crime happened. However, many times the psychological cost of a particular crime can haveRead MoreA Report Of A Stolen Bike957 Words   |  4 PagesWhen compared to other crimes, the case of a stolen bike seems like one that does not require a team of investigators. Actually, if asked to describe situation involving a report of a stolen bicycle, one might envision the victim being a child or young adult. The reality of the case is that there is an average of $50 million worth of bikes stolen each year in the United States (Jouvenal, 2007, p.26). The underground network of stolen bikes can be attractive to criminals for some bikes can cost upwardRead MoreWhat Did The Stolen 3 Generation Affected The Australian Population1423 Words   |  6 Pagestreated callously, anguished and tortured due to their race. 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According to  London s  Metropolitan Police Force,  street crime  is: Robbery, often called mugging , and also includes thefts from victims in the street where property is snatched and the victim is not assaulted.  [1] Crime on the  streets  of a  city  may include many other types of offences, for example  pickpocketing, the open carrying-on of the  illegal drugs trade, prostitution in the form of  soliciting  outsideRead MoreThe Role Of Aboriginal And Torres Strait Islander People1586 Words   |  7 PagesThe ‘Stolen Generations’ is a term used to describe the actions of which Aboriginal and Torres Strait Islander people, mostly children, were taken away from their families between the 1890’s and the 1970’s (Korff, 2014). Children were taken to institutions or adopted by non-Indigenous families and most never saw their families again. 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The Stolen Generation was the result of the trauma that the Aboriginal and Torres Strait Islanders face today. Due to this trauma, this has led to them to losing their culture where they have now fallen at a disadvantage such as their immediate socioeconomic causes, low levels of education and employment and poorer health. This has alsoRead MoreAssimilation Of Stolen Generations1413 Words   |  6 PagesHave you ever wondered what the Stolen Generations are and why they were taken from their families? Between 1910-1970, many Indigenous children were forcibly removed from their families because of many government policies. The generations of children removed under these policies became known as the Stolen Generations. These policies left a heritage of trauma and loss that continues to affect Indigenous communities, families, and individuals to this current day. The violent removal of IndigenousRead MoreIdentity Theft1365 Words   |  6 PagesTrade Commission, identity theft complaints have decreased since year 2008 (314,521 to 250,854). It is estimated by the FTC that as many as 9 million Americans have their identities stolen each year. As information technology progresses along with society, there is always an increased risk of having one’s identity stolen. â€Å"Identity theft was the number one complaint category in the CSN for calendar year 2010 with 19% of the overall complaints, followed by Debt Collection (11%); Internet Services (5%);Read MoreThe Death Penalty On The Criminal Justice System1491 Words   |  6 Pagesfrom of justice that he introduces is justice before the law, the type of justice that can equalize what has been taken. Aristotle focuses on the city as a community that both the offender and the victim live in. To rectify what has been taken, the victim must be restored. The way to do this is to take from the offender and give to the victim. This sort of corrective or rectificatory justice is known as ‘Aristotle’s standard interpretation’ (Brickhouse 188). When a person gets their life taken from

The Secret Circle The Captive Chapter Six Free Essays

They drove to the school. Despite the tension between them, the night seemed clear and cool and filled with magic, and the gym was transformed. It was so big that it seemed part of the night, and the twinkling lights woven around the pipes and girders overhead were like stars. We will write a custom essay sample on The Secret Circle: The Captive Chapter Six or any similar topic only for you Order Now Cassie looked around for any other members of the Circle. She didn’t see any. What she saw were outsiders looking in surprise at her and Adam. And in the boys’ eyes there was something more than surprise, something Cassie wasn’t at all used to. It was the kind of openmouthed stare guys turned on Diana when Diana was looking particularly beautiful. A sudden warmth and a glow that had nothing to do with Suzan’s artistry swept over Cassie. She knew she was blushing. She felt conspicuous and overwhelmed-and at the same time thrilled and excited. But through the wild mixture of emotions, one thing remained clear and diamond-bright within her. She was here to play a part and to keep her oath to be true to Diana. That was what mattered, and she clung to it. But she couldn’t just stand here with everyone staring at her any longer; it was too embarrassing. She turned to Adam. It was an awkward moment. They couldn’t sit down together in some dark corner-that would never do. Then Adam gave a crooked smile and said, â€Å"Want to dance?† Relieved, Cassie nodded, and they went out onto the dance floor. In a matter of seconds they were surrounded by other people. And then the music started, soft and sweet. They stared at each other, helplessly, in dismay. They were in the middle of the dance floor; to get out they would have to forge their way through the crowd. Cassie looked into Adam’s eyes and saw he was as confused as she was. Then Adam said under his breath, â€Å"We’d better not be too conspicuous,† and he took her in his arms. Cassie shut her eyes. She was trembling, and she didn’t know what to do. Slowly, almost as if compelled, Adam laid his cheek against her hair. I won’t think about anything, I won’t think at all, Cassie told herself. I won’t feel. . . But that was impossible. She couldn’t help feeling. It was dark as twilight and Adam was holding her and she could smell his scent of autumn leaves and ocean wind. Dancing is a very witchy thing-oh, Laurel had been right. Cassie could imagine witches in ages past dancing under the stars to wild sweet music, and then lying down on the soft green grass. Maybe among Cassie’s ancestors there had been some witch-girl who had danced like this in a moonlit glade. Maybe she had danced by herself until she noticed a shadow among the trees and heard the panpipes. And then maybe she and the forest god had danced together, while the moon shone silver all around them†¦. Cassie could feel the warmth, the course of life, in Adam’s arms. The silver cord, she thought. The mysterious, invisible bond that had connected her to Adam from the beginning†¦ just now she could feel it again. It joined them heart to heart, it was drawing them irresistibly together. The music stopped. Adam moved back just slightly and she looked up at him, cheek and neck tingling with the loss of his warmth. His eyes were strange, darkness just edged with silver like a new moon. Slowly, he bent down so that his lips were barely touching hers-and stayed there. They stood that way for what seemed like an eternity and then Cassie turned her head away. It wasn’t a kiss, she thought as they moved out through the crowd. It didn’t count. But there was no way that they could dance together again and they both knew it. Cassie’s knees were shaking. Find some people to join-fast, she thought. She looked around desperately. And to her vast relief she glimpsed a sleek auburn crop and a head of long, light-brown hair interwoven with tiny flowers. It was Melanie and Laurel, in animated conversation with two outsider boys. If they’d seen what happened on the dance floor a minute ago†¦ But Laurel swung around at Adam’s â€Å"hello† and said, â€Å"Oh, there you are!† and Melanie’s smile was quite normal. Cassie was grateful to talk with them while the boys talked about football. Her lightheartedness, inspired by the magic of the dance, began to return. â€Å"There’s Deborah. She always gets one dance in before heading off to the boiler room with the Hendersons,† Laurel murmured, smiling mischievously. â€Å"What do they do there?† Cassie asked as she followed Laurel’s gaze. Deborah was wearing a black micro-mini and a biker’s hat decorated with a gold link bracelet. Her hair was mostly in her eyes. She looked great. â€Å"Play cards and drink. But no, not what you’re thinking. None of the guys would dare try anything with Deb-she can outwrestle them all. They’re just in awe of her.† Cassie smiled, then she spotted someone else, and her smile faded. â€Å"Speaking of awesome†¦Ã¢â‚¬  she said softly. Faye had on a flame-colored dress, sexy and elegant, cut in her usual knockout style. Her hair was black and glossy, hanging untamed down her back. She was like some exotic creature that had wandered onto campus by accident. Faye didn’t see the three girls scrutinizing her. Her entire attention seemed to be focused on Nick. Cassie was surprised Nick was even here; he wasn’t the type to go to dances. He was standing by a blond outsider girl who looked frankly spooked. As Cassie watched, Faye made her way over to him and placed a hand with red-tipped fingers on his arm. Nick glanced down at the hand and stiffened. He threw a cold glance over his shoulder at Faye. Then, deliberately, he shrugged her hand off, bending over the little blonde, whose eyes widened. Throughout the whole incident his face remained as wintry and remote as ever. â€Å"Uh-oh,† Laurel whispered. â€Å"Faye’s trying to hedge her bets, but Nick isn’t cooperating.† â€Å"It’s her own fault,† Melanie said. â€Å"She kept after Jeffrey until the last minute.† â€Å"I think she’s still after him now,† said Cassie. Jeffrey was just coming off the dance floor with Sally. His expression was the exact opposite of wintry; he looked as if he was having a wonderful time, flashing his lady-killing smile in all directions. Proud, Cassie thought, to have the Homecoming Queen on his arm. But it was funny, she thought the next minute, how quickly people stopped smiling when they ran into Faye. Jeffrey tried to hustle Sally back onto the dance floor, but Faye moved as quickly as a stalking panther and cut them off. Then she and Sally stood on either side of Jeff, like a big, glossy black dog and a little rust-colored terrier fighting over a tall, slim bone. â€Å"That’s stupid,† Laurel said. â€Å"Faye could have almost any guy here, but she only wants the ones who’re a challenge.† â€Å"Well, it’s not our problem,† Melanie said sensibly. She turned to the outsider boy beside her and smiled, and they went together onto the dance floor. Laurel looked nettled for an instant, then smiled, shrugged at Cassie, and collected her own partner. Cassie watched them go with a sinking heart. She’d been able to block out Adam’s presence for the last few minutes, but here they were alone again. Determinedly, she looked around for some distraction. There was Jeffrey-he was in real trouble now. The music had started, Faye was smiling a lazy, dangerous smile at him, and Sally was bristling and looking daggers. The three of them were standing in a perfect triangle, nobody moving. Cassie didn’t see how Jeffrey was going to get out of it. Then he looked up in her direction. His reaction was startling. His eyes widened. He blinked. He stared at her as if he had never seen a girl before. Then he stepped away from Faye and Sally as if he’d forgotten their existence. Cassie was dismayed, confused-but flattered. One thing-it certainly got her out of her present dilemma with Adam. When she turned and looked into Adam’s eyes, she saw he understood, without even nodding. Jeffrey was holding out his hand to her. She took it and let him lead her onto the dance floor. She cast one glance back at Adam and saw that his expression was a paradox: acceptance mixed with something darker, more disturbing. It was another slow dance. Cassie held herself at a decent distance from Jeffrey, staring uncertainly down at his shoes. They were dark brown loafers with little tassels, the left one slightly scuffed. When she finally looked up at his face, her awkwardness vanished. That smile was not only blinding but openly admiring. When we first met he was trying to impress me, Cassie thought dizzily. Now he’s impressed. She could see the appreciation in his eyes, feel it in the way he held her. â€Å"We make a good couple,† he said. She laughed. Trust Jeffrey to compliment himself in complimenting her. â€Å"Thank you. I hope Sally isn’t mad.† â€Å"It’s not Sally I’m worried about. It’s her.† â€Å"Faye. I know.† She wished she had some advice for him. But nobody knew how to deal with Faye. â€Å"Maybe you’d better be worried too. What’s Diana going to say when she finds out you were here with Adam?† â€Å"Diana asked me to come with him, because she was sick,† Cassie said, flaring up in spite of herself. â€Å"I didn’t even want to, and-â€Å" â€Å"Hey. Hey. I was just teasing. Everybody knows Di and her prince consort are practically married. Although maybe she wouldn’t have asked you if she’d known how beautiful you were going to look.† He was still teasing, but Cassie didn’t like it. She looked around the dance floor and saw Laurel, who winked over her partner’s shoulder. Suzan was dancing, too, very close with a muscular boy, her red-gold hair shining in the gloom. And then it was over. Cassie looked up at Jeffrey and said, â€Å"Good luck with Faye,† which was the best she could offer him. He flashed the smile again. â€Å"I can handle it,† he said confidently. â€Å"Don’t you want to dance again? No? Are you sure?† â€Å"Thanks, but I’d better get back,† Cassie murmured, worried about the way he was looking at her. She managed to escape his restraining hand and started toward the sidelines, but before she could get there another boy asked her to dance. She couldn’t see Adam anywhere. Maybe he was off enjoying himself-she hoped so. She said â€Å"yes† to the boy. It didn’t stop with him. All sorts of guys, seniors and juniors, athletes and class officers, were coming up to her. She saw boys’ eyes wander from their own dates to look at her as she danced. I didn’t know dances were like this. I didn’t know anything was like this, she thought. For the moment she was entirely swept up in the magic of the night, and she pushed all troublesome reflection away. She let the music take her and let herself just be for a while. Then she saw Sally’s face on the sidelines. Jeffrey wasn’t with her. Cassie hadn’t seen Jeffrey in a while. But Sally was focused on Cassie specifically, and her expression was venomous. When that dance was over, Cassie evaded the next boy who tried to intercept her, and headed for Laurel. Laurel greeted her with glee. â€Å"You’re the belle of the ball,† she said excitedly, tucking her arm through Cassie’s and patting Cassie’s hand. â€Å"Sally’s furious. Faye’s furious. Everybody’s furious.† â€Å"It’s the magnet perfume. I think Suzan used too much.† â€Å"Don’t be silly. It’s you. You’re a perfect little-gazelle. No, a little white unicorn, one of a kind. I think even Adam has noticed.† Cassie went still. â€Å"Oh, I doubt that,† she said lightly. â€Å"He’s just being polite. You know Adam.† â€Å"Yes,† said Laurel. â€Å"Sir Adam the Chivalrous. He turned around and asked Sally to dance after you left with Jeffrey, and Sally almost decked him.† Cassie smiled, but her heart was still pounding. She and Adam had promised not to betray their feelings for each other, not by word or look or deed-but they were making a horrible mess of things tonight on all fronts. Now she was afraid to look for Adam, and she didn’t want to dance any more. She didn’t want to be the belle of the ball; she didn’t want every girl here to be furious with her. She wanted to go to Diana. Suzan arrived, her extraordinary chest heaving slightly in her low-cut dress. She directed an arch smile at Cassie. â€Å"I told you I knew what I was talking about,† she said. â€Å"Having a good time?† â€Å"Wonderful,† Cassie said, digging her nails in one palm. She opened her mouth to say something else, but just then she glimpsed Sean making his way toward her. His face was eager, his usually slinking step purposeful. â€Å"I should have warned you,† Laurel said in an undertone. â€Å"Sean’s been chasing you all night, but some other guy always got there first.† â€Å"If he does catch you he’ll be all over you like ugly on an ape,† Suzan added pleasantly, rummaging in her purse. â€Å"Oh, damn, I gave my lipstick to Deborah. Where is she?† â€Å"Hi there,† Sean said, reaching them. His small black eyes slid over Cassie. â€Å"So you’re free at last.† â€Å"Not really,† Cassie blurted. â€Å"I have to-go find Deborah for Suzan.† What she had to do was get away from all this for a while. â€Å"I know where she is; I’ll be right back,† she continued to the startled Suzan and Laurel. â€Å"I’ll come along,† Sean began instantly, and Laurel opened her mouth, but Cassie waved at both of them in dismissal. â€Å"No, no-I’ll go by myself. It won’t take a minute,† she said. And then she was away from them, plunging through the crowd toward the double doors. She knew where the boiler room was, or at least where the door that led to it was. She’d never actually been inside. By the time she reached C-wing she’d left the music of the dance far behind. The door marked custodian’s office opened onto a long narrow room with unidentifiable machinery all around. Generators were humming, drowning out any other noise. It was cool and dank†¦ spooky, Cassie thought. There were NO smoking signs on the walls and it smelled of oil and gas. A stairway descended into the school basement. Cassie slowly went down the steps, gripping the smooth metal handrail. God, it’s like going down into a tomb, she thought. Who would want to spend their time here instead of in the light and music up in the gym? The boiler room itself smelled of machine oil and beer. It wasn’t just cool; it was cold. And it was silent, except for the steady dripping of water somewhere. A terrible place, Cassie thought shakily. All around her were machines with giant dials, and overhead there were huge pipes of all kinds. It was like being in the bowels of a ship. And it was deserted. â€Å"Hello? Deborah?† No answer. â€Å"Debby? Chris? It’s Cassie.† Maybe they couldn’t hear her. There was another room behind the boiler room; she could glimpse it through an archway beyond the machines. She edged toward it, worried about getting oil on Laurel’s pristine dress. She looked through the archway and hesitated, gripped by a strange apprehension. Drip. Drip. â€Å"Is anybody there?† A large machine was blocking her way. Uneasily, she poked her head around it. At first she thought the room was empty, but then, at eye level, she saw something. Something wrong. And in that instant her throat closed and her mind fragmented, single thoughts flashing across it like explosions from a flashbulb. Swinging feet. Swinging feet where feet shouldn’t be. Somebody walking on air. Flying like a witch. Only, the feet weren’t flying. They were swinging, back and forth, in two dark brown loafers. Two dark brown loafers with little tassels. Cassie looked up at the face. The relentless dripping of water went on. The smell of oil and stale alcohol nauseated her. Can’t scream. Can’t do anything but gasp. Drip and swing. That face, that horrible blue face. No more lady-killer smile. I have to do something to help him, but how can I help? Nobody’s neck bends that way when they’re alive. Every horrible detail was so clear. The fraying rope. The swinging shadow on the cinder-block wall. The machinery with its dials and switches. And the awful stillness. Drip. Drip. Swinging like a pendulum. Hands covering her mouth, Cassie began to sob. She backed away, trying not to see the curly brown hair on the head that was lolling sideways. He couldn’t be dead when she’d just danced with him. He’d just had his arms around her, he’d flashed her that cocksure smile. And now- She stepped back and hands fell on her shoulders. She did try to scream then, but her throat was paralyzed. Her vision went dark. â€Å"Steady. Steady. Hang on there.† It was Nick. â€Å"Breathe slower. Put your head down.† â€Å"Nine-one-one,† she gasped, and then, clearly and distinctly so that he would understand, â€Å"Call nine-one-one, Nick. Jeffrey-â€Å" He cast a hard glance at the swinging feet. â€Å"He doesn’t need a doctor. Do you?† â€Å"I-† She was hanging on to his hand. â€Å"I came down to get Deborah.† â€Å"She’s in the old science building. They got busted here.† â€Å"And I saw him-Jeffrey-â€Å" Nick’s arm was comforting, solid. â€Å"I get the picture,† he said. â€Å"Do you want to sit down?† â€Å"I can’t. It’s Laurel’s dress.† She was completely irrational, she realized. She tried desperately to get a grip on herself. â€Å"Nick, please let me go. I have to call an ambulance.† â€Å"Cassie.† She couldn’t remember him ever saying her name before, but now he was holding her shoulders and looking her directly in the face. â€Å"No ambulance is going to do him any good. You got that? Now just calm down.† Cassie stared into his polished-mahogany eyes, then slowly nodded. The gasping was easing up. She was grateful for his arm around her, although some part of her mind was standing back in disbelief-Nick was comforting her? Nick, who hated girls and was coldly polite to them at best? â€Å"What’s going on here?† Cassie spun to see Adam in the archway. But when she tried to speak, her throat closed completely and hot tears flooded her eyes. Nick said, â€Å"She’s a little upset. She just found Jeffrey Lovejoy hanging from a pipe.† â€Å"What?† Adam moved swiftly to look around the machine. He came back looking grim and alert, his eyes glinting silver as they always did in times of trouble. â€Å"How much do you know about this?† he asked Nick crisply. â€Å"I came down to get something I left,† Nick said, equally short. â€Å"I found her about ready to keel over. And that’s all.† Adam’s expression had softened slightly. â€Å"Are you okay?† he said to Cassie. â€Å"I’ve been looking everywhere for you. I knew something was wrong, but I didn’t know what. Then Suzan said you’d gone to look for Deborah, but that you were looking in the wrong place.† As if it were the most natural thing in the world, he reached out to take her from Nick-and Nick resisted. For a moment there was tension between the two boys and Cassie looked from one to the other with dawning surprise and alarm. She moved away from both. â€Å"I’m all right,† she said. And, strangely, saying so made it almost true. It was partly necessity and partly something else-her witch senses were telling her something. She had a feeling of malice, of evil. Of darkness. â€Å"The dark energy,† she whispered. Adam looked more keen and alert. â€Å"You think-?† â€Å"Yes,† she said. â€Å"Yes, I do. But if only we could tell for sure†¦Ã¢â‚¬  Her mind was racing. Jeffrey. Jeffrey’s body swinging like a pendulum. â€Å"Usually we use clear quartz as a pendulum †¦Ã¢â‚¬  She snatched Melanie’s necklace off and held it up, looking at the teardrop of quartz crystal. â€Å"If the dark energy was here, maybe we can trace it,† she said, fired with the idea. â€Å"See where it came from-or where it went. If you guys will help.† Nick was looking skeptical, but Adam cut in before he could speak. â€Å"Of course we’ll help. But it’s dangerous; we’ve got to be careful.† His fingers gripped her arm reassuringly. â€Å"Then-we have to go back in there,† Cassie said, and before she could change her mind she moved, darting into the far room where the feet still swung. Nick and Adam were close behind her. Without letting herself think, she held the crystal up high, watching it shimmer in the light. At first it just spun in circles. But then it began to seesaw violently, pointing out a direction. How to cite The Secret Circle: The Captive Chapter Six, Essay examples

Obesity Global Burden among Indigenous Population-Free Samples

Question: Obesity in Two Indigenous Populations of Australia and Thailand? Answer: Introducation: The prevalence of obesity among the Indigenous population across various countries has thwarted the lives of many. The threats due to overweight and obesity have underpinned the health status of the people of these nationalities to a vast extent and efforts are in progress to mitigate the conditions and offer resolutions to the nagging issues thereby decreasing the chances of occurrence of health disparity (United Nations 2009). Hence I feel that the social determinants of health that encompass the complex and integrated system constituting the personal, economic, social, environmental factors that in turn influence the health of individuals should be critically analyzed. Such analysis will pave the way for better understanding the situations relevant to two nations, one having the developing status and the other one having an emerging economy (Perrin 2013). In the following report I will try to compare and contrast the global burden of obesity in the context of developed nation Aust ralia to that of the developing country of Thailand for their social determinants as well as the intervention modalities. I will use information retrieved from suitable academic journal articles to discuss and provide an insight into the chosen topic of obesity among the two populations and the subsequent interventions that are rampant to curb the throbbing condition holistically. Social determinants of health influencing obesity in the Australian and Thai populations In my exploration for finding pertinent data with respect to the social determinants of health among the Australian population I came across findings that stated that in this developed nation, obesity has spread like epidemic with gravely affecting its inhabitants. More than half of the adult population fell victim to obesity or are found to be overweight. I also came to know that the relative prevalence of obesity is higher among the males compared to the females in Australia. The greater value of the markers for obesity in the form of Body Mass Index (BMI) is found to be the second highest contributor to the burden of disease that in turn is reflected upon the morbidity and mortality (Rahman and Harding 2013). In my endeavor to identify the social determinants of obesity I also came across a modeling study that predicted the epidemiology of obesity progression and its subsequent outcomes. The model estimated that the rising levels of obesity will bring upon wrath to the younger mas s in contrast to the older adult cohort. In the situation relevant to the population, as per their predictions the healthy weight gain level is likely to decline with steady level maintenance of overweight. However, the rates of incidence pertaining to obesity as well as severe obesity are predicted to be increased manifold beyond 2016 thereby indicating for substantial increase of healthcare expenditures and concomitant implications in contrast to the bygone decades (Hayes et al. 2017). Further from these studies, I found that sedentary lifestyle comprising of lack of physical activities, improper nutritional intake and dearth of awareness regarding the potential hazards of obesity or overweight affected the Australian population more rigorously than anything else. In contrast to the Australian population, I will try to compare the social determinants of health in the Thai population where the rates of industrialization as well as the per capita source of income are less that has acquired Thailand the developing status. While investigating on the specific issue I came across articles that vividly discussed and explained the prevalence of obesity in the Thai population and mentioned it to be the second highest in terms of prevalence in the Southeast Asian region. Thailand has been recognized as a nation with low and middle level incomes that in turn affects the cause of obesity because of potential strain imposed on the limited resources. On information procured from this study I found that the etiology of obesity may be attributed to the causes of leading of unhealthy mode of lifestyle that further accentuates the risk of the disease prevalence among the children, adolescents and elderly Thai population. The epidemiological survey related to th e gender, age and geographical distribution of the obesity prevalence revealed that unhealthy consumption of food added to deteriorate the situation with increasingly higher rates of overweight and obesity. All these factors lead to increased levels of associated co-morbidities due to obesity that accounted for higher economic costs. I also found that the social impact of obesity is also greater in this population which again added for serious health consequences (Teerawattananon 2017). In another study that I referred to, findings based o the cross-sectional research suggested that significant lifestyle changes among the community dwellers in Bangkok in Thailand harbored negative health outcomes with increased prevalence of overweight or obesity. Alteration in dietary habits from traditional eating of consuming rice with vegetables were shifted to taking rice with animal meat among the current population that further lead to increase the consumption of energy dense food and caused for increased incidence of overweight and obesity in the relevant population. Irrespective of gender, dietary diversity through rise in the consumption of diversified food also contributed to the emanation of obesity in the Thai residents (Tsuchiya et al. 2017). Thus I feel that the impact of globalization has hit the Thai dwellers as well compelling them to shift their cultural and dietary patterns grossly from their traditional beliefs and practices. Interventions to combat obesity in the Australian and Thai populations According to the scenario in Australia, I came to know that the children and adolescents are particularly vulnerable to encounter the adverse health impacts of obesity. Hence measures to resolve this issue has highlighted on tackling the nutritional policies and governing the food supply and food markets initiatives stringently. Studies have emphasized on taking strict control and actions to mitigate the sedentary lifestyle, consumption of energy dense in addition to nutrient poor food products and beverages (Lobstein 2015). On further probing into the matter regarding the promulgation of appropriate interventional strategies to ameliorate the condition of obesity, I came across article that indicated towards the cost effectiveness of engaging in the non-surgical obesity interventions in the concerned population. The suggestions and recommendations made in these studies relied on health education and healthy eating promotional schemes among the vulnerable population to safeguard agai nst the negative impacts of obesity. Sex specific elements were found to majorly contribute towards cost effectiveness of the projected interventions and males were found to be likely benefited from adopting such practices (Boyers et al. 2015).Thus I believe, safe and suitable interventions in regulating the social determinants of health are vital to the Australian population. On the contrary in the Thai population, the trends and prevalence of obesity as per the National Health Surveys data for the duration of 1991-2009 showed that socio-economic status of the inhabitants accounted for the onset of obesity. The average increase in the rate of prevalence was greater in both males and females irrespective of their level of educational attainment. I found that the researchers have constantly hammered on the issue of providing sufficient education for abating the problems that ensue due to obesity among the men and women in Thailand (Aekplakorn et al. 2014). As per the findings from another study I also came across the vital issue pertinent to the economic burden of obesity on the Thai population. The propositions made by the Thai policymakers suggested on the enhancement of public awareness and promotion of healthy lifestyle to abate the condition of obesity amongst the concerned population. Large scale and effective strategies in line with the situation rel evant to the Thai population has been opined by appropriate authorities to resolve the scenario (Pitayatienanan 2014). Thus I feel that national health expenditure, and cost of productivity loss, cost of hospital related absenteeism and cost incurred due to premature mortality may be curtailed to a large extent on following of interventions in a satisfactory manner. Thus comparing and contrasting the social determinants of health and the associated interventions in the developed and developing countries of Australia and Thailand respectively, I can infer that the nature of problem and the root causes behind the disease burden is primarily attributed to the unhealthy lifestyle and lack of physical activity. Therefore the interventions should aim to foster public awareness and knowledge to educate the vulnerable population and ensure their quality of life, wellbeing and healthy weight management. Hence, I further feel that tackling of chronic metabolic syndrome like obesity needs greater and collaborative approaches involving the stakeholders and the policymakers to harbor optimal and effective solutions. References Aekplakorn, W., Inthawong, R., Kessomboon, P., Sangthong, R., Chariyalertsak, S., Putwatana, P. and Taneepanichskul, S., 2014. Prevalence and trends of obesity and association with socioeconomic status in Thai adults: national health examination surveys, 19912009.Journal of obesity,2014. Boyers, D., Avenell, A., Stewart, F., Robertson, C., Archibald, D., Douglas, F., Hoddinott, P. and van Teijlingen, E., 2015. A systematic review of the cost-effectiveness of non-surgical obesity interventions in men.Obesity research clinical practice,9(4), pp.310-327. Hayes, A.J., Lung, T.W.C., Bauman, A. and Howard, K., 2017. Modelling obesity trends in Australia: unravelling the past and predicting the future.International Journal of Obesity,41(1), pp.178-185. Lobstein, T., Jackson-Leach, R., Moodie, M.L., Hall, K.D., Gortmaker, S.L., Swinburn, B.A., James, W.P.T., Wang, Y. and McPherson, K., 2015. Child and adolescent obesity: part of a bigger picture.The Lancet,385(9986), pp.2510-2520. Perrin, V.A., 2013. Social determinants of health.Health Affairs,32(11), p.2060. Pitayatienanan, P., Butchon, R., Yothasamut, J., Aekplakorn, W., Teerawattananon, Y., Suksomboon, N. and Thavorncharoensap, M., 2014. Economic costs of obesity in Thailand: a retrospective cost-of-illness study.BMC health services research,14(1), p.146. Rahman, A. and Harding, A., 2013. Prevalence of overweight and obesity epidemic in Australia: some causes and consequences.JP Journal of Biostatistics,10(1), p.31. Teerawattananon, Y., 2017. Obesity in Thailand and Its Economic Cost Estimation. Tsuchiya, C., Amnatsatsue, K., Sirikulchayanonta, C., Kerdmongkol, P. and Nakazawa, M., 2017. Lifestyle-Related Factors for Obesity among Community-Dwelling Adults in Bangkok, Thailand.Kokusai Hoken Iryo (Journal of International Health),32(1), pp.9-16. United Nations. Department of Economic, 2009.State of the World's Indigenous Peoples(Vol. 9). United Nations Publications.

Tech For Special Ed Essays - Computational Linguistics,

Tech For Special Ed DYNAMYTE During my visit to a Technology Center, I was able to view various technological devices used for assisting disabled students. While many of the devices intrigued me, I found the machine DynaMyte to be the most impressive. The machine is used to help students to communicate. This machine has a touch screen that enables students to put sentences together. The screen consists of twenty-five boxes, which link to different aspects of a chosen topic. For instance, if a student touched the ?Home? topic, they will be linked to another page containing various sub-topics associated with the home. By choosing various words, the students can arrange sentences. With a touch of the screen, the computer through synthesized speech, communicates the sentence that the student has produced. The device is also useful by keeping track of the words they have created for their sentence. This device is used to help students who posses a lack of motor abilities, speech impediments, autism, cerebral palsy, as well as other disabilities. The machine has several ?switches? which the consumer could purchase, to help them compensate for their particular disability. The machine typically costs between seven and eight thousand dollars. The price can increase with several additives. Besides the ?switches?, the consumer could also opt for a larger screen, which would bring up the price of the DynaMyte. This machine was created to be a compact version of the DynaBox, which is twice the size of the DynaMyte. This machine is very useful in helping students to communicate. Though the instructor did mention noted concern about the students desire to pursue speaking by themselves, she stated that the overall opinion of this machine was optimistic. Technology

Rizal on Women essays

Rizal on Women essays In the letter, " To the Young Women of Malolos " (1888) that was written by our national Hero Dr. Jose P. Rizal tells his view about women. He observed that women before were not brave. They have less power than man. They could not use their intellect, they could not show their beautiful mannners or ways and no one could appreciate their modesty. This is due perhaps to ignorance. Rizal opened their eyes and delivered them from sevitude and awakened them from the long, long sleep because of ignorance. He showed that they have the right to educate themselves. They must learn and learn to use their intellectual capacities. They must be bright because women and the light in their family and the guardian to their children. Rizal taught them to become more reasonable rather than being blind from the truth. Obeying without knowing the reason, Why? Doing is commanded, knowing that what you think is the right thing to do?....Be wise enough and makke reasons for yourself. Womens role in the society before were not equal compared to man. They have to be humble to their husbands or any man in the society. But Rizal told us that women must be cherished, honored and love because man and women are equal. There is braveness among women that was just hidden because of excessive ignorance but now, let them bring it out and do the things that man could do. It is also stated in the letter of Rizal that this young women of Malolos have the right to find out what is really the true religion of Christ. True religion.......right teachings and beliefs....for salvation. God created man and women equally. So, there is no reason that one could be in the upper or lower level. Everyone has a freedom. What is life, if you dont know to value yourself as a person, more specifically to women and dont know to fight for their rights or freedom. ...

Supply Chain Management Principles Essay Example | Topics and Well Written Essays - 1500 words

Supply Chain Management Principles - Essay Example The process of conducting supply chain activities on a digital interface largely conducted by Apple Company reflects no physical activities pertaining to the procurement, stocking, transportation and other such conducts which are increasingly observed in regards to conservative warehousing practices. Apple through the help of online digital supply chain activities is found to conduct a billion transactions pertaining to media files in an annual period. The supply chain activities conducted over the digital sphere like the traditional warehousing activities also require the existences of products produced to be marketed to the final consumers. However unlike the traditional warehousing functions the supply chain management functions performed on a digital platform require only two parties i.e. the one providing or producing the content and the other the final consumer to whom the digital products would be transported. In turn the supply chain activities conducted by the company on the online sphere by Apple Incorporation is viewed as that which has helped in transforming the traditional supply chain concepts originally practiced by the company’s manufacturing and selling physical products. In evaluating the effectiveness of the supply chain activities conducted on a digital sphere it is found that Apple Corporation has a significant number of stock or inventory turnovers in comparison to other firms (Blanchard, 2010,p.71-72). The make-buy decision The make or buy decision is considered as a strategic decision in regards to supply chain management activities of companies. It is because the activities conducted in the realm of supply chain management activities contain large amount of outsourcing functions both in terms of procuring the materials from the supplier’s end rather than making such. Again the company can take help of distributors to help them distribute the products produced to the ultimate buyers. Thus in the former function it is found that materials are procured rather than producing such in the production units of the companies while the latter activity focus on gaining the supply chain support to sell the products produced by the firm. In the act of procurement of products from suppliers the firm focuses on enhancing the parameters of core competence. Similarly because of the lack of proper infrastructure the distributors support is gained to distribute the products to the consumers in an enhanced manner (Wisner, Tan and Leong, 2008, p.52-53; Chitale and Gupta, 2007, p.9). The firms also tend to produce their products for it helps to reduce the risks associated with procuring the products from the external environment and also saves time and money expended by the firm in the search for the right suppliers. Buying in addition to increasing the risks also makes the firm spend huge money and time while the function of making requires the firm to assimilate all its resources to produce the products and thus reducin g the level of core competencies (Berk, 2010, p.90-91). The making or buying decision process also requires the evaluation of the different risks associated with such. In regards to making the product specific risks arises relating to the

Critical thinking for resort management Essay Example | Topics and Well Written Essays - 1500 words

Critical thinking for resort management - Essay Example It is also considered as the pattern of several collaborative behaviors that are taught to the new members of an organization as a way of feeling, thinking and perceiving. Organizational culture affects the way groups and people interact with each other, with stakeholders, and with several clients in an organization. Several organizations in this world follow different types of organizational cultures. In terms of business perspective, organizational culture is also known as corporate culture. Culture of an organization can be identified through its business performance, employee management, customer services and structure of hierarchy, decision making strategy and information flow. Major Elements of Organizational Culture Organizational behaviors, values, beliefs and assumptions are considered as the major elements of organizational culture. The behavior allowed within an organization is a key element which is crucial to the strength of that organization’s corporate culture. Organizational behavior includes several things, such as use of technology by the employees and dress code of all the members of an organization. Organizational value is considered as one of the major element of the organization’s corporate culture. The value of an organization has great impact on its employees and members. The value of an organization can dictate the particular behaviors exhibited by its members. Examples include dedication to effective customer service, accountability of individual behavior, and personal and corporate integrity. Assumptions and beliefs are considered as the fundamental elements of an organizational culture. Leaders or the managers of an organization develop several strategies and implement those on the basis of assumptions and beliefs. These assumptions and beliefs are directly related with the organizational performance. The organizational beliefs can influence and motivate the managers to treat their colleagues and subordinates with valua ble respect that they actually deserve. Positive beliefs enhance effective workforce and business outcome. In addition to these, there are other elements that contribute to an effective organizational culture. Symbols and rituals are also referred as key elements of an organizational culture that enhances employee and employer morale. Organizational Culture’s Relationship with Organization’s Strategy and Performance Effective and strong organizational culture helps the managers of several departments within an organization to motivate their employees. Organization with effective corporate culture follows high business ethics that enhance high business performance and employee morale. An employee always expects significant compensation and reward against their hard work and effective performance. In addition to this, strong organizational culture helps the managers to develop effective strategies that can successfully drive the organizations towards business objectives. Therefore, it is important for an organization to maintain effective and strong corporate culture to maintain motivated workforce, significant strategy development process and high business output. Section 3 A review and critical thinking on resort management would help to help to establish the link between the culture of organization, the strategic management of the organizations and the future performance as an implication of effective strategies. The resorts and hotels are solely a service-based industry and thus the main assets of these resorts are the

Child abuse problem within my community and propose a solution Research Paper

Child abuse problem within my community and propose a solution - Research Paper Example However, any type of abuse to a child tends to scar the child for life. In this study an attempt is being made at analyzing the problem of Child abuse and trying to find the right strategies and interventions that could be used to minimize the pain and trauma that a child goes through when such a catastrophe happens. Body – Literature review Child abuse is an ugly scar on society, that has a very negative impact on the community and society at large and hence there is a dire need to address this problem by putting an end to the physical, emotional and psychological scourge faced by such vulnerable children. There are many common factors that contribute towards child abuse. Some of these factors include physical abuse, sexual assault, neglect, high levels of stress, abusive childhood, depression and anxiety. Such abuse towards children leaves a lasting impression on them and impacts upon their own lives as they grow into adults. Such abused adults are a threat to their own fami lies and society because they continue to exhibit the same pattern of behavior right through their lives. According to (Cindy, 312) individuals who once get into the habit of abusing do not hesitate from extending this practice towards other members of the family thus further strengthening this trend in the society. (Cindy, 312) Child abuse has proved to have very long term effects on the society, children who are subjected to this blight tend to maintain the same attitude on their future generations especially their own kids. This way a cycle is developed which takes conscious and intended efforts to break in the years to come. (Mary, 250) Some of the reasons for its prevalence involve having being abused during their childhood, insecurity, frustration, revenge, health problems, ego- identity and poor self image which makes them fall an easy prey to Child abuse. Larry J. Siegel et al., (2010) sheds light on the different aspects of Juvenile Delinquency in his in-depth analysis and cutting edge seminal research work titled ‘Theory, Practice and Law.’ In addition to the controversial issues discussed, the authors examine the important initiatives and intervention programs to help children who are delinquents. Problematic issues such as drugs, gangs, delinquency and capital punishment for juveniles are also important aspects of his study. According to (Larry, et al., 2010) adolescent dilemma comprising of conflict, stress, ego identities and problems within the family, school and community serves as a potent ground because they make children vulnerable to Child abuse. Uncertainty of the future due to poor experiences in life makes them disillusioned, depressed and frustrated making them easy prey for child abusers. Statistical figures have exhibited an alarming rise as far as child abuse is concerned. In Greenville South Carolina; 1019 cases of child abuse were reported in the year 2005 which speaks volumes of the negative effects it might have infl icted on the community. (Larry, 64) (Rachel, 220) believes that children who are abused are driven to extreme attitudes; either they become too indifferent towards love or too aggressive which results in bullying other children and in the former case, end up being terrorized themselves. The pioneering work of (Ruth & Kempe, 2001) presents a statistical view of abused children in the United States. According to them about 2% to 6% of children have been injured through physical assault and neglect by

Cyclo-oxygenase inhibitors of human diseases

Cyclo-oxygenase inhibitors of human diseases Historical background Cyclooxygenase (COX) inhibitors are a widely prescribed group of antipyretics and analgesics worldwide and are important component in the treatment of inflammatory conditions. Although first COX inhibitor was discovered more than a decade ago their origin dates back to ancient Mediterranean descent1. Back and other body pains where treated using extracts of poplar tree bark and leaves of myrtle. Use of willow bark emerged far more lately and its first appearance was reported in England in 17631. As was later discovered, the essence of the willow bark possessing anti-inflammatory and antipyretic properties was salicin. Further modification of its structural properties allowed generation of salicylic acid that eventually was developed via Kolbe reaction using phenol1,3. In 1899 Bayer company went ahead in synthesising more susceptible derivative of it, acetylsalicylic acid and named it aspirin. Following this phenylbutazone (1949) and indomethacin (1963) came along however the mystery of mechanism of their action in the body was not yet developed. It was not known until 8 years later when an idea surrounding the synthesis of prostaglandins within body was revealed and for which a Nobel Prize in physiology and medicine was awarded (1982)1. It was proposed that first non-steroidal anti-inflammatory drug (NSAID), aspirin, acted upon inhibition of an enzyme that played role in utilising unsaturated fatty acids into biochemical molecules exerting their action in conditions such as inflammation, pain, and fever and platelet synthesis. It was accepted that during changes occurring within stimulated cells and tissues prostaglandins synthesis was taking place 1,3. Structure of COX was isolated in 1976 and its second isoform was confirmed around 14 years later by few different laboratory investigations; investigations which greatly allowed appreciating the nature of first nonselective cox inhibitors NSAIDs in the treatment of human diseases1. 1.1 The pharmacology and chemistry of cyclooxygenase enzyme Cyclooxygenase (COX aka PGG2/H2 synthase) belongs to the family of enzymes known as myeloperoxidases and it is the crucial enzyme in the synthesis of prostaglandins, prostacyclin and tromboxane A2 resullting from the conversion of arachidonic acid (AA) 2,4. This heme-containing COX enzyme is a bifunctional biocatalyst with two interconnected active sites: cyclooxygenase and peroxidase which action involves generation of hydroperoxy endoperoxide PGG2 via cyclooxygenase cycle (Fig.1.) into its reduced form of hydroxy endoperoxide (PGH2) (Fig. 2.) 2,4. Both isoforms of COX enzyme are expressed in endothelial, monocytic and renal cells with COX-2 being more profound in inflammatory and cancer tissues. Both enzymes are characterised by signal peptide, endothelium growth like factor (EGF) region, membrane in-bound domain, catalytic part, interface between monomers and N-linked polysaccharides residues2. The signal peptide in COX-1 consists of 23 residues whereas COX-2 has only 17. The EGF like region constitutes a major part of the interface and is not found in other myeloperoxidases. It is involved in Cys-Cys cross linked bridges with lack of Cys9 in COX-1 and Cys512 in COX-2. The membrane in-bound domain accounts for 33% of overall similarity and 24% of identity within membranous face. This domain is described as consisting of 4 amphipathic a helices that surround the entry to the COX site. The catalytic part is known to be the largest part of the enzyme with remained homology between other myeloperoxidases. 180Â ° rotation between subunits is preserved with chemical interaction between polar, ionic and hydrophobic moieties. Differences in residue positioning prevent heterodimerization and dissociation from facial interaction inactivates the enzymes overall catalytic activity 1,2,3,4,5. Figure 1. Mechanism of COX cycle in cyclooxygenase active site showing free radicals formation denoted by ? prior to PGH2 synthesis in POX pathway (not shown) 2. Attraction of hydrogen atom from Tyr385 by peroxyl radical of PGG2 allows for the regeneration of the steps of the reaction in the COX cycle of prostanoid biosynthesis. The coloured boxes are to indicate the origin of oxygen atoms. PLA2 phospholipase A2, S secretory, C cytoplasmic. Figure 2. A diagram summarising changes made to AA in the distinct active sites of the PGG2/H2 synthase and products formed via action of each catalytic active site 2. 1.2 The nature of cyclooxygenase inhibition in the human body Inhibition of cyclooxygenase action is desired in the treatment of human diseases. Not only because it suppresses the inflammatory production of prostaglandins in the conditions such as: dysmenorrhoea, rheumatoid arthritis, osteoarthritis but also because it prevents platelet aggregation, suppresses tumour growth and prevents cancer5. Until 1994 it was not clear by which mode, mechanism or process inhibition of COX was carried out. Just complexation studies between COX and flurbiprofen allowed insight into molecular basis of COX inhibition. The investigation led by Garavito and his colleagues proposed such model of inhibition. In his model it was suggested that the enzyme in question possesses long hydrophobic path that originates from in-membrane bound moiety up to the heart of the dimer subunit. Blocking this channel stops the endogenous substrate (AA) from binding hence possible intervention in the process of prostaglandins biosynthesis5. 1.3 The types of cyclooxygenase inhibitors in the treatment of human diseases There are several types of COX inhibitors available in the treatment of human diseases. The very first one, aspirin, is known to act through non-selective and irreversible manner. As this manner suggests aspirin binds to both types of COX enzyme by acetylating Ser530 residue upon covalent modification. Consequently effects such as risk of excessive bleeding, ulcer formation or foetal deformation limit the use of aspirin in dealing with long term diseases. Nowadays it is mainly considered as the important component in the treatment of cardiovascular conditions due to its anti-platelet activity 1,3. Other types of non-selective NSAIDs such as piroxicam, ibuprofen or diclofenac, constitute majority of therapeutic agents being prescribed however due to harmful effects they are being considered less effective in the long term treatment. The damage to the gastrointestinal (GI) system is due to inhibition of COX-1 expressed in GI mucosa which results in formation of ulcers with associated bleeding. Therefore since the main target for choosing those drugs is found to be of inflammatory nature (inhibition of COX-2) they are nowadays preferred in topical dosage forms 1,3,5. The consequence of the undesired effects caused by non-selective COX inhibitors targeted new approach towards development of more specifically acting agents. The era began on discovery of the second isoform of cyclooxygenase and introduction of first COX-2 selective agent (1999) was introduced to the market within 10 years since its discovery with celecoxib and rofecoxib for the treatment of arthritis. The discovery proposed mechanism of actions of both enzymes within the body with COX-1 possessing more constitutive effects especially in GI tract. It was therefore suggested that COX-2 was an inducible form in conditions such as inflammation and pain, symptoms desired in treatment of human diseases associated with the effects of COX-2 isozyme 1,3. 2. ASPIRIN THE ORIGINAL COX INHIBITOR (Joyce) 2.1. Pharmacology and chemistry of Aspirin Plant ingredient salicin was discovered in the willow bark and leaves in the 17th century by a greek physician (Hippocrates) who prescribed it as an analgesic and antipyretic. Further into the 17th century a crude form of salicylic acid was made by a German scientist (Charles Frederic von Gerhardt). This was followed by production of a purer form of salicylic acid by another German chemist (Karl Johann Kraut). Finally in 1897 a German chemist Felix Hoffmann, who worked for the pharmaceutical company Bayer, was assigned the task to find a better derivative of salicylic acid. He also had his own personal reasons for wanting to find a better derivative. His father had been taking salicylic acid for his arthritis pain but could no longer take it without vomiting3,7. In 1889 Hoff man then found a way of acetylating the hydroxyl group on the benzene ring of salicylic acid to form acetylsalicylic acid. Hoffman father tried the new derivative and it was pronounced effective. The name ‘ASPIRIN was given to the drug by Bayer chief pharmacologist Henrich Dreser7. Aspirin was found to have antipyretic, analgesic and anti-inflammatory effects. It does this by inhibiting cyclo-oxygenase(COX) or prostaglandin endoperoxide synthase(PGHS) enzyme irreversibly. COX is responsible for cyclizing arachidonic acid and adds the 15-hydroperoxy group to form PGG2 which is the precursor to prostaglandins. An enzyme perioxidase is responsible for reducing the hydroperoxy group of PGG2 to the hydroxyl group of PGH2.(4)(See Figure 15- prostaglandins synthesis) Prostaglandins can be described as chemical mediators that produce a variety of strong physiological effects in the body. Most importantly they are responsible for the activation of the inflammatory response, production of pain, and fever. There are three isoforms of the COX enzyme of which aspirin has an effect on two which are COX-1 and COX-2. Aspirin binds covalently modifiying COX-1 through acetylation of its Ser-530 and COX-2 through acetylation of its serine 516 residue by placing a bulky constituent (acetyl) and this directly inhibits binding of arachidonic acid. Aspirins action is more potent against COX-1 than against COX-2. This difference in inhibition of the two COX enzymes by aspirin is due to the larger volume of the COX-2 active site produced by the Val-523 substitution at the side pocket. (1,7, 9) The difference in the size of the active site has been exploited by pharmaceutical companies to develop selective COX-2 inhibitors (section 4) COX-1 is an essential enzyme expressed in majority of tissues and also in platelets. It is responsible for prostaglandin production involved in homeostatic mechanisms e.g. platelet aggregation, gastric wall protection, regulation of renal blood flow and initiation of labour in childbirth. In contrast, COX-2, is an inducible form which becomes up regulated by inflammatory mediators such as cytokine (Interleukin and tumour necrosis factor). 2.2 The problems associated with aspirin(1, 10) a. Unwanted effects GASTRIC PROBLEMS The inhibition of COX 1 can produce gastric disturbances as an unwanted effect because the prostaglandin production in the GI tract is a homeostatic mechanism to protect the gastric mucosa. It causes inherent symptoms like heartburn; dyspepsia, nausea, and abdominal pain. (1, 10)This effect can cause Aspirin users to change or discontinue its use. Some of these inherent symptoms are quite common for most NSAIDs. Secondly it can also causes gastro duodenal mucosal lesions such as erosions and asymptomatic ulcers, which may or may not heal spontaneously; and finally more serious gastro ulcers with life-threatening complications like perforation, symptomatic ulcers, and bleeding ulcers. Symptoms of this could be black, bloody, or tar like stools or vomiting/coughing up blood REYES SYNDROME Reyes syndrome is a collection of symptoms consisting of altered consciousness, convulsions, low blood glucose, and enlargement of the liver associated with fatty infiltration of the liver. It is a deadly disease, which can strike any child, teenager, or adult without warning. All body organs are normally affected, but the liver and brain are antagonised the most. In 1965 it was stipulated that Reyess syndrome can be caused by the administration of aspirin in children under 16years of age. There is no discovered mechanism for the role of salicylate in this but it is thought that aspirin enhances the release of tumour necrosis factor which induces apoptosis of cells which can cause inflammation, viral replication e.t.c. SALICYLISM This is caused by the excessive ingestion of aspirin. There are two main pathways in the metabolism of aspirin. (10)Phase 1 reaction that involves the oxidation of aspirin to salicylic acid by a cytochrome P450 monooxygenase. By addition of a reactive group (OH) to get it ready for conjugation to a soluble component and hence aid excretion. This conjugation involves the attachment of small polar molecules glycine and gluconoride to salicylic acid. This results in further deactivation of the aspirin and the production of water-soluble metabolites that will be readily excreted in the urine or bile. The pathway conjugated with glycine, is the one that is easily overloaded in cases of toxicity. Thus elimination of salicylic acid slows down and accumulation leads to a variety of side effects. Below are the pathways showing oxidation and conjugation. This excess salicylate produces toxic effects include below. Ringing in ears Hyperventilation which causes increase in CO2- respiratory alkalosis, Dehydration: increased water loss due to hyperventilation Loss of carbonic acid metabolic acidosis. This in turn will reduce the blood pH, and make aspirin return to its non-ionised form allowing free aspirin in the blood stream. Hyperthermia. These pathways overload uncouples the energy producing processes (oxidative phosphorylation) of the mitochondria thus causing production of heat rather than ATP. Fatality especially in children Interactions with other drugs Reduced effect of aspirin if given with ibuprofen and avoid concomitant use of aspirin with NSAIDS due to increased side effects. Increase risk of bleeding when aspirin is given with coumarins, SSRIs, clopidogrel, illoprost, and sibutramine, Aspirin enhances effect of Heparins, Phenytoin, Valporate, Aspirin antagonises effect of Spirolactone, Sulfinpyrazone and Probenacid Rate of excretion of aspirin is increases by some antacids. The effect of aspirin on the gastrointestinal tract may be enhanced by the intake of alcohol and corticosteroids. 3. NON STEROIDAL ANTINFLAMMATORY DRUGS NON SELECTIVE COX INHIBITORS (Christina) 3.1 Isozymes of Cyclooxygenase Cyclooxygenase has various isozymes. The main isozymes are COX-1 and COX-2, however there is now evidence of a third form- COX-3. COX, originally known as prostaglandin H synthase is responsible for the oxidation of arachadonic acid to prostaglandin G2 and prostaglandin H2. It catalyses the reaction in which the arachadonic acid substrate and two molecules of O2 are converted to prostaglandin G2 and then in the perioxidase reaction Prostaglandin G2 is reduced to PGH2 by a 2 electron reduction. The COX isozymes are heme containing enzymes that are homodimers. Each monomer contains three main domains; A membrane binding domain, a N-terminal epidermal growth factor domain and a C-terminal catalytic domain. COX-1 is made up of 602 amino acids while COX-2 is comprised of 604.3 The catalytic reaction in COX takes place in a hydrophobic channel in the core of the enzyme while the peroxidise reaction takes place in the heme containing region near the surface of the enzyme. The membrane binding domain consists of four alpha helices with one helix that fuses with the catalytic domain. These helices congregate around an opening and through these openings fatty acids and NSAIDS are considered to enter the active site. The COX-1 isozyme is considered a constitutive enzyme. It is present in high volumes in most cells and tissues i.e. renal collecting tubules, monocytes, endothelium etc. However COX-2 is hardly noticeable in most cells, it is an inducible enzyme so it becomes more abundant in cells or tissues when macrophages are activated or by any other inflammation mediators e.g. TNF-a (tumor necrosis factor-alpha) or IL-1 (interleukin-1).5 Both COX-1 and COX-2 isozymes are attatched to the endoplasmic reticulum and nuclear envelope. The COX isozymes need to be N-linked glycosylated to enable them to be folded and attatched to the endoplasmic reticulum and nuclear envelope. The COX isozymes have very similar structures for their binding site, catalytic mechanisms and produce the same biosynthetic products3 COX-3 COX-3 a third isozyme was discovered in 2002 by Simmons and co-workers. They conducted a study on dogs and this resulted in them discovering a novel COX-1 splice variant termed COX-3 that was sensitive to acetaminophen (paracetamol). It was suspected for a while that acetaminophen worked by inhibiting a different specific isozyme due to the fact that it did not directly inhibit COX-1 and COX-2 very effectively at therapeutic concentrations but it generated prostanoids in neuronal systems. 3, 15 The Simmons and co-worker group showed that acetaminophen was the actual target for COX-3, and that it acted separately from COX-1 and COX-2. 3 Canine COX-3 is a membrane bound protein consisting of 613 amino acids with a molecular weight of ~65 kDa. It has a high expression in cells and tissues like COX-1 suggesting it may be a constitutive enzyme. However the question that needs to be asked is if generalisations can truly be made on the presence of COX-3 in humans based on Canine studies, so future experiments need to be designed to clarify whether a human COX-3 actually does exist that acts independently from COX-1 and COX-2 in vivo. 14 NSAIDs are known to inhibit COX in order for them to exhibit their anti-inflammatory actions, a structural NSAID binding study was carried out. The COX-1 active site contains a long hydrophobic channel that extends from the membrane binding domain to the core of the COX monomer. The tip of the COX active site houses Tyr385 that is located near the heme iron. Ser530 is positioned just below Tyr385 and that is the site for aspirin acetylation. Glu524 and Arg120 are positioned at the mouth of the COX-1 channel. A typical NSAID such as fluobriprofen, when introduced to the COX enzyme, its carboxylate moiety is usually directed towards the mouth of the COX-1 channel in order for it to be positioned in the most ideal place that will allow it to interact with the two polar residues Glu524 and Arg120. From these studies a better insight into the binding profiles of NSAIDs were observed. Non selective NSAIDs can bind in three different ways: Reversibly (e.g. Ibuprofen) Fast, low affinity reversible binding followed by a higher affinity, time dependant slowly reversible binding (e.g. fluobriprofen) Rapid, reversible binding followed by a covalent modification of the enzyme (e.g. Aspirin) 3 Arg120, Glu524, Tyr355 and His90 form a network of hydrogen bonds at the entrance of the COX channel acting like a gate to the binding site. NSAIDs generally bind between the upper portion of the COX channel near Tyr 385 and Arg 120 which is at the mouth of the COX channel. 3 Through the use of hydrogen bonding and electrostatic interactions, the carboxyl moiety of acidic NSAIDs like fluoribiprofen interact with Arg120 in both COX isozymes. The significant differences in the structure of the binding sites for both COX isozymes has been manipulated to enable the design of selective COX-2 inhibitors. In the COX-2 active site there is an extra accessible pocket due to the presence of a smaller valine amino acid residue at position 523 and a valine substitution at position 434, unlike COX-1, this difference increases the overall volume at the COX-2 active site by about 20%. 1 This means that due to reduced steric and ionic crowding at the mouth of the channel by Arg120, non acidic selective COX-2 inhibitors can show an enhanced and specific binding to the COX-2 enzyme. Another structural difference exists at the amino acid residue 513 where COX-1 has a histidine residue and COX-2 has an arginine moiety. 1 These small differences provides flexibility in the substrates that can be utilised in the COX-2 active site. 3.2 Problems Associated With Non Selective Non Steroidal Anti-Inflammatory Drugs NSAIDs are one group of drugs that are regularly used by the worlds population to relieve pain, reduce inflammation and lower temperature. They are COX inhibitors and act to inhibit the catalysation of arachadonic acid to PGH2. COX-1 is constitutively present in most cells while COX-2 is induced by chemical mediators of inflammation and activated macrophages.13 COX-1 and COX-2 as mentioned above have 2 specific roles. The 1st role gives PGG2 and the other role is in the peroxidise reaction that gives PGH2. Both COX-1 and COX-2 inhibitors work by inhibiting the 1st and main role i.e. inhibiting the conversion of arachadonic acid to PGG2. COX-1 and COX-2 possesses hydrophobic channels within their core. The classical NSAIDs exhibit their effects by blocking these enzymes halfway down the COX channel near Tyr385 and the Arg120 which is at the mouth of the COX channel by hydrogen bonding to the Arg120 residue. This results in the prohibition of any fatty acid substrates from entering the catalytic domain of the COX enzyme.3 In COX-1, these drugs tend to inhibit the enzyme quickly yet generally the inhibition is often reversible, however in COX-2 the inhibition is time dependant and often results in irreversible inhibition. As mentioned before, the COX-1 and COX-2 isozyme differ slightly. In the COX-2 active site there is an extra accessible side pocket due to the presence of a smaller valine amino acid residue at position 523 instead of isoleucin as in COX-1. This is important for understanding why some NSAIDs are selective for the COX-2 isozyme.13 There are a number of side effects associated with traditional NSAID therapy. NSAIDs can cause renal failure, liver damage/disorders, aseptic meningitis, skin reactions and bone marrow disturbances which can interfere with bone fracture healing. However amongst them all gastrointestinal (GI) toxicities is amongst the most common. These are believed to arise from the inhibition of COX-1 in the gastric mucosa.14 GI toxicities In humans and other species it has been shown that COX-1 not COX-2 is constitutively expressed throughout the GI tract.13 COX-1 is responsible for the synthesis of prostaglandins like PGE2 and PGI2 which are responsible for protecting the GI mucosa by reducing acid secretion in the stomach by the parietal cells, increasing blood flow in the mucosa and stimulating the release of viscous mucous. This leads to conditions of ulcers, dyspepsia, diarrhoea, nausea and vomiting and can even lead to gastric bleeding in some cases. These undesirable side effects have led to the development of COX-2 selective inhibitors. These drugs are effective anti-inflammatorys and reflect good analgesic effects. They have considerable less gastric damage due to the fact they selectively inhibit COX-2 with minimal action on COX-1. Unfortunately the use of COX-2 selective drugs has been associated with increased incidence of myocardial infarction and stroke.3 Renal effects Prostaglandins especially PGE2 and PGI2 are involved in regulating renal blood flow and vascular tone. Recent studies have shown that COX-2 is constitutively expressed in the macula densa, epithelia cells lining the ascending loop of henle and medullary interstitial cells of the renal papillae, while COX-1 is constitutively expressed in the collecting ducts, loop of henle and in the vasculature. The COX-2 enzyme is associated with normal renal function and inhibition of COX-2 results in NSAID-induced sodium retention while inhibition of COX-1 results in a disease in glomerular filtration rate.3 This conclusively tells us that both COX-1 and COX-2 are involved in the physiology of the kidneys. However therapeutic doses in patients with normal renal function are at little risk of renal complications. It is mostly neonates and the elderly who are more susceptible as well as patients with heart, liver or kidney disease. 4. SELECTIVE COX 2 INHIBITORS (Nadine) 4.1 Reasoning behind selective inhibition 4.2 Benefits and risks 5. MECHANISM OF ACTION OF COX INHIBITORS IN HUMAN DISEASES 5.1 Analgesic (Joyce) Pain can be defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is a self protection mechanism which helps of forces us to identify danger and move away from it. It is one of the main symptoms used to identify a condition in medicine. Removing pain is very essential in terms of either eliminating the disease or condition or in fact suppressing its effect. This can be done by the use of medicines called analgesics. Pain receptors also called nociceptors are present on special nerve fibres that are sensitive to noxious of harmless stimuli. The stimulation of these receptors are on A-delta and C-fibers which are located in skin, connective tissue, viscera, muscle e.t.c. COX inhibitors act by blocking transmission to peripheral nerves. Pain associated with I. Arthritis Arthritis is the inflammation of joints. The inflammation and movement of the joints cause extreme pain in the sufferer. There are two major types a. Osteoarthritis(10) This is a chronic disease that features the breakdown of the joints cartilage. Cartilage is flexible connective tissue found in between joints that cushions or protects the ends of the bones and allows easy mobility of joints. This breakdown of cartilage causes the bones to rub against each other creating friction, causing joint tension, pain and loss of mobility in the joint. There are different types of arthritis of which osteoarthritis is most common; it can also be referred to a degenerative joint disease. There are two types of osteoarthritis, primary of which is associated with old age, general wear and tear of the cartilage. And secondary where it occurs where there is a cause example obesity, trauma, or hereditary. Treatment: Paracetamol may be considered as first line therapy for Osteoarthritis patients with mild to moderate pain. If the pain does not respond to paracetamol or patient has severe symptoms then other traditional NSAIDs like Ibuprofen, diclofenac or coxibs should be used. Coxibs have shown to produce reduced GI side effects. However they have the probability of increasing cardiovascular risk because they inhibit prostacyclin production in endothelial cells but not thromboxane in platelets, hence this can increase the chance of a thrombus formation. The choice of a coxib or a specific NSAID should be based on the patient characteristics and risk factors. b. Rheumatoid arthritis(12 ) This is an autoimmune disease of unknown origin whose major characteristic is the inflammation and erosion of the synovial membrane or synovium. This membrane lines and surrounds the joint and synovial cavity. The synovium secretes a slightly viscous, clear fluid known as synovial fluid, which lubricates cavity that lies between the cartilage and joint on the bone. In Rheumatoid arthritis accumulation of the synovial fluid builds up within the joint space and causes inflammation. This makes the joint look and feel swollen. Rubor occurs do to the increased blood flow to the area because of inflammation. In conditions of long-term RA, joint degeneration can occur causing mobility to be very painful and restricted. Treatment: Aspirin used to be used to treat RA but because of its GI toxicity. The use of aspirin as first line of therapy has been superceded by other NSAIDs. There are a large number of NSAIDs that have been invented since aspirin, but have similarities in toxicities e.g. Ibuprofen, naproxen meloxicam, etodolac selective COX-2 inhibitors have been invented to control inflammation. These drugs were designed to combat the gastrointestinal risk of NSAIDS, but there are concerns of increases in cardiovascular risk. II. Cancer (11) Can be defined as an abnormal growth of cells as when a group ofcellsdisplayuncontrolled division,invasion, and sometimesmetastasis. Cells become cancer cells because of its damaging effect to the DNA of the cell. A normal cell will try to repair damaged DNA but in a cancer cell it replicates with the damaged DNA. The cancer cell continues making new cells that the body does not require. The most common cause of cancer pain is infiltration of the tumour into bone. Bone metastases occur as a consequence of different types of cancer. Another mechanism of pain apart from bone metastasis is the secretion of Prostaglandins by carcinomas. For this reason, NSAIDs should be included in any regimen to control pain associated with bone metastasis. Because NSAIDs do not activate opioid receptors, they can provide additional pain relief when combined with an opioid analgesic. Thus, combining an NSAID with an opioid analgesic may provide adequate pain control with a clinically significant reduction in opioid dose. This opioid-sparing effect of NSAID therapy allows the clinician to diminish the side effects associated with opioid therapy without sacrificing pain control. Coxibs: Another Option for Cancer Pain Management(11) The recent introduction of the coxibs, on their use in cancer patients is still being studied. Oncologists are replacing NSAIDs, with the use of coxib, because of the improved safety profile compared to traditional agents. Surgical oncologists are exploring the use of coxibs both preoperatively and during the post-operative period to reduce opioid usage in order to speed the recovery process 5.2 Anti-pyretic (Nadine) 5.3 Anti-inflammatory (Christina) To date there are over 100 inflammatory diseases- each of which causes the degeneration of connective tissue in one or more parts of the body. These include: Rheumatoid Arthritis Osteoarthritis Atherosclerosis Irritable Bowel Disease Alzheimers and many more. Inflammation is characterised by dolor, rubor, calor and tubor, its one of the bodys ways of responding to harmful stimuli, pathogens, injury or disease. These usually initiate an acute or chronic inflammatory response. Arthritis is a general term used to characterise inflammation in the joints. Rheumatoid arthritis describes arthritis that occurs on both sides of the body i.e symmetrical. These usually occur in the wrists, hands and knees. It is not known what causes this disease many theories have been put forward but it happens when the immune system begins to attack the joints. A number of anti-inflammatory drugs are available worldwide and are widely used to relieve pain, swelling and inflammation associated with soft tissue inflammation. A number of these drugs act via the inhibition of COX. When you experience pain and inflammation from arthritis, an increase in microvascular permeability occurs selectively in post-capillary venules. The endothelial cells undergo conformational change leading to vascular leakage through gaps between the adjacent endothelial cells. At the site of injury phagocytes are attracted and move into the affected tissue along with plasma. The plasma causes the associated swelling observed in inflammation and the phagocytes engulf dead cells and bacteria. Prostanoic acids are

Electroconvulsive Therapy Essay -- essays research papers

After researching electroconvulsive therapy (ECT), I have decided that if a close family member or even myself were severely depressed I would not support the use of ECT. Electroconvulsive therapy consists of an electrical shock, which is used to produce a seizure. Many people experience seizures due to some other type of illness or illnesses, and in these cases there is medicine taken in order to prevent these occurrences. In deciding my opinion on the topic of ECT I asked myself would I want to put myself or a loved one through what others are trying to avoid; a seizure. Although ECT has proven to be effective in some cases of depression, it has many risk factors involved and it does not ensure a lifetime with out the reoccurrence of depression.   Ã‚  Ã‚  Ã‚  Ã‚  Before ECT is administered the doctor will first do a physical examination on the patient to make sure they are physically able to have the treatment. If the physical examination shows the patient is physically able the next step will be to meet with an anesthesiologist. The purpose of this visit is for the anesthesiologist to examine the heart and lungs to ensure the anesthesia given through an IV will be safe for the patient. Another step taken will be many blood tests and a test showing the rhythm of the patient’s heart. All these procedures must be done before the first treatment of ECT is ever given. These steps are just the beginning of precautions for the treatments no one, not even the doctor...