UK NHS Framework for Coronary Heart Disease | Analysis

UK NHS Framework for Coronary Heart Disease | Analysis A Critical Analysis of the Impact of a Current Healthcare Policy on a Group of Clients/Users Introduction In considering the impact of a current healthcare policy on a group of clients/users, the United Kingdom’s National Service Framework (NSF) for Coronary Heart Disease (CHD), offers a classical example for examination of the foregoing. In particular women as a subject group provides an interesting basis by which to analyze user experience, quality of service as well as fairness/justice. Globally, 10 million of the 27 million deaths of women are as a result of Coronary Heart Disease with one third of the foregoing total, 10 million, occurring in developed countries (Bonita, 2000). And while Coronary Heart Disease is known to be a leading cause of death among men, it is also ‘the’ leading cause of death for European women (Mcguire, 2000). In the United Kingdom Coronary Heart Disease is the number one cause of premature death among both men and women and shows a marked skew with regard to social classification. The death rate attributed to Coronary Heart Disease among males from manual worker classifications is forty percent (40%) higher than for those from non-manual segments (National Health Service, 2005). And while coronary heart disease is four to five times more prevalent in males than females for the age groups under 65, the gap narrows considerably after this age. And this particular age occurrence discrepancy is one of the critical sources of misunderstanding, focus, appropriation, resources and service as the medical profession, insurance industry, and public in general tend to view coronary heart disease as primarily affecting males. And while the preceding is true, in terms of the age groups under 65 (Mcguire, 2000), the fact is that women live longer than men thus as the incidence of coronary heart disease and the associated care is spread out over a longer period as well as at a more advanced age. The circumstantial inequities that the preceding give or gave rise to shall be the examination points addressed herein in terms of considerations with respect to the impact of current health care policy in terms of analyzing user experience, quality of service as well as fairness/justice, with particular emphasis on women. In order to accomplish this broad and sweeping analysis, an understanding of the disease, and allied points will need to be established to provide the foundation from which to reach a determination as to the three subject areas indicated. Coronary Heart Disease A distressing fact that has been uncovered as a result of a study by the World Health Organization (1997) is that coronary heart disease is rising in developed countries. The World Health Organization (1997) attributed the foregoing to the increased overall age of relative populations as well as the onset of increasingly poor health behavioral patterns. Dr. Abby King (2000) indicated that of the forty plus studies that have been undertaken on a global basis concerning various aspects of coronary heart disease it was found that there was a correlation between physical activity and premature mortality. Dr. King (2000) stated that said study consisted of a field that was comprised thirty-three percent (33%) of woman. Said studies have shown that inactivity in women revealed on average a two-fold risk or the development of cardiovascular problems as compared to their peers who were or are more active. It was also uncovered through these studies that the economic costs in terms of not onl y the direct treatment but also, those associated with the relative inactivity of patients amounted to substantial outlays. The increase in coronary heart disease has also been attributed to the elevated cholesterol levels that are prevalent in Western countries. Dr. Anita Schmeiser-Rieder (2000) has found that approximately forty percent (40%) of women above the age of fifty-five (55) have serum cholesterol levels that are elevated. Dr. Schmeiser-Rieder (2000) indicated that the preceding condition peaked in women between the ages of sixty-five (65) and seventy-four (74) and that fully sixty-one percent (61%) of those researched had hypercholesterlomia. The disturbing finding that was uncovered in studies by the World Health Organization (1997) is that coronary heart disease and stroke will continue to be the leading cause of death among both men and women over the next twenty years, increasing to the second and third causes of death from its present ranking of fifth and sixth by 2020. The World Health Organization (1997) cites that the major causes of both stroke and coronary heart disease are: smoking high blood pressure cholesterol body mass index And while studies conducted by the WHO (World Health Organization) MONICA (2000) Project shows a decline in smoking trends, a rise in smoking among young woman as well as adult women has been noted in: Russia (Novosirbirsk) Germany (Augsberg) Belgium Spain (Catalonia), and Poland, where the recorded increase has been as much as ten percent (10%). As the number one cause of stroke and coronary heart disease, the rise in female smoking is alarming, made even more dramatic by the fact that females historically smoke less than their male counterparts across all age groups. The findings of varied studies has conclusively indicated that the incidence of stroke and coronary heart disease increases with respect to those individuals whose lifestyles expose them to the additional risks that are associated with the two conditions. The World Health Organization (1997) has determined that changes in lifestyle as well as personal habits effectively reduce the risk associated with contracting these diseases. The foregoing is of particular significance to women, as the emphasis on efforts to change lifestyles and habits has been primarily focused upon the male segment of the population whose rate of incidence with respect to stroke and coronary heart disease has been higher. The corresponding increase in poor lifestyle and smoking habits among females in the countries indicated reveals that such an approach has not only been short sighted, by failed to take into account the longer life cycle of females thus increasing the onset of coronary heart disease and stroke in later years as a result of higher age where female incidents almost match those of males. The foregoing factors are important base line informational points to develop an understanding of the varied inputs and considerations that comprise the complex variables inherent in equating the range of aspects to be addressed in analyzing user experience, quality of service as well as fairness/justice. The preceding points out the need to utilize what is termed as a ‘high reach’ strategy (Bonita, 2000) that reaches both the male and female segments of the population in terms of alerting them to the relative risks, preventive measures, lifestyle augmentation, and allied aspects known to have demonstrated a decrease in stroke and coronary heart disease when utilized in a proper manner. Such an initiative when conducted on a population-wide (high reach) basis helps to alert individuals to the relative dangers and causes of high blood pressure, negative connotations associated with smoking and lack of physical activity, the three highest contributors to the condition. Alerting populations to reduce the intake of salt, alcohol, saturated fat as well as the benefits of increased physical activity would reduce the relative levels of blood pressure and thus the corresponding reduction in medical costs assumed not only by individuals, but society at large. By combining the aforementioned with what is termed a high-risk strategy (Bonita, 2000), in efforts that are directed at the identification of women in this category, along with offering treatment to the women within this group whose risk factor(s) are above the norm in terms of the potential for a coronary disease event can generate significant improvements in long term results. The utilization of educational media efforts in combination with treatment availability is a preventive measure that recognizes the need to head off the high costs of medical facilities, and allied costs to the government via preventive measures. As the subject country being utilized for this examination is the United Kingdom, the foregoing is applicable. The same holds true for countries where insurance coverage’s are used to supplement individual treatment costs, along with the calculated losses to society with respect to the associated costs that accompany coronary heart disease events. In the case of the United Kingdom, with the taxpayers bearing the cost of medical care under the country’s socialized medical program, the realities of the treatment and after care costs of coronary heart disease are a real expenditure concern. In particular the recognition of the heretofore hidden costs in this area as a result of the scant attention paid to the real costs associated with women, the foregoing represents an opportunity to make an significant impact in cost controls, and more importantly the health of an entire segment of the population. And while women as a group have an overall lower absolute risk factor than men, in terms of the potential for women to have a coronary heart disease event, this differs depending upon the age group category. As indicated by Dr. Anita Schmeiser-Rieder (2000), forty percent (40%) of females who are above the age of fifty-five (55) years of age have elevated cholesterol levels and this condition actually peaked for the age group between sixty-five (65) through seventy-four (74) where sixty-one percent (61%) if the research group had this condition. The aforementioned supports the view that strategies aimed at high-reach in conjunction with high-risk represent a necessary approach to bring the incident of the risk of conditions that contribute to increased onset of coronary heart disease under preventive type control program measures. The preceding analysis takes on additional importance when one considers that estimates regarding the probability factors concerning woman above the age of fifty, as well as the increased incidence of smoking in young women and the need for education regarding lifestyle and health preventive measures to reduce probabilities later in life represent contributory factors that can be somewhat controlled. Prevention approaches to call attention to the risks of smoking, high cholesterol diets, and the lack of proper exercise represent measures that have shown to produce a reduction in coronary heart disease numbers over specified periods. Classified as lifestyle and personal habit changes, the reduction or elimination of known contributors that increase the potential of CHD (Coronary Heart Disease) has yielded positive results. It is important to note that in the instance of women, the absolute risk of coronary heart disease remains at relatively low levels until they reach their seventies and eighties, however, the reduction in conditions attributable to said condition in earlier years has been shown as a positive preventive measure (Bonita, 2000). As pointed out by Dr. Bonita (2000) the primary contributors to the coronary heart disease epidemic are: the onset of population aging, rapid urbanization, changes in nutrition, and smoking patterns, along with reduced physical activity Any program that purports to achieve relative success will need to incorporate the preceding along with post CHD treatment and follow up measures as well. Cardiac Rehabilitation Services The United Kingdom’s National Service Framework for coronary heart disease is under a revision program which the Secretary of State for Health, Alan Milburn, states the primary focus is the â€Å"saving of lives† by the reduction of â€Å"†¦the death rate from heart disease and †¦ stroke †¦Ã¢â‚¬  by â€Å"†¦ two fifths†¦Ã¢â‚¬  for individuals under the age of seventy-five (75) by the year 2010 (National Health Service, 2005). The preceding will be accomplished through the following measures (National Health Service, 2005): the development of a new vision concerning coronary heart disease, the establishment of a government-wide agenda, further development and improvement of the National Service Framework for CHD providing effective services to all individuals in the United Kingdom that can benefit The preceding directly address the three points user experience, quality of service as well as fairness/justice, along with other concerns. Through the modernization of the National Health Service’s treatment, care and public awareness approaches the objective is to improve the foregoing across age, gender, cultural, race, disability, locale, and religious lines, as well as being â€Å"†¦ responsive†¦Ã¢â‚¬  to the needs of individuals (National Health Service, 2005). Some examples of the need to revise and modernize the system is evidenced by the following facts (National Health Service, 2005): The wives of workers in the manual class are at twice the risk factor in developing coronary heart disease and stroke than the wives of workers whose jobs are of a non-manual classification. The morbidity rate among the manual class group is also higher than in the non-manual group designation, and this group also reflects increased incidences of angina, heart attack and stroke. The disparity in come between poor and rich has widened over the previous twenty years creating a further gap in health survivability as the more affluent segment of society has been able to afford private medical care as well as increased nutritional guidance and lifestyles that promote as well as can afford more physical activity. Historical records have shown that death rates are higher in the northern locales of the United Kingdom, representing almost three times the rate for individuals over the age of sixty-five (65) in cities such as Manchester than for Richmond or Kingston. The preceding further illustrates the inequities in terms of user experience, quality of service as well as fairness/justice. The new National Health Service program sets forth that it seeks significant improvement in the following areas, all of which will enhance the indicated three examination points (National Health Service, 2005): Standards The National Health Service is aiming to establish a ‘standard of care’ that includes an invitation for individuals whom have been admitted to a hospital for coronary heart disease to participate in programs consisting of cardiac rehabilitation and secondary prevention. The preceding is aimed at reducing future risk of cardiac problems and to help them to return to a normal life. Rationale Admission to a hospital represents individuals whose condition is severe. This signals that their lifestyles to this point have consisted of various high-risk exposures, such as smoking, high cholesterol diets, and other conditions that if changed can lead to significant improvements in rehabilitation. To accomplish the preceding said patients must be analyzed and then coached concerning the lifestyle changes and modifications needed to aid them in returning to a healthier manner of living to reduce future incidents and effect recovery. The World Health Organization (1997) defines cardiac rehabilitation as consisting of a â€Å"†¦ sum of activities†¦Ã¢â‚¬â„¢ that are necessary to effectively influence and identify the underlying causes of the disease to individuals through their own actions can help to effect their recovery. Through increasing the quality of service that offers comprehensive assistance that is custom tailored to their individual circumstances. The aforementioned provides the foundation to enable counseling and aiding individuals in understanding ways in which to change their lifestyle habits, as well as better understand their illness and effect the transition back to as normal and full a life as possible. The aim is to make rehabilitation â€Å"†¦ an integral†¦Ã¢â‚¬  aspect of the active as well as secondary preventive care regime. By establishing rehabilitative procedures immediately after discharge and the establishment of a long term formal program that focuses on returnin g the individual to the best health possible the government estimates a net gain of approximately  £15,700 per instance over a three year period. In the case of women, they represent one third of the individuals with coronary heart disease, yet just fifteen percent (15%) of their total utilize rehabilitative services (Green, 2000). The attention to improving the quality of service the initiative also aims at removing the disproportionate care provided that does not adequately cover rural parts of the country. Effective Interventions Participation barriers can be a result of varied causes, such as the lack of proper motivation to difficulties in attending rehabilitative sessions. In the case of women it was discovered that there was a lack of appropriate provisions, which the current modernization program seeks to correct to provide fairness as well as justice throughout the system. The foregoing also includes minority groups as well. In terms of improving the quality of service the new program consists of Four Phases (National Health Service, 2005): Phase 1 This Phase comes into effect before the discharge of an individual from the hospital, and is to be offered as a part of the acute care plan. It includes the following elements: review and assessment of psychological, physical and social needs for rehabilitation development of a written plan to meet identified needs counseling and advice on detrimental lifestyle aspects such as smoking, cholesterol, exercise, alcohol, etc. prescribing of medication and education on its proper use information concerning cardiac support groups Phase 2 As part of the early post discharge period individuals will receive the following: a comprehensive assessment of their cardiac risk which will include their psychological, social and physical needs for rehabilitation and the plan to achieve these ends lifestyle advice from trained therapists resuscitation training for members of the affected individual’s family Phase 3 This segment of the four phase plan comes into utilization four weeks after the cardiac events initial phase and consists of a series of structured exercise sessions along with ongoing access to support and advice from people trained to provide them with psychological interventions, promotion of health, exercise and associated advice. Phase 4 The final aspect of the four-tiered program that consists of: long term primary care follow up local cardiac support group involvement referrals to identified support services as initiated in Phase 1 The modernized and revised National Service Framework is a highly structured series of interlocking programs that are designed to alleviate as well as eliminate the missing components of the prior coronary heart disease plan which evolved over decades, into a comprehensive system that has been revised based upon today’s understandings. It aims to achieve coverage of all groups and categories of individuals through education, assessment, contact and a cardiac event that provides qualified, balanced and comprehensive coverage and care whose major components are as follows (National Health Service, 2005): The identification of individuals that are likely to benefit from a structured cardiac rehabilitation program before discharge from a hospital, the assessment of individual risks as well as needs, along with the development of a structured plan to achieve successful cardiac rehabilitation, the documentation and provision to deliver the proper treatment as well as advice the integration of required and agreed upon care that is weaved into the patients local network of primary and secondary treatment, preventive and related care, The experiences gained under the prior system, as well as all of the inequities have been addressed under the National Health Service’s new modernization plan that provides and sets relevant standards with effective interventions under structured service models that define and addresses the immediate priorities of each individual patient. Conclusion The scope and complexity that comprises the field of coronary heart disease makes this a subject whereby the factors inherent in its causes as well as manifestations entail equating aspects of human behavior across the entire spectrum of demographic, cultural, social and psychological realms to codify commonalities and possible associative elements that tend to explain the reasons and causes for the world’s most pervasive killer. As the field of examination represents healthcare, the core of understanding evolves an evolutionary process based upon decades of exposure, analysis and experience gained within the United Kingdom as well as on the world stage. The National Health Service has recognized the significance of the preceding and has crafted a program that seeks to build upon the known(s) within the subject field in a program that is flexible enough to improve upon itself to incorporate those aspects, considerations and new understandings that will inevitably will occur wi th new discoveries and as a result of the comprehensive data based system that will permit further modification and evolution. Thus, user experience, along with quality of service, and fairness/justice with respect to the new National Service Framework has been addressed to exclude the existing inequities and shortcomings, yet understands that it is an evolutionary process that will continue to modify and improve upon itself using past experiences along with the new framework as the foundation from which to accomplish this. The Secretary of State for Health, Alan Milburn (2000) firmly establishes the preceding in referring to the â€Å"†¦ National Service Framework for Coronary Heart Disease†¦Ã¢â‚¬  as the nation’s â€Å"†¦ blueprint for tackling heart disease†¦Ã¢â‚¬  Mr. Milburn’s statement goes on to add that the new ‘Framework† is based upon the understanding and recognition of past inequities and shortcomings which this new initiative addresses, along with the understanding of â€Å"†¦ the importance of modern prevention and primary care as well as the contribution of the more specialized services.† The fact that the National Health Service has undertaken this modernization program clearly indicates that it understood and recognized the prior user experience, service quality and fairness/justice components needed considerable improvement. Regardless of how deeply one would delve into the inequities of the past, there could be an argument made for areas and points that were not covered, as the list is extensive. And no matter how comprehensive the present system is, it is an evolutionary framework that will have its own initial and ongoing issues and inequities to face as well as resolve. The difference between the two systems is that the present one was developed with the understanding that it will continue to improve upon itself as it learns from its base of past expertise. In the complex and ever changing world of medical care, the preceding is all that can be asked from its healthcare agency, with the understanding that no matter how comprehensive the plan, modern changes and developments can and will render segments as obsolete, thus the need for a built in foundation that incorporates this as its framework. The very fact that past user experience, service quality and fairness/justice had shortcomings, along with other points is the reason behind the new Framework initiative, and this in itself is a progressive view that is responsive to the needs of the populace, which is the rationale for the government’s existence. Bibliography Bonita, Ruth, M.D. 2000. Woman, Heart Disease, and Stroke: A Global Perspective. Article at The First National Conference on Woman, Heart Disease and Stroke: Science and Policy in Action. Victoria, British Columbia, Canada Green, D.G., Casper, L. 2000. Delay, Denial and Dilution. IEA Health and Welfare Unit, London, the United Kingdom King, Abby, M.D. 2000. Physical Activity as a Contributor to Heart Disease in Woman. Article at The First National Conference on Woman, Heart Disease and Stroke: Science and Policy in Action. Victoria, British Columbia, Canada Maguire, Peg. 2000. Coronary Heart Disease, Not for Men Only. Article at The First National Conference on Woman, Heart Disease and Stroke: Science and Policy in Action. Victoria, British Columbia, Canada National Health Service. 2005. Coronary Heart Disease. National Service Framework for Coronary Heart Disease: Modern Standards Service Models, The United Kingdom Schmeiser-Rieder, Anita, MD. 2000. Cholesterol Levels in Woman in the Western World. Article at The First National Conference on Woman, Heart Disease and Stroke: Science and Policy in Action. Victoria, British Columbia, Canada WHO MONICA Project. 2000. WHO Mortality Data Base. World Health Organization, Geneva , Switzerland World Health Organization. 1997. Annual Report. World Health Organization, Geneva, Switzerland What is Liposuction? What is Liposuction? Liposuction – a way of getting rid of that extra fat on the body! In the busy world of today, managing time in our daily routine has become the most difficult thing to do! Because of which, people barely get time to exercise and keep themselves fit. And to add on to it, canned food exists in opulence! In a world which is ideal, Liposuction (Fat removal) would not be needed. Everyone would eat moderately, in the appropriate quantities and would exercise. But the world is far from ideal! And hence, with each passing year, Plastic Surgery for unwanted fat removal or Liposuction is becoming more and more favourite among the people! Everybody wants to look fit and healthy. Being overweight can be a factor of embarrassment and may be a social stigma. Obese (overweight) people when stigmatized, may even feel a bit low on confidence! Hence, to get rid of this embarrassment and in order to look presentable, such people seek for Liposuction/ Fat Removal treatment. Let’s find out more about this ‘Liposuction’ treatment: What exactly is Liposuction? The literary meaning of the term â€Å"Liposuction† is removal of fat from the body with help of suction. At the time of this procedure, thin, small, blunt-tipped tubes (cannula) are inserted through small incisions (cuts) in the skin. The doctor moves the tubes around under the skin to direct at specific fat deposits. The fat is thus suctioned out through these tubes. Non-surgical Liposuction: A substitute to surgical liposuction wherein different technologies are used to liquefy fat using non-invasive methods like lasers, ultrasonics and injections of chemical agents. With the advent of newer modern and improved techniques/ methods, Liposuction has become much easier, safer and less painful. These modern techniques are as following: Tumescent Liposuction: The area where the tube is to be inserted, a local anesthetic is used for numbing that particular area from where the fat is to be suctioned out. After that, a large amount of an anesthetic solution consisting of epinephrine and lidocaine is injected into the fatty tissue before suctioning out the fat. General anesthesia may not be required in this kind of procedure. Ultrasound-assisted Liposuction: In this method, ultrasound is used for liquefying the fat, thus making the fat removal easier. This kind of technique may prove beneficial in case of removing fat from the sides, upper abdomen and back. Laser-assisted Liposuction: In this method, low-energy waves are utilized for liquification of the fat, which is then removed with the help of a small cannula. The procedure is generally carried out as an outpatient procedure in a properly equipped Doctor’s office, surgical center or a hospital. Only when a large amount of fat is required to be removed from the body, an overnight hospital stay would be needed. In such a case, a deep sedation or general anesthesia with a local anesthetic may be administered. Why is it done? The chief motive behind Liposuction is to re-shape one or more regions in your body and NOT to reduce body weight. The â€Å"problem† areas which do not react to diet and exercise, are tackled by carrying out Liposuction. These areas are namely – the outer thighs and hips in case of female and the waist and the back in case of men. Also, the areas that are generally treated using Liposuction are – the face, neck, back, abdomen, upper arms, legs and buttocks. Liposuction may at times be carried out along with certain other Cosmetic Surgery procedures viz. â€Å"Tummy tuck† (Abdominoplasty), Face-Lift or Breast Reduction. A few clinical conditions may be treated with the help of Liposuction, which include the following: Abnormal enlargement of the male breasts (Gynecomastia or Pseudogynecomastia) Benign fatty tumours (Lipomas) Excessive sweating in the armpits (Axillary hyperhidrosis) Problems with fat metabolism in the body (Lipodystrophy) Liposuction is not used to get rid of Obesity. It will NOT help to clear out cellulite or stretch marks. What to anticipate after the treatment? After the procedure has been carried out, the treated area is tightly wrapped in order to diminish swelling, pain and bruising. Elastic bandages and tape, a special girdle or some type of fitting garment may be used, based on the area that has been treated. The patient may need to wear the compression garment for about 3-4 weeks. At least for the first 7-10 days, a lot of bruising and swelling is expected to occur. The fluid may evacuate from the site of incision for a few days. The patient may be prescribed antibiotics to reduce the risk of infection. After the procedure has finished, and the effect of anesthesia and sedation has been subsided, most of the patients may resume their daily activities as and when they feel comfortable. In case of larger areas undergoing liposuction, recovery may take a bit longer. Outcomes of the Surgery: When carried out in small regions on the body, Liposuction may give out the best desired results. But in case where a person regains weight after undergoing the procedure, the fatty bulges that were removed earlier are most likely to reappear or appear in another place. There may be quite notable changes observed in the body contour immediately after the surgery. It may take several months to a year for the full effects of the surgery to show up. Liposuction does not necessarily tighten the skin around the treated region. After the fat removal has been done, the skin around that region may become a bit loose. For the skin to tighten, it may take up to 6 months. In case of young people, skin retraction is faster. Every surgical procedure has its own advantages and disadvantages. And when it comes to Cosmetic Surgery, it’s no different! There are some risks that are involved with the procedure of Liposuction. Let’s have a look as to what complications may arise after the Fat Removal Surgery: If Liposuction is carried out by an experienced Cosmetic Surgeon in a well equipped surgical setup, it is usually safe. In cases, where a larger amount of area or more than one area have undergone the surgery, the chances of complications arising are more. Bruising, swelling (which is temporary), numbness and soreness in and around the region treated Minor scarring and irritation at the site of insertion of cannula Rippling or baggy skin Certain less common risks include: Uneven skin surface over the region treated Permanent change in colour of the skin Damage to the skin and the nerves, particularly in case of Ultrasound-assisted Liposuction It is very important for people to be careful and not gain extra weight after the surgery. As it may result in fat deposition in certain other parts which are deep inside the body, such as the internal organs like heart, liver etc. Such type of fat deposition can be more fatal. Dangerous risks include: Blood clots or fat clots, which may travel to the lungs (Pulmonary embolism) Excessive blood or fluid loss which may result in Shock Pulmonary edema – fluid accumulation in the lungs Toxic reaction to injected solution, particularly in cases when larger areas are treated. People who have severe heart problems, or blood clotting disorders or pregnant females should NOT undergo Liposuction procedure. Things to note: Liposuction is NOT a mean for reducing weight and it is never an alternative to exercise and a balanced diet. As a matter of fact, most of the Cosmetic Surgeons are of the opinion that the best candidates to undergo Liposuction would be healthy people who are at or very close to a healthy weight but who have stubborn fat deposit which does not respond well to exercise. Liposuction should be carried out only by an experienced Cosmetic Surgeon who is well-trained in Liposuction and knows well how to tackle the complications during surgery.

Upton Sinclairs The Jungle - Socialism :: Upton Sinclair The Jungle

The Jungle  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Socialism      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   During the late 1800's and early 1900's hundreds of thousands of European immigrants migrated to the United States of America. They had aspirations of success, prosperity and their own conception of the American Dream.   The majority of the immigrants believed that their lives would completely change for the better and the new world would bring nothing but happiness.   Advertisements that appeared in Europe offered a bright future and economic stability to these naive and hopeful people.   Jobs with excellent wages and working conditions, prime safety, and other benefits seemed like a chance in a lifetime to these struggling foreigners.   Little did these people know that what they would confront would be the complete antithesis of what they dreamed of.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The enormous rush of European immigrants encountered a lack of jobs. Those who were lucky enough to find employment wound up in factories, steel mills, or in the meat packing industry.   Jurgis Rudkus was one of these disappointed immigrants. A sweeper in slaughter house, he experienced the horrendous conditions which laborers encountered. Along with these nightmarish working conditions, they worked for nominal wages, inflexible and long hours, in an atmosphere where worker safety had no persuasion.   Early on, there was no one for these immigrants to turn to, so many suffered immensely.   Jurgis would later learn of worker unions and other groups to support the labor force, but the early years of his Americanized life were filled, with sliced fingers, unemployment and overall a depressing and painful   "new start."   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Sinclair, has shown in a dramatic style the hardships and obstacles which Jurgis and fellow workers had to endure.   He made the workers sound so helpless and the conditions so gruesome, that the reader almost wants a way out for Jurgis.   Sinclair's The Jungle is a "subliminal" form of propaganda for   Socialism.   At a time in our nations history where the rich were very wealthy, and the poor were penniless, Sinclair's portrayal of socialism in regards to the laborer is very appealing to a jobless, hungry, indigent man.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Sinclair's vision of socialism, wasn't as flawless and beneficial as it seemed.

Lewis Carrolls Alice In Wonderland Essay -- Lewis Carroll Alice In Wo

Lewis Carroll's Alice In Wonderland â€Å"So she sat on, with closed eyes, and half believed herself in Wonderland, though she knew she had but to open them again, and all would change to dull reality . . .† (Carroll 119). Wonderland: a place where everything is different and the imagination is free to roam wild. A place where it does not matter how big a person is, but the intellect that is in a person. Existing in the dreams of children everywhere, wonderland is a place of escape, causing a person to think in new, different ways: a place like no other. Through his novel, Alice’s Adventure’s in Wonderland, Lewis Carroll captures and writes about a little girl’s adventures through her own dreamland. Upon waking up and telling her sister about her dream, her sister contemplates on wonderland, feeling as if she can throw her troubles away and escape to its enchantment. However, being older and having more responsibilities than Alice, she is forced to return to reality. But will the wonder land leave Alice forever? Wonderland is a place of the imagination that makes a person question all that is around him but gradually minimizes with age. Wonderland is a place of enchantment. Nothing is as it should be. Everything that a person has come to expect in reality becomes questioned until he begins doubting who he really is. When Alice first embarks on her journey through wonderland, she too wonders if she has changed instead of her surroundings: â€Å"Dear, dear! How queer everything is to-day! And yesterday things went on just as usual, I wonder if I’ve changed in the night? Let me think: was I the same when I got up this morning? I almost think I can remember feeling a little different. But if I’m not the same, the next question i... ...composed of a fifty-two deck of playing cards, taking on daily roles as painters and royalty, nothing is how it seems in reality. Wonderland is a place far from the life Alice is used to living. Wonderland is a place of imagination for children of all ages. When Alice’s sister awakens from her mini-dream about Alice’s wonderland, she hopes that Alice will be able to keep this imagination with her as she grows up. She wishes Alice to be able to make other children’s â€Å"eyes bright and eager with many a strange tale† (Carroll 120). Although the novel she reads in the park with Alice no longer has the pictures that Alice enjoys reading, her sister still carries a part of wonderland with her hidden waiting to expose itself. Works Cited Carroll, Lewis. Alice’s Adventure’s in Wonderland and Through the Looking Glass. New York: Barnes & Noble Books, 1999.

Les Miserables - Reconciliation between a Man and Himself Essay

Les Miserables - Reconciliation between a Man and Himself The ending of the Victor Hugo novel, Les Miserables, contains a reconciliation between a man and himself, and his family. This is, in many ways, the entire purpose of the book. Goodness or saintliness can be achieved,   despite difficult or unwholesome beginnings. This theme is an enduring one, because of both its truth and its presentation. Fay Weldon may as well have been   describing Les Miserables when she said "The writer, I do believe, who get the best and most lasting response from readers are the writers who offer happy endings   through moral development .... some kind of spiritual reassessment or moral   reconciliation, even with the self, even at death."   The hero Jean Valjean undergoes quite the transformation throughout the   course of his story. He begins as a criminal and convict with absolutely no scruples. A kindly prelate forgives him after a theft, and simply turns the other cheek. This act of unexpected generosity inspires Valjean...

1- Explain the Differences Between Pangloss’s Philosophy of Life and Martin’s. How Do Each of These Characters Influence Candide

Pangloss’s philosophy of life is that all is for the best in the â€Å"best of all possible worlds. † This optimistic philosophy actually is the key element of Voltaire’s satire. Pangloss’s philosophy is against the ideas of the Enlightenment period. Pangloss believes that a powerful God had created the world and that, therefore, the world must be perfect. When creatures of the world, see something as wrong or evil, it is because they do not understand the ultimate good that will come out of it. Voltaire satirically shows the reader that Pangloss is not a believable character. Voltaire illustrates this by showing us that he keeps his optimistic thought even when he is imprisoned. Pangloss ignores any evidence that contradicts his initial opinion. He also uses illogical arguments to support his beliefs. Pangloss’s philosophy tries to impose a passive attitude toward all that is wrong in the world. If the world is the best one possible, then there is no reason to make any effort to change things. Martin is more believable than Pangloss, not because he is more sophisticated, but because he is smarter and more likely to draw conclusions with which we can identify. Martin had been robbed by his wife and beaten by his son and deserted by his daughter and also lived financial setbacks, and therefore he’s a pessimist whereas Pangloss is an optimist. He uses his experiences to judge the world whereas Pangloss was merely using a theory. As a result, Martin is more insightful than Pangloss to foresee events that will happen. Even though Martin’s philosophy is more believable than Pangloss’s, he’s still not good at predicting how some people will behave because his philosophy is coming from extreme pessimism. Therefore it might not be wrong to say that Voltaire is trying to prove that we need flexible thought in our lives based on real evidence. Both philosophers will ultimately fail because there’s no room for exceptions in their beliefs. Candide starts his journey with the influence of Pangloss’s belief of â€Å"best of all possible worlds†. Pangloss and Candide, suffer and witness a wide variety of horrors and tragedies together. During these tragedies, Pangloss’s s philosophy proves to be useless and even destructive at the end, because it prevents them from making realistic judgments. For example while Jacques was drowning, Pangloss doesn’t let Candide save him by saying that the bay of Lisbon had been formed for this Anabaptist to drown in. Also when Candide was buried under the rubble of the Lisbon earthquake, he asked for oil and wine because he was dying, but Pangloss ignored him and still tried to reason with the causes of the earthquake. At the end Candide rejects his philosophy of optimism and as he and his servant Cacambo travel and go through more horrors, Candide starts believing a pessimistic view of life. When Candide meets Martin, they set sail together and Martin is just the opposite of Pangloss. He does not believe that everything is for the best in this world. Even though Candide tries to oppose Martin by talking about free will but it does not solve the problem of presence of evil in the world. In general, Martin’s arguments seem more reasonable than Pangloss’s ideas. But, like Pangloss, Martin believes so firmly in his own view of the world that he is not flexible and usually dismisses real evidence that contradicts his philosophy. When Candide cannot find Cunegonde, Martin shows the bad influence of his pessimism. Instead of attempting to comfort his friend, Martin uses Candide’s distress to further confirm his own world-view. Just like Pangloss’s optimism, Martin’s pessimism also keeps him from taking initiative to improve the world.

What Have Been the Main Developments in Strike Activity in Britain over the Last 35 Years?

What have been the main developments in strike activity in Britain over the last 35 years? Strike activity is a form of industrial action that can occur in the workplace once conflict has risen. It is a complete stoppage of work by a group of employees and its aim is to express a grievance or to enforce a demand. (Dundon, Rowlinson, 2011) Employees will usually use a strike as a last resort to deal with issues in the workplace; workers are not able to perform a strike without a stringent process being adhered too with the help of their respective trade union. Employees can voluntarily become a member of a trade union in which they pay for a representative to aid in times of need. Trade unions are used to regulate pay and working conditions between the employer and employee therefore employees will have the support of their trade union during times of proposed strike activity. There have been numerous strikes within the private and public sector workforce since 1978 and this assignment is going to discuss the main developments in strike activity in Britain over the past 35 years. It goes without saying that pre 1978, strikes have occurred (Sapsford, 1982) and played a significant part into more current affairs that can have relevance to post 1978 therefore numerous references maybe made to pre 1978 due to the impact it has had on the present day. Thatcher The process by which strikes have to follow is currently regulated under the Trade Union and Labour Relations Act 1992 (Legislation. Gov, 2013) This law outlines the rights of Trade Unions amongst other things. Notably, this law enforces that trade unions must use a process to perform a strike and this process entails the use of a postal vote called a ballot. Gov. UK,2013) Before this particular law was implemented the leader of the conservative party, Margaret Thatcher, had initiated the idea of making strike action harder to participate in. Margaret Thatcher was the prime minister from 1979 through until 1990 (Blundell,2008) and it was at this stage in history when trade unions were being reined in by seve ral of Thatcher's proposals. Thatcher seen the unions and their occurrence of strike activity to be disruptive and believed that the behaviour of the unions could be repressed by introducing a ballot system (Phillips,1979). This meant that employees would have to participate in a secret ballot to decide on whether to involve themselves in strike action. The introduction of this process was ruled by the Trade Union Act 1984 and meant that unions wouldn't be able to lawfully strike unless they had a majority vote (Carby-Hall,1984) therefore prolonging and hindering the prospect of employees and unions participating in strike activity. Winter of Discontent Thatcher's introduction of such law appeared not long after one of the most momentous episodes of strike activity in history. The winter of discontent' occurred between 1978 to 1979 and was recognised as the largest stoppage of labour since the 1926 General Strike (Winter of Discontent,2007). This period of work stoppages appeared as a result of high unemployment and impolitic incomes policy, therefore workers felt the desire to fight the labour government and with the increasing size and militancy of public sector unions, the ‘winter of discontent ' achieved a record status of days lost through strikes(Reitan,2003). Numerous amounts of unions and employees participated in strikes throughout the period of the ‘winter of discontent'; Britain journeyed through power cuts, rubbish pilled in the streets and school closures along with a reduction to a three day working week (Elliott, 2008) all in the representation of workers welfare. A total of 39 million days were lost throughout the period between 1978 and 1979 (Gall, 2011) Coal Miners Strike The most significant affair of strike activity after Thatcher's regulatory implementation to tackle trade union power was the coal miners' strike in 1984. This work stoppage arose after the recession in the early 1980's which cut the demand for coal exposing the less productive parts of the industry. The strike lasted a whole year and included the involvement of several thousand workers and was the most important defeat for trade union movement since the General Strike in 1926 according to Lyddon. (Lyddon, 2013) This particular strike was catastrophic in regards to the potential effects not just on the coal mining industry, but also other industries that could have been affected by the decisions that lay within Mrs Thatcher's power. Nick McGahey, the vice president on the NUM told a news conference that the strikers are not just fighting for their own jobs, but for the jobs other people from different industries (Miners Strike,2013). The steel, engineering and electrical industry will also experience knock on effects of numerous pit closures. As one can imagine being placed in Margaret Thatcher's position as this moment in time may have been pressured to say the least, due to the scale of the strike. In 1984 there were 187,000 people in total who were miners and over half of them were participating in strike activity (Miners Strike, 2013). Along with the implications of the political decisions being made, unemployment rates were at an all time high of over 3 million people unemployed. This figure was the highest since the period of the General strike in 1926 (ONS, 2013). For Mrs Thatcher, a strike of this measure must have been enough to have to tame, never mind having to battle with such high unemployment figures. This situation alone could have been enough for the general public to view Mrs Thatcher in a negative light but she was re-elected as prime minister for the third time in 1987 (Margaret Thatcher, 2013).

Blood Brothers Essay

Blood Brothers’ is the story of two twins from a poor family in Liverpool. One of them is given away and they are forced to live apart, but somehow fate always brings them back together. The play is built upon the theme of the superstition that if twins are separated at birth then they will die on the day that they discover that they are twins. This theme is reinforced throughout the play by the words of the narrator to keep the audience thinking about what will happen. The first time we see the theme of superstition is when the narrator first begins to speak and he says: â€Å"So did you hear the story of the Johnstone twins? †¦Ã¢â‚¬ ¦. How one was kept and one Given away†¦.. Never knowing that they shared one name till the day they died†¦ † Willy Russell thought that the working class people were more superstitious in contrast with the middle and upper classes. I think this is because they were usually more religious than the upper classes. An example of there superstition is when Mrs Lyons places a pair of new shoes on the table and Mrs Johnstone says: â€Å"New shoes on the table’ take them off†¦. Never put new shoes on the table†¦.. You never know what’ll happen. † During the play Willy Russell explores class difference in great detail, showing how it can determine your chances further on in life. He also explores this theme in his other plays such as ‘Our day out’. In ‘Blood Brothers’ he does this by contrasting the backgrounds that the two boys are brought up in. Mickey, the twin who was kept, was brought up in a working class background with little money and spoke with a broad scouse accent and used slang terms. Whereas Edward was brought up in a family who had a car, a nice house and plenty of money. This meant that he would be able to get a good education and had many opportunities available to him in life. Throughout the play both women attempt to keep the twin apart, but somehow they always end up back together and ironically they make a pact to become ‘Blood Brothers’. Mickey and Edward are always trying to be like each other; Mickey wants to have a nice house, lots of money and a good education where as Edward wants to be able to do what he wants and not be spoilt like he is now. The playwright’s use of dramatic irony builds up drama and tension as the audience know that Mickey and Edward are really brothers and not just ‘Blood Brothers’. This makes the audience feel like they are part of the secret and helps them create a bond with the characters. This keeps the audience interested because they want to find out what is going to happen to them. The difference in class became more apparent during Edward and Mickey’s adulthood, when Eddie goes to university while Mickey is has to struggle to provide a living for his family. The playwright was quick to emphasise the high unemployment rate at the time the play was set and concerns that people faced. Because he was brought up by a single working class parent and had always struggled for money, Mickey lacked a father figure and this may have influenced his decision to help his brother, Sammy, during the robbery. Mickey’s role in the robbery triggers a huge change in his behaviour and also during his time I prison he becomes depressed and gets addicted to the anti-depressants he is prescribed, because of this Mickey’s wife, Linda, talks to Eddie and asks him for advice, and Mrs Lyons tells Mickey of this relationship because she wants them to argue and fall out so that they never find out that they are brothers. I think that at this point the audience would sympathise with Mickey because he has always had a bad life and know he has been told that his wife is seeing Edward. This event spurs Mickey on to seek revenge against Edward because he fells betrayed by him and Linda. An example if this is when Mrs Johnstone says to Linda:- â€Å"Mickey†¦ Mickey’s got a gun†¦ † Linda then realise where Mickey is going and she says:- â€Å"Mickey?†¦ Eddie?†¦ The Town Hall† One of the techniques that Russell uses to create drama in the play is by adding a narrator who intervenes several times during the events of the play. The role of the narrator is to emphasise the superstition of the twins and to keep the audience interested. An example of this is when the narrator sings: â€Å"Yes, the devil he’s still got your number†¦ he wants to speak to you†¦ seen him leanin’ on your door. † This builds up the drama because of Mickey’s unstable nature it will prepare the audience for events to come at the end of the play. Another example of this is when the narrator sings the song ‘madman’. As he repeats the lyrics over and over the suspense would build and also the theme of superstition is also repeated and reinforced. Also by using pulsating music the drama and tension is heightened. â€Å"There’s a man gone mad in the town tonight, He’s gonna shoot somebody down†¦.. Devil’s got your number†¦.. he’s callin’ you up today† This would remind the audience that there is a price to pay for separating twins; it will also reinforce the superstition of twins. I also think that it tells the audience that something important is going to happen. The final scene in the play is set in a very public place, the town hall, and there are councillors and other people there as well as Edward. This shows that Mickey’s mind is unstable and that he doesn’t care about the consequences of his actions because he fighting a private battle in public. This would also be used to heighten the drama in the final moments of the play. When Mickey enters onto the stage he has a gun held two handed because his hands are shaking so much. Then somebody stood next to Edward realise the reality of the situation and screams. This would add drama and tension to the scene and it would also show the audience that Mickey is a very real threat. For this final scene the use of stage directions is very important. Willy Russell has added pauses in areas of high tension so that the audience would be eager for the rest of the scene and the tension would grow, he also added pauses, along side the language and actions used by the characters in the play. By adding ellipsis into Mickey’s speech it would show the audience that he can’t even control what he is saying. He also uses the theme of guns throughout the play and I think this may have been a hint as to how the play ends. Mickey’s past encounters with guns and violence may be the reason he went so far over the edge that he threatened to shoot Edward. When Mickey and Edward were children they used to play shooting games, but know this is no longer a game. When Mickey tells Edward that he has stopped taking the pills I think that it is significant because it would tell Edward and the audience that Mickey is not thinking straight and that he is not in control of his action. It also shows that the only way Mickey can react is with violence. The use of dramatic irony throughout the play is one of the main themes but it is probably this scene where it is most important. The fact the audience know that Mickey and Edward are brothers is ironic because they don’t know themselves. It is also ironic that Mickey thought they were ‘Blood Brothers’ and has made the connection that they are both the sons of Mrs Johnstone. When Mickey says:- â€Å"Friends! I could kill you†¦ We were friends weren’t we? Blood Brothers, wasn’t it? Remember? † It would tell Edward and the audience that Mickey’s idea of a friend is built around a childish pact. The language Mickey uses is very basic and he talks in short sharp sentences. When Mrs Johnstone makes a dramatic entrance on to the stage she rushes to Mickey and Edward, who are stood just yards apart, and she tells them the truth about who they are, this is followed by the shooting of Mickey and Edward. The fact that Mickey and Edward are just yards apart would create drama because Mickey is out of control and has a gun and Edward is defenceless. When Mrs Johnstone had told her sons that they were brothers Mickey realises what sort of life he could have had and who he could have been. This made him feel uncontrollable rage towards his mother and this would have made the audience think that he may shoot Mrs Johnstone. By telling her two sons they were brothers Mrs Johnstone has caused both her sons deaths when she actually thought she was helping the situation. The final song and music would create a deep sadness in the audience and make them feel sorry for Linda and Mrs Johnstone’s loss. They would also be sad for Mickey who hasn’t had a very good life, they would feel sad for Edward because he hasn’t done anything to harm anyone and yet he gets shot. This would confirm in the audiences mind the superstition that if twins are separated they will die on the day they find out the truth. I think that will was successful in creating drama and suspense throughout the play but I think he could have increased the tension at the end of the play by introducing Mickey and Edwards real father into the scene and perhaps Linda getting killed by Mickey as well as Edward. By adding another character it may make the audience think that Mickey will become even more confused and this may lead to the death of other characters.