Multibacillary Leprosy (MB) Case Study

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

Shaping Identity in William Gibsons Neuromancer Essay -- Numbers Gibs

Shaping Identity in William Gibson's Neuromancer The number â€Å"one† is not a thing. Math has no definitive reality. Numbers are a social construct, a system of symbols designed to express the abstractions through which properly developed societies explain aspects of reality. It follows that, as humanity seeks to understand more of what it is to exist, bigger numbers are needed. Soon, we need machines to understand the numbers. Society plants a base on information technology, efficiency, and a mechanical precision that is startling. What is desirable in a product is distilled to a formulaic essence and packaged neatly. Humans, too, are boiled down to science. Glossy shots, red lipstick, concrete biceps, and an ever-decreasing waistline set the standard. People are reduced to little more than the sum of their parts, a pair of matchstick legs, a rippled midsection, the right shoes and right make-up. Information technology makes the dissimilation of these trends mercilessly easy: In response to the Atkins Diet, tens of thousa nds of Americans strike carbohydrates from their diets. A cell phone that simply calls someone is archaic at best; people need infinite text messaging and a built-in digital camera (with no roaming charges) so that they can e-mail pictures of their new car to their friends in California, New York, or Antarctica. Jessica Simpson mistakes canned tuna for chicken and millions of viewers laugh at her in unison. Still, â€Å"one† is not a thing. These societal constructs chip away at the very humanity of the people who live amidst them. In William Gibson’s Neuromancer, a motley cast of characters face this cold steel reality, that their humanity is being systematically stripped, and that even attempts to take advantage... ... as perceived in Mary Shelley's Frankenstein and William Gibson's Neuromancer.† 1996. Retrieved November 16th, 2004. http://www.geocities.com/Paris/5972/gibson.html. Meyer, Chuck. †Human Identity in the Age of Computers: Cyberpunk Identity.† April 1997. Retrieved November 20th, 2004. http://fragment.nl/mirror/Meyer/CyberpunkIdentity.htm. Myers, Tony. †The Postmodern Imaginary In William Gibson's Neuromancer.† 2001. Retrieved November 20th, 2004. http://www.postanarki.net/myers.htm. Saffo, Paul. †Consensual Realities in Cyberspace.† Phrack Magazine. 1989. Retrieved November 16th, 2004. http://www.phrack.org/show.php?p=30&a=8. Shaw, Debbie. †THEREFORE I AM - TECHNOLOGY & HUMAN IDENTITY.† Updated January 1997. Retrieved November 16th, 2004. http://learning.unl.ac.uk/humanIT/cybersf/ident.htm

Myanmar

Myanmar is one of the most underdeveloped countries in the world. Despite its lush natural resources, the country formerly known as Burma has remained among Asia’s struggling economies, notwithstanding the fact that its neighbor, Thailand, has periodically rebounded from the boom-bust cycle of the international economy, including 1990s Asian Financial Crisis. Even if there be economic pitfalls like these, Myanmar has always been known for its two social pillars – the Buddhist monks and the Burmese military. For years, the these two socio-political institutions have always been embroiled in a love-hate relationship especially in amassing the support of the Burmese people, as evidenced in the current political crisis engulfing all of Myanmar today. On the other hand, it is important to note that Myanmar was a former direct British colony, from 1824-1886 and subsequently became a province of India until it gained full independence in 1948. Burmese history post-independence though may be best described as a waltz between the exercise of democracy and the iron grip of the Burmese military institution, as the Burmese military junta has always wielded political and economic power in Burma since the time of Gen. Ne Win until today, under the leadership of Gen. Than Shwe. Presently, several indicators may serve to show the level of development Burma has reached – the Per Capita Gross Domestic Product (PCGDP), Literacy Rate, and the Life Expectancy. These three are very important indices in determining whether or not the Burmese government and its people are successful in substantially improving the lives of members of their society. The Burmese PCGDP is pegged at $1,800 (2006 est.), a far cry from the $9,200 (2006 est.) PCGDP of its neighbor Thailand and even its similarly situated neighbor Laos whose PCGDP is at $ 2,200. (cia.gov) On the other hand, Burma has been successful in ensuring that majority of its population can read and write, as its 89.9% literacy rate is only a few percentages lower than Thailand’s 92.6%. Life expectancy in Burma is also very low at 62.52 years old, while Thailand’s life expectancy is at 72.55 years old. Actually, the life expectancy in more underdeveloped neighbor Bangladesh is slightly higher than the Burmese average, at 62.84 years old. (cia.gov) Over and above the usual economic explanations as to the depressing levels of poverty in Burma, a major basis for the continuing economic underdevelopment in Burma shall always be the authoritarian rule of the Burmese government and the patent lack of democracy and freedom in the country. A main factor for the stunting of the Burmese economy is the strict government controls on all sectors of the economy by the ruling junta. Even as the world has already started embracing the principle of eliminating barriers to international trade, the Burmese economy continues to institute questionable economic policies such as a distorted interest rate regime and multiple official exchange rates. (cia.gov) Moreover, the discredited image of the Burmese military junta to the world has also resulted in a lukewarm investment climate, diminishing foreign assistance by developed countries, and economic sanctions, especially due to its protracted and continued crackdown on pro-democracy dissidents including Nobel Peace Prize winner Aung San Suu Kyi. Such an unfortunate economic and political situation would definitely lead to dire results insofar as human development is concerned, the result of which would be the low life expectancy of the Burmese people. To a certain extent, it is very safe to surmise that the low life expectancy can be logically attributed to the failures of years of military junta rule in delivering basic social services to the people. Had the Burmese government been very effective in delivering primary healthcare to its impoverished countryside notwithstanding ensuring sustained food security, the necessary consequence of such a situation would perhaps lead to a higher life expectancy rate than what Burma currently faces. Apparently, if one looks at the CIA world ranking on life expectancy, Burma at 168th place would find itself in the company of countries and states which had histories of problematic governments and states which do not necessarily hold the interest of their peoples at heart due to pervasive corruption, civil strife, among others. (cia.gov) On the other hand, it would seem surprising that an impoverished country like Burma would have such a high literacy rate of 89.9%, especially as similarly situated underdeveloped countries such as Haiti and Cambodia have very low literacy rates, at 52.9% and 50.2%, respectively. The explanation for this would perhaps lie on the fundamental interest of the Burmese junta to educate and consolidate the people towards assimilating themselves to the legitimacy of the authoritarian regime, as an uneducated people would definitely plant the seeds of civil unrest and challenge the regime. This conjecture is offered in the light of similarly high literacy rates in other authoritarian yet impoverished regimes the world over, such as Cuba and North Korea, both of which have literacy rate of 99%. (cia.gov) The primordial prerequisite for the economic development of Burma today needs more than a simple implementation of liberalization measures in its economy, as the basic problem lies in the very structure of its institutions, particularly the manner by which the Burmese government wields power. If there is no room for discussion of different economic theories and policies which have worked for countless other impoverished nations, no shift towards economic liberalization and deregulation policies can ever be hoped in Burma as an authoritarian government shall always tend to believe only the policies and theories which it would want to pursue and implement. While a vast majority of the Burmese people is literate enough, it cannot be said fully at this point whether their literacy actually amounts to the development of countless professionals, scientists, engineers and skilled workers, as their poorly planned economy remains in shambles. In the ultimate analysis, prior to any economic cure which may be instituted to jumpstart its economic for the development of its resources and its people, a political solution must decisively be done if Burma is to move progressively and proactively forwards as a nation. Works Cited: Burma. CIA World Factbook. Retrieved from   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  November 20, 2007. November 15, 2007. Thailand. CIA World Factbook. Retrieved from   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   https://www.cia.gov/library/publications/the-world-factbook/geos/th.html,   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   November 20, 2007. November 15, 2007. Rank Order – GDP – per capita (PPP). CIA World Factbook.       November 20, 2007. November 15, 2007. Rank Order – Life expectancy at birth. CIA World Factbook.             November 20, 2007. November 15, 2007. Myanmar This essay will investigate the role of images in the media’s presentation of current events using the example of Myanmar/Burma protests. It is a well-known scientific fact that humans absorb the greatest amount of information through the visual channel; therefore, contemporary media places a significant emphasis on the use of effective images in the presentation of news. Images coupled with specific vocabulary are the most powerful tool of framing public discourse concerning current events. As for the background information about the crisis in Myanmar/Burma, there has been a series of protests against human rights abuses and crackdown on ethnic minorities going on in the country since late August. The protests have been started by monks and supported by ordinary citizens. In late September, the military government of Myanmar/Burma responded with the police violence and arrests. Such a response sparked a wave of international indignation, and both Myanmar/Burma activists and their supporters abroad call upon the international institutions to take a decisive action to solve the crisis that has not been fully settled yet. For the purposes of this essay, three most influential news media providers were selected, namely CNN, BBC, and Reuters. There is little variation in their representation of the events in Myanmar/Burma, yet each news provider uses its own set of images to communicate its message to its target audience. CNN launched a series of articles tracking down all the developments of the situation in Myanmar/Burma. The article ‘Satellite photos may prove abuses in Myanmar/Burma, researchers say’ (CNN, 2007) is accompanied by a photograph showing a crowd of monks on a demonstration who are surrounded by other citizens. Deep red apparel of the monks contrasts with predominantly white clothes of other citizens, yet this photograph communicates a powerful message that many Myanmar/Burma citizens are united around the noble cause of confronting their government because of human rights abuses. The photograph is probably taken from the plane or any spot high above the Earth surface. This very fact reminds the Western viewer that many media channels are banned from doing on-the-ground reporting from Myanmar/Burma. It further amplifies the perception of the Myanmar/Burma government as authoritarian and undemocratic one. The thing that is probably missing from the image is the presence of authorities. It is well-known that streets of major Myanmar/Burma cities are flooded with the police and sometimes special forces. While the image effectively captures the peaceful spirit of the protests and high level of self-organization, it fails to convey the atmosphere of confrontation between citizens and authorities. BBC frames the story with a noticeable human touch. British media is known to focus on the human factor before examining international political implications of a certain event. The story titled ‘Monks trying to escape Rangoon’ (BBC, 2007) goes together with a photograph of two young monks fleeing away at the top of a truck. In the background it is possible to spot several other trucks carrying other exiles away. This image communicates a dual message: first of all, it persuasively portrays Buddhist monks as innocent victims of the oppressive regime rather than violent protesters; secondly, it indicates that the number of exiles exceeds the number of transport facilities available to them. Furthermore, it makes viewers think about the future of the protesters who are forced to leave their home country because of their political beliefs. It also puts the story in the wider regional context, since the conflict in Myanmar/Burma will also affect all the neighboring countries if exile becomes mass. The inscription under the image reads ‘Many monks are desperate to leave Rangoon, witnesses say.’ The image advances the story by showing that the protesters are ready to trade the risk and insecurity of fleeing to another country from relative political freedom they can enjoy abroad. Another BBC story, ‘Burmese play tense waiting game’ (BBC, 2007), also features an effective use of visual images. One of the images that accompany the story features Gen Than Shwe who heads the ruling junta and controls the army. The facial expression of Gen Than Shwe is conspicuously aggressive and hostile. To the Western viewer, such an image reminds of other historical forms of military dictatorship, ranging from Soviet-era military buildup to juntas in Latin America. Perhaps the most effective use of visual images has been done by the Reuters (2007). Together with a series of stories, it offers a slideshow of 25 photographs representing the course of development of events in Myanmar/Burma. One of the photographs features a Buddhist monk standing by a placard that reads ‘Free Political Prisoners, Listen to the People.’ Young man is wearing glasses (the fact that resonates with the collective image of ‘intelligentsia’ from developing countries) and has a very determined expression on his face. While there is a grammatical mistake in the word ‘Political,’ the image still credits the protesters for their brave attempts to attract the attention of international community. In such a way, Western media frames the public discourse about the events in Myanmar/Burma is a sympathetic way and calls upon Western governments and international organizations to render necessary support to the peaceful protesters and population of the country. References CNN. ‘Satellite photos may prove abuses in Myanmar, researchers say.’ September 28, 2007. October 3, 2007. BBC. ‘Monks ‘trying to escape Rangoon’.’ October 3, 2007. October 3, 2007. BBC. October 3, 2007. ‘Burmese play tense waiting game. October 3, 2007. October 3, 2007. The Reuters. ‘Myanmar junta arrests more.’ October 3, 2007. October 3, 2007.   

Freedom or Liberty - 1145 Words

Freedom and Liberty Every day the federal government as well as state and local government pass laws to make us a safer society. As they make society safer they are slowly chewing away at our rights, liberties, and personal freedom. Where is the balance? A serf toiling away in a field had very little liberty. He couldn’t vote and didn’t have any true freedom of speech or assembly. But he did have freedom to think his own thoughts, and he was given by his creator the right to moral agency. Within his confined world, he had the freedom to make choices, either good or bad. We now have laws regulating everything. We are forced to wear seatbelts, to wear motorcycle helmets. Smokers can’t even smoke outside. Kids are†¦show more content†¦(Thomas Jefferson) It is the hopeful goal of liberty that citizens govern their government rather than the reverse. We â€Å"The People† are charged with the protection of our liberties, and we should guard against tyrannical figures imposing intended wills upon that of our own. To regenerate the process in today’s America, we must demand regulation of soft money in politics. Personal or corporate interests cannot dominate the political landscape. If we truly believe that every voice has value, then we cannot continue to give merit to special interests. As stated before, our legislature must be made of the people and for the people. If we divert and move with speed to this end, then we truly we will have government of the people and for the people. But†¦Ã¢â‚¬ ¦if it wasn’t for central government†¦..there would be no civil rights legislation, there would be no title 9. We are now in the twenty first century, and the world has changed since 1776. And there are prices to pay if the government is going toShow MoreRelatedThe American Liberty And Freedom944 Words   |  4 Pageshistory we have seen how American liberty and freedom is always centered on the dominant white male image. As time continues on those of minority decent have had work twice as hard to receive the same level of equality as all whites both male and female. Women and African Americans have struggled much more because back then white men believed that they couldn’t be trusted and that they were not worthy of holding power. The inequality of American liberties and freedom has been displayed recently whenRead MoreFreedom, Liberty, and Independence 1302 Words   |  6 Pages held strong in their beliefs and the pursuit of their individual ri ghts of freedom, liberty, and independence. The Jacksonian period was a time in American history that has been personified as a time of extreme change and upheaval in the areas of economic growth, political interests, and expansion. 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