Audit of Syphilis Screening in Pregnancy

Audit of Syphilis Screening in Pregnancy Tables Table 1:Syphilis confirmatory test results for forty nine  pregnant woman 18 Table 2:Syphilis screening results of eleven new-borns of  positive syphilis mother 24 Table 3: Positive syphilis confirmatory test results for sixteen  pregnant woman 30 Figures Figure 1: The laboratory turnaround time of syphilis screening  for mothers 28 Figure 2: The laboratory turnaround time of syphilis screening  for new-borns 28 Tables Table 1: Syphilis confirmatory test results for forty nine pregnant woman 18 Table 2: Syphilis screening results of eleven new-borns of positive syphilis mothers 24 Table 3: Positive syphilis confirmatory test results for sixteen pregnant woman 30 Figures Figure 1: The laboratory turnaround time of syphilis screening for mothers Figure 2: The laboratory turnaround time of syphilis screening for new-borns ABSTRACT Objective: A re-audit of syphilis screening in pregnancy was carried out to ensure that the improvements in laboratory and clinical aspects of management for the antenatalof pregnant women with positive syphilis screening and their new-born babies fully met were in accordance with the UK National Guidelines on the Management of Syphilis (Kingston et al., 2008) and the Guidelines for the Management of Syphilis in Pregnancy and the Neonatal Period (Stringer et al., 2013). Methods: Patients’ data were collected via query of the three databases: Clinisys Labcentre, Telepath and EuroKing. The n the data were analysed using Microsoft Access 2013. Results: Samples from Forty nine49 pregnant woman with positive syphilis results serology were referred to a reference laboratory laboratory were sent to MRI for syphilis serological confirmatory testing. Sixteen pregnant woman with of these women were confirmed to have had had positive syphilis were identified. Ten pregnant woman were re-tested screened at least twice during their pregnancy and six pregnant woman were only screened tested once during pregnancy. Over-testing of for treponemal IgM were seen in nineteen patients[h1] with non-reactive RPR titre. Only eleven babies born to mothers with syphilis were followed-up with serial serological tests for syphilis. Only four new-borns were fully screened. Some of the new-borns were not tested with treponemal IgM due to sample insufficiency. Conclusion: There were some improvements seen since the first audit which includes the changes of the confirmatory testing schedule in MRI, lower screening false positive rate, and increased follow-up of the new-borns. There were also things to improve in the management of syphilis in pregnancy and the new-borns of positive syphilis mothers. Treponemal IgM test should be performed only when the RPR test were reactive to prevent over-testing of patients. The test algorithm for screening of syphilis in new-borns should give priority to RPR test and treponemal IgM to prevent under-testing[h2]. In-house confirmatory testing should be considered to allow reduction of test turnaround time’s thereby aiding patient management.Improvements[h3] should be made in the management of syphilis in pregnancy and the new-borns of positive syphilis mothers. Treponemal IgM test should be performed only when the RPR test were reactive to prevent over-testing of patients. The test algorithm for screening of sy philis in new-borns should give priority to RPR test and treponemal IgM to prevent under-testing[h4]. 1.0  INTRODUCTION 1.1  Syphilis Syphilis is an infectious disease caused by Treponema pallidum (T.pallidum) subspecies pallidum. The disease is transmitted from human to human, and humans are its only known natural host (Woods 2005). Epidemiologically, in the UK, cases of syphilis have increased in England since 1997 led by a series of outbreaks reported from Manchester, London and Brighton (Health Protection Agency 2009). Since 1999, diagnoses of infectious syphilis have been made in heterosexuals where the outbreaks are linked to sex work, students and young people. But, there was a changing pattern of infection between 1999 and 2008, when seventy three percent of new diagnoses of infectious syphilis were reported in men who have sex with men (Health Protection Agency 2009). The transmission is primarily by sexual activity (Zeltser Kurban 2004) (vaginal and anal intercourse) and by direct contact with active primary or secondary lesions (Lafond Lukehart 2006) for example through oral sex and kissing at or near an infectious lesion (Kent Romanelli 2008). T.pallidum may invade the host through normal mucosal membranes and also through minor abrasions in the skin (Zeltser Kurban 2004) such as from sexual trauma, causing an inflammation, ulcer and then spreading through the blood stream to other parts of the body (Goh 2005). 1.2  Syphilis in Pregnancy Mothers with untreated syphilis may seriously complicate their pregnancy. Vertical transmission of T.pallidum across the placenta (Singh Romanowski 1999) can occur at any time during pregnancy (Vaules et al., 2000; Oswal Lyons 2008), this leads to wide dissemination of the spirochete in the fetus (Woods 2005). Fetal infection resulting in spontaneous abortion, still-birth, premature delivery, non-immune hydrops fetalis and also congenital infection (Singh Romanowski 1999; Vaules et al., 2000; Ledger 2000). Vertical transmission may occur at any stage of syphilis infection. However, the transmission is more common in mothers with primary and secondary stage of syphilis (Singh Romanowski 1999; Vaules et al., 2000; Oswal Lyons 2008) as the risk of transmission depends on the levels of spirochaetemia which are higher in these stages compared to other stages (Vaules et al., 2000). Syphilis may also be transmitted during birth by contact of the new born with the mother’s genita l lesion (Ledger 2000; Berman 2004). 1.3  Congenital Syphilis Signs of infection for early congenital syphilis may appear within the first two years of the infant’s life with clinical manifestations include hepatosplenomegaly, rash, fever, and signs of neurosyphilis, especially bulging fontanel, seizures, and cranial nerve palsies (Mattei et al., 2012; De Santis et al., 2012). As for late congenital syphilis, the sign of infection may only be seen over the first two decades with clinical manifestations such as frontal bossing, nasal cartilage destruction, and dental abnormalities (Mattei et al., 2012; De Santis et al., 2012). Congenital syphilis leads to multiple organ infection because of the widespread haematogenous dissemination (De Santis et al., 2012) that will further cause death in the fetus or new born. However, the disease is almost preventable if mothers with syphilis are treated early in pregnancy (Walker Walker 2007). 1.4  Serologic Test Diagnosis of syphilis is made based on clinical signs and symptoms, microscopic examination and serologic tests (Little 2005). Two types of serologic testing were available; non-treponemal specific tests and treponemal specific tests (Clyne Jerrard 2000). Non-treponemal tests are widely used for testing and screening for syphilis as they are rapid, simple and inexpensive (Ratnam 2005). The example of  non-treponemal tests include the Venereal Disease Research Laboratory (VDRL) test and the rapid plasma reagin (RPR) test (Kent Romanelli 2008). Due to the rate of false-positive results which present in about one to two percent for these tests, the positive results have to be confirmed by sets of treponemal-specific tests such as the T.pallidum particle agglutination (TPPA) test, T.pallidum haemagglutination (TPHA) test and treponemal enzyme immunoassay (EIA) test (Kent Romanelli 2008). 1.4.1  Antenatal Screening The detection and treatment of infectious syphilis are extremely important in preventing congenital syphilis (Chakraborty Luck 2007; Simms Broutet 2008). An effective antenatal screening programme can have a huge impact in the way of managing both mother and baby. All pregnant women should be screened for syphilis at their first antenatal appointment (French et al., 2009) and the test should be repeated early in the third trimester (Goh Thornton 2007). Also, all infants born to seropositive mothers should be examined at birth and at monthly intervals for three months until it is confirmed that serological tests are and remain negative (Oswal Lyons 2008). The primary screening tests recommended (Kingston et al., 2008) are either treponemal EIA or TPPA/TPHA. If the screening test is positive, it must be confirmed by either one of the opposite tests. VDRL or RPR will be performed when the confirmatory test gives positive results (Kingston et al., 2008). 1.5  Audit on Diagnostics of Syphilis in Pregnancy The diagnosis of infectious syphilis in women in the UK increased between 1999 and 2007. The increase of syphilis cases in women has also led to the re-emergence of congenital syphilis in the UK which may suggest sub-optimal management of patients with syphilis (Health Protection Agency 2009). In 2011, an audit on diagnosis of syphilis in pregnancy was performed at the Pennine Acute NHS Trust (PAHT) to ensure the syphilis screening in pregnant women and also the serological diagnostic of their new-born babies followed the UK standard for Microbiology Investigations in Serological Diagnosis of Syphilis which were introduced by Public Health England in 2007 (Public Health England 2014b). The purpose of introducing the standard was to assure equivalence in the investigation strategies in different laboratories across the UK (Public Health England 2014b). The audit reveals the concerns about the delays in syphilis confirmations and insufficient follow-up for new-borns of positive syphilis mothers. At least eighteen percent of positive syphilis cases took more than one month for confirmation and the turnaround time for eleven percent of the syphilis screening cases out of forty five cases took more than one week. It is also found that there was inconsistency in performing treponemal IgM test where fifty three percent of cases (twenty four cases out of forty five cases) were not tested for treponemal IgM. For the management of neonates, only four new-borns were followed-up and among four new-borns, only one have been followed up according to the guidelines. Recommendations made from the audit includes the improvement of time to confirmation of specimens, changes of confirmation test by using treponemal IgM to all pregnant woman, referral of all pregnant woman with inconclusive syphilis confirmation to Genitourinary Medicine (GUM) clinic and management of new-borns where follow-up should be completed according to the guidelines provided (Vladana et al., 2011). 1.6  Re-audit of Syphilis Screening in Pregnancy A re-audit of syphilis screening in pregnancy at the PAHT was performed to discover if changes made after the first audit recommendations have led to the improvement of services. The re-audit was carried out three years after the first audit done in 2011. The re-audit aimed to ensure that the improvements in laboratory and clinical aspects of management for the antenatal women with positive syphilis screening and their new-born babies were in accordance with the UK National Guidelines on the Management of Syphilis (Kingston et al., 2008) and the Guidelines for the Management of Syphilis in Pregnancy and the Neonatal Period (Stringer et al., 2013). 2.0  METHODOLOGY 2.1  Background The PAHT comprises four major district general hospitals; North Manchester General, Fairfield General Hospital, Rochdale Infirmary and The Royal Oldham. Some 12,000 women annually present for antenatal care. Women usually attend for antenatal care at one of three antenatal clinics or one of several General Practice Clinics within the community. In the UK antenatal infectious disease screening is usually performed at three months gestation (http://www.screening.nhs.uk/). Women are offered screening for rubella immunity, hepatitis B virus infection, human immunodeficiency virus infection and T.pallidum (syphilis) infection. Among 12,000 women screened within the PAHT in the period 1st January 2013 to 31st December 2013, a series of forty nine pregnant woman with positive syphilis serology were identified. To determine whether syphilis screening and follow up care of babies born to these mothers followed the UK Guidelines of the Management of Syphilis (Kingston et al., 2008) and the Gui delines for the Management of Syphilis in Pregnancy and the Neonatal Period (Stringer et al., 2013), a retrospective study was performed. 2.2  Diagnosis of Syphilis Pathway Patients’ blood sample was collected with informed consent at the antenatal clinic and laboratory test requests were made. The patients’ information was recorded in the maternity information system database; â€Å"EuroKing† (Euroking, Chertsey, Surrey, UK). Samples were transported to The Royal Oldham Hospital (TROH) microbiology laboratory via the hospital transport system to be tested. Patient demographic information was recorded in the laboratory data system Clinisys Labcentre (Clinisys, Chertsey, Surrey, UK). If the syphilis screening test was negative, a report was generated and then posted to the antenatal clinics where the sample came from. If the syphilis screening test was positive, the sample was sent to a reference laboratory, Manchester Medical Microbiology Partnership Laboratory at Manchester Royal Infirmary (MRI) for confirmatory testing. Testing at the MRI comprises two treponemal enzyme immunoassay tests for total treponemal antibody; a T.pallidum specific assay (EIA); the T.pallidum particle agglutination assay (TPPA); the reagin precipitin assay (RPR) and where appropriate a T.pallidum specific IgM enzyme immunoassay (IgM) in accordance with national guidelines (Kingston et al., 2008). These results were recorded in the MRI laboratory database system, (Telepath; CSC Healthcare, Banbury, Oxfordshire, UK) and a printed copy of the patient test results was sent back to TROH microbiology laboratory. The reference laboratory report was transcribed onto the Clinisys Labcentre system and a printed report was generated to be to the antenatal clinics. Finally, the patients’ report received by the antenatal clinics was recorded in the patients’ notes and updated in the EuroKing system. 2.3  Data Collection Data collection for the study was accomplished via query of the three databases: the PAHT laboratory database system, Clinisys Labcentre, the MRI database system, Telepath and the maternity information system database, EuroKing. The data gathered including the patients’ hospital number, NHS number and specimen number, date of birth, the date of sample collection and report, and also the syphilis serology data which includes the patients’ treponemal EIA, TPPA, RPR and treponemal IgM results. The sample collection and sample reported data were obtained to investigate the turnaround time taken for the diagnosis within the laboratory. 2.4  Analysis of Data The laboratory system data was presented as Microsoft Excel spreadsheets (Microsoft Corporation, Seattle, USA). All the patients’ data were then imported and assembled in Microsoft Access 2013 (Microsoft Corporation, Seattle, USA). The data for the forty nine pregnant woman with positive syphilis serology were analysed using Microsoft Access 2013 (Microsoft Corporation, Seattle, USA). 2.5  Clinical Audit This was conducted under the Clinical Audit provision of the NHS National Research Ethics Committee (National Research Ethics Service 2008). The work was registered and approved as a Clinical Audit with the Clinical Audit Department of the PAHT. Data analysed was anonymised before release from the Trust to comply with Data Protection Guidelines (Caldicott Committee 1997). The clinical audit used the UK National Guidelines on the Management of Syphilis (Kingston et al., 2008) as a standard. 3.0  RESULTS Fifty positive syphilis serology results were identified from forty nine pregnant woman undergoing routine antenatal infectious disease screening at TROH microbiology laboratory. All specimens were screened with Chemiluminescent Microparticle Immunoassay test using the Abbott Architect Syphilis TP Assay (Abbott Diagnostics, Chicago, USA). The fifty specimens were also sent to the Manchester Medical Microbiology Partnership Laboratory, MRI which acts as a reference laboratory for syphilis serological confirmatory testing. 3.1  Confirmation Methods by MRI The reference laboratory confirms syphilis screening with two treponemal EIAs, a semi-quantitative TPPA, a semi-quantitative RPR, and where appropriate a T.pallidum specific EIA for IgM antibody in accordance with national guidelines (Kingston et al. 2008). The first treponemal EIA test was the same Abbott Architect Syphilis TP Assay (Abbott Diagnostics, Chicago, USA) used at TROH for syphilis serological testing; the second treponemal EIA test used the DiaSorin Liaison XL System (DiaSorin S.p.A, Saluggia, Italy), the semi-quantitative TPPA was the Serodia TPPA Assay (Fujirebio Diagnostics, Inc., Tokyo, Japan), the semi-quantitative RPR was the Abbott Syfacard – RR card test (Abbott Diagnostics, Chicago, USA), and the T.pallidum specific EIA for IgM were run using CAPTIA Syphilis-IgM Assay (Trinity Biotech, Ireland, UK). Where necessary, further testing using T.pallidum specific immunoblotting and/or T.pallidum specific polymerase chain reaction testing are also used in confir mation testing. All specimens were confirmed using treponemal EIA, TPPA and RPR but only about twenty nine specimen out of fifty specimen were tested using treponemal IgM. There were seventeen positive screening with syphilis and thirty three negative screening with syphilis. Negative screening was defined by having negative results for either one or both treponemal EIA, TPPA titres of less than 1:80 and RPR titre of less than 1:2; positive results were defined by having positive results for both treponemal EIAs, a TPPA titre of greater than or equal to 1:160, RPR titre greater than or equal to 1:2 and positive results of treponemal IgM (Table 1). Table 1: Syphilis confirmatory test results for forty nine pregnant woman. Patient numbers with symbol â€Å"*† are pregnant woman with positive syphilis results. Patient Test TEIA1 TEIA2 TPPA RPR IgM EIA InterpretationResult 1 1 Positive Negative Negative Negative Not Done Negative *2 1 Positive Positive 1:640 Negative Not Done Positive 2 Positive Positive 1:320 Negative Negative 3 1 Positive Negative Negative Negative Not Done Negative 4 1 Positive Negative Negative Negative Not Done Negative *5 1 Positive Positive 1:5120 1:64 Not Done Positive 2 Positive Positive 1:5120 1:64 Not Done 3 Positive Positive 1:2560 1:8 Not Done Patient Test TEIA1 TEIA2 TPPA RPR IgM EIA Result 6 1 Positive Negative Negative Negative Negative Negative *7 1 Positive Positive 1:640 Negative Not Done Positive *8 1 Positive Positive 1:1280 Negative Not Done Positive 2 Positive Positive 1:2560 1:1 Not Done 9 1 Negative Negative Negative Negative Not Done Negative 10 1 Positive Negative Negative Negative Negative Negative 11 1 Positive Negative Negative Negative Not Done Negative 2 Positive Negative Negative Negative Not Done *12 1 Positive Positive 1:5120 1:4 Negative Positive 2 Positive Positive 1:5120 1:4 Not Done Patient Test TEIA1 TEIA2 TPPA RPR IgM EIA Interpretation *13 1 Positive Positive 1:640 1:64 Not Done Positive 14 1 Positive Negative Negative Negative Negative Negative 15 1 Positive Negative Negative Negative Not Done Negative 16 1 Positive Negative Negative Negative Not Done Negative 17 1 Positive Negative Negative Negative Negative Negative 18 1 Positive Negative Negative Negative Not Done Negative 2 Positive Negative Negative Negative Not Done *19 1 Positive Positive 1:640 Negative Not Done Positive 2 Positive Positive 1:1280 Negative Not Done 20 1 Positive Negative Negative Negative Not Done Negative Patient Test TEIA1 TEIA2 TPPA RPR IgM EIA Result 21 1 Positive Negative Negative Negative Not Done Negative *22 1 Positive Positive 1:640 1:4 Not Done Positive 2 Positive Positive 1:1280 1:4 Not Done 23 1 Positive Negative Negative Negative Not Done Negative 24 1 Positive Negative Negative Negative Not Done

car accident :: essays research papers

Traumatic events come in many different ways at many different times of ones life. Mine came on the school bus while I was on my way home from school. The bus had stopped to let a couple kids off and I stood up to throw some trash away. I stood up we were rear ended by a young lady who had been trying to get a bee out of the car and not realized the bus had stopped. I was standing up and the impact caused me to bang into the seat in front of me and the one behind me. I didn’t realize what had happened until moments later when someone said something. As I began to sit down I felt a sharp pain shoot through my body and my heart started to beat rapidly.   Ã‚  Ã‚  Ã‚  Ã‚  The accident made me realize that nothing is for certain and you shouldn’t take anything for granted. I had always viewed riding a school bus has something that wouldn’t put me in danger, after all the drivers are trained professionals, right? What I never considered was the actions of others and how complete strangers can change your life in a bigger and more significant way than some of the people closes to you. I had never really considered dying at a young age because my grandparents lived to be old. After that bus ride home my outlook on life was severely changed and I started to appreciate my parents more an tell them I loved them a lot more often because wasn’t sure if we’d both be around to say it the next time.   Ã‚  Ã‚  Ã‚  Ã‚  The car accident will always be a major moment in my life because of what it showed me. That accident gave me visual proof that God has a plan for everyone and everything has a reason or hidden message. Just when I was coming to a point in my life where I was beginning to see where I fit in at school, it reminded me to cherish every moment has though it was my last, because I don’t know when it’ll be over.

Important Events in Contemporary History

INT1010 Contemporary World One Event #1: The Korean War 1950 On June 25th 1950, communist North Korea proceeded to invade western- supported South Korea to unite Korea by force. Significance to contemporary history: Event #2: Malayan Independence 1957 What happened? Significance to contemporary history: Malayan Independence reinforced the ending of colonialism in South East Asia. Also, it signified the ability and right to self-rule for previously colonized states. Following independence, Malaya’s tin and rubber export also gave a significant boost to the US dollar. Event #3: The formation of the Berlin Wall 1961 What happened? In August 1961, a physical partition of between East and West Germany was put in place in Berlin under the command of President Khrushchev. Significance on contemporary history: The Berlin Wall symbolized the acceptance of the status quo in Europe by both sides. The most significant aspect of the Berlin Wall is arguably the fact that it clarified worldwide the difference between the two superpowers and their varying political system. The Berlin Wall went on to become the symbol of the ultimate measure of inadequacy of communism. Event #4: The Cuban Missile Crisis 1962 Significance to contemporary history: The Cuban Missile Crisis marks the first and only time the world has come close to a nuclear war. As a result, both The Soviet Union and The United States worked towards improving their communication and easing tensions, which led to the creation of a ‘hot-line’ between American and Soviet capitals. However, both parties also continued the development of their nuclear weapons, which resulted in a world of mutually assured destruction (MAD). Event #5: Islamic Revolution In Iran (also known as the Iranian Revolution) 1979 What happened? Significance in contemporary history: The revolution brought much attention to Islam and interest in the concept â€Å"neither East nor West† that is, not American or Soviet policies. The newly Islamic republic also called for the overthrow of or other monarchies and the replacement of them with Islamic leaders. Internally, the revolution gave rise to the improvement of healthcare and education while also, eliminating secularism and the American influence in the government. Bibliography Timon Singh, ‘The Construction of The Berlin Wall’, 2009, http://www. euinfrastructure. com/news/construction-of-the-berlin-wall/, accessed 23 March 2010 Anthony Best, International History of the Twentieth Century and Beyond, Oxon 2004, p240-242, 250-253, 463-466.

Human Nature Is Good, And Being A Beast - 1165 Words

Thomas Hobbes was an English philosopher, and the author of Leviathan. Hobbes declared that human life was â€Å"solitary, poor, nasty, brutish, and short†(Hobbes, 107). Hobbes felt that the natural state of man was beast-like, and savage. Thus, he felt that it is civilization that influences and challenges humanity from our fundamental wickedness. Within his view, human nature is dangerous; which can only be rescued through culture and community. According to Hobbes, being â€Å"civilized† is good, and being a â€Å"beast† is not accepted. Contrast this with the view of Jean-Jacques Rousseau. Rousseau was an Enlightenment philosopher, and wrote The Social Contract which heavily influenced the French Revolution: â€Å"Man is born free, and yet we see him everywhere in chains†(Rousseau, 5). He declared that humans in previous times were â€Å"noble savages†. That humans are ultimately naturally good, and it is â€Å"civilization† that turns hu man-kind into a savage beast. Thus, Rousseau argued that present-day humans should seek to restore the natural conditions in which they were created to live a more natural life. Both theorists argue the origins of power, each with their own arguments. To begin with, Hobbes’ and Rousseau’s views differ from each other in terms of the natural origin and state of mankind. Hobbes’ theory is largely based on the idea of â€Å"individualism†: that society can be explained by examining the individuals who form it. Consequently, Hobbes claimed that all humans are ultimatelyShow MoreRelatedInner Evil in Lord of the Flies by William Golding Essay620 Words   |  3 Pagesthey fear more than the beast. The beast is not a tangible object that can be killed or destroyed by conventional means, but an idea symbolizing the primal savage instincts within all people. 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How does William Golding use it in such a simple story of English boys to precisely illustrate how truly destructive humans can be? Golding was in World War Two, he saw how destructive hu mans can be first hand, and how ‘normal’ people can turn into savages. In the book Lord of the Flies by William Golding, Golding uses the theme of human nature to show how easily society can fall, and how self-destructive human nature is towards itself. Throughout the story there are recurringRead MoreHuman Nature In Lord Of The Flies Essay1230 Words   |  5 PagesHuman nature is the â€Å"general psychological characteristics, feelings, and behavioral traits of humankind†. Between the Book, Lord of the flies and The Crucible, human nature is strongly portrayed through similar characters such as Simon and Mary Warren, Satan/Devil and the Beast, and Jack and Abigail. 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Effect Of Raising Minimum Wage - 1215 Words

Effects of Raising Minimum Wage The minimum wage in this country has been a controversial issue. Many people believe it will help reduce poverty and boost the economy. However, they are not looking at the downfalls this will bring to our country. This could make the unemployment population rise, it will raise prices of other things, and would have little effect on reducing poverty. Raising the minimum wage would have a negative influence on our country. This movement throughout our country is being put into effect as we speak. This movement is for all fast food chains and small businesses to raise the prices of minimum wage. Sixteen states have already agreed to raise the prices of minimum wage in 2016. These states include: Alaska, Arkansas, California, Colorado, Connecticut, Hawaii, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New York, Rhode Island, South Dakota, Vermont, and West Virginia. An article on the states raising minimum wage from CNBC says, â€Å"These wage increases range from 5 cents an hour in South Dakota to a dollar in California, Massachusetts and Nebraska.† However, it will not stop here. These groups that are pushing for raises in minimum wage are asking for fifteen dollars an hour. These campaigners call their movement the â€Å"fight for 15.† As Christine Owens, executive director of the National Employment Law Project said, We ve seen incredible momentum this past year in the fight to raise wages to a level that will make a meaningful differenceShow MoreRelatedEffect Of Raising Minimum Wage1215 Words   |  5 PagesEffects of Raising Minimum Wage The minimum wage in this country has been a controversial issue. Many people believe it will help reduce poverty and boost the economy. However, they are not looking at the downfalls this will bring to our country. 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What are the negative impacts on the rest of the working classRead MoreThe Effects Of Raising The Minimum Wage1944 Words   |  8 Pages At one point or another, minimum wage is a term that most American people will familiarize themselves with. The topic of minimum wage can sometimes be a particularly controversial one, so it is important that we understand the true effects that this has on our nation’s economy. Before the fall of our economy and the increase in prices of everyday necessities, such as monthly bills, groceries and gasoline, a family could have found it easier to survive off o f this wage; however, as the prices continueRead MoreThe Positive and Negative Effects of Raising Minimum Wage805 Words   |  4 Pagessensitive topic for many Americans is their income. Many people’s income relies on minimum wage. In 2012, 3.6 million people received an hourly pay at or below minimum wage. There is an ongoing debate in government as to what the minimum wage should be. Stuck at $7.25, Obama has suggested raising the minimum wage to $9.00. Depending on a person’s perspective, raising minimum wage could be positive or negative. Minimum wage has the ability to change lives, and change the economy. Small businesses and unemploymentRead More The Negative Effects of Raising the Minimum Wage Essay1552 Words   |  7 PagesIf we took away the minimum wage, we could wipe out unemployment completely because we would be able to offer jobs at every possible skill level. -- Michele Bachmann Proponents of raising the minimum wage claim that if the minimum wage was raised, then many economic and social problems would be alleviated. This contention is at odds both with economic principles and years of creditable research. The effect of raising or even having a minimum wage has been studied extensively and theRead MoreThe Effects Of Raising Minimum Wage On The United States2322 Words   |  10 PagesThe Effects of Raising Minimum Wage My topic of interest is the effects of raising minimum wage in the U.S. Minimum wage is defined as the lowest wage permitted by law or by special agreement. In 1938, President Roosevelt signed a bill called the Fair Labor Standards Act of 1938, which set the minimum wage at $0.25. Although, overtime inflation devalued the amount of the dollar so it was raised there on. After raising the minimum wage the cost of living would keep going up every year. Also, currentlyRead MoreThe Effects Of Raising Minimum Wage On The United States969 Words   |  4 PagesEffects of Raising Minimum Wage Raising minimum wage has in the recent years become a very controversial and personal issue, and although it is slowly becoming a more popular idea, some people still resist the movement. What people who oppose the adjustment of minimum wage are not considering, is that by raising minimum wage, it will allow low income families or otherwise low income individuals to earn more, in turn, allowing them to spend more money on goods and services. It will also help theRead MoreThe Effects of Raising the Minimum Wage on US Economy1507 Words   |  6 Pagesyear, the minimum wage has been increasing from less than a dollar to $7.25 now. The question that comes to everybody is that should we increase the minimum wage by too far. Does the minimum wage increase reduce the unemployment since now the current wage is high enough? Some people might think that we should increase the minimum wage in order to increase the labor supply. However, if we think deeply than this, there are more disadvantag es than advantages of increasing the minimum wage. The fartherRead MoreRaising the Minimum Wage: A Counter-Intuitive Solution Essay753 Words   |  4 PagesWhile some believe that raising the minimum wage will resolve poverty issues and lack of pay with the signing of legislation, the raising of the minimum wage to $10.10 an hour (as advocated by President Obama and the Democrats) would cause the poverty issue to be worse than it already is; inflation would occur, employees would be laid off, and minimum wage employees would lose welfare benefits, thus offsetting the wage increase. The Government should consider the effects on the American economy asRead MoreMinimum Wage And The Wage Essay1204 Words   |  5 PagesThe minimum wage is one of the most controversial issues on our country, which is United States has been facing last ten years. There have been never ending debates over this issue until the government, company, and others party stand together, and raise the minimum wage throughout the nations. There are communities that believe raise the minimum wage has negative impact of every sector of the country. Other communities have different beliefs over the issue, raising the minimum wage helps the poor

Macbeth Character Analysis - 1140 Words

Macbeth Thane of Glamis and Cawdor General in the King’s army Physical description and traits: Macbeth is ambitious, as well as superstitious, he is known for his military prowess, boldness and bravery. He is peerless, affectionate, loyal, dominant in imposing stern terms upon he vanquished. He is hubris, as well as an opportunist. He has a conscience, which hinders him at first in securing the crown. Role in Play: Macbeth is the protagonist, he is also the tragic hero. Role in the Plot: Macbeth plays the role of an ambitious character that murders Duncan in order to secure the crown, during the play, he fluctuates between murderous fevered action and moments of terrible guilt. Lady Macbeth Physical†¦show more content†¦Like Duncan, he represents divine right to the crown. He shows gratitude, wisdom, moderation, religiousness, and resolution. Role in Story: Malcolm is the antagonist, his return to the thrown symbolizes restoration of order following Macbeth’s reign of terror. Role in Plot: He is another person that Macbeth has to fight in order to secure the thrown. Donalbain Younger son of Duncan Physical description and traits: Role in Play: Role in Plot: Like Malcolm, Donalbain is another person Macbeth would have to step over to keep the crown. Lennox Scottish Nobleman Physical description and traits: Lennox is very observant, he is suspicious, sarcastic, fearful, and courageous. Role in Play: Lennox has the gift of irony, regarded as having a shrewd mind, for he early suspects Macbeth. Role in Plot: Exposes Macbeth. Ross Scottish Nobleman Macbeth’s cousin Physical descriptions and traits: Neutral and colorless. Role in Play: Herald and messenger Role in Plot: Brought good news about Macbeth’s military victory, and bad news about Macduff’s family, causing Macduff to avenge his family. Siward Earl of Northumberland General in English forces Physical description and traits: likable, brave, soldier. Role in Play: Antagonist, Ally of Macduff and Malcolm Role in Plot: He isShow MoreRelatedMacbeth s Character Analysis : Macbeth1086 Words   |  5 PagesMacbeth s Character Analysis Shakespeare presents Macbeth as a noble thane of King Duncan in the beginning of the play. The three witches tell Macbeth he will become King of Scotland; his desire and ambition to become king causes him to suffer. Macbeth’s greed causes his change in character, and this is revealed by what he says, what he does, and what others say about him. Macbeth’s changes are revealed through what he says. Thomas Thrasher said, â€Å"Macbeth is a noble character of flawless moralsRead More Macbeth: Character Analysis Of Macbeth Essay1040 Words   |  5 Pages Macbeth: Character Analysis of Macbeth nbsp;nbsp;nbsp;nbsp;nbsp;Macbeth was a true Shakespearean tragic hero. He had many noble qualities as well as several tragic flaws. He was a courageous, brave and good nobleman who was haunted by superstition, moral cowardice and an overwhelming ambition. Progressively through the play, his flaws started consuming his qualities until they are that can be seen of him. nbsp;nbsp;nbsp;nbsp;nbsp;Macbeth was a courageous and strong nobleman. He and BanquoRead MoreEssay Macbeth Character Analysis577 Words   |  3 Pages Character Analysis nbsp;nbsp;nbsp;nbsp;nbsp;In the tragedy Macbeth, written by William Shakespeare, many character traits are portrayed through the various characters throughout the play. Macbeth was one of Shakespeareamp;#8217;s greatest tragedies. It was completed in 1606 and was most likely first performed before King James I and his royal family at Hampton Court. King James I is believed to be a direct descendent of the character Banquo. Probably the most potent character trait expressedRead MoreLady Macbeth Character Analysis1057 Words   |  5 PagesLady Macbeth: If we look at the stage time Lady Macbeth’s character gets throughout the play, we cannot be consider her to be marginalised. Appearing in about 10 scenes, she has a great number of powerful, memorable monologues and is for all intents and purposes, the female protagonist. It is however the changes her character goes through that classifes her as marginalised. Her character is the one undergoing the greatest transformation. She begins the play with full strength and a dominating personalityRead MoreMacbeth Character Analysis964 Words   |  4 Pages In the Shakespearean play ‘Macbeth’, the title character and his wife Lady Macbeth become the victims of the destructive force that is evil. Although the two characters shelter a sinister persona, Macbeth is less virtuous, demonstrating his villainous qualities conspicuously due to the crimes he committed that Lady Macbeth did not instigate. However, it is evident that Lady Macbeth, intertwined with other outside factors, was the primary motivation for Macbeth’s immoral inclinations, as she is viewedRead MoreMacbeth Character Analysis1102 Words   |  5 Pagestough doesn’t make you mentally strong, in the play Macbeth, there is a huge theme of manhood placed throughout. William Shakespeare is the creator of Macbeth and is a genius for placing the theme in this tragedy play. The main character, Macbeth, struggle to find his manhood. Banquo , Macbeth’s best friend, is a true man, as well as a character with the name of Macduff. In acts one through fo ur of Shakespeare’s play Macbeth, Banquo, as well as Macbeth and Macduff, will show or try to prove their manhoodRead MoreMacbeth Character Analysis928 Words   |  4 PagesA story is only as good as the characters within them, and in the case of William Shakespeare’s play Macbeth, countless individuals are used to progress the tragedy of the disaster that is Macbeth. Lady Macbeth assists in her husband’s inevitable demise by initially providing the reprehensible plan to murder Duncan, and by lowering her husband’s confidence with criticism. Early on in Shakespeare’s play, Macbeth receives a mysterious message from three witches, promising his title as Thane of CawdorRead MoreMacbeth Character Analysis747 Words   |  3 Pageshalf by supernatural force and half by your own action, because sometimes people can make their decisions and that will affect their destiny. In â€Å"Sports Genes†, â€Å"Into the Wild†, and â€Å"Macbeth†, the main characters all made their own choice but there were still outside forces that effected their decisions. In â€Å"Macbeth† although he made his own decisions of doing all the bad things he is doing, but the witches are the ones who affected his decisions and made him do all the things. In â€Å"Sports Genes†Read MoreCharacter Analysis Of Macbeth1120 Words   |  5 PagesThe tragic poem of Macbeth is filled with challenges against the accepted societal norms. Macbeth was a normal man whose greed and ambition had led him to murder the king for th e throne. Shakespeare often displays conflicts through characters internal battle with themselves, contemplating whether to make decisions that could alter societys view on them. One of the most significant examples of this is through the unfortunate Macbeth, who had violently forced his way into the throne. This path thatRead MoreMacbeth Character Analysis953 Words   |  4 Pagescan affect you in the long run and can easily contribute to a downfall. Macbeth was fully aware of the choices he made with the inhumane torture and disrespect he had on the citizens of Scotland. Being a tragic hero is when one experiences an immense tragedy which leads to a downfall, but Macbeth never had a tragedy because his death originated from the choices he made and reactions he had while he had authority as king. Macbeth being selfish and only caring about himself creates an undeserving and

Peace essay free essay sample

OAt least three (probably more) properly cited quotes from the (each) novel. 0 Accurate and insightful analysis of the novel. 0 Generally correct grammar and mechanics. Suggested essay topics Essay option #1 : John Knowles book A Separate Peace is the story of Gene Forresters oming of age. Using the events of the book, trace the Journey by which Gene is transformed from an unconfident, fearful, angry teenager to a grown up who has managed to successfully deal with these negative feelings and to live a life of inner peace and harmony. Since the object of this essay is to show how Gene gets from POINT A to POINT B, you need to decide upon the stages or steps of development which make up his Journey and what he eventually learns by the end of the novel. It is imperative that telling quotes and analysis from the books final chapter is used to llustrate the final stage of his growth. We will write a custom essay sample on Peace essay or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Essay option #2: Using the scenes and events from the novel, compare the personalities, characteristics, and motivations of both Gene and Finny. Explore how lay out general ideas about both characters and which one is better suited to be successful in this world and why. You will support your thesis by selecting specific examples of each characters behavior and then discussing whether that behavior is typical or uncharacteristic of human beings in general. Your essay will include analysis of BOTH characters actions and motivations. Honors option #1: By focusing on the major conflicts in both A Separate Peace and The Kite Runner, write an essay that compares the two novels and what their central message is. You will support your thesis by selecting specific examples from both novels and then discussing which novel presents the most accurate representation of true human nature. Your essay must include sufficient analysis of both novels. Since you are comparing the novels, you need to craft a thesis that explores subtle or significant similarities or differences in the stories. Honors option #2: Both A Separate Peace and The Kite Runner tell the story of a arrator who struggles to come to grips with the guilt over his role in a traumatic event from his childhood. Using the events from both books, draw parallels between the coming of age Journey undertaken by the main characters. Since the object of this essay is to show how both narrators get from POINT A to POINT B, you need to decide upon the stages or steps of development which make up their Journeys and what they eventually learn. It is imperative that you use telling quotes and analysis from the books final chapters are used to illustrate the final stage of growth.