Assess the representation of women in eighteenth-century literature Essay

Assess the representation of women in eighteenth-century literature - Essay Example We might take issue with this, but it is easy to see why the novel has been such a keen topic for feminist criticism. In Sense and Sensibility, Austen draws on her own experiences as a young woman to understand the position of women deprived of economic means. It is of course notable that Austen was herself a rarity at the time – an independent female writer, and Sense and Sensibility, her first published novel, was originally published under the pseudonym, ‘A Lady’. Defoe’s Moll Flanders, like several of his other novels, is presented in the form of an autobiography. The character, in this case Moll, is looking back on her life and, as Pollak suggests, is ‘attempting to make sense of it through the act of writing’ (p.139). There is some question over the position of Defoe in presenting the immorality and deprivation of Moll’s past life. Through writing, is he attempting to discourage such immorality by exposing it to the light of day an d public criticism, or is he taking advantage of the excitement readers feel for the forbidden, the lowlife, and the illicit. The latter is surely the case to some extent. There is even some question as to the sincerity of Moll’s conversion from immorality. Defoe writes that she is no longer ‘so extraordinary a Penitent, as she was at first’ (p.5). ... a tool to make the story appear more genuine and authentic for readers, it is possible that Defoe is leaving room for doubt as to his own opinions on women and the position they are given in the society of his novels. As Pollak writes, this ploy ‘works subtly and perhaps surprisingly to unsettle the very truths about gender that his plots seem to affirm’ (p.141). At this juncture, it is worth recalling the terms in which Defoe, writing as the editor of Moll’s racy account, describes the severe difficulty faced in his task. He has had â€Å"no little difficult to put it [Moll’s account] into a Dress fit to be seen, and to make it speak language fit to be read. When a Woman debauch’d from her Youth, nay, even being the Off-spring of Debauchery and Vice, comes to give an Account of all her vicious Practices...an Author must be hard put to wrap it up so clean’ (p.1). There is an air here of Moll being a fallen woman, and being tainted by all that she has engaged in. In this comment by the editor, there is an even a sense of his distaste at handling such material. However, as noted above, at many points Defoe continues to be ambiguous about his own opinion of Moll and her failings. We are left with the fundamental question: is she an immoral soul, or a woman forced by the circumstances of her gender to stoop to low acts in order to seek independence. Defoe adopts a similarly ambiguous position in his presentation of the prescribed roles for women in contemporary society. Moll recounts, in the course of her account, being mocked as a child for believing that she could one day become a gentlewoman by working for an honest livelihood. In this instance, we must ask, as does Pollak, ‘Is the older, more experienced Moll simply exposing her earlier childish ignorance

The traditional role for soldiers in Elizabethan times Essay Example for Free

The traditional role for soldiers in Elizabethan times Essay The traditional role for soldiers in Elizabethan times was as a hero, very brave and fighting for the country. Black characters were normally seen as slaves and not important people. I agree with the title that Shakespeare has inverted these roles in Othello. I am going to study the two characters Iago and Othello. Iago plays a soldier who hates Othello and causes a lot of trouble. Othello is a black General who thinks that Iago is his loyal friend. In Iago Shakespeare has turned the idea of soldiers being brave, heroic and fighting for ones country to a villain who only looking out himself and has no sense of loyalty. Othello is different to traditional Black roles because he is seen as a powerful soldier who is sophisticated and respected instead of savage and low in society. Iagos philosophy is contrary to how soldiers are expected to behave. He is not following Othello out of loyalty In following him, I follow but myself. This shows he is only following Othello for personal gain, whereas soldiers are expected to fight for country and leaders. This would have intrigued the audience and given them something new that they werent used to. Unlike the traditional image of black characters in Elizabethan plays Othello is portrayed as sophisticated and important. When he is accused of witchcraft and corrupting Desdemona by Brabantio he stays calm and controlled handling the situation in a civilized manner, convincing Brabantio that maybe it is not a bad marriage after all. When Othello is talking to Brabantio he recounts the times he has told him tales from his life of being taken by the insolent foe and sold to slavery; of my redemption thence and portance in my travellers history this shows us that he has been through a lot so is worldly and experienced. His redemption shows us he is not a pagan as Brabantio described him. This would fascinate the audience who normally saw black characters in a very different light, and would shock them to see a black person in such a place of power. The impression we get of Iago as he persuades Othello is that he is very manipulative and cunning. He thought out his plan, scheming, almost like he playing a game of chess as each part of his plan falls into place. Iago knows that Othello is a bit insecure in his position so he uses flattery to get his trust. My Lord you know I love you. This makes Othello feel more secure. The way that Iago uses the things he knows about people shows us he is the one in control making things happen, as if he is the puppet master and all the other characters are just his puppets. Iago twists the story of how Desdemona and Othello she did deceive her father marrying you to make Desdemona look bad and untrustworthy. The audience like Iago because he is the one in control who makes everything happen. Without him the play would seem duller. He charms us with his cleverness and the way he speaks to the audience also makes them feel more like his friend. Soldiers were meant to be seen as people who follow the order of command instead of being the ones in control; Iago is the opposite of this. As Iago persuades Othello our opinion of him disintegrates and he starts to fit the traditionally weak character black people were given. His language becomes fragmented and disjointed No, not much moved: I do not think but Desdemonas honest. Not keeping the control he seemed to have at the beginning of the play. We can see that Iago has significantly influenced Othello as Othello takes on Iagos animalistic language I had rather be a toad and misogynistic terms impudent strumpet. Not only has he lost his controlled measured tone he also get to the point where he losses physical control and goes into a trance or fit. Othello takes on the villainous aspect of the traditional black role by the way he treats Desdemona Desdemona My Lord Othello I am glad to see you mad Desdemona why sweet Othello? Othello Divel. This shows us his darker side, as he is unforgiving and harsh even when she is crying. At the end of the play when Othello realises that Iago has tricked him he does regain some of the nobility he had in the beginning of the play. His speech returns to the eloquent and structured way he talked before although he still uses the animalistic tones he picked up from Iago as he describes himself as a circumcised dog. He is still insecure about how people see him so he explains of one who loved not too wisely but too well romanticising the fact that he has killed his wife which makes the audience feel sorry for him. He feels remorse and kills himself which makes it seem like a more valiant death instead acting like the savage villains black roles were normally given. Iago is the only one left at the end of the play alive that knows the whole story and what went on. He retains control by swearing not to speak leaving the other characters not knowing exactly what went on giving us an enigmatic ending. This shows us how very strong willed he is, as he has not changed but instead suspends our impression of him. I agree that Shakespeare inverts the traditional roles given to soldiers and black characters but I dont think that it is as straightforward as that. At the beginning of the play Othello is not very much like traditional black characters but as the play progresses we see him start to fit into that role more although he does redeem himself somewhat in the end. Iago shows no redeeming qualities that a soldier should have and is only working for his best interests right up until the end of the play. When Shakespeare wrote the play what was he trying to say? What he shows in this play is that on the outside a black character who is the leader of a white soldier, but looking deeper, we see that it is still the white person in control using Othello, exploiting him and eventually making him lose his life. Even when the black person is given power the white person is the one in control and it all ends tragically. Maybe in a society in which black people were not given many opportunities he was trying to justify this fact. Or maybe Shakespeare was just being a playwright trying to pull in large audiences by writing about sex, violence, exotic black characters and unconventional soldiers.

Comparison of Beta Blockers Use

Comparison of Beta Blockers Use 1.1 Background Beta-blockers are a medication used to treat high blood pressure and heart problems. They are used by millions of people around the world everyday. In 2004, they were the fifth most widely prescribed class of medicine. Beta-blockers are effective, life-saving medicines with more than 25 years of widespread and generally safe use. There are fourteen beta-blockers are currently available. These included Acebutolol, Atenolol, Betaxolol, Bisoprolol, Carvedilol, Esmolol, Labetalol, Metoprolol, Nadolol, Penbutolol, Pindolol, Propranolol, and Timolol. Beta-blockers are just one class of prescription medicine used to treat high blood pressure and heart disease. Four other classes are commonly used to treat high blood pressure, for example. These include the diuretics, calcium channel blockers, ACE inhibitors, and angiotensin-receptor blockers. These four plus beta blockers are often used in combination, two or more at a time. Indeed, many people with high blood pressure will require two or more high blood pressure medicines to bring their blood pressure down to a normal and healthy range. Although they are used primarily to treat people with high blood pressure, they are also used to treat other heart conditions. These include angina (heart or chest pain), abnormal heart rhythms, coronary artery blockages, and heart failure. They are also used, along with other treatments, to help prevent repeat heart attacks in people who have already had one, to prevent migraine headaches, and to treat performance or stage-fright anxiety. High blood pressure is one of the most significantly and persistently under-diagnosed and under-treated medical conditions. It raises your risk of heart disease, heart attack, heart failure, stroke, dementia, vision loss, and kidney failure. In most who have high blood pressure, it is a lifelong condition. Yet studies show that only 30% of people with high blood pressure getting the medicines, care, and blood pressure control they need. Uncontrolled high blood pressure is a leading cause of death. Because it has no symptoms and often goes undetected, high blood pressure is often called the nations leading silent killer. Beta-blockers work by blocking adrenaline in the heart and blood vessels. Adrenaline speeds up the heart rate, makes the heart muscle contract more strongly, and constricts arteries throughout the body. All these raise blood pressure. In blocking adrenaline, beta-blockers slow down the heart and reduce its workload. That helps to decrease blood pressure. Choosing a beta-blocker, and its dose, depends on what people need it for. Studies show that some beta blockers are more effective and safer than others for certain conditions. People respond to the various beta-blockers differently. There are important differences in how the various beta-blockers work that will affect the use of them. In effect, beta blockers differ in the type of beta receptors they block (ÃŽÂ ²1, ÃŽÂ ²2, and ÃŽÂ ±) and, therefore, their effects. Non-selective beta blockers, for example, propranolol, block ÃŽÂ ²1 and ÃŽÂ ²2 receptors and, therefore, affect the heart, blood vessels, and air passages. Selective beta blockers, for example, metoprolol primarily block ÃŽÂ ²1 receptors and, therefore, mostly affect the heart and do not affect air passages. Labetalol and carvedilol block beta and alpha-1 receptors. Blocking alpha receptors adds to the blood vessel dilating effect of labetalol and carvedilol. Beta-blockers are generally safe medicines. They have not been shown to cause any serious long-term or irreversible negative consequences, even after many years of use. But side effects are common among people taking beta-blockers. The majority of people can expect to experience at least one. These include fatigue or drowsiness, dizziness or lightheadedness, slow heartbeat, low blood pressure, difficulty breathing, numbness, tinkling or coldness of fingers, toes or skin, weight gain, mental depression, disturbing dreams, reduced libido, erectile dysfunction in men, or ability to reach orgasm in both men and women. Most side effects can be avoided or minimized by starting with a low dose and increasing it gradually. Also, some of these adverse effects go away or diminish in time, after body gets used to the drug. Overall, the strongest evidence on beta-blockers links them to a lower risk of repeat heart attack and early death in the aftermath of a heart attack. More than 60 studies have examined this, and all have found a marked benefit for the pills. There is also compelling evidence that some beta blockers lower the risk of death in people with heart failure, preventing 3.8 deaths per 100 patients in the first year of treatment. Therefore, everyone who has had a heart attack should be taking a beta-blocker. Below are the list of beta-blockers that use in Klinik Kesihatan Greentown: No:  1. Generic Name:  Atenolol Trade Name:  TENORMIN ® Dosage Form:  Tablet Strength:  100mg No:  2. Generic Name:  Bisoprolol Trade Name:  CONCOR ® Dosage Form:  Tablet Strength:  2.5mg , 5mg No:  3. Generic Name:  Carvedilol Trade Name:  DILATREND ®, CASLOT ® Dosage Form:  Tablet Strength:  6.25mg , 25mg No:  4. Generic Name:  Labetalol Trade Name:  TRANDATE ® Dosage Form:  Tablet Strength:  100mg No:  5. Generic Name:  Metoprolol Trade Name:  BETALOC ® Dosage Form:  Tablet Strength:  100mg No:  6. Generic Name:  Propranolol Trade Name:  INDERAL ® Dosage Form:  Tablet Strength:  40mg 1.2 Objectives 1.2.1 To list down types of beta-blockers in Klinik Kesihatan Greentown. 1.2.2 To analyze the usage of each beta-blockers in Kinik Kesihatan Greentown. 1.2.3 To compare the most commonly used beta-blockers in Klinik Kesihatan  Greentown based on the results. CHAPTER 2:  LITERATURE REVIEW From the past, beta blockers is widely use for the treatment of hypertension besides treatment such as stable and unstable angina, arrhythmias, bleeding esophageal varices, coronary artery disease, asymptomatic and symptomatic heart failure, hypertension migraine, and secondary prevention post-myocardial infarction (Mark Helfand, MD, et al., 2007). Although some study shows that beta-blockers are not first-line drugs in the treatment of hypertension (Wiysonge CS, et al., 2007) but when initiating a beta-blocker, it is proven to be as effective and safe as initiating an ACE-inhibitor first (Ferenc Follath, 2006). Besides, beta blockers provide similar clinical outcomes and are associated with fewer adverse events than calcium antagonists in randomized trials of patients who have stable angina. (Paul A. Heidenreich, MD, et.al., 1999) There is also evidence that suggest B-blockers are useful in managing angina and reducing mortality after myocardial infarction and in heart failure (H T Ong, consultant cardiologist, 2007) but beta blockers appear to be less effective when used as monotherapy in black hypertensives (Walter Flamenbaum, MD, 1985). Additionally, beta-blockers may be considered as a first-line option in women of child-bearing potential because of concern about foetal renal maldevelopment with ACE inhibitors or angiotensin receptor blockers (British Hypertension Society, 2008). When starting beta blockers, it should be started at the lowest dose, with the dose increased every two to four weeks until the target dose or highest tolerated dose is reached because beta-blockers showed little evidence of useful antiarrhythmic action in the dosage used (J M Roland, et.al., 1979). It also should reconsider in the treatment of hypertension since doses smaller than those recommended are almost as effective and much cheaper. (A K Scott, et al., 1982) On the other side, when beta blocker treatment given as secondary prophylaxis after myocardial infarction it is highly cost effective (G Olsson, L A Levin, N Rehnqvist, 1987). Among all the beta-blockers, atenolol had the most widely used in Klinik Kesihatan Greentown because study proven atenolol is more effective than placebo in lowering blood pressure but does not appear to reduce the rates of cardiovascular morbidity or mortality (Carlberg B., et al., 2004). One of the studies also shown that the use of atenolol (started 72 h before operation) is effective in reducing the incidence of supraventricular arrhythmias following elective coronary artery bypass operations in patients with good left ventricular function (R. K. Lamb, et al., 1988). When compare between atenolol versus nifedipine versus the combination, atenolol was slightly better than nifedipine on exercise time, but the combination was slightly better for decreasing the number of attacks (El-Tamimi, H. Davies, G.J., 1992). Anyway, atenolol should be avoided in the early stages of pregnancy and given with caution at the later stages, as it is associated with fetal growth retardation, which is related to duration of treatment. (Lydakis C., et al., 1999) Metoprolol, which shows the second higher usage in Klinik Kesihatan Greentown, is an effective drug for treatment of stable exercise-induced angina pectoris (Arnman K Rydà ©n L. 1993) where metoprolol also can reduce total mortality, sudden death, and death due to progressive heart failure and improved quality of life (Mark Helfand, MD, et al., 2007). There is also a study about 62 patients taking metoprolol 100 mg twice daily, nifedipine 10 mg three times daily and the combination in a randomised double blind crossover study, metoprolol was better than nifedipine; the combination was better again (Uusitalo, A, et.al, 1986). On the other side, both carvedilol and metoprolol also showed parallel beneficial effects on symptoms, exercise, ejection fraction, and oxidative stress in heart failure (Marrick L. Kukin, MD, et. al, 1999). Treatment with metoprolol will resulted in lower all-cause mortality than treatment with a thiazide diuretic (Mark Helfand, MD, et al., 2007) but metoprolol did not benefit mortality or ischemic events in a longer-term (Mark Helfand, MD, et al., 2007). Although carvedilol and immediate release metoprolol had similar effects on quality of life, but metoprolol improved exercise capacity more (Mark Helfand, MD, et al., 2007). Yet, the chronic use of the more selective beta-1 selective blockers such as atenolol and metaprotenol has been shown in several studies to not significantly increase asthma or worsen pulmonary function (J Respir, 2003). Among all the beta blockers, labetalol is among the physicians choice because the efficient hypotensive action, together with apparent freedom from maternal and fetal side-effects, and consequent improved perinatal mortality, suggest that it is a suitable drug for use in pregnancy complicated by hypertension (C A Michael, 1979). Besides, labetalol appears to be better able to prevent the appearance of fetal growth retardation compare to atenolol (Lardoux H, et al., 1983). The most significant effect is when comparing side-effect liabilities, it is clear that quantitatively labetalol produces no greater burden of side-effects than drugs of the ÃŽÂ ²-adrenoceptor-blocking group (B. N. C. Prichard D. A. Richards 1982). It also may be considered relatively safer then pure non-selective beta-adrenoceptor blocking drugs in patients with airways obstruction (S H Jackson D G Beevers 1983). Among the incidence of side-effects, was similar with atenolol, metoprolol and pindolol but was slightly less with labetalol (J J McNeil W J Louis 1979). Of all this reason, labetalol become one f the common prescribe drug for pregnant women. For the next drug, propranolol, it should be used with care in patients with known vascular disease (P D McSorley D J Warren 1978). Carvedilol which is other beta blockers has a powerful antiarrhythmic effect, where a study shows after AMI, even in patients already treated with an ACE inhibitor, carvedilol suppresses atrial as well as ventricular arrhythmias in these patients (McMurray, J., et al., 2005). It also may adversely affect recovery from severe hemorrhagic shock (Taniguchi T., et al., 2009). Next, carvedilol is the only beta blocker shown to reduce mortality in post-MI patients who are already taking an ACE inhibitor (Mark Helfand, MD, et al., 2007). In one of the study also shown that administering carvedilol in addition to conventional therapy reduces mortality and attenuates myocardial remodelling in patients with left ventricular dysfunction following acute MI. Mortality was significantly lower with carvedilol than with metoprolol in patients with mild to severe CHF, suggesting that carvedilol may be the preferred beta-blocker (Keating GM Jarvis B. 2003). However, patients with CHF and asthma tolerated carvedilol poorly and because of that asthma still remain a contraindication to beta-blockade (Kotlyar E, et al., 2002). For bisoprolol, neither dose of bisoprolol showed any obvious influence on reducing attack duration or severity (Mark Helfand, MD, et al., 2007). CHAPTER 3:  METHODOLOGY 3.1 Study Design A case control study is conducted from 1st Mac 2009 till 8th May 2009. We will identify the usage of Beta Blocker drugs in Klinik Kesihatan Greentown. Inclusion criteria for this study are based on the date noted on the cupon. Exclusion criteria is the date for the part supply prescriptions which we will take the last date the patient comes to collect the their medication. A total of 3 months prescription (October 2008 till December 2008) will be taken to be analyzed. Comparison between all beta blockers is then done when all data has been analyzed. 3.2 Data Collection Each month of prescription is divided among us group members to evaluate and count the frequency usage of those Beta Blocker drugs. Time that given to finished the evaluation of the prescription is 1 month from the date the prescription is given. The Beta Blocker drugs that has be taken count for this study is between Metoprolol Tartrate, Atenolol, Carvedilol, Propanolol HCL, Bisoprolol Fumarate, and Labetolol HCL. 3.3 Statistical Methods/Data Analysis Data has been analysis using Microsoft Excel which the results is shown through bar and pai chart. 3.4 Ethical Consideration Permission to conduct this study is obtained from the chief pharmacist and our local preceptor of Hospital Raja Permaisuri Bainun and Klinik Kesihatan Greentown. CHAPTER 4:  RESULTS Graph 1 show the total usage of each type of Beta-blockers used in October 2008 at Klinik Kesihatan Greentown. From the graph, we found that atenolol is among the most frequently used Beta-blocker drug used by Klinik Kesihatan Greentown on October 2008 which is 449 patients, followed by metoprolol, 404 patients, propranolol, 20 patients, labetalol and carvedilol, 1 patient each, while no patient was prescribed with Bisoprolol. Graph 2 shows the total usage of each type of beta-blockers in November 2008 at Klinik Kesihatan Greentown. The graph indicates that atenolol is the most highly used if compared with other Beta-blockers which have 358 patients, followed by metoprolol, 324 patients, propranolol, 35 patients, bisoprolol, 4 patients, labetalol, 2 patients and carvedilol, have 1 patient only. Graph 3 shows the total usage of each type of Beta-blockers in December 2008. From the graph we can conclude that atenolol rated as the most widely used where there are 377 patients, followed by metoprolol, 303 patients, then propranolol, 27 patients, bisoprolol, 14 patients, labetalol, 3 patients and carvedilol, 8 patients. Graph 4 shows the overall usage of each beta-blocker used in Klinik Kesihatan Greentown based on total amount of prescriptions prescribed on October, November and December 2008. From types of beta-blocker, we can conclude that atenolol is the most widely used which have 1184 patients compared with other beta-blocker drugs. While metoprolol is the second beta-blocker drug that commonly used which have 1034 patients, followed by propranolol, 82 patients, bisoprolol, 18 patients, carvedilol, 10 patients and labetalol, 6 patients. Graph 5 displays the total usage of beta-blockers based from October, November and December in year 2008 at Klinik Kesihatan Greentown. From the overall, the month of October 2008 shows the highest percentage of beta-blockers used in Klinik Kesihatan Greentown which are 38% or total usage are 875, followed by December 2008 which are 31% or total usage are 732 and November 2008 are 31% or total usage are 724. CHAPTER 5:  DISCUSSION 5.1 Atenolol Beta-blockers work by blocking adrenaline in the heart and blood vessels. Adrenaline speeds up the heart rate, makes the heart muscle contract more strongly, and constricts arteries throughout the body. All these raise blood pressure. In blocking adrenaline, beta-blockers slow down the heart and reduce its workload. That helps to decrease blood pressure (Houghton T, Fremantle N, Cleland JG. 2002). Atenolol in this case is a beta blocker used not only to treat hypertension but also is the primary medication treatment for angina and after an heart attack (American Academy of Family Physician, 2000). Based on our study, at Klinik Kesihatan Greentown the most used beta blocker from October 2008 till December 2008 was atenolol. This could be due to many factors; one of it to be the effective treatment towards treating hypertension. It is also widely use because doctors nationwide has been prescribing this drug for a long time and it is shown by patient age on the prescription studied, geriatric patients prefer sticking to atenolol than changing to other beta blockers as they safe and satisfied with the treatment of atenolol. Atenolol also has very less adverse effects compared to other beta blockers .It is also known to effectively lower blood pressure to its normal range by decreasing the heart rate. It easy to consume as the daily dosing is usually 1 tablet a day(100mg) or half a tablet a day(50mg) ( Shekelle, P. G., et al., 2003 ). According to a study it has chosen four of the five indicated beta blockers as Best Buy drugs for people with angina, based on price. They are atenolol, metoprolol tartrate, and propranolol. Generic acebutolol is substantially more expensive than these four and no more effective. Taking a beta-blocker after a heart attack lowers the risk of a repeat attack and death by 15% to 25%. Five beta-blockers -atenolol, carvedilol , metoprolol tartrate, propranolol, and timolol- have been proven in studies to reduce deaths in people whove had heart attacks. The evidence is somewhat stronger for atenolol, however. On that basis, and because they are available at lower cost than carvedilol (Coreg) and timolol, atenolol is chosen as one of the best buys around. Studies of carvedilol are complicated by its use therefore atenolol is a much suitable drug to be considered alongside its market price (Houghton T, Fremantle N, Cleland JG. 2002). 5.2 Metoprolol Metoprolol is the second commonly used in Klinik Kesihatan Greentown after atenolol. It is a first-line therapy for hypertension, angina, congestive heart failure, coronary artery disease, secondary prevention of heart attack (Bradley HA, et al., 2006). Besides that, metoprolol is also used to treat migraine headaches, panic disorder, anxiety and hyperthyroidism (Cleland JGF, et al., 2002). It is a selective beta-1-blocking agents which do not significantly affect respiratory function or antagonize salbutamol effects in patients with COPD (Fogari R, et al., 2001). Metoprolol does not significantly affect FEV1 or FVC at a dose of 200 mg daily when compared with placebo in patients with moderately severe COPD and significant reversible component (Fenster PE, et al., 1990). Metoprolol is used to decrease symptoms such as rapid heart rate, sweating and tremor which are associated with thyrotoxicosis. It is also used to prevent migraine, although it is not fully understood how metoprolol works in this area (Erdmann E, et al., 2005). At low doses, cardioselective beta blockers such as metoprolol selectively block the beta receptors found in the heart and are less likely to cause side effects. These medications may be better than nonselective beta blockers for people with obstructive lung disease, asthma, poor circulation, diabetes, and depression (Torp-Pedersen C, et al., 2007). Based on the analysis of the COMET (Carvedilol Or Metoprolol European Trial) study, metoprolol patients had a 34% lower risk of death than placebo patients. Metoprolol reduced mortality and all-cause hospitalization by 19%. All-cause mortality plus hospitalization for heart failure went down 31%. All-cause hospitalization alone was lowered by 13%, hospitalization for all heart-related causes by 20%, and hospitalization for worsening CHF by 32% ( Woolfenden J,et al, 2003). Selective beta-1-adrenergic blockade is routinely preferred to non-selective blockade in patients with coexistent COPD and CHF to minimize the risk of inducing bronchoconstriction (Abraham T, et al, 1983). Compared to metoprolol tartrate, carvedilol reduced the total days lost. This effect was mostly due to increased longevity. Metoprolol tartrate has been shown to improve well-being after myocardial infarction (Olsson G, et al,1993). Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy, indicating that the effect of carvedilol was in addition to that of an active control (Waagstein F, Bristow MR, Swedberg K, et al, 1993). 5.3 Propranolol From the graph, propranolol is one of the least used in Klinik Kesihatan Greentown. Propranolol is used most often for the treatment of high blood pressure, angina, and abnormal heart rhythms. It is also used to treat the symptoms of anxiety. Propranolol was the first beta-blocker available in the United States. Beta-blockers are drugs that interfere with nerve signals transmitted by the chemical norepinephrine. They reduce the force and speed of the heartbeat and prevent dilation of certain blood vessels. These actions reduce the work load on the heart, relieve the muscle tremors that often accompany anxiety, and reduce the blood pressure in the brain to prevent migraines.  ( Division of Simon and Schuster 1230, avenue of the Americans New York, NY 10020). Because of the risk of side effects, propranolol should be used with caution in people with impaired kidney or liver function (Division of Simon and Schuster 1230, avenue of the Americans New York, NY 10020). It works by affecting the response to nerve impulses in certain parts of the body, like the heart. As a result, the heart beats slower and decreases the blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart. Propranolol is also affects the bodys sugar metabolism, it should be used with caution in people with diabetes or hypoglycemia (low blood sugar). Propranolol may mask certain clinical signs of thyroid disease and interfere with thyroid-function tests. Similarly, propranolol may interfere with tests for glaucoma  ( Division of Simon and Schuster 1230, avenue of the Americans New York, NY 10020).   Propranolol is thus used for the symptomatic relief of thyrotoxicosis (hyperthyroidism). It has no direct effect on the cause, namely overproduction of thyroid hormones, which requires to be treated concurrently. This is clearly shown at Klinik Kesihatan Greentown because most of propanolol usage was to treat thyrotoxicosis. Scores on various subjective rating scales showed that propranolol had a larger mood elevating effect than atenolol. Heart rate and blood pressure were significantly reduced 24 h after atenolol medication; these effects were absent or reduced after propranolol had been given (A.  A.  Landauer, et al., 1978  ). 5.4 Bisoprolol From the graph we know that the total usage of bisoprolol is only 6 patients out of the 3 month that we have evaluated. It shows that bisoprolol is also less than one of the least used in Klinik Greentown Ipoh. This is due to the price of the medicine. As in a journal, the greatest absolute cost discrepancy for both groups was under-estimation of linezolid ($800 and $400) and over-estimation of clopidogrel ($60) and bisoprolol therapy ($62) by residents and pharmacists, respectively (Wilbur K., 2009). It shows that bisoprolol is one of the expensive Beta blocker drugs compared to the others of Beta blocker drugs. Perhaps it cant give the same effect of atenolol which the most used Beta blocker. Based on a journal, serious adverse effects (e.g. serious bradycardia or hypotension) occurred in 3.1% of patients switching from metoprolol tartrate to carvedilol, and 2.3% experienced worsening heart failure. In the metoprolol to bisoprolol group, worsening heart failure occurred in about 2% of patients. Serious adverse effects also occurred in about 2% of the metoprolol to bisoprolol patients. Adverse effects were higher in patients switched to the equivalent dose rather than half the equivalent dose. (Pharmacists Letter / Prescribers Letter, 2009) Other than that, bisoprolol is also difficult to get the stock of drugs because it is the List A drug and have its own procedures to make the ordering from the company. 5.5 Carvedilol From the graph we can conclude that carvedilol have the least favorable number of usage compare to others beta blockers but then its still a preferable drug for physician to prescribe due to its beneficial effect. First of all, carvedilol is proven to lower mortality in patients with mild to severe congestive heart failure (Keating GM, 2003), besides it also suppresses atrial as well as ventricular arrhythmias (McMurray et. al 2005) and it is the only beta blocker shown to reduce mortality in post-MI (Mark Helfand et. al, 2007). But then on the other side, when compare to metoprolol, it is lack in improved exercise capacity (Mark Helfand et.all 2007) and it may adversely affect recovery from severe hemorrhagic shock (Taniguchi T et.all 2009). Between, patients with CHF and asthma tolerated carvedilol poorly and yet, asthma still remains a contraindication to beta-blockade. All the prescribing for beta blockers in Klinik Kesihatan Greentown also mostly due to the restriction of cost w here carvedilol is listed as A list drug therefore it needs a specialist to start and indirectly reduce A listed drug. 5.6 Labetalol From the graph, we can see that labetalol shows the least usage in Klinik Kesihatan Greentown. This is because the main indication of labetalol is for use in pregnancy complicated by hypertension with apparent freedom from maternal and fetal side-effects, and consequent improved perinatal mortality (C A Michael, 1979). Beside that, labetalol should be avoided in asthmatic patient because it produced more bronchial blockade than atenolol (A D Mackay, et al., 1981) and reduced the effect of inhaled salbutamol on FEV1 (S H Jackson D G Beevers, 1983). Furthermore, labetalol was associated with a significant less reduction or increase in cardiac output than on pure beta blockers (Lund-Johansen P, 1983) and probably induced SLE syndrome (R. C. Brown, et al., 1981). Lastly, considerable differences in dose (atenolol 138 +/- 13 mg daily; labetalol 308 +/- 34 mg daily; metoprolol 234 +/- 22 mg daily), labetalol will required a higher dose to produce similar antihypertensive effects (J J McNe il W J Louis, 1979) and the cost for labetalol is higher than atenolol and metoprolol. CHAPTER 6:  CONCLUSIONS Finally, we can conclude that atenolol have the highest usage among beta-blockers in Klinik Kesihatan Greentown followed by metoprolol, propranolol, bisoprolol, carvedilol and the least usage which is labetalol. Commencing from this study, we found that further studies is needed so that physician can prescribe more convincingly and led to a better life for patients.

Looking for Dr. Fuller :: Buckminster Fuller Essays

Looking for Dr. Fuller It's the next to next to last day of English 381: The Personal Essay. We're reading Annie Dillard's Teaching A Stone to Talk and I call attention to a blurb on the jacket by Edward Albee. A student notes asks about another quotation from Dr. R. Buckminster Fuller. She doesn't know who Fuller is, and no one else in the class does either, but the running speculation is that he's a fundamentalist evangelist, a sort of Dr. Norman Vincent Peale. I fumble for an explanation of Fuller--architect, philosopher, voice of a generation like Dr. Spock. I joke that I should bring in my Whole Earth Catalog so I can illustrate my remarks. I explain that Fuller invented the geodesic dome and when some in the class aren't certain what that is, I scrawl a bad drawing on the board. Finally someone saves me by mentioning Epcot Center, and we go off awhile on that. I mention that another dome much closer is in Downs, Illinois, ten miles down the road in a one-tavern town. Here is an essay possibility, the connection between Epcot Center and Downs, Illinois. But that's not the road to travel in this essay. At the library I plug Fuller's name into the computer. Twenty books pop up, their call numbers ranging from C, to H, to P, to T, and I suddenly recognize a title Operating Manual for Spaceship Earth, its publication place of Carbondale reminding me that Fuller taught at Southern Illinois University. There's a picture of his geodesic dome house in Carbondale, by the way, in the plates between pages 96 and 97 of Ideas and Integrities: A Spontaneous Autobiographical Disclosure. For kicks I also ask the computer to find The Whole Earth Catalog, call number AP2.W5. My book search will take me, then, to five different floors. The Whole Earth Catalog is yellowing and brittle. Its publishers, the Portola Institute, probably didn't expect back in 1969 that the they would show up on university library shelves, and so they didn't bother with acid-free paper. When I flip through the pages I remember the day I bought a copy myself, a later edition, at least, in 1975 and, reading, through it, came upon a recipe for baking bread, from the Tassajara Bread Book. It was summer. Breaking bread sounded like a righteous thing for a college freshman to do and so in my mother's kitchen I measure yeast and molasses and water and whole wheat and salt and oil and kneaded out six loaves.

KamaSutra and the War Between the Sexes Essay -- Movie Film Essays

KamaSutra and the War Between the Sexes    The movie KamaSutra is a tale of love and passion. It is set in ancient India and is a story about Tara, a princess and Maya, her maid. Maya was always in Tara's shadow. Everything she used were the leftovers of the Princess. Maya always had to move in Tara's shadow. Even though she was prettier and more accomplished in the arts Maya could never be seen as Tara's equal. To avenge herself Maya seduces Tara's husband, the king of a neighboring province. For Maya it's only an act of revenge, for now Tara will have to spend the rest of her life with what Maya had used. On Tara's wedding night, Maya offers herself to Tara's husband. After Maya seduces Tara's husband she finally finds herself. Instead of seeing herself as Tara's shadow she now sees herself as equal to the queen, for now Tara will have to spend the rest of her life with something Maya has used. Tara gets rejected repetitively by her husband. Her shyness and inhibited sexuality annoys Rajsingh. On their wedding night he le aves her to go to one of his courtesans. Thereafter Tara is always portrayed as either crying or watching her husband leave with other woman. She is a bitter, jealous, and ugly woman till Maya teaches her the art of loving. When her husband, Rajsingh now sees her he desires her. It is after the point that she sees herself as a sexual person that she can find herself. The queen emerges as a strong woman, no longer a weeping lost soul. When Rajsingh starts to falter after he is rejected by Maya, Tara takes control of the state and of the King. It is through intercourse that the relationship of the male and the female are depicted. It is the tool of love, power, destruction, and identity. Through sexu... ...n emphasis on the emotional aspect of the child. These differences pave the way for unhappy adult interactions. The divorce rate in most western countries is alarming. In eastern countries they are definitely on the rise. The two sexes are taught so well to be different from each other that when it is time for them to live together they can't. The only solution maybe to go back and unlearn exactly what comprises femininity and masculinity. So that the future children grow up to fill our expectations of what is human, rather than what feminine or masculine.    Work Cited Horney, Karen. "The Distrust Between the Sexes." A World of Ideas: Essential Readings for College Writers. 5th ed. Ed. Lee A. Jacobus. Boston, MA: Bedford/St. Martin's, 1998. 337-351. KamaSutra. Dir. Mira Nair. Earl Jackson Jr, Stategies of Deviance. Indiana University Press 1995

The Draft in the USA Essay -- Army Military War Essays Papers

The Draft in the USA The draft is a taboo subject in America, but regardless of its controversy it is a subject that must be examined. The daft, however rash, is essential for America in case of a national emergency. Many people in this age of America lack patriotism for their country. Of course, many citizens ignore the fact that they are living in one of the only countries that offer you freedom and the choice to succeed as far as you want. However, â€Å"Of those to whom much is given, much is required† (Mackenzie) and all that is asked of you in America is to give yourself to her when asked. Many people would not risk their lives for America. That is when the government should put a call to action and reinstate the draft to insure the safety of American citizens. The people that oppose the draft believe that it segregates the poor from the rich and it cuts America right down the middle. â€Å"†¦poor blacks, Hispanics, and rural whites should not serve so disproportionately in the ranks of the military and that those in the ‘upper classes’ should also serve†¦Ã¢â‚¬  (Akil) the opposed believe it’s unfair to decide by wealth. They believe that if the draft is to be reinstated it should not be in regards to race, wealth or any discriminatory trait. The draft may be prejudiced but it doesn’t mean it is not needed. There are many flaws in it, but there are also flaws in government, society, in every individual. These flaws are fixable, and in the future they will be corrected now Am...

Existentialism in Waiting for Godot Essay

Existentialism is a philosophy that repudiates the idea of religion or any ‘supreme’ being bringing meaning to life, and advocates the idea that individuals are instrumental in finding a purpose to life through free will, choice, and personal responsibility. Hence in Samuel Becket’s existentialist play Waiting For Godot, he puts forth an idea that all of humanity is wasting their lives in inaction- waiting for the salvation of a deity, when that divine being may or may not even exist. As inferred from the phrase â€Å"existence precedes essence†, there is no pre-existent spirituality or soul; no god, Christian or otherwise; no cosmic compassion for human life; no salvation in heaven and damnation in hell; neither preset destiny nor inevitable fate; and nor is there the transcendence of our worldly existence. Everyone must bear the responsibility for their own existence, since it is not predetermined or shaped by any external force; a subsequent anxiety is one of the aspects of human nature. Nevertheless, the burdens of anxiety and responsibility are often too heavy to bear, and we often seek to shift them on certain individuals, institutions, religions, or even on a ‘Godot’. Existentialism manifests itself in Waiting for Godot through its motifs of despair, absurdity, alienation, and boredom. One of the most prevalent themes is that of loneliness as a consequence of godlessness. In a blank futile universe devoid of purpose, design or care – represented by the featureless Beckettian landscape, human beings are alone, and condemned to be free. Afraid of this isolation Estragon and Vladimir cling together despite their quarrels, and Pozzo and Lucky do not untie themselves. This futility leads to another characteristic of existentialism: despair. Since there is no preset will, Existentialism preaches the individual freedom of choice. Estragon and Vladimir have made the choice of waiting, without any instruction as Vladimir says that Godot â€Å"didn’t say for sure he’d come†. Yet they wait to know exactly how they stand. The boredom of waiting prompts them to ponder over their identity, as inactivity leads the individual to think. Estragon remarks: â€Å"We always find something, eh Didi, to give us the impression that we exist? It is learnt that man needs a rational basis for existence but fails to find one, making his life no better than a wasted passion. The two tramps, Estragon and Vladimir vainly attempt to put order in their lives by waiting for Godot who never arrives, and reiterate that â€Å"Nothing is to be done. † This inaction further questions their very entities, and Estragon anxiously doubts: â€Å"Where do we come in? † Whenever Estragon and Vladimir make a decision, the stage directions dictate that â€Å"They do not move. † and continue to show passivity. Therefore, even their resolution to go is not strong enough to produce action. Many times Estragon says â€Å"Let’s go†, but Vladimir always reminds him that they can’t as they are â€Å"waiting for Godot. †This inability to act renders Vladimir and Estragon unable to determine their own fates. Instead of acting, they can only wait for someone or something to act upon them- referring to the existentialist argument of man’s desperate need to establish his own purpose and meaning to life. Furthermore, Vladimir and Estragon ponder suicide by hanging themselves from the tree, but once again their anxiety stops them, as the latter remarks: â€Å"Don’t let’s do anything. It’s safer. † Kierkegaard’s notion of ‘Dread’ or ‘Angst’ includes ideas of existentialism which talk about a state in which the individual’s freedom of choice places him in a state of anxiety, as he is surrounded by almost infinite possibilities. This could explain the inactivity of both the tramps. They are aware of the different choices they can make but are hesitant, just as they decide to leave at the end of the act but remain motionless. Thus, the end of act 1 firmly asserts the characters’ hopelessness. Beckett infers that people pass time with habits to cope with the existentialist dilemma of the dread or anxiety of their existence. Estragon and Vladimir idly pass their time to escape the pain of waiting and even thinking. Vladimir expresses this idea at the end of the play: â€Å"Habit is a great deadener. † All the events narrated through the course of the play – the Crucifixion story, the suicide plan, playing talk – seem nothing more than silly pastimes. Once during the Pozzo-Lucky encounter, the tramps behave as if they are in a theatre; Vladimir even asks Estragon to keep his seat while going off to the urinal at â€Å"The end of the corridor, on the left. † Pozzo and Lucky’s coming can also well be interpreted as an act to entertain Vladimir and Estragon; a way in which Becket questions whether life itself is just a mere source of entertainment to pass the time while waiting for salvation. However, the distractions end sometime or the other, leaving them again with their futile inaction: â€Å"The essential doesn’t change. † This once again echoes the existentialist theory that life will end in nothingness as it has begun, reducing all of man’s achievements and accomplishments to nothing. Time has little significance in this futile lifecycle. The past often becomes misty to Estragon as he often asks questions like â€Å"What did we do yesterday? † He does not remember Pozzo and Lucky and even the place in Act Two, and shortly, Pozzo fails to recognize the tramps (Estragon and Vladimir) too. The mysterious boy returns with the same message; Godot never comes and tomorrow never seems to arrive. Vladimir, therefore, is right to say that â€Å"time has stopped. † Estragon conveys the horror of this uneventful repetitive existence in â€Å"Nothing happens, nobody comes, nobody goes, it’s awful! â€Å".