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Murder, scandals, and the frightening world of surveillance all intertwine to form Francis Ford Coppola’s thriller, The Conversation. The viewer, engulfed in a restricted narration, explores the mystery Harry Caul, the protagonist, has caught himself in. A narration that begins objective with spurts of subjectivity is enhanced by the peculiar character traits of Harry. A plot that slowly unravels with surprising turns and leaves the viewer dangling at the end explores the dangers and horrors of surveillance.

Exploring the complex character of Harry Caul is key to understanding the movie. At the beginning we hear him say he doesn’t care about what the subjects he’s surveying are saying, just as long as he gets a fat recording. Arriving home from the job we find his door loaded with locks and upon entering an alarm goes off. On the floor is a birthday gift. Harry then calls the manager of the apartments and wants to know how the manager entered his home. Instantly in the first ten minutes of the film we are shown how secretive Mr. Caul is. He even is surprised that someone knows it’s his birthday. A birthday is something that almost every normal person wants shared and know. This fact emphasizes how he is a loner even more. His secrecy is even greater emphasized when he travels to see his girlfriend, Eve.

When he arrives Harry mentions it’s his birthday and she didn’t even know. This fact triggers Eve’s curiosity even more and she tries to find out more about him. Harry won’t tell her where he works or where he even lives. He becomes upset with these questions and tells her to stop. Someone becoming nervous about these simplest of questions shows incredible insecurity, and paranoia. This side of him is strange as it completely contrasts and is hypocritical with his treatment of other people.

Harry dives into other peoples’ lives, it’s his instinct to survey. Upon entering Eve’s apartment he stops at the top of the stairwell and listens. She then tells him that how he slowly and quietly puts the key into the door, then opens it quickly it seems as if he’s trying to catch her doing something. Eve even tells Harry she feels like he listens to her phone conversations, which he becomes instantly defensive over. This gives the viewer the thought that he might even of have tapped her line. Besides his dealings with Eve, Harry acts the same at his job.

In fact Harry is a leading surveillance expert. When listing notables to a surveillance convention his name is the top of the list. Everyone at the convention even knows his name and wants Harry to give the approval on their product. It seems that Harry is scared of being out done and having his life surveyed. This fear keeps him on top of the surveillance world.

As we follow the plot line and try to learn more about why the conversation is important we also are on the search to understand Harry Caul. This is a sub meaning that runs right along with the movie. This blankness and secrecy of Harry continue the mysteriousness of the plot.

The last yet most important trait is Harry’s conscience. At the beginning of the movie Harry tells his co-worker he doesn’t care what the subjects are talking about, just as long as he gets a fat recording. This impersonal attitude proves to be false. The fact that he does have a conscience creates conflict of the movie and leads into the cause and effect aspect.

The narration being restrictive we see all that Harry sees. When listening to the conversation Harry recorded the viewers are keyed onto certain passages. One is when the two subjects are talking about the bum. The woman says how sorry she feels for the bum and the man replies, “He isn’t hurting anyone.” To which she responds “neither are we.” Here we are given the notion that these two are lovers.

When Harry tries to turn his tapes into the director the assistant director attempts to take them. At this moment Harry begins to wonder what they are use for. He takes his tapes and leaves. But leaving the building Harry sees the two subjects he recorded. Here is where Harry’s conscience and the fact that the narration is restrictive plays a large part. Harry returns to his workshop and clarifies one point of the conversation that was hidden. Here the man subject says “He would kill us if he got the chance.” This is the important part of the movie. Harry’s conscience kicks in and we learn that he had once done some work where his tapes had some people killed. The fact that the two subjects seem to be innocent lovers nags at Harry. His line where said he didn’t care what was said on the tapes becomes null.

The simple cause is Harry made the recording. Interestingly enough the effect is that people might die, and another part of the effect is that Harry’s conscience kicks and he wants to stop what he started. This is a very interesting idea and shows the complexity of Harry’s character and how it ties into causality. He tries to trick himself into being impersonal, but his character won’t let him.

Another important piece of the meaning is how the story and plot interact. The plot draws you along throughout the movie giving you bits and pieces of what the story is. Up through the murder scene and briefly after the viewers are to believe that the director’s wife was cheating on him. That was the reason why the recordings were made. The viewer believes this to be the story, yet after the murder Harry tries to see the director but he isn’t admitted. On the way out of the building Harry sees the girl however. At this moment a whole different chunk of the story is shown. This new chunk is that of a conspiracy.

The plot and narration does an excellent job of tricking the viewer. Through its restrictive view and a few objective scenes where Harry feels upset and you see the two subjects of the recording the viewer is almost positive it is a simple affair ending in murder. The temporal order of all the flashbacks had an important role in tricking the viewer. Through constant repetition of the flashbacks the viewer is keyed into their conversation, which makes them seem compassionate, innocent. The compassion they show the bum is implanted in your thoughts. This set the viewer up for even a greater surprise.

Now the story is expanded. It now includes how the assistant director and the wife used Harry to further their scheme. The ending comes abruptly after this leaving the viewer hanging. The story isn’t resolved. The plot only showed you the middle chunk of the story. By leaving this line open it furthers the mystery. Adding to this mystery is the fact that Harry, the great bugger, is now under surveillance. Incredibly he can’t even figure out how. Showing once again his incredible fear of being watched and listened to he rips his whole apartment apart in vein. Here another question is left. What is going to happen to Harry? Is he going to be able to out smart the assistant director? Will they kill him like the director? These questions add to the mysteriousness of the movie.

From the beginning with sounds that the viewer wonders what they are and could consider them non-diegetic, then realizes it is the recording of voice, to the end where the story is left in question the viewer never once has a complete understanding. The character of Harry Caul is a mystery in itself. Thoughout the movie his strange traits are revealed. Then through a restrictive narration you embark on this mystery man’s journey, which is also strange and deceiving. The flashbacks you can’t understand. And when you realize that there was a huge conspiracy, you still don’t receive a complete conclusion. Though these forms of narrative the director and writers formed a mysterious and sinister vision of surveillance. A disturbing vision that the viewer is left to think and worry about.

Multiple Sclerosis (MS)

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Multiple Sclerosis (MS)

Pathophysiological Phenomenon

Multiple sclerosis common abbreviated as MS is an autoimmune disorder that affects the Central Nervous System (CNS). MS results when the immune cells start invading the brain as well as the spinal cord resulting in its inflammation, tissue damage as well as neurodegeneration of white matter which is myelin (Norris, 2018). Researchers have tried to identify various causes of MS but currently there is no solid cause of this autoimmune disorder. Pathologically multiple sclerosis is defined as the presence of scars as a result of inflammation. The immune system erodes away the protective layer of the nerves referred to as the myelin, this affects the communication between the brain and other body organs.

There are four main forms of MS that have been recognized: relapsing-remitting MS, primary progressive MS, secondary progressive MS and progressive relapsing MS (Faissner, 2019). According to a studies all these forms of MS have different neuropathologists a clear indication that multiple sclerosis comes from a variety of a group of related heterogeneous diseases. Most common form of MS that tend to occur is the relapsing-remitting MS. Course of MS tends to vary between patients and is usually not predictable. Although the cause is unknown it involves a combination of genetic susceptibility in combination with non-genetic triggers including certain non-genetic triggers including environmental factors, certain viruses and also metabolism: A combination of these factors have been believed to result in an autoimmune disorder that attacks the Central Nervous System.

Incidence of Phenomenon and Impact

According to the National Institute of Health, it is estimated that MS affects roughly 400,000 people in the United States, this is double the number from when the first national research occurred in the year 1975 (Norris, 2016). Globally, National MS Society approximates more than 2.3 million people globally are living with multiple sclerosis. From the MS Discovery Forum, approximately there are 200 new cases reported every week in the United States. According to statistics, Americans living further from the equator, that is southern U.S. States have higher rates of MS as compared to those living in the northern states (Dilokthornsaku, 2016). Incidences of MS are also quite higher in people living in Norther Europe which experience cold climatic conditions. Lowest risk seems to occur among Asians, Africans and the Native Americans as well. In children, prevalence is not as high, according to a research by Nashi M. et al (2017), children make up only 4% of all MS cases. The highest number of individuals with MS are aged between 45 and 49 years an indication that age is a factor when it comes to MS.

There are various risk factors that can increase the development of MS; such as age, race, sex, family history, climate, season of birth and vitamin D. In this regard women are twice more likely to be affected in comparison to their male counterparts. The onset of the disease is often between 20 and 30 years although it can occur at any given age (Norris, 2018). Family history is also a risk factor; if one of your immediate family members has MS then it’s highly likely that one can develop the disease because of the genetic disposition associated with Multiple Sclerosis. Low exposure to sunlight leads to a deficiency in Vitamin D, which correlates with a higher risk of MS which may explain why cold areas have higher cases of MS as compared to areas with warm or cool climatic conditions. Viruses such as Epstein Bar have also been linked with MS. Patients born with MS are more frequent in winter and spring in comparison to autumn where it’s less frequent. It is argued that this could be as a result of lower vitamin D during the pregnancy period.

MS has an impact on the society both physically, financially and economically. The firs impact that can be felt especially because it is a disorder that leads to loss of mobility functions. MS can affect an individual’s way of life, this is due to high medical cost and emotional toil an affected person. MS has resulted in intangible costs, direct costs and indirect costs. Various cost estimates per person battling MS have been published indicating how high the course of treatment is. MS does not adversely affect individuals and families only but also the society at large. It is quite challenging given the amount of research and funding people invest in battling MS. The economic impact of MS on a particular country can be arrived at by identifying the number of MS patients in a country. In regards to intangible cost people with MS are dependent on care givers, since they need help in performing daily tasks. MS patients cannot carry out mundane tasks on their own due to physical and cognitive impairments. However, the data collected showcases that majority of care givers are informal, they are not certified care givers and lack proper training (Santos, 2019). A majority of the care givers are spouses or immediate family members. The time spent by informal care givers taking care of their loved ones may led up to psychological stress and anxiety. This is because they not only have to sacrifice their time; they also incur treatment cost and physical burden thus it can be deterrent to their physical health as well (Santos, 2019).

According to a research by Raggi A. et al (2016) people with MS most likely end up losing or quitting their jobs, work loss can also be cited as one of the indirect costs of MS. MS patient are easily fatigued, have difficulty in speech delivery, cognitive impairment and also experience difficulty in mobility. These symptoms are hindrance at any place of work especially one that are physically challenging. These significantly affects the labor force, whereby MS patients have to search for less tasking jobs one that require minimum physicality and low stress, however in most instances this means they have to work low paying wages. These can also affect the informal caregivers who have to forfeit their jobs and sacrifice their time to care for the patient. Studies indicate that informal caregivers experience works strain having to balance between their job and care giving.

Early mortality as a result of MS can also be identified as an indirect cost. Economic strain due to the underlying economic gain that could have been made. People who die due to MS would have contributed to the working force of the nation thus helping build on the nation’s economy (Ponzio, 2015). One of the direct costs is the medical and non-medical costs. Medical costs include a variety of things such as: inpatient and outpatient care, rehabilitation, drug prescription, physician services and other medical supplies. Direct cost of the medical cost can be estimated to range from 10,000 euros per person. Direct non-medical cost includes the modifications needed to make mobility and the stay of MS patient quite wholesome. Modifications such as mobility whereby wheelchairs will be needed and varying form of transportations, which require funds. To most families getting enough funds to ensure their loved one is completely taken care off and his needs are met may be MS not only affects an individual’s health it encompasses a far wider scope such as family and friends as well as the society.

Pathophysiology and Recent Findings

Multiple Sclerosis is among the most common forms of neurological disorders. As stated earlier, there is little knowledge as to the causes of this autoimmune disorder but with age, there has been so many research by the scientist to try and explain the results of this disease. Recent findings argue that MS may not be just a single disease but rather it is a wider spectrum involving both non-genetic trigger as well as genetic susceptibility of a person. In regards to MS pathology illustrates the conditions that correlate with the lesions. Physiology on the other hand illustrates the different actions that resulted to the development of lesions. Lesions are visible through magnetic resonance; they vary in sizes some are quite small while other are the size of a golf ball. Pathologically MS can be defined as the existence of sclerosis in the central nervous system, distributed in space. Simon Faissner explains how Physiologically MS destroys axons that are in the CNS that are shielded by the myelin (Faissner, 2019). The MS also attacks the nerve cell close to the brains gray matter. This leads to the damaging of axons in the spinal cord, optic nerve and brain. This hinders the transmission of visual information from the eye to the brain (Zephir,2018). The progression of MS in the brain results in the shrinkage of the cerebral cortex. In the case that the MS exacerbates the inflammation damages the myelin and the axons within that space. The signs and symptoms of MS also vary depending on the location of the lesion and the extent of the inflammation.

The cause of MS varies for each individual; the time span and onset of each symptom vary with the specific type. According to Faissner et al (2019)there are 4 types of MS, they derive their names from the progression of the symptoms. First is the Relapsing-remitting MS, the symptoms come in forms of attacks; this is referred to as a relapse. People can recover or return to their disabled form in between attacks. A remission is the period when the disease is inactive. A relapse may occur in a year, month or even week. A majority of the people are initially diagnosed with this form. The second form of MS is the secondary-progressive MS; this are individuals who have past experiences with relapses. However gradually symptoms begin to appear which lead to deterioration in health. Relapsing-remitting MS if left untreated can result in Secondary – progressive MS. The third form of MS is the primary-progressive MS it is associated with continuous worsening of the symptoms without any relapses. It’s also characterized with minor reliefs and it’s less common. The last form of MS and the rarest is the progressive-relapsing MS; it’s marked with steady deterioration of the symptoms and acute relapses. Some of the early of MS include: loose urine bladder, blurry and double vision, constant dizziness, muscle spasms, weakness and stiffness, numbness in the leg and face, and difficulty in balance (Dobson, 2019). In later stages of the MS various symptoms may arise such as, fatigue, cognitive dysfunction and depression. Stiffens and muscle spasms can affect the balance which hinders standing and walking. In more severe cases it may lead to paralysis. Research has found that when people with MS experience worse fatigue when they have a high fever or when they are exposed to heat (Dobson, 2019). Pain is not considered one of the first sign of MS. Pain shooting down the leg and limb spasm can be considered as symptoms of MS. Relapses in the MS can be indications of further damages in the brain. Relapses can either be mild or severe and also its duration varies.

The National Institute of Neurological Disorders and Strokes is spearheading the funding of research on the brain and nervous system. Although no definitive cause of MS has been established major strides have been made in the research of MS. In regards to treatment strides have been made to curb exacerbation of MS. New developments such as the biomarkers that have been developed to help monitor and diagnose MS. Biomarkers help in monitoring the progression of the disease. NINDS is currently monitoring various programs such as the Central Vein Sign in MS; it’s a study researching if scientist can be able to distinguish the central veins passing through brain plaques, in an attempt to distinguish MS from other neurological disorder (Absinta, 2019). Achieving this will ensure great growth and milestone in this field. Genetic research is also exploring the role genes have to play and whether it’s a potential increased risk for MS.

Medical Differential Diagnosis

There has been a misconception that attack on the CNS causing demyelination is an indication that an individual may be suffering from acute multiple sclerosis. There are various diseases that can mimic MS, this include Lyme disease, migraine, radiological isolated syndrome, spondyplopathies, neuropathy, lupus, stroke and vasculitis. These diseases have the ability to mimic MS and many a times misdiagnosis are made due to the similarity in symptoms (Thompson, 2018). Differential diagnosis entails narrowing down to the specific diagnosis. There are several differential diagnoses that are applied to the MS in order for physicians to really establish that a person is suffering from MS. The first is the spinal cord neoplasm where metastatic as well as spinal cold neoplasm including ependymomas and astrocytomas are considered. When imaging is conducted, and there is the presence of cysts as well as hemorrhage then the diagnosis of neoplasm is supported. ADEM is another differential diagnosis. ADEM is a post infectious autoimmune attack on either the brain or the spinal cord. It is characterized by onset of motor and sensory nerve dysfunction with encephalopathy which later proceeds to coma eventually resulting in death. MRI is useful in pointing out occurrence of lesions in cases of ADEM or MS. The condition can be treated with the use of steroids before biopsy is considered. Another differential diagnosis is Baló concentric sclerosis but is associated with inflammation of cerebrospinal fluid, however, it has fulminant progression when compared to multiple sclerosis (Sand, 2015).

Sarcoidosis is another differential diagnosis characterized with enhancement of white and pia matter lesions when imaging is done. Radiation myelitis which is also characterized with demyelination as well as presence of the spinal cord lesion may lead to its diagnosis as MS. Finally, another differential diagnoses are the vasculitis processes including lupus erythematosus leading to spinal lesions that may be seen as mimicking MS as there are multiple lesions that are present. Clinical history is important in helping one establish the right diagnosis. Doctors adapt various methods, to either rule out or confirm a diagnosis. This includes physical examination, medical history and neurological exam. However, the physician can suggest MRI scans and lumbar puncture. MRI which can be used adjunct to clinical diagnosis in looking at presence of lesions even when at times the scan appears normal (Norris, 2018).

Collaborative treatment options

MS has no cures however there are treatments that have been adopted that can derail the progression of the disease. Plasma exchange effective in treating flare ups, in individuals with exacerbating forms of MS. Can be used as substitute of methylprednisolone. Plasma exchange entails replace harmful Plasma from an individual’s blood with replacement Plasma, then transfusion it back (Moser, 2019). It’s important to note that this treatment has not been proven to be effective for both secondary and chronic progressive MS.

Corictosteroids methylprednisolone is injected into the vein; it is prescribed for 3-5 days. The steroids aid in suppressing the inflammation of the immune system, this ensures quick recovery from attacks. The drug does not have any long term effect on the progression of the disease. Disease – altering system vary from injected, infusion and oral treatment. Injected treatment uses Beta interferon drug which helps to regulate immune cells. This drug however has certain side effects including depression and flu-like symptoms (Auricchio, 2017). Another injection is use of Glatiramare acetate that is effective as it aids in balancing the immune cells. Its side effects are quite mild, mainly swelling in the injected area. Infusion treatment is another option whereby Natalizumab is administered once in a month and its main purpose is to prevent the immune system cells from damaging the brain and spinal cord. Although it has been deemed effective it poses serious risk for viral infection of the brain. Alemtuzumabb is also used it mainly targets to destroy the protein on the top of immune cells. It’s administered for five consecutive days and then a follow up a year later for 3 days’ infusion. These drugs may increase the autoimmune disorder therefore it’s recommended for people who have two or more inadequate MS therapies. Finally, for the oral treatment, there are various drugs that are used including Teriflunomide that reduces the swelling of activated immune cells. It is a once daily form of medication. Its side effect is nausea, hair loss and liver damage. Dirixomel fumarate is also used and it is administered twice daily (Auricchio, 2017). This drug makes the immune system less inflammatory, this helps manage the progress of the MS.

Tremors are also common in MS patients, whereby they experience uncontrollable shaking. Medication such as clonazepam can be helpful. Assistive devices, such as weight in spoons are quite helpful. Muscle spasm and weakness is also a common symptom. Mild muscle spasms are manageable through stretching and exercising it can be through yoga, water or physical therapy. It is recommended that people with MS stay physically active this reduces stiffness of the bones. Fatigue can be both cognitive and physical, however, it can be battled through engaging in daily physical activities that are mild or moderate (Feys, 2016). Also drugs such as modanfil help in battling fatigue. Occupational therapy aids people in walking while also managing your energy. Joining support groups helps in managing the stress. Support group provides an environment for one to talk with others on how they feel being a safe space. Although MS still has no cure, people are managing to live with MS through its management

References

Auricchio, F., Scavone, C., Cimmaruta, D., Di Mauro, G., Capuano, A., Sportiello, L., & Rafaniello, C. (2017). Drugs approved for the treatment of multiple sclerosis: review of their safety profile. Expert opinion on drug safety, 16(12), 1359-1371.

Absinta, M., Nair, G., Monaco, M. C. G., Maric, D., Lee, N. J., Ha, S. K., … & Reich, D. S. (2019). The “central vein sign” in inflammatory demyelination: The role of fibrillar collagen type I. Annals of neurology, 85(6), 934-942.

Dilokthornsakul, P., Valuck, R. J., Nair, K. V., Corboy, J. R., Allen, R. R., & Campbell, J. D. (2016). Multiple sclerosis prevalence in the United States commercially insured population. Neurology, 86(11), 1014-1021.

Dobson, R., & Giovannoni, G. (2019). Multiple sclerosis–a review. European journal of neurology, 26(1), 27-40.

Faissner, S., Plemel, J. R., Gold, R., & Yong, V. W. (2019). Progressive multiple sclerosis: from pathophysiology to therapeutic strategies. Nature Reviews Drug Discovery, 1-18.

Feys, P., Giovannoni, G., Dijsselbloem, N., Centonze, D., Eelen, P., & Lykke Andersen, S. (2016). The importance of a multi-disciplinary perspective and patient activation programmes in MS management. Multiple Sclerosis Journal, 22(2_suppl), 34-46.

Moser, T., Harutyunyan, G., Karamyan, A., Otto, F., Bacher, C., Chroust, V., … & Sellner, J. (2019). Therapeutic Plasma Exchange in Multiple Sclerosis and Autoimmune Encephalitis: A Comparative Study of Indication, Efficacy, and Safety. Brain sciences, 9(10), 267.

Norris, T. L., & Lalchandani, R. (2018). Porth’s Pathophysiology: Concepts of Altered Health States. Lippincott Williams & Wilkins.

Raggi, A., Covelli, V., Schiavolin, S., Scaratti, C., Leonardi, M., & Willems, M. (2016). Work-related problems in multiple sclerosis: a literature review on its associates and determinants. Disability and Rehabilitation, 38(10), 936-944.

Sand, I. K. (2015). Classification, diagnosis, and differential diagnosis of multiple sclerosis. Current opinion in neurology, 28(3), 193-205.

Santos, M., Sousa, C., Pereira, M., & Pereira, M. G. (2019). Quality of life in patients with multiple sclerosis: A study with patients and caregivers. Disability and health journal, 12(4), 628-634.

Thompson, A. J., Banwell, B. L., Barkhof, F., Carroll, W. M., Coetzee, T., Comi, G., … & Fujihara, K. (2018). Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. The Lancet Neurology, 17(2), 162-173.

Toledano, M., Weinshenker, B. G., & Solomon, A. J. (2015). A clinical approach to the differential diagnosis of multiple sclerosis. Current neurology and neuroscience reports, 15(8), 57.

Muscle Adaptations to Anaerobic Training

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Muscle Adaptations to Anaerobic Training

Anaerobic training has to do with high-intensity training methods whereby the source of energy does not rely upon the use of oxygen. The number of sports and the sprinting, high-intensity training relies on anaerobic training to attain top performance. The body goes through a series of adaptations that have consistent anaerobic training, with virtually every system in the body affected. From the endocrine system to the cardiovascular system anaerobic training gives adaptations that are beneficial for high performance and good health. Worth noting, anaerobic training mainly focuses on anaerobic energy systems such as alactacid and lactic acid and getting physiological adaptations that benefit these systems. This text highlights the muscle adaptations to anaerobic training.

Hypertrophy is one of the adaptations through which anaerobic training boosts the size of muscles. Hypertrophy is achieved by optimizing the levels of actin and myosin, which are the proteins that facilitate the movement of muscles on a microscopic level. Anaerobic training inhibits the degradation proves and boosts the production of such proteins. This causes increased myofibrils levels, which are an additional component of the muscle cell. However, whether anaerobic training causes hyperplasia is still unknown. Hyperplasia is the increase in the number of muscle fibers and not the size as it would be hard to count it. The magnitude of muscle growth and protein synthesis depends on the nutrition, hormone receptor response, hydration, and training program (Sözen, 2018). A strategy which incorporates a combination of metabolic and mechanical factors tend to optimize hypertrophy. Mechanical factors such as eccentric actions, heavy loads, and low-to-moderate volumes. Metabolic factors main focus is putting stress on the glycolytic energy system that is said to take effect after 43 seconds of high volume and high-intensity activity with short periods of rest.

Fiber-type transitions are another muscle adaptation to anaerobic training. Essentially, the proportion of fiber types that an individual has is relatively unchangeable and is determined by genetics (Vermeulen, Plancke, Boshuizen, de Bruijn, & Delesalle, 2017). However, hypertrophy makes Type-II fibers to change into Type-I fibers. Additionally, hypertrophy makes Type II-x fibers to change and behave more like Type II-a which is viewed as the capacity to respond to low stimulus levels.

Architectural and structural changes are also muscle adaptations that take place during anaerobic training. Structural changes boost expression of strength and muscle function. Anaerobic training leads to increased density of cytoplasm, myofibrils, and activity of Na-K ATPase. It also ignites an increase in t-tubule density and sarcoplasmic reticulum. Two architectural changes influence how force is transmitted to bones and tendons. There is boosted muscle fascicle length and also increased cross-sectional area in the muscle fiber causing resulting in boosted pennation angle.

Decreased capillary and mitochondrial density are also additional muscle adaptations to anaerobic training. The gross number of capillaries and mitochondria stays the same however the density reduces due to hypertrophy. This means that the number of capillaries and mitochondria per muscle is low, but the total number remains the same as before hypertrophy. However, this does not affect aerobic performance due to the improved efficiency of capillaries and mitochondria. Raising buffering capacity is efficient for acid-base balance. One can buffer out lactic acid more faster. It is a by-product of the metabolic processes which is heavily depended upon during anaerobic exercise. This leads to delayed fatigue during exercise hence leading to opportunities for more longer and productive training sessions. Additionally, the overall muscle efficiency improves due to increased storage of glycogen, ATP, and creatine phosphate. Additionally, the enzymes which function by using the substrates in the metabolic processes are active and more, by extension, more efficient.

References

Sözen, H. (2018). The effects of aerobic and anaerobic training on aerobic and anaerobic capacity. J Int Anatolia Sport Sci Vol, 3(3).

Vermeulen, R., Plancke, L., Boshuizen, B., de Bruijn, M., & Delesalle, C. (2017). Effects of training on equine muscle physiology and muscle adaptations in response to different training approaches. Vlaams Diergeneeskundig Tijdschrift, 86(4), 224-231.

Chapter 9 Reflection- Conflict Theory

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Chapter 9 Reflection- Conflict Theory

Chapter 9 talks about conflict theory, a societal construction explaining the conflicts in society as caused by inequality and other social factors. There are many types of conflict theories, and they fall under different categories. For example, race-based conflict theory suggests that conflict in society is caused by the whites being privileged over people of color and other minority groups.

However, the issue of racism is not the only thing that determines conflict theory explanation as an economic power. Especially in a capitalistic nation like the United States, those who have money can be said to be untouchable. In contrast, those who are not financially stable are the ones who find themselves in crime most of the time. Therefore, conflict theory explains the societal conflicts that arise due to competition between those who have and those who do not have. It also discusses the impacts of the many different factors that come into play when discussing these factors.

Reference

Williams III, F.P., & McShane, M.D. (2018). Criminological theory (7th ed.). New York: Pearson.

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Chapter 9

The Egyptians and the Mayans had some of the most elaborate rituals when it came to the burials of their kings. The Egyptians preserved their pharaohs in elaborate tombs enclosed in ornate tombs that still attract tourists to this day. The Mayans, though less detailed, still had some remarkable traditions surrounding the burial of their kings. The tow kingdoms existed at different periods and in different places, but there are several reasons why they share similarities in the burial rites. These include the high esteem with which they held their kings and rulers and a shared belief in life after death.

Kings and rulers were held in high esteem by the people over whom they ruled. The Egyptians believed that their Pharaohs were wise men close to the gods. The kings were therefore highly respected, and this is shown in their burial place and the rituals surrounding their death. Their coffins were made of wood and gold, to show that their kings were just as precious in life as in death. The Egyptians also took care to bury their kings to maintain a connection with the goods such as Ra, the god of the sun. The Mayans shared similar beliefs in the elaborate tombs built for their kings and the shrines on top of the pyramids. The kings would still hold a special place in their kingdom even after death.

The second reason why the Mayans and Egyptians had similar burial rituals is that they believed in life after death. Egyptian Pharaohs were mummified, which kept their bodies intact for many years. It was thought that the spirit lived on after death and needed to get back to the body for rest. The Mayans allowed their kings to decompose, but the bones were later sprinkled with mercury oxide. Such after death rituals show a belief in life after death. The pyramids of both Mayans and Egyptians contained everyday objects and paintings, an indication of the continuity of life after death.

Multiple Sclerosis disease

Multiple Sclerosis (MS) is a chronic, often disabling disease that randomly attacks the central nervous system (brain and spinal cord). The progress, severity and specific symptoms of the disease cannot be predicted; symptoms may range from tingling and numbness to paralysis and blindness. MS is a devastating disease because people live with its unpredictable physical and emotional effects for the rest of their lives. MS is a well-known disease, but poorly understood. In the United States there are approximately 200 new cases diagnosed each week; MS is a common disease and not always caused by genetics. Therefore, I feel we all need to have a better understanding of this disease that has no cure yet. I hope to make MS more understanding in my paper. In my paper I will explain what MS is, who gets MS, what MS has to do with the metabolism, some new techniques being used to pinpoint genetic factors, what some of the symptoms of MS are.

Multiple Sclerosis (MS) is a progressive disabling illness that affects nerve cells in the brain and spinal cord (Bernard). Under normal conditions an insulating sheath made of fatty myelin, which speeds the passage of nerve impulses, surrounds these nerve cells. In MS, this myelin sheath is inflamed or damaged, disrupting nerve impulses and leaving areas of scarring (sclerosis). The disruption of nerve signals within the brain and spinal cord causes a variety of symptoms that may affect vision, sensation, and body movements. These symptoms usually wax and wane through a series of relapses (episodes when symptoms suddenly get worse) alternating with remissions (periods of recovery, when symptoms improve). (Brunnscheiler) For many patients, a long history of MS attacks over several decades’ leads to slowly progressing disability, but for others the disability is more rapid and severe. MS is a life-long chronic disease diagnosed primarily in young adults who have a virtually normal life expectancy. Consequently, the economic, social, and medical costs associated with the disease are significant. Estimates place the annual costs of MS in the United States in excess of $2.5 billion. (Melvin) No one knows exactly how many people have MS. It is believed that, currently, there are approximately 250,000 to 350,000 people in the United States with MS diagnosed by a physician. (Boyden) This estimate suggests that approximately 200 new cases be diagnosed each week. Also, MS is the most common nerve disease to develop in young persons after birth, and it affects over 1 million young adults worldwide. Close relatives of a person with MS are 8 times more likely than average to develop the disease themselves, and children of a person with MS run 30 to 50 times the average risk. (Waxman) Most people experience their first symptoms of MS between the ages of 20 and 40, but a diagnosis is often delayed. This is due to both the transitory nature of the disease and the lack of a specific diagnostic test–specific symptoms and changes in the brain must develop before the diagnosis is confirmed. (Health Central) Although scientists have documented cases of MS in young children and elderly adults, symptoms rarely begin before age 15 or after age 60. Whites are more than twice as likely as other races to develop MS. In general, women are affected at almost twice the rate of men; however, among patients who develop the symptoms of MS at a later age, the gender ratio is more balanced. (Waxman) To understand what is happening when a person has MS, it is first necessary to know a little about how the healthy immune system works. The immune system — a complex network of specialized cells and organs — defends the body against attacks by “foreign” invaders such as bacteria, viruses, fungi, and parasites. It does this by seeking out and destroying the interlopers as they enter the body. Substances capable of triggering an immune response are called antigens. (Hofmann) The immune system displays both enormous diversity and extraordinary specificity. (Hofmann) It can recognize millions of distinctive foreign molecules and produce its own molecules and cells to match up with and counteract each of them. In order to have room for enough cells to match the millions of possible foreign invaders, the immune system stores just a few cells for each specific antigen. When an antigen appears, those few specifically matched cells are stimulated to multiply into a full-scale army. Later, to prevent this army from overextending, powerful mechanisms to suppress the immune response come into play. T-cells, so named because they are processed in the thymus, appear to play a particularly important role in MS. They travel widely and continuously throughout the body patrolling for foreign invaders. In order to recognize and respond to each specific antigen, each T cell’s surface carries special receptor molecules for particular antigens. T cells contribute to the body’s defenses in two major ways. Regulatory T cells help orchestrate the elaborate immune system. (Kaser) For instance, they assist other cells to make antibodies, proteins programmed to match one specific antigen much as a key matches a lock. Antibodies typically interact with circulating antigens, such as bacteria, but are unable to penetrate living cells. Chief among the regulatory T cells is those known as helper (or inducer) cells. Helper T cells are essential for activating the body’s defenses against foreign substances. (Kaser) Yet another subset of regulatory T cells acts to turn off, or suppress, various immune system cells when their job is done. Killer T cells, on the other hand, directly attack diseased or damaged body cells by binding to them and bombarding them with lethal chemicals called cytokines. ( Kaser) Since T cells can attack cells directly, they must be able to discriminate between “self” cells (those of the body) and “nonself” cells (foreign invaders). To enable the immune system to distinguish the self, each body cell carries identifying molecules on its surface. T cells likely to react against the self are usually eliminated before leaving the thymus; the remaining T cells recognize the molecular markers and coexist peaceably with body tissues in a state of self-tolerance. In autoimmune diseases such as MS, the detente between the immune system and the body is disrupted when the immune system seems to wrongly identify self as nonself and declares war on the part of the body (myelin) it no longer recognizes. (Hauser) Through intensive research efforts, scientists are unraveling the complex secrets of the malfunctioning immune system of patients with MS. Components of myelin such as myelin basic protein have been the focus of much research because, when injected into laboratory animals, they can precipitate experimental allergic encephalomyelitis (EAE), a chronic relapsing brain and spinal cord disease that resembles MS. The injected myelin probably stimulates the immune system to produce anti-myelin T cells that attack the animal’s own myelin. (Leuven) Investigators are also looking for abnormalities or malfunctions in the blood/brain barrier, a protective membrane that controls the passage of substances from the blood into the central nervous system. It is possible that, in MS, components of the immune system get through the barrier and cause nervous system damage. Scientists have studied a number of infectious agents (such as viruses) that have been suspected of causing MS, but have been unable to implicate any one particular agent. (Mayo Clinic) Viral infections are usually accompanied by inflammation and the production of gamma interferon, a naturally occurring body chemical that has been shown to worsen the clinical course of MS. It is possible that the immune response to viral infections may themselves precipitate an MS attack. The genes a person inherits may help determine whether that person is at increased risk for developing MS. ( Melvin) While there is evidence from studies that this genetic component exists, it appears to be only one factor among several. Most likely an individual s genetic blueprint ultimately determines if that individual will be susceptible to a triggering factor, which in turn initiates the autoimmune process that leads to the development of MS. In the past few years, scientists have developed a set of tools that gives them the ability to pinpoint the genetic factors that make a person susceptible to MS. These tools are the methods of molecular genetics techniques used to isolate and determine the chemical structure of genes. (Colin) In the 1980s, scientists began to apply the tools of molecular genetics to human diseases caused by defects in single genes. This work led to major advances in understanding diseases such as Duchenne muscular dystrophy and cystic fibrosis. The situation for diseases such as multiple sclerosis is more complicated. Scientists now believe that a person is susceptible to multiple sclerosis only if he or she inherits an unlucky combination of several genes. (Colin) Advances in molecular genetics and the identification of large families in which several members have MS “multiplex” MS families have made possible research to uncover MS susceptibility genes. Since 1991, the National MS Society has supported an international project searching for these genes. (National Multiple Sclerosis Society) However, even though genetic (inherited) factors seem to play a large role in the development of MS, no single MS gene has been identified so far. Instead, scientists suspect that MS develops because of the influence of several genes acting together. Many multiplex families from throughout the world have agreed to participate in these studies. The researchers are looking for patterns of genetic material that are consistently inherited by people with MS. These recognizable patterns are called “DNA markers.” (Melvin) When one of these markers is identified, scientists focus on that area, seeking additional markers closer to that gene. Eventually the location of that gene can be identified. This process of moving closer to the gene until it is identified has to be repeated for each of the marker regions from the multiplex families. (Melvin) By 1996, as many as 20 locations that may contain genes contributing to MS were identified, but no single gene was shown to have a major influence on susceptibility to MS. (Melvin) Research will likely find that other, as yet unidentified, genes contribute to MS. After the location of each susceptibility gene is identified, the role that the gene plays in the immune system and neuralgic aspects of people with MS will have to be determined. Because the immune system is so involved in MS, many scientists think at least some of the susceptibility genes are related to the immune system. Already there have been reports linking some immune system genes to MS. Further indications that more than one gene is involved in MS susceptibility comes from studies of families in which more than one member has MS. Several research teams found that people with MS inherit certain regions on individual genes more frequently than people without MS. Of particular interest is the human leukocyte antigen (HLA) or major histocompatibility complex region on chromosome 6. HLAs are genetically determined proteins that influence the immune system. ( Kaser) The HLA patterns of MS patients tend to be different from those of people without the disease. Investigations in northern Europe and America have detected three HLAs that are more prevalent in people with MS than in the general population. Studies of American MS patients have shown that people with MS also tend to exhibit these HLAs in combination–that is, they have more than one of the three HLAs–more frequently than the rest of the population. Furthermore, there is evidence that different combinations of the HLAs may correspond to variations in disease severity and progression. (Kaser) Studies of families with multiple cases of MS and research comparing genetic regions of humans to those of mice with EAE suggest that another area related to MS susceptibility may be located on chromosome 5. Other regions on chromosomes 2, 3, 7, 11, 17, 19, and X have also been identified as possibly containing genes involved in the development of MS. (Hauser) These studies strengthen the theory that MS is the result of a number of factors rather than a single gene or other agent. Development of MS is likely to be influenced by the interactions of a number of genes, each of which (individually) has only a modest effect. Additional studies are needed to specifically pinpoint which genes are involved, determine their function, and learn how each gene’s interactions with other genes and with the environment make an individual susceptible to MS. In addition to leading to better ways to diagnose MS, such studies should yield clues to the underlying causes of MS and, eventually, to better treatments or a way to prevent the disease. (Ronthal) Finding the genes responsible for susceptibility to MS may lead to the development of new and more effective ways to treat the disease. Such research could also uncover the basic cause of the disease and help predict the course of the disease in an individual. This would make it easier for physicians to tailor therapies and provide information to help people make life decisions. Another possible benefit may be the early diagnosis of people in families where one or more member already has MS. Many physicians believe that the earlier MS is diagnosed and treatment begun, the better the outcome will be. Symptoms of MS may be mild or severe, of long duration or short, and may appear in various combinations, depending on the area of the nervous system affected. Complete or partial remission of symptoms, especially in the early stages of the disease, occurs in approximately 70 percent of MS patients. The initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye. (Brunnscheiler) Inexplicably, visual problems tend to clear up in the later stages of MS. Inflammatory problems of the optic nerve may be diagnosed as retrobulbar or optic neuritis. Fifty-five percent of MS patients will have an attack of optic neuritis at some time or other and it will be the first symptom of MS in approximately 15 percent. This has led to general recognition of optic neuritis as an early sign of MS, especially if tests also reveal abnormalities in the patient’s spinal fluid. (National Multiple Sclerosis Society) Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance at some time during the course of the disease. These symptoms may be severe enough to impair walking or even standing. In the worst cases, MS can produce partial or complete paralysis. Spasticity, the involuntary increased tone of muscles leading to stiffness and spasms–is common, as is fatigue. (Brunnscheiler) Fatigue may be triggered by physical exertion and improve with rest, or it may take the form of a constant and persistent tiredness. Most people with MS also exhibit paresthesias, transitory abnormal sensory feelings such as numbness, prickling, or “pins and needles” sensations; uncommonly, some may also experience pain. Loss of sensation sometimes occurs. Speech impediments, tremors, and dizziness are other frequent complaints. Occasionally, people with MS have hearing loss. (Brunnscheiler; National Multiple Sclerosis Society) Approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked. In fact, they are often detectable only through comprehensive testing. Patients themselves may be unaware of their cognitive loss; it is often a family member or friend who first notices a deficit. Such impairments are usually mild, rarely disabling, and intellectual and language abilities are generally spared. (Brunnscheiler) Cognitive symptoms occur when lesions develop in brain areas responsible for information processing. (Brunnscheiler) These deficits tend to become more apparent as the information to be processed becomes more complex. Fatigue may also add to processing difficulties. Scientists do not yet know whether altered cognition in MS reflects problems with information acquisition, retrieval, or a combination of both. Types of memory problems may differ depending on the individual’s disease course (relapsing-remitting, primary-progressive, etc.), but there does not appear to be any direct correlation between duration of illness and severity of cognitive dysfunction. (National Multiple Sclerosis Society) Depression, which is unrelated to cognitive problems, is another common feature of MS. (Brunnscheiler) In addition, about 10 percent of patients suffer from more severe psychotic disorders such as manic-depression and paranoia. Five percent may experience episodes of inappropriate euphoria and despair–unrelated to the patient’s actual emotional state known as “laughing/weeping syndrome.” This syndrome is thought to be due to demyelination in the brainstem, the area of the brain that controls facial expression and emotions, and is usually seen only in severe cases. (National Multiple Sclerosis Society) As the disease progresses, sexual dysfunction may become a problem. Bowel and bladder control may also be lost. (Health Central) In about 60 percent of MS patients, heat, whether generated by temperatures outside the body or by exercise may cause temporary worsening of many MS symptoms. In these cases, eradicating the heat eliminates the problem. Some temperature-sensitive patients find that a cold bath may temporarily relieve their symptoms. For the same reason, swimming is often a good exercise choice for people with MS. (Wenzel) The erratic symptoms of MS can affect the entire family as patients may become unable to work at the same time they are facing high medical bills and additional expenses for housekeeping assistance and modifications to homes and vehicles. The emotional drain on both patient and family is immeasurable. Counseling may help MS patients, their families, and friends find ways to cope with the many problems the disease can cause. (Lambert) There is as yet no cure for MS. Many patients do well with no therapy at all, especially since many medications have serious side effects and some carry significant risks. (Health Central) Naturally occurring or spontaneous remissions make it difficult to determine therapeutic effects of experimental treatments; however, the emerging evidence that MRIs can chart the development of lesions is already helping scientists evaluate new therapies. Until recently, the principal medications physicians used to treat MS were steroids possessing anti-inflammatory properties; these include adrenocorticotropic hormone (better known as ACTH), prednisone, prednisolone, methylprednisolone, betamethasone, and dexamethasone. Studies suggest that intravenous methylprednisolone may be superior to the more traditional intravenous ACTH for patients experiencing acute relapses; no strong evidence exists to support the use of these drugs to treat progressive forms of MS. Also, there is some indication that steroids may be more appropriate for people with movement, rather than sensory, symptoms. (Mayo Clinic) While steroids do not affect the course of MS over time, they can reduce the duration and severity of attacks in some patients. The mechanism behind this effect is not known; one study suggests the medications work by restoring the effectiveness of the blood/brain barrier. Because steroids can produce numerous adverse side effects (acne, weight gain, seizures, psychosis), they are not recommended for long-term use. (Bernard) One of the most promising MS research areas involves naturally occurring antiviral proteins known as interferons. Two forms of beta interferon (Avonex and Betaseron) have now been approved by the Food and Drug Administration for treatment of relapsing-remitting MS. A third form (Rebif) is marketed in Europe. Beta interferon has been shown to reduce the number of exacerbation s and may slow the progression of physical disability. When attacks do occur, they tend to be shorter and less severe. In addition, MRI scans suggest that beta interferon can decrease myelin destruction. (Mayo Clinic) Investigators speculate that the effects of beta interferon may be due to the drug’s ability to correct an MS-related deficiency of certain white blood cells that suppress the immune system and/or its ability to inhibit gamma interferon, a substance believed to be involved in MS attacks. Alpha interferon is also being studied as a possible treatment for MS. (Mayo Clinic) Common side effects of interferons include fever, chills, sweating, muscle aches, fatigue, depression, and injection site reactions. (Health Central) Scientists continue their extensive efforts to create new and better therapies for MS. Goals of therapy are threefold: to improve recovery from attacks, to prevent or lessen the number of relapses, and to halt disease progression. In conclusion, MS is a disease that is well known but poorly understood by the medical and nursing community as well as the general public. It has no known cure and the genes that are accountable for it have yet been pin pointed. The United States is capable of finding a cure for this disease; over the years, medical researchers have found cures for many diseases that were thought incurable. Not only time and money are needed to find a cure for this disease, but faith and heart are needed to realize the importance.

Bibliography:

Works Cited

Bernard, Bobby. Multiple Sclerosis Continues to Puzzle Scientists. The Vermillion March 1998

Brunnscheiler, H. Problems Associated with MS, 28 July, 1999

Inteli Health http://www.intelihealth.com, 28 July, 1999

Boyden, Kathleen M. Compolmer-1 in the Treatment of Multiple Sclerosis. Journal of Neuroscience Nursing, 5 October 1998

Waxman, Stephen. Demyelinating Diseases — New Pathological Insights, New Therapeutic Targets. New England Journal of Medicine 29 Jan. 1998, Vol. 338, No. 5, 323-327.

Hofmann, Robert. Health Central General Information about Multiple Sclerosis

16 July, 1999

Kaser, Arthur. Inter Multiple Sclerosis American Journal of Human Genetics June 1998, 62:492-495

Multiple Sclerosis

Name of Student

Name of Institution

Multiple Sclerosis

Multiple Sclerosis is a disease that disrupts information-flow between the body and brain, and also within the brain. It is a disabling, unpredictable disease that targets the central nervous system. Its cause is yet unknown and is assumed to be exposure to environmental factors, also unknown, to people who may react. The total number of victims are unknown but are estimated to be over two million world over. The unknown number of victims is because the symptoms may be completely invisible and because responsible bodies have not been required to register new cases.

The contraction of this disease is based on several risk factors the first of which is age. Studies on research data have shown that the age group of between fifteen to sixty have the highest likelihood of getting the disease. The other risk factors are gender, family history, certain infections, race, climate, lifestyle and certain autoimmune diseases. Lifestyle, smoking for instance, makes an individual to be more inclined to register the second series of attack on the central nervous system(CNS)(Weiner, 2005). These attacks are thought to be done by the immune system of the body that has lost some of its purpose of protecting the body(Phelps, 2010). Whilst both men and women are victims of this terrible disease, most of the cases have been registered in women. Women therefore, have been deduced to be more inclined to contract the illness than their male counterparts(Weiner, 2005). Through study on race and family history, it has been concluded that white people especially from Northern Europe or of this decency are more vulnerable. They have reported more cases unlike their Asian, African and Native Americans counterparts(Phelps, 2010). People who have type 1 diabetes, the thyroid disease, the inflammatory bowel disease, and other viral infections that have been linked to the MS are also more likely to develop it(Longnecker, 2008). The infections make patients susceptible to the symptomatic development of the Multiple Sclerosis. Climate is thought to affect the contraction rates as individuals from the more temperate regions have been affected a lot less than individuals from the colder parts of the globe(Longnecker, 2008).

The objectives/ aims and purposes of this study are highlighted in the following sentences. First, the resarch study aims to identify the target group/ the groups that have fallen more victims to MS. The second objective is to identify the typical symptoms of MS and the root causes of these symptoms. Thirdly, the study analyzes the fatality and effects of MS, the effectiveness of the diagnosis and available treatment.

Research Hypotheses

A hypothesis is a statement of investigation for a researcher. Usually, the development of a theory is based on an assembly of facts organized in an intricate pattern such that a relationship arises therefrom. The resultant theory has more meaning and is more concrete because it has its backing on substantial facts (Martin & Bridgmon, 2012). From that point, relationships that do not ackmowledge individual facts in a theory are examined. When doing this, the researcher normally has little knowledge of the correctness of the relationships he or she attributes to the facts. These formulated relationships are what make up a hypothesis. A verified hypothesis is sufficient ground to interpret a particular theory in the future. Essentially, the hypothesis is a predictor of something unknown (Martin & Bridgmon, 2012). Such prediction can be tested to ascertain whether it is valid. During such testing, the prediction may turn out to be in line with common sense. In the same measure, the prediction could turn out to be correct or incorrect. Overall, the testing is empirical. This means that the outcome is not necessarily important so long as it is an answer to the prediction. Overall, a hypothesis serves the function of relating different phenomena in some way to permit an empirical analysis of the same. This function calls for a research design that eventually proves or disproves the hypothesis based on the data gathered during the research (Martin & Bridgmon, 2012).

Hypothesis 1

Among people with multiple sclerosis, there is no difference in recurrent fall frequency with and without physical therapy.

Hypothesis 2

Among people with multiple sclerosis, there is a difference in recurrent fall frequency with and without physical therapy.

The research is also guided by the following thesis and antithesis.

Thesis: Physical therapy helps prevent recurrent falls in people with multiple sclerosis.

Antithesis: Physical therapy does not help prevent recurrent falls in people with multiple sclerosis.

The nature of this disease is not clear yet to scientists in this field. This research proposal examines some of the facts behind the MS and restates clarity.

The Background of Multiple Sclerosis

The first case of multiple sclerosis was registered in Rotterdam in the late 1300s on a woman who has been canonized as St. Lidwina. Through to the 1800s, no one understood really this disease. Over the years, individual cases of MS have been stated in great detail. Jean-Martin Charcot, the father of modern neurology, introduced the first cohesive perspective of MS in 1869(Longnecker, 2008). The diagnosis of MS is not easy but has been made simpler to technicians by introduction of technically advanced resources. Previously, there were no neurologists with the skill to carry out this diagnosis. At the moment, the FDA approved treatments for MS are six(Longnecker, 2008). There are also seventy new therapies at different stages of trial which will be tested at Stanford. There’s a Multiple Sclerosis center at Stanford that has a team of highly qualified neurologists offering a special diagnostics and treatment. The treatment offers comprehensive individualized care combined with great research opportunities. It also has access to clinical trials and state-of-the-art technology that include the electrodiagnostics and the Magnetic Resonance Imaging(MRI). It has services like immunology infusion, information on current treatment and research and follow-up services.

Early Signs and Symptoms of MS

It has symptoms that include optic neuritis(vision problem). In this case, an individual’s central vision is disrupted because of the inflammation of the optic nerve. The degenerative effect is slow so this makes the vision problem not be noticed immediately. The other symptom is numbness and tingling on the fingers, arms, legs and face. This occurs when the MS affects the brain and spinal column prompting them to send mixed signals(Longnecker, 2008). Involuntary spasms of muscles and chronic pain are also common occurrences. The condition also comes with knee jerking movements that are involuntary and extremely painful. The third symptom is unexplained weakness and fatigue that affects e80% of victims at the early stages of the infection(Weiner, 2005).. MS is also characterized by problems in balance coupled with dizziness. Also affecting an up to 80% population of total victims, problems with the bladder, bowls and sexual dysfunctions also characterize MS. The problems occur because most of these activities are controlled by the central nervous system that is attacked by the MS(Weiner, 2005). Problems with language, memory loss, shortened attention span and reduced levels of concentration mark another symptom. The cognitive malfunction affects at least half the total victims. Major depression and the pseudo bulbar affect are also common among people with the MS. Other symptoms may include seizures, memory loss, uncontrollable shaking, breathing problems, slurred speech and problems in swallowing(Longnecker, 2008).

There are mixed information on the group that is targeted by the Multiple Sclerosis. Whilst previously scientists still held on to the ground that it affects no particular group or race of the human, contradictory information and research have proven otherwise. Scientists have now observed that the Multiple Sclerosis is more common among people from Northern Europe, or of this line of decency(Weiner, 2005). They hold that it has become more common among the Latino or people with Latino backgrounds. Their research holds that people of African decency, Asians or Native Americans have the lowest risk. The findings of this research has a created a presumption that vitamin D plays a factor in the level of risk. People around the equator, who are exposed to more sunlight hence more vitamin D, have low levels of risk of contraction(Longnecker, 2008).

The MS is not easy to diagnose because the early warning signs are always not directly associated with it as they are also caused by other conditions(Weiner, 2005). Symptoms like poor vision and memory loss are often handled for what they are because MS tend to appear with different symptoms in victims. The MS is not easy to diagnose because it has no single tests. It also takes time because diagnosis can only be confirmed after evidence of at least two episodes of activities of the disease on the central nervous system(Longnecker, 2008). Despite all the challenges however, a series of technical advances have been made that make the whole process possible, though it still is gradual.

There are no death cases directly linked to the Multiple Sclerosis. The medication has also been considered very safe with mild side effects. Though conditions like severe pulmonary complications, severe sepsis and aspiration pneumonia may lead to death. Aspiration Pneumonia is a result of deposition of food and liquid particles in the respiratory tract as a result of difficulty in swallowing. Poor nutrition, decreased sensation, immobility/ inactivity and bladder incontinence may cause sepsis, especially if left untreated. The MS also limits an individual’s ability to exercise, weakens their muscles and make them vulnerable to other infections. It is the contraction of such diseases like cancer, heart complications and stroke that may lead to an individual’s demise. Cases of victims committing suicide to avoid the problems they are going through have also been reported. Multiple Sclerosis is therefore not directly fatal, but both the physical and mental conditions that come with it are what may be fatal(Longnecker, 2008).

The MS has no permanent cure and the only available treatments are control measures(Jelinek, 2010). A number of disease-modifying drugs have been proven to slow the progression of MS in some people. These drugs suppress or alter the activities of the body’s immune system and are based on the theory that the immune system attacks the myelin surrounding nerves. The drugs serve to reduce the development of new brain lesions and the frequency and severity of attacks like the convulsions. Early diagnosis is very important as it creates time to find the drug that a patient can use comfortably. It also helps in curbing the developments of the disease, by slowing its growth and advances from early stages.

The objectives that have been set for this research proposal serves to explain diagnosis and treatments for MS. They also examine vulnerability of some individuals and the environmental factors that propagate this disease.

The Conceptual Framework of The Proposal.

Multiple Sclerosis

Factors for InfectionSymptoms

environmental, diet, gender, geneticweakening of muscles, breathing problems, cognitive problems, balance problems, dizziness and fatigue

DiagnosisOther Infections

MRI, Cerebrospinal Fluid(CSF), Respiratory Pneumonia, Heart attacks

Evoked Potentials(EP)Sepsis

Treatment/ Control

Drugs-oral and injections(intravenous, subcutaneous, intrathecal)Therapy

This conceptual framework explains the relationship among the variables of the proposal. The independent variable is the factors for infection. It leads to infection and symptoms. The symptoms lead to diagnosis, other infections and treatment. Diagnosis, affected by symptoms, also lead to treatment and control.

Research Methodology

Introduction

This proposal identifies the target group of the proposal and the reasons for their high likelihood of infection. Research conducted on information throughout the years from the first case in 1300 to date have pointed to geographical locations among other factors. The other factors include lifestyle, genetically factors and climatic factors. The research points out that people from a place of high infection rate who move out before puberty reduce the levels of risks. Now whilst diet and lifestyle may be the same among different populations, factors like climate and family trees make others more susceptible to infections. Most cases of MS are not diagnosed early because of the less obvious symptoms. The proposal examines the symptoms and their relation to each other. It scrutinizes the irregular symptomatic infections because so far, to two known patients have suffered from symptoms at the same rate, stage and style. The symptoms are always bare, but there are no measures that can help medics diagnose MS. The only option is to wait for the second attack by the Ms on the central nervous system and this takes time. The time taken/ lost leads to further development of the Multiple Sclerosis yet the earlier its arrested, the better and more stable an individual’s condition remains.

The MS itself has proven to be controllable, but the diseases/ opportunistic infections that may set in as its result have adverse effects (Jelinek, 2010). Through therapy and administering of drugs, the adverse effect of the immune system on the central nervous system is reduced. This leaves the patient in a more stable state. But the problems it causes like weakened muscles lets in other infections like heart diseases. Patients diagnosed with Multiple Sclerosis leave in fear of these other infections than their primary health state.

The Study Design

This research proposal adopts a qualitative design. It examines whether physical therapy helps avoid recurrent falls among people with Multiple Sclerosis. Information about the subject were collected through questionnaires, interviews and observations. This is a narrative research that has focused on a particular individual. Data in this research have been gathered through the collection and study of his testimonials.

Intervention

Multiple Sclerosis lacks a cure but measures to control it have been implemented(Weiner, 2005). Drugs that target to reduce the activities of the immune system, which is believed to be the primary cause of the disease, have been invented(Jelinek, 2010). When the immune system’s activities that target the central nervous system have been reduced, the speed with which the MS advances is curbed. The other mode of intervention is through the Behavioral Intervention. This has been effective in improving depression, motor function as well as fatigue. It has the potential to modify the disease by ameliorating the symptoms.

The method of intervention recommended by this study is therapy. There are two kinds of therapy that have been employed in the intervention against Multiple Sclerosis. The first is Physical Therapy(PT). The Physical Therapy can be used to intervene on the following symptoms; fatigue, walking difficulties, weaknesses, poor balance/ fall risk. It can also be used to intervene on stiffness, spasms and spasticity, pain, tremor/ ataxia, sensory changes that include proprioception and decreased functional independence. The second is Occupational Therapy(OT). The Occupational Therapy can be used to intervene on fatigue, weakness, balance/ fall risk, stiffness, spasms, spasticity and cognitive changes. It can also intervene on reduced manual dexterity, pain, tremor/ ataxia and sensory changes that include proprioception(Jelinek, 2010).

The reason for choice of therapy is that unlike drugs and medication, it just do not try to stop the development of the disease. It makes an attempt at reversing some of the conditions. It recreates psyche where hope had been lost, serves to strengthen weakened muscles and encourages a victim to take on the conditions head on. Occupational Therapy does not let the victim mentally fall into a state of regression, instead it instills in him the confidence to fight back and hold on.

Study Sample

The study is conducted at The Walden University Department of Online Students Registered with Disability. The choice for Walden University is factored by the love for the students whose mobility have been impaired. It therefore has a wide base from which proper and detailed information on Multiple Sclerosis, the biggest cause for mobility impairment.

Sampling Strategy

There are four sampling strategies overly. They include simple random, systematic, stratified random and cluster sampling strategies. The strategy chosen for this study is the systematic in which the produced samples are treated as random. It addresses the following issues. The first issue is to get sincere respondents who can help avoid response bias. Response bias results when a respondent deliberately conceals information from the researcher for various reasons. The second strategy is to help avoid non-response especially when respondents fail to answer phone calls, turn up for meetings or fill questionnaires. The third strategy is to get detailed full-cycle information. Therefore, the respondents should be experienced and well versed with social and scientific factors on Multiple Sclerosis(Jelinek, 2010).

Sampling frames

A sampling frame is the list of all the intendeded respondents for a study(Sparks, 2010). It is a list or other device, that a researcher uses to define his population of interest(Douglas, 2011). The randomness of choice of sampling depends on the level of accuracy of information required by the study(Velma, 2009). The element is introduced by picking a random number from and with which the selection should be started and based. Its samples form a block sample frame. There are two kinds of sampling frames which are list and non-list. Rarely can a researcher get direct contact to the population of his interests. The researcher must therefore rely upon a sampling frame to create a representation of all the elements of the population of interest(Jerry, 2009).

In this study, one in every ten students will be chosen to form a list sample frame. The sampling strategy and the sampling frames give a total of three group samples/ lists for the study.

Allocation of Treatment Arms

The three groups are then subjected to the three different methods of intervention. Every is allocated a different method from the previous. The purpose of different allocation is to verify/ compare the efficiency of each of the three intervention techniques to Multiple Sclerosis. The first group, marked as I, is subjected to medical intervention. The second group, marked as II, is subjected to the behavioral intervention. The third group is subjected to intervention by use of therapy, this group is christened group III.

The study variables

There are three variables for a research study. These are the dependent, independent and the confounding variables. The validity and reliability of a research study is increased when the variables are controlled by ensuring that the causal effects are eliminated(Jerry, 2009). It is also known as isolation of the independent variable. The process of isolating the independent variable, involves changing the other variables into consonants. Eradication of the research variables involves employing scientific measurements to negate or nullify them(Velma, 2010).

The research study on Multiple Sclerosis will have two variables that will govern the style of research after the conversion of the variables of research into constants. They include the independent and dependent variables. The independent variable of the study is physical therapy whilst the dependent variable is the falls in people with multiple sclerosis. This study does not bear a confounding variable.

Methods of Data Collection

Though a part of the research is observational, most of the data collection is conducted through survey. Methods like the use of questionnaires and interviews are employed. The reason for survey is to improve the level of communication with the respondents to get even their personal information. Survey improves precision and clarity of information as no research content is based upon assumptions. Questionnaires are distributed to the respondents/ members of the sample frames/ groups. The best response is then picked from the questionnaires once they have been submitted by the respondents. The respondent who filled the questionnaire is visited for an interview. The process is tedious but very effective.

Data Management

Data management is the manner in which data collected from a study is handled to serve the purposes of the study and also serve as a base of reference for future studies(Jelinek, 2010). When done effectively, data management helps in achieving clarity and cohesion of a research and study and intended future studies as well(Jerry, 2009). There are set procedural and order/ steps and guidelines for Data Management. The first is data collection from the recipients, then Data maintenance, storage, validation/ correction and manipulation(Jerry, 2009). The steps before precede data views, access, security and documentation(Jelinek, 2010). To achieve a high level of efficiency, this research study aims to follow the data management protocol.

Data mangement will be conducted is described in the paragraph herein. The recipients mail back their responses/ questionnaires. The questionnaires are then filed according to the samples/ groups that had earlier been set and marked as I, II and III respectively. The collected data is then validated and corrected to comply with the scientifically facts. Responses based on mythical theories without a scientific support are cancelled. The data is then extracted and changed into essays. The process of extraction is also known as Data Manipulation and Reporting.

The views and responses of the data must be clearly outlined in the essay. Relevant explanations are given where necessary to give clarity and make observational references. The data of this research findings should be made accessible to researcher’s and victims for future references. To make this easier, there should be hardcopies of the findings in the order of educational journals. A report on the data is also made as part of the documentation procedures.

Data Analysis

The aims of this research are to determine the number and incidences of MS patients with fall incidences while analyzing the effects that the condition has on the patients’ life, work and education

The paper also examines the effectiveness of the PT and OT in slowing down the advancements of the disability and reducing the frequency of falls . The General Practice Research Database and Hospital Episode Statistics data (Creswel, 2014) is the preferred method of data analysis for this study. Based on patient records and hospital intervention, the two methods will enable accurate compilation and analysis of data.

General Practice Research Database (GPRD)

The calculations on the follow up durations per patient are done annually to determine the fall incidences of patients per year and whether a diagnosis has occurred due to such falls (Carlin & Louis, 2008). The fall incidences will be estimated using passion regression models with logarithm (time at risk) as the offset variable (Martin & Bridgmon, 2012). The gender analysis is done separately and year and age are used as the variables for the models.

Hospital Episode Statistics (HES)

The available HES data for the patient population will be analyzed. Estimates of fall incidences within the time duration will be made using the GPRD data (Ott & Longnecker, 2008). The fall incidence rates will then be calculated using extra diagnosis from HES. Age-specific rates of fall incidence will be estimated from inverse polynomials and fitted to ratio cases from GPRD and HES versus GPRD alone (Creswel, 2014).

Dissemination of Research

Victims of Multiple Sclerosis are the main stakeholders in this research proposal. They are the focal point of the research. Because of their immediate contacts with the MS patients, the families and friends have information on the effects of this disease. The information that is firsthand, especially on the falling incidences and they should be handled is vital to the research(Martin & Bridgmon, 2012). For this reason these family members will also be part of the processes of the research. Research institutions that include health facilities and professionals, schools and their staffs and members of the community also play a vital role as stakeholders in this research. The reason for this is that they are privy to information on research and challenges faced by the victims of MS.

There is a need and necessity to formulate Government policies galvanizing the education and employment of MS patients. The victims always get victimized and discriminated against because of their sluggish movements and mobility problems. For this reason, Government representatives will also take part in the research. The media will also take part as the issue of MS fall incidences is a serious issue that should attract public awareness (Jelinek, 2012). They not only come to create awareness on the fall cases and reasons for fall, but also to decampaign the discrimination against the MS patients. Lastly, the research will source for sponsors who will also become part of the project to evaluate its progress and look into matters of transparency and accountability.

Ethical Issues

Physicians assert that in cases of probable diagnosis, at the early stages before the second attack on the CNS, patients should not be informed of the contraction of the disease. They base this on the argument that a medic’s first role is not to create panic but to relieve patients of pain (Phelps & Hassed, 2012). Telling patients the truth, they argue, could trigger mental agony rather than give patients a piece of mind. Justification for this is that the early phases of MS do not exhibit serious falls. Moreover, it is hard to precisely predict future experiences (Phelps & Hassed, 2012). Most patients will not understand anything about such future experiences.

Respect for persons calls for voluntary informed consent plus adequate patient information regarding the research aims, procedure, methods, potential risks and anticipated benefits (Phelps & Hassed, 2012). Patient autonomy is a very crucial principle – patients should be allowed freedom of expression, comment and adjustment as the research progresses. Moreover, when analyzing the benefits and risks of the research, they should be weighed critically based on the potential benefits of new interventions against the current ones (Phelps & Hassed, 2012). Lastly, justice should prevail when selecting the participants in the research. There should be no reasons other than ethical or scientific ones for including participants into the research.

The need to source for funding makes it necessary to seek IRB approval. The IB approval only comes when the validity of the research is clearly stated and emphasized. This research has its relevance steeped in the statements that follow. It articulates the woes and tribulations of the MS patients at school, work and even in their everyday life. Policy statements have been slow to capture the problems faced by the victims of MS. The key factor for this is that the research and reports made about this filed have not been sufficient. The research findings of this proposal therefore will serve to enhance policy development and create awareness concerning Multiple Sclerosis.

Secondly, assurances on the respondents/ participants ‘safety throughout the research have to be paramount. The research aims at participation of MS patients and other stakeholders at free will. During the research, measures to control and lessen any jeopardy/ risks of harm that might suffice during the research will be put in place. Moreover, there will be an efficient consent procedure whereby no participant feels compelled to take part in the research. In addition, withdrawal decisions will be honored. Lastly, before seeking IRB approval, the respondents’ perceptions on the research will be clarified.

References

Bowling, A. (2014). Optimal Health with Multiple Sclerosis: A Guide to Integrating Lifestyle,

Alternative, and Conventional Medicine… New York: Springer

Carlin, B. P. and Louis, T. A. (2008). Bayesian Methods for Data Analysis. New York: Springer

Creswell, J. W. (2014). Qualitative, Quantitative, and Mixed Methods Approaches. California:

SAGE Publications

Jelinek, G. (2010). Overcoming Multiple Sclerosis: An Evidence-Based Guide to Recovery.

Australia: Allen & Uwin

Martin, W. E. and Bridgmon, K. D. (2012). Quantitative and Statistical Research Methods:

From Hypothesis to Results. San Francisco: Jossey-Bass

Ott, R. L. and Longnecker, M. T. (2008). An Introduction to Statistical Methods and Data

Analysis. Wadsworth: Cengage Learning

Phelps, K. and Hassed, C. (2010). General Practice – Inkling: The Integrative Approach.

Australia: Churchil Livingstone

Weiner, H. L. (2005). Curing MS: How Science Is Solving the Mysteries of Multiple Sclerosis.

New York: Crown Publishing Group

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Chapter 7: Ethics

Section seven of the book “A Text with Readings” by Manuel Velasquez centers on ethics. According to Kant, ethics is about how individuals are to be worthy of happiness rather than being a doctrine concerning how to make themselves happy. In their daily activities, individuals are faced with moral questions that need to be addressed by values they have selected for themselves. In broader terms, ethics consists mainly of studying morality. It thus tries to define the things that are morally good in life as well as the actions that tend to be ethically correct. Ethics centers on morality, but it is not morality itself. Morality comprises of the standards that a person or a group possess concerning what is good and evil or what exists to be right and wrong.

The chapter further discusses ethics in terms of relativity and introduces two crucial words, and that is descriptive relativism and ethical relativism. Descriptive relativism articulates that societies typically differ in their moral standards. On the other hand, ethical relativism is the perception that the things that are morally right or wrong depend on an individual’s culture or society. Moreover, it further argues that there is no correct set of moral standards that are outlined for individuals to follow, but they should follow the norms that are accepted by their societies and culture. Therefore the author maintains that the ethical relativist should not assert that their moral standards are mistaken nor those of another culture.

Ethical relativism outlines that individual’s need to respectful and tolerant of other cultures moral beliefs and rejects the perception that their moral beliefs are the correct ones. However, they can criticize their own moral beliefs as well as those of others by rationally evaluating them. According to several traditional beliefs, individuals need to decide on what is morally right and wrong by observing the consequences of their actions. This leads to the consequentialist theory that holds that if one’s actions are right, then the act is correct and otherwise. However, there are those individuals who have adopted hedonism which is the outlook that only happiness or pleasure is inherently moral and it is only unhappiness or pain that is intrinsically immoral.

The chapter also discusses ethical egoism which asserts that morally right action is the one that initiates good and less bad consequences for an individual compared to any other activity. According to Harry Browne who is an American author, individuals should put their happiness ahead of others since the other individuals are doing the same. This is what is called ethical egoism. However, ethical egoism tends to have some disadvantages. Several philosophers maintain that ethical egoism is not impartial since it tends to favor an individual’s interests first and hence it is not morally dependable. In discussing the issue of ethics, rules, and consequences, Velasquez manages to answer the question of whether these issues makes an action right and whether they define morality. The author emphasizes on Act Utilitarianism and Rule Utilitarianism. Act utilitarianism holds that individuals should always act in a way that their actions generate the utmost happiness for every individual. Rule utilitarianism maintains that individuals should follow the rules that produce causes maximum pleasure.

The nonconsequentialist theories argue that the morality of an action critically depends on other factors rather than consequences and the issue leads to the Divine command theory as well as Buddhism. The Divine command concept tends to be a nonconsequentialist theory, and it commands individuals to abide by laws of God while Buddhism stresses on deliberate action, and it links morality to wisdom. The chapter closes by discussing that ethics are grounded on an individual’s character and emphasizing on the application of theories such as the normative ones to address issues such as abortion and euthanasia.

Works Cited

Velasquez, Manuel. Philosophy: A text with readings. Cengage Learning, 2016.

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Chapter 7. Local Governments in Texas

Challenges Facing County Governments

Counties are facing many issues that are becoming more demanding by the day. One such issue is problems with structural finances. Property taxes are going down when the growing cost of services is increasing, and the infrastructure in place is aging. These warrant repairs and maintenance of infrastructure under local governments such as roadways, sidewalks, water and sewer lines as well as municipal facilities. The growth of metropolitan areas is also causing increasing stress on roadways meaning these part of infrastructure requires attention as well. On top of these, counties have to deal with the economic impacts of climate change that bring about water scarcity and extreme weather. Technology is also bringing about regulatory problems to local governments as vocal parties demand that these advanced technologies be bound by regulation in ways that ensure existing industries are protected.

Declining county funding is a very significant problem for county governments. In addition to this, state governments are limiting the counties’ capacity to raise revenue. Forty-five states have put some limitations on the abilities of counties to raise money through property tax. Counties are forced to cut funding from crucial areas such as public safety to cover the deficits. States are increasing mandates for counties to implement without providing the funding required to do so.

To deal with the fragmentation of programs and services, county governments should engage nonprofits an social enterprises to generate a hybrid model of public services and one driven by profit. The need for public trash collection, habilitation of people dependent on drugs, safe housing options, and so forth have been answered by private entities. Citizens are given some degree of power to resolve their own issues that would otherwise burden these governments. Citizen engagement is thus essential, and the use of technology can help further this initiative. Citizen engagement means collaborative work that aides in building on past developments and incorporating new services.

Differences Between Strong-Mayor, Weak-Mayor and Council-Manager

A weak mayor kind of government uses a mayor-council method where he/she is subordinate to the council in terms of the mandate for policymaking and administration powers. The council employs a city manager and appoints the mayor as opposed to being elected. The council-manager is appointed by the council in which the mayor is a member. The mayor is elected by the citizens. A strong mayor or the mayor-council form of government has the mayor as the chief executive officer of the city and does not employ as city manager, maybe an admin to help run daily affairs. The strong-mayor form of government is the most desirable for me because, as a mayor, one would like to do things his way. The issues one promised the electorate deal with once elected will be easily executed without needing approval and without including limitations.

Chapter 8. Public Opinion and the Media in Texas

Why Texas Democrats Trust the Supreme Court more than Other Government Branches

Despite the Supreme Court being the least understood branch of government, it is the most trusted. Democrats in Texas believe that supreme court judges follow the law and not political ideas when rendering their decisions on issues. Texas Democrats believe that Supreme Court judges base their decision solely on the law. There have been partisan battles recently over the highest court in the land. However, a majority of people, including Texas Democrats, believe that the court holds a moderate position in this liberal-conservative continuum. This opinion about the supreme court by Texas Democrats increases with more knowledge on the court and the decision of judges. In essence, the Supreme Court is specially capable of commanding respect, especially when compared against other government branches, and most of all, those citizens that are aware of the roles of justices under the constitution.

Why Republicans and Independents in Texas Trust Trump more than the Supreme Court

Trust in the executive, particularly Trump, is strongly related to party support. Almost all Republicans have trust in the president because he is, of course, conservative as they are. Republicans trust the Supreme court more than they distrust it but not as much as they trust the president. Some believe that the Supreme Court sometimes leans to the liberal side. A good example is a decision made by the supreme court in the last few terms. The decision to stop President Trump’s addition of work as an eligibility requirement for Medicaid is one that may be considered by liberals as to lean towards the liberal direction because it was President Obama who expanded this program. Independents do not support the Supreme court as much as they do the president because they believe that the Supreme Court may be leaning to one side of this partisan continuum. Unlike the president who has the right to have biased ideas, the Supreme Court should be strictly unbiased, and when a little biasness is perceived, independents would rather side with the side that is not selling out. Independents in Texas might have supported Trump despite them being on no side, which means they have trust in him.

Chapter 9. Voting and Political Participation in Texas

Effects of voter ID laws on Turnout in Texas

The Texas voter ID laws require voters to have with them a government-issued ID such as an identification certificate, a driver’s license, a US passport or a military ID. Such requirements disenfranchise minority voters who face significant limitations when applying for these IDS. The laws accept a license to carry a gun but decline a government or school-issued ID, which is just absurd. It is known that white people in Texas are the minority with licenses to carry handguns. Minorities face huge barriers to obtain a gun license; that is why these laws can be perceived to be discriminatory. Other states permit various forms of ID that are excluded from Texas laws, which keep a lot of people from voting. These laws, according to Judge Nelva Gonzales Ramos from the US District Court of Southern District of Texas, had a discriminatory effect. These laws affect voter turn out by targeting particular races and enacting restrictions that most certainly appear to keep them away from the ballot. These patterns of requirements under these laws cannot be explained by grounds other than race.

Barriers should not accompany the right to vote. The voter ID laws keep many away from the ballot, deprive them of their constitutional right to vote, and directly oppose the country’s progress towards including more Americans in the democratic process. Many Americans do not have access to the forms of identification included in these laws. These voters are disproportionally low-income, from racial minority groups, and other vulnerable demographics. These voters have a hard time obtaining ID because either they cannot afford to obtain the documents required to obtain a photo ID card issued by the government. A study by GAO indicates that voter ID laws reduce voter turn out by about 2 to 3 percentage points, which means tens of thousands of Texas residents cannot vote.

Why I oppose these laws

I oppose these laws because almost 11 percent of Americans do not have a government-issued photo ID (ACLU). Again, obtaining this ID requires money, an expense that low-income Americans cannot foot. This includes the combined cost of document fees, waiting time, and the cost incurred during travel. When these costs are combined, they come to between $75 to $175. The elderly and people with disabilities cannot be able to travel as well as those people coming from rural areas. People from Rural Texas travel up to 170 miles to the next ID office.

The discriminatory aspect of these laws mostly influences my stand against this law. Minority voters do not have the IDs required for voting as compared to white people. A quarter of African-Americans across the nation of voting age do not have photo IDs from the government in which is quite disproportional, considering only 8 percent of whites lack these photo IDs. Besides, allowing permits for handguns to vote and disallowing other forms of ID such as student IDs is straight-up discriminatory. Again, the majority of minorities do not have handgun permits, which are also hard to obtain when one is from either of these groups.

Chapter 10. Campaigns and Elections in Texas

The Role of the Media in elections

The media is central to the proper function of a democratic nation. The media usually plays a watchful role. They conduct autonomous scrutiny and discuss the strengths and shortcomings of candidates, bodies that oversee elections, the government, and informs the public of the extent these agencies have carried out their mandate as required and join them in holding them accountable. The media also ensure public participation in elections by educating them on how to exercise this democratic right. They also provide reports on how the election is progressing. The media give candidates as well as their affiliated parties a platform to communicate with the electorate. It also allows the public to communicate their ideas, concerns and needs to the authorities and to people seeking to join the administration and provide a platform for them to interact on these issues.

The media so far has played most of its part as the backbone of this democratic nation. It has informed, criticized, and stimulated debate on various crucial occasions. The credibility of the media has, however, been in question. Its effectiveness is based on its responsibility to get its facts right, which I believe it has done. The media has dug deep, collected opinions from different people, and countercheck their facts thoroughly. It has not held back in rooting out deception and exposing liars, hypocrites, and the corrupt using counterchecked facts.

Where the media does not show much merit is avoiding to cause panic by exaggerating facts. It appears that the media these days is reliant on the information that cause havoc in order to draw public attention. The press is yet to lose the respect of the people and the nation at large, but there have been instances of irresponsibility, exaggeration, and mongering to influence sales.

Challenges that hinder minor party candidates from succeeding in statewide

Minority party candidates are a long way from ousting the Republican and Democratic hegemony that has characterized American politics for way over 150 years. Republicans and Democrats still reinforce archaic laws that ensure voters have only two choices at the ballot. When these two parties came to power during the early years, each with its turn, they created restrictions that bar outsiders from participating fully in the state as well as national elections.

In Arizona, for instance, Republicans and Democrats need to collect 6,000 valid signatures in order to be included in the ballot. However, this number is six times higher for independents who are required to bring them in the form of valid petitions. In reality, an independent would need to collect around 50,000 signature to make sure that they have 37,000 that are valid (Galen). Only candidates that are able to fund themselves or have independent notoriety can be able to make these targets. It is clear that these two dominant parties have no interest in entertaining further competition. Even if independents join the Green or Libertarian parties, which are considered traditional failures, they solve the ballot problem, but still, they suffer from the wasted-vote theory where voters see them as fringe groups with no likelihood of winning.

Works Cited

ACLU. “Oppose Voter ID Legislation – Fact Sheet.” American Civil Liberties Union, 2017, www.aclu.org/other/oppose-voter-id-legislation-fact-sheet.

Galen, R. “Opinion | Reed Galen: Here’s How to End America’s Ballot Box Duopoly.” NBC News, 17 Apr. 2018, www.nbcnews.com/think/opinion/how-republicans-democrats-prevent-independent-candidates-getting-ballot-ncna866466.

Multinational Enterprises

Table of Contents

Executive Summary—————————————————————————–3

Introduction————————————————————————————–4

MNE Analysis———————————————————————————–5

Industry/Sector Analysis———————————————————————–6

Country Analysis——————————————————————————–7

Analysis of Regional Organization———————————————————–8

FMSS/ Mode of Entry analysis and recommendation————————————-9

Conclusion—————————————————————————————15

Works Cited————————————————————————————-17

Executive Summary

Multinational enterprises are firms that have grown due to the availability of open market entries in many nations. Countries have opened their markets for foreign direct investments, which have encouraged companies to invest in those countries. The reason for this liberalization of markets is because foreign direct investments come with economic development as many locals get employed in addition to improved infrastructure among other benefits (Cantwell). This article touches on multinational business management. It first begins by introducing multinational businesses and their management. It then goes ahead to pick an MNE, Pv Crystalox, and analyzes it. The analysis is based on the current area of operations of the company. The analysis leads to the identification of a new target market are for the business. The identified market for Pv Crystalox is Brazil. Brazil is also analyzed to check inform the mode of entry for the business. After the analysis, it is found that Brazil is a low market region with moderate potential of growth in market. The possible methods for Pv Crystalox to enter into Brazil are analyzed. This is termed FMMS analysis (Eroglu).

There are five identified methods, which include no entry, sole venture, joint venture, exporting, and licensing. Each of these methods is examined and after a considerable deliberation of Brazil’s economic situation and government policies, sole venture is chosen as the mode of entry for Pv Crystalox. Sole venture is chosen because is seen as the most appropriate method for business that wants to exercise full control of their activities. The method offers Pv Crystalox high level of control for its businesses in Brazil. Moreover, it encourages it to apply experience gained in other countries in Brazil. Another thing that motivated this choice was that Pv Crystalox will integrate itself into the economic system of Brazil and develop at a fast pace and generally maximize profits. It is concluded that sole venture is the best methods of entry for Pv Crystalox and was to be adopted by the firm. The paper recommends Pv Crystalox to adopt sole venture in its mover strategy to Brazil. After this analysis, that summarizes the content of the article. Lastly, the various works cited in the articled are referenced.

Introduction

Multinational enterprises are businesses that operate in many nations. Most multinational enterprises operate in neighboring countries within a single continent. However, some large multinational enterprises exist in more than one continent. These enterprises get into new economies at a fast pace and grow depending on the government policies of the concerned nations. The main reason for the spread of multinational enterprises all over the world is the liberalization in many countries. Many nations have opened their markets for foreign direct investments. This implies that companies can move from one nation to another and establish their businesses. One thing that encourages many companies to invest in other nations is the availability of grace periods and the equal government duties and subsidies for new businesses (Dunning and Sarianna). This paper explores a multinational enterprise, Pv Crystalox. It assesses the strengths and the weaknesses of the company, examines its area of operation, and identifies a country that the MNE is supposed to extend its operations. After identifying the nation, it goes ahead and analyses the existing market of the country and business feasibility in the region. It then recommends the best move that the enterprise can use to get into the nation. Brazil has been chosen as the area of expansion for Pv Crystalox (Willeke).

MNE analysis

Pv Crystalox is a multinational enterprise based in the United Kingdom. The company produces and supplies multicrystalline silicon wafers. It provides the silicon wafers to several main photovoltaic producers all over the world. The company utilizes silicon feedstock to come up with multicrystaline silicon wafers and ingots. The production facilities for the silicon ingots is situated in Oxfordshire, UK, while the production services for the silicon wafers is situated in Erfurt, Germany. The company has fully owned subsidiary, solar silicon GmbH, is charged with production of silicon for the enterprise in the Bitterfeld. The company has other branches in Germany, Italy, Japan, USA, and China. Pv Crystalox is currently the leading supplier of photovoltaic silicon wafers (Pvcrystalox.com. 2013).

One of the strengths enjoyed by the company is a large market share. The company is currently commanding a half the world’s market in the production of silicon. The company has branches in several nations (Solar Power Feed-in Tariffs).

However, the company does not have any headquarters or industries in Australia and Latin America. These nations experience sunny weather over a half of the year. This gives reason for the production of solar panels in such nations. Competitors such as Sharp electronics, Kaneka Corporation, SolarWorld AG, Swiss Wafers AG, and ReneSolar Ltd have expanded their operations into many nations and established industries, as well as solar panel offices. However, in Latin America, none of these offices exist so far (Sharp-solar.com. 2013).

Strength of the company is that it has invested hugely on its research and demand sector. Its research and demand departments worldwide keep updating the business with any developing information, and projection future market demands that guide the decision makers and leaders in coming up with sound decisions with regard to the handling of its products. The other strength is that the company has focused on supply chain management. This helps in improving their productivity, speeding delivery, and reducing operations costs (Gatto).

Industry or Sector Analysis

The current environment in which Pv Crystalox operates predominantly is in the United Kingdom. The future of solar PV in this region is very vital to the subsidy level offered. Installation of big PV units in the past had been more profitable and numerous. Further installation of these units in the region would take up a large proportion of the residual budget while not meeting the aim of increasing household distribution generation of for households.

There are many estimates on the capacity of PV in the UK by 2020. DECC projects that 2.7 GW of PV will be available. The national grid projects that 1.5 GW may be installed, which was a revision from their earlier 3.5 GW estimate.

The market for PV can be broken into two—downstream and upstream. Upstream involves the marching of raw materials, like silicon, and the fabrication of inverters and PV modules. Downstream market touches on financing and installation of PV.

The United Kingdom is has little involvement in the upstream of PV. The upstream of UK capacity includes two manufacturing plants for PV units; Sharp’s Wrexham and Crystalox plant. The two combine to deliver 570 MW–a figure more than 90% of the total production capacity in UK by 2009 (IEA). Another company that manufactures in the UK is Romag.

Downstream services involve domestic businesses. It contributes up to a half of the quality established in the market of Solar PV. There is slight public information on how the downstream market unfolds. Collection of information about these values is very challenging. Majority of these units fitted in the UK are small in electrical capacity and volume.

Currently, the government supports the operation of Pv Crystalox in the UK. It does so through Feed –In Tariffs and involvement in the Renewables Obligation.

Country Analysis

The country that Pv Crystalox will venture into is Brazil. Brazil is a country found in the Latin. America. Brazil is a situated in a region that sunshine is not a problem. This implies that the production and sell of silicon wafers and ingots will be handy in Brazil. Many people will most likely buy Solar panels due to the sunny nature of Brazil.

In Brazil, there is low GDP and the GDP is projected to reduce at a rate of 4.32% due to the rise in inflation. Additionally, Brazil in the year 2012 earned revenue of $ 201.9 billion from exports. The and lower and the middle class in Brazil is composed of 67% of the total population. This creates a huge pool of demand for the solar products. Moreover, external analysis of Brazil technology shows that Brazil is constantly progressing towards a better future.

Moreover, the government of Brazil has good policies that touch on foreign direct investments and multinational enterprises. The country offers subsidies to new businesses. Its market is open to foreign direct investments. New businesses are given a six-year grace period after their founding before they start paying taxes to the government. This is hard to come by anywhere. Moreover, the tax rates levied by the government industries are same for both local and foreign countries. This means that companies have the chance of easily settling in Brazil, as there is no bias by the government.

Analysis of regional organization

The region that the country will establish its business is a large industrial region. Brazil has go many industries that are situated in collections forming families of industries. They industries enhance each other in so many ways. Some industries depend on each other for labor, market, source of raw materials and much more. The specific region that Pv Crystalox will be situated will be an area with good road networks. Brazil has good road networks linking industries to their main markets. Photovoltaic solar panels, being international products, can be exported to other neighboring countries in the Latin America. Therefore, the availability of good road networks makes it easy for the products to reach the market. Another important thing that Brazil emphasizes on is education for its populace. The level of literacy is high in Brazil. Many people have gone to school and therefore there is enough pool of labor for the business. The business will not have to import expats (Athukorala).

The establishment of Pv Crystalox in Brazil will also benefit the local population due to improved infrastructure. The establishment of an industry comes with the need for social amenities, such as water, electricity, and roads. This not only profits the organization but also brings many advantages to the local population. People will be able to water, electricity and good roads due to repairs that come with industries. Corporate social responsibility is another area that Pv Crystalox might consider while if Brazil.

FMSS/Mode of Entry Analysis and Recommendation

The method of entry for any firm into a foreign market is always determined by several factors. Firms do not just wake up one day and decide to venture into a market. There needs to be a study of the chosen market before deciding on the most appropriate mode of entry. Various modes of entry exist for MNEs to choose from before getting into new markets. The most typical entry modes available include exporting mode, joint venture mode, a sole venture ode, and a licensing mode. The choice of these methods depends on a number of factors that are based on a tradeoff between returns and risks (Gilroy).

There are three main determinant factors for the choice of an entry mode. They include location advantage of the firm, ownership advantage of the firm, and internalization advantages of incorporating transactions within the firm in a given nation. Ownership advantage involves the ability of a firm to come up with differentiated products, the size of the firm and its multinational experience. Location advantage entails the market potential and the investment risks resent in the new market. Internalization advantages involves contractual risks that are concerned with the cost of drafting and enforcing contacts, the risk of decline in value of services , and the risk of knowledge dissipation in a given area (Heinecke).

The choice of the most appropriate method of investment depends on the above three mentioned factors. It is through striking a balance in the above factors that a firm is able to effectively invest in a market and draw maximum profits from it. Most firms prefer investment modes that have both high market potentials and multinational experience. This is because the two factors aid in the growth of the business as the business adapts and develops at a fast rate. The development is owed to the fact that the firm has prior knowledge and skills and there is market for its activities. However, it is difficult to come by nations that offer both advantages. Most countries have these advantages but in limited scales. Some could offer high market potential but no multination experience on the firm and vice versa (Kleinert). Moreover, nations usually have policies that govern businesses. In some countries, policies for foreign direct investments are different from those of local investments. However, some nations treat all businesses equally. Restrictive policies for foreign direct investments usually curtail MNEs from venturing in certain markets. Changes in government policies also affect the way in which businesses operate in certain markets. This is because a change in the policies of a nation may bring repatriation of business earnings. Worse still, it can cause expropriation of a company’s assets (Jäger-Waldau).

Exporting as a mode of entry has its advantages and its misgivings. Companies normally choose exporting as a mode of entry due many factors. One such factor is limited resource availability. Exporting is chosen by businesses that lack the requisite capital to invest in new economies. Others prefer exporting when there are restrictive policies in the host nation while other prefers it when the host nation has a high investment risk. Exporting is normally characterized by low resource investment and this implies that the firm incurs low risk alternatives, as well as earns low return alternatives. However, the method does not come with market control, which is indispensable for many market-oriented firms. Firms do not get full control of investment activities in the host country and have no effect on decisions made that pertain to their operations (Lymbersky).

Another investment mode adopted by MNEs if the joint venture mode. This mode implies that a multinational firm collaborates with a business that is already established in the host nation. The two are commonly businesses in the same production line. There are usually signed covenants concerning risk/return sharing. Joint ventures are usually characterized by relatively low investment. They provide returns, controls, and risks that are in tandem with the extent of equity participation of the firm concerned. The motivations behind many firms investing in this mode are usually not in harmony with those of the partner firm in the host nation (Mababaya). However, the mode comes with a competitive advantage. This competitiveness is brought about by the integration of the two companies, which gives them a wider view of the market than that which can be spotted by individual businesses. The firm has the advantage of moving resources across national boundaries with ease. They can also use the experience gotten in one nation in another country whenever needed.

Sole venture is another mode of entry that is most commonly used by large firms with enough resources and skills to utilize in host countries. This is the most appropriate method for firms that require full control of their activities. The method is characterized by high resource investment and hgh return or risk alternative. The mode also offers a high level of control for businesses. Moreover, a firm can utilize the experience gained in one country in another country when need arises. The entry modes entails that a firm gets into a country and begins its operations from zero. This gives it a chance to integrate itself into the country’s economic system and develop depending on its financial position and the other environmental factors in the host nation. Most firms chose this mode because they prefer full control of their resources foreign countries. Full control comes with general profit maximization and hence firms should remain subordinate parents to their foreign venture (McIntyre, Ivanaj, and Ivanaj. ).

Licensing is another mode of entry for firms. It is characterized by low resource investment. It also comes with low risk or return alternatives and low control. This is the most unpopular means of venturing in foreign nations by firms. Mostly small firms that are at the initial stages of growth adopt the method. There no big businesses that always claim their growth from this method. However, most big firms say that firms normally use this method as a litmus test to the feasibility of their operations in the target market (Quaschning).

Low control levels usually come with higher costs compared with the integration of assets and skills within firms whenever managers cannot predict future contingencies. A high level of uncertainties makes the cost for drafting and enforcing contracts very expensive. Low modes of control profit many businesses. This is because it allows them to benefit from the economies of scale in the market. They do not encourage bureaucratic disadvantages that come with sole ventures and joint ventures. This is because firms are not tied up by changes in local policies (Rugman). Moreover, if so, they always have the liberty to opt out any time they want. Nations that experience lower market potential are projected to possess a lower rate of attracting foreign investments. Businesses always want to grow and develop. A number of factors apart from capital determine this development. The market for the products of a company determines whether a company grows or not. Therefore, when there is no possibility of growth in the market potential, then there is no need for investment. This point explains the above case. However, ventures with branches all over the world are not hindered by such factors. Most of them could have interest in those nations because of the need to enjoy slow profit objectives and growth. Brazil and India are two third world countries that do not have some good market potential for investment, but their potential is moderate. They may not be as lucrative as developed countries, but may still harbor the market potential and strategic importance that warrants consideration for MNEs (van). Additionally, these countries act as potential markets for MNEs as they come with an extra benefit—they have a higher propensity of better returns owing to greater market instabilities.

When firms decide to venture into low markets such a Brazil and India, they normally do so with a high likelihood of adopting the sole venture entry mode. This satisfies their need for managing and monitoring their resources and services all over the world.

Joint venture and exporting are appropriate methods of entry in low potential markets. This is because there is a reduced risk view. However, these methods do not come with flexibility, control, and change required by firms to hold on to long-term competitiveness. Joint venture usually creates hindrances for strategic coordination. Therefore, larger companies with high multinational experience will most likely go for sole venture mode as an entry mode into lower market potential countries.

Joint ventures are commonly chosen by smaller firms with lower multinational experience as entry modes especially in nations with higher projected market capital. This is normally due to the greater possibility of the firms to grow in such markets. Moreover, returns in such areas are better. Joint venture allows firms to share risk and costs, as well as complementary assets and skills with the partner company in the host country. This is advantageous, as the firm does not incur all the death alone. Furthermore, the venture allows for more investments as risks are spread across a wide pool. This method cuts the long-term doubt at a reduced cost compared to ideal market approaches.

Firms that have a higher propensity of coming up with differentiated products have the capability of choosing sole venture entry mode in countries with high investment risk. However, MNEs with high multinational experience harbor lower possibilities of choosing sole entry mode in those nations.

The availability of increased market potential encourages firms to invest in foreign nations while low market growth rate implies that firms will most likely avoid entry. High levels of investment contingencies hinder firms from venturing into countries while low investment risks attract MNEs. In nations with high market potential coupled with high contingency investments, MNEs may opt for exporting modes or joint ventures. Therefore, companies should strive to strike a balance between all the above factors (Wustenhagen, Rolf, and Wuebker).

Based on the above-discussed factors, it is evident that the best method for Pv Crystalox to venture into the Brazilian market is through the sole venture entry method. Pv Crystalox is a company that has branches all over the world. It has the necessary capital to invest in a country like Brazil. Moreover, Pv Crystalox has a high market experience in many nations that will help it advance well in a nation like Brazil. Brazil has no restrictive measures for foreign direct investments. In fact, its foreign policies are very favorable. The country encourages foreign direct investments by offering subsides to MNEs. The country is a democratic country that is developing on a daily basis. There is stability in the nation. The nation has sunny weathers throughout the year. This weather, coupled with the large pool of its populace makes it a vantage point for Pv Crystalox to venture into. Sole venture for Pv Crystalox will be aided by the fact that Brazil offers subsidies to industries that promise common good for the entire population.

Pv Crystalox has ownership advantage. This is evidence by its capacity to offer differentiated products and its multinational experience. The company has many firms in nations all over the world. Going into Brazil will be a walk in the park for the MNE. This is because all the company needs is permission. Another thing that gives Pv Crystalox an ownership advantage is its size. The company is so large and has networks throughout the world this is something essential for sole mode of entry. The firm will benefit from profit maximization and grow at a fast rate.

Moreover, the investment risks in Brazil are moderate given the current state of its economy. This is advantageous to Pv Crystalox as it gives it the advantage of profiting from the unstable market of Brazil. The company may adopt a fast mover strategy and solidify its operations within a very short time. Sole mode of entry is best for emerging markets because of the inconsistent markets.

Conclusion

The paper has touched on management of international business by exploring a Multinational Enterprise, Pv Crystalox. The document began by giving an overview of multinational business and introducing us to the main purpose of this document, which was to identifying an MNE and going all the way to establishing ways of extending its operations in a new market. The current state of Pv Crystalox has been analyzed followed by a country analysis of its current area of operation. The paper also explores the target country of venture and gives a regional analysis of the country. It further goes ahead to give the possible entry modes that Pv Crystalox can adopt and selects the best mode of entry for the company after analysis its potentials. The various modes of entry discussed in the paper include no entry, exporting, joint venture, sole venture, and licensing. The method chosen for Pv Crystalox was sole venture which is so far the best method that will for its in Brazil considering regional conditions. Briefly, the aim of the project has been realized.

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