How Do Marxs Criticisms Of Capitalism Relate To Todays Life - 1375 Words

How Do Marx's Criticisms Of Capitalism In The Communist Manifesto Relate To Life Today? (Essay Sample) Content: Name Course Lecturer Date How Marx's criticisms of capitalism in â€Å"The Communist Manifesto† relate to life today The â€Å"Manifesto of the Communist Party† is authored by Karl Marx and Frederick Engels; the document avails the history of the contemporary labor movements by revealing the various ills of capitalism and the oppression of workers. Marx criticized capitalism as a system that favored the owners of the capital while discriminating against the owners of labor; hence, the book can be envisioned as directed to workers since it reveals their suffering and provides the action plan on how workers should salvage themselves from the bondage of the bourgeoisie. The author will analyze how Marx's criticisms of capitalism in â€Å"The Communist Manifesto† relate to life today by comparing and contrasting the quality of life for the working classes, income inequality gap, the effects of global trade, the division of wealth and private properties between the economic classes and worker exploitation by those who own â€Å"means of production.† THE QUALITY OF LIFE FOR THE WORKING CLASSES Marx and Engels held that society was divided into two great classes: The bourgeoisie and the proletariats (15). The bourgeoisie has reduced the value of the relationship between man and his natural superiors; it has also reduced the connection between individuals to â€Å"cash payments† (15). The interactions in families have been reduced to money relationships while many professional that were honored, such as the priest and the physicians, have been reduced to paid laborers (16). According to Brown, Marx was right to claim that capitalism has reduced the value of relationships to â€Å"payments† since capital continues to be influential in the contemporary world (91). Brown posits that in the current world of â€Å"financialization,† the objective and the character of the states, universities, NGOs, and corporations, resembles the bourgeoisie in controlling the welfare of others. For example, the sovereign democracies such as Greece have been brought down on t heir credit ratings and forced to rely on other nations and the global financial institutions due to the effects of capitalism (Brown 91). Through monetization of everything, the finance capital has changed the measure and nature of value by reconfiguring nations, human conduct, firms, and human anxiety. THE INCOME INEQUALITY GAP The proletariats earn by selling their labor to the bourgeoisie; the â€Å"proletarian has lost all the individual character, and consequently, all the charm for the workman,† because the demand for labor low while the supply is high making the wages low (Marx and Engels 18). The increase in labor supply reduces the payable wages making the income gap between the bourgeoisie and the workers even larger. Unlike the bourgeoisie who own capital and the final product in the production process, the proletariats â€Å"live only so long as they find work and find work only so long as their labor increases capital† (Marx and Engels 18). The ratio of income for the wealthy and the poor, from the 1970s, has increased by a factor of five; showing that the bourgeoisie continues to be influential while the proletariats suffer under the capitalism (Percy 12). Again, the United Nations Conference on Trade and Development, in 1997, noted that the inequality in wage between the unskil led and skilled labor was becoming a global trend with income distribution â€Å"hollowing out† in the middle class. The global economy has been characterized by job and income insecurity, revealing the widening gap between the bourgeoisie and the proletariats of the 21st century (Percy 19). THE EFFECTS OF GLOBAL TRADE Marx and Engels believed that â€Å"The bourgeoisie has through its exploitation of the world market given a cosmopolitan character to production and consumption in every country† (16). Capitalism contributed to the destruction of the old industries and replaced by new industries that draw their raw materials from remote areas while the final products are consumed across the world. The global trade contributed to the inter-dependence of nations through material and intellectual production (Marx and Engels 16). According to Marx, the global trade led to improved means of communication and facilitated the civilization of even the most barbarian nations. Marx and Engels held that Bourgeoisie influenced many nations to embrace bourgeoisie as a means of production by making them bourgeois (16). Hence, bourgeoisie nations have emerged to control peasant nations in various aspects of the political and economic spheres. German notes that the contemporary capitalism has made it possible for people to buy exotic fruits that come across the world by going to Sainsbury’s or get clothes whose origin is Malaysia or Philippines (15). The enhanced communication makes it possible for people watch events that are happening across the world through television, internet or satellite. However, German believes that the current capitalism continues to discriminate against the poor since the industrial or agricultural products that are designed for the advanced capitalists’ nations have ruined the livelihoods of the poor nations, thereby increasing inequality (15). The spread of the â€Å"currency crisis† that started in Thailand spread to Indonesia, Malaysia and Philippines and later the International Monetary Fund (IMF) was approached to rescue Indonesia by giving out $30 and $17 billion for Thailand, is considered to be the effect of the modern day financial capitalists (Percy 7). For instance, IMF will decide which country to assist and which one to leave out; this makes IMF a modern-day capitalist to other nations. Also, the contemporary capitalism has been associated with overproduction and under-consumption which has made it difficult to recognize the surplus value as profit. The overproduction of financial capital by various capitalists in the U.S and other nations has been associated with the liquidity crises, debt, bubbles, and depreciation of the currency value, market manipulation and excessive volatility (Brown 93). THE DIVISION OF WEALTH AND PRIVATE PROPERTY BETWEEN ECONOMIC CLASSES The economic class is determined by the private ownership of capital or labor. The bourgeoisie owns the means of production (capital) while the proletariats own labor (Marx and Engels 18, 23). However, labor is subject to manipulation making it difficult for the workers to accumulate wealth since they are not paid enough to settle their needs; hence, they do not have property. The bourgeoisie accumulates wealth by exploiting labor; therefore, the division of wealth between the owners of the capital and the workers is uneven; this leads to class struggles since workers contribute greatly to the creation of the capitalist’s wealth. Marx was opposed to private property because it contributed to the exploitation of others in the quest for â€Å"social status in production† (23). Marx felt that communism would replace capitalism in the near future because it does not advocate for the appropriation of the society’s products to a few individuals. Percy notes that since the 1970s, the inequality in wealth and income has been increasing in the United States (11). For instance, in 1997, 447 billionaires had accumulated wealth that was equivalent to 50 percent of the total assets of the world’s poor people. LABOR LAWS The bourgeoisie state did not envision the availability of labor laws; however, since the capitalist owned the means of production, the bourgeoisie dictated the terms of labor that favored their in...

Lies Youve Been Told About History Papers Writing Service

<h1> Lies You've Been Told About History Papers Writing Service</h1> <p>A extraordinary history paper will dissect the setting of a statement or part of proof. The essayist doesn't ought to do an investigation of the consequences of the report. Note down data of each source When it's a major research undertaking, there's increasingly opportunity to get muddled. Composing, it is conceivable to consistently obtain another person's contentions to help own announcements. </p> <p>If you need to secure average history papers, simply use look into administrations scholarly Pro-papers. A few understudies don't get an opportunity to look at craftsmanship history till they take a college preparing program, so workmanship history may be a spic and span territory of study for you. At the very same time, it isn't unprecedented assist understudies with speculation papers history task help. Article help composing administrations are extremely important for understudies . </p> <p>Content composing has a lot of points of interest that empowers perusers to think about different assorted things. Our Spanish tweaked inquire about papers scholars begin composing without any preparation by complying with the guidelines and guidelines to forestall copyright infringement. Every once in a while, you're composing a theme, and in various examples, you are mentioned to pick one all alone. The English language is hard to learn, yet in the event that you compose so you may speak with their perusers. </p> <p>If a decent or administration is being introduced, there ought to be an undeniable organization esteem reflected in the most reasonable manner. One explanation clients go to others for the great substance that they themselves can't compose predominant substance. There are numerous reasons why you should favor our administrations. There are various motivations to utilize such administrations in any event, when you compose your own paper s. </p> <h2> History Papers Writing Service and History Papers Writing Service - The Perfect Combination</h2> <p>According to specialists from look into paper writingservice, the gauge of the activity will rely to a great extent upon the character of the inquiries. At the very same time, basically in light of the fact that you might want a paper modest doesn't connote the standard of the substance ought to endure. In the event that you might want to get high astounding examination and theory papers in time and at a reasonable cost, you ought to likely evaluate utilizing EssaySupply.com. You may experience some of the example papers to measure the standard of our composing administration. </p> <p>You must be certain the administration you utilize will flexibly your paper to you on schedule. On the off chance that you have any inquiries, you can connect with our well disposed help group night and day and get prompt help. For any more data you may ge t in touch with us and we administration come back to you as before long help conceivable. Some composing administration pivot time might be eight days, however others give a shorter period. </p> <h2> Top History Papers Writing Service Secrets </h2> <p>Building certainty is a central advance to fundamental inclination, to be a purchaser. Words are mystical, and you should exploit those! Effective papers aren't finished inside a snapshot of splendid or motivation, anyway are made over a series of steps. </p> <p>Whether you should make a paper of unique perfection, simply get an exposition here and our essayists will give assistance. Composing a proposition requests profound shrewdness and ace level research capacities. The equivalent is appropriate to top paper journalists. </p> <p>If you are scanning for top exposition composing organizations, give a shot the referenced previously. For you to make that unequaled research paper or research paper that gets you the absolute best grades, you want a hand from an expert In the range of your examinations, you're relied upon to finish numerous sorts of papers the entirety of the route through your scholarly life. The most reasonable time to buy a history paper is NOW. History paper help occupied people that are some of the time working alongside examining. </p> <h2> The Lost Secret of History Papers Writing Service </h2> <p>Inadequate Customer Support The nature of buyer support is the impression of the evaluation of the administrations the supplier gives. No one will ever ready to realize that you've utilized their master administrations. The business composing ought to be clear if need to get the customer to peruse the full archive. </p> <h2> The Benefits of History Paper s Writing Service </h2> <p>What each site has pertinent substance and is at the pinnacle of the game, look for the administrations of an independently employed web content essayist productively is totally an absolute necessity see. Picking to announce your business by means of article composing administrations SEO would be an exceptional and keen way to deal with acknowledge high cluster of perusers. Despite what occurs, you realize that you'll get the predictable substance without expecting to disclose your necessities to an alternate author. Without a doubt the most exceptional substance on your site is the greatest spot to acquire the web crawlers. </p> <p>You will be encircled by composing experts all through the arrangement of request position, and the second you decide to buy exposition and select an allotted essayist, things will get considerably additionally energizing. On the off chance that it's in this way, at that point you'll be possessing some t roublesome energy for an understudy alongside being an author. Proceed to make some incredible memories with your mates, and when you're back, the piece will be set up to download. A substance piece composed by customary author may be instructive, however it won't be that engaging. </p> <h2> Using History Papers Writing Service </h2> <p>Research can likewise assist you with getting something new and gives you great amazing articles and their perusers. Composing the article you would now be able to compose your articles. Your article should be submitted to Counseling. </p> <h2> All About History Papers Writing Service</h2> <p>Also, in case you're concentrating abroad or inside a city with prevalent open transportation and breathtaking open doors for bicycle sharing or ride-sharing, you may not feel the interest for a private car. There are a wide range of research paper composing administrations are accessible which will have the option to assist you with least expensive research paper articles. Investigate the areas where you have essential comprehension. </p>

Writing a Custom Research Paper

<h1>Writing a Custom Research Paper</h1><p>Writing a custom research paper is a significant advance for understudies who are hoping to get kudos for their difficult work. All things considered, how might you be a decent understudy on the off chance that you don't have the fundamental aptitudes to compose well? Research papers offer understudies a chance to substantiate themselves and show that they have composed great quality scholastic papers. You will gain proficiency with a couple of methods that will assist you with making your examination paper to look amazing.</p><p></p><p>As an educator, you may not be acquainted with composing a custom research paper. So as to create a quality paper, you should know a couple of stunts. Utilizing these tips, you will have the option to assemble a perfect work of art that will leave your understudies with a fulfilled look on their face.</p><p></p><p>Use an assortment of sources w hen composing a custom research paper. Make certain to take notes about the sources you use so you can add it to your paper later. Understudies frequently lean toward utilizing on the web sources instead of printed sources. Discover what kinds of sources you should utilize with the goal that you can ensure that they will assist with improving your understudies' scholastic success.</p><p></p><p>The initial phase in setting up an examination paper is to ensure that you are utilizing a decent configuration. To start with, note that you ought to compose your own layout. Before you really start composing your exploration paper, you should definitely know the framework of the examination venture. Now, it is critical to set up the establishment. This will guarantee that your whole research paper streams effectively, along these lines guaranteeing that you won't have any issues in the future.</p><p></p><p>You ought to likewise ensure that your examination paper has been sorted out appropriately. This is significant on the grounds that understudies like to understand articles and books so as to pick up data. They like to peruse and they like to locate their own specific manner through a book. On the off chance that you find that you don't have the opportunity to sort out your examination appropriately, consider counseling an expert. Proficient editors or even proficient duplicate editors can assist you with making your examination paper look professional.</p><p></p><p>Having sorted out research papers will make your exploration paper increasingly amazing. Ensure that you use boldface type and numbers when composing your examination paper. This will make the data simpler to peruse. It is likewise a smart thought to incorporate a list of chapters toward the finish of your examination paper. While it is ideal to have a rundown of references remembered for your examination paper, there is no explanatio n that your peruser ought not get an opportunity to experience your whole research paper.</p><p></p><p>The last tip when composing a custom research paper is to check the language structure. Ensuring that your spelling and language structure are right is significant. Understudies who are hoping to get kudos for their difficult work will welcome this fact.</p><p></p><p>Writing a custom research paper is a great deal of fun, however it requires some time and exertion. Utilize these tips to guarantee that your exploration paper is both amazing and professional.</p>

Femi Lewis - ThoughtCo

What Are The Key Areas Of Discussion In Your MBA Diversity Management Essay Sample?

What Are The Key Areas Of Discussion In Your MBA Diversity Management Essay Sample?A diversity MBA Essay Sample can be a very valuable tool for your preparation for your opportunity to earn your MBA. They are organized by discipline, allowing you to compare notes on specific MBA topics, and the process can help you put the program into context and gain some knowledge about the student handbook. But, what do they really say about your potential, and what are the other things that you should take away from them?Diversity management and hiring personnel are topics that are often dealt with in MBA programs, but not as much as many students may think. But, a diversity MBA Essay Sample, though on the surface it may seem quite basic, can be one of the most powerful tools for your MBA career. This MBA coursework is applicable not only to senior management but to all of the career stages, from entry level to executive. A diversity MBA Essay Sample will lay out key issues of diversity and incl usion management and give you an insight into how certain students have taken part in hiring and managing diverse departments at their own institutions.In terms of quantitative learning, you can expect to see a number of quantitative activities included in the MBA requirements, to test your quantitative reasoning skills. Data mining is a large part of the curriculum, as are questions in business statistics and a great deal of in-depth research. In addition, there will be extensive practice with mathematical computations, and a great deal of theory in the areas of statistics and econometrics. However, don't be surprised if there is a large focus on humanities (including language, art, music, and psychology) in addition to math and science.Of course, as is the case with all MBA programs, there will be courses on diversity management that include specific instruction in a related area. These general topics include organizational dynamics, business ethics, human resources, the workplace , and diversity leadership. This diversity MBA Essay Sample will give you an understanding of the discipline, and some ideas about the types of topics that may be covered in your MBA program.There are a few key areas that you should pay attention to, when it comes to diversity management and the MBA. When it comes to employee diversity, it is always a good idea to know the processes that are in place at the company, and what type of training they offer to make sure that they are in compliance with the laws and regulations. Also, there will be several important studies about professional development, including looking at what types of events, seminars, and forums are created to help individuals of different backgrounds to learn more about diversity management and their own abilities. In other words, there will be a great deal of advice from experts in the field.At the individual level, you will find that there are several different disciplines that involve diversity management. One o f the areas is the law. There will be several courses on discrimination law, which deals with issues like racial and ethnic discrimination, religious discrimination, disability discrimination, sexual harassment, and transgender discrimination. There will also be courses on technology, as well as other areas.After studying the various topics, you can expect to be evaluated in the areas of quantitative, critical thinking, and critical reading. Each of these sections will involve your personal statements, and written papers in the subject areas. If you are planning to write a thesis, or if you have some experience in the area of diversity management, your written test scores should be quite high. If you do not, do not despair; there are plenty of online sample papers and exams, which can help to gauge your performance.When it comes to diversity management, it is always important to prepare a diversity MBA Essay Sample, and this study will give you a good overview of the required curric ulum. As you start your work at the company, and your profile in the workplace begins to increase, it will become more important to not only get on the ball with your studies, but to put them to use as early as possible.

Research Paper Topics For the Aeneid

<h1>Research Paper Topics For the Aeneid</h1><p>Research paper subjects for the Aeneid are not hard to think of, however to make them fascinating is an alternate story. There are numerous angles to recollect when composing a paper that identifies with any writer's career.</p><p></p><p>The most significant viewpoint is to compose as unbiasedly as could be expected under the circumstances. In the event that you have an inclination towards one writer or the other, you won't be extremely objective and your exposition will endure. It is ideal to be as goal as could reasonably be expected, regardless of whether it implies disregarding the substance of your most loved novel.</p><p></p><p>Another thing to remember when composing for examine paper subjects for the Aeneid is that it must be intriguing. You can't just expound regarding the matter and call it adequate. The purpose of the exposition is to get a thought of what the Aeneid is about. Because the substance of the novel is fascinating doesn't mean it will be intriguing enough.</p><p></p><p>By utilizing clear models, individuals will relate the material to their own lives. Since the Aeneid covers a wide scope of subjects, you will require a rundown of the entirety of the key points. Regardless of whether you don't have to expound on every point, composing a proposition explanation or rundown of topics helps.</p><p></p><p>When searching for sources, attempt to discover sections that talk legitimately to your background. This is substantially more fascinating than simply perusing the work and attempting to recognize the principle theme.</p><p></p><p>Not just will your examination paper to be an intriguing perused yet it will likewise assist you with understanding the bigger importance of the Aeneid. This is a subject that was composed by antiquated writers, so the genuine signifi cance will be not quite the same as one individual to another.</p><p></p><p>Remember that when you are composing for look into paper points for the Aeneid, you have to compose as though you were perusing the work. Don't simply understand it and feel, 'That bodes well.' Instead, attempt to comprehend the content with the goal that you can apply it to your own life.</p><p></p><p>The Aeneid will be a profoundly foreseen expansion to writing and any great understudy of writing should attempt to get however much data on the book as could reasonably be expected. Finding out about antiquated journalists and their work is an extraordinary method to show signs of improvement at perusing and composing and is very rewarding.</p>

Essay Topics and Answers

Essay Topics and AnswersYour essay topics and answers need to be just right. You need to write a proper essay and your topic should not be picked randomly. You want to know what types of topics and answers will work for you.When you sit down to write your essay, there are several things that should be taken into consideration when choosing the essay topics and answers. You want your topic to be educational and you want it to be relevant to the job you are applying for. It's important that you will be able to use this topic in your resume. It is also important that your topic and answers must be interesting.Many college students have found that their topic is not very useful. They get into so much trouble and have so many problems because they don't know how to structure their essays. It doesn't matter if it's your first time or your tenth time writing an essay. You have to find the right topic and answer for each essay that you write. You can still get a good grade if you don't spend all your time studying and rewriting.But if you cannot come up with a good topic and answer for your essay, you might want to look at the sources. If you find that you cannot easily find information about something, then you might want to try another one. You need to find the best sources of information for your topic. By doing this, you will be able to come up with a well-structured topic and answer that is applicable to the job you are applying for. You don't want to end up rewriting your entire essay.When looking for interesting topics and answers, you want to keep in mind the kind of people that are reading your essay. You want to make sure that they have an interest in what you are writing. You also want to make sure that your topic is also something that they are interested in.You can find a lot of these sources online. You can go to various college websites and find sites like CollegeBoard.org and CourseFinder.com that list different types of courses. These sites also give y ou information on how to format your assignments, how to assign sources and information, and the way to structure your essays.You also want to make sure that you know how to edit. While some people are intimidated by editing, you can actually do it yourself. Just make sure that you have the right knowledge to edit. If you don't know how to do it properly, you might be better off having someone edit your essay for you.Making sure that your essay topics and answers are correct is not only important but also very important. It helps to have a good grade. And even if you have a poor grade, you will still get a job interview and it's more important to you to get a job interview than it is to write a good essay.

Set During the Civil Rights Movement, Fences by August...

Fences Fences by August Wilson took place during the civil rights movement. The play is about Troy Maxson who is a fifty- three year old man whose life revolves around the generation gaps between his father and his son Cory. This paper will discuss Troy‘s relationship with his father, Troy and Cory relationship, civil rights influences on generation gaps. Troy views his father as abusive not a good father causing friction between him and his father. Troy describes his father to not have the â€Å"walking blues† like Bono’s father who walked out on him but rather provided for his family (1310). Even though his father provided Troy with necessities, he did not get the love and support of his father. His father would basically â€Å"sit down and eat two chickens and give you the wing† when it came time to eat. In which he proves that his father was not a great dad to begin with. During this time Troy’s father used to work in the fields and could not go to school in which â€Å"he was trapped† to be a farmer as most people had to use their own physical strength for food and shelter (1310). During the progression of the civil rights movement, Troy gets the opportunity to be a driver instead of a farmer. This causes a friction between Troy and the memory of his father because of the different societies they live. This generation gap affects how Troy’s father raises Troy â€Å"to become a man †¦at age fourteen† (1310). Troy’s father raises Troy to become terrifiedShow MoreRelatedAugust Wilson Fences984 Words   |  4 PagesAmerican Minister and a human rights activist. It means that sometimes you have to fight in order to achieve peace. I agree with what he said because in order to get what you want you have to fight for it. Two literary works that reflect this quote are Fences, a play about the struggles of African American before and during the Civil Rights Era in the 1950s and 60s, by August Wilso n and â€Å"The Yellow Wallpaper† a short story that shows the difference between women and men during that time, by CharlotteRead MoreAfrican Americans During World War I1579 Words   |  7 PagesMany African Americans had moved north during the Great Migration to escape conditions in the south, but found that discrimination was still prevalent in northern cities. African Americans not only had difficulties finding jobs, but still felt the stigma of being black. Living within the time of legal discrimination, many African Americans soon realized that though they may have escaped the violence of the south, they still had to deal with the challenges and setbacks of being black in America. TheRead MoreAnalysis Of Fences By August Wilson1656 Words   |  7 Pagesand typically a positive thing. There are times, however, when the people that children emulate are not the best examples society has to offer. In the play Fences Cory looks up to his dad when it comes to sports. Howev er, by the end of the play the reader starts to notice that Troy is not the man to look up to. The plot in Fences by August Wilson is centered around an African American family that looks at the world a little differently by that I mean when Troy was young people believed blacks shouldn’tRead MoreSpirituality Religion in August Wilsons Fences1072 Words   |  5 PagesFen Spirituality amp; Religion | In August Wilson’s â€Å"Fences† | | Mia Savage ENG 102 Essay #3 | 11/11/2011 | Introduction: â€Å"Fences† is one of ten plays written by August Wilson that document historic periods in Black American life. It is a colorful and thoughtfully written piece that tells the story of one family’s struggle in Civil Rights Era America, an empowering and complicated time for lower and middle class blacks struggling to attain an ideal of the â€Å"American Dream†. TroyRead MoreFences : Fences By August Wilson1541 Words   |  7 PagesName: Alejandro Ahmed Date: 12/6/16 Unit: American Drama Title: Fences Author: August Wilson Year of Publication: 1986 Fences Study Guide Descriptive i. Overview: â€Å"Fences†, was a play written by August Wilson in 1986. The play communicates the story of the son of an unsuccessful sharecropper, Troy Maxson, who has lived most of his life independently due to his father’s abuse during his childhood. The play focuses on Troy’s interactions and conflicts with other characters, and the complicated relationshipsRead MoreFences Is A Family Drama Written By August Wilson1797 Words   |  8 PagesFences is a family drama written by August Wilson, which portrays the scenario of 50’s American society. The play explores the turmoil in the socio-economic situation faced by the African-American people in the period along with their experience of life, civil rights, personal relationships and racial situation. The play concentrates on describing different ‘fences’ of life, which were faced by the African-American society during 50’s. The play was set in 1950, almost a decade prior than the civ ilRead MoreThe African American Struggle During The United States Essay2085 Words   |  9 PagesThe African American Struggle in the United States Before the civil rights movement in America, many writers that grew up during times of oppression and racial discrimination began to speak out about the problems African Americans faced. Wilson, Hughes, and Hansberry explore the themes of racism and the American dream in their works to reveal the situation for black Americans in the United States during the time period after World War II. The American dream is the idea that every person shouldRead MoreFences Research Paper1912 Words   |  8 PagesFences Lives are lead with anxiety over certain issues and with apprehension towards certain events. This play, Fences written by the playwright August Wilson deals with the progression of a family through the struggles of oppression and the inability to obtain the American Dream. The characters in the play develop throughout the story and can be viewed or interpreted in many different ways, but one man remains constant during the play and that is Troy. Due to certain eventsRead MoreThe Theme Of Fences, By August Wilson1566 Words   |  7 Pagesbecause of these interests that people develop their own dreams and aspirations for their future. These dreams may be about career or finding happiness or even about family. There are many hurdles in the path to achieving dreams. In the play, Fences, August Wilson centralizes many conflicts in the plot around each individual character’s pursuit of their dreams and aspirations and the difficulties they face. Although there are many different themes in this play, the main theme concerns the pain and sufferingRead MoreThe Tragedy Of Troy Maxson2580 Words   |  11 Pagesthere must be specific elements in the creation of a tragic hero that can be difficult to determine in contemporary tragedy, which focuses on the realism of sociological issues of society such as in August Wilson’s play Fences. Since Wilson introduced the protagonist of his Pulitzer Prize winning play Fences to audiences in 1985, many have debated as to whether or not Troy Maxson should be classified as a tragic victim of circumstance or a tragic hero. Wilson’s poetic use of literary devices makes it

Phantom Limb Pain free essay sample

Abstract Phantom limb pain is a common symptom experienced by over 90% of amputees. It’s defined as a painful sensation from a part of the body that no longer exists. There are a variety of methods for treating this neuropathic pain, but at the moment there is no specific treatment to tackle the pain completely. A mixture of medications and therapies has been proposed and trialed including drugs, surgical treatment and neuromodulation. Nonetheless, it is essential that a specific mechanism is targeted to in order to achieve the best therapeutic method. From central stimulation to mirror therapy, the development of a wide range of treatments available today is due to central mechanisms of phantom limb pain that provide major grounds for research. Other treatments, aside from those related to the central mechanism, are also worth considering in order to improve our understanding. Results of these trials currently suggest that mirror therapy seems to be the most effective treatment based on central mechanisms, with the remaining therapies giving rise to a range of positive to negative outcomes. Introduction Phantom limb pain first arose during the sixteenth century by a French military surgeon, Ambrose Pare (Weinstein, 1998). He described this as pain being perceived from a part of the body which no longer exists, therefore belonging to neuropathic pain syndromes. The phantom limb is generally described to have a tingling sensation and a definite shape that resembles the limb pre amputation. Moreover, some claim to feel it move through space in the same way that the normal limb would have, for example, walking, sitting and stretched out (Melzack, 1973). Almost all amputees would report these non painful sensations immediately after surgery (Nikolajsen et al, 2005). Initially, the phantom limb feels normal causing the amputee to use the limb for its would be usual purposes such as reaching out for objects. However, eventually sometimes the limb begins to change shape resulting to a change in type of pain and sensation reflecting the extent of neurological damage this causes (Melzack, 1973). The spectrum of pain from a phantom limb ranges from rare, short lasting painful shocks to a continuous, excruciating pain where the subject feels intense perception of the absent limb (Flor et al, 2006). It seems to be more severe and vivid in the distal compartments of the limb sharing a variety of characteristics such as throbbing, stabbing, cramping or burning (Hill, 1999). Blakeslee and Ramachandran have stated that some people misidentify a limb for representing another, for example, one patient described her phantom arm of being 6 inches too short (Ramachandran et al, 1998). Similarly. the onset of pain varies between individuals ranging from immediately to many years after the amputation (Nikolajsen et al, 2005). Some experience the limb to be telescoped into the stump until only the foot or hand could be felt (Melzack, 1973). These variants of the pain has lead to a broader definition where phantom limb pain is now also applied to describe pain in regions which have been completely denervated but not amputated (Portenoy et al, 1996). These findings provided the root of extensive research encouraging scientists around the world to experiment and understand this condition. However, it still remains as a poorly understood and challenging to tackle pain syndrome. Recently, a review in 2005 has approximated that there were about 1. 6 million individuals suffering from limb loss in the USA with this amount set to double by the year 2050 (Ziegler-Graham et al, 2008). This emphasises the importance of trying to establish a certified treatment or therapy in order to improve the quality of lives of those suffering. Currently, scientists and researchers have proven that there are a variety of ways to approach phantom limb pain in terms of treatment and management with variable success rates. How effective each method truly is depends on the patient and potentially the basis of the treatment. Surveys of amputees have shown that any form of therapy has been portrayed in a negative light due to the reduced possibility of it making any difference (Sherman et al, 1984). As a result its essential to highlight how each treatment or therapy works in order to improve the prevention of this pain. With treatments such as mirror box therapy, scientists are attempting to tackle phantom limb pain from every possible aspect and mechanism there is. This leads to the branching of other approaches such as pharmacologic, anaesthetic, neurostimulatory, surgical, psychiatric and psychological (Portenoy et al, 1996). Thus far, no treatment has been fully proven in terms of its effect at relieving phantom limb pain. Experiments and investigations have been carried out over the years to reveal which method is most efficient with most conclusions directing towards central mechanisms. However, is this the most effective approach? This essay attempts to address and explore the various techniques of managing phantom limb pain focused around central mechanisms. Pain In order to fully appreciate the workings of each treatment and therapy, pain itself must be understood first. Up until the 1960s, pain was understood as an inevitable response to any tissue damage. However, in recent years, great advances have been made in our awareness of the mechanisms that underlie pain and its possible treatment (Loesar et al, 1999). Pain has been defined by the International Association for the Study of Pain as an unpleasant sensory and emotional experience which we primarily associate with tissue damage or describe in terms of such or both (Mersky et al, 1994). This definition incorporates two important factors; first it reflects a sensory experience with the individuals cognitive response, secondly, it suggests a relationship which is neither uniform nor constant between pain and tissue damage. Pain causes an individual to withdraw from damaging experiences and to avoid similar situations in the future. Most pain resolves promptly once the painful stimulus is removed and the body has healed. However, there are some cases where the pain persists despite the removal of the stimulus and apparent healing of the body. Similarly, pain may also arise in absence of any stimulus, damage or disease (Niv et al, 2007). This diversity of pain experiences accounts for its difficulty in achieving an explicit definition. Pain is not a single experience that can be specified in terms of a defined stimulus condition. Instead it can be agreed that pain, like vision and hearing, is a complex perceptual experience (Melzack, 1973). As a result, pain may represent a multidimensional space comprising several sensory and affective inputs characterised by a combination of different qualities and unique events. However, there are methods of classifying different types of pain. The two main branches are nociceptive and non nociceptive. Nociceptive includes somatic and visceral pain whereas non nociceptive refers to neuropathic and sympathetic. Nociception is the process where afferent activity produced in both central and peripheral nervous systems by stimuli are capable of causing tissue damage This is first detected by nociceptors which can distinguish mechanical, thermal and chemical changes above a certain threshold. Once this threshold is exceeded the nociceptors are stimulated to transmit a signal along the spinal cord to the brain. This triggers a multitude of autonomic responses and may result in a subjective experience of pain (Patel, 2009). In addition to these subtypes, its important to consider that other types do exist, such as, referred pain. Following from stimulation of the nociceptors, there are several pain pathways which lead to the brain to represent the type of pain triggered. These pain pathways are described as a sequence including different tracts leading to the brain. It begins with the neuronal fibres emanating from the peripheral receptors and synapsing in the dorsal horn of the spinal cord. Here, several tracts carry the nociceptive signals to the brain. Examples of these tracts include: the spino-thalamic tract, the most prominent ascending pain pathway terminating in the thalamus, the spino-reticular tract which terminates in the reticular formation and the thalamus and the spino-hypothalamic tract which projects to the supra-spinal autonomic control centres. Phantom limb pain can be categorized as chronic neuropathic pain syndromes which involves pain in a limb that has been amputated, or which results from partial or whole deafferentation. Its suggested that the onset and severity of phantom limb pain may be associated with the nature of the amputation. For example, depending if the amputation was due to chronic purposes or traumatic purposes the outcome may vary, although so far evidence for this is insufficient to draw a credible conclusion (Houghton et al, 1994). Moreover, phantom limb pain is more widespread when amputation occurs during adulthood as oppose to in children and congenital amputees. This suggests a psychological background where greater attention is given to the lost limb creating pain memories which may contribute to the pain further (Katz et al, 1990). In addition to phantom limb pain, other derivative and surrounding pains exist, including stump and pre amputation. Stump pain is a common symptom of early post amputation, however in the majority of patients it subsides with healing. Its defined as a sensation in the existing body part next to the amputated limb or deafferentation line. Furthermore, phantom and stump pain are an interrelated phenomena where reports indicate a greater prevalence of phantom pain among amputees with coexistent stump pain compared with amputees without stump pain. (Flor et al, 2006). For a long while, the dominant theory for phantom limb pain was the irritation and inflammation at the nerve endings of the amputation labeled neuromas. Consequently, surgeons would amputate the stump further with intentions of eliminating the pain. However, as expected the pain would return, if not more severely, with two phantoms present for the same limb as oppose to the one original. This discounted the theory of neuromas to be accountable for the pain and lead to an explanation that it may be related to the changes of the plasticity of the central nervous system (Flor et al, 2006). This lead to further research into the central mechanisms of amputees in order to fully grasp the changes and harm created. Central Mechanisms Currently, the most common explanations surrounding phantom limb pain are focused around central mechanisms. As well as other explanations such as peripheral and behavioural, central seems to have a major influence on the outcome of phantom limb pain. Since many changes occur here, its essential to identify what occurs at each level precisely. This provides a basis for potential treatment and therapy, despite the success rate still remaining ambiguous. Changes at the level of Spinal Cord Evidence surrounding changes at the spinal cord in amputees is weak, however experimental evidence based on animal models have shown that neuropathic injuries do involve spinal cord processes. At the spinal cord the amputated peripheral nerve form communications with the neurones in the receptive field into the dorsal horn via axonal sprouts. Some neurons that aren’t responsible for transmission of pain also sprout into the dorsal horn in an area involved in the transmission of nociceptive afferent inputs (Flor et al, 2006). This is followed by a process called central sensitisation where  there is an increase in nociceptor activity associated with inflammatory pain. This corresponds to an adaptation in how responsive the synaptic neurones from the dorsal horn are, eventually creating an expansion of the neuronal receptive field. As a result, hyper-excitability and increased neuronal activity also occurs. During the course of this process, the activity of NMDA receptors also increases. Transmitters like substance P, neurokinins and tachykinins mediate this process at the dorsal horn. A process called the windup phenomenon then occurs where theres an up regulation of NMDA receptors. Consequently, the firing pattern of the central nociceptive neurones is changed. This may initiate less local inhibitory mechanisms between segments in the spinal cord, resulting to nocioceptive inputs at the supra spinal centres as well as spinal disinhibition. Deafferation is also observed at dorsal roots which are injured or damaged from the spinal cord. This may correspond with the effects of peripheral denervation centrally. This leads to spinal hyper-excitability. Amputees with damaged cervical nerve roots show signs of hyper excitability in dermatomes next to the denervated limb, suggesting the hyper excitability has diffused. The combination of the changes at the spinal cord and the increased afferent input have been proposed to result in the progression of phantom limb pain. Changes at the level of the Brain When it comes to changes in the brain, the most common cause is cortical reorganisation; changes in the functional and structural somatosensory cortex subsequent to amputation. During reorganisation, the cortical areas representing the amputated extremity are taken over by areas in both the primary somatosensory and the motor cortex (Baron et al, 2010). The process of cortical reorganisation has been studied in human and animal models following deafferentation and amputation where it partly demonstrates why the stimulation of afferent nociceptive neurones from the stump or its surrounding area produces a response in the missing limb. There is now evidence for considerable reorganisation of primary somatosensory, motor cortices and in subcortical structures following amputation (Grusser et al, 2001). Studies have shown that the degree of cortical reorganisation has a direct link to the extent of pain and size of the differentiated region. As a result, Ramachandran et al used these findings to propose that painful and non painful referred phantom sensations are parallel to perceptual reorganisational processes in the somatosensory cortex. This lead to the idea of topographical remapping, which is a relationship identified between areas of sensation from the mouth to stimulation sites in arm amputees (Halligan et al, 1951). However, studies have shown that topographical remapping has only been found in a small percentage of amputees (Grusser et al, 2001) suggesting that phantom pain and referred sensation in the phantom are associated to differing central process. Similarly, another study further demonstrates how referred phantom sensations may be less related to cortical changes in the brain. It illustrates how the greater the shift of the mouth representation into the area that previously represented the arm, the more distinct the phantom pain. Another proposed mechanism is stemmed from the body schema theory, initially discovered by Head and Holmes in 1912. This is a concept in the brain where the entire body is thought of as a template; meaning any modification to the body, such as an amputation, would result to the sensation of a phantom limb. To develop this explanation further, Melzack proposed a hypothses in 1989 of the ‘neuromatrix’ and ‘neurosignature’. In order to conceptualise the neuromatrix hypothesis, a system of neurones within a branch is visualized. This system incorporates a variety of inputs including somatosensory, limbic, visual and thalamorcortical components. This instigates complex interactions of neural networks in the brain. These interactions do not reside in a specific region of the central nervous system which contributes to the difficulty of understanding phantom limb pain (Portenoy et al, 1996). This then evokes pain or other experiences. Neurosignature, however is a cause of the deprivation of various inputs from the limbs to the neuromatrix creating an abnormal neurosignature which results in the generation of phantom limb pain. Treatment based on Central Changes After understanding the basic central changes which occur during phantom limb pain, potential treatments can be developed and observed. Some treatments surrounding central mechanisms are perceived to be a lot more effective than others. In order to a reach a full judgment, each treatment must be discussed and observed separately. Studies and trials represent how patients have responded to each therapy, identifying which method of management is most effective. As a result its beneficial to consider these case studies when comparing treatments. Mirror Therapy A common therapy used today is mirror therapy, first unveiled by Ramachandran and Rogers-Ramachandran in 1996. This allows a patient to feel the imaginary movement of the removed body part to behave as a normal limb via a mirror reflection (Ramachandran et al, 1996). The reflection of the normal body is superimposed on the perceived position of the phantom, helping to integrate and reorganise the mismatch between proprioception and visual feedback of the removed body. Therefore enhancing this treatment effect for phantom limb pain (Weeks et al, 2010). Rizzolatti used the idea of a mirror neurone to explain the method of this therapy (Rizzolatti et al, 2006). He discovered that a mirror neurone in the cortex fires when a person acts and when a person observes the same action performed by another. Consequently by mimicking the behaviour, the subject will experience not only sensation, but also the similar emotion. To relate this to phantom limb pain, a patient will enable to experience the same sense of feeling and emotion of the normal body part by simply observing its mirror reflection. This is said to relieve pain by interfering with motor intention, proprioception and visual system. For example, out of five patients with painful phantom hand clenching, four achieved short term relief when a mirror allowed them to unclench the hand (Dolin et al, 2004). However, a person without phantom limb pain and no amputations wont be able to feel these sensory experiences since they benefit from a non mirror neurone block preventing any influence, whereas a patient with an amputation does not have this non mirror neurone block allowing the mirror to have its influence (Ramachandran et al, 2008). Furthermore, Ramachandran attempted to tackle the pain by addressing the phenomena learned paralysis. He believed the phantom to be paralysed and occupying the same position pre-amputation. The mirror box therapy attempts to negate this learned paralysis by unlearning the phantom paralysis with the aid of a reflection of the limb. This allows the patient to receive visual feedback of every message sent to the phantom limb. These explanations suggest the positive outcome of this therapy. A case study was conducted where 22 patients suffering from phantom limb pain were given mirror therapy for 15 minutes for a total of 4 weeks. They each recorded the number and duration of pain episodes throughout the trial, giving results where 100% reported a decrease in pain (Chan et al, 2007). This itself illustrates the positive outcome of mirror therapy in phantom pain sufferers. Central Stimulation Techniques Stimulating the central nervous system can be indicative for managing phantom limb pain. However, since these techniques are deemed expensive and invasive, its usually dealt with as a last resort when other easier interventions have failed. This includes stimulation of the motor cortex which was initially a method of treatment for central post stoke pain. It was only until recently, when this technique has been applied to other neuropathic pain syndromes, including phantom limb pain. This involves an implantation of the neuro stimulator directly into the subcutaneous tissue which stimulates the pre central gyrus using epidural surgical leads (Nguyen et al, 2011). The stimulation of the motor cortex is usually an extradural procedure where stimulation of the cortex responding to the upper limb is more feasible than stimulation of the lower limbs. This continuous stimulation is aimed to relieve the pain even though overall success is minimal (Wester et al, 1987). Spinal cord stimulation consists of low voltage stimulation of the spinal nerves to block the feeling of pain. Electrodes are placed in the epidural spas adjacent to the spinal area which is presumed to be the source of pain. Initially, a temporary electrical stimulator is implanted and over a specific time period, patients are carefully monitored to observe any pain reduction. Patients who respond positively then proceed to receive a permanent implant. Pain is reduced due to the electric current interfering with the pain signal from the brain. Clinical results indicate beneficial outcomes of this treatment in patients suffering from phantom limb pain, both short term and long term. Positive results were observed 52. 4% of 62 patients at the two year follow up, however this declined to 39% in the five year follow up (Viswanathan, 2010). However, considering how difficult phantom limb pain is to manage, even the slightest benefit can have a positive impact. Having said this, experiments and studies surrounding spinal cord stimulation have concluded that this technique is least effective with patients suffering from phantom limb pain as oppose to those suffering from other neuropathic pain syndromes (Kumar et al, 1998). Due to the uncertain outcome, its strongly recommended to trial the stimulation on a patient before complete insertion of an implantable pulse generator, avoiding any potential inconveniences. Asynchronous stimulation allows the separation of cortical zones which otherwise are reorganised during phantom limb pain. In this case asynchronous stimulation of the mouth which represents the invaded areas of the amputated arm and stump, separated the two cortical regions. As a result this reduced cortical reorganisation and therefore decreased phantom limb pain (Flor et al, 2000). This provides promising future treatment methods. Other examples of central stimulation includes sensory thalamic stimulation, which in contrast to spinal cord stimulation, has the ability of blocking potential spontaneous neuronal activity. This has been shown to have the capacity to mediate phantom sensations with a reported 80% experiencing initial pain relief (Dettmers et al, 2001). As a result, some propose this treatment to be more effective than spinal cord stimulation even though this has not yet been fully proven. A further development of central stimulation is deep brain stimulation. The aim of deep brain stimulation is to identify where pain pathways aggregate in the brain to enable to destruction of associated structures which manifest the pain (Rokyta et al, 2012). This procedure is considered invasive, has a high morbidity rate and low availability in comparison to other stimulation techniques. For these reasons, this routine isnt recommended (Dolin et al, 2004). Transcutaneous Electrical Nerve Stimulation (TENS) This method consists of a small device with two electrodes which are placed at the end of a stump to deliver electrical currents aimed to reduce pain. The reasoning behind this may be that the electricity from the electrodes stimulates the nerves to send signals to the brain which disrupt normal pain signals. Another mechanism behind this, is that the electrical currents also stimulate the nerves to assist the body in producing natural painkilling endorphins. The electrical currents can be adjusted to different wave lengths according to the severity of the pain. However, with regards to phantom limb pain, the efficacy of this treatment is undecided. A study conducted by Mulvey et al in 2012 showed that the average pain intensity decreased on movement and at rest. They recruited 10 individuals suffering from phantom limb pain to receive transcutaneous electrical nerve stimulation for 60 minutes over their transected afferent nerves. This study shows how TENS can potentially treat phantom limb pain however another study demonstrates how further trials are needed in order to conclude the effectiveness of transcutaneous nerve stimulation (Katz et al, 1991). Destructive Lesions of Central Nervous System Dorsal root entry zone, abbreviated to DREZ, lesioning is another treatment linked to phantom limb pain consisting of surgery which destroys the area where damaged nerves join the central nervous system. This intercepts pain messages from nerves to the brain therefore reducing any possible pain. A study by the Xuanwu Hospital in Beijing where 14 patients suffering from upper limb phantom pain were undertaken to evaluate their reaction from dorsal root entry zone lesions. Results of this study showed that 9 of the 14 (64. 3%) had satisfactory pain relief whilst the remaining 5 had poor pain relief experiencing no alterations in their phantom limb pain at all (Zheng et al, 2009). These results arent sufficient to credit DREZ as an efficient method of managing phantom limb pain. DREZ branches from cordotomy which has minimal literature supporting its use since its invasive and irreversible. Similarly, the development of later additional neuropathic problems can possibly arise (Dolin et al, 2004). Other Treatments As mentioned earlier, its beneficial to consider other approaches of treatment aside from central mechanisms in order to appreciate the extent of techniques used and to provide a broader insight as to how this pain can be tackled. Alongside central mechanisms, the second most used approach would be peripheral. Whether peripheral focused management is more effective than central is debatable but having an insight into this subject will better understanding. Currently, an array of treatments and therapies stem from the peripheral understanding of phantom limb pain. Examples include pharmacological drugs, and up and coming treatments like farabloc. Peripheral Mechanisms Over the years clinical observations have suggested that peripheral causes contribute to the phantom experience. Due to the strong positive correlation between stump and phantom limb pain, the events at the stump can be related to phantom pain. For example, pressure on the stump can elicit the phantom experience. Similarly, infiltration of a stump neuroma can alleviate or abolish phantom limb pain. Amputation of the limb results in severing of the peripheral nerve axon with inevitable neuroma formation. These are said to produce abnormal spontaneous and evoked impulse activity (Dolin et al, 2004). This ectopic, increased spontaneity is assumed to be a cause of an up regulation of sodium channels (Devor et al, 1993). This coincides with changes in the dorsal root ganglion cells which also display increased sensitivity (Jensen et al, 1983). Studies have provided evidence that in amputated limbs, the nerve endings remain sensitive to stimuli. Cooling these nerve endings increases firing rates and reduces blood flow causing its temperature to drop (Flor et al, 2000). Patients who exhibit phantom sensations are said to display such patterns of limb temperature. This lead to the development of sympathetic blocks which increase blood flow to the stump reducing the overall intensity of the pain (Flor et al, 2000) Farabloc Farabloc is a woven mesh of stainless steel and nylon thread designed to shield from electromagnetic fields. Its essentially a metal sock made to wear at the end of an amputated stump in order to block any electromagnetic frequencies above 1MHz and allow any frequency below 1 MHz (Stannard et al, 2010). The effect of this is to stabilise cellular permeability which in turn controls the release of inflammatory factors and modifies pain perception. Consequently, sufferers of phantom limb pain are able to wear this with comfort and experience pain reduction at the same time. Furthermore, this treatment can be applied to other neuropathic pain syndromes such as arthritic related pain and fibromyalgia. The practicality of this treatment contributes to its efficiency allowing it to be more widely accepted by patients and healthcare professionals. Conclusion Its apparent that these treatments share a positive impact on phantom limb pain with some evidently being better than others. Having considered the majority of possible treatments centred on central mechanisms, as well as an insight to peripheral, its now possible to reach an informed judgement as to which treatment has had the most effective outcome. The studies and trials mentioned provide a basis to make comparisons between different treatments allowing a more statistical measure. Generally, treatments derived from central mechanisms range from being highly invasive, such as deep brain stimulation, to not being invasive at all such as mirror therapy. This demonstrates how judging the effectiveness of a specific therapy requires certain qualities be taken into account. These include; ease of availability, efficiency, duration of therapeutic effect, and overall effectiveness at reducing pain. Central stimulation techniques generally have a positive influence on managing the phantom experience, however there are several obstacles related to this technique. For example, deep brain stimulation is very invasive with unpredictable outcomes, therefore putting the patient at risk during its course. As a result, the potential risks influence the cost of these procedures causing it to be one of the most expensive treatment options available. This already indicates how this solution isnt efficient or widely available. Moreover, the variable success rates of all central stimulation techniques further impedes its effectiveness representing a decreased overall benefit. However, there are a handful of central techniques which are more welcomed than others. For example, sensory thalamic stimulation is considered more effective than spinal cord stimulation with 80% of patients experiencing pain relief (Dettmers et al, 2001). In addition, asynchronous stimulation and transcutaneous electrical nerve stimulation are considered almost equally as successful at reducing phantom limb pain, both being more cost effective and efficient than other methods. On the other side of the spectrum, mirror therapy has had a major influence on how phantom limb is approached and managed. Ramachandran discovered how the pain wasnt a consequence of neuromas being irritated by muscle activity surrounding the stump, but due to a further involvement of central factors. He concluded how in addition to peripheral inputs, there are central factors and other contributions to the pain. Further research into the cortical behaviour of phantom limb patients lead him to develop mirror therapy. Studies showing how 100% of subjects experienced some scale of pain relief successfully illustrates how beneficial this therapy is. Alongside its high success rates, it also benefits from minimal equipment and preparation requirements further enhancing its efficiency and availability. However, although most results demonstrate positive outcomes, an extensive review by Rothgangel et al, 2011, has identified that the current studies aren’t sufficient to draw firm conclusions from since enough isn’t understood as to how and when mirror therapy should be applied. Albeit, it’s clear the results of mirror therapy are significantly greater than all other treatments discussed.