Spina Bifida Essay Example

Spina Bifida Essay Approximately one in 1000 children born in North America is affected with spina bifida, which makes the latter one of the most common and disabling congenital defects. Due to advances in medicine and technology over the past 40 years, the predicted lifespan of a child born with this disability has improved considerably. The focus of treatment now lies in the ongoing medical and rehabilitative management of the disability, including multiple and complex neurological, surgical, orthopaedic, gastrointestinal, and urological surgical procedures, as well as long-term use of orthotic aids and mobility devices and ongoing physiotherapy regimens. Risk Factors Spina bifida is one of the most common, serious malformations of human structure. At birth, it tends to be more common in girls than in boys. Additionally, the prevalence of spina bifida varies across time, by region, and by both race and ethnicity. Since the early 1980s, estimation of the prevalence of spina bifida in many industrialized countries has been complicated by the availability of prenatal diagnosis and the elective termination of some affected fetuses (Chan et al, 1993). A recognized chromosomal, teratogenic, or Mendelian malformation syndrome can be identified in a small proportion of individuals with meningomyelocoeles (Kallen Harris, 1998). However, most affected individuals do not have an underlying malformation syndrome. The list of variables that have been implicated as risk factors for the non-syndromic form of spina bifida is long and varied, ranging from maternal consumption of blighted potatoes to a short inter-pregnancy interval. However, most of the associati ons that have been reported are weak and have not been replicated in subsequent studies. Consequently, only a few variables have been established, or are strongly suspected to be risk factors for spina bifida: history of previous affected pregnancy with same partner, inadequate maternal intake of folic acid, pregestational maternal diabetes, valproic acid and carbamazepine. We will write a custom essay sample on Spina Bifida specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Spina Bifida specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Spina Bifida specifically for you FOR ONLY $16.38 $13.9/page Hire Writer A family history of spina bifida or anencephaly is one of the strongest risk factors for these disorders. The risk for spina bifida or anencephaly, or both, in the siblings of affected individuals ranges from 3% to 8% and is consistently higher than that of the general population. An increase in the risk of spina bifida has also been reported for second and third degree relatives of affected individuals (Carter Evans, 1973). One study has suggested that the risk of having a child with spina bifida or another type of neural tube defect might be increased in couples who have had a child with Downs syndrome, and the risk of having a child with this syndrome might be increased in couples who have had a child with a neural tube defect (Barkai et al, 2003). It is apparently that additional investigation is needed to confirm or rule out any potential link between these two disorders. It is generally accepted that inadequate intake of natural folate, or its synthetic form, folic acid, before and during early pregnancy, is associated with an increased risk of spina bifida and anencephaly. Case-control studies, randomized clinical trials, and community-based interventions with vitamin supplements have shown that the failure to consume folic acid supplements or folic acid-containing multivitamins increases the risk of having an affected child by two-fold to eight-fold (Wald et al, 2001). Moreover, the risk of having a child affected by a neural tube defect is indirectly related to both maternal folate and folic acid intake (from dietary sources and supplements) and maternal folate status. The mechanism underlying the association between neural tube defects and folate has not been established. However, folate participates in two metabolic pathways that, if disrupted, could have an adverse effect on the development of the embryo. One of these pathways is important for nucleic acid synthesis, and the other for a range of methylation reactions. Disruptions in folate metabolism can also result in raised homocysteine concentrations, which are teratogenic to the neural tube in some animal models (Wald et al, 2001). Women with pregestational diabetes are at increased risk of having a child with spina bifida and other types of birth defects (e.g., diabetic embryopathy). In these women the risk of having a child with a malformation of the central nervous system, including spina bifida, is two-fold to tenfold higher than the risk in the general population. The mechanism underlying this teratogenic effect has not been established, but it is clearly related to the degree of maternal metabolic control. Indeed, there is evidence that the risk of congenital malformations in the offspring of diabetic women is associated with first-trimester blood glucose concentrations (assessed by glycosylated haemoglobin concentrations) (McLeod Ray, 2002). Whether raised glucose concentrations are directly teratogenic, or whether they serve as a marker for another teratogenic agent (e.g., ketone bodies, free oxygen radicals) is unclear. Many anticonvulsant drugs are known teratogens. However, different anticonvulsants are associated with different constellations of malformations. An increased risk of spina bifida is associated with in-utero exposure to valproic acid or carbamazepine alone, or in combination with each other or other anticonvulsants. In infants exposed to valproic acid or carbamazepine the risk of spina bifida might be as high as 1%-2%. Women who use these drugs for indications other than epilepsy (e.g., bipolar disease, migraine, chronic pain) are also at increased risk of having a child with spina bifida if they become pregnant while taking these drugs. The mechanisms by which valproic acid and carbamazepine increase the risk of spina bifida have not been established. Diagnosis Maternal serum ÃŽ ±-fetoprotein and ultrasound are now routinely used to identify fetuses that have or are likely to have either spina bifida or anencephaly. Positive findings from either of these two screens can be followed by amniocentesis or detailed sonography, or both. When amniocentesis is done, amniotic fluid ÃŽ ±-fetoprotein and acetylcholinesterase concentrations can be used to confirm the presence of an open fetal malformation and differentiate between open ventral wall defects (e.g., gastroschisis and omphalocoele) and open neural tube defects (Loft, 1990). Â  Additionally, the fetal karyotype can be examined to rule out chromosomal anomalies. However, sonography can also be used to differentiate between ventral wall and neural tube defects, and to identify additional structural malformations that are characteristic of fetuses with chromosomal abnormalities. When a diagnosis of spina bifida is confirmed, ultrasound is used to assess spontaneous leg and foot motion, leg an d spine deformities. Most fetuses with spina bifida that are not electively terminated receive no treatment until after birth. Several studies have investigated whether method of delivery influences the outcome for infants with the disorder. Anteby and Yagel (2003) concluded that, in general, there is no conclusive evidence that caesarean section improves the outcome in children with spina bifida relative to vaginal delivery. However, caesarean section might be justified for large lesions, to reduce the risk of trauma, and is done after in-utero treatment of spina bifida because the forces of labor are likely to produce a dehiscence. Treatment Closure of the spinal lesion is usually done within 48 hours of birth. However, there are data indicating that, with antibiotics, the risk of infection does not rise until a week after birth. Â  If there are overt signs of hydrocephalus, and imaging studies confirm the presence of ventriculomegaly, a shunt is usually placed at the same time as the lesion is closed (Charney, 1985). However, in most cases hydrocephalus is not manifest until a few days after surgical closure. Spina bifida is a disorder that might be suitable for in-utero treatment, since it is compatible with life, is associated with substantial morbidity, and is routinely detected before 20 weeks of gestation. Moreover, neurological deterioration of affected fetuses might occur during gestation. Specifically, leg movement can be seen on sonograms of some affected fetuses before 17 to 20 weeks, whereas later in gestation and in neonates there is typically some degree of deformity and paralysis (Korenromp, 1986). The lo wer limb movements noted early in gestation could be secondary to spinal are reflexes. However, such movements could be of cerebral origin and their absence in later gestation may be the result of neural tissue damage caused by exposure to amniotic fluid or trauma. Additionally, animal studies, in which a model for spina bifida is created by laminectomy and exposure of the spinal cord to amniotic fluid, show that function can be retained if the lesion is closed before birth (Meuli et al, 1995). The first cases of in-utero spina bifida repair were done in 1994 with an endoscopic technique (Bruner et al, 1999) that proved unsatisfactory and was abandoned. In 1998, in-utero repair of spina bifida by hysterotomy was reported. Early experience suggested that infants treated by hysterotomy had improvement in hindbrain herniation, and possibly a diminished need for shunting relative to infants treated postnatally. It might be that in-utero treatment reduces the need for shunting by eliminating the leakage of spinal fluid that puts back-pressure on the hindbrain, such treatment allows reduction of the hindbrain hernia and relieves the obstruction of the cerebrospinal fluid outflow from the fourth ventricle. Compared with historical controls, infants treated in utero have a lower incidence of moderate to severe hindbrain herniation and hydrocephalus requiring shunting. In a series of 50 spina bifida cases treated in utero at the Childrens Hospital of Philadelphia, reversal of hindbrain herniation was reported in all cases, and the proportion requiring shunting was less than that in historical controls (43% versus 85%) (Johnson et al, 1989). A similar proportion requiring shunting (54%) was also noted in a series of 116 spina bifida cases treated in utero at Vanderbilt University Medical Center (Bruner et al, 2004). Comparisons between infants with spina bifida who were treated in utero and historical controls are however subject to substantial bias. Infants treated in utero represent a highly selected subset of affected individuals. Additionally, the medical management of such infants might differ from that of historical controls for reasons unrelated to the in-utero repair. Prognosis Short-term and long-term survival of individuals with spina bifida has increased with improvements in medical and surgical management. The most recent population-based data indicate that 1-year survival is about 87%, and that roughly 78% of all individuals with spina bifida survive to the age of 17 years (Wong et al, 2001). Unfortunately, these individuals continue to be subject to excess morbidity and mortality into and throughout adulthood. Whether treated in utero or postnatally, individuals with spina bifida are at substantial risk for leg weakness and paralysis, sensory loss, bowel and bladder dysfunction, and orthopaedic abnormalities (e.g., clubfoot, contractures, hip dislocation, scoliosis, kyphosis). In general, the functional level of the defect corresponds to the anatomical level of the bony spinal defect as determined by radiology. However, a retrospective study published in 2002, noted that functional level was higher (worse) than the anatomic level in 48% of individuals with spina bifida, and lower than the anatomic level in 14% of individuals (Rintoul et al, 2002). Individuals with spina bifida are at risk for associated malformations of the nervous system, including hydrocephalus and Chiari II malformations. Process Neonates with spina bifida should have baseline imaging studies of the central nervous system and subsequent serial head measurements to assess the velocity of head growth and the need for shunting. Orthopaedic deformities should also be treated shortly after birth, and ultrasonography and urodynamic studies should be done to assess the status of the urinary tract and provide a baseline for continuing assessment. At this age, bowel function is usually not a substantial difficulty since affected infants have the gastrocolic reflex and pass stools with most feedings. Medical care and monitoring of individuals with spina bifida is best provided by regular assessments by a multidisciplinary team. This team should be under the direction of a skilled physician with training in the care of children who have multiple disabilities, and should include a coordinator who is responsible for patient follow-up. Additional team members should include a nurse specializing in the care of children with multiple handicaps, a paediatric neurosurgeon, urologist and orthopaedic surgeon, a physical therapist, and a social worker. Other sub-specialists should be available on an as needed basis. Team members should be in direct communication with each other and with the patient’s primary care physician, who should provide routine medical care (e.g., immunizations) and continuing emotional support for the family. Psycho-Social Implications As it is well known children with spina bifida have problems with perceptual and cognitive skills, particularly complex visual-spatial tasks involving figure-ground relations, form consistency, spatial memory, and the location of stimuli in space (Fletcher et al. 2000). It has been shown that children with spina bifida demonstrate preserved abilities on measures that include simple visual discrimination and simple spatial relations (Fletcher et al. 2000). For instance, Dennis et al. (2001) found that children aged 6 to 15 years with spina bifida were as adept as matched control individuals in the perception of visual illusions concerned with size, length, and area. Various studies indicate that parents of disabled patients express a need for greater support on psychosocial aspects of their adolescents’ condition, including a desire for more anticipatory guidance in the areas of vocational/educational training, sexuality, and daily living skills (Samuelson et al, 1992). Therefore, rehabilitation professionals who serve children with spina bifida and their families should help the family by nurturing the youth through stressful periods, and by teaching family members tangible ways to strengthen adaptive functioning. Thus, while the rehabilitation team can help with the important outcomes of functional status and medical management of the condition, effective, family-centered care must also attend to the crucial developmental skill building. Two major focuses are needed in supporting families that are coping with spina bifida: a lifelong focus and an adolescent-specific focus. In the former, rehabilitation team members must discuss autonomy skills and cognitive development early and continuously to encourage experience in decision-making appropriate for the developmental stage. In addition, it is recommended that rehabilitation professionals assess parents’ need for anticipatory guidance and resources on an ongoing basis. For optimal success, it is crucial that these interventions start early in a child’s life. For example, a toddler can be given options: which shirt to wear, what breakfast cereal to eat, or where to go for a walk. The focus on making appropriate decisions continues through the school years. Moreover, age-appropriate chores should be assigned for all children. Creativity may be needed to develop an appropriate chore for a child with mobility impairments, but the data suggest that this is cr itical to developing self-sufficiency (Sawin et al., 1999). Conclusion Giving the increasing incidence of spina bifida and diversity of its occurrence, the resolution to this dilemma requires two-fold approach. From the critical perspective, it is necessary to focus both on clinical research and simultaneously on the various sociological aspects of disabled patients, particularly their health status, functional status, and health-related quality of life. Simultaneously, the ability of healthcare providers to suggest preventive measures, anticipatory guidance, and wellness approaches to care for individuals with lifelong chronic illness and disability should be stimulated.

Al Capone Essays - Five Points Gang, Bootleggers, The Untouchables

Al Capone Essays - Five Points Gang, Bootleggers, The Untouchables Al Capone Al Capone is America's best known gangster and the single greatest symbol of the collapse of law and order in the United States during the 1920s Prohibition era. Capone had a leading role in the illegal activities that lent Chicago its reputation as a lawless city. Capone was born on January 17, 1899, in Brooklyn, New York. Baptized Alphonsus Capone, he grew up in a rough neighborhood and was a member of two kid gangs, the Brooklyn Rippers and the Forty Thieves Juniors. Although he was bright, Capone quit school in the sixth grade at age fourteen. Between scams he was a clerk in a candy store, a pinboy in a bowling alley, and a cutter in a book bindery. He became part of the notorious Five Points gang in Manhattan and worked in gangster Frankie Yale's Brooklyn dive, the Harvard Inn, as a bouncer and bartender. While working at the Inn, Capone received his infamous facial scars and the resulting nickname Scarface when he insulted a patron and was attacked by her brother. In 1918, Capone met an Irish girl named Mary Mae Coughlin at a dance. On December 4, 1918, Mae gave birth to their son, Albert Sonny Francis. Capone and Mae married that year on December 30. Capone's first arrest was on a disorderly conduct charge while he was working for Yale. He also murdered two men while in New York, early testimony to his willingness to kill. In accordance with gangland etiquette, no one admitted to hearing or seeing a thing so Capone was never tried for the murders. After Capone hospitalized a rival gang member, Yale sent him to Chicago to wait until things cooled off. Capone arrived in Chicago in 1919 and moved his family into a house at 7244 South Prairie Avenue. Capone went to work for Yale's old mentor, John Torrio. Torrio saw Capone's potential, his combination of physical strength and intelligence, and encouraged his prot g . Soon Capone was helping Torrio manage his bootlegging business. By mid-1922 Capone ranked as Torrio's number two man and eventually became a full partner in the saloons, gambling houses,and brothels. When Torrio was shot by rival gang members and consequently decided to leave Chicago, Capone inherited the outfit and became boss. The outfit's men liked, trusted, and obeyed Capone, calling him The Big Fellow. He quickly proved that he was even better at organization than syndicating and expanding the city's vice industry between 1925 and 1930. Capone controlled speakeasies, bookie joints, gambling houses, brothels, income of $100,000,000 a year. He even acquired a sizable interest in the largest cleaning and dyeing plant chain in Chicago. Although he had been doing business with Capone, the corrupt Chicago mayor William Big Bill Hale Thompson, Jr. decided that Capone was bad for his political image. Thompson hired a new police chief to run Capone out of Chicago. When Capone looked for a new place to live, he quickly discovered that he was unpopular in much of the country. He finally bought an estate at 93 Palm Island, Florida in 1928. Attempts on Capone's life were never successful. He had an extensive spy network in Chicago, from newspaper boys to policemen, so that any plots were quickly discovered. Capone, on the other hand, was skillful at isolating and killing his enemies when they became too powerful. A typical Capone murder consisted of men renting an apartment across the street from the victim's residence and gunning him down when he stepped outside. The operations were quick and complete and Capone always had an alibi. Capone's most notorious killing was the St. Valentine's Day Massacre. On February 14, 1929, four Capone men entered a garage at 2122 N. Clark Street. The building was the main liquor headquarters of bootlegger George Bugs Moran's North Side gang. Because two of Capone's men were dressed as police, the seven men in the garage thought it was a police raid. As a result, they dropped their guns and put their hands against the wall. Using two shotguns and two machine guns, the Capone men fired more than 150 bullets into the victims. Six of the seven killed were members of Moran's gang; the seventh was

Branding Assignment Example | Topics and Well Written Essays - 2000 words

Branding - Assignment Example The companies look at branding to create certain amount of awareness and reputation related to the product and the organization and places the firm at a better place in the market. The real value of brand comes from its ability to add values and delivering profit to the organization by creating loyalty among the customers. Branding is not only used in terms of marketing but also from the financial perspective. Getting the value recognition and image for the customers helps the organization to gain financial impact (Schatte, 2010; Clifton, 2010; Blackett and Boad, 1999; Franzen and Moriarty, 2008). This report focuses on the company Cinnabon Inc., that started its first operation in the year 1985 in the Sea Tac Mall. The company was specially known for its â€Å"world's best cinnamon roll†, which was prepared after the team found the best flavoured cinnamon in Indonesia and mastered the recipe (Cinnabon, Inc., 2012a). This company has grown into a world famous brand with its un matched craving appeal among the customers for their baked goods and various types of beverages. This report aims to design a branding strategy for Cinnabon Inc. Current branding strategy of Cinnabon Inc. Few decades ago Cinnabon Inc. ... bon to the distribution channel along with the varied range of products and at the same time making sure that the expanding brand of Cinnabon continuous to operate as an integrated and seamless whole (Fehrenbach, 2013; BusinessWire, 2013). Multi-Channel Operations Cinnabon Inc, does not operates as a one-dimensional brand that plays in just one segment or channel. They are into a multichannel business leading the brand across different channels and ensuring that every channel integrates with each other so that it can accelerate the brand image. Thus, the multichannel brand management successfully is the major challenge for the organization. The organization is currently operating in about 48 countries with over 900 franchises and is approaching towards the annual sales of about $1 billion (Fehrenbach, 2013; Goudreau, 2012). In recent years the organization has experienced a magnificent growth by creating and marketing new products that can looked through two new conduits such as lice nsed product that are sold by other outlets like fast-food restaurants and consumer packaged goods that are sold in grocery stores. Immediate consumption food services has been operating as the main channel through the franchise bakeries, which is the most common company’s face to the consumers; but now the company has planned to move towards few more newer channels like grocery retail and food service licensing (Thorn, 2013). Therefore, the main aim of Cinnabon Inc. at present to manage these multichannel operations such they mingle among themselves well and enhance the brand image of the organization. Protection of Brand Image Using multiple channels to make the products available to the consumer opens door to other challenges too like protecting the brand. According to Cole there are

Intermodal Transportation Research Paper Example | Topics and Well Written Essays - 1500 words

Intermodal Transportation - Research Paper Example However, recent findings and literature regarding intermodal transportation ports review a contradictory outcome of these measures. The following paper investigates and discusses the effects of actions taken to up security at ports. Actions taken to improve the security at ports has negatively affected throughput, increasing costs and reducing the quality of operations. In 2005, a research by Ronald W. Tarr, Vicki McGurk, and Carol Jones made the realization that there are dangers facing intermodal transport ports after 9/11 are volatile (Tarr, et al., 2005). This unpredictability arises from the likelihood that terrorists may use intermodal transport to deliver weapons and explosive material. Oversized significance of stepping up security measures in these ports. The article explores the effects of training through collaboration and decision-making and its support of the response of transit organizations in the course of the 9/11 attacks (Tarr, et al., 2005). These effects revealed the substandard quality of intermodal transportation during the attacks and the ways the harmed output during the implementation of the already established security measures. A recent research by Nil Kula Degirmenci and Gul Denktas Sakar recognized number of security-linked challenges the intermodal transportation sector has been dealing with for the past several years (Degirmenci and Sakar, 2012). Among these challenges are piracy and terrorism. The researchers noted that security measures alone could not address the many low-quality operations, equipment, and industry players. Degirmenci and Sakar proceed to propose a system for gaining a general insight of the current security concept in intermodal transportation ports. This system takes into account the legal, innovative, and economic aspects. Consequently, system identifies key elements of security in intermodal transport by concentrating on requirement

You may do two papers on one artist's Research Paper

You may do two papers on one artist's - Research Paper Example While his mother assisted him in appreciating art as a young boy of 12 years, working at his father’s barbershop opened him up to the business world and to social issues of his surroundings. Mentorship alone is not enough to develop and sharpen skills and thus Hunt went through schooling. The first formal training that Hunt attended was at Juniors School of Art Institute at Chicago and later he joined University of Illinois to further his studies. At this early age, Hunt began experimental sculptors from abstract though guided by the twentieth century’s artists. This made him impress the community around him and he joined several exhibitions like Artists of Chicago, Vicinity Show, and American Show. While in the American show, Museum of Modern Art purchased a piece for its collection. In 1962, he was the youngest artist to exhibit in Seattle World’s fair, which is an international survey exhibition. According to Richard Hunt as quoted in the Lubeznik centre, â€Å"My career in sculpture began in 1955. It was then, while still a student, I began to exhibit my sculpture around Chicago in all sorts of places-art fairs, small galleries, local art centres, and the like† (Lubeznik centre). Hunt describes his career in the next twelve years that followed this and how he grew in the area of sculptural development. In addition, his skills enabled him to develop as a private, independent studio based and self-generated artist. In 1974, Richard accepted to head the project of Thunderbird Park that had started in 1952 with his grandfather Mungo Martin. He later dropped the project and started his own studio to pursue his own career. According to Galleria Silecchia, â€Å"Among other public works, Richard was selected for a major installation at the Vancouver International Airport and was a part of a multi-artist commission to create the furnishings for the University of

Impact Of Woolf Reforms On Civil Justice System Law Essay

Impact Of Woolf Reforms On Civil Justice System Law Essay The Woolf reforms have successfully increased access to justice for litigants despite being confronted with extensive variables and multifaceted difficulties. However, the reforms have failed in some major aspects, ultimately falling victim to the notoriety and reality of legal reform. The civil justice system and the Woolf reforms will firstly be discussed, moving into an analysis of the prominent areas of the Civil Procedure Rules, with the essay concluding with an overall analysis of the reforms, exposing the reasons for its failures, in reference to the reality of the civil justice system. The Civil Justice System and the Emergence of the Woolf Reforms and Access to Justice The civil justice system has the dual function of serving the public good and acting as a private means. Its social purpose is to provide the machinery for giving effect to the rights of citizens, whilst contributing to the social and economic well being of the community and regulating the exercise of executive power under the democratic principle of the rule of law. For these purposes to be fulfilled, there must be effective access to justice with an awareness of every citizen of their rights, entitlements, obligations and responsibilities, and of the procedures for redress. The underlying basis of the Woolf reforms is therefore to ensure that the justice system provides opportunities for the public to make good their rights. An unambiguous aspiration to overhaul the justice system culminated in 1994, when the then Master of the Rolls, Lord Woolf, was appointed by the Lord Chancellor, Lord Mackay, to assess the practices and procedures of the civil courts in England and Wales. There was a four year, all-embracing inquiry and extensive consultation process that made over three hundred recommendations designed to improve the limitations of civil litigation. There were two reports, published in June 1995 and July 1996, that revealed the findings of the wide-ranging inquiry and provided the foundation for the subsequent Civil Procedure Rules 1998. It is widely accepted that the perceived deficiencies of the civil justice system were met by proposals of radical change and the Woolf reforms were far more than a modification or clarification of the justice system. This investigation into the countrys legal system was required to maintain the integrity and political legitimacy of the system, preventing it from being brought into disrepute. The impact that the competency of a nations justice system can have on considerations such as the economy and political presence in international affairs was also recognised. This is especially the case when identifying London as a prominent dispute resolution centre in the world, attracting litigants from across the globe. The reputation of England and Wales was assessed and the pre-Woolf litigation landscape was in need of reform if this historic justice system was to maintain its standing as one of the most competent providers of justice. Findings of the Woolf Reforms The perceived deficiencies revealed by Woolfs inquiries were readily agreed by the users of the civil justice system. In essence, litigation in England and Wales was too slow, too expensive and too uncertain. These injustices were predominantly identified to be the result of the English adversarial tradition and allowing parties to assume the proactive and dominant case management role, leaving the judiciary to perform simply a reactive role. Too Slow The pre-Woolf landscape contained too much delay that crippled the efficiency of the system and provided a disincentive to those seeking to enforce their rights. This introduced an additional cause of stress, such as through making it more difficult to establish the facts and leading parties to settle for inadequate compensation.  [1]  Lord Woolf identified delay to be the direct result of the adversarial culture of litigation that lawyers practised within and thrived upon. The time taken to progress a case from an initial claim to final hearing was a matter of concern, especially in making litigation expensive. Too Expensive The ever-increasing cost of litigation was found to limit access to justice. However, for some academics, high costs do not automatically entail that low income citizens are prevented from participating in the justice process because of the existence of what Michael E. Stamp  [2]  has named the fiscal illusion, where a belief arises that legal services are becoming unaffordable because they have increased in relative price. Stamp argues that society must alter the proportion of income devoted to different goods and services and rely upon increasing the productivity of legal services to match the increasing costs rather than solely aiming to decrease costs whilst maintaining current levels of efficiency. The Woolf reforms took on the dual approach of aspiring to increase the output of the justice system and endeavouring to strip away unnecessary costs. Stamps comment is an understatement of how low income citizens are being priced out of litigation and fails to stress the importan ce of access to justice for every citizen, irrelevant of social or financial status. Despite the above debate, it is accepted that the cost of a claim is a barrier to some and a problem for all litigants  [3]  and in more direct opposition to Stamp, Sir Thomas Bingham  [4]  robustly describes costs to be a cancer eating at the heart of the administration of justice. The system was too expensive with patterns of costs being higher than the claim was worth. High costs act as a deterrent to those making and defending claims and a number of businesses say that it is often cheaper to pay up, irrespective of the merits, than to defend an action. For individual litigants the unaffordable cost of litigation constitutes a denial of justice.  [5]  The primary intention to provide justice for individuals and businesses was being undermined by the inefficient cost of the machinery. This begins to expose the cruel reality of accessing justice that will run throughout this assessment of the Woolf reforms. Too Uncertain Uncertainty for litigants was a simple but significant limitation of accessing justice arising from unpredictable costs, timings and timetabling, and the uncertainty of judicial decisions. Uncertainty constituted a strong deterrent for litigants and must not be minimised as an issue. The English Adversarial Tradition There was a definitive intention to shift the litigation culture from that of adversarialism to compromise, co-operation and settlement. Woolf described the adversarial system as likely to encourage an adversarial culture and to degenerate into an environment in which the litigation process is too often seen as a battlefield where no rules apply.  [6]  There was a determination of lawyers to manipulate court procedures, delay and disrupt the opposition counsel, increase the costs of the litigation for personal profit and impose professional protectionalism. Woolf identified that main procedural tools for conducting litigation efficiently have each become subverted from their proper purpose  [7]  and the powers of the court have fallen behind the more sophisticated and aggressive tactics of some litigators.  [8]  Lawyers were accused of abusing the disclosure of information, disputing unquestionable points, making tactical appeals and deploying tactics to drag out litigati on, thereby driving up costs. Any analysis of this tradition identifies that the burden of this abuse falls on the client. Woolf disclaimed any potential shift towards an inquisitorial system and abandoning adversarialism in its entirety, in order to maintain its benefits, such as its impartiality compared to inquisitorial techniques. The proposed reform of case management (as set out below), was therefore created to be compatible with the adversarial tradition, establishing conditions where it could survive the transfer of control from the parties to the judiciary. Conclusion on the Findings of the Woolf Reports The justice system was essentially failing the litigant, on and for whom the whole system should, in principle, focus and deliver. Fairness, speed of process, reasonable results and the availability of appropriate procedures were all found to be lacking within a system which promised all these goals. The impression of litigation is a fragmented, inefficient and incomprehensible system failing to fulfil its function and its potential, to promptly distribute affordable and certain justice. It is difficult to take issue with Lord Woolfs findings and the principles of reform that emerge from his conclusions. The reliability and diligence of the access to justice reports are uncontested and the research element of the reforms will continue to act as a valuable identification of the positives and, importantly, limitations of the civil justice system. In this facet of investigation and assessment, Woolf was undoubtedly successful. However, the means and choice of initiatives that Woolf proposed to remedy the exposed limitations are open to debate and critique, particularly when commonly identified as being radical and controversial in their nature and the direction in which they attempt to guide the justice system. Objectives of the Woolf Reforms The aims of the reforms can be condensed into one overriding objective, set out in Civil Procedure Rules 1.1, which was to increase the competency of the civil justice system to decide and deal justly the cases set before it. This includes such considerations as reducing excessive costs, ensuring cases are dealt with expeditiously, honestly and in a manner that is proportionate to their nature. This would create equal footing for parties, guaranteeing that there is a reasonable allotment of resources per case by the court. The vision of Woolf and the principles of his report were reinforced in the Civil Procedure Rules (CPR) which came into force on 26th April 1999. The CPR established a common set of procedures and rules for both the county courts and High Court to follow and gave effect to the three hundred plus changes, amounting to the most radical change to procedure in the last one hundred years. The Woolf reforms did not tinker with the existing system; they rewrote it.  [9]  The CPR are extensive, but some elements are considered to be more prominent than others. It is these that I will focus on in my assessment of the CPR as the implementation of the Woolf reforms. The following six elements of the CPR were, and continue to be, considered to have had the most effect on the English civil procedure. Case Management Technique Lord Woolf believed case management to be vital in solving the key problems of cost, delay and complexity, identifying that the three are interrelated and stem from the uncontrolled nature of the litigation process. In particular, there is no clear judicial responsibility for managing individual cases or for the overall administration of the civil courts.  [10]  The transfer of control from the parties to the judge was designed to improve the pace and efficiency of litigation through imposing tighter timeframes and reducing case duration. Woolf recommended that in relation to case management, the complexity of rules should be eased through modernising terminology and eliminating the distinctions between procedure and practice. Woolf not only sought to change the legal culture of the parties and their counsel, but also the role of the judiciary within an organised court service. Case management was an interventionist approach, imposing a more dominant role for the courts whilst not dismissing the English adversarial tradition in its entirety. The judiciary were equipped with wide discretionary powers, for example, imposing early trial dates and refusing any plea to delay the start of a trial. The governing role of the judge is a common aspect of other continental legal systems and its introduction constituted a shift of the English legal system towards the majority.  [11]   Positives Case management has improved access to justice through increasing the speed of litigation. This initiative determined that it was the judges rather than the lawyers who dictate pace. No longer are the larger claims allowed to fester in the do not touch drawers of solicitors filing cabinets.  [12]  Lawyers were too often judged to slow down litigation, Woolf himself regarding that in the majority of cases the reasons for delay arise from failure (by the lawyers) to progress the case efficiently, wasting time on peripheral issues or procedural skirmishing to wear down an opponent or to excuse failure to get on with the case.  [13]  Many academics view the shift in management from the lawyers to the more responsible and non-partisan judiciary to be an effective reform. For example, 98% of respondents to the 2001 Woolf Network Third Survey considered that the newly introduced Case Management Conferences worked well in their case.  [14]  The increase of discretionary power and control has meant that time-wasting and tactical applications have not been tolerated, and breaches of judicial instruction in relation to the final hearing can result in claims being struck out. Limitations It is argued that a judge does not necessarily or automatically possess the skills or know-how to manage cases competently, reducing the predictability of a claim. The concern is that competency levels are suggested to decrease down the ranks of the judiciary whilst the levels of discretion are maintained. Case management has also been argued to constitute judicial over-involvement, where lawyers who have obtained a deeper knowledge of the case are prevented from deciding how the case should progress. This not only places the responsibility irrationally with the judge, who has only briefly assessed the claim, but also could be construed as reflecting a mistrust of the professionalism of counsel to the dispute. Case management is predicted to fail as a permanent solution because the institution of judicial case management represents a one-time productivity increase where the immediate effect may be lower costs of obtaining justice, but, over the long run, the cost savings will evaporate as a direct result of the cost disease.  [15]  This educated prediction of unavoidable failure of case management, and the Woolf reforms and CPR as a whole, must be treated with care, because it is in essence a prediction. However, this calculated forecast of the reform process suggests a negative outcome of case management that cannot be ignored. The necessary technological advances within the system have also been insufficient to support the implementation of case management. The increased judicial use of computers and telephone conferences, the acceptability of email correspondence in many courts and the advantage of claims beginning online, have all been beneficial, but this is the limit of any technological input. This is not due to the lack of technology available, but rather the justice system barely tapping into the phenomenal potential of technology. It is characteristically a lack of resources and allocated funds that have limited the use of technology, thereby failing to adequately complement the reforms. Conclusion It is apparent that there should not be an outright restoration of the responsibility to manage cases back to the parties and their lawyers. The wholesale rejection of judicial case management does not emanate from a fair evaluation of an initiative that has speeded up litigation and, as a direct result, decreased costs. There must be a reassessment of this reform, with the aim of improving the ability of the judiciary to effectively administer and control cases, essentially through a development of training judges in management techniques. In combination with this training, it is vital that there is an increase in the availability of technological support. This initiative seems to be a clear example of the dangers of such an interventionist approach. Pre-Action Protocols Pre-action protocols constitute strict procedures and sensible codes of practice which are dependent upon the facts and nature of a case, which parties when confronted with the prospect of litigation are expected to follow. The original two protocols in the CPR, for example, concerned personal injury and clinical negligence respectively. The aim overall was to encourage the early settlement of claims and avoid litigation, such as through an early exchange of full information of the dispute. The protocols follow a similar pattern as the encouragement to participate in alternative dispute resolution, in that compliance with the protocols is not compulsory, but an unreasonable refusal to participate will affect the awarding of costs. Positives The success of the pre-action protocols is clear from their expansion from the original two to the current ten, in March 2010. The protocols have increased the structure and organisation of claims, creating certainty for litigants of the pre-trial steps that they are expected to take, such as the effort to settle. This sequentially has stimulated increased levels of dispute resolution and early settlement through the improvement of the pre-action investigation, earlier exchange of information and the enhancement of the relationship and understanding between parties through more pre-action contact. The protocols have also been credited with ensuring that disputes which are litigated are done so on the foundation of detailed preparation and consideration. Further positives include the decrease of nuisance ill-founded claims and the success of the attached code, which categorises disputes which do not fall within the protocols. Limitations The protocols have been criticised solely for their burden and lengthy requirements. The obligation to perform tasks such as writing letters, disclosing information and exchanging expert reports all combine to duplicate the process of the claim to follow. A dispute is essentially fought twice, unnecessarily increasing time and costs. Conclusion The protocols were a strong success only falling foul in the adverse effect of the burden of administration. They represent the strength of the reforms and suggest that radical reform can be effective if implemented correctly. The Track System Under case management, a track system was proposed to assign different procedures to different cases that are separated on the merits of complexity and financial value. The CPR classifies cases into one of the three tracks of small claims, fast track and multi-track.  [16]  The small claims track is for cases of less than  £5,000 in value and the fast track including claims that are more valuable than  £5,000, but fall below  £15,000, or that fail to fit within the small claims criteria. Fast track cases are deemed to be simpler disputes, and on a slight variation, include landlord-tenant disputes and personal injury cases that are valued between  £1,000 and  £5,000. The multi-track includes all the cases over  £15,000 that fail to be placed in the fast track and small claims. Positives The fast track arrangements have been successful in having cases heard quicker, with it being claimed that this guarantees a final hearing within 30 weeks from soon after the defence has been sent to court.  [17]  The track system overall is merited for recognising that cases of different size and complexity should be dealt with in different ways with it having been noted that the criticism that such distinctions will condemn many claimants of small sums to second class justice is wholly misconceived.  [18]  This initiative has increased certainty of timetabling and improves efficiency by ensuring that judicial time is spent proportionately to the issues in claims. Limitations The track system is highly controversial because of its technique of the early classification and has struggled to contend with the extensive variables that determine the costs awarded to a party.  [19]  The most influential variable that has hindered success is the unpredictability of the length of a dispute.  [20]  In some cases it is close to impossible to balance and account for variables, such as complexity and financial value, in the early stages of a case. The track system must also contend with all the disadvantages of going to court, regardless of which track, including the common problems of cost and time. Conclusion The immediate defence of the track system that the analysis and clarification of costs is an ambitious and difficult task is not sufficient to excuse its failure. The system has fallen victim to the overload of variables and has failed to present itself as a competent antidote and controller of excessive costs. This initiative is a disappointment and current calls for its removal are justified. The concerns of the track system once again support the use of Alternate Dispute Resolution processes to reach a settlement, rather than proceed to trial. Costs Most of the descriptive guidelines of the overriding objective set out in the CPR concern the costs of litigation. High costs are often magnified by the issue of delay which acts as drag or friction upon the economy by reducing the ability of individuals and corporations to increase productivity and fully utilise capital.  [21]  At a minimum, costs must be more predictable and affordable, despite the difficulties of quantifying and identifying the sources of abstract costs not directly related to the litigation process. The objective must be reducing delay that creates excessive costs and constructing an initiative to reduce any influx in costs if a claim is inhibited by delay. The general rule of costs that the losing party must pay those of the successful party still remains. However, CPR 44.3 has modified this long-standing rule by introducing exceptions to it and giving the court discretion in the allocation of costs in certain cases. The rules of paying costs also can require the losing party to pay on account before the final sum of costs is decided by the court. This scheme, coupled with the ability to order costs or a proportion of costs which have been summarily assessed to be paid within fourteen days has established in todays litigation system a concept of what one learned commentator has described as pay as you go system for costs.  [22]  The early and continuous payment of costs promotes early settlement as the parties assess their cases earlier and can make calculations as to whether their costs will exceed their revenue. This scheme communicates the reality of a claim directly to the parties, encouraging them to rationally manage their fi nances and clarify and target their personal goals within the claim. Parties also have an incentive to adopt a more co-operative approach because of the threat of court imposed financial penalties for unreasonable conduct. This is an example of the court utilising a more forceful, realistic and arguably manipulative technique in the practical application of a reform through costs. Positives Michael Bacon identified that several long established principles relating to legal costs have either been modified or disappeared completely as a result of the Woolf reforms, and one or two totally new concepts and procedures have been introduced.  [23]  This dramatic reform has increased the predictability and certainty of costs and balanced unequal financial means between litigants through orders for the party with greater financial resources, but with the weaker case, to pay interim costs. There has also been increased enforcement of procedural rules, and action taken in respect of unreasonable conduct, by the court through automatic costs sanctions. Limitations The new costs regime has been criticised predominantly for failing to sufficiently reduce and control costs. Costs have been front loaded and perceived decreases in costs have been shown to be cancelled out by adverse effects of other reforms. In addition, cost sanctions have been criticised for being oppressive and punitive instead of preventing non-compliance with court convention. Conclusion Costs have not been successfully reduced and only minor reductions can be identified. The reasoning that costs are difficult to control because of their dependence upon a high number of variables, and the reality that there cannot be a sole recommendation targeting the financial burdens of litigation, are not justification for the failure of a multifaceted scheme designed to reduce costs. The only positive is that the emphasis on costs has raised the profile and importance of costs overall. This awareness has instigated a new outlook on reducing costs that may develop into a culture. The costs scheme constitutes the major criticism of the reforms overall. Alternative Dispute Resolution Reform of the justice system was required to promote more cases to an earlier, controlled settlement as opposed to an untidy, pressured one at the door of the court. The encouragement for early settlement follows Woolfs vision of litigation as the last resort for disputing parties, with the view that any settlement is better than proceeding to trial. This has allowed alternative dispute resolution (ADR) to take a fundamental role, and information on the sources of ADR is provided at all civil courts and legal aid funding is made available for ADR processes. ADR is the umbrella term for a group of techniques used to solve disputes other than through the traditional court adjudication. However, proceedings should not be issued or commenced if settlement is still being explored. The competency of the Centre for Dispute Resolution (CEDR) which nominates mediators, liaises with both parties and prepares the mediation agreement, also became relevant. In theory, ADR prevents the limitations of the court process from proceeding to fruition. If a claim is settled in mediation, the costs, complexity, adversarialism, time and ineffectiveness of the court procedure are all circumvented. The reduction of cases progressing to trial also reduces the burden on the courts, allows for a more efficient and better resourced procedure and, ultimately, better access to justice. The court was therefore equipped with the power to direct parties to attempt ADR under CPR 26.4 and to order a months postponement, facilitating parties to secure a settlement. In combination with ADR processes, offers to settle, known as Part 36 offers, provide yet another stimulus to settle before court action. Part 36 offers departed from the traditional structure of settlement, allowing both the claimant and defendant to make an offer to settle before the issuing of the claim or during the actual proceedings. If an offer has been made then this will be taken into consideration by the court when awarding costs. Positives There has been a clear cultural change and increased numbers of settlements through the vigorous promotion of ADR. There now exists a regime that encourages and obliges parties and their lawyers to consider settlement and utilise ADR processes. The largely aggressive adversarial behaviour associated with disputes has been softened with a more co-operative and collaborative approach. This culture immediately decreased the number of claims reaching court, with a 19.6% fall in the number of proceedings issued from 2000 to 2001 in the Queens Bench Division.  [24]  ADR has offered willing litigants the opportunity to participate in a quicker, cheaper and more specific and flexible technique for resolving their dispute. ADR also has many personal advantages for the participants as it can be creative, reduce stress and repair relationships. Limitations The essential limitation of ADR is its reliance upon the original participation in mediation. A settlement then relies upon the facts of a case and the parties approach to ADR. Many parties take a half-hearted approach to mediation and have no real intention to negotiate for a settlement. They intend instead to avoid the financial implications of unreasonably refusing to mediate. It is argued that as a result of both failed settlement attempts and indifferent participation in mediation, ADR does not necessarily reduce costs. Mandatory mediation is argued to constitute the greatest failure of ADR. Professor Dame Hazel Genn,  [25]  through the voluntary pilot mediation scheme of the Central London County Court (CLCC), identified that the Woolf reforms have motivated parties to mediate in order to avoid financial penalties for unreasonable refusal and create the appearance of following judicial direction. There was also the 2004 Automatic Referral to Mediation Scheme (ARMS) run at CLCC, where one hundred cases a month were selected at random and sent to mediation before any court hearing. Parties unwilling to partici

The Evolution of Grant in Ernest J. Gaines A Lesson Before Dying Essay

After the Civil War ended, many blacks and whites, especially in the South, continued living as if nothing had changed with regards to the oppression and poor treatment of African Americans. Narrator Grant Wiggins, of Ernest J. Gaines' A Lesson Before Dying, possesses a similar attitude toward race relations. Through his experiences with a young man wrongly accused of murder, Grant transforms from a pessimistic, hopeless, and insensitive man into a more selfless and compassionate human being who can see the possibility of change in relations between whites and blacks. Grant Wiggins, one of the few black men of the time to have a college education, lives with his aunt on a plantation just outside Bayonne, Louisiana in 1948, and teaches at the all-black school held at the all-black plantation church. Considering the poor relations between blacks and whites at the time in which the story is set, it comes as no surprise that Grant sees tension frequently in his community – not only through the ways in which persons of various races treat one another, but also in the justice, or lack thereof, served in court cases. The white authorities accuse Jefferson, an innocent student Grant taught a few years prior, of first-degree murder. During the trial, Jefferson's state-appointed defense lawyer pleads for the jury to have sympathy on Jefferson as he is a hog and does not possess the intelligence to commit the crimes of which he is accused. Because the whites dominate the society, the court finds Jefferson guilty as charged and the judge sentences him to death by electrocution. Upon hearing the verdict, Miss Emma, Jefferson's aunt, resolves to persuade Grant to teach Jefferson that he is, in fact, a man – not a hog – and to get him to wal... ...statements as truth reveals Grant's transformation into a selfless, compassionate, and optimistic man. Grant realizes he has made mistakes and does not desire to be esteemed higher than he believes he deserves. Paul expresses his desire to befriend Grant, thus breaking the barriers of race and reaching out to Grant. Grant returns to his classroom, crying, a changed man. Work Cited Gaines, Ernest J. A Lesson before Dying. New York: Vintage, 1993. Works Consulted Folks, Jeffrey. â€Å"Communal responsibility in Ernest J. Gaines‘s A Lesson Before Dying. Mississippi Quarterly 52.2 (1999): 253 Piacentino, Ed. â€Å"The Common humanity that is in us all†: Toward Racial Reconciliation in Gaines’s A Lesson Before Dying.† Southern Quarterly 42.3 (2004): 71 Vancil, David. â€Å"Redemption According to Ernest Gaines,† African American Review, 28 (Fall 1994), 490.