Water fluoridation

Water fluoridation ABSTRACT The safety and efficacy of water fluoridation has been a topic of great controversy throughout Americas communities. Scientific evidence has shown that ingesting low to moderate levels of fluoride can benefit the dental health of a community, especially those populations in a community that may be classified as having low socioeconomic status. Children in all areas, but especially those with low SES, are at greatest risk for developing dental caries and having a community water fluoridation program (CWFP) will help them reduce their dental caries. Moderation of fluoride ingestion for individuals is the key. Low to moderate daily ingestion of fluoride, averaging 1.0 mg/liter per day is optimum. Dental and skeletal fluorosis can occur if ingestion levels are greater than 3.0 mg/liter per day for long periods of time. This is a discussion on the safety and efficacy of water fluoridation. INTRODUCTION This commentary presents the on-going controversy on community water fluoridation in the United States, and I will attempt to analyze science-based evidence in support of water fluoridation. There have always been questions on the safety and efficacy of fluoride in drinking water, some school of thought believes that fluoridation has some adverse effects to exposed human populations, especially in infants and children. Another school of thought believes that water fluoridation is essential in preventing tooth decay, and therefore the practice should be sustained. According to the Center for Disease Control and prevention (CDC) water fluoridation is one of the 10 great public health achievements of the 20th century in the United States (CDC, 1999), which is attributable for increased lifespan of Americans by 25 years ( Bunker et al., 1994). This paper will discuss science-based evidence that proves the efficacy and safety of water fluoridation among children as well as offer some reco mmendations to the various stakeholders. POSITION STATEMENT Water fluoridation is the adjustment of the concentration level to the optimally regulated level of which the naturally occurring fluoride presents in public or community drinking water supplies. In most cases, deflouridation is needed when the naturally occurring fluoride level exceeds recommended limits. The recommended fluoride concentration in drinking water by the U.S. Public Health Service (PHS) is 0.7-1.2mg/L, to effectively prevent dental caries and minimize the occurrence of dental fluorosis (NRC, 2006). Low decay rates were found to be associated with continuous use of water with fluoride content of 1ppm (Meskin, 1995). There has been serious questions as to the efficacy of fluoride intervention in preventing both tooth decay, as it benefit is said to be merely cosmetic or topical (CDC, 1999). Such topical effect of fluoride can be achieved by the use tooth without the risking the overexposure from ingested fluoride (NRC, 2006). However, it has also been reported that fluor ide exposure provides both systemic and topical protection. Ingested fluoride deposited on tooth surface during tooth formation, and fluoride contained in saliva provides long-lasting systemic protection against booth tooth decay than topical application using tooth paste or fluoride foams (CDC, 2001). WHAT IS FLUORIDE Fluoride is a naturally occurring element. It is found in rocks and soil everywhere. Fluoride can be found in fresh water and ocean water. Naturally occurring fluoride levels ranges from 0.1ppm to over 12ppm (NRC, 2006).Fluoride is present in the customary diets of people and in most portable water sources. The average dietary intake of fluoride is approximately 0.5mg daily from either naturally occurring fluoride in the water or the fluoride found in produce. It is also a normal component of tooth enamel and bone studies have shown that the calcified tissues of both enamel and bone are made up of a combination of hydroxyl- and fluor-apatites of varying composition depending on the abundance of fluoride at the site of formation. These tissues are the principal sites of deposition of fluoride (NRC, 2006). HOW FLUORIDE PREVENTS AND CONTROLS DENTAL CARIES Dental caries is an infectious, transmissible disease in which bacterial by-products (i.e., acids) dissolve the hard surfaces of teeth. Unchecked, the bacteria can penetrate the dissolved surface, attack the underlying dentin, and reach the soft pulp tissue. Dental caries can result in loss of tooth structure, pain, and tooth loss and can progress to acute systemic infection. Cryogenic bacteria (i.e., bacteria that cause dental caries) reside in dental plaque, a sticky organic matrix of bacteria, food debris, dead mucosal cells, and salivary components that adheres to tooth enamel. Plaque also contains minerals, primarily calcium and phosphorus, as well as proteins, polysaccharides, carbohydrates, and lipids. Cryogenic bacteria colonize on tooth surfaces and produce polysaccharides that enhance adherence of the plaque to enamel. Left undisturbed, plaque will grow and harbor increasing numbers of cryogenic bacteria. An initial step in the formation of a carious lesion takes place when cryogenic bacteria in dental plaque metabolize a substrate from the diet (e.g., sugars and other fermentable carbohydrates) and the acid produced as a metabolic by-product demineralizes (i.e., begins to dissolve) the adjacent enamel crystal surface (CDC,2009). Demineralization involves the loss of calcium, phosphate, and carbonate. These minerals can be captured by surrounding plaque and be available for reuptake by the enamel surface. Fluoride, when present in the mouth, is also retained and concentrated in plaque. Fluoride works to control early dental caries in several ways. Fluoride concentrated in plaque and saliva inhibits the demineralization of sound enamel and enhances the remineralization (i.e., recovery) of demineralized enamel (Featherstone, 1999 Koulourides, 1990). As cryogenic bacteria metabolize carbohydrates and produce acid, fluoride is released from dental plaque in response to lowered pH at the tooth-plaque interface. The released fluoride and the fluoride present in saliva are then taken up, along with calcium and phosphate, by de-mineralized enamel to establish an improved enamel crystal structure. This improved structure is more acid resistant and contains more fluoride and less carbonate (Featherstone, 1999). Fluoride is more readily taken up by demineralized enamel than by sound enamel. Cycles of demineralization and remineralization continue throughout the lifetime of the tooth. Fluoride also inhibits dental caries by affecting the activity of cryogenic bacteria. As fluoride concentrates in dental plaque, it inhibits the process by which cryogenic bacteria metabolize carbohydrates to produce acid and affects bacterial production of adhesive polysaccharides. In laboratory studies, when a low concentration of fluoride is constantly present, one type of cryogenic bacteria, Streptococcus mutans, produces less acid. Whether this reduced acid production reduces the carcinogenicity of these bacteria in humans is unclear (Van Loveren, 1990). Saliva is a major carrier of topical fluoride. The concentration of fluoride in ductal saliva, as it is secreted from salivary glands, is low approximately 0.016 parts per million (ppm) in areas where drinking water is fluoridated and 0.006ppm in non fluoridated areas. This concentration of fluoride is not likely to affect cryogenic activity. However, drinking fluoridated water, brushing with fluoride toothpaste, or using other fluoride dental products can raise the concentration of fluoride in saliva present in the mouth 100- to 1,000-fold. The concentration returns to previous levels within 12 hours but, during this time, saliva serves as an important source of fluoride for concentration in plaque and for tooth remineralization (Murray,1993). Applying fluoride gel or other products containing a high concentration of fluoride to the teeth leaves a temporary layer of calcium fluoride-like material on the enamel surface. The fluoride in this material is released when the pH drops in the mouth in response to acid production and is available to remineralize enamel. In the earliest days of fluoride research, investigators hypothesized that fluoride affects enamel and inhibits dental caries only when incorporated into developing dental enamel (i.e., preeruptively, before the tooth erupts into the mouth) (Murray,1993). Evidence supports this hypothesis, but distinguishing a true preeruptive effect after teeth erupt into a mouth where topical fluoride exposure occurs regularly is difficult. However, a high fluoride concentration in sound enamel cannot alone explain the marked reduction in dental caries that fluoride produces . The prevalence of dental caries in a population is not inversely related to the concentration of fluoride in enamel, and a higher concentration of enamel fluoride is not necessarily more efficacious in preventing dental caries (Mcdonagh etal.,2000). The laboratory and epidemiologic research that has led to the better understanding of how fluoride prevents dental caries indicates that fluorides predominant effect is post eruptive and topical and that the effect depends on fluoride being in the right amount in the right place at the right time. Fluoride works primarily after teeth have erupted, especially when small amounts are maintained constantly in the mouth, specifically in dental plaque and saliva (Mcdonagh etal., 2000). Thus, adults also benefit from fluoride, rather than only children, as was previously assumed. RISK FOR DENTAL CARIES The prevalence and severity of dental caries in the United States have decreased substantially during the preceding 3 decades. National surveys have reported that the prevalence of any dental caries among children aged 1217 years declined from 90.4% in 19711974 to 67% in 19881991; severity (measured as the mean number of decayed, missing, or filled teeth) declined from 6.2 to 2.8 during this period (Burt, 1989). These decreases in caries prevalence and severity have been uneven across the general population; the burden of disease now is concentrated among certain groups and persons. For example, 80% of the dental caries in permanent teeth of U.S. children aged 517 years occurs among 25% of those children. Populations believed to be at increased risk for dental caries are those with low socioeconomic status (SES) or low levels of parental education, those who do not seek regular dental care, and those without dental insurance or access to dental services (Meskin,1995). Persons can be at high risk for dental caries even if they do not have these recognized factors. Children and adults who are at low risk for dental caries can maintain that status through frequent exposure to small amounts of fluoride (e.g., drinking fluoridated water and using fluoride toothpaste). Children and adults at high risk for dental caries might benefit from additional exposure to fluoride (e.g., mouth rinse, dietary supplements, and professionally applied products). All available information on risk factors should be considered before a group or person is identified as being at low or high risk for dental caries. However, when classification is uncertain, treating a person as high risk is prudent until further information or experience allows a more accurate assessment. This assumption increases the immediate cost of caries prevention or treatment and might increase the risk for enamel fluorosis for children aged NATIONAL GUIDELINES FOR FLUORIDE USE PHS recommendations for fluoride use include an optimally adjusted concentration of fluoride in community drinking water to maximize caries prevention and limit enamel fluorosis. This concentration ranges from 0.7ppm to 1.2ppm depending on the average maximum daily air temperature of the area (PHS, 1991). In 1991, PHS also issued policy and research recommendations for fluoride use. The U.S. Environmental Protection Agency (EPA), which is responsible for the safety and quality of drinking water in the United States, sets a maximum allowable limit for fluoride in community drinking water at 4ppm and a secondary limit (i.e., non-enforceable guideline) at 2ppm (EPA,1998). The U.S. Food and Drug Administration (FDA) is responsible for approving prescription and over-the-counter fluoride products marketed in the United States and for setting standards for labeling bottled water and over-the-counter fluoride products (e.g., toothpaste and mouth rinse) (ADA,2007). Nonfederal agencies also have published guidelines on fluoride use. The American Dental Association (ADA) reviews fluoride products for caries prevention through its voluntary Seal of Acceptance program; accepted products are listed in the ADA Guide to Dental Therapeutics (ADA, 2007). A dosage schedule for fluoride supplements for infants and children aged 16 years, which is scaled to the fluoride concentration in the community drinking water, has been jointly recommended by ADA, the American Academy of Pediatric Dentistry (AAPD), and the American Academy of Pediatrics (AAP) (Meskin,1995). In 1997, the Institute of Medicine published age-specific recommendations for total dietary intake of fluoride. These recommendations list adequate intake to prevent dental caries and tolerable upper intake, defined as a level unlikely to pose risk for adverse effects in almost all persons. COST-EFFECTIVENESS OF FLUORIDE MODALITIES Documented effectiveness is the most basic requirement for providing a health-care service and an important prerequisite for preventive services (e.g., caries-preventive modalities). However, effectiveness alone is not a sufficient reason to initiate a service. Other factors, including cost, must be considered. A modality is more cost-effective when deemed a less expensive way, from among competing alternatives, of meeting a stated objective (Garcia,1989). In public health planning, determination of the most cost-effective alternative for prevention is essential to using scarce resources efficiently. Dental-insurance carriers are also interested in cost-effectiveness so they can help purchasers use funds efficiently. Because half of dental expenditures are out of pocket (Garcia, 1989), this topic interests patients and their dentists as well. Potential improvement to quality of life is also a consideration. The contribution of a healthy dentition to quality of life at any age has not been quantified, but is probably valued by most persons. Although solid data on the cost-effectiveness of fluoride modalities alone and in combination are needed, this information is scarce. In 1989, the Cost Effectiveness of Caries Prevention in Dental Public Health workshop, which was attended by health economists, epidemiologists, and dental public health professionals, attempted to assess the cost-effectiveness of caries-preventive approaches available in the United States (Downer et al., 1981). Community Water Fluoridation Health economists at the 1989 workshop on cost-effectiveness of caries prevention calculated that the average annual cost of water fluoridation in the United States was $0.51 per person (range: $0.12$5.41) (Burt, 1989). In 1999 dollars, this cost would be $0.72 per person (range: $0.17$7.62). Factors reported to influence the per capita cost included: size of the community (the larger the population reached, the lower the per capita cost); number of fluoride injection points in the water supply system; amount and type of system feeder and monitoring equipment used; amount and type of fluoride chemical used, its price, and its costs of transportation and storage; and expertise of personnel at the water plant. When the effects of caries are repaired, the price of the restoration is based on the number of tooth surfaces affected. A tooth can have caries at >1 location (i.e., surface), so the number of surfaces saved is a more appropriate measure in calculating cost-effectiveness than the number of teeth with caries. The 1989 workshop participants concluded that water fluoridation is one of the few public health measures that results in true cost savings (i.e., the measure saves more money than it costs to operate); in the United States, water fluoridation cost an estimated average of $3.35 per carious surface saved ($4.71 in 1999 dollars). Even under the least favorable assumptions in 1989 (i.e., cities with populations A Scottish study conducted in 1980 reported that community water fluoridation resulted in a 49% saving in dental treatment costs for children aged 45 years and a 54% saving for children aged 1112 years (Downer et al., 1981). These savings were maintained even after the secular decline in the prevalence of dental caries was recognized. The effect of community water fluoridation on the costs of dental care for adults is less clear. This topic cannot be fully explored until the generations who grew up drinking optimally fluoridated water are older. School Water Fluoridation Costs for school water fluoridation are similar to those of any public water supply system serving a small population (i.e., Assessment of the Adverse Health Effects of fluoride Evidence of the adverse health effects of prolonged exposure to high concentrations of fluoride are well documented by several peer reviewed studies, which are examined in this paper. Higher concentrations of total ingested fluoride from potential sources like drinking water, food and beverages, dental-hygiene products such as toothpaste, and pesticide residues can have adverse health effects on humans (NRC, 2006). Some of the adverse health effects of fluoride in drinking water are enamel fluorosis, skeletal fluorosis, bone cancer and bone fracture. (NRC, 2006, PHS, 1991). Fluorosis is caused mainly by the ingestion of fluoride in drinking water (Viswanathan et al., 2009). Fluoride has high binding affinity for developing enamel and as such high concentration of cumulative fluoride during tooth formation can lead to enamel fluorosis, a dental condition from mild to severe form characterized by brown stains, enamel loss and surface pitting (DenBesten Thariani, 1992). These dental ef fects are believed to be caused by the effects of fluoride on the breakdown rates of early-secreted matrix proteins, and on the rates at which the degraded by-products are withdrawn from the maturing enamel (Aoba Fejerskov, 2002). Children are much more at risk of enamel fluorosis, especially in their critical period from 6 to 8 years of age, than adults. Fluoride uptake into enamel is possible only as a result of concomitant enamel dissolution, such as caries development (Fejerskov, Larsen, Richards, Baelum, 1994). There is a 10% prevalence of enamel fluorosis among U.S. children in communities with water fluoride concentrations at or near the EPAs MCLG of 4 mg/L (NRC, 2006). The CDC estimates that 32% of U.S. children are diagnosed with dental fluorosis (CDC, 2005). Today, there are convincing evidence that enamel fluorosis is a toxic effect of fluoride intake, and that its severe forms can produce adverse dental effects, and not just adverse cosmetic effects in humans (NRC, 200 6). Burt and Eklund (1999) states: â€Å"The most severe forms of fluorosis manifest as heavily stained, pitted, and friable enamel that can result in loss of dental function†. Epidemiological data from both observational and clinical studies have been examined. Sowers, Whitford, Clark Jannausch (2005) investigated prospectively for four years bone fracture in relation to fluoride concentrations in drinking water in a cohort study, by measuring serum fluoride concentrations and bone density of the hip, radius, and spine. The authors reported higher serum fluoride concentrations in the communities with fluoride concentrations at 4 mg/L in drinking water; and higher osteoporotic fracture rates in the high fluoride areas that were similar to those in their previous studies in 1986 and 1991. It is unclear in their recent study whether existing factors in the population like smoking rates, hormone replacement and physical activity were examined as potential cofounders for fractures. Fasting serum fluoride concentrations are considered a good measure of long-term exposure and of bone fluoride concentrations (Whitford, 1994; Clarkson et al., 2000). Findings by t he Sowers studies were complemented in several ways by Li et al. (2001) in a retrospective cohort ecologic study. The combined findings of Sowers et al. (2005) and Li et al., (2001) lend support to the biological gradients of exposures and fracture risk between 1 and 4 mg/L of fluoride concentration. Evidently, the physiological effect of fluoride on â€Å"bone quality† and the fractures observed in the referenced animal studies are consistent with the effects found in the observational studies. RECOMMENDATIONS Before promoting a fluoride modality or combination of modalities, the dental-care or other health-care provider must consider a persons or groups risk for dental caries, current use of other fluoride sources, and potential for enamel fluorosis. Although these recommendations are based on assessments of caries risk as low or high, the health-care provider might also differentiate among patients at high risk and provide more intensive interventions as needed. Also, a risk category can change over time; the type and frequency of preventive interventions should be adjusted accordingly. Continue and Extend Fluoridation of Community Drinking Water Community water fluoridation is a safe, effective, and inexpensive way to prevent dental caries. This modality benefits persons in all age groups and of all SES, including those difficult to reach through other public health programs and private dental care (CDC, 2001a). Community water fluoridation also is the most cost-effective way to prevent tooth decay among populations living in areas with adequate community water supply systems. Continuation of community water fluoridation for these populations and its adoption in additional U.S. communities are the foundation for sound caries-prevention programs. In contrast, the appropriateness of fluoridating stand-alone water systems that supply individual schools is limited. Widespread use of fluoride toothpaste, availability of other fluoride modalities that can be delivered in the school setting, and the current environment of low caries prevalence limit the appropriateness of fluoridating school drinking water at 4.5 times the optimal concentration for community drinking water. Decisions to initiate or continue school fluoridation programs should be based on an assessment of present caries risk in the target school(s), alternative preventive modalities that might be available, and periodic evaluation of program effectiveness (CDC, 2001a). Frequently Use Small Amounts of Fluoride All persons should receive frequent exposure to small amounts of fluoride, which minimizes dental caries by inhibiting demineralization of tooth enamel and facilitating tooth remineralization. This exposure can be readily accomplished by drinking water with an optimal fluoride concentration and brushing with fluoride toothpaste twice daily(CDC, 2001a). Supervise Use of Fluoride Toothpaste among Children Aged Childrens teeth should be cleaned daily from the time the teeth erupt in the mouth. Parents and caregivers should consult a dentist or other health-care provider before introducing a child aged Use an Alternative Source of Water for Children Aged 8 Years Whose Primary Drinking Water Contains >2 ppm Fluoride In some regions in the United States, community water supply systems and home wells contain a natural concentration of fluoride >2ppm. At this concentration, children aged 8 years are at increased risk for developing enamel fluorosis, including the moderate and severe forms, and should have an alternative source of drinking water, preferably one containing fluoride at an optimal concentration. In areas where community water supply systems contain >2ppm but 8 years. For families receiving water from home wells, testing is necessary to determine the natural fluoride concentration (CDC, 2001a). Label the Fluoride Concentration of Bottled Water Producers of bottled water should label the fluoride concentration of their products. Such labeling will allow consumers to make informed decisions and dentists, dental hygienists, and other health-care professionals to appropriately advise patients regarding fluoride intake and use of fluoride products (CDC, 2001). CONCLUDING POSITION STATEMENT When used appropriately, fluoride is a safe and effective agent that can be used to prevent and control dental caries. Fluoride has contributed profoundly to the improved dental health of persons in the United States and other countries. Fluoride is needed regularly throughout life to protect teeth against tooth decay. To ensure additional gains in oral health, water fluoridation should be extended to additional communities, and fluoride toothpaste should be used widely. Adoption of these and other recommendations in this paper could lead to considerable savings in public and private resources without compromising fluorides substantial benefit of improved dental health. What is consistent from the literature review is the fact that infants and children are much more at risk of overexposure and the development of adverse health effects. A community water fluoridation program (CWFP) is very safe and efficient, not only in terms of reducing dental caries, but also on the communitys budg et (CDC, 2001a). A CWFP can especially help those communities who have populations in the low SES category. These populations have children whose parents or guardians dont always have access to dental insurance and so regular dental checkups to curb the dental caries is not always an option. Reducing dental caries before they lead into more extreme oral morbidity can be very beneficial to these children. Implementing a fluoridated water program can also be beneficial to a whole community in terms of saving communities thousands and millions of dollars. Implementing a water program would follow strict guidelines set by the EPA, so the optimum level of fluoride would be followed, staying in the range of 0.7 to 1.2, where people would ingest no more than an average of 1 mg/liter of fluoride per day. Moderation is the key. There are studies confirming that ingestion of fluoride greater than the optimum level could produce dental fluorosis. Though unconfirmed by studies, individual reports have even suggested that ingestion of fluoride >8 mg/liter per day over a long period of time could produce skeletal fluorosis. However, with proper surveillance and reporting of fluoride in water systems, the greater population could be served, increasing the dental health of all individuals, especially the youth and saving dollars from excessive health care costs (ADA, 2009). Remember, a little prevention now can go a long way later. REFERENCES ADA (2005).Fluoridation Facts: ADA statement commemorating the 60th anniversary of community water fluoridation. Retrieved October 19, 2009 from www.ada.org/public/topics/fluoride/facts/fluoridation_facts.pdf ADA.(2007). ADA Guidelines to Dental Therapeutics. Retrieved October 23, 2009 from http://www.ada.org/prof/resources/pubs/advocacy.asp ADA (2009). Fluoride: Natures tooth decay fighter. J of the Am. Dental Ass., 140(1), 126-126. Alphajoh, C.(2009). (PhD Student). Service Learning Activity: Environmental Health. Walden University. Assessed November 13, 2009 from http://environmentalhealthtoday.wordpress.com/2009/05/13/commentary-and-position-statement-on-the-safety-and-efficacy-of-water-fluoridation/ Aoba, T., Fejerskov, O. (2002). Dental fluorosis: Chemistry and biology. Crit. Rev. Oral. Biol. Med., 13(2), 155-170. Bowden, G.(1990). Effects of fluoride on the microbial ecology of dental plaque. J Dent Res 1990; 69(special issue):653—9 Brunelle, J.(1987. The prevalence of dental fluorosis in U.S. children. J Dent Res.(Special issue) 68:995. Bunker, J.P., Frazier, H.S., Mosteller, F. (1994). Improving health: measuring effects of medical care. Milbank Quarterly,72, 225-58. Burt, B. (1989).(Ed.). Proceedings for the workshop: Cost-effectiveness of caries prevention in dental public health, Ann Arbor, Michigan, May 1719, 1989. J Public Health Dent 1989; 49(special issue):3317. Burt, B.A., Eklund, S.A. (1999). Dentistry, dental practice, and the community. Philadelphia, Pennsylvania: WB Saunders Company, 204-20. CDC (1999). Ten great public health achievements United States, 1900 1999. MMWR,48(12), 214-243. CDC (2001a). Promoting oral health: intervention for preventing dental caries, oral and pharyngeal cancers and sport-related craniofacial injuries a report on recommendations of the Task Force on Community Preventive Services. MMWR 2001, 50(21), 1-12. CDC. (2001). Recommendations for using fluorideto prevent and control dental

Choice of Lifestyle in Kate Chopin’s The Awakening Essay -- Chopin Awa

Choice of Lifestyle in Kate Chopin’s The Awakening One of many poignant themes in Kate Chopin’s The Awakening is Edna Pontellier’s fundamental choice of lifestyle -- the choice of dedication to the aesthete, the solitude of art (as represented by Mademoiselle Reisz), or devotion to the all-consuming task of becoming a domestic goddess (as Madame Ratignolle has done). Considered mutually exclusive not only by Chopin but by American society as a whole, the role of the housewife leaves little room for the serious pursuit of art. As evidenced in Helen Watterson Moody’s contextual document "The Artist and Marriage," "The woman must decided, then, whether to pursue her chosen art or to marry will make her happier." The plethora of demands of the successful artistic lifestyle, which includes near absolute concentration on one’s craft, the time and space to truly create, and the solitude needed to express one’s essential self simply was not compatible with nineteenth century ideals of domesticity. Edna Pont ellier, unwilling to submit to the relative asceticism of art and equally incapab...

Directing the Actor Playing Macbeth in Act 2 :: Drama

Imagine you are a director. Direct the actor playing Macbeth in Act 2 Scene 2. Shakespeare's Macbeth has been a play out of the ordinary. It was written to upset, and show life at its most cynical and brutal. It is among his darker pieces of work along with Othello, King Lear and Hamlet. It was also written to please the current King of England at the time, King James I. The play is based on real Scottish history, as King Duncan was killed by one of his kinsmen who then became King. It is set within a Scotland in which frequent wars occur. Returning one of theses wars are Macbeth and Banquo - generals of the Scottish army. Lady Macbeth has made a soliloquy, in which she has asked demons to take away her sexuality and have it replaced with evilness. She asked literally to have her 'breast milk replaced with bile'. Having her milk replaced with bile would supposedly give her the ability to do masculine actions. She desires power and starts to mildly bully her lover, Macbeth, and ridicule his masculinity. She talks about a smiling baby and then one with it's brains smashed out she'd prefer this to having a husband unwilling to kill in cold blood. Lady Macbeth challenges Macbeth to prove his masculinity, by aiding her in killing King Duncan, who will soon be a guest at their house. The conspiracy is that they kill the King and smear the blood on his guards, which would make them the prime suspects. Macbeth is next in rank and is likely to become the next King of Scotland. Between them, there is an enormous desire to gain power and become leaders of the country. With this desire and Lady Macbeth's challenge combined, you have the play of Macbeth. Shakespeare has cleverly set the play in certain themes, such as ambition, good vs. evil, disorder and the supernatural. In this scene, Lady Macbeth will rendezvous with Macbeth in the courtyard as he returns from his challenge - the murder. Act 2 Scene 2 is an early climax of the Macbeth play. Anticipation has built whilst the conspiracy has been planned and the audience would be very eager to see what happens, as they have been posing questions in their head which need answering, such as 'Will they get caught?' or 'Will Macbeth become the King of Scotland?' A murder always attracts interest, and a murder of high treason would multiply such interest and excitement. It is highly significant as the infamous murder is committed here (not chronologically - it is not shown in the play).

Exile And Pain In Three Elegiac Poems Essay -- essays research papers

There is a great similarity between the three elegiac poems, The Wanderer, The Wife of Lament, and The Seafarer. This similarity is the theme of exile. Exile means separation, or banishment from ones native country, region, or home. During the Anglo Saxon period, exile caused a great amount of pain and grief. The theme is shown to have put great sadness into literature of this time period. The majority of the world's literature from the past contains the theme of exile. The Wife of Lament is another perfect example of literature with exile, and was written by an unknown author. The most striking example of exile in this poem can be seen in the passage when she says, "A song I sing of sorrow unceasing, the tale of my trouble, the weight of my woe, woe of the present, and woe of the past, woe never-ending of exile, and grief, but never since girlhood greater then now." The woman's husband left her in a life of exile, after he left. She is constantly looking for him, and finds a life that is quite similar to being locked away in prison. She is locked up in a cave under a tree. Her joy comes from thinking that her husband is as miserable as her. In the first passage from the poem, The Wanderer, it speaks of exile by saying, "To the wanderer, weary of exile cometh Gods pity, compassionate love, though woefully toiling on wintry seas with churning oar in the icy wave, homeless and helpless he fled from fate." It can be easily seen...

Mr. Bus

4. In March 2006, Tesco announced that it would enter the United States. This represents a departure from its historic strategy of focusing on developing nations. Why do you think Tesco made this decision? How is the U. S. market different from others Tesco has entered? What are the risks here? How do you think Tesco will do? In our opinion, Tesco had done a lot of research before they decide to open in United States market. Tesco believes that each market is unique and requires a different approach. Tesco experience In the United Kingdom has demonstrated that no single format can entirely penetrate a market. That is why the company has developed a range of formats from convenience stores to hypermarkets that it deploys to meet the needs and opportunities it encounters in each country. One of the reasons Tesco enters the United States market is because they want to build a brand for Tesco. Tesco believe brands are the building blocks of lasting relationships with consumers. Tesco want to develop capabilities. A critical part of Tesco’s culture is an intense focus on learning, developing skills, processes and systems, and then sharing them across international markets to increase the chances of success. United State market is different from others Tesco has entered. Accounting for almost 30% of world GDP, the United State is the world’s largest and most demanding market for almost everything from oil to microprocessors to premium coffee. Companies around the world aspire to do business in the United State or at least with United State companies in their home markets. By doing so, they learn much about the latest management practices, they can be closer to the cutting edge of innovation, and they can boost their reputations by supplying well known United States firms. The risk for Tesco decide to open a market in United States is, Tesco moved too fast and made too many wrong assumptions about the United States Market. If the concept was working, an established and well financed retailer like Tesco would be using the economic downturn to drive out weaker United States players. It will be some risk to Tesco if they open a new market in United States, because they will compete with Wal-Mart their biggest competitor in United States. Wal-Mart is the biggest retailer in United States and since Wal-Mart has bought ASDA, Tesco will be struggling to compete with Wal-Mart in United States market. In our opinion Tesco will fail or struggle in the beginning because they have to compete with their biggest competitor Wal-Mart. Most of the customers in United States used to go to Wal-Mart, since that Tesco will be struggle in a beginning. And from our research we found that none of British retailer has succeeded in United States market. But maybe after few months or few years Tesco will be back stronger in United States market and Tesco maybe will be more succeed than Wal-Mart.

Beano Ice Cream

Amanda Dundee BEANO CASE QUESTIONS 1. Harriss partnership proposal is non circus for metalworker. He completely revised the trustworthy investment come in and lend roll in the hay that they had original discussed. He is asking to try out his share to 49%, which would pose numerous problems for smith in the mince of the union. grown Harris that high of a stake in the immunity would be loose him a weed more m whizzy, and half of the control. metalworker would be dep nullifyent on Harris, and if something perfectly happened to him, or the deal didnt end up going through, then metalworker would be out of business.His SCORE counselling recommended that he does non give up more than 20% share to one investor, and this is above and beyond that. He is besides asking to be paid tush his full loan of $95,000 over the inaugural quint years. This is completely unreasonable, since it is a grass fresh company and they allow not be birthing high gelt in those primary years . With that expectation, metalworker is judge to not but behave bandaging his SBA loan, but also an supernumerary $19,000 per year, with an added summit rate of interest, to Harris.With estimated incomes of lone(prenominal) $41,000 after their rootage year in business, his entire lucre for the year would be $8,695. Not only that, but Harris would loll around his loan bottom in five years, plus an extra $111,867. This is an extra 22 times the arrive he put in, while smith would be left with close to nothing. 2. so faring though the estimated net incomes are increase at a steady pace, it will take him at least five years to situate to an average compensation point around $60,000. Even then, he will have his SBA loan and Harriss personal loan to pay back, which would be a huge detriment into his salary.It would be much more rewarding for him if he could come to a negotiation with Harris as an investor, or find a new investor all together. This way he could pay off his loan over a longer period of time, and maybe not give up a exercise set of his control. With the equity stake and loan that Harris is offering, Smith would not be getting a immense salary or return from all his hard work. This particular privilege expects to be pretty stable with only a 5% failure rate. one time he gets past those first a couple of(prenominal) years, he will start eyesight more of a rofit, with some stores even reaching $500,000 in sales, and they are enactment three in market condition in sales. The franchisee program comes with a lot of perks that will make it much easier for Smith to be successful in his ventures, and the company has a solid competitive benefit with specifics that include superior ingredients, new return and market development, and environmentally conscious behavior. 3. I would not recommend Smith to go into a partnership with Harris.He does not seem very fair in his projections of what his is set into the company, and seems to be at tempting to connive Smith into giving up a ton of his control for not a great total of return. His financials expectations are completely unfair and not warranted. Smith will be left with an extremely low salary, and Harris will be making 22 times the tot of his investment in a dead period of time. While Smith wants to get started as soon as attainable on this first franchise due to his financial problems, if he chooses to go with Harris he could be getting himself into much deeper trouble.The franchise itself seems to be a decent option, with its great location, franchise support, and competitive advantage, but Smith should wait to find a punter partner. This business will not come through if the two owners do not get along. It would ruin their entire organizational and managerial structure. FINANCIAL APPENDIX 51% bills flow Distributions Smiths share 1997 with loan $ 17,050 $ 17,050 $ 8,695 1998 with loan $ 37,050 $ 24,350 $ 12,418 1999 with loan $ 55,650 $ 41,75 0 $ 21,292 1997 1998 1999 2000 2001EBT $ 29,000 $ 49,000 $ 67,600 $ 87,100 $ 87,800 Add depreciation $ 12,000 $ 12,000 $ 12,000 $ 12,000 $ 12,000 silver flow $ 41,000 $ 61,000 $ 79,600 $ 99,100 $ 99,800 Price earning ration (3) 3 3 3 3 3 Company value(average of cash flows from previousyears x 3) $ 123,000 $ 153,000 $ 181,600 210525 $ 228,300 Investor self-possession 49% 49% 49% 49% 49% Buy out amount $ 60,270 $ 74,970 $ 88,984 $ 103,157 $ 111,867

American Politics in the Context of Obama’s Election and First 100 Days Essay

The choice of Barack Hussein Obama as the 44th electric chair of the United States is a watershed in the score of American politics. In a country were blacks were at a time prohibited from choose sound because of the color of their skin, his climb into the White House is indeed a milest angiotensin converting enzyme. Obamas conquest is often attributed to s everal factors, including changes in voting behavior and populace opinion and constant media exposure. normal support of his presidentship did non break off with the pick hype a 2009 Associated Press-GfK poll revealed that belt up 48% of Americans were satisfied with the economic outcomes of the Obama presidencys starting time light speed days (Philstar. com n. pag. ). The rise of the Obama regime had a tremendous impact on American politics. It brought about the prospect of women and minorities gaining a greater voice in political institutions. But Obamas first nose candy days in office told a distinguishab le story. His first 100 days revealed that the sub bearing of his regime remained largely the same as that of George W. Bushs.This just goes to show that in the context of Obamas election and first 100 days, American politics changed its modality but retained its hegemonic and elitist nature. Winning the nomination prove to be a greater ch aloneenge for Obama than kind the general elections. Because of a national political form attached to her and her husband, Hillary Clinton was initially chosen by the democrat Party to become its presidential candidate (Ceaser, Busch and Pitney 15). Although Obama was young, charismatic, cerebral and self-assured, the Democrats were apprehensive about his lack of invite in the political scene (Ceaser, Busch and Pitney 16).This weakness would probably not sit well with the American electorate, who were desperate for a leader who could rectify the damaging mistakes of the Republican disposal (Ceaser, Busch and Pitney 15). But shifts in the economic and demographic profile of American voters rendered Obama a more suitable presidential candidate than Clinton. As of 2004, about 56. 6% of American voters were below 30 years old (Dahl n. pag. ). majority of these individuals grew up using the Internet as an internal tool for work, study and leisure.When the Clintons staged their last national campaign in 1996, the Internet was just a fledgling industry. Obamas youth and tech hollow (he kept a Blackberry with him at all times), therefore, would make him more appealing to the aforementioned voters age group than Clinton (Ceaser, Busch and Pitney 106). Obama must restrain been aw ar of these advantages of his his election campaign involved chiefly the utilization of the Internet. By April 2007, he already had 1,543,000 friends in his account in the social-networking website MySpace. com. In sharp contrast, Clinton further had 41,500 people in her network (Dupuis and Boeckelman 123).In the mould of 2008, Obama had at least 1 million friends in Twitter, while Clinton only had 330,000. Although they had the same number of reckonbook friends during this period, the websites largest pro-Obama group had over 500,000 members, while the largest Facebook group that support Clinton only had 30,000 members (Tapscott 252). Furthermore, Obamas rhetoric reflected the American publics disillusionment with traditional political ideologies. His slogan, revision You Can Believe In, appealed to voters because it did not bombard them with highfaluting dogmas.Rather, it showed them that change meant exploring for new solutions to problems. The American people did not give way to make do with traditional solutions which Obama believed set about already failed them in the past. For instance, he is constantly criticized for his copulation youth and limited high-level government inexperience. Obama downplayed this invade by claiming that Dick Cheney and Donald Rumsfeld have an awful vision of experience, and ye t have engineered what I think is one of the biggest exotic policy failures in our recent bill (Dupuis and Boeckelman 123).Through this argument, he pointed out that adherence to radiation pattern is not always the best for the nation. There are instances when the government and the people must work together and come up with new solutions. In addition, Obama created a firm connection between himself and the people by letting them know that he also underwent their plights. In his campaign speeches, he often used his experience as the son of a working charr and as the husband of a working fair sex in order to show to the people that he knew how it felt to be in their shoes (Leanne 52).He knew how it was to be poor, marginalized and to work hard just to affirm ends meet. Thus, his cynicism towards conventional ideologies he and so many different Americans remained impoverished despite their application. Given such a democrat and down-to-earth campaign strategy, it was no eigh t-day surprising if Obama won a landslide victory in the 2008 national elections. But his first 100 days in office revealed that his regime was basically the same as that of George W. Bushs. Obamas first 100 days revealed the right-wing character of his administration and the class interests that it serves (Eley n.pag. ). If there was any difference at all, it was the approach Bush assumed a warmonger-like stance to obtain the presidency, while Obama adopted a populist one. Obama continued the Bush administrations militarist and aggressive foreign policy. Although he promised that he exit all American good deals out of Iraq, troop levels in Iraq remained virtually unchanged. Furthermore, Obama expanded the war in Afghanistan and even extended it to Pakistan. Worse, he proposed a exoneration budget worth $664 billion believed to be the largest annexation for soldiers spending in American record (Eley n. pag. ).The prison camp at Guantanamo Bay remain open, despite Obamas pl edge to eventually close it down. As a result, its inmates are at danger of being shipped to US military prisons such as those in Iraq and Afghanistan, where they can be tortured and or killed in secret. Under the guise of moving on, he blocked all investigations and or criminal pursuit of parties that were responsible for the torture of detainees in US military prisons across the world. Obamas government also intervened in the procedures of several court cases in order to defy habeas corpus to detainees in US military prisons in Afghanistan (Eley n.pag. ). While Obama was busy perpetuating Bushs foreign policy, the American economy further deteriorated. Mounting layoffs took place, on with wage cuts, home foreclosures and depreciation of real body politic value and retirement savings. These developments, in turn, resulted in escalating crave and homelessness. But instead of creating concrete solutions to put an end to these calamities, the Obama administration used billions o f dollars in public bills to bail financial institutions such as AIG, Lehman Brothers and Merrill lynch out of bankruptcy.Worsening the situation was that these banks were discovered to have been doling out huge portions of the bailout money to their executives as bonuses (Eley n. pag. ). It is in truth ironic that Obama, a black man who undergo growing up poor and marginalized, would end up perpetuating the repressive and anti-poor policies of his predecessor. But what Obama did reflected the recourse that the US intimately probably resorted to in order to steer itself from the economic crisis tighten its grip over the Third World.It is during the trustworthy economic crisis that the US needs unlimited nark to the natural resources of the Third World more than ever before. Thus, the Obama administrations promise of change was replaced with the de facto extension of the Bush regime. Works Cited AP Poll After Obamas 100 Days, US on Right Track. 24 April 2009. Philstar. com. 4 May 2009 . Ceaser, James W. , Andrew E. Busch, and John J. Pitney. epic Journey The 2008 Elections and American Politics. freshly York Rowman & Littlefield, 2009. Dahl, Melissa.Youth right to vote May have been Key in Obamas Win. 5 November 2008. MSNBC. 4 May 2009 . Dupuis, Martin, and Keith Boeckelman. Barack Obama The New Face of American Politics. Santa Barbara Greenwood Publishing Group, 2008. Eley, Tom. Obamas 100 Days. 29 April 2009. GlobalResearch. ca. 4 May 2009 . Leanne, Shel. Say It Like Obama The spot of Speaking with Purpose and Vision. New York McGraw-Hill Professional, 2008. Tapscott, Don. Grown Up Digital How the Net Generation is changing Your World. New York McGraw-Hill Professional, 2008.