Hemoglobin Malaria Haemoglobinopathies

Hemoglobin Malaria Haemoglobinopathies Despite major advances in the understanding of the molecular pathophysiology and control and management of the inherited disorders of hemoglobin (haemoglobinopathies), thousands of infants and children with this disease are dying. As a result in heterozygote advantage against malaria the inherited hemoglobin disorders are the commonest monogenic disease. Population migrations have ensured that haemoglobinopathies are now encountered in most countries including the UK. Haemoglobinopathies have spread from areas in the Mediterranean, Africa and Asia and are now endemic throughout Europe, the Americas and Australia. This review examines the available literature to find out more about the prevalence of haemoglobinopathies in the UK. The data on the demographics and prevalence of the gene variants of haemoglobinopathies was extracted from books, journals, reference sources, online databases and published review articles from the WHO. Introduction It has been estimated that approximately 7% of the world population are carriers of such disorders and that 3000 000 4000 000 babies with severe forms of haemoglobinopathies. Haemoglobinopathy disorders occur at their highest frequency in tropical regions and population migrations have ensured that they are now encountered in most countries. Because of this, haemoglobinopathies have become a global endemic, so the World Health Organization published journals and reviews with recommendations on screening programmes and management of haemoglobinopathies. The programmes are tailored to specific socioeconomic and cultural contexts and aimed at reducing the incidence, morbidity and mortality associated with these diseases. www.who.int/en/ The WHO Executive Board wrote a review on haemoglobinopathies. In this article, the WHO Executive Board recognized that the prevalence of haemoglobinopathies varies between communities, and that insufficiency of relevant epidemiological data may hamper effective and equitable management of haemoglobinopathies. On this note England implemented the LIVE programmes. The Executive Board also recognizes that haemoglobinopathies are not yet officially recognized as priorities in Public Health Sector. This raised an issue about awareness of haemoglobinopathies. The WHO Executive Boards advice for prevention and management of haemoglobinopathies was to design, implement and reinforce in a systematic equitable and effective manner, comprehensive national, integrated programs for prevention and management of haemoglobinopathies, including surveillance, dissemination, such programs being tailored to specific socioeconomic and cultural contexts and aimed at reducing the incidence, morbidity and mortality associated with these diseases. www.who.int/en/ With immigration in the UK on its highest, the prevalence of haemoglobinopathies is expected to increase. The NHS has implemented programmes for individuals with haemoglobinopathies by implementation of LIVE program (NHS Plan, 2000). LIVE program is set-up to implement variant screening in the whole of UK by the year 2007. LIVE program started as early as January 2004 in high prevalence. The NHS Trusts involved are to offer variant screening by end of 2004/5 (NHS Plan, 2000). Low prevalence Trust are expected to have implemented the screening program by January 2008 and so far 86 out of 90 Trusts have successfully implemented the program. Antenatal and Newborn Screening programs have compiled a training pack to assist Low Prevalence Trusts with the implementation of haemoglobinopathies screening programmes. The NHS Plan (2000) made a commitment to implement effective and appropriate screening programs for women and children including a new national linked Antenatal and Newborn screen ing programs for haemoglobinopathies. The NHS Plan (2000) recommends that all pregnant women living in high prevalence areas are offered screening for haemoglobinopathies. All pregnant women living in low prevalence areas are offered screening for haemoglobinopathies. If a woman is identified as being at increased risk using the family origin questionnaire, she will then be offered screening for haemoglobinopathies (NHS Plan, 2000). The Low Prevalence Trust is where the fetal prevalence of sickle cell disease is less than 1.5 per 10 000 pregnancies. Low prevalence trusts are to offer screening for variants based on an assessment of risk determine by a question to women about their babys fathers family origin by the end of 2005/6 (NHS Plan, 2000). Background on Haemoglobinopathies Haemoglobin: is the oxygen carrying capacity of the blood and it is also a protein. Haem is iron containing pigment, while globin is made up of chains which are a globular tetrameric protein which accounts for 97.4% of the mass of the haemoglobin molecule (Tortora et.al., 2006) . The globin tetramer consists of four polypeptides which are two alpha (ÃŽ ±) chains and two non-alpha chains. The synthesis of ÃŽ ¶ and ÃŽ µ chains is done during the first 10 to 12 weeks of fetal life. Within the fourth to the fifth week of intrauterine life ÃŽ ± and ÃŽ ² chains are synthesized. The non-alpha is beta (ÃŽ ²), gamma (ÃŽ ³), delta (ÃŽ ´), epsilon (ÃŽ µ) zeta (ÃŽ ¶) chains. Haemoglobin transports oxygen from the lungs to all parts of the body and it gives blood its red colour (Fleming, 1982) Haemoglobin synthesis Haem and globin synthesis occur separately but in a carefully coordinated fashion. Globin synthesis is under the genetic control of eight functional genes arranged in two clusters, the ÃŽ ± globin gene cluster on chromosome 16 and the ÃŽ ² globin gene cluster on chromosome 11. The major haemoglobin in the foetus is HbF (ÃŽ ±ÃŽ ²) 2 and in adults HbA (ÃŽ ±ÃŽ ²) 2 (Fleming, 1982). Haemoglobin Structure The primary structure of haemoglobin is made-up of amino acid sequence of globin. And the secondary structure comprise of nine non-helical sections joined by eight helices; tertiary structure describes globin chain folding to form a sphere and the quaternary structure of haemoglobin describes the tetrahedral arrangements of the four globin subunits ( Fleming, 1982). The external surface of each folded globin is hydrophilic and the inner surface is hydrophobic, this protects the haem from oxidation, which is also why each haem chain sits in a protective hydrophobic pocket. In haemoglobin A, ÃŽ ± ÃŽ ² dimmers are held together strongly at the ÃŽ ±1 ÃŽ ²1 or ÃŽ ±2ÃŽ ²2 junction. The tetramer is held together much less tightly at the ÃŽ ±1 ÃŽ ²2 and ÃŽ ±2 ÃŽ ²1 contact areas (Fleming, 1982). Haemoglobin function Each haemoglobin molecule can carry four oxygen molecules. Oxygenation and deoxygenation are accompanied by molecular expansion and contraction via haem haem interaction (Bienz, 2007). Under physiological conditions, blood in the aorta carries about 19.5ml of oxygen per 100ml of blood. Upon entering the tissues about 4.5ml of oxygen are donated per 100ml of blood. 2,3-DPG is an important modulator of haemoglobin A oxygen affinity in red cells (Fleming, 1982). Haemoglobin disorder (haemoglobinopathies) Haemoglobinopathies is a hematological disorder due to alteration of a genetically defect, that results in abnormal structure of one of the globin chains of the haemoglobin molecule (Bienz, 2007). Haemoglobinopathies are any of a group of diseases characterized by abnormalities, both quantitative and qualitative in the synthesis of haemoglobin (Hb) (Bienz, 2007). Qualitative affecting the quality of haemoglobin e.g. Sickle cell disorder and quantitative affecting the amount of haemoglobin produced e.g. Thalassaemias. Most of them are genetically inherited but occasionally they can be caused by a spontaneous mutation. Haemoglobinopathies are the worlds most common monogenic autonomic and recessive disease in humans (Anionwu et.al., 2001). 2.1Haemoglobinopathies fall into two main types; There are two categories of haemoglobinopathies. The two categories are: qualitative and quantitative; Qualitative affecting the quality of the haemoglobin e.g. Sickle cell disorder. In this disease the globin structure is abnormal. Quantitative the haemoglobin structure is normal but the amount of haemoglobin produced is affected. e.g. alpha and beta thalassaemias (Bienz, 2007). History of haemoglobinopathies In 1910 Herrick wrote an article in it he used the term â€Å"sickle† to describe the shape of the red blood cells of a 20 year old medical student from Grenada. This student had consulted Dr Herrick in 1994 complaining of a cough, fever and Feeling weak and dizzy. He constantly had anaemia episodes, jaundice, chest complications as well as recurring leg ulcers on both ankles. When his blood was examined, his red blood cells showed a large number of thin, elongated, sickle shaped and crescent- shaped forms (Herrick, 1990). The name thalassaemia was coined by the eminent haematologist George Whipple in 1936 as an alternative to the eponymous ‘Cooleys anaemia. He wanted a name that would convey the sense of an anaemia which is prevalent in the region of the Mediterranean Sea, since most of the early cases originated there. Thalassaemia is derived by contraction of thalassic anaemia (from the Greek thalassa -sea, an none and anemia blood) (Fleming,1982). Origins and Geographic distribution of haemoglobinopathies Carriers are found in all parts of the world: people from the North Mediterranean (South Europe) coast are 1-19% carriers. People of Arab origin are over 3% carriers. In Central Asia 4-10% and in South East Asia, the Indian subcontinent and China 1-40% carriers (the very high rates in this part of the world are due to HbE). In the Americas, North Europe, Australia and South Africa the local population has very low carrier rates but thalassaemia is still present because of the significant immigration from high prevalence area (Anionwu et.al.; 2001). Sickle cell and thalassaemia disorder mainly affect individual who are descended from families where one or more members originated from parts of the world where falciparum malaria was, or is still endemic. Population with such ancestry include those from many parts of Africa, the Caribbean the Mediterranean (including southern Italy, Northern Greece and Southern Turkey), Southeast Asia and thalassaemia gene is much wider now due to the hi storical movements of at-risk populations to North and South America, the Caribbean and Western Europe (Livingstone 1985). The geographic distribution of the thalassaemias overlaps with that of sickles cell disease. This is because carriage of these abnormal genes affords some protection against malaria. Thus, being heterozygous for one of these conditions offers a selective survival advantage and increases the opportunity for these genes to be passed on (Campbell et.al.,2004) 4Types and terminology of sickle cell and thalassaemia There are various types of sickle cell and thalassaemia disorders. The thalassaemia syndromes include alpha and beta thalassaemia major as well as beta thalassaemia intermedia. Sickle cell disorders (or Fickle cell disease include sickle cell anaemia (Hb SS), Sickle haemoglobin C disease (Hb SC) ÃŽ ² disease and E beta thalassaemia (www.sickle-thalassaemia.org/sickle.cel.htm) 4.1Sickle Cell Disorder: affects the normal oxygen carrying capacity of the red blood cells. The red blood cell forms a crescent or a sickled shape when it is deoxygenated. The ‘sickled cells are unable to pass freely through capillaries; the sickle cells also get stuck in blood vessels forming clusters which block the blood vessels and the blood flow. They dont last as long as normal, round red blood cells, which leads to anemia. This results in a lack of oxygen to the tissues in the affected area, resulting in hypoxia and pain (sickle cell crisis). Other symptoms include severe anaemia, damage to major organs and infection (NHS Antenatal and Newborn; 2006). There are several types of Sickle cell disease. The most common are: sickle cell anemia (SS), sickle hemoglobin C disease (SC), sickle beta plus thalassaemia and sickle beta zero thalassaemia. Each of these can cause pain episodes and complications. HbSS sickle is due to two sickle cell genes (â€Å"S†), one from each parent. This is commonly called sickle cell anemia. An individual with sickles cell anemia have a variation in the ÃŽ ²-chain gene, which then causes a change in the properties of hemoglobin which results in sickling of red blood cells (www.sickle-thalassaemia.org/sickle.cel.htm) HbSc inherited one sickle cell gene and one gene from an abnormal type of haemoglobin called â€Å"C†. It is due to the variation in the ÃŽ ²-chain gene. An individual with this variant suffers from mild chronic haemolytic anaemia. (NHS Antenatal and Newborn; 2006). HbS beta thalassaeamia: This form of sickle is due to inherited one sickle cell gene and one gene for beta. 4.2Thalassaemias: is a term used for the description of a globin gene disorders that results from a diminished rate of synthesis of one or more globin chains and a consequently reduced rate of synthesis of the haemoglobin or haemoglobins of which that chain constitutes a part ; ÃŽ ± thalassaemia indicates a reduced rate of synthesis of the ÃŽ ± globin chain, similarly, ÃŽ ², ÃŽ ´, ÃŽ ´ ÃŽ ² and ÃŽ µ ÃŽ ³ ÃŽ ´ ÃŽ ² thalassaemia indicate a reduced rate of synthesis of the h, ÃŽ ´, ÃŽ ´, +ÃŽ ² and ÃŽ µ + ÃŽ ³ + ÃŽ ´ + ÃŽ ² chains, respectively (Modell et.al, 2001). Thalassaemia is the most common single gene disorder known. It is autosomal recessive syndromes, which is divided into ÃŽ ±- and ÃŽ ² thalassaemia. Types of thalassaemia There are two types of thalassaemia: (i)Thalassaemia minor (thalassaemia trait) (ii)Thalassaemia major Thalassaemia minor is when a person inherits one thalassaemia gene, while thalassaemia major is a severe form of anaemia if a person inherits two thalassaemia genes, one from each parent (Bienz, 2007). Subtypes of thalassaemia Alpha (ÃŽ ±) thalassaemia results from inadequate production of ÃŽ ± chains, which are normally controlled by two pairs of chromosomes. If one or two are malfunctioning, then there is a healthy carrier state. If three are non- functional then anaemia results, known as HbH Disease, which can be quite severe but usually does not need blood transfusions and is compatible with a normal life span (Anionwu et al, 2001). If all four genes are non functional then the result is severe anaemia of the unborn child, leading to heart failure and death (miscarriage). This condition is known as hydrops felalis (Fleming, 1982). Beta (ÃŽ ²) Thalassaemia is caused by the bodys inability to produce normal haemoglobin, leading to a life threatening anaemia (Bienz, 2007). The severity of illness depends on whether one or both genes are affected and the nature of the abnormality. If both genes are affected, anemia can range from moderate to severe. Beta thalassaemia results from inadequate or lack of production of ÃŽ ² chains (Anionwu et.a.l, 2001). Homozygous, ÃŽ ² thalassaemia has two forms: major, in which the patient can survive only with regular transfusions of blood and intermedia in which the patient can survive with occasional or even with no transfusions at all. The condition requires frequent blood transfusions and treatment to prevent complications from iron overload, such as diabetes and other endocrine disorders (Anionwu et.a.l, 2001). Both of these conditions can restrict a child or adults ability to conduct their normal daily activities and can have profound psychological affects on individuals a nd their families This form of thalassaemia is the most important and constitutes a major public health problem in many parts of the world, because of the high frequency of carriers and the demanding treatment that must be followed (Fleming, 1985). Association of Haemoglobinopathies with Malaria Malariais a vector borne infectious disease caused by protozoan parasites. It is widespread in tropical and subtropical regions, including parts of the Americans, Mediterranean, Asia and Africa. It causes diseases in approximately 515 million people and kills between one and three million people, the majority of whom are young children. Malaria parasites are transmitted by female Anopheles mosquitoes. The parasites multiply within red blood cells, causing symptoms that include symptoms of anemia (Campbell et al, 2004). Sickle cell developed as a by product of human defense mechanisms against malaria. The most severe form of malaria, falciparum malaria, leads to very high death rate in young infants. This is particularly a problem between the time immediately after birth, when they are protected by immunity from the mother, and the time when they are old enough to acquire their own immunity. Malaria is a parasite which lives within the red blood cells and feeds off the protein that is contained within those red cells, haemoglobin (Campbell et al, 2004). When the malarial parasite enters the blood stream through a mosquito bite, it penetrates the red blood cells by attaching to the outside membrane or envelope of the red blood cell and gaining entry (Franklin, 1990). Once in the red blood cell, the malarial parasites use the haemoglobin as a source of energy, so that they multiply within the red cells. The parasites multiple filling-up the red blood cells and once they are filled-up the red cells bur st, thereby releasing the multiple parasites in the blood. Each new young parasite enters a single cell again and multiplies again, thereby causing a disease or infection. Whenever the parasites burst out of the cells they cause illness and fever in patients. Malaria can be severe by causing death; death is believed to be caused by red cells not being able to pass through the narrow gaps in the smallest blood vessels and by blockage of tissues when so many parasites are in the red blood cell (Campbell et al, 2004). Over the years human genes developed ways to prevent malaria becoming serious and potentially lethal, the developments were to prevent malarial parasites from spreading and multiplying (Tortora et.al,2006). The most changes were changes (mutation) in the type of haemoglobin (haemoglobin S) within the red blood cell which would in turn slow down the multiplying of the parasite (Campbell et al, 2004). The individuals with haemoglobin S are known to have a sickle cell trait or being carriers of sickle cell haemoglobin. When sickle-cell haemoglobin has given up its oxygen in the cells, the red cells stick together to form crystalline groupings of haemoglobin known as polymers. The red blood cells become deformed into sickle shapes and the presence of these crystalline polymers within the red cells inhibits the growth of the malarial parasite (Beinz, 2007). Even though individuals with haemoglobin S stills suffer from malaria, they are protected from the most severe effects of malaria (Li vingstone, 1985). Diagnosis Diagnosis for sickle cell disease The most used diagnose test for sickle cell is the haemoglobin electrophoresis. HbS and HbC amino acid substitutions change the electrical charge of the protein, the migration pattern of the haemoglobin with electrophoresis or isoelectric focusing results in diagnostic patterns with each of the different haemoglobin variants. HbSBeta-thal requires careful evaluation of red blood cell count and mean corpuscular red cell volume (MCV) and specifically quantifying HbA, S, A2 and F. In emergency setting, the presence of HbS is detected using a five minute solubility test called sickledex. Sickledex test does not differentiate sickle syndromes from the benign carrier state (HbAS or a sickle trait (NHS Antenatal and Newborn; 2006). Diagnosis for thalassaemias When testing for thalassaemias, a blood test is the simplest and most effective test for diagnosis and also the use of a test called Haemoglobin Electrophoresis. The blood of individuals with thalassaemias tend to be microcytic (smaller in size) and hypochromic (paler in colour) (NHS Antenatal and Newborn; 2006). 7 Pathophysiology 7.1Sickle-cell Sickle-cell anemia is caused by changes (mutation) in the structure of the ÃŽ ² -globin chain of the haemoglobin replacing the amino acid glutamic acid with the less polar amino acid valine at the sixth position of the ÃŽ ² chain. When two wild type ÃŽ ±-globin subunits associate with two mutant ÃŽ ²-globin subunits forms hemoglobin S. Haemoglobin S polymerizes under low oxygen conditions, which causes distortion of red blood cells and also causes red blood cells to lose their elasticity, resulting in red blood cells forming an irreversible sickle shape (Fleming,1982). Very often a cycle occurs, as the cells sickle they cause a region of low oxygen concentration which causes more red blood cells to sickle. Repeated occurrence of sickling causes cells to not return to normal even when oxygen levels are normal. The deformation of cells makes it difficult for the cells to pass through capillaries resulting in vessel occlusion, severe anemia, ischemia and other problems (Beinz, 2007). 7.2Thalassaemias The pathophysiologic effects of the thalassaemias range from mild microcytosis to death in uterus. The anaemia manifestation of thalassaemia is microcytic hypochromic haemolytic anaemia (Belcher, 1993). The haemoglobin abnormality is caused by substitution of a single amino acid for another; or substitution of two amino acids, also amino acid deletion or fusion (point of mutation) and the synthesis of elongated chains. In alpha trait, one of the genes that form the alpha chain is defective (Beinz, 2007). In alpha-thalassaemia minor, two genes are defective and in haemoglobin H disorder, three genes are defective. Alpha-thalassaemia major is most fatal thalassaemia disorder; this is because four of the chains forming genes are defective. Without alpha chains, oxygen cannot be released to the tissues (Belcher, 1993). In beta-thalassaemia haemoglobin abnormality is due to the uncoupling of alpha and beta-chain synthesis. This causes a depression in beta-chain synthesis, resulting in er ythrocytes with a reduced amount of haemoglobin and accumulation of free alpha chains, which are unstable and easily precipitate the in cell (Bienz, 2007). 8.Causes Genetic control of haemoglobin synthesis The synthesis of structurally normal haemoglobin chains is determined by allelic genes situated on the autosomal chromosome (Beniz, 2007). Haemoglobinopathies occur due to an inheritance of one or more faulty copy of gene(s) that contain the information for the cells to make the globin chains. The gene may result in abnormality in the production or structure of the haemoglobin protein causing haemoglobinopathies (Franklin, 1990). Thalassaemia is an inherited autosomal recessive blood disorder. Genetic defects in Thalassaemia results in reduced synthesis of one of the globin chains which make up haemoglobin. Reduced synthesis of one of the globin chains causes the formation of abnormal haemoglobin molecules, which in turn causes anaemia. Anaemia is a symptom of the Thalassaemias. It is caused by under production of globin proteins, often through mutations in regulatory genes (Franklin, 1990). Inheritance of Haemoglobin Disorder Due to haemoglobin mutation, individuals who had haemoglobin trait had a resistance to dying from malaria, therefore passed on their haemoglobin trait gene to their children (Campbell et.al,2004). As time went on more individuals with the trait were born and eventually individuals who had haemoglobin trait had children together (Franklin, 1990). In that satiation (partnership), if both parents carry the trait gene, there is a one in four chance that any one child will receive the haemoglobin trait gene from one parent and also from the other, thereby having a haemoglobin disorder(Franklin, 1990) . Clinical Manifestations 9.1Thalassaemias clinical manifestations Individuals who inherited the alpha trait are usually asymptomatic, with possible mild microctyosis. Alpha- thalassaemia minor has signs and symptoms almost identical to those of beta-thalassaemia; mild microcytic hypochronic anemia, enlargement of the liver and spleen, and bone marrow hyperplasia (Belcher, 1993). Alpha- thalassaemia major cause hydrops fetalis and fulminana intrauterine congestive heart and liver, edema and massive ascites. The disorder usually is diagnosed post mortem (Bienz, 2007). Beta-thalassaemia minor causes mild to moderate microcytic-hypochronic anemia, mild splenomegaly, bronze coloring of the skin, and hyperplasia of the bone marrow. Skeletal changes depend on the degree of reticulocytosis, which in turn depends on the severity of the anaemia (Bienz, 2007). People who have beta-thalassaemia minor usually are asymptomatic, whereas those with beta- thalassaemia major the anemia is severe, resulting in a great cardiovascular burden, with high output congestive heart failure (Belcher, 1993). Blood transfusions can increase the persons life span by a decade or two. Individuals with beta-thalassaemia major have an enlarged liver and spleen, and growth and maturation are retarded (Belcher, 1993). A characteristic deformity develops on the face as the bones expand to accommodate hyperplastic marrow (Belcher, 1993). Both and beta thalassaemias major are life threatening. Children with thalassaemia major usually are week, fail to thrive, how poor development and experience cardiovascular compromise with high-output failure; if the condition goes untreated, these children die by 6 years of age (Modell et.al., 2001) Blood transfusions can return haemoglobin and hematocrit to normal levels, alleviating the anaemia induced cardiac failure. Iron overload and hemochromatosis, which are complications of transfusion therapy, are treated with chelating agents (Bienz, 2007). . 9.2.Sickle-cell clinical manifestations The severity of sickle cell disorder depends on the amount of haemoglobin S and the clinical manifestations, which are signs and symptoms of the individuals with sickle-cell (Belcher, 1993) . Manifestations of the sickling are those of hemolytic anemia; pallor, jaundice, fatigue and irritability. Extensive sickling can precipitate four types of crises: vaso-occlusive or thrombotic crises and a plastic crisis (Belcher, 1993). A vaso-occlusive crises begins with red blood cells sickling in the microcirculation. Vasospasm brings a log-jam effect causing blood flow to stop flowing in the vessels and this will lead to thrombosis (blood clot formation) and infarction of local tissue occur, resulting in ischemia, pain and organ damage (Modell et.al.,2001). Vaso-occlusive crisis is believed to be extremely painful and lasts an average of 4 to 6 days. This crisis may develop spontaneously or may be precipitated by localized hypoxemia (low PO2) exposure to cold, dehydration, acidosis (low pH), or infection. In infancy, sickle-cells first manifestation is the symmetric painful swelling of the hands (see Fig 3) and feet, but in older children and adults, the large joints and surrounding tissues become swollen and painful. Individuals with the sickle-cell disorder suffer from severe abdominal pain caused by infarction in abdominal structures (Belcher, 1993). Any cerebral vascular accidents may cause paralysis or othe r central nervous system deficits, and if penile veins are obstructed priapism may occur. Studies have shown that bone, especially weight- bearing bones, are also a common target of vaso-occlusive damage, this is due to bone ischemia (Bienz, 2007). The spleen of individuals with sickle-cell disorder is frequently affected due to its narrow vessels, functions in clearing defective red blood cells and this results in a sequestration crisis (Belcher,1993). A sequestration crises, is occurrence of large amounts of blood pool in the liver and spleen. It only occurs in young children and death results from cardiovascular collapse (NHS Antenatal and Newborn,2006). An aplastic crisis develops when a compensatory increase in erythropoiesis is compromised; this then results in profound anemia (Belcher,1993). A hyperhemolytic crisis is rare but may occur with certain drugs or infections. G-6-PD deficiency, when also present, contributes to this type of crisis (Belcher,1993). Clinical manifestations of sickle cell disease do not usually appear until an infant is at least 6 months old. The most cause of death in individuals with sickle-cell anemia is infections, but it is major problem at all ages. Infections are due to splenic dysfunction from sickle damage (Belcher,1993). This occurs from a few months of age especially with certain bacteria e.g. pneumococcal sepsis. Infection tends to rapidly overwhelm the immune system (NHS Antenatal and Newborn,2006) . Sickle-cell haemoglobin C is known to be milder, with symptoms related to vaso-occlusive crises resulting from higher hematocrit and blood viscosity. Obstructive crises cause sickle cell retinopathy is most common in older children, and this include renal necrosis, and aseptic necrosis of the femoral head (Belcher, 1993). The mildest of sickle-cell is the sickle-cell thalassaemia the individuals with this form of sickle-cell tend to be microcytic and hypochromic, which makes the cells less likely to clog the microcirculation even when sickling (Belcher, 1993). Severe hypoxia can be seen in individuals with the sickle cell trait and may cause vaso-occlusive episodes. The cells in these people form an ivy shape (Belcher, 1993). Recent studies have shown that stroke is co-exiting with Sickle cell disease. At least 1% of patients with sickle cell disorder suffer from stroke and those individuals result in physical disability, IQ reduction, Learning difficulties, TIAs and seizures (Beinz, 2007). Treatment of haemoglobinopathies. 10.1Treatment in Sickle-cell anemia. Febrile illness: Children with fever are screened (a full blood count, reticulocyte count and blood culture taken) for bacteremia. In young children the fever is treated with intravenous antibiotics, the children would be admitted at the hospital so that they can be monitored (Belcher, 1993).. But older children with reassuring white blood cell counts are managed at home with oral antibiotics, but if the older children have a history of bacteremia episodes, they get a hospital admission. (Modell et al, 2001) Zn administration: is when zinc is given to stabilize the cell membrane (Beinz, 2007). Painful (vaso-occlusive) crises: individuals with sickle cell disorder experiences painful episodes called vaso-occlusive crises. Vaso-occlusive crises is often treated symptomatically with analgesics (Beinz,2007). Pain management requires opioid administration at regular intervals until the crises has gone. The frequency, severity and duration of these crises episodes vary tremendously form episodes to episode or from person to person (Belcher,1993). Individuals who suffer from milder vaso-occlusive crises manage their pain on NSAIDs e.g. diclofenac or naproxen. And if the crises is severe, individuals require inpatient management, where intravenous opioids. Diphenhydramine is used to stop the itchiness associated with the opioids (Modell et al, 2001). Acute chest crises management is similar to vaso-occlusive crises treatment with the addition of antibiotics, oxygen supplementation for hypoxia, and close observation. If the pulmonary infiltrate worsen or the oxygen requirements increase,

English Literature and Background Essay

MA (Previous) Semester I Paper I Paper II Paper III Paper IV Paper V Semester II Paper I Paper II Paper III Paper IV Paper V Semester III Paper I Paper II Paper III Paper IV Paper V History, Structure and Description of English –I English Literature up to the Early Seventeenth Century—I English Literature up to the Early Seventeenth Century—II English Literature of the Seventeenth & Eighteenth Century—I English Literature of the Seventeenth & Eighteenth Century—II History, Structure and Description of English –II English Literature of the Nineteenth Century—I English Literature of the Nineteenth Century—II English Literature of the Twentieth Century—I English Literature of the Twentieth Century—II MA (Final) American Literature—I Indian Writing in English—I Postcolonial Literature English Language Teaching Inter-Disciplinary (ID-I) : Writing for Academic and Professional Purposes Seminar Semester IV Paper I American Literature—II Paper II Indian Writing in English—II Paper III Specializations: 1) Women’s Writing 2) Indian Literatures in Translation 3) Modern Classics in Translation one specialization to be offered in each college Paper IV Project Work Paper V Inter-Disciplinary (ID-II) : Literature and Film Seminar Department of English University College of Arts & Social Sciences Osmania University, Hyderabad MA (Previous) Semester I—(Papers I to V) Semester I—(Papers I to V) Paper I Unit 1 History, Structure and Description of English-I a) Indo-European Family of Languages b) Descent of English: Old English, Middle English and Modern English a) Language as a System of Communication b) Levels of Language Description: Phonology and Morphology a) Phonetic Description of Consonants b) Phonetic Description of Vowels a) Noun Phrase Structure (Determiners, pre and post modifiers, number, and gender) b) The Simple Sentence in English a) Verb Phrase Structure (Verb types, tense, aspect, concord; phrasal verbs) b) Coordination and Subordination (Semantic Implications) Look more:  example of satire in huckleberry finn Unit 2 Unit 3 Unit 4 Unit 5 Paper II Unit 1 English Literature up to the Early Seventeenth Century—I Background Renaissance; Reformation; Development of British Drama; University Wits Poetry Geoffrey Chaucer Edmund Spenser General Prologue to The Canterbury Tales Sonnets 34 (â€Å"Lyke as a Ship†¦Ã¢â‚¬ ) Sonnet 54 (â€Å"Of the World’s Theatre†¦Ã¢â‚¬ ) Sonnet 68 (â€Å"Most Glorious Lord of Life†¦Ã¢â‚¬ ) Everyman in His Humour The Duchess of Malfi The Spanish Tragedie Doctor Faustus Unit 2 Unit 3 Drama Ben Jonson John Webster Drama Thomas Kyd Christopher Marlowe Unit 4 2 Department of English University College of Arts & Social Sciences Osmania University, Hyderabad Unit 5 Prose Francis Bacon Sir Philip Sidney Essays (â€Å"Of Truth†, â€Å"Of Death†, â€Å"Of Revenge†) An Apologie for Poetrie Paper III Unit 1 Unit 2 English Literature up to the Early Seventeenth Century—II Background Translation of the Bible; Utopia; Tragedy; Comedy Drama William Shakespeare Drama William Shakespeare Poetry John Donne George Herbert Poetry Andrew Marvell Richard Lovelace King Lear Henry IV: Part I Twelfth Night The Tempest â€Å"A Valediction†, â€Å"The Canonization† â€Å"The Good-Morrow† â€Å"Virtue†, â€Å"Pulley†, â€Å"Collar† â€Å"To His Coy Mistress†, â€Å"Garden† â€Å"To Althea From Prison† To Lucasta, Going Beyond the Seas† Unit 3 Unit 4 Unit 5 Paper IV Unit 1 Unit 2 Unit 3 Unit 4 English Literature of the Seventeenth and Eighteenth Centuries—I Background Allegory; Neo-Classicism; Epic; Rise of the English Novel Poetry John Milton Paradise Lost (Bks I & IX) Poetry John Dryden Absalom and Achitophel â€Å"Mac Flecknoe† Fiction Daniel Defoe Robinson Crusoe Henry Fielding Joseph Andrews Prose John Dryden Essay of Dramatic Poesy (Up to â€Å"Examen of ‘The Silent Woman’†) Preface to Shakespeare (Up to the paragraph Samuel Johnson beginning â€Å"So careless was this great poet†¦Ã¢â‚¬  3 Unit 5 Department of English University College of Arts & Social Sciences Osmania University, Hyderabad Paper V Unit 1 Unit 2 Unit 3 English Literature of the Seventeenth and Eighteenth Centuries—II Background Pastoral Poetry; Restoration Comedy; Satire; Sentimental Comedy Poetry Alexander Pope Poetry William Blake â€Å"The Rape of the Lock† (Canto I) â€Å"An Essay on Criticism† (Part I) Songs of Innocence (â€Å"The Lamb†, â€Å"Holy Thursday†, â€Å"The Chimney Sweeper†) Songs of Experience (â€Å"The Tyger†, â€Å"Holy Thursday†, â€Å"The Chimney Sweeper†, â€Å"London†, â€Å"A Poison Tree†) â€Å"Elegy Written in a Country Churchyard† The Way of the World The Rivals â€Å"Sir Roger in Church† â€Å"The Aims of the Spectator† â€Å"Mr. Bickerstaff on Himself† â€Å"The Spectator Club† Unit 4 Unit 5 Thomas Gray Drama William Congreve R B Sheridan Prose Joseph Addison Richard Steele 4 Department of English University College of Arts & Social Sciences Osmania University, Hyderabad MA (Previous) Semester II—(Papers I to V) Paper I Unit 1 History, Structure and Description of English—II a) Word Formation in English b) Change of Meaning a) Levels of Language Description: Syntax b) Varieties of Language: Dialect, Idiolect, Register, and Style a) Word Stress in English b) Properties of Connected Speech: Weak forms/Elision and Intonation a) Behaviourist and Cognitivist Approaches to Language Learning/Teaching; Differences between First Language Acquisition and Second Language Learning b) Role of English in India and the Objectives of Teaching English at the College Level a) Techniques of Teaching Prose, Poetry, Grammar, and Vocabulary b) Language Testing Unit 2 Unit 3 Unit 4 Unit 5 Paper II Unit 1 Unit 2 English Literature of the Nineteenth Century—I Background Romanticism; Fancy and Imagination; Gothic; Historical Novel Poetry William Wordsworth S T Coleridge Poetry P B Shelley John Keats â€Å"Intimations Ode†, â€Å"Tintern Abbey† â€Å"Rime of the Ancient Mariner† â€Å"Ode to the West Wind†, â€Å"To a Skylark† Odes: â€Å"On a Grecian Urn,† To Autumn,† â€Å"To a Nightingale† Emma Wuthering Heights Unit 3 Unit 4 Fiction Jane Austen Emily Brontà © 5 Department of English University College of Arts & Social Sciences Osmania University, Hyderabad Unit 5 Prose Charles Lamb William Hazlitt â€Å"Dream Children†, â€Å"Old China† â€Å"The Indian Juggler†, â€Å"The Fight† Paper III Unit 1 English Literature of the Nineteenth Century—II Background Science and Religion; Pre-Raphaelites; Dramatic Monologue; Realism and Naturalism Poetry Alfred Lord Tennyson Robert Browning Poetry Elizabeth Barrett Browning â€Å"Ulysses†, â€Å"Lotos Eaters† â€Å"My Last Duchess†, â€Å"Andrea Del Sarto† Unit 2 Unit 3 G M Hopkins Matthew Arnold Unit 4 Fiction Charles Dickens Thomas Hardy Prose Matthew Arnold John Ruskin Sonnets from the Portuguese 21 (â€Å"Say over Again †¦Ã¢â‚¬ ) 32 (â€Å"The first time that †¦Ã¢â‚¬ ) 43 (â€Å"How do I love thee †¦Ã¢â‚¬ ) â€Å"Pied Beauty†, â€Å"God’s Grandeur†, â€Å"Windhover† â€Å"Dover Beach† Hard Times Tess of the d’Urbervilles â€Å"The Study of Poetry† Unto This Last (Section I) Unit 5 Paper IV Unit 1 Unit 2 English Literature of the Twentieth Century—I Background Modernism; Dada and Surrealism; Symbolism; Stream of Consciousness Poetry W B Yeats T S Eliot â€Å"Easter 1916†, â€Å"Second Coming†, â€Å"Byzantium† The Waste Land 6 Department of English University College of Arts & Social Sciences Osmania University, Hyderabad Unit 3 Fiction D H Lawrence Joseph Conrad Prose Virginia Woolf E M Forster Drama G B Shaw J M Synge Sons and Lovers Heart of Darkness A Room of One’s Own â€Å"Art for Art’s Sake† (from Two Cheers for Democracy) Saint Joan Riders to the Sea Unit 4 Unit 5 Paper V Unit 1 Unit 2 English Literature of the Twentieth Century—II Background Postmodernism; Impressionism; Existentialism; Movement Poetry Poetry Ted Hughes Phillip Larkin Seamus Heaney Fiction William Golding Graham Greene Drama Samuel Beckett Tom Stoppard Short Story Roald Dahl A S Byatt â€Å"Thought Fox†, â€Å"Hawk Roosting† â€Å"Churchgoing,† â€Å"Toads† â€Å"Digging†, â€Å"Punishment† Lord of the Flies The Power and the Glory Waiting for Godot Indian Ink â€Å"Lamb to the Slaughter† â€Å"The Umbrella Man† â€Å"Sugar† (from Sugar and Other Stories) Unit 3 Unit 4 Unit 5 7 Department of English University College of Arts & Social Sciences Osmania University, Hyderabad Syllabus of M A (English) (With effect from 2009-10) MA (Final) Semester III—(Papers I-V) Paper I Unit 1 American Literature—I Background American Frontier; American Renaissance; American Transcendentalism; American Puritanism Poetry Phyllis Wheatley Walt Whitman â€Å"On Being Brought from Africa to America† â€Å"When Lilacs Last in the Door-yard Bloom’d†, â€Å"Out of the Cradle Endlessly Rocking†, â€Å"Crossing the Brooklyn Ferry† â€Å"I taste a liquor never brewed†, â€Å"She sweeps with many-colored brooms†, â€Å"After great pain a formal feeling comes† The Scarlet Letter The Adventures of Huckleberry Finn The Hairy Ape Death of a Salesman â€Å"The American Scholar† â€Å"Civil Disobedience† Unit 2 Emily Dickinson Unit 3 Fiction Nathaniel Hawthorne Mark Twain Drama Eugene O’Neill Arthur Miller Prose Ralph Waldo Emerson Henry David Thoreau Unit 4 Unit 5 8 Department of English University College of Arts & Social Sciences Osmania University, Hyderabad Paper II Unit 1 Indian Writing in English—I Background Indian Nationalist Movement; Use of English for political awakening; Reform Movements; Rise of the Indian Novel Poetry (Selections from Indian Poetry in English. Ed Makarand Paranjape. Macmillan, 1993) Sri Aurobindo â€Å"I have a hundred lives† â€Å"The Golden Light† â€Å"Thought the Paraclete† Toru Dutt â€Å"Sita†, â€Å"Our Casuarina Tree† Sarojini Naidu â€Å"The Pardah Nashin†, Ghanashyam† Fiction Krupabai Satthianandhan Mulk Raj Anand Fiction Raja Rao R K Narayan Prose Rabindranath Tagore B R Ambedkar Kamala: a Story of Hindu life Untouchable Kanthapura The Man-Eater of Malgudi â€Å"Nationalism in India† (from Nationalism) â€Å"The Annihilation of Caste† (Collected Works of B R Ambedkar, Vol III) Unit 2 Unit 3 Unit 4 Unit 5 Paper III Unit 1 Unit 2 Postcolonial Literatures Background Colonialism-Imperialism; Postcolonialism; Nationalism; Diaspora Poetry Christopher Okigbo Edward Brathwaite Judith Wright â€Å"Heaven’s Gate†, â€Å"Death lay in Ambush† â€Å"Didn’t He Ramble†, â€Å"Calypso† â€Å"Eve to Her Daughters†, â€Å"Bullocky† Things Fall Apart The Edible Woman Unit 3 Fiction Chinua Achebe Margaret Atwood 9 Department of English University College of Arts & Social Sciences Osmania University, Hyderabad Unit 4 Drama Wole Soyinka Derek Walcott Prose V S Naipaul Ngugi wa Thiong’o Kongi’s Harvest Dream on Monkey Mountain Unit 5 â€Å"Indian Autobiographies† (from Literary Occasions: Essays) â€Å"The Language of African Literature† (from Decolonizing the Mind) Paper IV: ENGLISH LANGUAGE TEACHING Unit I History of English Language Teaching in India: Some important landmarks: a) Critique of Macaulay’s Minute; b) Landmarks of English Education in India after Independence: Kunzru Committee, the three language formula and Kothari commission. c) Ramamurthy Commission Report d) Curriculum and its components; Syllabus/ Paper Design; materials development Major Approaches, Methods and Syllabi: a. Traditional methods – Use of the Grammar Translation method, Direct method, Reading method; b. Structural Approach: Audio-Lingual Method, Types of syllabi: structuraloral-situational, notional-functional; linguistic competence and communicative competence; Error analysis and Remedial teaching c. Communicative approach, Krashen’s Monitor Model (Natural method); task based syllabus d. Humanistic Approaches: Community Language Learning, Suggestopaedia Classroom Techniques: a. Lecture mode; classroom discussion; Peer and pair work; b. Role play; Team teaching; Teaching large classes. c. Teaching Aids: Use of the Blackboard, flip charts, , OHP, audio visual tools, Television, d. Traditional and digital Language Lab; the Computer and the Internet. Teaching of Language skills: a. The teaching of listening, speaking, reading, writing and related study skills b. Teaching of literature c. Stylistic approach to the teaching of literature (norm, deviation, and foregrounding); d. Teaching of language through literature. 10 Unit II Unit III: Unit IV: Department of English University College of Arts & Social Sciences Osmania University, Hyderabad Unit V: Testing and Evaluation: a. Importance of Testing, traditional testing methods; Different types of tests b. Group Discussion (GD) c. Interview d. Course Evaluation Paper V : Inter –Disciplinary ID-I : Writing for Academic and Professional Purposes Unit 1: Language CompetenceA. Communicative Grammar: Nouns, articles, prepositional phrases, tenses subject verb agreement, modal verbs, difference between spoken & written language B. Sentence structure, kinds of sentences-statements, interrogatives, question tags passive constructions, reported speech; use of conditionals, compound & complex sentences C. Academic Reading : read to write- focus on the gist, idiom, rhetoric, style and genre specific features in different texts ; intensive & critical reading, note making Unit 2: Organization of writing A. Guided writing, expansion, use of connectives, sequencing, writing a paragraph free writing, mind mapping. Paraphrasing, summarizing, writing an abstract Writing letters, resume and email ( e-mail etiquette) B. C. Unit 3: Academic Writing A. B. C. proposals, SOPs ( statement of purpose) structure of a report, report writing Writing an essay; (descriptive, argumentative and scientific) Unit 4: Professional Writing A. Inter office memos, professional reports( business, survey, minutes of a meeting) B. Editing, writing a review, creative writing (Ad writing, slogan writing and writing headlines). C. Technical writing; product and process writing, writing a user manual SEMINAR PRESENTATION 11 Department of English University College of Arts & Social Sciences Osmania University, Hyderabad MA (Final) Semester IV—(Papers I-V) Paper I Unit 1 Unit 2 American Literature—II Background American Dream; Multiculturalism; Lost Generation; American Comedy Poetry Robert Frost Wallace Stevens Robert Lowell Unit 3 Fiction Ernest Hemingway Saul Bellow Drama Lorraine Hansberry Neil Simon Short Fiction Henry James William Faulkner Issac Asimov â€Å"West Running Brook†, â€Å"Home Burial† â€Å"Sunday Morning† â€Å"The Emperor of Ice-Cream â€Å"For the Union Dead† â€Å"At a Bible House† The Old Man and the Sea Seize the Day Raisin in the Sun Sunshine Boys â€Å"The Middle Years† â€Å"Go Down Moses† â€Å"The Bicentennial Man† Unit 4 Unit 5 12 Department of English University College of Arts & Social Sciences Osmania University, Hyderabad Paper II Unit 1 Indian Writing in English—II Background Decolonization; Counter DisPapers; Partition Literature; Myth and Literature Poetry (Selections from Indian Poetry in English. Ed Makarand Paranjape. Macmillan, 1993) Nissim Ezekiel Kamala Das A K Ramanujan Unit 3 Fiction Salman Rushdie Shashi Deshpande Drama Girish Karnad Mahesh Dattani Short Fiction Bharati Mukherjee â€Å"Enterprise† â€Å"Poet, Lover, Birdwatcher† â€Å"An Introduction† â€Å"The Old Playhouse† â€Å"A River†, â€Å"Love Poem for a Wife-I† Unit 2 Midnight’s Children The Binding Vine Hayavadana Final Solutions â€Å"A Wife’s Story†, â€Å"Management of Grief† (both from The Middleman and Other Stories, 1989) â€Å"The Accompanist† â€Å"A Devoted Son† (both from Games at Twilight, 1978) Unit 4 Unit 5 Anita Desai 13 Department of English University College of Arts & Social Sciences Osmania University, Hyderabad Paper: III: (Specializations) A) Women’s Writing B) Indian Literatures in Translation C) Modern Classics in Translation Paper III A) Women’s Writing Unit 1: Background The Woman Question: New Woman; Women’s Liberation Movement; Feminism; Re-reading the Canon Prose Mary Wollstonecraft Unit 2: Vindication of the Rights of Women (Introduction and Chapter 2) The Second Sex (Essay on Biology) Simon de Beauvour Unit 3: Poetry Elizabeth Barret Browing Sylvia Plath Margaret Atwood Grace Nichols Anne Stevenson Fiction Virginia Woolf Nadine Gordimer Drama Carly Churchill Alima Ata Aidoo â€Å"A Curse for a Nation† â€Å"Lady Lazarus† â€Å"Circle† – Mud Poems â€Å"Making Poetry†, The Spirit is too Blunt an Instrument Unit 4: Mrs Dalloway July People Unit 5: Top Girls Anowa Paper III (B): INDIAN LITERATURES IN TRANSLATION Unit 1: i) ii) Background Types of Natya (Nataka, Prakarana, and Prahasana) and Theory of Rasa and Kavya Indian Concept of Translation (from Translation as Discovery by Sujit Mukherjee, Chapter 2 & 3) Scope of Comparative Literature (â€Å"Comparative Literature in India: A Perspective† by Bijay Kumar Das from Comparative Indian Literature ed. Rao & Dhawan) 14 iii) Department of English University College of Arts & Social Sciences Osmania University, Hyderabad iv) Dalit Aesthetics (â€Å"Dalit Literature and Aesthetics† from Towards an Aesthetics of Dalit Literature by Sharavan Kumar Limbale) Poetry Sangam Poety – from Poems of Love and War Trans by AK. Ramanujan, Akam Poems – â€Å"Kurinci† (page 15), â€Å"Neytal† (page 41),†Palai† (page 53), â€Å"Mullai† (page 81), â€Å"Marutam† (page 97), Puram Poems – â€Å"King Killi in Combat† (page 123) Gurram Joshua – I was one of them†, The Bat Messenger† (From Twentieth Century Telugu Poetry. An Anthology ed. By Velcheru Narayan Rao, OUP 2002) Jibananda Das – â€Å"Banalata Sen†, The Naked Solitary Hand† (From Signatures ed by Satchidanandan, Sahitya Academi, New Delhi) Drama Kalidas Unit 2: i) ii) iii) Unit 3 i) Abhgnana Shakuntalam from The Plays of Kalidasa by Barbara Stoller Miller, Ed Columbia University Press, 1984 Silence! the Court is in Session (OUP) ii) Unit 4: i) Vijay Tendulkar Fiction Premchand Godan; a novel of peasant India Tans by Jai Ratan and P. Lal Bombay: Jaico, 1979 ii) U.R Anantha Murthy Smakara: A Rite of Dead Man Trans by A.K. Ramanujan (OUP) Short Fiction Unit 5: i) Folktales – â€Å"Bopoluchi† (A Punjabi Folk Tale), â€Å"Why the Fish Laughed† (A Kashmiri Folk Tale), Folktales from India selected and ed. By A.K. Ramanujan, Penguin Books India, 1994. Ismat Chugtai – â€Å"Chauti Ka Jowra† from Inner Courtyard. Ed Lakshmi Holmstrom, Rupa, 2002. Mahasweta Devi – â€Å"Shishu† from Women’s Writing, Vol II Ed by Tharu & Lalitha, OUP, 1991. ii) iii) 15 Department of English University College of Arts & Social Sciences Osmania University, Hyderabad Paper III (C) : Modern Classics in Translation Unit 1: Background Enlightenment; Bourgeois Experience; Epic Theatre ; Magic Realism. Poetry Charles Baudelaire : The Sick muse, Even She was called Bautrice By Many Who knew Not Wherefore, The Remorse of the Dead Pablo Neruda: What Spain was Like, The Heavenly Poets, Opium in the East Joseph Brodsky: Odysseus to Telemachus, Nune Dimmittis, Nature Morte Unit 3: Fiction Gustav Flaubert: Milan Kundera: Drama Anton Chekhov Betrolt Brecht Unite 2: Madame Bovary Book of Laughter Forgetting Unit 4 The Cherry Orchard Mother Courage Unit 5: Short Fiction Franz Kafka Gabriel Garcia Marquez PROJECT WORK Metamorphosis No one Writes to the Colonel PAPER IV Paper V: Inter-Disciplinary (ID-II) Literature and Film Unit1: Background: a) Elements of a narrative: Theme, Plot, Structure, Setting, Character, Point of View b) Narrative devices : genres, montage, film noir, flashback, special effects Unit 2: Drama and Film a) George Bernard Shaw – Pygmalion (1913) b) George Cukor (Director) – My Fair Lady (1964) Unit 3 : Novel and Film a) EM Forster – A Passage to India (1924) b) David Lean (Director) – A Passage to India (1984). Unit 4: Short Fiction and Film a) Ruskin Bond – â€Å"The Blue Umbrella† b) Vishal Bhardwaj (Director) – â€Å"The Blue Umbrella† (2007) 16 Department of English University College of Arts & Social Sciences Osmania University, Hyderabad Suggested Reading Beja, Morris. Film & Literature, an introduction, Longman, 1979. Bluestone, George. Novels into film, Johns Hopkins Press, 1957. Boyum, Joy Gould. Double Exposure : Fiction into Film, Seagull Books, 1989. Corrigan, Timothy, ed Film and Literature: An Introduction and Reader. Prentice Hall, 1999. Das Gupta, Chidananda. Talking about films. Orient Longman, 1981 Deborah Cartmell and Imelda Whelehan, eds. Adaptations: from text to screen, screen to text. Routledge, 1999. Elliott, Kamilla. Rethinking the novel/film debate. CUP, 2003. Literature –Film Quarterly. McFarlane, Brian. Novel to film: an introduction to the theory of adaptation. OUP, 1996. Ray, Satyajit. Our Films, Their Films. Orient Longman, 1976. Reberge, Gaston. The Subject of Cinema, Seagull Books, 1987. Stam, Robert and Alessandra Raengo, eds. A Companion to literature and film. Blackwell Pub., 2004. SEMINAR PRESENTATION

Family, one word with many meanings. Essay

Family, one word with many meanings. In the Merriam-Webster dictionary family means a group of individuals living under one roof and usually one head. What does family mean to you? Most people would say family means love, friendship and caring. Others may say anger,disfunctional, and pain. For the past seventeen years of my life my immediate family have been my biggest support system. My immediate is my parents, sisters, brothers, grandparents, aunts and uncles. They have been my guiding lights through life. To me family means to love, being caring,supportive and being happy. However, there are other team environments that can also be considered as family. Cheerleading from age 3 to 14(delete) I participated in cheerleading for the Detroit Police Atletic League (PAL) from age 3 to 14 years old. Cheerleading is an activity performed by a team of individuals dedicated to working together to acheive excellence and a common goal. The cheerleading team can be considered as a form of family. They act as family members in time of need. They listen to problems, help solve problems, assist with homework, and help you acheive the cheer team goals. Cheerleading is a very competive sport. Many people believe that cheerleading is not a sport. They are right it is not just a sport it is more so a family. The team works togehter, help each other, listen to each other and work toward the common team goal. Cheerleaders are stereotype all the time. It is said that cheerleaders are out there to be pretty and popular, but what people don’t know is that the countless hours of hard work the team must endure to acheive the goal of excellence. The cheering team works together to acheive perfection and perform awesome routines. Cheerleaders develop friendships that will often last a lifetime. The squad becomes your second family and together the team grows and mature. They develop life lifr skills that will benefit each cheerleader forever. As a former cheerleader for 12 years I have made special bonds with people that I truly care about. Cheerleading taught me to be strong and fight for what I believe in. It has taught me to be a think postive and keep a happy spirit. My cheerleading experience helps me keep my life in order. Participating in cheerleading has developed a sense of displine in me to make sure I continue  to do the right things. My coaches were like parents to me. They treated me as if I were one of their child and wanted me to do my very best with anything they taught the cheerteam. They are the reason I have a love for cheerleading.The sport of cheerleading teaches hard work, perseverance, competitiveness, and teamwork. My immediate and cheerleading family have supported me through this whole journey. Every time I had to participate in a cheering activities, my immediate family was there cheering me on. When we had cheerleading competitions my parents made sure I could see them in the stands before I performed. My family showed so much love and support it had an impact on me excelling in this sport. Dancing from age 7 to 15(delete) Dancing has been apart of my life as well for nine years. When I was seven years my mother enrolled me into a dance school named MBS Training Center. My mother, father and other immediate family members showed how proud they were of me by coming to my recitals at the end of the year and showing their graditude for doing so well. Over the years dance has helped me to grow in other ways. From it I have learned that hard work really does pay off. I learned that discipline and self control are not only a vital part of dancing, but a necessary part of life. Also,I have recognized that motivation and perseverance are keys to success. What matters is not who wins in the beginning, but who is still on her feet in the end. Perhaps the most important lesson dance has taught me is responsibility. (Need to expand on this) Marching band senior year(delete) Joining the flag team in band auxiliary was something new for me senior year. I didn’t believe I could do it but all of my family supported me through it all. They had faith in me and it motivated me to do nothing but the best. The band is like a family as well. Everyone in the band has to play a different role to support each other and keep everyone strong. You depend on your bandmates to lead you in the right direction. With love, care and support from family and band leaders I will be able to achieve this new  challenge just like the rest. (Need to expand on this) School work (delete) My education is important to me and important part of life. Education is a tool that is an essential part of acheiving my future goals. Even though I participated in extracurricula activities throughout my entire life I still manage to maintain a 3.5 or above Grade Point Average (GPA). My family and I have high expectations for me. In order for me to continue to do the things I loved I had to maintain excellent grades. Establishing a school familt is vital to completing your high school education. Your school family is with you during the hours you spend at school. They can help you accomplish your goals. I have put forth a commendable effort in my academic career, by being on the Honor Roll and maintaing an excellent GPA all four years in high school. I have also been recognized by the National Honors Society award and received Principal’s award. It makes me happy to know that my accomplishments brings a smile to my family’s faces. Everything I do is to make them proud and continue to live our legacy. Education is an important aspect in life and vital to acheiving successful I have as a goal. I know I have to be on my p’s and q’s to achieve every goal my family and I have for myself. Knowing that they are there to encourage me makes it a bit easier. CLOSING (delete) Without my family I AM NOTHING. They are the reason I strive to be the best at any obstacle thrown at me. Anything that I planned on doing or wanted to achieve their were there for me. Now I am looking to establishing a college family at your university. Having a college family will be vital to my future success since immediate family maynot be located in near the immediate family.

Kyoto Protocol And Global Warming - 1173 Words

In December 1997, Kyoto protocol was signed to address global warming specifically. Global warming is the â€Å"gradual increase in the average temperature of the Earth s atmosphere and its oceans due to green house gases emissions.†(NRDC, 2005) In the past 100 years, the rate of global warming is unprecedented. In fact, global warming has become one of the most challenging environmental problems in the 21st century. In order to effectively address this issue, international cooperation is necessary. Through international cooperation, undeveloped countries are able to overcome financial obstacles in meeting their targets. In addition, it could also promote worldwide technology sharing, data foundations and public awareness of climate change.†¦show more content†¦For starters, modern economy relies heavily on fossil fuels, which is a main resource that contributes to global warming. Adopting renewable energy might sharply reduce GHG emissions. However, according to inte rnational energy agency, â€Å"switching from fossil fuels to low-carbon sources of energy will cost $44 trillion between now and 2050†(IEA, 2009). In case 44 trillion is too abstract, 1 trillion dollar can fill up an entire soccer field and stack more than 10 feet high. This cost could be intimidating for any country. Moreover, the cost also depends on how long it takes for us to start reducing emissions. â€Å"The IPCC report showed that continuing to hold off on reducing emissions could increase costs by 40 percent† (IPCC, 2008) For developing countries, this cost would be a financial burden and a limiting reagent on GDP growth. Socially, civilian’s life quality will be affected by the GDP reduction. As a result, it becomes more challenging for countries to take initiative in addressing this problem. The question eventually came down to whom should bear the astronomical cost? Are we willing to invest in something that might cost more than its benefits? Evaluation on its Successfulness The achievements of Kyoto Protocol have been controversial. Nevertheless, the agreement has had a mix of success. In order to evaluate its successfulness, we need data of the emission level of Annex I parties from 1990 to 2012 explicitly. As a result, the United States did not ratify theShow MoreRelatedGlobal Warming And The Kyoto Protocol1470 Words   |  6 Pagesthe global warming agenda and tackle the issues surrounding the Kyoto Protocol. The second part will look at climate change and the protocol from the respective lenses of realism and liberalism. I will argue that while none of the theories precisely covers the entirety of the issue, each provides helpful analysis falls short of clarifying the entire climate change picture. Can states cooperate effectively through the structure of the Kyoto protocol to solve an international problem of global warmingRead MoreGlobal Warming : The Kyoto Protocol1183 Words   |  5 PagesIntroduction According to the American Meteorological Society, there is a 90 percent probability that the global temperature will increase between 3.5 to 7.4 â„Æ' by 2100 [1]. This increase in global warming could trigger widespread catastrophes such as rising sea levels and famine. International cooperation is crucial because there is not a single country that accounts for 26% of global emissions, and mitigation will require more than 15 countries in order to account for at least 75% of emissionsRead MoreGlobal Warming And The Kyoto Protocol1737 Words   |  7 Pagesgovernments have been working on addressing one of the major challenges the world has been challenged to this day which widely is known as Global Warming. The Kyoto protocol is the well-known abiding playground internationally recognized as a global treaty placing obligations on developed nations to significantly minimize their Green House Gas emissions first adopted in Kyoto, Japan in 1997. Three actions are recommended for th e UN to take up on: First, the UN shall bring all the major actors onboard toRead More Global Warming and the Kyoto Protocol Essay886 Words   |  4 Pages Global Warming and the Kyoto Protocol   Ã‚  Ã‚  Ã‚  Ã‚   In the world today there are talks about why and how the people of this planet are polluting the rivers, lakes, soil, and even air. With these talks countries are coming up with great ways to reduce this problem. They see the effects and they are happy and life goes on but there is another problem, the one the everyday people just can’t solve with their own hands, that problem is the theory of global warming. During December of 1997, a meeting inRead More Global Warming and the Kyoto Protocol Essay1229 Words   |  5 PagesGlobal Warming and the Kyoto Protocol Environmental issues are becoming a growing concern for the world as well as for the worlds leaders. Pollution, littering and the burning of fossil fuels are all problems that have drastically affected humans over the past few years. Impure drinking water, radiation, less ecological diversity and cancer are a few of such harms that the world has experienced. However, one of the most prominent concerns is the greenhouse effect. The greenhouse effect, a naturalRead MoreThe Kyoto Protocol: An Attempt to Manage Global Warming Essay1010 Words   |  5 PagesThe Kyoto protocol is one of the most important treaties signed in contemporary days. It has great limitations and is yet to evolve to another level, but it addresses an issue that affects not one, two or ten countries – it affects the entire world. That is why countries have to work and cooperate to create a binding legal document that sets specific standards to greenhouse gas emissions. In recent decades we have witnessed a gradual change in our environment. Our planet is heating up very quicklyRead MoreThe Kyoto Protocol Essay1388 Words   |  6 Pagespaper examines the Kyoto Protocol and the United States position on their participation in the Kyoto Protocol. To understand the underpinnings of the Kyoto Protocol one must agree that our planet is warming, and we (its citizens) are contributing to its warming. Any general argument about global warming has to address at least the following five questions: 1. Is global warming really occurring? 2. If global warming is occurring, are humans responsible for it? 3. If global warming is occurring, whatRead More Global Warming Blown Out of Proportion Essay1126 Words   |  5 PagesGlobal Warming Blown Out of Proportion The United States by no means should consider complying with the Kyoto Protocols. My conviction in the negation towards passing this bill is that the whole Global Warming idea is highly blown out of proportion by politicians and the mass media. Global warming, as it may exist in the most gentle form, is the result of natural changes and could yield positive benefits. It is a predictable, quantifiable process. Thus the Kyoto planRead MoreGlobal Warming And Climate Change1339 Words   |  6 PagesIntroduction Environmental Problem Kyoto was created in 1997 during the Third Conference of the Parties of the UNFCCC with the objective to globally reduce GHG emissions and ultimately address climate change (United Nations, 1997). 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