Pandemic free essay sample

TuberculosisWe are entering the third decade of what may be the most devastating epidemic in human history: HIV/AIDS. The HIV/AIDS Pandemic is a large-scale epidemic affecting more than one country. AIDS was first clinically diagnosed in the early 1980s but retrospective diagnosis suggests it existed well before this date. AIDS is a syndrome, which develops from an impaired ability to fight diseases. It undermines the body’s defenses against viruses, infections and malignancies. Here, we describe the origins and evolution of these viruses, and the circumstances that led to the AIDS pandemic. Pandemic Assignment Since scientists identified the HIV as the cause of AIDS in 1983, it has spread insistently, causing one of the most harmful pandemics ever recorded in human history. However, concerted global efforts to fight the pandemic are making a significant difference. More than nine million people living with HIV in low and middle-income countries now have access to life-saving antiretroviral treatments. We will write a custom essay sample on Pandemic or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page HIV/AIDS Overview Human immunodeficiency virus (HIV) invades the body through the exchange of certain body fluids. The virus invades cells such as T helper cells and begins to replicate itself in the human body. Acquired immunodeficiency syndrome (AIDS) of humans is caused by two lentiviruses, â€Å"HIV-1 and HIV-2; HIV-1 accounts for the majority of infections in the world, and has at least 10 genetic subtypes† (Lamptey, Wigley, Carr, Collymore, 2002). Both HIVs are the result of multiple cross-species transmissions of simian immunodeficiency viruses (SIVs) naturally infecting African primates. However, as according to Sharp Hahn (2011), one transmission event, involving SIVcpz from chimpanzees in southeastern Cameroon, gave rise to HIV-1 group M—the principal cause of the AIDS pandemic† and noted that by â€Å"tracing the genetic changes that occurred as SIVs crossed from monkeys to apes and from apes to humans†. AIDS Pandemic and the Efforts to Stop HIV/AIDS According to Merson â€Å"on June 5, 1981, few suspected a pandemic of AIDS when the Centers for Disease Control reported five cases of Pneumocystis carinii pneumonia (PCP) in young homosexual men in Los Angeles† (2006). Morbidity and Mortality Weekly Report (MMWR) reported that all the men had other unusual infections as well, indicating that their immune systems were not working; two had already died by the time the report was published. In a timeline created by AIDS. com, â€Å"this edition of the MMWR marks the first official reporting of what will become known as the AIDS epidemic† (2014). Although â€Å"after pandemic HIV-1 first emerged in colonial west central Africa, it spread for some 50 to 70 years before it was recognized† (Sharp Hahn, 2011) because phylogenetic and statistical analyses have dated the last common ancestor of HIV-1 to around 1910 to 1930. For a while the American government completely ignored the emerging AIDS pandemic. The first attempt to treat HIV was in â€Å"September 1986, when early results from clinical trials involving AZT (zidovudine) – a drug that was first investigated as a cancer treatment – showed that it might slow the attack of HIV† (AVERT, 2013). Although AZT could slow progression to AIDS in HIV positive individuals with no symptoms, a year’s supply for each person would cost around seven-thousand dollars and many did not have adequate health insurance to cover the cost. In 1995, â€Å"FDA announced that the drug 3TC (lamivudine) had been approved for use in combination with AZT in treating AIDS and HIV† (AVERT, 2013) after a number of studies had shown that HIV could quickly become resistant to AZT and that the drug had no benefit for those in the early stages of the disease. On April 5th 1990 Ryan White, schoolboy who had become infected with HIV via a blood transfusion for his haemophilia, died. He was known for his fight to return to public school after he was banned due to fears of spreading of AIDS to other children. â€Å"Following Ryan’s death, the American government implemented a new programme named after him – the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act† (AVERT, 2013). Its aim was to improve the quality and availability of care for low-income, uninsured and underinsured individuals and families affected by HIV. In 2000, the government funded programs such as needle exchange services and abstinence-only education and in 2001 the Centers of Disease Control (CDC) set a goal to halve the number of people infected with HIV each year in the USA to 20,000 by the end of 2005 but by 2003 it was already clear that the CDC’s goal would be missed, the number of new infections had shown no sign of declining. In 2006, President Bush signed the reauthorisation of the Ryan White HIV/AIDS Program, â€Å"since its creation in 1990 the program had provided federal funding for thousands of Americans living with HIV/AIDS unable to pay for their treatment themselves† (AVERT, 2013). In 2007, raltegravir – was approved by the FDA which according to AVERT â€Å"Raltegravir was the first of a new class called integrase inhibitors† and â€Å"the significant progress in treatment proved to be particularly important to thousands of HIV positive Americans whose treatment had been failing due to drug resistance (2013). It was believed to provide extended years of meaningful survival to patients. In July 2010, â€Å"the USAs first HIV/AIDS Strategy was released† (The White House Office of National AIDS Policy, 2010) and reducing new HIV infections was included as one of the Strategys three core aims. According to AVERT (2013), â€Å"in order to reduce new infections without an increase in funding, the Strategy recommended that HIV prevention efforts be intensified in the communities where HIV is the most heavily concentrated†. MedlinePlus concluded that â€Å"there is no cure or vaccine to prevent HIV/AIDS, but early detection through HIV testing and treatment can frequently turn this fatal disease into a manageable chronic disease† (2009). The HIV-1 pandemic is a complex mix of diverse epidemics within and between countries and regions of the world. â€Å"AIDS remains the fourth leading cause of death in low-income countries† (International AIDS Vaccine Initiative, 2014). While there will never be a solution to HIV and AIDS, a preventive vaccine would do a great deal to curb the pandemic. But unfortunately, the problem with developing a vaccine is that the HIV genome mutates very quickly. Stowell (2006) explains that all organisms vary a little throughout the centuries. The HIV genome mutates around 1000 times more quickly than the human genome around 1000 times more mutations accumulate in a single year, relative to the length of the genome. Antiretroviral treatment has transformed AIDS from an inevitably fatal condition to a chronic, manageable disease in some settings.

How to Write Headlines and Subheads

How to Write Headlines and Subheads How to Write Headlines and Subheads How to Write Headlines and Subheads By Mark Nichol The first thing most readers notice in print or online is a headline. Think of it as a virtual handshake. If your headline is the text equivalent of a cold, dead fish, you’ll make a poor first impression. Or think of it as analogous to a cover letter or a request for a date. You only get one chance to introduce yourself make it good. Various types of headlines exist, and some are more suitable than others for various types of content. Here are eight categories appropriate for selling something, whether it’s a product or an idea, along with a sample headline of that type: 1. Direct: â€Å"Lawn Mowers on Sale† Such an approach may seem dull, but consider that no single reader personality prevails; some people like an unadorned statement. Many people looking for lawn mowers on sale will be gratified to see the headline â€Å"Lawn Mowers on Sale† â€Å"Ah, just what I was thinking.† 2. News: â€Å"Remote-Control Lawn Mower to Debut in April† A journalistic headline conveys authority and is straightforward without being plain. 3. How-To: â€Å"How to Select the Best Lawn Mower for Your Yard† The words â€Å"how to† have launched a million headlines (many of them right here on this site), and for good reason: What do you type into a search engine when you want to learn how to do something? â€Å"How to† tells readers that somebody out there wants to help them. 4. Question: â€Å"Is Your Lawn Mower the Right One for the Job?† A query to readers is an invitation, a promise that they’ll get something out of the experience; all they have to do is pick up the magazine or click on the link and read. 5. Command: â€Å"Go to Lawn Mowers R Us for the Best Deals† You don’t have to be a current or former military service member to know that a directive gets one’s attention. Of course, it’s more likely to succeed in a marketing pitch if it aligns with the target audience’s desires. 6. List: 7 â€Å"Things to Look for in a New Lawn Mower† The next-best approach to a how-to headline is a list. Look in the archives here at Daily Writing Tips and notice how many headlines start with a number. People like enumeration; it offers a promise that they will come away from the reading experience with quantifiable results. 7. Testimonial: â€Å"I Got a Great Deal on a New Lawn Mower† A testimonial, an authentic or fictional statement about the value of a good or service, is a time-honored advertising strategy. People are drawn to anecdotal evidence especially if it is accompanied by a photograph of a celebrity or an attractive model who has ostensibly offered the claim even though such overtures are notoriously unreliable. But if you routinely employ testimonials that stand the test of trust, even readers who practice critical thinking will find them appealing. 8. Teaser: â€Å"The Most Important Purchase You’ll Make This Year† Take care with this approach, because you can easily overextend yourself. â€Å"My most important purchase of the year will be a lawn mower? Really?† If you can back up the tease a survey of real estate agents concludes that good lawn care drives up property values and is a significant factor in home sales over the asking price then by all means use it. But be careful: One unsubstantiated teaser headline can drive a reader away forever. Conciseness Notice that none of the sample headlines above is more than ten words long. Many effective headlines are half that long, or even shorter. Make sure your headlines are no longer than they need to be, but nail the technique or catch the vibe you want first, then reduce the word count if possible. Take care, however, not to truncate unnecessarily: You might think, for example, that â€Å"How to Select the Best Lawn Mower for Your Yard† has three extraneous words at the end, but the best lawn mower overall may not be the best lawn mower for your yard, and the use of the word your personalizes the message hey, reader, I to help you! Originality Copy and paste your final draft into a search engine. If it comes up, consider altering one or more words or starting over again. There’s nothing wrong with using an existing headline there are only so many ways to string together a handful of words about a topic but you may not want your article to be associated with the content beneath that existing one, especially if it’s of inferior quality. And don’t hesitate to use a basic, functional headline, or to assume that it’s already been taken: In an online search, the headline for this post (the most fundamental wording I can think of for the topic) came up only in a single extent reference, and was in an obscure video tutorial. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Freelance Writing category, check our popular posts, or choose a related post below:Using "a" and "an" Before Words10 Colloquial Terms and Their MeaningsPrepositions to Die With

7 derechos de los indocumentados si son arrestados

7 derechos de los indocumentados si son arrestados Si eres uno de los 11 millones de indocumentados que viven en los Estados Unidos, estos son tus derechos en los casos de arresto o si la Policà ­a te para en la calle o te ordena parar mientras manejas un auto. Derechos de los indocumentados La policà ­a no puede entrar en una vivienda sin que tenga orden judicial (warrant). La excepcià ³n es si tiene motivos fundados de que se est cometiendo un delito (atacando a una persona, traficando con drogas, etc.). Si la policà ­a llama a la puerta, pedir el warrant muy educadamente y sin perder los nervios. Si no la tienen sà ³lo pueden ingresar si se les da permiso, pero se les puede decir que no. Si la policà ­a para a un inmigrante en la calle o cuando est manejando o en el trabajo recordar que se tiene el derecho a permanecer en silencio. La à ºnica excepcià ³n son algunos estados en los que se est obligado a decir el nombre. Verifica si resides en uno de esos estados. Si es asà ­, se dice. Si la policà ­a lo para a uno se le puede preguntar si se puede ir (free to leave, en inglà ©s). Si la respuesta es afirmativa (hay que oà ­r el yes), se puede ir, pero sin movimientos bruscos. Nunca perder la calma (aunque por dentro se està © muy nervioso). Si se es arrestado se tiene el derecho a pedir hablar con un abogado. Es muy conveniente cargar siempre con el nombre y el nà ºmero de telà ©fono de un abogado de inmigracià ³n con buena reputacià ³n (o incluso ms de uno, por si no contesta o no puede hacerse cargo del caso). Si se est como indocumentado en Estados Unidos no cargar con documentos como el pasaporte u otros como la matrà ­cula consular que puedan probar que se est ilegalmente en el paà ­s. Si se tienen se guardan en un lugar seguro, pero no se les lleva con uno. La razà ³n de lo anterior es que para que el gobierno pueda deportar a una persona es necesario que pruebe que est aquà ­ ilegalmente (o que ha hecho algo que amerita la deportacià ³n). Si no se dice nada, si no hay rà ©cords de ninguna clase entonces tiene difà ­cil probar su caso. Lo ms aconsejable es no hablar ni mostrar documentos y esperar por el abogado. Si se est ilegalmente en el paà ­s y se tienen personas dependientes como por ejemplo hijos menores, tomar la precaucià ³n de hablar con personas de confianza quià ©n debe hacerse cargo de ellos, cules son las instrucciones, cà ³mo acceder al dinero ahorrado para gastos, etc. Es incluso muy conveniente hacer un escrito ante notario. Jams firmar algo que no se entiende. Esto puede ser porque est en inglà ©s y sà ³lo se habla espaà ±ol o porque no se acaba de entender las consecuencias del documento que se le pone delante. Tampoco firmar ningà ºn papel si no se est de acuerdo con lo que dice, aunque se entienda. En estos casos esperar por el abogado. Una vez que se firma es muy difà ­cil dar marcha atrs. NO importa lo mucho que insistan. Si no se quiere firmar o no se entiende, no se firma. Muy importante Jams dar o enseà ±ar a la Policà ­a un documento falso. Jams decir que se es ciudadano americano si es una mentira. Esto es muy grave. Permanece callado, si asà ­ se desea. Pero no mentir, si se habla. Si la policà ­a lo para a uno, permanecer siempre en calma. Jams mostrarse violento, muy nervioso, hacer movimientos extraà ±os o salir huyendo, esto à ºltimo es considerado como una violacià ³n migratoria que amerita la deportacià ³n. Saber que existen en las carreteras retenes migratorios internos en algunas partes del paà ­s. A tener en cuenta De los estimados 11 millones de indocumentados presentes en Estados Unidos, aproximadamente menos de cinco podrn beneficiarse de las medidas anunciadas por el presidente Obama que les protege frente a la deportacià ³n. Si crees que puedes calificar para esas medidas, infà ³rmate con abogados u organizaciones de apoyo a inmigrantes que sean reputados. Evita ser và ­ctima de un fraude migratorio y considera reportar los casos que sepas. No  pagues a personas que ofrecen cosas que simplemente no existen o que cobran por sus gestiones cantidades completamente desorbitadas. Y ten presente que por ahora DAPA y DACA extendido no se estn aplicando. Y si recibes una carta para presentarte en Corte es el momento de buscar abogado. Tener presente que puede haber una demora grande en los casos en las Cortes migratorias. De interà ©s En algunos estados, como por ejemplo Nueva York o California, algunos indocumentados podrà ­an ser considerados PRUCOL. En estos casos, tendrà ­an derecho a algunos beneficios sociales de los que generalmente los indocumentados estn excluidos. Y es que hay importantes diferencias entre estados en lo que afecta a indocumentados: unos son muy estrictos y otros han pasado medidas para hacerles la vida un poco menos difà ­cil. Finalmente, la presidencia de Donald Trump est teniendo un  gran impacto en las comunidades migrantes. Esos son 9 asuntos migratorios sobre los que ya se ha pronunciado y conviene estar familiarizados. Adems, conviene saber cules son las 7 nuevas prioridades de deportacià ³n, segà ºn orden ejecutiva de enero de 2017. Este artà ­culo es meramente informativo. No es asesorà ­a legal.

Multi-national organization that is an ideal candidate for acquisition Research Paper

Multi-national organization that is an ideal candidate for acquisition - Research Paper Example According to Miller, Vandome and John (2010) have reported that the company has furthered its growth in the foreign market and has branches in Sweden, United States, UK and other 100 countries. It is headquartered in London, UK. AS of 23rd December 2011 it had a market capitalization of approximately ? 39.5 billion. It has an operating income of US $8.15, a net income of US$ 6.33 billion, and 57,200 employees in the year 2012. AstraZeneca is involved in the development, manufacturing, and selling of pharmaceutical and biotechnological products. According to Magidibe (2011) reported that the pharmaceutical industry is also risky because to develop a drug requires huge investments and out of the many thousands of discovered compounds. As a result, only one might be approved drug for sale with the failure rate being high and very difficult to get the return on investment. To venture into a foreign market requires a consideration of various factors. Cultural diversity plays a crucial rol e in the organizational structure of the business. Cross-cultural diversity is emphasized as it helps create cohesion in the organization. To attain international business success, the organization must employ the services of the people in the nation you have established your business. This is leads to product diversity. According to McDowell (2011) found out that productive diversity refers to the business benefits that emerge through the employment of many different people. Such advantages are referred to as diversity dividend and comprise of: expanded global opportunities; an improved business to business relations; enhanced innovation and creativity; advanced communication between the parties; superior teamwork skills; quality customer service; and reduced workplace conflict. For an organization to be effective in their translation of goals into results there must be an alignment between organizational structure and the business strategy. Alignment is attained when the shared be liefs, ways of working and values within the organization drive towards the realization of strategic objectives and goals. The pharmaceutical industry has many challenges if you want to establish the organization globally. It therefore needs a strategy in order for it to survive in the foreign environment. According to Afuah (2009) is of the opinion that strategy is the actions taken by managers to attain certain goals and objectives of the firm. The key aspects of global strategies include: treating the global market as a domestic market; creation of a global marketing mix; creation of production and distribution systems; concentrating on the power brands. With my pharmaceutical company investing in a nation that we were not aware of the pharmaceutical industry, therefore the need to align with AstraZeneca. The conduction of business analysis found out that pharmaceutical industry is characterized by rising consumer expectations and an ageing population which continues to create un met medical needs. Cherubini (2013) argues that there are the enormous needs of the developing nations nearby a fundamental driver behind continued research and development (R&D) investment so as to create novel drugs. However, the costs of healthcare have consistently raised faster than GDP thus creation of an unsustainable situation in healthcare systems, whether it is publicly or privately funded. Entry into a foreign market requires a strategy. The probable strategy to enter the European market is by utilizing

The Burgelman Case Study Essay Example | Topics and Well Written Essays - 1000 words

The Burgelman Case Study - Essay Example Surveys and exploratory studies are examples of descriptive research designs, which are more quantitative than qualitative and have more aspects of this type of theory. Quantitative studies tend to rely on hard data and statistics that can provide generalizable results about a population, whereas qualitative studies could be more of a case example or subjective viewpoint. Bergemann's case study states having a qualitative method in place: â€Å"A qualitative method was chosen as the best way to arrive at an encompassing view of ICV project development has a ten- to twelve-yeartime horizon (Biggadike, 1979), and a truly longitudinal study was thus beyond the available resources† (Burgelmann, 2009). In terms of statistics, the single case study is not very representative. Another disadvantage in reference to flexible designs could be their lack of scientific credibility when compared to fixed designs using inferential statistics, which Burgelmann addresses explicitly as a possib le drawback. Of course, it is fitting at this level of research for authors to be forward with possible limitations of the study; however, this admission does not make the study more statistically or empirically viable, just because of this admission.   #2 Since this is a qualitative study, it tends to focus more on theory forming, rather than theory testing.

Traveling in the New Kingdom of Egypt Essay Example for Free

Traveling in the New Kingdom of Egypt Essay Life on the road to Thebes is hard for anyone, not the least for a foreigner from the land of Egypt’s former enemy. Not that it makes much difference if you have money. The poor walk; the rich take horses or camels. If you are walking along the roads and are suspected of being a foreigner, be prepared to be harassed. As for me, I am fortunate. I am neither poor, nor rich for I have some skills of value. These skills I would consider modest in comparison to the military conquests of other men which have defined most of my life. My name is Jakarob, the son of a stone mason from the land of Syria, but that land has long been abandoned by my family. The Hittite invasion swept away my father’s house. As a result, I received very little knowledge of stonemasonry and instead, survived by learning the art of languages such as Akkadian, Sumerian, and Egyptian. My knowledge of the surrounding regions, languages, and eventual journey into Egypt has made me a valuable asset to the court of Pharaoh Ahmose I. The caravan I ride with is apart of a group of professionals answering the request of the pharaoh; many of them have military expertise. These men are like me in ancestry. We are Semites who came across the Sinai into the land of Egypt seeking refuge in the land of Egypt from the Hittites. Our kings are referred to by the Egyptians as Hyksos, or â€Å"rulers of foreign lands† (Kishlansky, p. 22). We settled throughout the land of Egypt, taking up their customs, traditions, and assimilating into their culture. My father was among the first Semites to arrive in Egypt and settle. However, regardless of how assimilated our people have become in Egypt, we will never fully be accepted as Egyptian. To them we will always be foreigners. The most important innovation our people brought to the Egyptians was military technology, and hence the reason the caravan I am in consists of primarily military men. Before the Semites, the Egyptians had an army which was not very mobile. We introduced the chariot, along with a variety of tactics associated with using the chariot in combat. Then around 1552 B. C. E. , Ahmose I was able to expel the Hyksos and begin again the reign of Egyptian pharaohs (p. 23). Now it seems that no matter what Ahmose does, he will never get rid of his need for Semite military expertise, not to mention translators like myself. The chariot has become a symbol of Egyptian power, and in order for them to continue dominating local dissenters, the pharaoh must rely on our knowledge of chariot methods and tactics. Personally I have no qualms with helping the pharaoh build his base of power. Life under the Egyptians is much more preferable to life under the Hittites. Before coming to Egypt, my family spent a number of years fleeing the Hittites in Babylon and southern Mesopotamia. In this region I learned how to use the character system of writing of â€Å"cuneiform† and the language of Akkadian (p. 14). With this knowledge I was also able to learn how to write characters in my native tongue of Sumerian. The reason for this similarity I learned was that â€Å"for over a thousand years, scribes used the same symbols to write not only in Sumerian but also in the other languages of Mesopotamia, such as Akkadian, Babylonian, and Persian† (p. 15). Thus, culturally the peoples of Mesopotamia and Egypt share a common link in their system of languages. In contrast, the Hittites do not share in this cultural similarity. Instead, they originate from the Indo-European people with writing traditions vastly different than the cuneiform system. At one time, part of the Hittites’ land was of the Akkadian Empire under King Sargon and the Hittite influence was minimal (p. 16). Alas, that time has long since past, as well as the later period in which the Babylonian Hammurabi ruled his strong empire and prevented the Hittites from forming theirs. Over a period of time, Hammurabi’s successors were unable to deter the rise of the Hittites, and Babylon was overrun. Now on the road to Thebes, the threat of Hittite invasion is very far away. The Sinai desert protects Egypt from incursions by Hittite chariots. Egypt is a land of great wonder and ancient power, for the reign of the pharaohs has stretched back for generations. The source of Egyptian power comes from multiple sources, including religious authority, strong government bureaucracy, and the magnificent pyramids. Each of these pillars of Egyptian strength supports the other. King Zoser, â€Å"the founder of the Old Kingdom who built the first of the pyramid temples, the Step Pyramid at Sakkara,† could not have done so without an efficient bureaucracy and religious legitimacy (p. 21). Likewise, the pyramids reinforce a pharaoh’s power and religious significance, for the pyramids is the resting place for pharaohs in the afterlife. In other words, â€Å"the pyramids strengthen the image of the living king by honoring the physical remains of his predecessors† (p. 21). This focus on the afterlife is partially the reason for their early downfall. As I make each step closer to Thebes, I think about how the focus of Ahmose I have changed since his predecessors. Men from a multitude of backgrounds can contribute to the pharaoh’s court, even peasants (p. 22). I have no doubt my contribution will expand its power and that the second rise of Egypt’s power has just begun.

Rhetorical Analysis of an Advertisement :: Advertising, Marketing

Rhetorical Analysis of an Advertisement Advertisements are all over the place. Whether they are on TV, radio, or in a magazine, there is no way that you can escape them. They all have their target audience who they have specifically designed the ad for. And of course they are selling their product. This is a multi billion dollar industry and the advertiser’s study all the ways that they can attract the person’s attention. One way that is used the most and is in some ways very controversial is use of sex to sell products. For me to analyze this advertisement I used the rhetorical triangle, as well as ethos, pathos, and logos. The target audience is both males and females in their late teens to mid twenties. This company gets the male side of the equation by getting their attention and interest drawn to the attractive woman on the right with bright colors drawing your attention there as well as the bottle of whiskey which is right in the middle of the page. Then what gets these peoples attention to stay there is the fact they have an incredibly good looking female who is posing in next to nothing. Then a way that they try and get the females to look at the advertisement and read it is by showing a very plain girl who seems to be very typical of girls during their younger years. Then beside they show the same girl who now has become a women who is very attractive and just seems so much more powerful and sure of herself. One way that you can achieve that is if you drink Evan Williams Kentucky straight bourbon whiskey. The purpose is to get young adults even ones that are under age to drink their whiskey. One piece of specific information that is sent across to you is that the whiskey is aged for seven years before it is sold. The writer’s whole purpose of this advertisement is to try and sell Evan Williams Kentucky Straight Bourbon Whiskey. The reason that I think that it advertises to people that are under age because the girl that is on the left in my opinion seems to be under age. Then they got that bottle of whisky which is in between each of the pictures. The author of this advertisement is all about sexual stereotypes such as blonde hair blue eyes and a very large breast size.

Introduction to Epidemiology

Aug 17 2011 Introduction to Epidemiology Epidemiology is considered the basic science of public health, and with good reason. Epidemiology is: †¢ †¢ †¢ A quantitative basic science built on a working knowledge of probability, statistics, and sound research methodology A method of causal reasoning based on developing and testing hypotheses pertaining to occurrence and prevention of morbidity and mortality A tool for public health action to promote and protect the public’s health based on science, causal reasoning, and a dose of practical common sense (2).As a public health discipline, epidemiology is instilled with the spirit that epidemiologic information should be used to promote and protect the public’s health. Hence, epidemiology involves both science and public health practice. The term applied epidemiology is sometimes used to describe the application or practice of epidemiology to address public health issues.Examples of applied epidemiology include the following: †¢ †¢ †¢ †¢ the monitoring of reports of communicable diseases in the community the study of whether a particular dietary component influences your risk of developing cancer evaluation of the effectiveness and impact of a cholesterol awareness program analysis of historical trends and current data to project future public health resource needs ObjectivesAfter studying this document and answering the questions in the exercises, you should be able to do the following: †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ Define epidemiology Summarize the historical evolution of epidemiology Describe the elements of a case definition and state the effect of changing the value of any of the elements List the key features and uses of descriptive epidemiology List the key features and uses of analytic epidemiology List the three components of the epidemiologic triad List and describe Hill’s criteria of causation Understand the natural history of disease and the three types of prevention Understand infectivity, pathogenicity, and virulence List and describe primary applications of epidemiology in public health practice List and describe the different modes of transmission of communicable disease in a population 1 Page 2 Applied Epidemiology I A number of exercises are provided. It is suggested you attempt to answer these questions and then compare your answers with those at the end of this document. Introduction The word epidemiology comes from the Greek words epi, meaning â€Å"on or upon,† demos, meaning â€Å"people,† and logos, meaning â€Å"the study of. Many definitions have been proposed, but the following definition captures the underlying principles and the public health spirit of epidemiology: â€Å"Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the cont rol of health problems. † (17) Key terms in this definition reflect some of the important principles of epidemiology. Study Epidemiology is a scientific discipline with sound methods of scientific inquiry at its foundation. Epidemiology is data-driven and relies on a systematic and unbiased approach to the collection, analysis, and interpretation of data.Basic epidemiologic methods tend to rely on careful observation and use of valid comparison groups to assess whether what was observed, such as the number of cases of disease in a particular area during a particular time period or the frequency of an exposure among persons with disease, differs from what might be expected. However, epidemiology also draws on methods from other scientific fields, including biostatistics and informatics, with biologic, economic, social, and behavioral sciences. In fact, epidemiology is often described as the basic science of public health, and for good reason. First, epidemiology is a quantitati ve discipline that relies on a working knowledge of probability, statistics, and sound research methods.Second, epidemiology is a method of causal reasoning based on developing and testing hypotheses grounded in such scientific fields as biology, behavioral sciences, physics, and ergonomics to explain health-related behaviors, states, and events. However, epidemiology is not just a research activity but an integral component of public health, providing the foundation for directing practical and appropriate public health action based on this science and causal reasoning. Determinants Epidemiology is also used to search for determinants, which are the causes and other factors that influence the occurrence of disease and other health-related events.Epidemiologists assume that illness does not occur randomly in a population, but happens only when the right accumulation of risk factors or determinants exists in an individual. To search for these determinants, epidemiologists use analytic epidemiology or epidemiologic studies to provide the â€Å"Why† and â€Å"How† of such events. They assess whether groups with different rates of disease differ in their demographic characteristics, genetic or immunologic make-up, behaviors, environmental exposures, or other so-called potential risk factors. Ideally, the findings provide sufficient evidence to direct prompt and effective public health control and prevention measures. Health-related states or eventsEpidemiology was originally focused exclusively on epidemics of communicable diseases3 but was subsequently expanded to address endemic communicable diseases and non-communicable infectious diseases. By the middle of the 20th Century, additional epidemiologic methods had been developed and applied to chronic diseases, injuries, birth defects, maternal-child health, occupational health, and environmental health. Then epidemiologists began to look at behaviors related to health and well-being, such as amount o f exercise and seat belt use. Now, with the recent explosion in molecular methods, Introduction to Epidemiology – Epi 592J Page 3 epidemiologists can make important strides in examining genetic markers of disease risk.Indeed, the term health related states or events may be seen as anything that affects the well-being of a population. Nonetheless, many epidemiologists still use the term â€Å"disease† as shorthand for the wide range of healthrelated states and events that are studied. Specified populations Although epidemiologists and direct health-care providers (clinicians) are both concerned with occurrence and control of disease, they differ greatly in how they view â€Å"the patient. † The clinician is concerned about the health of an individual; the epidemiologist is concerned about the collective health of the people in a community or population. In other words, the clinician’s â€Å"patient† is the individual; the epidemiologist’s â⠂¬Å"patient† is the community.Therefore, the clinician and the epidemiologist have different responsibilities when faced with a person with illness. For example, when a patient with diarrheal disease presents, both are interested in establishing the correct diagnosis. However, while the clinician usually focuses on treating and caring for the individual, the epidemiologist focuses on identifying the exposure or source that caused the illness; the number of other persons who may have been similarly exposed; the potential for further spread in the community; and interventions to prevent additional cases or recurrences. Application Epidemiology is not just â€Å"the study of† health in a population; it also involves applying the knowledge gained by the studies to community-based practice.Like the practice of medicine, the practice of epidemiology is both a science and an art. To make the proper diagnosis and prescribe appropriate treatment for a patient, the clinician comb ines medical (scientific) knowledge with experience, clinical judgment, and understanding of the patient. Similarly, the epidemiologist uses the scientific methods of descriptive and analytic epidemiology as well as experience, epidemiologic judgment, and understanding of local conditions in â€Å"diagnosing† the health of a community and proposing appropriate, practical, and acceptable public health interventions to control and prevent disease in the community. SummaryEpidemiology is the study (scientific, systematic, data-driven) of the distribution (frequency, pattern) and determinants (causes, risk factors) of health-related states and events (not just diseases) in specified populations (patient is community, individuals viewed collectively), and the application of (since epidemiology is a discipline within public health) this study to the control of health problems. Evolution Although epidemiologic thinking has been traced from Hippocrates (circa 400 B. C. ) through Grau nt (1662), Farr, Snow (both mid-1800’s), and others, the discipline did not blossom until the end of the Second World War. The contributions of some of these early and more recent thinkers are described next. Hippocrates (circa 400 B. C. ) attempted to explain disease occurrence from a rational instead of a supernatural viewpoint. In his essay entitled â€Å"On Airs, Waters, and Places,† Hippocrates suggested that environmental and host factors such as behaviors might influence the development of disease.Another early contributor to epidemiology was John Graunt, a London haberdasher who published his landmark analysis of mortality data in 1662. He was the first to quantify patterns of birth, death, and disease occurrence, noting male-female disparities, high infant mortality, urban-rural differences, and seasonal variations. No one built upon Graunt’s work until the mid-1800, when William Farr began to systematically collect and analyze Britain’s mortalit y statistics. Farr, considered the father of modern vital statistics and disease surveillance, developed many of the basic practices used today in vital statistics and disease classification. He extended the epidemiologic analysis of morbidity and mortality data, looking at Page 4 Applied Epidemiology I he effects of marital status, occupation, and altitude. He also developed many epidemiologic concepts and techniques still in use today. Meanwhile, an anesthesiologist named John Snow was conducting a series of investigations in London that later earned him the title â€Å"the father of epidemiology. † Twenty years before the development of the microscope, Snow conducted studies of cholera outbreaks both to discover the cause of the disease and to prevent its recurrence. Because his work classically illustrates the sequence from descriptive epidemiology to hypothesis generation to hypothesis testing (analytic epidemiology) to application, we will consider two of his efforts.It is important to mention that at the time of John Snow’s investigations the most widely accepted cause of diseases, including cholera, was due to miasma, or foul air. Therefore most believed that cholera was transmitted by air, especially foul-smelling air near water. The germ theory, that disease was transmitted by microbes, did not gain acceptance until later in the 1800s. Snow conducted his classic study in 1854 when an epidemic of cholera developed in the Golden Square of London. He began his investigation by determining where in this area persons with cholera lived and worked. He then used this information to map the distribution of cases on what epidemiologists call a spot map. His map is shown in Figure 1. 1.Because Snow believed that water was a source of infection for cholera, he marked the location of water pumps on his spot map, and then looked for a relationship between the distribution of cholera case households and the location of pumps. He noticed that more cas e households clustered around certain pumps, especially the Broad Street pump, and he concluded that the Broad Street pump was the most likely source of infection. Questioning residents who lived near the other pumps, he found that they avoided certain pumps because the water they provided was grossly contaminated, and that other pumps were located too inconveniently for most residents of the Golden Square area.From this information, it appeared to Snow that the Broad Street pump was probably the primary source of water for most persons with cholera in the Golden Square area. He realized, however, that it was too soon to draw that conclusion because the map showed no cholera cases in a two-block area to the east of the Broad Street pump. Perhaps no one lived in that area, or perhaps the residents were somehow protected. Upon investigating, Snow found that a brewery was located there and that it had a deep well on the premises where brewery workers, who also lived in the area, got th eir water. In addition, the brewery allotted workers a daily quota of malt liquor. Access to these uncontaminated rations could explain why none of the brewery’s employees contracted cholera.To provide further evidence that the Broad Street pump was the source of the epidemic, Snow gathered information on where persons with cholera had obtained their water. Consumption of water from the Broad Street pump was the one common factor among the cholera patients. According to legend, Snow removed the handle of the Broad Street pump and aborted the outbreak. Snow’s second major contribution involved another investigation of the same outbreak of cholera that occurred in London in 1854. In a London epidemic in 1849, Snow had noted that districts with the highest mortalities had water supplied by two companies: the Lambeth Company and the Southwark and Vauxhall Company. At that time, both companies obtained water from the Thames River, at intake points downstream of London.In 18 52, the Lambeth Company moved their water works upstream from London, thus obtaining water free of London sewage. When cholera returned to London in 1853, Snow realized the Lambeth Company’s relocation of its intake point would allow him to compare districts that were supplied with water upstream from London with districts that received water downstream from London. Table 1. 1 shows what Snow found when he made that comparison for cholera mortality over a 7-week period during the summer of 1854. Introduction to Epidemiology – Epi 592J Page 5 Figure 1. 1 Distribution of cholera cases in the Golden Square area of London, August-September 1854 Table 1. Mortality from cholera in the districts of London supplied by the Southwark and Vauxhall and the Lambeth Companies, July 9-August 26, 1854 Districts with Water Supplied by Population Deaths from Mortality Risk per (1851 Census) Cholera 1,000 Population 167,654 844 5. 0 Southwark and Vauxhall Co. only Lambeth Co. only Both c ompanies Source: 27 19,133 300,149 18 652 0. 9 2. 2 Page 6 Applied Epidemiology I The data in Table 1. 1 show that the risk of death from cholera was more than 5 times higher in districts served only by the Southwark and Vauxhall Company than in those served only by the Lambeth Company. Interestingly, the mortality risks in districts supplied by both companies fell between the risks for districts served exclusively by either company.These data were consistent with the hypothesis that water obtained from the Thames below London was a source of cholera. Alternatively, the populations supplied by the two companies may have differed on a number of other factors which affected their risk of cholera. To test his water supply hypothesis, Snow focused on the districts served by both companies, because the households within a district were generally comparable except for which company supplied water. In these districts, Snow identified the water supply company for every house in which a deat h from cholera had occurred during the 7-week period. Table 1. 2 shows his findings. Table 1. Mortality from cholera in London related to the water supply of individual houses in districts served by both the Southwark and Vauxhall Company and the Lambeth Company, July 9August 26, 1854 Water Supply of Individual House Population Deaths from Mortality risk per (1851 Census) Cholera 1,000 Population Southwark and Vauxhall Co. 98,862 419 4. 2 Lambeth Co. Source: 27 154,615 80 0. 5 This further study added support to Snow’s hypothesis, and demonstrates the sequence of steps used today to investigate outbreaks of disease. Based on a characterization of the cases and population at risk by time, place, and person, Snow developed a testable hypothesis. He then tested this hypothesis with a more rigorously designed study, ensuring that the groups to be compared were comparable. After this study, efforts to control the epidemic were directed at changing the location of the water intake of the Southwark and Vauxhall Company to reduce sources of contamination.Thus, with no knowledge of the existence of microorganisms, Snow demonstrated through epidemiologic studies that water could serve as a vehicle for transmitting cholera and that epidemiologic information could be used to direct prompt and appropriate public health action. More information on John Snow can be found at: www. ph. ucla. edu/epi/snow. html In the mid- and late-1800’s, many others in Europe and the United States began to apply epidemiologic methods to investigate disease occurrence. At that time, most investigators focused on acute infectious diseases. In the 1900’s, epidemiologists extended their methods to noninfectious diseases.The period since the Second World War has seen an explosion in the development of research methods and the theoretical underpinnings of epidemiology, and in the application of epidemiology to the entire range of health-related outcomes, behaviors, and even kno wledge and attitudes. The studies by Doll and Hill (13) linking smoking to lung cancer and the study of cardiovascular disease among residents of Framingham, Massachusetts (12), are two examples of how pioneering researchers have applied epidemiologic methods to chronic disease since World War II. Finally, during the 1960’s and early 1970’s health workers applied epidemiologic methods to eradicate smallpox worldwide.This was an achievement in applied epidemiology of unprecedented proportions. Today, public health workers throughout the world accept and use epidemiology routinely. Epidemiology is often practiced or used by non-epidemiologists to characterize the health of their communities and to solve day-to-day problems. This landmark in the evolution of the discipline is less dramatic than the eradication of smallpox, but it is no less important in improving the health of people everywhere. Introduction to Epidemiology – Epi 592J Page 7 Uses Epidemiology and t he information generated by epidemiologic methods have many uses. These uses are categorized and described below. Population or community health assessment.To set policy and plan programs, public health officials must assess the health of the population or community they serve and determine whether health services are available, accessible, effective, and efficient. To do this, they must find answers to many questions: What are the actual and potential health problems in the community? Where are they? Who is at risk? Which problems are declining over time? Which ones are increasing or have the potential to increase? How do these patterns relate to the level and distribution of services available? The methods of descriptive and analytic epidemiology provide ways to answer these and other questions.With answers provided through the application of epidemiology, the officials can make informed decisions that will lead to improved health for the population they serve. Individual decision s. People may not realize that they use epidemiologic information in their daily decisions. When they decide to stop smoking, take the stairs instead of the elevator, order a salad instead of a cheeseburger with French fries, or choose one method of contraception instead of another, they may be influenced, consciously or unconsciously, by epidemiologists’ assessment of risk. Since World War II, epidemiologists have provided information related to all those decisions.In the 1950’s, epidemiologists documented the increased risk of lung cancer among smokers; in the 1960’s and 1970’s, epidemiologists noted a variety of benefits and risks associated with different methods of birth control; in the mid-1980’s, epidemiologists identified the increased risk of human immunodeficiency virus (HIV) infection associated with certain sexual and drug-related behaviors; and, more positively, epidemiologists continue to document the role of exercise and proper diet in reducing the risk of heart disease. These and hundreds of other epidemiologic findings are directly relevant to the choices that people make every day, choices that affect their health over a lifetime. Completing the clinical picture. When studying a disease outbreak, epidemiologists depend on clinical physicians and laboratory scientists for the proper diagnosis of individual patients.But epidemiologists also contribute to physicians’ understanding of the clinical picture and natural history of disease. For example, in late 1989 three patients in New Mexico were diagnosed as having myalgias (severe muscle pains in chest or abdomen) and unexplained eosinophilia (an increase in the number of one type of white blood cell). Their physicians could not identify the cause of their symptoms, or put a name to the disorder. Epidemiologists began looking for other cases with similar symptoms, and within weeks had found enough additional cases of eosinophilia-myalgia syndrome (EMS) t o describe the illness, its complications, and its risk of mortality.Similarly, epidemiologists have documented the course of HIV infection, from the initial exposure to the development of a wide variety of clinical syndromes that include acquired immunodeficiency syndrome (AIDS). They have also documented the numerous conditions associated with cigarette smoking—from pulmonary and heart disease to lung and cervical cancer. Search for causes. Much of epidemiologic research is devoted to a search for causes, factors which influence one’s risk of disease. Sometimes this is an academic pursuit, but more often the goal is to identify a cause so that appropriate public health action might be taken. It has been said that epidemiology can never prove a causal relationship between an exposure and a disease. Nevertheless, epidemiology often provides enough information to support effective action.Examples include John Snow’s removal of the pump handle and the withdrawal o f a specific brand of tampon that was linked by epidemiologists to toxic shock syndrome. Another example is the recommendation that children not be given aspirin due to its association with Reye syndrome. Just as often, epidemiology and laboratory science converge to provide the evidence needed to establish causation. For example, a team of epidemiologists were able to identify a variety of risk factors during an outbreak of pneumonia among persons attending the American Page 8 Applied Epidemiology I Legion Convention in Philadelphia in 1976, called â€Å"Legionnaire’s disease. However, the outbreak was not â€Å"solved† until the Legionnaires’ bacillus was identified in the laboratory almost 6 months later. Disease control, elimination, and eradication. The ultimate goal of epidemiology is to improve the health of populations and through the reduction in disease. The definitions of disease control, elimination, and eradication as applied to infectious diseases are given below. (Dowdle WR. The principles of disease elimination and eradication. MMWR 48(SU01);23-7, 1999. ): Control: The reduction of disease incidence, prevalence, morbidity or mortality to a locally acceptable level as a result of deliberate efforts; continued intervention measures are required to maintain the reduction. Example: diarrheal diseases.Elimination of disease: Reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberate efforts; continued intervention measures are required. Examples: neonatal tetanus. Elimination of infections: Reduction to zero of the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts; continued measures to prevent reestablishment of transmission are required. Example: measles, poliomyelitis. Eradication: Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate effor ts; intervention measures are no longer needed. Example: smallpox.Extinction: The specific infectious agent no longer exists in nature or in the laboratory. Example: none. The above definitions are specific to infectious disease, but some of the concepts can carry over to other conditions, such as nutritional disorders, inborn errors of metabolism, and chronic diseases. Introduction to Epidemiology – Epi 592J Page 9 Exercise 1. 1 In the early 1980’s, epidemiologists recognized that AIDS occurred most frequently in men who had sex with men and in intravenous drug users. Describe how this information might be used for each of the following: a. Population or community health assessment b. Individual decisions c. Search for causes Page 10 Applied Epidemiology I The Epidemiologic ApproachLike a newspaper reporter, an epidemiologist determines What, When, Where, Who, and Why. However, the epidemiologist is more likely to describe these concepts in slightly different terms: c ase definition, time, place, person, and causes. Case Definition (â€Å"What? †) The identification of disease can be based on symptoms, signs, and diagnostic tests. A symptom is a sensation or change in health experienced by an individual. Examples of symptoms reported by an individual are a cough, fatigue, anxiety, and back pain. Signs, or signs of disease, are an objective evidence of disease observed by someone other than the affected individual, such as a physician or nurse.A case definition is a set of standard criteria for deciding whether a person has a particular disease or other health-related condition. By using a standard case definition we attempt to ensure that every case is diagnosed in the same way, regardless of when or where it occurred, or who identified it. We can then compare the number of cases of the disease that occurred in one time or place with the number that occurred at another time or another place. For example, with a standard case definition, we can compare the number of cases of hepatitis A that occurred in New York City in 1991 with the number that occurred there in 1990. Or we can compare the number of cases that occurred in New York in 1991 with the number that occurred in San Francisco in 1991. With a standard ase definition, when we find a difference in disease occurrence, we know it is likely to be due to a real difference or due to the quality of the disease reporting system rather than the result of differences in how cases were diagnosed. A case definition consists of clinical criteria and, sometimes, limitations on time, place, and person. The clinical criteria usually include confirmatory laboratory tests, if available, or combinations of symptoms (subjective complaints), signs (objective physical findings), and other findings. For example, see the case definition for rabies below; notice that it requires laboratory confirmation. Rabies, Human Clinical description Rabies is an acute encephalomyelitis that almos t always progresses to coma or death within 10 days of the first symptom.Laboratory criteria for diagnosis †¢ Detection by direct fluorescent antibody of viral antigens in a clinical specimen (preferably the brain or the nerves surrounding hair follicles in the nape of the neck), or †¢ Isolation (in cell culture or in a laboratory animal) of rabies virus from saliva, cerebrospinal fluid (CSF), or central nervous system tissue, or †¢ Identification of a rabies-neutralizing antibody titer greater than or equal to 5 (complete neutralization) in the serum or CSF of an unvaccinated person Case classification Confirmed: a clinically compatible illness that is laboratory confirmed Comment Laboratory confirmation by all of the above methods is strongly recommended. Source: 3 Compare this with the case definition for Kawasaki syndrome provided in Exercise 1. 3 on page 12. Kawasaki syndrome is a childhood illness with fever and rash that has no known cause and no specifically d istinctive laboratory findings.Notice that its case definition is based on the presence of fever, at least four of five specified clinical findings, and the lack of a more reasonable explanation. A case definition may have several sets of criteria, depending on the certainty of the diagnosis. For example, during an outbreak of measles, we might classify a person with a fever and rash as having a Introduction to Epidemiology – Epi 592J Page 11 suspect, probable, or confirmed case of measles, depending on what additional evidence of measles was present. In other situations, we may temporarily classify a case as suspect or probable until laboratory results are available. When we receive the laboratory report, we then reclassify the case as either confirmed or â€Å"not a case,† depending on the lab results.In the midst of a large outbreak of a disease caused by a known agent, we may permanently classify some cases as suspect or probable, because it is unnecessary and wast eful to run laboratory tests on every individual with a consistent clinical picture and a history of exposure (e. g. , chickenpox). Case definitions may also vary according to the purpose for classifying the occurrences of a disease. For example, health officials need to know as soon as possible if anyone has symptoms of plague or foodborne botulism so that they can begin planning what actions to take. For such rare but potentially severe diseases, where it is important to identify every possible case, health officials use a sensitive, or â€Å"loose† case definition.On the other hand, investigators of the causes of a disease outbreak want to be certain that any person included in the investigation really had the disease. The investigator will prefer a specific or â€Å"strict† case definition. For instance, in an outbreak of Salmonella agona, the investigators would be more likely to identify the source of the infection if they included only persons who were confirmed to have been infected with that organism, rather than including anyone with acute diarrhea, because some persons may have had diarrhea from a different cause. In this setting, a disadvantage of a strict case definition is an underestimate of the total number of cases. Exercise 1. 2In the case definition for an apparent outbreak of trichinosis, investigators used the following classifications: Clinical criteria Confirmed case: signs and symptoms plus laboratory confirmation Probable case: acute onset of at least three of the following four features: myalgia, fever, facial edema, or eosinophil count greater than 500/mm3 Possible case: acute onset of two of the above four features plus a physician diagnosis of trichinosis Suspect case: unexplained eosinophilia Not a case: failure to fulfill the criteria for a confirmed, probable, possible, or suspect case Time Onset after October 26, 1991 Place Metropolitan Atlanta Person Any Assign the appropriate classification to each of the person s included in the line listing below. (All were residents of Atlanta with acute onset of symptoms in November. ) Page 12 Applied Epidemiology I ID # 1 2 3 4 5 Last name Abels Baker Corey Dale Ring myalgia yes yes yes yes yes fever yes yes yes no no facial edema no yes no no no eosinophil count 495 pending 1,100 2,050 600 Physician diagnosis trichinosis trichinosis ? trichinosis EMS ? trichinosis Lab confirm yes pending pending pending not done Classification __________ __________ __________ __________ __________Exercise 1. 3 The following is the official case definition for Kawasaki syndrome that is recommended by CDC: Kawasaki Syndrome Clinical case definition A febrile illness of greater than or equal to 5 days’ duration, with at least four of the five following physical findings and no other more reasonable explanation for the observed clinical findings: †¢ Bilateral conjunctival injection †¢ Oral changes (erythema of lips or oropharynx, strawberry tongue, or fis suring of the lips) †¢ Peripheral extremity changes (edema, erythema, or generalized or periungual desquamation) †¢ Rash †¢ Cervical lymphadenopathy (at least one lymph node greater than or equal to 1. cm in diameter) Laboratory criteria for diagnosis None Case classification Confirmed: a case that meets the clinical case definition Comment If fever disappears after intravenous gamma globulin therapy is started, fever may be of less than 5 days’ duration, and the clinical case definition may still be met. Source: 3 Discuss the pros and cons of this case definition for the purposes listed below. (For a brief description of Kawasaki syndrome, see Benenson’s Control of Communicable Diseases in Man). a. Diagnosing and treating individual patients b. Tracking the occurrence of the disease for public health records c. Doing research to identify the cause of the disease Introduction to Epidemiology – Epi 592J Page 13 Numbers and RisksA basic task of a he alth department is counting cases in order to measure and describe morbidity. When physicians diagnose a case of a reportable disease they are suppose to report the case to their local health department. For most reportable conditions, these reports are legally required to contain information on time (when the case occurred), place (where the patient lived), and person (the age, race, and sex of the patient). The health department combines all reports and summarizes the information by time, place, and person. From these summaries, the health department determines the extent and patterns of disease occurrence in the area, and attempts to identify clusters or outbreaks of disease.A simple count of cases, however, does not provide all the information a health department needs. To compare the occurrence of a disease at different locations, during different times, or in different subgroups, a health department converts the case counts into risks, which relates the number of cases to the size of the population. Risks are useful in many ways. With risks, the health department can identify groups in the community with an elevated risk of disease. These so-called high-risk groups can be further assessed and targeted for special intervention; the groups can be studied to identify risk factors that are related to the occurrence of disease.Individuals can use knowledge of these risk factors to guide their decisions about behaviors that influence health. Descriptive Epidemiology In descriptive epidemiology, we organize and summarize data according to time, place, and person. These three characteristics are sometimes called the epidemiologic variables. Compiling and analyzing data by time, place, and person is desirable for several reasons. First, the investigator becomes intimately familiar with the data and with the extent of the public health problem being investigated. Second, this provides a detailed description of the health of a population that is easily communicated . Third, such analysis identifies the populations at greatest risk of acquiring a particular disease.This information provides important clues to the causes of the disease, and these clues can be turned into testable hypotheses. Time (â€Å"When? †) Disease risks usually change over time. Some of these changes occur regularly and can be predicted. For example, the seasonal increase of influenza cases with the onset of cold weather is a pattern that is familiar to everyone. By knowing when flu outbreaks will occur, health departments can time their influenza vaccination campaigns effectively. Other diseases may make unpredictable changes in occurrence. By examining events that precede a disease increase or decrease, we may identify causes and appropriate actions to control or prevent further occurrence of the disease.We usually show time data as a graph (Figure 1. 3). We put the number or risk of cases or deaths on the vertical, y-axis; we put the time periods along the horizo ntal, x-axis. We often indicate on a graph when events occurred that we believe are related to the particular health problem described in the graph. For example, we may indicate the period of exposure or the date control measures were implemented. Such a graph provides a simple visual depiction of the relative size of a problem, its past trend and potential future course, as well as how other events may have affected the problem. Studying such a graph often gives us insights into what may have caused the problem.Depending on what event we are describing, we may be interested in a period of years or decades, or we may limit the period to hours, days, weeks, or months when the number of cases reported is greater than normal (an epidemic period). For some conditions—for many chronic diseases, for example—we are interested in long-term changes in the number of cases or risk of the condition. For other conditions, we may find it more revealing to look at the occurrence of t he condition by season, month, day of the Page 14 Applied Epidemiology I week, or even time of day. For a newly recognized problem, we need to assess the occurrence of the problem over time in a variety of ways until we discover the most appropriate and revealing time period to use. Some of the common types of time-related graphs are further described below. Secular (long-term) trends.Graphing the annual cases or risk of a disease over a period of years shows long-term or secular trends in the occurrence of the disease. We commonly use these trends to suggest or predict the future incidence of a disease. We also use them in some instances to evaluate programs or policy decisions, or to suggest what caused an increase or decrease in the occurrence of a disease, particularly if the graph indicates when related events took place, as depicted in Figure 1. 3 (note the scale of the y-axis). Figure 1. 3 Malaria by year, United States, 1930-1990 Works Progress Administration Malaria Control Drainage Program Relapses from Overseas Cases 1000 Reported Cases per 100,000 Population 100Relapses from Korean Veterans Returning Vietnam Veterans 10 Foreign Immigration 1 0. 1 0. 01 1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 Source: 9 Year Seasonality. By graphing the occurrence of a disease by week or month over the course of a year or more we can show its seasonal pattern, if any. Some diseases are known to have characteristic seasonal distributions; for example, as mentioned earlier, the number of reported cases of influenza typically increases in winter. Seasonal patterns may suggest hypotheses about how the infection is transmitted, which behavioral factors increase risk, and other possible contributors to the disease or condition.The seasonal pattern of an unknown disease is shown in Figure 1. 4. What factors might contribute to its seasonal pattern? From only the single year’s data in Figure 1. 4, it is difficult to conclude whether the peak i n June represents a characteristic seasonal pattern that would be repeated yearly, or whether it is simply an epidemic that occurred in the spring and summer of that particular year. You would need more than one year’s data before you could conclude that the pattern shown there represents the seasonal variation in this disease. Introduction to Epidemiology – Epi 592J Page 15 Figure 1. 4 Cases of an unknown disease by month of onset 450 400 350 300 Cases 50 200 150 100 50 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Source: 14 Month of Onset Day of week and time of day. Displaying data by days of the week or time of day may also be informative. Analysis at these shorter time periods is especially important for conditions that are potentially related to occupational or environmental exposures, which may occur at regularly scheduled intervals. In Figure 1. 5, farm tractor fatalities are displayed by days of the week. Does this analysis at shorter time periods suggest any hypothesis? In Figure 1. 5 the number of farm tractor fatalities on Sundays is about half the number on the other days. We can only speculate why this is.One reasonable hypothesis is that farmers spend fewer hours on their tractors on Sundays than on the other days. Figure 1. 5 Fatalities associated with farm tractor injuries by day of death, Georgia, 1971-1981 Source: 15 Page 16 Applied Epidemiology I Examine the pattern of fatalities associated with farm tractor injuries by hour in Figure 1. 6. How might you explain the morning peak at 11:00 AM, the dip at noon, and the afternoon peak at 4:00 PM? Figure 1. 6 Fatalities associated with farm tractor injuries by time of day, Georgia, 1971-1981 Source: 15 Epidemic period. To show the time course of a disease outbreak or epidemic, we use a graph called an epidemic curve.As with the other graphs you have seen in this section, we place the number of cases on the vertical axis and time on the horizontal axis. For time, we use either the time of onset of symptoms or the date of diagnosis. For very acute diseases with short incubation periods (i. e. , time period between exposure and onset of symptoms is short), we may show time as the hour of onset. For diseases with longer incubation periods, we might show time in 1-day, 2-day, 3-day, 1-week, or other appropriate intervals. Figure 1. 7 shows an epidemic curve that uses a 3-day interval for a foodborne disease outbreak. Notice how the cases are stacked in adjoining columns. By convention, we use this format, called a histogram, for epidemic curves.The shape and other features of an epidemic curve can suggest hypotheses about the time and source of exposure, the mode of transmission, and the causative agent. Figure 1. 7 Date of onset of illness in patients with culture-confirmed Yersinia enterocolitica infections, Atlanta, November 1, 1988-January 10, 1989 8 7 6 Thanksgiving Christmas New Year’s Cases 5 4 3 2 1 0 1 4 7 10 13 16 19 22 25 28 1 4 7 10 13 16 1 9 22 25 28 1 4 7 10 November December January Source: 18 Date of Onset Introduction to Epidemiology – Epi 592J Page 17 Place (â€Å"Where? †) We describe a health event by place to gain insight into the geographical extent of the problem. For place, we may use place of residence, birthplace, employment, school district, hospital unit, etc. , epending on which may be related to the occurrence of the health event. Similarly, we may use large or small geographic units: country, state, county, census tract, street address, map coordinates, or some other geographical designation. Sometimes, we may find it useful to analyze data according to place categories such as urban or rural, domestic or foreign, and institutional or noninstitutional. Not all analyses by place will be equally informative. For example, examine the data shown in Table 1. 3. Where were the malaria cases diagnosed? What â€Å"place† does the table break the data down by? Would it have been more or l ess useful to analyze the data according to the â€Å"state of residence† of the cases?We believe that it provides more useful information to show the data in Table 1. 3 by where the infection was acquired than it would have to show where the case-patients lived. By analyzing the malaria cases by place of acquisition, we can see where most of the malaria cases acquired their disease. Table 1. 3 Malaria cases by distribution of Plasmodium species and area of acquisition, United States, 1989 Species Area of Acquisition Vivax Falciparum Other Total Africa 52 382 64 498 Asia 207 44 29 280 Central America & Caribbean 107 14 9 130 North America 131 3 13 147 (United States) (5) (0) (0) (5) South America 10 1 2 13 Oceania 19 2 5 26 Unknown 6 2 0 8 Total 532 448 122 1,102 Source: 6By analyzing data by place, we can also get an idea of where the agent that causes a disease normally lives and multiplies, what may carry or transmit it, and how it spreads. When we find that the occurrence of a disease is associated with a place, we can infer that factors that increase the risk of the disease are present either in the persons living there (host factors) or in the environment, or both. For example, diseases that are passed from one person to another tend to spread more rapidly in urban areas than in rural ones, mainly because the greater crowding in urban areas provides more opportunities for susceptible people to come into contact with someone who is infected.On the other hand, diseases that are passed from animals to humans often occur in greater numbers in rural and suburban areas because people in those areas are more likely to come into contact with disease-carrying animals, ticks, and the like. For example, perhaps Lyme disease has become more common because people have moved to wooded areas where they come into contact with infected deer ticks. Although we can show data by place in a table—as Table 1. 3 does—it is often better to show it pictorial ly in a map. On a map, we can use different shadings, color, or line patterns to indicate how a disease or health event has different numbers or risks of occurrence in different areas, as in Figure 1. 8. Page 18 Applied Epidemiology I Figure 1. 8 AIDS cases per 100,000 population, United States, July 1991-June 1992 Source: 4For a rare disease or outbreak, we often find it useful to prepare a spot map, like Snow’s map of the Golden Square of London (Figure 1. 1), in which we mark with a dot or an X the relation of each case to a place that is potentially relevant to the health event being investigated—such as where each case lived or worked. We may also label other sites on a spot map, such as where we believe cases may have been exposed, to show the orientation of cases within the area mapped. Figure 1. 9 is a spot map for an outbreak of mumps that occurred among employees of the Chicago futures exchanges. Study the location of each case in relation to other cases and to the trading pits. The four numbered areas delineated with heavy lines are the trading pits.Does the location of cases on the spot map lead you to any hypothesis about the source of infection? Figure 1. 9 Mumps cases in trading pits of exchange A, Chicago, Illinois, August 18-December 25, 1987 #1 #3 #2 #4 Key: Pit areas are numbered and delineated by heavy lines. Individual trading pits within pit areas are outlined by light lines. Affected person (N= 43) Desk areas Source: CDC, unpublished data, 1988 Introduction to Epidemiology – Epi 592J Page 19 You probably observed that the cases occurred primarily among those working in trading pits #3 and #4. This clustering of illness within trading pits provides indirect evidence that the mumps was transmitted person-to person. Person (â€Å"Who? ) In descriptive epidemiology, when we organize or analyze data by â€Å"person† there are several person categories available to us. We may use inherent characteristics of people (for example, age, race, sex), their acquired characteristics (immune or marital status), their activities (occupation, leisure activities, use of medications/tobacco/drugs), or the conditions under which they live (socioeconomic status, access to medical care). These categories usually determine, to a large degree, who is at greatest risk of experiencing certain undesirable health conditions, such as becoming infected with a particular disease organism. We may show person-related characteristics in either tables or graphs.In analyzing data by person, we often must try a number of different categories before we find which are the most useful and enlightening. Age and sex are most critical; we almost always analyze data according to these. Depending on the health event we are studying, we may or may not break the data down by other attributes. Often we analyze data by more than one characteristic simultaneously; for example, we may look at age and sex simultaneously to see if the sex es differ in how they develop a condition that increases with age—such as with heart disease. Age. Age is probably the single most important â€Å"person† attribute, because almost every health-related event or state varies with age.A number of factors that also vary with age are behind this association: susceptibility, opportunity for exposure, latency or incubation period of the disease, and physiologic response (which affects, among other things, disease development). When we analyze data by age, we try to use age groups that are narrow enough to detect any agerelated patterns that may be present in the data. In an initial breakdown by age, we commonly use 5-year age intervals: 0 to 4 years, 5 to 9, 10 to 14, and so on. Larger intervals, such as 0 to 19 years, 20 to 39, etc. , may conceal variations related to age which we need to know to identify the true ages at greatest risk.Sometimes, even 5-year age groups can hide important differences, especially in children less than five years of age. Take time to examine Figure 1. 10, for example, before you read ahead. What does the information in this figure suggest health authorities should do to reduce the number of cases of whooping cough? Where should health authorities focus their efforts? You probably said that health authorities should focus on immunizing infants against whooping cough during the first year of life. Now, examine Figure 1. 11. This figure shows the same data but they are presented in the usual 5-year intervals. Based on Figure 1. 11 where would you have suggested that health authorities focus their efforts?Would this recommendation have been as effective and efficient in reducing cases of whooping cough? You probably said that health authorities should immunize infants and children before the age of 5. That recommendation would be effective, but it would not be efficient. You would be immunizing more children than actually necessary and wasting resources. Sex. In general, mal es have higher risks of illness and death than females do for a wide range of diseases. For some diseases, this sex-related difference is because of genetic, hormonal, anatomic, or other inherent differences between the sexes. These inherent differences affect their susceptibility or physiologic responses.For example, premenopausal women have a lower risk of heart disease than men of the same age. This difference is attributed to higher estrogen levels in women. On the other hand, the sex-related differences in the occurrence of many diseases reflect differences in opportunity or levels of exposure. For example, Figure 1. 12 shows that hand/wrist disorders occur almost twice as often in females than in males. What are some sex-related differences that would cause a higher level of this disorder in females? Page 20 Applied Epidemiology I Figure 1. 10 Pertussis (whooping cough) incidence by age group, United States, 1989 Source: 9 Figure 1. 11 Pertussis (whooping cough) incidence by a ge group, United States, 1989 Source: 9 Figure 1. 2 Prevalence of hand/wrist cumulative trauma disorder by sex, Newspaper Company A, 1990 Source: NIOSH, unpublished data, 1991 Introduction to Epidemiology – Epi 592J Page 21 You may have attributed the higher level of disorders in females to their higher level of exposure to occupational activities that require repetitive hand/wrist motion such as typing or keyboard entry. With occupationally-related illness, we usually find that sex differences reflect the number of workers in those occupations. You may also have attributed the higher level of disorders in females to anatomical differences; perhaps women’s wrists are more susceptible to hand/wrist disorders. Ethnic and racial groups.In examining epidemiologic data, we are interested in any group of people who have lived together long enough to acquire common characteristics, either biologically or socially. Several terms are commonly used to identify such groups: race, nationality, religion, or local reproductive or social groups, such as tribes and other geographically or socially isolated groups. Differences that we observe in racial, ethnic, or other groups may reflect differences in their susceptibility or in their exposure, or they may reflect differences in other factors that bear more directly on the risk of disease, such as socioeconomic status and access to health care. In Figure 1. 13, the risks of suicide for five groups of people are displayed. Figure 1. 3 Suicide death rates for persons 15 to 24 years of age according to race/ethnicity, United States, 1988 Source: 22 Clearly this graph displays a range of suicide death rates for the five groups of people. These data provide direction for prevention programs and for future studies to explain the differences. Socioeconomic status. Socioeconomic status is difficult to quantify. It is made up of many variables such as occupation, family income, educational achievement, living conditions, and social standing. The variables that are easiest to measure may not reflect the overall concept. Nevertheless, we commonly use occupation, family income, and educational achievement, while recognizing that these do not measure socioeconomic status precisely.The frequency of many adverse health conditions increases with decreasing socioeconomic status. For example, tuberculosis is more common among persons in lower socioeconomic strata. Infant mortality and time lost from work due to disability are both associated with lower income. These patterns may reflect more harmful exposures, lower resistance, and less access to health care. Or they may in part Page 22 Applied Epidemiology I reflect an interdependent relationship which is impossible to untangle—does low socioeconomic status contribute to disability or does disability contribute to lower socioeconomic status? Some adverse health conditions are more frequent among persons of higher socioeconomic status.These condition s include breast cancer, Kawasaki syndrome, and tennis elbow. Again, differences in exposure account for at least some of the differences in the frequency of these conditions. Exercise 1. 4 The following series of tables (Exercise 1. 4, Tables 1-4) show person information about cases of the unknown disease described in Figure 1. 4 on page 15. Look again at Figure 1. 4, study the information in the four exercise tables and then describe in words how the disease outbreak is distributed by time and person. Exercise 1. 4, Table 1 Incidence of the disease by age and sex in 24 villages surveyed for one year Males Females Age Group Population* # Cases Risk per Population* # Cases Risk per (years) 1,000 1,000

Lord of the Flies

In this essay, I will talk about the key points that led to the loss of civilization. â€Å"We did everything adults would do. What went wrong? † -William Gilding, Lord of the Flies The first point, I would like to introduce Is Jack's Impact on the community. Jack Is a very strong individual, who believes that If you can't solve a problem, you should Just avoid it. As well as that he Is the oldest and the strongest, which In theory should make him sensible, despite that, he chooses not to support rules and senselessly. â€Å"Jack's face swam near him. â€Å"And you shut pulp Who are you, anyway? Sitting there telling people what to do.You ant hunt, you can't sing?† â€Å"I'm chief. I was chosen. † â€Å"Why should choosing make any difference? Just giving orders that don't make any sense† Now it is quite obvious, that Jack represents an autocratic government, where power is taken; and Ralph represents democratic governments, where power is given. Moreover , Jack understands mob mentality, and uses physical examples, of tortures to threaten other savages. As a result of Jack's actions, mob mentality starts to grow. Mob mentality, happens when individuals, act as a group. Therefore, they try to hide their personality, which makes them free of all laws and obligations.An example In the book would be how the savages, attacked Rally's shelters and they weren't' even sorry for a bit, but If adults would've been there†¦ â€Å"Someone was throwing stones: Roger was dropping them, his one hand still on the lever. Below him, Ralph was a shock of hair and Piggy a bag of fat. † William Gilding, Lord of the Flies. To Roger, it is literally indifferent, who Ralph and Piggy are. To him, they are Just a ‘shock of Hair' and ‘a bag of fat'. It is impossible that Roger would have pushed the lever, if adults were there and Jack wasn't. This is how mob mentality influences the people.It can also be seen, when all of the characters are present at the killing of Simon. Another important factor, responsible for the loss of civilization, is the death of Simon. It can be described as the watershed moment, because after that they aren't afraid to kill. If he was regarded as the ‘Beast', killing him didn't stop the boys being scared of the ‘Beast'. â€Å"We was [was >were] on the outside. We never done nothing, we never seen nothing. † [Salad Ralph] Lord of the Flies, William Gilding. Ralph tells Piggy; hide the fact, that they were both present at the murder of Simon.Ralph is still ashamed that they hadn't stopped the savages. Above all, darkness and evil of humanity affected the boys, the most. Gilding, himself fought in the WI and saw Hiroshima, AS concentration camps and much more; so he really understands what mankind is capable of. â€Å"Maybe there is a beast What I mean is†¦ Maybe it's only us. † Lord of the Flies, William Gilding Simon and Piggy achieve same-but-different con clusions. Piggy has rational, external, empirical attitude, saying: we're afraid of each other. Simon has a more spiritual believe: it's not each other we need to be afraid of, but us.In Lord of the Flies, Gilding expresses the real side of the human-beings. â€Å"What a man does defines him, not what is done by others. † William Gilding. To conclude my essay, those were the main points that influenced the loss of civilization: Jacks impact, mob mentality, murder of Simon and the darkness & evil of humanity. Those aren't all the point that affected it. I personally didn't like the book- I think it was boring. â€Å"The writer probably knows what he meant when he wrote a book, but he should immediately forget what he meant when he's written it. † William Gilding Lord of the flies Slipping Away William Gilding states â€Å"†¦ The shape of society must depend on the ethical nature of the Individual. † In Lord of the Flies when he brings two tribes of boys together to sustain an island surrounded by evil (204). Upon analyzing Gildings characters, we can see that the boys stranded on the island are willing to do anything to anyone in order to survive. Despite the evil in Roger and Jack, the innocence and good in Piggy and Ralph surfaces.When we look at the way Gilding describes the boys on the Island, we can all twice the change within all of them. In the beginning of the novel the kids are innocent British school boys, but later Jack transforms into a child whoso obsessed with hunting. Jack is only interested in torturing and killing the pig when he â€Å"raised his spear and sneaked forward† (135). Just how much one can change because of their surroundings. Ralph and Jack have tension between them most of the time because Ralph can clearly se e the transformation within Jack.Because of the darkness In Jack, it highlights the Innocence In Piggy when he believes â€Å"[they'd] hurt he next telling. ,. And that's [him]† (93). Piggy feels that without any reason no one would survive on the island. Because of the chaos on the island, Piggy's constantly paranoid. In a world of destruction, the worst comes out from the good. As we observe Roger, we can infer the changes he comes across. As Jack and Roger are trying to kill Ralph, they set the island on fire. When the twins are being held captive by Roger, they explain to Ralph how â€Å"they hate [him]† (188).Jack and Roger were childish enough to set their environment on fire Just to get what they want. They want the rest of the boys to be on their side and in order to do that they have to exile Ralph. Clinton 2 While Jack and Roger are trying to find Ralph, Sam n Eric find him first and warn him how â€Å"[Rorer's] a terror† (189). Roger is the one in cha rge of murdering Ralph or Jack would be the one â€Å"sharpening the stick. † The island Is obviously changing more than one of the boys. Not only do bad things happen to good people, but good people can turn bad.When Piggy and Ralph find the rest of the boys, Ralph starts mentally hurting Piggy. Piggy's insecurities show when they talk about him â€Å"being called Piggy† (25). With this Ralph goes behind Piggy's back and tells the tribe his name is â€Å"Piggy. † Ralph is displaying his callousness to Piggy now that the rest of the boys are there. He's trying to come off's the leader type for the first time impression. In the same scene when thieve Introducing themselves, Ralph continues to push Piggy around by telling him to â€Å"go back, and take names. That's your job. So long† (157).Ralph turns bossy and thinks he can tell everyone what to do and how to do it. Piggy feels that Ralph thinks he's better than him to show off for the rest of the tribe. Ralph believes that now he's chief he doesn't have to do any of the hard work and he can make everyone else do it. All Piggy wants is for Ralph to have his back and be his friend. However, Plays being the only voice of reason makes him the weak target. In the speak† (44). The rest of the boys believe they can push piggy around. He feels unwanted and nobody understands him and his needs.He notices Ralph becoming angry when he's constantly shouting â€Å"shut up† at him. Not only does Piggy have ideas to get off the island alive, but nobody acknowledges him. He believes they are turning against each other and attacking. The tribes think being on the island is a lot of fun. Piggy thinks â€Å"rules are they only thing [they've] got† (91). Piggy Just wants to be friends with everyone, but since they pick on him and Hess so gullible, that can't happen. He thinks â€Å"the world is slipping away' when the boys become something they aren't (204).Ultimately, the good in Ralph and Piggy comes out do to the darkness in Jack and Roger. In the novel, William Gilding places two tribes of boy to survive the evil within themselves on an Clinton 3 island. They need to be able to handle themselves and each other in order to get off the island alive. William Gilding discusses how â€Å"the theme is an attempt to trace the defects of human society back to the defects of human nature† (204). He figured that if he put a group of boys in the wild to survive with only the clothes on their backs, they would turn into savages. Lord of the flies Slipping Away William Gilding states â€Å"†¦ The shape of society must depend on the ethical nature of the Individual. † In Lord of the Flies when he brings two tribes of boys together to sustain an island surrounded by evil (204). Upon analyzing Gildings characters, we can see that the boys stranded on the island are willing to do anything to anyone in order to survive. Despite the evil in Roger and Jack, the innocence and good in Piggy and Ralph surfaces.When we look at the way Gilding describes the boys on the Island, we can all twice the change within all of them. In the beginning of the novel the kids are innocent British school boys, but later Jack transforms into a child whoso obsessed with hunting. Jack is only interested in torturing and killing the pig when he â€Å"raised his spear and sneaked forward† (135). Just how much one can change because of their surroundings. Ralph and Jack have tension between them most of the time because Ralph can clearly se e the transformation within Jack.Because of the darkness In Jack, it highlights the Innocence In Piggy when he believes â€Å"[they'd] hurt he next telling. ,. And that's [him]† (93). Piggy feels that without any reason no one would survive on the island. Because of the chaos on the island, Piggy's constantly paranoid. In a world of destruction, the worst comes out from the good. As we observe Roger, we can infer the changes he comes across. As Jack and Roger are trying to kill Ralph, they set the island on fire. When the twins are being held captive by Roger, they explain to Ralph how â€Å"they hate [him]† (188).Jack and Roger were childish enough to set their environment on fire Just to get what they want. They want the rest of the boys to be on their side and in order to do that they have to exile Ralph. Clinton 2 While Jack and Roger are trying to find Ralph, Sam n Eric find him first and warn him how â€Å"[Rorer's] a terror† (189). Roger is the one in cha rge of murdering Ralph or Jack would be the one â€Å"sharpening the stick. † The island Is obviously changing more than one of the boys. Not only do bad things happen to good people, but good people can turn bad.When Piggy and Ralph find the rest of the boys, Ralph starts mentally hurting Piggy. Piggy's insecurities show when they talk about him â€Å"being called Piggy† (25). With this Ralph goes behind Piggy's back and tells the tribe his name is â€Å"Piggy. † Ralph is displaying his callousness to Piggy now that the rest of the boys are there. He's trying to come off's the leader type for the first time impression. In the same scene when thieve Introducing themselves, Ralph continues to push Piggy around by telling him to â€Å"go back, and take names. That's your job. So long† (157).Ralph turns bossy and thinks he can tell everyone what to do and how to do it. Piggy feels that Ralph thinks he's better than him to show off for the rest of the tribe. Ralph believes that now he's chief he doesn't have to do any of the hard work and he can make everyone else do it. All Piggy wants is for Ralph to have his back and be his friend. However, Plays being the only voice of reason makes him the weak target. In the speak† (44). The rest of the boys believe they can push piggy around. He feels unwanted and nobody understands him and his needs.He notices Ralph becoming angry when he's constantly shouting â€Å"shut up† at him. Not only does Piggy have ideas to get off the island alive, but nobody acknowledges him. He believes they are turning against each other and attacking. The tribes think being on the island is a lot of fun. Piggy thinks â€Å"rules are they only thing [they've] got† (91). Piggy Just wants to be friends with everyone, but since they pick on him and Hess so gullible, that can't happen. He thinks â€Å"the world is slipping away' when the boys become something they aren't (204).Ultimately, the good in Ralph and Piggy comes out do to the darkness in Jack and Roger. In the novel, William Gilding places two tribes of boy to survive the evil within themselves on an Clinton 3 island. They need to be able to handle themselves and each other in order to get off the island alive. William Gilding discusses how â€Å"the theme is an attempt to trace the defects of human society back to the defects of human nature† (204). He figured that if he put a group of boys in the wild to survive with only the clothes on their backs, they would turn into savages. Lord of the Flies KOURTNIE MCLAURIN ENGLISH 4 DESCRIPTIVE ESSAY: LORD OF THE FLIES MAIN CHARACTER: RALPH Lord of the Flies is a novel by author William Golding. Lord of the Flies story line is about a group of British boys stuck on an uninhabited island who try to govern themselves, with disastrous results. The setting takes place on an unnamed island, during a nuclear war. The book sets out their descent into brutality, left to them in an exquisite country, far from modern civilization, the well-educated children regress to a primitive state.Ralph, one of the older boys, is the protagonist of the novel who at first is overjoyed to be on a tropical island free from adult restraints. He is neither the smartest nor the strongest but has a kind of quiet charisma and good looks. He tries to keep the boys focused on trained order and the rules of civilization but loses his authority and almost his life to Jack’s, the antagonist of the story, seizure of power. By nature, he is an innocent, mild- temp ered boy who accepts leadership when it is thrown at him. He portrayed as a democratic leader who tries to keep the boys together on the island.Ralph has courage when the occasion demands it, but he really longs for the secure world of grown-ups, especially when order starts breaking down on the island. He dreams about a rescue and insists the signal fire burn at all times so that they can be seen. There’s conflict. Ralph knows that the main reason for the disorder on the island is Jack, representation of evil in the novel. There is a constant conflict between the two boys. Ralph stands for civilized ideals, while Jack leads a tribe of savages and lapses into primitive rituals. In the midst of the savagery, Ralph holds on to rationality and the hope of rescue.There is only one occasion when Ralph lapses into mild savagery; it occurs when he joins the ritual dance at the feast, the same feast where Simon is killed. The guilt that Ralph experiences as an outcome of his being a part of Simon's death is unbearable. It forces him to totally accept the fallen nature of all mankind. Armed with the truth, like Simon before him, he becomes the hunted animal, full of desperation and despair. Only civilization, which appears in the form of the naval officer, can save Ralph from the savagery that surrounds him. Lord of the Flies Daniel Santana Mrs. Caston English CP9, Period 1 6/6/12 Essay for LORD OF THE FLIES When man is taken or is separated from civilization, man can become primitive. In the novel Lord of the Flies, William Golding addresses what happens to man when they are taken out of civilization. The book begins with a plane that is filled with British school boys that crashes on an abandoned island. Since there are no adults with them on the island, the boys are forced to create their own civil society which slowly falls apart throughout the novel.In the novel Golding states that the boys are becoming uncivilized when they talk about the beast and what it is, the murder of Piggy, and the hunting of Ralph. One way the boys are becoming less civilized is when they start to fear that there is a beast on the island. For example Golding writes, â€Å"In a moment the platform was full of arguing and gesticulating shadows to, Ralph, seated, this seemed the breaking up of sanity. Fear, beast, no general a greement that the fire was all important†¦Ã¢â‚¬  (88).This shows that the boys have lost their sense of worldly reason of the world and their fear has now created the ‘Beast’ that roams within the sea. It also shows that they have so much fear that they have no agreement to have the fire keep going so they can be rescued. Later in the story the children chant, â€Å"‘Kill the beast! Cut his throat! Spill his blood! Do him in! ’†¦The beast was on its knees in the center, its arms folded over its face. It was crying out against the abominable noise, something about a body on the hill.The beast struggled forward, broke the ring, and fell over the steep edge of the rock†¦Ã¢â‚¬  (153). This shows that they boys are overcome by the fear of the beast they turn to a primitive state to deal with this fear and they kill the beast without knowing it was Simon. This act shows in their rage against the beast they don’t hear Simon as he tries to tell the boys there is no beast while they are stabbing him. These quotes clearly lay out how the boys become more savage like from their fear of the ‘beast’ on the island. Another way that the boys were becoming uncivilized is when they murdered Piggy.For example, once the boys break into two tribes, â€Å"Jack had backed right against the tribe and they were a solid menace that bristled with spears. The intention of a charge was forming among them†¦Ã¢â‚¬  (180). This shows that they are becoming uncivilized because when Piggy is talking he’s saying that if it is beater to be savages than having law and order the hunters are about to attack them. Also it shows that Jack and his hunters have converted to savagery. In addition Golding describes the murderess act, â€Å"High overhead, Roger, with a sense of delirious abandonment, leaned all his weight on the lever† (180).This shows that Roger has no reason for what he is going to do, he’s actin g on impulse. Also its shows that they have lost everything that is good to man and now they have become savages. These examples demonstrate the extreme loss of a civilized behavior. Another example of the boys becoming less uncivilized is when they and hunt Ralph so they can kill him. For example Samneric are talking, â€Å"I dunno. And Ralph, Jack, the chief says it’ll be dangerous—and we’ve got to be careful; and throw our spears like at a pig† (188). This shows that the boys have no sympathy for taking a human life.Also it shows that the boys are going to hunt Ralph as if he was an animal. In addition Ralph talks to Samneric and continue to explain, â€Å"‘What are you going to do—? From the top of the towering rock came the incomprehensible reply. ‘Roger sharpened a stick at both ends,† (180). This shows that the boys have no lost their sanity and now they are complete savages. They transposed from having law and order to be ing savages so they can kill Ralph. In conclusion, the novel Lord of the Flies by William Golding illustrates the boy’s loss of civilization.When the boys talk about the beast and fear it, they become less civilized because they would stop at nothing to kill the beast and push back the time of being rescued further. The death of piggy illustrates the boy’s loss of civilized behavior because they have no remorse for taking the life of a human being. The have completely lost their civilized behavior because they hunt Ralph and they would stop at nothing to kill him cause he is seen as a threat to Jacks new, wild society. When human beings are taken from society over time they will become savage like and lose reason for what they do. Lord of the Flies ‘Lord of the Flies’ is frequently read as the story of changing identities. The plot gives an opportunity to trace the process, in which several boys turn into savage beasts on an isolated island. These changes do not occur overnight, but are accompanied by a series of profound implications, which make the story extremely realistic and teaching. In this essay I will turn my attention to exploring this process of losing identity and ultimate human devastation. ‘Lord of the Flies’ is the narration about the three identities, lost through violence, savageness, and inner moral conflict. Identity loss as the leading theme of the book The loss of identity among boys and their ultimate moral devastation is the major conflict of the book. Golding was extremely interested in investigating the inner causes and complications of such identity loss. It is difficult to justify these irreversible changes by external conditions in which the boys found themselves, yet for someone this justification may seem possible. The fight between their freedom and self-control has become the biggest challenge the boys had to face. In this fight self-control was tragically defeated, giving place to wildness, cruelty, desolation and violence. The humans are weak under the rays of freedom which are colored with unreason and the desire to hurt. Those boys have become the brightest depiction of the traditional human identity, regularly exposed to temptations which it cannot stand. Ralph and his changing identity ‘Ralph too was fighting to get near, to get a handful of that brown, vulnerable flesh. The desire to squeeze and hurt was over-mastering.’[1] Ralph’s presence on the island led him to the state when he could not control his premature instincts anymore. The outstanding feature of Ralph’s personality in this story is that he experienced the loss of his identity twice: the first took place when he appeared on the island, and the second occurred after he was elected the leader and could not successfully hold that position. The change which occurred to Ralph could be connected to some magic spell of the island, but unfortunately this change found its reasonable explanation. Ralph was a well-bred and disciplined young boy, but being on an island without any adults significantly contributes into his identity loss. He could not perform the role of the leader and reasonably recognized the difficulties of being without parents. The loss of his leadership identity made him realize his ineffectiveness which he tried to compensate through cruelty and violence. ‘Ralph went for the end of innocence, the darkness of man’s heart, and the fall through the air of a true, wise friend called Piggy.’[2] The moment when Ralph sees the officer and realizes that his life is saved, becomes the culmination of his devastation: he simultaneously perceives the irreversibility of his change and the power of evil which exists in every human soul. Jack as the symbol of release from former identities Jack is completely different from Ralph; he is not subjected to reflecting upon the despair of his identity loss. ‘I’m scared of him, and that’s why I know him. If you’re scared of someone you hate him but you can’t stop thinking about him. You kid yourself he’s all right really, an’ them when you see him again; it’s like asthma an’ you can’t breathe.’[3] In his identity loss and devastation Jack has gone beyond reasonable measures, making the other boys afraid of him. He has demonstrated his ill nature to the fullest. Through his example, the reader reveals the tragic truth: human evil does not have any measures. The mask which he used in hunting, in reality was ‘a thing on its own, behind which Jack hid, liberated from shame and self-consciousness.’[4] He was unreasonable enough to call for disregarding his leadership, which broke one of the major human principles, and led to disorder and freedom to fight with each other. Piggy: a tragic victim of his identity loss Out of the three major characters, Piggy is the most civilized, and the biggest victim of the identity loss among the boys. This may put a contradictory tint onto the whole discussion: the reader risks thinking that reason cannot lead to any positive outcomes. Yet, this assumption is deceptive. Piggy’s age and appearance (glasses, in particular) turn him into an outcast from the start. His identity is lost through the efforts of others: he is called fatty, and he is mocked on for wearing glasses. These glasses are inseparable from his identity, as they let him watch the world in its true colors. As soon as they are taken by other boys to make the fire, he realizes that blindness and identity loss are synonymic. The loss of his identity has not led to devastation: it has led to his death which made him the victim of those who had lost their identities earlier. ‘How can you expect to be rescued if you don’t put first things first and act proper?’[5] The tragic character of Piggy’s identity loss is that it did not stem from Piggy’s character but was urged by other’s cruelty. He was the only person who lost his identity through his death. Conclusion The process of identity loss leading to devastation starts from the moment boys appear on the island. They do not display any strivings towards rescuing themselves, but prefer swimming in the lagoon. They hide their faces behind the masks, and hide from consciousness, shame, and reason. Their education is turned into primitiveness – the brightest sign of identity loss. Trying to kill the boar and dancing around it in the blood dance is the scene at which transformation into savages and as a result, identity loss is completed. There is no way back towards being civilized. The gradual degradation which all boys experienced broke all connections with their previous world. The appearance of the officer on the island has indicated total devastation of the boys’ moral identity. BIBLIOGRAPHY GOLDING, William, Lord of the Fli [1] W. Golding, Lord of the Flies, Penguin Non-Classics, 1999, p. 103. [2] ibid.,   p. 184. [3] ibid., p. 83. [4] ibid., p. 55. [5] ibid., p. 38. Lord of the Flies Bianca Adams Ms. Knapp Honors English 16 April 2013 Lord of the Flies: Formal Essay The Bible is the number one selling book in the world almost every year. Christianity has had a huge influence on literature, and music today. A commonly known rapper named Tupac often uses God in his music. For example in his song â€Å"Only God Can Judge Me† he says â€Å"Oh my Lord, tell me what I'm livin for everybody’s droppin got me knockin on heaven's door.Even though American Schools are secular environments, the Bible is still often represented in the curriculum. In the novel there are many ways to show that there’s an allegory towards the Bible. For example, William Golding uses his characters in the novel â€Å"Lord of the Flies† to symbolize Biblical ideas. In chapter 1 when the plane crashes with the choir boys, Ralph removes his clothes and bathes in the water, which shows an act of Baptism. Baptism is something that happens so your sins can be washed away.Al so the snake thing being referred to all the time in the book can relate to Satan in the garden of Eden. Satan often described himself as serpent. But unlike Adam & Eve the boys from the plane crash were mistaken about the creature. They were even unable to recognize the danger of evil within themselves that propels them to violence. Such as torturing the pigs in such a cruel way just to satisfy their hunger. Simon is the Christ figure Lord of the Flies Daniel Santana Mrs. Caston English CP9, Period 1 6/6/12 Essay for LORD OF THE FLIES When man is taken or is separated from civilization, man can become primitive. In the novel Lord of the Flies, William Golding addresses what happens to man when they are taken out of civilization. The book begins with a plane that is filled with British school boys that crashes on an abandoned island. Since there are no adults with them on the island, the boys are forced to create their own civil society which slowly falls apart throughout the novel.In the novel Golding states that the boys are becoming uncivilized when they talk about the beast and what it is, the murder of Piggy, and the hunting of Ralph. One way the boys are becoming less civilized is when they start to fear that there is a beast on the island. For example Golding writes, â€Å"In a moment the platform was full of arguing and gesticulating shadows to, Ralph, seated, this seemed the breaking up of sanity. Fear, beast, no general a greement that the fire was all important†¦Ã¢â‚¬  (88).This shows that the boys have lost their sense of worldly reason of the world and their fear has now created the ‘Beast’ that roams within the sea. It also shows that they have so much fear that they have no agreement to have the fire keep going so they can be rescued. Later in the story the children chant, â€Å"‘Kill the beast! Cut his throat! Spill his blood! Do him in! ’†¦The beast was on its knees in the center, its arms folded over its face. It was crying out against the abominable noise, something about a body on the hill.The beast struggled forward, broke the ring, and fell over the steep edge of the rock†¦Ã¢â‚¬  (153). This shows that they boys are overcome by the fear of the beast they turn to a primitive state to deal with this fear and they kill the beast without knowing it was Simon. This act shows in their rage against the beast they don’t hear Simon as he tries to tell the boys there is no beast while they are stabbing him. These quotes clearly lay out how the boys become more savage like from their fear of the ‘beast’ on the island. Another way that the boys were becoming uncivilized is when they murdered Piggy.For example, once the boys break into two tribes, â€Å"Jack had backed right against the tribe and they were a solid menace that bristled with spears. The intention of a charge was forming among them†¦Ã¢â‚¬  (180). This shows that they are becoming uncivilized because when Piggy is talking he’s saying that if it is beater to be savages than having law and order the hunters are about to attack them. Also it shows that Jack and his hunters have converted to savagery. In addition Golding describes the murderess act, â€Å"High overhead, Roger, with a sense of delirious abandonment, leaned all his weight on the lever† (180).This shows that Roger has no reason for what he is going to do, he’s actin g on impulse. Also its shows that they have lost everything that is good to man and now they have become savages. These examples demonstrate the extreme loss of a civilized behavior. Another example of the boys becoming less uncivilized is when they and hunt Ralph so they can kill him. For example Samneric are talking, â€Å"I dunno. And Ralph, Jack, the chief says it’ll be dangerous—and we’ve got to be careful; and throw our spears like at a pig† (188). This shows that the boys have no sympathy for taking a human life.Also it shows that the boys are going to hunt Ralph as if he was an animal. In addition Ralph talks to Samneric and continue to explain, â€Å"‘What are you going to do—? From the top of the towering rock came the incomprehensible reply. ‘Roger sharpened a stick at both ends,† (180). This shows that the boys have no lost their sanity and now they are complete savages. They transposed from having law and order to be ing savages so they can kill Ralph. In conclusion, the novel Lord of the Flies by William Golding illustrates the boy’s loss of civilization.When the boys talk about the beast and fear it, they become less civilized because they would stop at nothing to kill the beast and push back the time of being rescued further. The death of piggy illustrates the boy’s loss of civilized behavior because they have no remorse for taking the life of a human being. The have completely lost their civilized behavior because they hunt Ralph and they would stop at nothing to kill him cause he is seen as a threat to Jacks new, wild society. When human beings are taken from society over time they will become savage like and lose reason for what they do. Lord of the Flies KOURTNIE MCLAURIN ENGLISH 4 DESCRIPTIVE ESSAY: LORD OF THE FLIES MAIN CHARACTER: RALPH Lord of the Flies is a novel by author William Golding. Lord of the Flies story line is about a group of British boys stuck on an uninhabited island who try to govern themselves, with disastrous results. The setting takes place on an unnamed island, during a nuclear war. The book sets out their descent into brutality, left to them in an exquisite country, far from modern civilization, the well-educated children regress to a primitive state.Ralph, one of the older boys, is the protagonist of the novel who at first is overjoyed to be on a tropical island free from adult restraints. He is neither the smartest nor the strongest but has a kind of quiet charisma and good looks. He tries to keep the boys focused on trained order and the rules of civilization but loses his authority and almost his life to Jack’s, the antagonist of the story, seizure of power. By nature, he is an innocent, mild- temp ered boy who accepts leadership when it is thrown at him. He portrayed as a democratic leader who tries to keep the boys together on the island.Ralph has courage when the occasion demands it, but he really longs for the secure world of grown-ups, especially when order starts breaking down on the island. He dreams about a rescue and insists the signal fire burn at all times so that they can be seen. There’s conflict. Ralph knows that the main reason for the disorder on the island is Jack, representation of evil in the novel. There is a constant conflict between the two boys. Ralph stands for civilized ideals, while Jack leads a tribe of savages and lapses into primitive rituals. In the midst of the savagery, Ralph holds on to rationality and the hope of rescue.There is only one occasion when Ralph lapses into mild savagery; it occurs when he joins the ritual dance at the feast, the same feast where Simon is killed. The guilt that Ralph experiences as an outcome of his being a part of Simon's death is unbearable. It forces him to totally accept the fallen nature of all mankind. Armed with the truth, like Simon before him, he becomes the hunted animal, full of desperation and despair. Only civilization, which appears in the form of the naval officer, can save Ralph from the savagery that surrounds him. Lord of the Flies Bianca Adams Ms. Knapp Honors English 16 April 2013 Lord of the Flies: Formal Essay The Bible is the number one selling book in the world almost every year. Christianity has had a huge influence on literature, and music today. A commonly known rapper named Tupac often uses God in his music. For example in his song â€Å"Only God Can Judge Me† he says â€Å"Oh my Lord, tell me what I'm livin for everybody’s droppin got me knockin on heaven's door.Even though American Schools are secular environments, the Bible is still often represented in the curriculum. In the novel there are many ways to show that there’s an allegory towards the Bible. For example, William Golding uses his characters in the novel â€Å"Lord of the Flies† to symbolize Biblical ideas. In chapter 1 when the plane crashes with the choir boys, Ralph removes his clothes and bathes in the water, which shows an act of Baptism. Baptism is something that happens so your sins can be washed away.Al so the snake thing being referred to all the time in the book can relate to Satan in the garden of Eden. Satan often described himself as serpent. But unlike Adam & Eve the boys from the plane crash were mistaken about the creature. They were even unable to recognize the danger of evil within themselves that propels them to violence. Such as torturing the pigs in such a cruel way just to satisfy their hunger. Simon is the Christ figure Lord of the flies Slipping Away William Gilding states â€Å"†¦ The shape of society must depend on the ethical nature of the Individual. † In Lord of the Flies when he brings two tribes of boys together to sustain an island surrounded by evil (204). Upon analyzing Gildings characters, we can see that the boys stranded on the island are willing to do anything to anyone in order to survive. Despite the evil in Roger and Jack, the innocence and good in Piggy and Ralph surfaces.When we look at the way Gilding describes the boys on the Island, we can all twice the change within all of them. In the beginning of the novel the kids are innocent British school boys, but later Jack transforms into a child whoso obsessed with hunting. Jack is only interested in torturing and killing the pig when he â€Å"raised his spear and sneaked forward† (135). Just how much one can change because of their surroundings. Ralph and Jack have tension between them most of the time because Ralph can clearly se e the transformation within Jack.Because of the darkness In Jack, it highlights the Innocence In Piggy when he believes â€Å"[they'd] hurt he next telling. ,. And that's [him]† (93). Piggy feels that without any reason no one would survive on the island. Because of the chaos on the island, Piggy's constantly paranoid. In a world of destruction, the worst comes out from the good. As we observe Roger, we can infer the changes he comes across. As Jack and Roger are trying to kill Ralph, they set the island on fire. When the twins are being held captive by Roger, they explain to Ralph how â€Å"they hate [him]† (188).Jack and Roger were childish enough to set their environment on fire Just to get what they want. They want the rest of the boys to be on their side and in order to do that they have to exile Ralph. Clinton 2 While Jack and Roger are trying to find Ralph, Sam n Eric find him first and warn him how â€Å"[Rorer's] a terror† (189). Roger is the one in cha rge of murdering Ralph or Jack would be the one â€Å"sharpening the stick. † The island Is obviously changing more than one of the boys. Not only do bad things happen to good people, but good people can turn bad.When Piggy and Ralph find the rest of the boys, Ralph starts mentally hurting Piggy. Piggy's insecurities show when they talk about him â€Å"being called Piggy† (25). With this Ralph goes behind Piggy's back and tells the tribe his name is â€Å"Piggy. † Ralph is displaying his callousness to Piggy now that the rest of the boys are there. He's trying to come off's the leader type for the first time impression. In the same scene when thieve Introducing themselves, Ralph continues to push Piggy around by telling him to â€Å"go back, and take names. That's your job. So long† (157).Ralph turns bossy and thinks he can tell everyone what to do and how to do it. Piggy feels that Ralph thinks he's better than him to show off for the rest of the tribe. Ralph believes that now he's chief he doesn't have to do any of the hard work and he can make everyone else do it. All Piggy wants is for Ralph to have his back and be his friend. However, Plays being the only voice of reason makes him the weak target. In the speak† (44). The rest of the boys believe they can push piggy around. He feels unwanted and nobody understands him and his needs.He notices Ralph becoming angry when he's constantly shouting â€Å"shut up† at him. Not only does Piggy have ideas to get off the island alive, but nobody acknowledges him. He believes they are turning against each other and attacking. The tribes think being on the island is a lot of fun. Piggy thinks â€Å"rules are they only thing [they've] got† (91). Piggy Just wants to be friends with everyone, but since they pick on him and Hess so gullible, that can't happen. He thinks â€Å"the world is slipping away' when the boys become something they aren't (204).Ultimately, the good in Ralph and Piggy comes out do to the darkness in Jack and Roger. In the novel, William Gilding places two tribes of boy to survive the evil within themselves on an Clinton 3 island. They need to be able to handle themselves and each other in order to get off the island alive. William Gilding discusses how â€Å"the theme is an attempt to trace the defects of human society back to the defects of human nature† (204). He figured that if he put a group of boys in the wild to survive with only the clothes on their backs, they would turn into savages. Lord of the Flies Bianca Adams Ms. Knapp Honors English 16 April 2013 Lord of the Flies: Formal Essay The Bible is the number one selling book in the world almost every year. Christianity has had a huge influence on literature, and music today. A commonly known rapper named Tupac often uses God in his music. For example in his song â€Å"Only God Can Judge Me† he says â€Å"Oh my Lord, tell me what I'm livin for everybody’s droppin got me knockin on heaven's door.Even though American Schools are secular environments, the Bible is still often represented in the curriculum. In the novel there are many ways to show that there’s an allegory towards the Bible. For example, William Golding uses his characters in the novel â€Å"Lord of the Flies† to symbolize Biblical ideas. In chapter 1 when the plane crashes with the choir boys, Ralph removes his clothes and bathes in the water, which shows an act of Baptism. Baptism is something that happens so your sins can be washed away.Al so the snake thing being referred to all the time in the book can relate to Satan in the garden of Eden. Satan often described himself as serpent. But unlike Adam & Eve the boys from the plane crash were mistaken about the creature. They were even unable to recognize the danger of evil within themselves that propels them to violence. Such as torturing the pigs in such a cruel way just to satisfy their hunger. Simon is the Christ figure