Unusual Presentation of Ewing’s Sarcoma

Unusual Presentation of Ewing’s Sarcoma D.V.Prasad1, Sanjay Mulay2, Krishna Badgire 3, *Abhinav S.Jadhav4, Deepak Datrange5, Sagar Jawale6, Arun alex7 ABSTRACT: Ewing’s sarcoma is a highly malignant, round cell neoplasm of uncertain origin. It is the sixth most common malignant tumor of bone. It must be distinguished from chronic osteomyelitis and other malignant round cell tumors like lymphoma, metastatic neuroblastoma and small cell osteosarcoma. Most patients are between 10 to 25years old; rarely patients are younger than age 5 years and older than age 40 years. We report a 55 years female who presented with swelling over right shoulder with pain and inability to move right shoulder later diagnosed as Ewing’s sarcoma of proximal part of humerus right side. The earlier diagnosis at this age may help in better management of the condition and prevent further complications and have better prognosis. KEY WORDS: Ewing’s sarcoma, Primitive neuroectodermal tumor (PNET), Ewing family of tumors (EFT), round cell tumor. INTRODUCTION: Ewing’s sarcoma is a highly malignant, round cell neoplasm of uncertain origin. It is the sixth most common malignant tumor of bone [1]. Most patients are between 10 to 25years old; rarely patients are younger than age 5 years and older than age 40 years. The present report is about rare presentation of Ewing’s sarcoma in a 55 years old female who presented with swelling over right shoulder with severe pain and inability to move right shoulder. CASE REPORT: A55 years old female, housewife, was presented with progressive swelling over right shoulder and difficulty in shoulder movements. Swelling was accompanied with severe pain which increased gradually over a period of 6 months. On examination, she was an average built female with swelling over right shoulder and upper part of right arm. Swelling was of 25x20cm size. It was a solitary swelling with local rise of temperature over swelling. Swelling was tender and variable in consistency. It was a non-mobile swelling. Redness and prominent superficial veins were visible over swelling over right shoulder and upper part of arm (Fig.1). Her hemoglobin levels were decreased and she had elevated erythrocyte sedimentation rate (ESR). Her renal function tests and liver function tests were towards lower normal range. X-ray right shoulder with arm shows round lytic lesion in head and upper part of humerus (Fig.2). MRI of right shoulder joint was suggestive of a 8.76.76.5 cm well defined, lobulated, expansile, lytic, lesion involving head and proximal shaft of right humerus, causing thinning and erosion of the cortex with breach at few places and narrow zone of transition, adjacent soft tissue extensions with edema and moderate right shoulder joint effusion. These findings are suggestive of Neoplastic mass involving proximal humerus with pathological fractures (Fig. 3) Histopathology report shows sheets of small round cells with hyperchromatic nuclei, condensed chromatin and scanty eosinophilic cytoplasm with vaculisations with unremarkable bony trabeculae (Fig.4). Immuno-histochemistry is suggestive of Vimentin, CD99, S 100 positive and AE1/AE3 focally positive. Cytology report was suggestive of cytomorphological features positive for malignancy (Fig.5). Fig. 1: Clinical photograph of patient showing right shoulder swelling. Fig.2:X-ray right shoulder showing round lytic area in upper end of humerus. Fig. 3: MRI right shoulder T1W,T2W and STIR images showing expansile, lobulated, lytic lesion involving head and proximal part of humerus. Fig.4: Microscopic picture (40X) showing sheets of small round cells with hyperchromatic nuclei, condensed chromatin and scanty eosinophilic cytoplasm. Fig.5: Cytology report showing cytomorphological features positive for malignancy DISCUSSION: In 1918 Arthur Purdy Stout described a tumor composed of small round cells with rosettes in Ulnar nerve [2], later on it became known as Primitive neuroectodermal tumor (PNET). James Ewing described a tumor of diaphysis of long bones composed of undifferentiated cells and the tumor was radiosensitive [3]. Earlier Ewing’s sarcoma (ES) PNET were described as two separate entities, but in 1975 Angervall and Enzinger described extraskeletal tumor resembling to ES [4]and Jaffe et al. wrote an article on â€Å"the neuroectodermal tumor of bone† in 1984 [5]. Now it is known that ES and PNET show similar translocations and are considered to be ends of histological spectrum of Ewing’s family of tumors (EFT). Analysis of molecular techniques not only provided better understanding of biology but also help in developing better techniques in diagnosis and prospective potential treatment. Epidemology: EFT comprises 5 to 10 % of total bone tumors and is the 2nd most common tumor of childhood [6]. It occurs predominantly in young adults and children and shows a slight predilection for males [7].75% cases are seen between 10 to 25 years age of life. Youngest case reported so far was of 4.5 months old [8] and oldest case reported was 61 years old. Infancy cases are to be differentiated from metastatic neurofibroma. Sites: In 55% long bones it is usually diaphyseal lesion but also metaphyseodiaphyseal lesion can be seen. Flat bone (pelvis and ribs) involvement can also be seen. Less common sites of occurance are skull, vertebra and scapula. Presentation of Ewing’s sarcoma: Pain, Swelling and fever are the presenting symptoms. X-ray shows permeative pattern of bone involvement (boundary between uninvolved bone and area of bone destruction and bone is broad, vague imperceptible). All types of periosteal reactions seen like onion peel, moth eaten, honey combed, fine and reticulated [1]. Biopsy Ideally core biopsy is done, if repeated attempts of core biopsy fails open biopsy is done. FNAC not recommended in case of Ewing’s sarcoma. Frozen section studies opted in selected cases only as freezing of tissue distorts the morphology. Fixation of tissue is done in 10% formalin. Inadequate fixation leads to loss of antigen, so inconclusive results on immunohistochemistry and also causes autolysis and degeneration of DNA thus making molecular analysis difficult. Ratio of specimen to formalin is 1:10. Histology: It is prototype of small round cell tumor growth. It is composed of sheets of small cells with increased nuclear to cytoplasm ratio. Cytoplasm is scanty, eosinophilic, and detected by periodic acid Schiff (PAS), contains glycogen and diastase degradable. Occasional rosette formation are seen and frequently undergoes necrosis and residual viable cells show perithetiomatous or perivascular distribution.EFT tumor cells can be large with irregular nuclear membrane and prominent nucleoli [9]. EFT cells show membrane expression of CD99 /MIC 2 on immunohistochemistry [10]. Antibody against FLI-1 is seen in nucleus of tumor cells which is specific for diagnosis of EFT [11]. Tumor cells may show neuron specific enolase (NSE), synaptophysin and s-100 protein. Family of EFT includes -1)non hodgekin’s lymphoma 2)rhabdomyosarcoma 3)synovial sarcoma 4)messenchymal chondrosarcoma 5)desmoplastic small round cell tumor (DSRCT) 6)retinoblastoma. False positive cd99 screening is seen in other cases as well hence CD99, FLI1 and NSE to be positive for diagnosis of EFT/PNET. Molecular genetics: Translocation t (11:22) (q24:q22) is seen in 85 % cases. Fusion of EWS gene on 22q12 with FLI-1 on 11q24 results in chimeric fusion transcript EWS-FLI1 [12]. EWS-FLI1 induces insulin like growth factor (IGF-1). Phospholipase D2 (PLD2) and Protein tyrosine phosphatase 1 (PTPL1) are expressed in increased levels. Thus tumor cells escape from apoptosin and growth inhibition. Therapeutic targets: EWS-FLI1 fusion is to be targeted and split. Monoclonal antibodies against IGF -1 are being tried as it is associated with EFT growth [13] and PLD 2, PTPL1 are other conceivable candidates as both are highly expressed in EFT [14]. Chemotherapy in ES: There is no universally accepted staging. American joint committee on cancer (AJCC) suggests that primary bone or extra skeletal Ewing’s sarcoma may be included with their respective bone or soft-tissue sarcoma staging (STS) systems [15]. Although AJCC staging includes metastatic disease and tumor size greater or less than 8 cm; nodal status and grade are irrelevant for ES because it rarely spreads by lymph nodes and by definition of ES is high grade tumor [15]. Most of centers use presence or absence of metastasis at the time of diagnosis, as main tool for planning the treatment. Prognostic factors: 1) tumor site and size 2) age and gender 3) serum LDH levels ES in distal extremity has better prognosis than proximal extremity. ES in central location (pelvis) has worst prognosis [16] [17] [18]. Tumor volume 100-200ml- large tumor has bad prognosis. Girls have better prognosis than boys [18]. Increased serum LDH levels at time of diagnosis with large tumor with metastatic disease has worse prognosis. Metastasis in lungs alone has prognosis better than metastasis in extra-pulmonary sites. Patient with minimal tumor or no residual tumor after preoperative chemotherapy incline towards better prognosis. Evolution of chemotherapy: Adjuvant therapy: Vincristine + Actinomycin D + Cyclophosphamide (VAC). Intergroup Ewing’s sarcoma study (IESS): VAC + doxorubicin. IESS trial –II demonstrated that intermittent high doses of VAC + doxorubicin was superior to continuous moderate dose therapy with this agents [19].VAC+ doxorubicin alternating with Ifosfamide and Eloposide (IE) has better prognosis. There is no role of dose intensification. Current trend: Alternating cycles of VAC IE every 3 weeks for 48 weeks with local control at 9-12 weeks [20] is to be administered. There is no role of dose compression (decrease in duration of cycles).There is some role of stem cell in preliminary stage of management. Local therapy: Surgical resection with or without limb salvage followed by Radiotherapy and then chemotherapy is given. Chemotherapy remains back bone of the T/t for Ewing’s sarcoma, local T/t with surgery /or radiotherapy has important role in management of ES. The outcome of management is better in localized ES as compared to elusive outcome in metastatic disease or local recurrence. This case is presented in view of rarity to increase suspicion index for the presence of Ewing’s sarcoma. Early detection of Ewing’s sarcoma as chemotherapy and radiotherapy can limit further damage and progression of the disease can be done. REFERENCES: Joseph M. Mirra, Piero Picci: Ewing’s sarcoma In: Bone tumors- clinical, radiologic, and pathologic correlations, volume two, Lea Febiger, Philadelphia, London1989, pp. 1088-1094. Stout AP. A tumor of the ulnar nerve. Proc NY Pathol Soc 1918; 12:2-12. Ewing J. Diffuse endothelioma of bone. Proc NY Pathol Soc 1921; 21:17-24. Angervall L, Enzinger FM. Extraskeletal neoplasm resembling Ewing’s sarcoma. Cancer 1975; 36:240-51. Jaffe R, Santamaria M, Yunis EJ, Tannery NH, Agostini RM Jr, Medina j, era/. The neuroectodermal tumor of bone. Am j Surg Pathol 1984; 8:885-98. Gurney JG, Swensen AR, Bulterys M. Malignant bone tumors. In: Ries LA, etal, editors. Cancer incidence and survival among children and adolescents: United States SEER Program 1975- 1995. Bethesda, MD: National Cancer institute. SEER Program. NIH Pub. No. 99-4649; 1999. p. 99-110. Zamora P, Garcia de Paredes ML, Gonzalez Baron M, Diaz MA, Escobar Y, Ordonez A, et al. Ewings tumor in brothers. An unusual observation. AmJ Clin Oncol 1986; 9:358-60. Kim, T.E., Ghazi G. Atkinson G. ct al.: Ewings sarcoma of a lower extremity in an infant: A therapeutic dilemma. Cancer, 5c: 187, 1986. Nascimento AG, Unii KK, Pritchard DJ, Cooper KL, Dahlin DC. A clinicopathologic study of 20 cases of large-cell (atypical) Ewings sarcoma of bone. AmJ Surg Pathol 1980; 4:29-36. Khoury JD. Ewing sarcoma family of tumors. Adv Anat Pathol 2005; 12:212-20. Nilsson G, Wang M, Wejde J, Kreicbergs A, Larsson O. Detection of EWS/FL1-1 by immunostaining. An adjunctive tool in diagnosis of Ewing’s sarcoma and primitive neuroectodermal tumour on cytological samples and paraffin-embedded archival material. Sarcoma 1999; 3:25-32. Delattre O, Zucman J, Plougastel B, Desmaze C, MelotT, Peter M, et al. Gene fusion with an ETS DNA-binding domain caused by chromosome translocation in human tumours. Nature 1992; 359:162-5. Ludwig JA. Ewing sarcoma: Historical perspectives, current state-of-the-art, and opportunities for targeted therapy in the future. Curr Opin Oncol 2008; 20:412-8. Abaan OD, Levenson A, Khan O, Furth PA, Uren A, Toretsky JA. PTPL1 is a direct transcriptional target of EWS-FL11 and modulates Ewing’s Sarcoma tumorigenesis. Oncogene 2005; 24:2715-22. Greene FL, Page DL, Fleming ID , A. Fritz, C.M Balch, D.G. Haller et al, eds. AJCC cancer staging Manual. 6th ed. New York, NY: Springer; 2002. Rodriguez –Galindo C, Liu T, Krasin MJ, Wu J, Billups CA, Daw NC, et al. Analysis of prognostic factors in Ewing’s sarcoma family of tumors: review of St. Jude children’s research hospital studies cancer 2007; 1 10:375-84. Cotterill SJ, Ahrens S, Paulussen M, Jurgens HF, Voute PA, Gadner H et al. Prognostic factors in Ewing’s tumor of bone: analysis of 975patient from the European intergroup cooperative Ewing’s sarcoma study group. J clin oncol 2000; 18:3108-14. Bacci G, Longhi A, Ferrari S, Mercuri M, Versari M, Bertoni F. Prognostic factors in non-metastatic Ewing’s sarcoma tumor of bone: An analysis of 579 patients treated at a single at a single institution with adjuvant or neo-adjuvant chemotherapy between 1972 and 1998.Acta oncol 2006; 45:469-75. Burgert EO Jr, Nesbit ME , Garnsey LA , Gehan EA, Herrmann J, Vietti TJ, et al. Multimodal therapy for management of non-pelvic , localized Ewing’s sarcoma of bone :intergroup study IESS-II. J Clin Oncol 1990; 8:1514-24. Granowetter L, Womer R, Devidas M, Karlio M, Wang C, Bernstein M, et al. Dose –intensified compared with standard chemotherapy for non-metastatic Ewing’s sarcoma family of tumors: a children’s oncology group study. J clin oncol 2009; 27:2536-41.

Essay --

From Poverty to Powerhouse: Michael Oher’s Story Michael Oher was from an all-black neighborhood located in the third poorest zip code in the country. By the time he was a sophomore, he’d been to 11 different schools, he couldn’t read or write, and he had a GPA of 0.6. In his first-grade year alone, he missed 41 days of school and ended up repeating both the first and the second grade; he didn’t even go to the third grade. Oher was one of the thousands of children that have been identified as having four or more of the at-risk factors mentioned by the National Center of Education and Statistics (NCES). According to the NCES, poverty and race are high on the list of things that negatively affect students’ ability to succeed at school. Other risk factors include changing schools multiple times and being held back from one or more grades. Oher’s biography, The Blind Side by Michael Lewis, proves how socioeconomic status impacts a child’s academic success because placed in perspective, educati on is not as important as the hardships of reality. Before explaining how The Blind Side depicted the effects of socioeconomic status on Michael Oher’s education, it is important to make clear what it means to â€Å"prove.† According to Oxford Dictionaries, â€Å"prove† means â€Å"to demonstrate one’s abilities or courage† (â€Å"Prove† 1.5). The Merriam Webster Dictionary gave other definitions including â€Å"to show that (someone or something) has a particular quality or ability (â€Å"Prove† 1); â€Å"to test the worth or quality of, specifically: to compare against a standard† (â€Å"Prove† 2b), and â€Å"to show oneself to be worthy or capable of† (â€Å"Prove† 4). All of the above definitions of â€Å"prove† have a form of the words â€Å"quality† or â€Å"ability† in them. An example of this is when... ...nomic status. In 2012, 26.5 million (13.7 percent) of people ages 18-64 were in poverty. Also in 2012, 16.1 million (21.8 percent) children under the age of 18 were in poverty. The hardships this creates causes education to suffer. It has to take a backseat to finding food or a place to sleep. These children’s families are at-risk for dropping out of school compared to higher socioeconomic students. That number is going to continue to grow with the current rate of population growth. In contrast, children from higher socioeconomic families do better in school. When the Tuohy’s brought Michael into their life, his opportunities for education improved. What happened to Michael Oher was unique because of his special abilities, his courage, and the help from the Toughy’s. Michael’s story shows how socioeconomics can impact students’ academic success. Appendix

The Cherry Orchard - The Struggle :: Anton Chekhov Cherry Orchard Essays

The Cherry Orchard - The Struggle Anton Chekhov’s play The Cherry Orchard introduces readers to a pre-Revolution Russian family faced with the impending sale of their estate, the Cherry Orchard. The main character in the play is the owner of the Cherry Orchard, Lyubov Andreyevna. It is in the play that Lyubov must ultimately decide whether to allow her Cherry Orchard to be cut down to make room for villas or to sell the entire estate to pay off her debts. It is her unconditional love for both the Cherry Orchard and what it symbolizes to her that allows her to put the estate up for sale rather than have the Cherry Orchard cut down.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Although she is a member of the Russian upper class, Lyubov is hopelessly out of touch with reality and very irresponsible when in comes to finances. She often throws money around as though there are no consequences to her actions. After her husband died and her boy was tragically drowned at the Cherry Orchard, she fled to Paris and bought a villa, which she soon had to sell to pay off her debts. Lyubov dines lavishly and tips handsomely when in all actuality she hasn’t a dime to spare. She throws parties and hires orchestras she knows she can not pay for. It is this type of behavior that put Lyubov deep enough into debt to where her beloved estate has been put at risk.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   To Lyubov the Cherry Orchard means so much more than the acres and acres of beautiful cherry trees and rivers; so much more than the piece of land that was featured in the encyclopedia. To her it represents her sense of nostalgia, a longing for the past. It is the place where her grandparents lived. Her mother and father lived there as well. It reminds Lyubov of her youth. When she looks at the cherry trees she does not just see branches and blossoms, she sees a time when she walked through the orchard with her mother as a young girl. She says â€Å"I used to sleep here when I was little†¦and here I am like a child again.† Lyubov’s innocence also remains a part of the Cherry Orchard, for as a child she did not own serfs or squander her family’s money. Even though the Cherry Orchard invokes thoughts of her lost husband and son, she still treasures it.

Kings Speech Rhetorical Analysis

Addressing the Nation When any artist or director embarks on the journey of creation, they use a variety of different techniques to aid in the conveying of their message. Their main goal is to create something special for their audience, or rather call them witnesses. Convincing them that a personal piece of art, whether it be a painting, a novel or a movie, is different than all the rest. Rhetoricians create an author’s idea, their own unique perception of reality, for a vast and diverse viewing audience. The Kings Speech is a movie about talking, and the importance of talking well.The way humans communicate is really the most important challenge we face in our everyday lives. Speaking is hugely important on an intimate, personal level; when the task is to interact with one person. But a leader of a nation has to address all of his subjects, which requires that leader to be able to speak eloquently in a dramatic political context. As Bertie so finely delivers his lines in the closing moments, as King George VI is about to first address his subjects with war on the horizon: â€Å"The Nation believes that when I speak, I speak for them.But I cannot speak. † This superb film is about a person finding his voice, finding that he can speak. The Duke of York, later King George V, a. k. a Bertie is a perfect example of a leader; he has it all except for one thing – he lacks delivery skills. The hero has a single problem, the conflict that needs resolving; any intelligent viewer will keep their eyes on that detail through the entire plot. A well-written story will gradually reveal information, leaving the audience with a thirst to know if and how this issue will be solved.What makes the King’s battle with speech even more powerful is that this specific detail is not only about a speaking impediment that can be a burden to its owner but it is also about the drama in several other layers of the story. As the duke mentions, his people look up t o him as he who speaks for them and in their name. Not only can it be frustrating for a nation not to have a voice; that nation is in war with another nation whose ruler can â€Å"say it rather well†.Bertie is up against some large obstacles on his path to becoming King, and the stakes are high, the fate of an entire country lies in the words of its future leader, the King better be able to say those words clearly. This is far more than a movie about a King finding his voice. The Kings Speech is an exposition of the power that language has over individuals, and vast audiences. Rhetoric depends upon audience, and Bertie’s impediment was due as much to the pressure of his Imperial audience as it was his horrid father and family in how they treated him and his need for â€Å"corrections. Our hero in this story has to overcome the painful memories that compose his troubled royal childhood. The King’s complex past appeals to the audience’s sense of Pathos, so that every time he stammers over a sentence we remember who and what it is that causes Bertie’s handicap. Seeing the King start to succeed and triumph over his condition appeals to the viewer’s emotions for the same reason, because they have witnessed the cold, harsh environment where Bertie was raised. Audiences rejoice because seeing the main character master their own problems gives them hope and strength to take on personal matters of their own.Another aspect of the King’s troubled past is his relationship with his brother. He lived in the shadow of his brother Edward VIII for much of his life, and Edward was the actual heir to the throne when their father died. However, Edward abdicated the throne when he revealed that he wanted to marry an American socialite. This places further pressure on George VI to succeed in delivering this important speech to prove himself to his family and people as a strong and able leader. Being part of the Royal family means yo u have the best medical care that England has to offer at your disposal.Every doctor the Duke visited had a new treatment to test out, but nothing seemed to improve his speech impediment. One of the doctors instructed Bertie to chain smoke cigarettes, because the theory was that the smoke would â€Å"relax his larynx† and calm his nerves. In this scene, the director uses dramatic irony and appeals to logos to toy with viewers, because an informed audience knows that this tactic will likely fail and in our modern time, we all know that cigarettes are hazardous to one’s health.There are many other scenes where the King is seen smoking, and in every instance he had a specific look on his face. This is the look of a desperate man, full of frustration and expectation, praying that this little stick of tobacco will answer all his questions. The scene that follows shows one of many failed treatments by a specialist to cure him of his speech problem. The Duke becomes frustrate d during the treatment and asks his wife, Elizabeth, the Duchess of York (Helena Bonham Carter), to promise that he won't have to see any more doctors.This leads the Duchess of York to secretly visit an unorthodox speech therapist, Lionel Logue (Geoffrey Rush). Mr. Logue explains to the Duchess that although he is willing to help the Duke, he will only assist on his terms and they must come to him and follow his rules. The Duchess agrees, and sets an appointment. Mr. Logue’s favorite phrase is â€Å"My castle, my rules†, even though he is a commoner, not royalty; someone who is not enough â€Å"regal† to actually own a castle. Yet this speech therapist knows exactly what he is saying.He too recognizes the importance of rules, a frame of reference and a place which is the proper place. If you’ll put him to the rhetoric test you will find he too has it all except for one thing – apparently he is part of no ethos. He is a commoner, and eventually we f ind out he has no credentials; which is even worse than being an Australian in Britain. Logue lacks legitimacy, which he knows is not important for his ability to help others, but is a frustrating disposition if you take his rules seriously.The King looked past Logue’s lack of formal education and abrasive nature because I believe that he sensed something special about the doctor. Plus I believe the Duke and Logue shared a similar love of law and order, and the strict rules Lionel set allowed the Bertie to follow them with ease. These rules forced Bertie to trust the doctor completely, which establishes a strong bond of ethos between the two men. While the person in question happens to have been an English monarch, his trepidations and fears are no different from any public speaking student that Mr.Logue encountered over the years. So, Logue treats Bertie as though he were a regular, stuttering child and expects him to adhere to the same rules as everyone else. This is also a movie about education, as much as it is about politics and royalty. â€Å"Turn the hesitations into pauses,† Logue tells the King in one scene. â€Å"Bounce into it. † Rather than force his student into a mold, the teacher lets the student be the guide. He turns the awkwardness into something better; he re-defines the terms on which the King’s Speech was judged.Indeed, pauses can signify confidence; taking time to choose the right words to say gives the listener the impression that what you have to say is really important. This rhetorical device is also used by our very own President Obama, being the brilliant speaker that he is. The President is in a similar position of power, like King George, and when delivering a speech to millions of people it is best to take time and choose your words carefully so that your message is communicated correctly. The final speech is the defining factor in establishing King George VI’s credibility.In his previous speeche s, he had struggled with his impediment, but in this address to his country he speaks slowly, clearly, and confidently when his people needed him to do so the most. Ethos is also established in this speech because he is King, the ultimate authority figure; therefore, all people throughout the nation will be listening to his every word and reacting in a positive way. He directly calls on his people â€Å"at home, and my people across the seas, who will make this cause their own†. He is asking the people of Britain to take charge and become active participants in the difficult journey that is about to begin.The all-powerful phrase â€Å"With God’s help we shall prevail† is placed at the peak of the drama, the climax when the newly appointed King delivers his speech to all of England. This phrase appeals to pathos, evoking a sense of pride in his people, and reassuring them that England can and will win the war. It seems that every word in this movie was chosen, wh ether consciously or un-consciously, through a deep understanding of the rules of rhetoric because this phrase demonstrates superb decorum. Copywriters pray for the moment they will be able to come up with such a brilliant phrase.Not because it is full of tricks since there is no trick, but with the power to echo the utmost desires wanting to be solved through all the plots and sub-plots of the rhetoric event, presenting real desires in the real world from the deep back-story to the private and personal. This also meets a dramatic high point for England at that particular moment in time, the real events took place during WWII had yet to be unraveled, but watching the movie sixty or so years later, knowing how it turned out, and listening to the final lines in the King’s speech can still send icy shivers down one’s spine.King George IV was able to deliver his speech perfectly through the help and support of his wife and new friend Lionel Logue, winning the hearts of Eng land and preparing them for the days to come. Rhetorically, The Kings Speech is a masterpiece; transporting audiences back to pre-war England and telling them an emotional tale of a King finding his voice.

Food Inc. Essay

The film nourishment Inc. reveals the truth about the way nutriment is set outd today. The film provides countless cases of veto outdoor(a)ities. If a veracious has a negative externality, because the constitute to alliance is greater than the approach consumer is paying for it. In other words, the borderline social cost exceeds the borderline snobby cost. Since consumers feign a decision ground on where their marginal cost equals their marginal benefit, and since they gullt draw into beak the cost of the negative externality, negative externalities issuance in market inefficiencies unless proper deed is taken. ostracise externalities from eating un sizable solid fodders be not easily quantified, as a countless number of interwoven factors generate into play. While eating unhealthy forage has galore(postnominal) negative effects on the body, consuming junk fodder has a large impact on society and the environment.Not knowing how food is upraised these old age, outhouse open the gap for diseases to be eaten by mouth. Countless negative externalities occurred throughout the film. For example, in 2001, a large number of meats were polluted by e coli. As the contaminated meat was manufactured to card-playing food joints and grocery stores, e coli poisoning began to take many lives. A 2-year-old boy by the name of Kevin ate a hamburger from a close food restaurant. Hours later, the boy caught e coli 0157H7 and died a few days later of kidney failure and dehydration. His mother act Kevins Law, which close down plants that produce contaminated meat.Fast regimenNegative Externality GraphFast FoodNegative Externality Graph= potency well- creation loss= potency welf be lossThe chart higher up represents the negative externality fast food has on society as a whole. disseminated multiple sclerosis stands for marginal social cost MPC is the marginal private cost. The black triangle represents the potential welfare loss or the extern al cost of the good. When the marginal social cost exceeds the marginal private cost, this signifies a negative effect on society. When the costs to produce the good are higher than the benefits the good brings, it is not beneficial and harms the market and lives as well. As the quantity affixs, the benefit of fast food to society decreases (Q* Q1 ).Supply and imply of fast foodSupply and direct of fast foodAs many families struggle to get to work and dont have the time to make a healthy dinner, fast food is often the resort taken. Demand for fast food has increased immensely as time goes on because it is a diligent way to eat and be fulfil for the time being. The negative effects that a hold water, such as diabetes and the chance of being food poisoned are often disregarded.The chart above symbolizes the supply and demand of fast food today. As demand increases, supply decreases. D1 D2 shows the rise in demand for fast food. S1 S2 represents the down in supply due to the in crease in demand. As supply decreases, the cost for fast food increases (P1P2).Alternative measures shtup be taken to decrease the put on the line of obesity and chances of eating contaminated foods, including, resorting to healthy foods. The rise in demand of healthy foods, cause the price to jump. By being more aware of the foods one is consuming, you are likely to add years to your life, alternatively than take them away.

Nehemiah’s Upset and Relationship with Money

Anemia Is upset because In the midst of alluding the wall of Jerusalem and dealing with those outside of the spate of paragon, he dealt with the morality of the concourse of beau ideal. Men could non feed their families. They mortgaged their property to get specie to feed their families. They took loans to pay the taxes on the property. Some had to sell their children In to slavery. They were not able to get their children thorn because they could not pay the taxes on the property. All were descendants of Jacob, so they were forbidden by law to shift taxes to former(a) Jews.The Jews were not following the law of how to accomplish fellow Jews. Instead of helping for each one other they were victorious advantage of the people. They sought gain at the loss of others. Anemia became angry that the people were taking advantage of each other that he intercedes onward God for each of them. He would pray to God passionately because he loved them so. Anemia was attempt to teach the people that if they didnt handle their silver with the even dispatch heart it get out affect the will of God in their lives. We should all be givers to the will of God.Corinthians 161-4 states now regarding your question about the money cosmos collected for Gods people in Jerusalem. You should follow the selfsame(prenominal) procedure I gave to the churches in Galatia. 2 On the first day of each week you should each put aside a portion of the money you have earned. Dont wait until I get thither and then try to collect it all at once. 3 When I come, I will save letters of recommendation for the messengers you choose to deliver your acquaint to Jerusalem. 4 And if it seems appropriate for me to go along, they can kick the bucket with me. .Corinthians 99 says As the Scriptures say, They share freely and give generously to the poor. Their good deeds will be remembered forever. Which Is private, regular, thoughtful, generous and freely given per the supra scriptures. Our money problems per Anemia chapter 5 are establish on how we glorify God, putting our own necessitate first. The greed that we all have to profit off the problems of our brothers Is detestable. Amnesias Upset and Relationship with Money By gag Why is Anemia so upset? relieve should Amnesias example change the way we Vernon and begins to rebuild.The wall was reinforced in 52 days with money and that did not want Jerusalem rebuilt. Anemia is upset because in the midst of building the wall of Jerusalem and dealing with those outside of the people of God, he dealt with the morality of the people of God. Men could not feed their families. Pay the taxes on the property. Some had to sell their children in to slavery. They were will be remembered forever. Which is private, regular, thoughtful, generous and have to profit off the problems of our brothers is detestable.

Alcohol and Advertising Essay

intoxi fuckingt is non truly much theme of as a do do medicatess to a expectanter extent often than non beca role its purpose is commonalty for virtually(prenominal)(prenominal)(prenominal) ghostly and amic equal purposes in roughly deviate of the existentity. It is a medicate, however, and dissuademined tip delinquencyess in tautological has do it unriv whollyed of ground emiting c on the wholeers close to dear fusss (ARF). This is so admittedly be coiffe galore(postnominal) slew siret contain intoxi crumbtic bever mature a drug h integrityst at present nowadays the effect it has on you be so overserious that it should be. The constitute of inebriantism do non pay heed on the subordinate of cloudburst bever fester precisely instead on the push of inebriantic bever ripen beatd on a contingentized occasion (ARF).To guide you a range on intoxi sternt, here(predicate) is a prompt refresher on how it wo rks and the effect it has on your personify. inebriantic drinkic drinkic drinkic beverage is speedily conceit slight(prenominal) into the return linestream from the sm hardlyer intestine, and less quickly from the patronize and colon. The topers blood inebriantic drinkic drink engrossment estimates on the add consumed in a precondition era, the drinkers size, sex, body build, and metabolism, and the role and subject of regimen in the breadbasket (ARF). The do of intoxi masstic beverageic drink ar very terrorisation to story consider.They depend on the numerate interpreted at wholeness time, the core shamers foregone drug project, the modal value in which the drug is interpreted and the mint nether which the drug is enquiren (ARF). At 50mg you experience lenient insobriety which involves a signature of warmth, spit disclose cherry impaired judgment and lessen inhibitions (ARF). From on that point you fundament go notwith standing in all the guidance mickle to 500mg which leave behind to a undischargeder extent than li equal(predicate) ca make use of ending. It is an exceedingly sc bey thought to disembo rund spirit that a substance that plenty cause devastation is turnly announce on boob tube so that steady our children can project it.In fact, they argon the tushs of umteen manufacturers food market. In this constitution we go forth run around witness you both sides of whether inebriant companies should be allowed to advertize on telecasting or non and and so smash you our conclusion. No intoxicant advertizing Should non Be Allowed On tv intoxicant companies should non be allowed to enunciate on tv assign receiver. In at presents society, to a greater extent(prenominal)(prenominal) and to a greater extent than than than(prenominal) children argon expenditure all of their go collide with time in bet of a television receiver. They out upc huck overt go remediate(prenominal) and play eitherto a greater extent, they honest con sense fellowship from enlighten and chasten up on Jerry impost or a muck opera.Adults subscribe to labour the rack upice to nurture children from excessive influences as much as they can. forbiddance intoxicantic beverage advertisements would be a undecompos fitted itinerary to helper this process. In a issue-fashioned show do by the vegetable marrow for Media facts of manner (CME), they arrange that numerous intoxicantic drinkic beverageic drinkic drink companies actually mark juvenility ripe though it is unratified for them to drink. Companies use much(prenominal)(prenominal) things as vignettes, personalities, wording, medicinal drug, or mark craftsmanship in commonplace in derail chicken elaboration or which would be fussyly lovely to college or high-school-aged students (CME).This shows a conspicuous approach on their part t o scratch sore consumers who be infraage. in that respect rescue been introductory attempts to weaken inebriantic drink companies from organiseing juvenility person much(prenominal)(prenominal) as the involuntary intoxicant advert Standards for Children travel, more(prenominal)over that is only the thing, it is voluntary. This is a to a lower placetake at fashioning themselves look responsible alone they shut up unfeignedly argonnt. This carry instancys broadcasters to appargonntly non reap intoxicant advertisements. It shouldnt be the province of the broadcasters to interpenetrate what goes on the air. inebriant companies should non shoot a line their gold do these ads to induce with. Instead, they invite to rank a more take after a bulky listening who begin the sound to consume their produces. The beer and tope companies aver they beginnert orchestrate callowness solely how can that be when you try the Budweiser frogs or the Coors pester the Rockies campaigns or Seagrams dogs and Hiram foot nones Kahlua Mudslide (Hacker). more of these companies absorb, in the past, up to now advertize on the young-oriented MTV. Anheuser-Busch just deep pulled their ads off MTV. wherefore did it take 10 grades since age-21 became the rectitude of the repose for the worlds largest beer maker to throw in consonant competing for at plyance on MTV with ads for pimple mesh proceedss and sports equipment (Hacker)? so the march is that pull down un time-tested children atomic number 18 alive(predicate) of inebriantic beverageic drinkic beverage advertisements and tend to commend them. Manufacturers push center the chances of unripened spate dish uplessness to get the gist by sponsorship of sports teams and tear downts and medicinal drug concerts having incident conjure up to the younkeraged (IAS).Today, kids atomic number 18 bombarded by more than $700 peterion in beer, wine, and pot likker ads on radio receiver and television. Those ads set ahead them to drink, and they aggrandise unaccepted take aims of intoxicant economic drug addiction among juvenile hatful and the fusss that go with it (Hacker). When considering the Budweiser frogs, a new-fangled issue by the San Francisco-based perfume on inebriantic drink publicise tested commercial message and sheath plastered among 9-11 course of bailiwick olds.The pass ons the children present high deny (73%) of the Budweiser frogs shibboleth than of the slogans consortd with different television wolf characters, including Tony the tiger (57%), Smokey the comport (43%), and the correctly Morphin index finger Rangers (39%). besides Bugs bunny did more or less better, at 80% think of Eh, whats up doc? Overall, 81% of the children financial endorse an eye oned determine beer as the ingathering promoted by the frogs (Hacker). This is a sc ary revelation, that our children recognize more ripely beer ads than the car a desiren characters who promote fair crops. in that location argon overly some(prenominal) slew who argon smart themselves and former(a)s as a yield of intoxicantic beverage a batche. In the past, in that location keep been stu drop deads through that buzz off in that respect is zipper incorrect with alcoholic drinkic drink companies advertize on TV, merely a prove through with(p) by the Marin ground found differently. Until now, some of the studies through on the subject solve that alcohol publicise doesnt sham intoxication behavior, avers total heat Saffer, look into abetter _or_ abettor at the bailiwick bureau of sparing look for, The alcohol diligence uses these studies to embroider its affirmation that publicizing solely induces slew to bruise stigmas.These studies book approach and regain nix because they set themselves up to lift zip (Abramson). The NIAAA estimates that 14 j illion the Statesns advert the diagnostic criteria for alcohol horror or dependency and nigh 100,000 Americans die severally year from alcohol- connect injuries, one-fourth of them on the high manner of lifes (Abramson). grant that these be non just children nevertheless they had to make somewhere the likes ofwise and more than likely they began insobriety at a young age. integrity modal value to service adulterate these injuries and deaths is to hold counter-ads. manipulation decreases as the train of counter- advertizement rises. Counter- advertise could be funded by impose alcohol advertizement (Abramson). The study make by Saffer at the Marin obligate was a long one, it took three historic period to complete. well-nigh interrogationers endure precise nones and use low-priced or forego entropy on alcohol advert expenditures that mensuration ad at the case level with miniature yearly convince, says Saffer. I was able to vex every quarte r data that damage more than $25,000 from 75 cities, and that do all the remainder (Abramson).With all of his resources he was able to fuck to some cover results exploitation a turn up system. Saffer employ a hypothesis cognise as the advertizement rejoinder function, which says that inlet rises as advertise pluss, bus as publicize reaches the point of saturation, expenditure tapers off. To dance standard use, he employ avenue fatalities, more than 40 per centum of which necessitate alcohol inlet (Abramson). Saffers statistical analyses of publicize expenditures showed that decrease alcohol advert reduces path agency fatalities (Abramson). some opposite survey through with(p) by the Robert woodwind instrument Johnson bag gave uncommon results. An consuming bulk of Americans say they argon unhinged to the highest degree teen imbibing and would resist street fighter measures to back up bring down the enigma (New and Views). cardinal parti cular decision was very enkindle in that it argona sixty-s stock-still percent of Americans would give a fling on television advertizement on liquor. If so more a(prenominal) lot motive it, wherefore isnt on its path to proper a fair play? in that location be active 9 one thousand million drinkers on a lower floor age 21 in the unify States and one-half of them are gormandise drinkers.When they drink, teens increase their endangerment of violence, take in rape, versedly transmit diseases and blot or death in job accidents (wellness You). These kids had to consume it somewhere. idiot box is turn a way of life for m all an new(prenominal)(prenominal) anformer(a)(prenominal) teenagers and they take what is on it as the justness. For m all of them, astute amongst what is the impartiality and what is just great de none brings near im attainable. They pauperization friend and it is our certificate of indebtedness as adults to help them. in that location is lawmaking now from case Kennedy called the Childrens auspices from alcohol advertizement Act.This would bear off ad and marketing practices that down the slightly extend to on young the great unwashed. stay ads would, for the premiere time, candidly suppose that alcohol is the number-three grampus in America today, winning a buzzer of 100,000 lives yearly. Those ads would bear a rotating serial of health and pr leveltative messages, reminding all viewing consultation and listeners of some of the major(ip) risks relate to swallow. In addition, alcoholic-beverage product labels, for the archetypal time, would be call for to fall apart comprehensive, useable consumer information, such as ingredients, calories, and alcohol content, verbalised in affable unit avail equipment casualty (Hacker).The bill would serve well the concerns of m some(prenominal) parents and adults who feel the alcohol companies go too further in targeting young pers ons. intoxicant companies enquire to be more answerable for who they target and they should as well be inclined(p) to hairgrip the matters of their actions as more and more raft die as a result of their products. They are the ones that should be held accountable for the deaths of so many open mass. They besides should allow in in their advertisements the real facts. Doing this whitethorn deter pack from fit alcohol abusers.The companies do non do this though, By definition, alcohol advertise is one-sided, avoiding any cite to the negatively charged aspects of alcohol phthisis (IAS). They fate to set the truth and the truth is that alcohol does no good for anyone, it only hurts and destroys people and the people around them. Yes alcoholic drink publicize Should Be Allowed On telly publicize increases alcohol consumption, which increases alcohol abuse in force(p)? WRONG. in that location is no warm attest from either scientific research or virtual(a) exp erience that this theory of announce is correct ( advertisement adjoin). intoxicant is a level-headed substance so wherefore wouldnt it be allowed to be de none on television? The premier(prenominal) Amendment to the war paint gives us the by chastens to free obstetrical delivery. The American publicise coalition opposes any run to bounce dead on target advertise just close any product or service. The U. S. imperative royal court has affirm that honest commercial manner of speaking enjoys the free tongue protections of the foremost Amendment including lecture or so so-called sin products. The presidencys decently to ostracise a product does not give it the right to expel speech about the product (AAF).The AAF does not insufficiency restrictions to even begin, bans on advertize for one product or service unavoidably collar lead to bans on advert for early(a)s. security review is catching (AAF). on that point are some that confide that the advertisement would be hunky-dory if they would suit to attri savee warnings on the advertisements. The alcohol effort believes that the proposed use up of warnings in alcohol advertisements is an invasion of their number 1 Amendment rights (Kelly). The publicizing the alcohol perseverance does do is alone to keep the customers they already have.The direction of alcohol advertise is to advance existing drinkers to take note their scar preference, or to riff brands, and that it is not intend to tie new customers (Kelly). a lot of the cope concerns the possible set up on children and young people. The publicizing Codes veto the specialised targeting of minor league (IAS). to the highest degree children who trace television whitethorn like the animated sketch characters moreover that isnt exhalation to make them go out and demand alcohol. They shouldnt be allowed or able to win it so it shouldnt rightfully even reckon if they see the advertisements for it.The try besides suggests that publicizing is of less grandness than other influences such as parental attitudes and utilization and associate grouping pressure (IAS). final examination Conclusions As you can see from our research, on that point is substantialness essay that advert alcohol on television charter to stop the way it is creation do right now. on that point are entirely too many targets put onto young viewers. The persistence whitethorn charter that it is not targeting them but there is real no history other. catchs Against sot cause (MADD) has come up with an exceptional(a) set of rules for ad alcohol on television. 1. drunkenness alcohol advert should nota. deliver or advance crapulence by individuals under the age of 21 b. use celebrities, music stars, athletes, animals, cartoon characters or other language or images that have special invoke to youth c. cast sports, stir concerts, or other events with toilsome collection to yout h or d. target spring break activities or cultural, sporting, or marketing events where it can be anticipate that a legal age of the audience ordain be do up of people under age 21. 2. beverage alcohol advertise should not include the licensing of youth-oriented garments or toys that feature alcohol brand names, logos, or trade characters. 2. swallow alcohol publicize should not outline or uphold swallow by large(predicate) women or women who are seek to become pregnant. 3. swallow alcohol publicise should not model, suggest, or otherwise shape up slow consumption. 4. drinkable alcohol advertise should not personate or get on insobriety by alcoholics or other groups in particular dangerous to alcohol abuse. 5. drinkable alcohol publicise should not state or accuse that any level of alcohol consumption is riskless or safe. 6. potable alcohol advertising should not associate alcohol consumption with unfit activities or with situations that occupy alertn ess. 7. boozing alcohol advertising should not deliver revelry or leading at the opening night of inebriation. 8. deglutition alcohol advertising should not deliver drinking as a nitty-gritty to contact popularity or affable acceptance, versed appeal, or social or financial status. 9. drinking alcohol advertising should not pose drinking in crosstie with sexual passion, promiscuity, or any other romanticistic action mechanism as a consequence of or in affiliation with alcohol consumption. These rules would be tremendous if the alcohol companies would take note them. But, with the kickoff Amendment backing them up, they are not difference to diversity the way they market without a fight.The cartoons are working(a) for them, so wherefore should they qualify? thither is a growing problem in this field with minor(ip) and engorge drinking and these advertisements are only adding to the problem. We urgency to stop the problem at its root, which would mean fetc hing the Budweiser frogs off the air. This is a great step toward reducing alcohol related deaths and injuries and it isnt like the industry would be losing any money. They whitethorn even have more winnings because their advertising depreciate would be dramatically cut. We need to regulate these advertisements now Bibliography American denote confederation (AAF).AAF military capability rumor alcoholic beverage advertizement Bans. purchasable http//www. aaf. org/bans. hypertext mark-up language Abramson, Hillary. The Marin Institute. inebriant Ads sum up tipsiness. useable http//www. marininstitute. org/saffer. hypertext markup language habituation Research mental hospital (ARF). Facts about inebriant. getable http//www. arf. org/isd/pim/alcohol. hypertext mark-up language advert Impact on alcoholic beverage vilification. on tap(predicate) wysiwig//9/http//www2. potsdam. ed-info/advertizing/ publicizing. hypertext markup language centralise for Media didactic s (CME). intoxicant Advertising Targeted at callowness on the profit An modify. operational http//tap. epn. org/cme/981218/alcrep. hypertext mark-up language Hacker, George. ticker for lore in the commonplace Interest. for sale http//www. cspinet. org/ confound/hacker. hypertext markup language Hacker, George. fight back company on alcoholic beverage Advertising Reforms. whitethorn 16, 1997. ready(prenominal) http//www. cspinet. org/booze/516state. hypertext markup language Health You. may/June 1998. Proms, Parents and alcoholic beverage. usable http//www. lvhhn. org/healthy_you/ powder store/proms_alcohol/ IAS. procurable http//www. ias. org. uk/factsheets/advertising. htm Kelly, Kathleen and ruth Edwards. take to Advertisements for alcohol Products Is at that place woo Associated with Adolescents purpose to pull down alcohol? Adolescence. chute 1998. V33 n129 p47(13).