Helicobacter Pylori Treatment and Rosacea

Helicobacter Pylori Treatment and Rosacea Running title: Helicobacter Pylori Treatment and Rosacea Parviz Saleh1, Mohammad Naghavi-Behzad2, Hamdieh Herizchi3, Fatemeh Mokhtari3, Mohammad Mirza-Aghazadeh-Attari2 , Reza Piri4* 1- Chronic Kidney Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran 2- Students Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran 3-Department of dermatology, Tabriz University of Medical Sciences, Tabriz, Iran 4- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Effects of Helicobacter pylori Treatment on Rosacea: a Single Arm Clinical Trial Study Abstract: Rosacea is a chronic dermatologic disease. Helicobacter pylori has been discussed as one of its causative factors. In this clinical trial study, it was tried to evaluate the effect of H. pylori standard eradication protocol on the rosacea clinical course. In this single-arm clinical trial, patients with approved H. pylori infection based on serological studies were assessed to examine rosacea existence. Then, the patients with concurrent rosacea and H. pylori infection were included in the study and underwent a standard Helicobacter pylori eradication therapy. Rosacea was evaluated using Duluth rosacea grading score at beginning, 2 months later, and at the end of the trial (day 180). Of 872 patients with positive H. pylori, 167 patients (19.15%) manifested the clinical features of rosacea. The patients with concurrent rosacea were younger (p Keywords: Rosacea, Helicobacter pylori, Prevalence, Eradication, Treatment Effects of Helicobacter pylori Treatment on Rosacea Introduction: Rosacea is a chronic dermatological disorder mostly affects facial convexities, which is characterized by telangiectasia, flushing and papulopustular changes (1, 2). These findings tend to be in cluster patterns, which allow identification of different subgroups of patients. In other words, rosacea includes a wide spectrum of dermatological manifestations with different severities (3-5). Pathogenesis of rosacea is thought be related to vascular changes, but the main process of pathogenesis for rosacea is still unknown. A combination of dermal connective tissue damage and vascular dysfunction consisting endothelial damage, impaired reactivity, and autonomic dysfunction has been proposed (5-9). So researchers have always tried to reveal the pathophysiology process by proposing possible pathogenic factors such as solar irradiation, sensitivity to noxious stimuli, change in redox status, and the presence of parasitic mites (Demodex folliculorum) (10-14). The role of Helicobacter pylori related gastritis in the pathogenesis of rosacea has been also a subject of controversy. Diverse prevalence of H. pylori infection has been reported among rosacea patients (15-21), ranging from zero to 100%. Some studies have suggested that rosacea could be considered as an extra-gastric symptom of H. pylori infection or reported improved rosacea clinical course post H. pylori eradication (22) (23), while others concluded no significant relationship between H. pylori infection and rosacea (24, 25). Based on our literature review, no confident and precise conclusion has been made about any change in the clinical course of rosacea after H. pylori eradication yet today. So the present clinical trial aimed to evaluate changes in the clinical course of rosacea after H. pylori eradication by standard treatment protocol. Subjects and Methods Study design In this single-arm clinical trial which was conducted in clinical-educational centers of Tabriz University of Medical Sciences (Tabriz, Iran) from May 2013 to November 2015, patients with proved H. pylori infection based on serological study were screened for evaluation of concurrent rosacea disease. Then, the patients with concurrent rosacea clinical presentation and H. pylori infection were enrolled into the study. Considering sample number limitation, sampling was performed during a year to calculate sample size, then study power was calculated 0.85 according to that number of samples. Rosacea severity was graded using Duluth rosacea grading score (26) before and after H. pylori eradication protocol. Finally, the patients were examined 2 and 6 months after medication, to compare dermatological findings of rosacea with primary findings. All participants were provided an informed written consent, and the study protocol was in compliance with the Helsinki Declaration and was approved by the Ethics Committee of Tabriz University of Medical Sciences. In all stages of study patients information were anonymous and based on codes and patients could refuse to take part in the study at any stage. This study is registered at Iranian Registry of Clinical Trials (IRCT2015051418946N3). Study population All patients who were 20-65 years old, with confirmed H. pylori infection and active rosacea, attending clinical-educational centers of TUMS were included in the study. Prior H. pylori eradication treatment, the existence of any other dermatologic problem, allergy to clarithromycin or omeprazole, antibiotic therapy within past 2 months, topical treatment of rosacea in past 3 weeks, history of hospitalization in past 6 months, pregnancy and breastfeeding, patients were considered as exclusion criteria of the study. H. pylori infection evaluation H. pylori stool antigen test was implicated to confirm H. pylori infection before enrolling the patients into this study (day 0) and to confirm H. pylori eradication (day 60). Stool samples were collected in a standard container. In the laboratory, using an applicator stick 4-5 mm of stool was transferred in a diluent vial, then it was vortexed for 20 seconds. Then, 4 drops of vial were dispensed in ImmunoCard STAT HpSA kit (Meridian Diagnostics, Inc., OH, USA); positive predictive value of this test was 89.3% based on literature (27). The positive and negative results were concluded based on the manufacturers recommendation. Rosacea evaluation Rosacea severity was evaluated using Duluth rosacea grading score (26) at beginning (day 0), 2 months later (day 60), and at end of the trial (day 180). Dermatology team examined rosacea based on detecting primary and secondary signs and symptoms of rosacea and graded them as absent, mild, moderate, or severe (0-3), based on the Duluth scoring system. Primary features of rosacea included: flushing (transient erythema), non-transient erythema, papules and pustules, telangiectasia. Secondary features included: burning or stinging, plaques, dry appearance, edema, ocular manifestations, peripheral location (present or absent), phymatous changes. Finally, rosacea condition was compared in day 0, day 60, and day 180 by the same team. H. pylori treatment Standard two-week triple therapy was administered to eradicate H. pylori, including metronidazole 500 mg orally twice per day, clarithromycin 500 mg orally twice per day, and pantoprazole 40 mg orally per day. Primary and secondary outcomes The primary outcome was the severity of rosacea before and after H. Pylori eradication. Secondary outcomes were H. Pylori eradication rate and prevalence of rosacea among patients with H. Pylori and demographic differences between H. Pylori positive patients with rosacea and without rosacea. Demographic and outcome measurement All demographic information was collected at patients enrollment time. Patients rosacea stage was evaluated on day 0, 60, and 180, then they were compared. Same dermatology team reevaluated clinical course of rosacea to decrease inter-observer error. Statistical methods Statistical analysis was performed by SPSS software package, version 16.0, for windows (SPSS Inc.). Quantitative data are presented as mean  ± standard deviation (SD), while qualitative data are demonstrated as frequency and percent (%). Paired sample t-test, chi-square, and Friedman test were used for analysis of data. Mann-Whitney U test was used to compare between groups and Wilcoxon ranked sum test was used to compare within groups. Probable confounding factors were considered as inclusion and exclusion criteria. However, some factors which could have been confounding factors were analyzed using multivariate analysis but they were not presented in results the section. P value less than 0.05 was considered statistically significant. Normal distribution of data was assessed using Kolmogorov-Smirnov test. Results In the present study 872 patients with positive H. pylori stool antigen were assessed by dermatologists team. Of 872 patients, 167 patients had clinical features of rosacea. Some demographic information about patients is shown in Table 1; of all patients with a positive test for H. pylori, patients diagnosed with rosacea had lower ages (p>0.001) and the difference in gender composition was also statistically significant (p=0.034); in this conclusion, multivariate analysis was used. Based on the results, rosacea prevalence among patients with positive H. pylori stool antigen was 19.15% (167/875). Of 167 patients with positive H. pylori stool antigen and rosacea, 17 patients rejected to take part in the study while 150 patients agreed. Of 150 patients who underwent H.pylori eradication therapy, 138 (92%) had negative H. pylori stool antigen (successful treatment) at the end of the trial. Rosacea Duluth score at day 0, 60 and 180 was 15.55 ±4.34, 14.11 ±3.96 and 12.57 ±3.62, respectively; the differences between all stages were statistically significant (p Based on Wilcoxon signed-rank test, comparison of primary and secondary features of rosacea between stages of study is shown in table 3; Of secondary rosacea features, burning or stinging, plaques, dry appearance edema and ocular manifestations the difference between two stages of study were mostly significant; but the differences for peripheral involvement and phymatous change were mostly not statistically significant. Discussion Rosacea as a chronic dermatological disease, with an almost unknown pathogenesis process so far, has been the subject of many studies. One of the proposed pathogenic processes attributed to rosacea is gastric infection with H. pylori, so many researchers have tried to examine this association by trying to investigate the correlation between H. pylori infection and rosacea or by observing changes of rosacea after H. pylori eradication. Based in the present study, Prevalence of rosacea among H. Pylori positive patients was 19.15% in this study, which seems as twice as the highest reported rate in other populations, ranging from 1-10% (2, 28-31). This different has been correlated to various variables including race, culture and diet of these. In a study by Argenziano et al. potential association between rosacea and serological evidence of H. pylori infection was investigated and they concluded that there is a significant association between rosacea and H. pylori infection (32), while A bram et al. evaluated several suspected risk factors for rosacea and concluded that there was no statistically significant differences between rosacea patients and those of control group (33). Patients with rosacea and H. pylori infection had female gender predominance and lower age in comparison to those suffering only H. pylori infection. H. pylori cure rate after routine triple therapy was 92%. During 6 months of follow-up, H. pylori eradication among those who had rosacea and H. pylori infection led to a significant improvement in rosacea condition based on Duluth score grading. There was a significant decrease in intensity of almost all primary and secondary criteria except phymatous changes, telangiectasia, and peripheral involvement; this difference in phymatous changes, telangiectasia, and peripheral involvement might be due to the more time taking nature of these criteria to be resolved. Based on the literature, diverse conclusions have been made regarding rosacea resolution after H. pylori eradication. In a study by Szlachcic et al. investigating the link between Helicobacter pylori infection and rosacea, it was concluded that after H. pylori eradication therapy among patients with rosacea and H. pylori infection, H. pylori cure rate was 97%, and in 85% of patients the symptoms of rosacea decreased markedly or disappeared within 2-4 weeks (22); although H. pylori cure rate in the present study is less than that reported in this study, the effect of H. pylori eradication on rosacea is similar in both of the studies. In another study conducted by Rojo et al. on the role of H. pylori in rosacea and chronic urticarial, it was concluded that H. pylori eradication led to a significant improvement both in rosacea (75.6%) and urticarial (85.7%) when compared with control group (22%) in 4 weeks (34); results of that study is similar to what was concluded in the present study, although no precise description of clinical features of rosacea was presented after treatment. On the hand, Bamford et al. in a study investigating effect of treatment of H. pylori infection on rosacea concluded that rosacea was significantly improved after H. pylori eradication, although this improvement was also significant in control group, the difference between the improvement of rosacea was not statistically significant between intervention and control group (35); this fact that both groups had significant improvement in rosacea totally undermined the association of H. pylori infection and rosacea which was concluded in the present study, also in this article the improvement was attributed to probable placebo effect. In another study by Herr et al. relationship between H. pylori and rosacea was examined by evaluating the response of patients with rosacea to H. pylori eradication, and they concluded that there was no statistically significant change in rosacea condition both in intervention and control group, although papulopustules had significantly decreased in interven tion group comparing baseline and follow-up (36), which is the only improvement detected after H. pylori eradication in this study, but in the present study besides improvement of papulopustules, almost all the other clinical manifestations of rosacea had improved. In a study by El-khalawany evaluating the effect of H. pylori eradication in rosacea subtypes it was concluded that H. pylori eradication led to a significant improvement in rosacea, where papulopustular subtype improved significantly more than erythematotelangiectatic subtype (37); these results are similar to the results of present study, since in the present study almost all clinical manifestations of rosacea had decreased while no statistically significant change was shown about telangiectasia. According to the mentioned literature, different conclusions have been derived from studies about the efficacy of H. pylori eradication in rosacea treatment; ranging from significant improvement in rosacea (22) or significant improvement between baseline and follow-up but not when compared to control group (35) to no significant improvement in rosacea. One of the reasons which might be responsible for these diverse conclusions is multifactorial nature of rosacea where ethnic group, bacterial subtypes or genetics might be other confounding factors. One of the main limitations of this study was lack of control group, so it might have affected this study to prevent coming to a precise and confident conclusion, also this might have led to undermining probable placebo effect of administered treatment. The main thought behind not including a control group was not willing to deprive patients of H. pylori treatment where their H. pylori infection had already been proved. Another factor which could have resulted in a more precise and reliable conclusion was including possible confounding factors such as gender, ethnic groups, and occupational environment status and analyzing rosacea improvement while taking confounding factors into account. In conclusion, the present study indicated that prevalence of rosacea among patients with H. pylori infections is slightly more than what literature attribute to different populations, it also showed a statistically significant improvement in rosacea when Duluth scores were compared between baseline and follow-up. Considering the present controversy about the association of H. pylori infection and rosacea, it is suggested that further clinical trials considering multifactorial nature of rosacea take all possible confounding factors into account, also as far as rosacea is a dermatological condition with different manifestations, recognition of alterations in the dermatological pattern of rosacea might lead to a more confident conclusion. Acknowledgments: This Study was supported by Tabriz University of Medical Sciences. Conflict of Interests: No conflict of interests are declared References: 1.Plewig G, Kligman A M. Acne and rosacea: Springer Science Business Media: 2012. 2.Powell F C. Rosacea. New England Journal of Medicine 2005: 352: 793-803. 3.Tan J, Blumeà ¢Ã¢â€š ¬Ã‚ Peytavi U, Ortonne J, et al. An observational crossà ¢Ã¢â€š ¬Ã‚ sectional survey of rosacea: clinical associations and progression between subtypes. British Journal of Dermatology 2013: 169: 555-562. 4.Tan J, Berg M. Rosacea: current state of epidemiology. Journal of the American Academy of Dermatology 2013: 69: S27-S35. 5.Steinhoff M, Buddenkotte J, Aubert J, et al. Clinical, cellular, and molecular aspects in the pathophysiology of rosacea. In: Journal of Investigative Dermatology Symposium Proceedings: Nature Publishing Group, 2011: 2-11. 6.Del Rosso J Q. Advances in Understanding and Managing Rosacea: Part 1 Connecting the Dots Between Pathophysiological Mechanisms and Common Clinical Features of Rosacea with Emphasis on Vascular Changes and Facial Erythema. Journal of Clinical Aesthetic Dermatology 2012: 5. 7.Fimmel S, Abdel-Naser M B, Kutzner H, et al. New aspects of the pathogenesis of rosacea. Drug Discovery Today: Disease Mechanisms 2008: 5: e103-e111. 8.Pouralibaba F, Babaloo Z, Pakdel F, et al. Serum level of interleukin 17 in patients with erosive and non erosive oral lichen planus. J Dent Res Dent Clin Dent Prospects 2013: 7: 91. 9.Naderi N J, Tirgari F, Esmaili F, et al. Vascular endothelial growth factor and Ki-67 antigen expression in relation to age and gender in oral squamous cell carcinoma. J Dent Res Dent Clin Dent Prospects 2012: 6: 103. 10.Tisma V S, Basta-Juzbasic A, Jaganjac M, et al. Oxidative stress and ferritin expression in the skin of patients with rosacea. Journal of the American Academy of Dermatology 2009: 60: 270-276. 11.Guzman-Sanchez D A, Ishiuji Y, Patel T, et al. Enhanced skin blood flow and sensitivity to noxious heat stimuli in papulopustular rosacea. Journal of the American Academy of Dermatology 2007: 57: 800-805. 12.Marks R. The enigma of rosacea. Journal of Dermatological Treatment 2007: 18: 326-328. 13.Lacey N, Delaney S, Kavanagh K, et al. Miteà ¢Ã¢â€š ¬Ã‚ related bacterial antigens stimulate inflammatory cells in rosacea. British Journal of Dermatology 2007: 157: 474-481. 14.Golfroushan F, Azimi H, Ali E T H. Comparison of Efficacy of Topical Combination Solution of Salicylic Acid% 2 and Erythromycin% 4 with Topical Solution of Erythromycin 4% Alone in Mild to Moderate Acne Vulgaris Treatment: A Double-Blinded Randomized Clinical Trial. Medical Journal of Tabriz University of Medical Sciences Health Services 2013: 34. 15.Zandi S, Shamsadini S, Zahedi M, et al. Helicobacter pylori and rosacea. Eastern Mediterranean health journal= La revue de sante de la Mediterranee orientale= al-Majallah al-sihhiyah li-sharq al-mutawassit 2002: 9: 167-171. 16.Hernando-Harder A C, Booken N, Goerdt S, et al. Helicobacter pylori infection and dermatologic diseases. European Journal of Dermatology 2009: 19: 431-444. 17.Elà ¢Ã¢â€š ¬Ã‚ khalawany M, Mahmoud A, Mosbeh A S, et al. Role of Helicobacter pylori in common rosacea subtypes: a genotypic comparative study of Egyptian patients. The Journal of dermatology 2012: 39: 989-995. 18.Bhattarai S, Agrawal S, Rijal A, et al. The study of prevalence of Helicobacter pylori in patients with acne rosacea. Kathmandu University Medical Journal 2014: 10: 49-52. 19.Prelipcean C C, Mihai C, Gogălniceanu P, et al. Extragastric manifestations of Helicobacter pylori infection. Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi 2006: 111: 575-583. 20.Yousefi L, Ghotaslou R, Akhi M T, et al. Frequency of Helicobacter pylori blood-group antigen-binding adhesion 2 and sialic acid binding adhesion genes among dyspeptic patients in Tabriz, Iran: H. pylori babA2 and sabA genes. Journal of Analytical Research in Clinical Medicine 2015: 3. 21.Salehi M R, Aboei M S, Naghsh N, et al. A comparison in prevalence of Helicobacter pylori in the gingival crevicular fluid from subjects with periodontitis and healthy individuals using polymerase chain reaction. J Dent Res Dent Clin Dent Prospects 2013: 7: 238. 22.Szlachcic A. The link between Helicobacter pylori infection and rosacea. Journal of the European Academy of Dermatology and Venereology 2002: 16: 328-333. 23.Tà ¼zà ¼n Y, Keskin S, Kote E. The role of Helicobacter pylori infection in skin diseases: facts and controversies. Clinics in dermatology 2010: 28: 478-482. 24.DakoviĆ¡ Z, VesiĆ¡ S, VukoviĆ¡ J, et al. Ocular rosacea and treatment of symptomatic Helicobacter pylori infection: a case series. Acta dermatovenerologica Alpina, Pannonica, et Adriatica 2007: 16: 83-86. 25.Mayr-Kanhà ¤user S, Krà ¤nke B, Kaddu S, et al. Resolution of granulomatous rosacea after eradication of Helicobacter pylori with clarithromycin, metronidazole and pantoprazole. European journal of gastroenterology hepatology 2001: 13: 1379-1383. 26.Wilkin J, Dahl M, Detmar M, et al. Standard grading system for rosacea: report of the National Rosacea Society Expert Committee on the classification and staging of rosacea. Journal of the American Academy of Dermatology 2004: 50: 907-912. 27.Chisholm S A, Watson C L, Teare E L, et al. Non-invasive diagnosis of Helicobacter pylori infection in adult dyspeptic patients by stool antigen detection: does the rapid immunochromatography test provide a reliable alternative to conventional ELISA kits? Journal of medical microbiology 2004: 53: 623-627. 28.Kyriakis K P, Palamaras I, Terzoudi S, et al. Epidemiologic aspects of rosacea. Journal of the American Academy of Dermatology: 53: 918-919. 29.Tan J, Berg M. Rosacea: Current state of epidemiology. Journal of the American Academy of Dermatology: 69: S27-S35. 30.McAleer M A, Fitzpatrick P, Powell F C. Papulopustular rosacea: Prevalence and relationship to photodamage. Journal of the American Academy of Dermatology 2010: 63: 33-39. 31.Abram K, Silm H, Oona M. Prevalence of Rosacea in an Estonian Working Population Using a Standard Classification. Acta Dermato-Venereologica 2010: 90: 269-273. 32.Argenziano G, Donnarumma G, Arnese P, et al. Incidence of antià ¢Ã¢â€š ¬Ã‚ Helicobacter pylori and antià ¢Ã¢â€š ¬Ã‚ CagA antibodies in rosacea patients. International journal of dermatology 2003: 42: 601-604. 33.Abram K, Silm H, Maaroos H I, et al. Risk factors associated with rosacea. Journal of the European Academy of Dermatology and Venereology 2010: 24: 565-571. 34.Rojo-Garcia J M, Munoz-Perez M A, Escudero J, et al. Helicobacter pylori in rosacea and chronic urticaria. Acta dermato-venereologica 2000: 80: 156-157. 35.Bamford J T, Tilden R L, Blankush J L, et al. Effect of treatment of Helicobacter pylori infection on rosacea. Archives of dermatology 1999: 135: 659-663. 36.Herr C, Hee You C. Relationship between Helicobacter pylori and Rosacea. J Korean Med Sci 2000: 15: 551-554. 37.El-khalawany M, Mahmoud A, Mosbeh A-S, et al. Role of Helicobacter pylori in common rosacea subtypes: A genotypic comparative study of Egyptian patients. The Journal of Dermatology 2012: 39: 989-995. Tables: Table 1. Demographic information about patients with positive H. pylori stool antigen (%) Variables Patients with* P value + HPA without rosacea (N=705) +HPA with rosacea (N=167) Age (years old) 54.38 ±10.71 43.21 ±9.84 Gender 337 (47.81%) female, 368 (52.19%) male 95 (56.89%) female, 72 (43.11%) male 0.03 Marital status Single, Divorced or widowed (643(91.2%)), Married (62(8.8%)) Single, Divorced or widowed (145 (86.82%)), Married (22 (13.18%)) 0.1 +HPA: Positive H. pylori antigen * U Mann-Whitney test was used. **Data are shown as Mean  ± Standard Deviation and number (%) Table 2. Rosacea Duluth grading of patients at day 0, 60 and 180 of trial (N=138)*. Variables Day 0 ** Day 60** Day 180** P value Primary Features Flushing 2.28  ± 0.71 2.02  ± 0.51 1.82  ± 0.52 Non-transient erythema 2.34  ± 0.54 1.9  ± 0.64 1.42  ± 0.72 Papules and pustules 1.8  ± 0.59 1.71  ±0.51 1.58  ± 0.52 Telangiectasia 1.78  ± 0.93 1.72  ±0.67 1.74  ± 0.84 <

August Wilsonâ??s Fences :: essays research papers

August Wilson’s Fences August Wilson''s 1985 Pulitzer Prize-winning play, "Fences" thoughtfully examines the escalating racial tensions in America during the 1950s. The playwright deftly handles such complex social issues as racism and adultery without smug commentary. The subtle discussion of black America offers more insight than lecture, which heightens the dramatic impact upon the audience. Wilson recognizes that the family lies the foundation for American society as a whole, and shrewdly chooses family as the emphasis for "Fences." The play''s central focus is the Maxson''s, the instrument Wilson uses to introduce African-American culture to those who are unfamiliar. In the mid-1950s, America was still experiencing a post-World War II economic boon, and could at last allow foreign affairs to take a back seat to domestic issues. The social climate was becoming increasingly heated with the 1954 Supreme Court decision Brown v. The Board of Education of Topeka, which ruled school segregation was unconstitutional. This landmark ruling ignited racial tensions across America, which had been slowly simmering for years. The protagonist of "Fences" is former baseball player-turned Pittsburgh garbage man Troy Maxson, and the antagonist is clearly racism. It is racism which has defied Troy Maxson at every turn and his skin color stood in the way of his quest to grab a piece of the American dream for himself and his family. Racism creates the conflict, which causes Troy to feel that he has been "fenced" in by a discriminatory society. It has heated tensions within the Maxson home between Troy and his wife, Rose, and Troy and his son Cory. August Wilson establishes an impression of the 53-year-old Troy Maxson early in Act I, writing that he is "a large man with thick, heavy hands; it is this largeness that he strives to fill out and make an accommodation with.

Development of the Aztec, Akkadian and Hittite Empires

Chris Scarre ( 2013, p.198 ) suggests that the development of imperiums was driven by the desire for security, or for economic addition or by the mere personal aspiration of swayers and elites. To what extent do you hold with this statement? Answer utilizing grounds from, and doing mention to, at least three of the undermentioned imperiums: the Aztec, the Roman, the Chinese, the Akkadian and the Hittite. The purpose of this paper is to find as to whether I agree or disagree with the above statement. In order to find the extent of agreement/disagreement, a scope of goaded forces will be explored environing the imperiums of the Aztecs, the Akkadians and the Hittites. To get down with, the word imperium will be defined to give a unequivocal apprehension and how it fits into the three aforementioned imperiums. Empire is defined as: ‘a group of states or peoples ruled over by an emperor, empress, or other powerful crowned head or authorities: normally a district of greater extent than a land, as the former British Empire, Gallic Empire, Russian Empire, Byzantine Empire, or Roman ‘ . ( Oxford Companion to Archaeology, 2012 ) Evidence of suggested forces behind the constitution of imperiums and their possible death will be used to back up any agreement/disagreement. The first imperium to be covered is the Aztecs, which existed during the late Post-Classic period, and located in the dumbly populated basin of Mexico. The Aztecs came to command big countries of Mesoamerica North of the Gulf of Tehuantepec and were the last of the Chichimec folk to go forth their place at Aztlan by drouth or overaˆ?population which my have been the driving force to the constitution of the imperium. The desire for wealth seem to hold progressed when the Aztecs served as soldier of fortunes through which a series of confederations and rebellions formed, ensuing in growing of wealth and metropoliss. To farther confirm the rise of an imperium, the Aztecs took control of an country of 200 000 square kilometers with a public of about 10 million. This demonstrates the push for growing in set uping a powerful imperium. Having exp lored the development affecting the growing of the Aztec imperium. The societal complexness every bit good as the handiness of historical grounds of stuff remains are found amongst the ruins stating the narrative as it unfolded at the clip. To confirm archeological grounds I shall concentrate on the capital, Tenochtitlan ( C. AD 1325 ) , which grew to be the largest and most complex metropolis in the new universe. Archaeological grounds suggests that much of Tenochtitlan was destroyed in 1521 or subsequently demolished by the colonial Spaniards. It was non until the terminal of the fourteenth century that several twelve warring metropolis provinces existed, one in peculiar which demonstrates the desire for wealth is that of Mexica-Tenocha having a portion of testimonial from combined military triumphs. Further grounds of the desire for power and aspiration by the swayers during the twelvemonth 1519 whereby the mature Aztec imperium dominated some 400 antecedently independent civil o rders through bullying, confederation, and outright conquest. Such procedures of military, wealth, confederation and land size is for me a requirement to the formation of an imperium. The Aztec imperium at the clip showed no marks of failing, was extremely organised, hierarchal and warlike. With the rise of an imperium came its autumn from grace as the imperium proved delicate and did non last the reaching of aggressive European incomers who efficaciously disrupted the top degree of the societal hierarchy and so broke the coercive forces that held the imperium together. ‘The Aztec Empire came to an disconnected terminal on 13 August 1521, when Hernan Cortes and his Spanishconquistadorstook the Aztec capital and its emperor Montechzuma ( Montezuma ) II ‘ (The Aztec Empire: Guggenheim Museum, 2012 ) .Having explored factors impacting a scope of driving forces, I am certain that Scarre has provided a grade of simplification and has non omitted any factors that do non back up the development of imperiums. Not limited to the Aztecs, the rise of imperiums occurred on a planetary footing which brings us on to the second of the imperiums to be discussed which is the Akkadians. The Akkadians were initiated by the swayer Sargon, who was driven by pitiless aspiration through the conquering of the metropolis of Sumer, developing into an enlargement into the universe beyond. It can besides be argued that the Akkadians were besides driven by economic addition through the connexions with the lands of Dilmun, Magan, and Meluhha. Within this desire for economic addition it can be a plausible and a simplified procedure of economic growing and security for the people. Although the imperium was established, the capital, Akkad, has non been located archaeologically. The statement made by Scarre relies on driving forces and taking into history the Akkadian imperium, the readings made through archeological surveies seem to carry through the procedures required in the development of an imperium. Sargon a nd his replacements besides conquered the great city state of Elba, to obtain goods and natural stuffs. The cardinal site of Troy where a great trade of activity was seen from seven consecutive metropoliss, Troy I to Troy VII clearly demonstrates to lift and autumn of an imperium through natural to warfare. The wealth of Troy was apparent when a monolithic cache of about 9000 objects that have become known as the Treasure of Priam connoting power and wealth but fell merely as the Akkadian imperium did. ‘Archaeological grounds has shown that the Akkadian civilisation collapsed suddenly near 4170 Â ± 150 calendar year B.P. , possibly associating to a displacement to more waterless conditions ‘ ( Cullen, 2000 ) . Although records detailing this are rare, the alterations in regional fruitlessness are preserved in next ocean basins. There is besides grounds of volcanic ash sherds which may hold held a direct but temporal nexus between Mesopotamian aridification and societal prostration. With this sudden displacement to a more waterless status within the part, this may hold besides been a lending factor to the autumn of the Akkadian Empire. Not merely did the imperium prostration from environmental factors but besides by occupying forces from the E. Although I tend to hold with the procedures of imperiums lifting and the drive force behind them, it is more hard to confidently support factors imputing to their ruin. The Akkadian imperium is known to hold risen through conquer ing and economic addition but with two changing factors of natural and semisynthetic forces, we can non presume that warfare or environmental factors played a remarkable portion in the prostration of that imperium. I am non convinced that warfare brought down the Akkadian imperium and am non convinced that environmental factors played a exclusive portion in their death. A cardinal site which besides reinforces the desire for wealth and power. Small is known about the following imperium, the Hittites who were lost to history. What we do know are found on clay tablets (Explore/World Cultures: Hittities British Museum, 2013 ) . It was during the periods from approximately 1650/1600 to 1200 BC that the male monarchs of Hattusha ruled an imperium that reached across the wide lands of Anatolia, widening at times even into the North of Syria. ‘They conquered Babylon, and Troy was seemingly one of their vasals. Besides Egypt and Assyria/Babylonia, the Hittites were the 3rd world power of the Ancient Near East ‘ ( The Excavations at Hattusha, 2011 ) The Hittites as with any other imperium established the capital Hattusa which comprised beginnings of both written and archeological grounds, nevertheless, research into this part is still ongoing. As small is known, one thing nevertheless does come into light which surrounds the aspiration of the male monarch. It was Hattusili I who at the clip became the first male monarch to establish a run in Northern Syria. Such a run implies that the king knew of the importance environing the desire to hold entree to the sea and for the take-over of trade paths. It was through this run that the male monarch was driven strictly by economic addition through trade and power. Due to little other grounds, there is small to indicate to any concrete informations on the degrees of societal complexness either through archeological findings. From what grounds we have, there is no indicant of any complexness of growing giving the feeling of simpleness in the constitution of the imperium. Although the prostration of the Hittites is non really clear, grounds does demo devastation and forsaking which occurred around 1200-1185 BC at the terminal of the bronze age. One other indicant points to about 1200 BC when the imperium was overwhelmed by encroachers, the individuality of whom is unsure but who were likely portion of the general motions of people in the period of agitation in the Mediterranean at the clip. To reason, I can see no disagreement in Scarres statement and to the full support and agree that imperiums were and are still driven by power, economic addition, security and personal aspiration. If we take into history the procedures involved, I do non believe that there are any complexness. Social and proficient ability does nevertheless find the advancement of a civilisation but as with any other imperium, the leading determines its stableness and length of service. The greater the leader, the greater the imperium. Archaeological grounds exists sing imperiums through the Roman and Greek ruins foregrounding the desire for wealth and the push for power through warfare. I can flatly state that I agree with the statement in that imperiums do lift and fall as evidenced with the Roman imperium, the British imperium in India and the three listed above and that all are driven by one manner or another even to this twenty-four hours. ( 1588 words ) Bibliography Asher, N. ( 2012 )The Oxford Companion to Archaeology( 2nd Ed ) Available at: hypertext transfer protocol: //dictionary.reference.com/browse/empire? s=t Accessed: 31 January 2014 Cullen H.M. et Al ( 2000 ) A scholarly article on the prostration of the Akkadian imperium from Geology, April 2000, volume 28, no. 4 ; pp.379–382. Available at: hypertext transfer protocol: //leilan.yale.edu/pubs/files/cullen2000.pdf ( Accessed: 1 January 2014 ) Scarre, J. ( Ed. ) ( 2013 )The Human Past: World Prehistory and the Development of Human Societies3rdEdition London: Thames and Hudson, pp. 454, 455, 456, 457 Scarre, J. ( Ed. ) ( 2013 ) The Human Past: World Prehistory and the Development of Human Societies 3rd Edition London: Thames and Hudson, p. 198 The Guggenheim Museum, Exhibitions-The Aztec Empire-Overview Available at: hypertext transfer protocol: //pastexhibitions.guggenheim.org/aztecs/overview.html. ( Accessed 1 January 2014 ) The British Museum, Explore/World Cultures ( 2013 ) [ Hittites ] Available at: hypertext transfer protocol: //www.britishmuseum.org/explore/cultures.aspx ( Accessed 28 December 2013 )The Excavations at Hattusha – A undertaking of the German ArchaeoIogical Institute ( 2011 ) Available at: hypertext transfer protocol: //www.hattuscha.de/English/english1.htm ( Accessed 31 January 2014 )1

Should Ministry of Education Review its Corporal Punishment essays

Should Ministry of Education Review its Corporal Punishment essays The media has reported that a Principal who slapped a female student with a soft cover book was demoted. We were told that the Principal did the act, which is against the spirit of corporal punishment, in a fit of anger. According to the Ministry of Education, the solely form of corporal punishment that is acceptable is canning, where another disciplinary teacher must bear witness to prevent accusations of abuse by the student. However, canning is only imposed upon male students while female students are punished through other methods such as detention. Even though it seems that the Principal has to bear full responsibility for having slapped the student, violating the Ministry of Educations rules, it is an unknown what prompted the principal to do what he knows is wrong. Hence, before we condemn the Principal, we should consider the situation again. All naughty students who go against the school rules, behave defiantly, including female students as well, gives problems to teachers. However, the punishments meant for female students seem to be ineffective. Others might even deem it as the Ministry of Education is over-protecting the female students. As such, should the Ministry of Education review its corporal punishment policy? The Ministry of Educations corporal punishment policy has the propensity of stereotyping the boys to be naughtier than girls are. It also brings about the old fashion perception that girls are more vulnerable than boys are, and thus, the cane is spared upon the females. Nonetheless, I denounce such perception of girls being more vulnerable as we are currently living in the 21st century where there is equality in gender. Girls have claimed that they are able to do whatever the boys are capable of and even excel the boys. So should the corporal punishment not be imposed upon girls? We ought to take into consideration that some female students are as naughty and can get even naughtier th ...

Free Essays on The Scream

The Scream Through the fog of the cold autumn night we drove, searching for some area of sanctuary for our little ritual. Eric’s truck was cold and I could feel the heat from the tip of my cigarette warming my nose. â€Å"I know!† Eric said abruptly, â€Å"Holy Family Cemetery!† and he jerked his truck into the left-turn lane. As we meandered down Waverly Road I said, â€Å"We’re pathetic, you know. Lying to our girlfriends is not only futile but when they catch us it’s going to cause a bigger fight than if we had just told them we wanted to get high tonight.† With a sigh he says, â€Å"I know, but would you rather go to the movies tonight or fight with Jen?† I just silently nodded, not even caring if he saw me give in. The tires crackled over the gravel road leading up the hill to the old cemetery. Holy Family Cemetery is safely perched on top of a hill and surrounded by trees; it’s totally invisible from the road and very dark. The dense and dreary fog aided our disappearance and we felt secure that we had found a safe spot to puff the pipe. We drove slowly through the narrow roads of the necropolis and made our way to a nice central location. As the truck slowed to a stop Eric said, â€Å"We’ll have to suffer the cold. I don’t want Julie smelling weed in my truck tomorrow.† I said, â€Å"You know, they are probably getting high in my bathroom right now.† â€Å"Just get out, man.† â€Å"Alright, alright, I already loaded the pipe, spark it up.† I said and handed him my skull and bones pipe behind my back as I got out of the truck. We moved down to the rear and Eric lowered the tailgate to sit on. The cold metal unmercifully penetrated the denim on my derriere and made me sit up straight in surprise. After a moment I settled down and the heat from my hindquarters drove back the cold from the car. I took the pipe from Eric and again I felt the warmth on my nose. This time it was more intense and the fire felt as though it woul... Free Essays on The Scream Free Essays on The Scream The Scream Through the fog of the cold autumn night we drove, searching for some area of sanctuary for our little ritual. Eric’s truck was cold and I could feel the heat from the tip of my cigarette warming my nose. â€Å"I know!† Eric said abruptly, â€Å"Holy Family Cemetery!† and he jerked his truck into the left-turn lane. As we meandered down Waverly Road I said, â€Å"We’re pathetic, you know. Lying to our girlfriends is not only futile but when they catch us it’s going to cause a bigger fight than if we had just told them we wanted to get high tonight.† With a sigh he says, â€Å"I know, but would you rather go to the movies tonight or fight with Jen?† I just silently nodded, not even caring if he saw me give in. The tires crackled over the gravel road leading up the hill to the old cemetery. Holy Family Cemetery is safely perched on top of a hill and surrounded by trees; it’s totally invisible from the road and very dark. The dense and dreary fog aided our disappearance and we felt secure that we had found a safe spot to puff the pipe. We drove slowly through the narrow roads of the necropolis and made our way to a nice central location. As the truck slowed to a stop Eric said, â€Å"We’ll have to suffer the cold. I don’t want Julie smelling weed in my truck tomorrow.† I said, â€Å"You know, they are probably getting high in my bathroom right now.† â€Å"Just get out, man.† â€Å"Alright, alright, I already loaded the pipe, spark it up.† I said and handed him my skull and bones pipe behind my back as I got out of the truck. We moved down to the rear and Eric lowered the tailgate to sit on. The cold metal unmercifully penetrated the denim on my derriere and made me sit up straight in surprise. After a moment I settled down and the heat from my hindquarters drove back the cold from the car. I took the pipe from Eric and again I felt the warmth on my nose. This time it was more intense and the fire felt as though it woul...

The Roaring 20s Essay Example | Topics and Well Written Essays - 1500 words

The Roaring 20s - Essay Example The Roaring 20's While the smoking pipes of industries spewed off smoke in the same war-time vigour, the working classes had ever more money to spend. America had begun to think. The press had recently got some serious readers. The war had gifted them to the news papers. Although American casualties in the war were quite low when compared to their European allies and foes; the soldiers came back with a shaken mind: they had recently lost their innocence and could not return to their roots. They yearned for a life in the cities, in fun and frolicking city-life, they had seen in Europe. The industries in Europe and America were facing a slight problem. The war had ended long back and they needed new avenues to apply their engineering skills. They mechanised farms and invented gadgets that gave more free time to American housewives. Consumerism was coming of age. Farm machines such as harvesters and planters had reduced employment opportunities in agriculture. The crop prices like urban wages depended o n market forces without any protection from the state. But in the postwar boom, businesses flourished and the rich were richer beyond their wildest dreams. The only business that Americans were now doing was business. For the first time in history, the new wealth had helped youths enroll in universities. The number of enrollments almost doubled during the 1920s. Americans were now enjoying the world's highest per capita income. ... The telephone, camera and typewriter, all American inventions - were consumed by Americans in tonnes. People fell in love with entertainments. They went to a movie once a week, and had more disposable income with them. The movies were also changing. They provided very little to think. They were entertainers. By the end of the 1920's 100 million movie tickets were sold in the country every week. Actors Charlie Chaplin, Mary Pickford and Rudolf Valentino had become 'stars'. Although prohibition was in place, the underground 'speakeasies' were doing brisk business. The night clubs were bulging with young men and women who flaunted new dressing styles, fashion, glamour and all the spoils of wealth. They also took to more daring modes of dress and dance. Dancing, movies, automobile touring, radio and concerts were becoming part of American lives. Many American women had left the farms to join the nation's home-front war duties and turned themselves in to resolutely modern dolls rather tha n a hard working farm-pig. They also received the right to vote in 1920 and had recently involved themselves in politics. They cut thir hair short and wore flappers, boldly spoke their minds and flaunted their newly attained status. Western youths had started to rebel. They were disillusioned by the savagery of war and blamed the older generation for it. The university guys became the new intelligentsia. European works of philosophy and Psychology were sweeping in to American living rooms. Freud and Marx were favourite topics of discussion. The Godless world had come in to being in the American minds. Religion, they believed should be a burden to be relieved. Their creative energy spilled in the form of new music and architecture and art and everything that had not been invented

Human Sexuality Essay Example | Topics and Well Written Essays - 750 words

Human Sexuality - Essay Example Whether it would be positive or negative, the power of research and its importance, are undeniable and relevant. For any researcher(s), it becomes the question first and foremost, as to what any long term impact the individual(s) work, would have had on the ability for greater understanding. Articles and research papers are often times written by those who seek to research issues and then wish to deliver what they find to the rest of the world. Others may also wish to produce articles themselves, only this time, on assessing the impact of the work of others, such as the case would be with John Bancroft. In his work 'Alfred C. Kinsey and the Politics of Sex Research', Bancroft looks to the work done by Kinsey and the response of others to the research itself. With that being said, in regards to Kinsey, "It was evident from his own research, and has been confirmed in various ways since, that major changes in sexual behavior had been underway through much of the first half of the 20th century," (Bancroft, p.2). This statement in itself, would give credence to the validity of Kinsey's work and show the need for greater study and debate. The article discusses the attention paid towards contraception and how the debate would consider, for instance, the use of contraception and its ability to control the size of average families. From a social standpoint, there would be those that felt it was important to have the opportunity to be aware of such issues and others would think that an issue like sexuality, should be kept in the confides of the home and in the bedroom between a man and woman. While it would have been easy to single out Kinsey for his research, it is important to note that, "He was not the first to report results of sex surveys in the US," (Bancroft, p.3). With that in mind, it would be fair to classify Kinsey as one of many, who would have put together studies on the matter at hand. Author Bancroft asserts, regards to assessing Kinsey's impact, "But one clear part of Kinsey's legacy is that sex became less mysterious," (Bancroft, p.4). When certain things have not been discussed in any great detail before, they can often times seem to some, as being unknown and dangerous even. Kinsey's work would take away the disguise and uncertainty about regular human sexual activity and reveal it to be nothing more, than typical behavior that would occur among healthy human beings. His greatest desire would be to reveal the distinct natures of male and female human beings and how each one would approach sexual intercourse. Sometimes, after research has been performed, the results lead to the production of revised guidelines. This would be true as a result of Kinsey's work. Based on his findings, "The American Law Institute, after much debate, published its revised Model Penal Code in 1995. This was clearly influenced by Kinsey's findings," (Bancroft, p.4). The author further goes on to detail that, as a result of Kinsey's work, the revised Model Penal Code would make it so that such things as being a homosexual, living together when you were not married, as well as the sexual activity of two people who were willing participants, were no longer seen as crimes. With such a revision taking place, it would lead many to consider the influence of Kinsey in the area of sexual activity, to be considerable and not to be