Acl Reconstruction Graft Information

Graft report Patellar graft The patellar tendon bone-tendon-bone graft has been the â€Å"gold standard† graft choice for ACL reconstructions since it became common practice in the mid-1980. It has been used extensively by surgeons since that time and still remains the graft of choice for a high number of orthopedists who perform this surgery regularly. The patellar tendon graft has consistently demonstrated excellent surgical outcomes with a 90-95% success rate in terms of returning to pre-injury level of sports.A patellar tendon graft is harvested through a 3-4†³ long incision based just along the medial border of the tendon†¦ The middle third of the tendon 10-11 mm wide is then removed along with 2-2. 5 cm long bone blocks still apart of the tendon at each end of the graft from the tibial tubercle and the outer surface of the patella. This gives a composite bone-tendon-bone graft that has very strong insertion points of the tendon soft tissue into bone. The tensil e strength of this graft has been measured by Noyes (1984) to be about 2950 Newton’s to failure, versus the strength of an intact ACL at 2160 N.What happens to the remaining patellar tendon after a third of it has been removed? Over the course of three to four months after surgery the tendon regenerates or â€Å"grows back†. Initially it seems to overgrow into a thick, large tendon that then remodels back to a more normal contour by 12-18 months postoperatively. Surgeons have even been able to re-harvest another patellar tendon graft from the original tendon once enough time has passed for tendon reconstitution (although there's now evidence that this repaired tissue may not be as strong as normal patellar tendon tissue).Patellar tendon ruptures at the donor site are unlikely after the first few months post-op. Patellar tendon ruptures can and do occur however during the initial 6-8 weeks after surgery if the remaining tendon is stressed too hard. One of the advantages of this construct is that because the bone-tendon interface is quite strong, the surgeon only has to fix the block of bone in the bone tunnel rather than trying to fix the soft tissue itself.A headless screw is inserted next to the bone plug (like a square peg in a round hole) to interference fit and locks the bone in place. The patellar tendon fibers are thereby immediately secured and are stable enough to begin motion and weight bearing when tolerated. The ends of the graft heal bone-to-bone in around 6-8 weeks, which appears to be quicker than the healing process for soft tissue-to-bone. Interference screws are now available in a bioresorbable material that actually dissolves within the bone over 2 to 3 years.The â€Å"gold standard† graft isn't perfect, however. There may be more pain associated with this donor site than from any of the other graft choices. As a result there is sometimes a greater initial atrophy or wasting response of the quadriceps muscle compared to s ay either a hamstring or cadaver allograft. This can require more prolonged physical therapy to recover from and could possibly delay the initial return to sports. The incision (scar) is bigger, and almost all patients end up with a permanent loss of sensation 2-3†³ in size just lateral to the incision.There is a risk of patellar tendon ruptures, as well as fracturing the patella both intraoperative as well as postoperatively, although bone grafting the defect in the patella at the time of surgery has reduced the incidence of the latter. Patients who kneel a lot for a living are often unhappy with the patellar tenderness and sensitivity that can occur at the incision site and should probably consider an alternative graft choice. One of the bigger issues with patellar tendon grafts that recently has a number of orthopedists switching to alternative grafts is the incidence of anterior knee pain when patients try to resume athletic activities.Specifically there are some studies5 s howing an increased rate of patellofemoral pain and/or tendonitis of the patellar tendon with stairs, jumping, skiing and other such activities 6-12 months out from surgery. Ultimately these are often treatable with continued strengthening, rest from sports, and time, but these symptoms can delay the expected time of return to sports. In summary, the patellar tendon BTB graft is a safe and effective option for ACL reconstruction. It has a consistently successful clinical track record at all levels of athletic activity with excellent outcomes and reproducible results.Its major disadvantages are primarily increased tenderness kneeling on the donor incision site, and the possible risk of problems with patellar and patellar tendon pain upon initial return to sports. Semitendinosus Semitendinosus grafts are made with the semitendinosus tendon either alone, or accompanied by the gracilis tendon for a stronger graft. The semitendinosus is an accessory hamstring (the primary hamstrings are left intact), and the gracilis is actually not a hamstring, but an accessory adductor (the primary adductors are left intact as well).The two tendons are commonly combined and referred to as a four strand hamstring graft, made by a long piece. which is removed from each tendon. The tendon segments are folded and braided together to form a quadruple thickness strand for the replacement graft. The braided segment is threaded through the heads of tibia and femur and its ends fixated with screws on the opposite sides of the two bones. Hamstring grafts require a smaller incision and are usually less painful to harvest.Thus the initial postoperative period is often easier and more comfortable with this graft choice. Similarly, because there is no violation of the patellar tendon, there seem to be fewer problems with knee pain during the first few months that a patient is allowed to return to sports. The hamstring incision is away from the patella so patients are usually comfortable kneeli ng after their reconstruction. Because the quadriceps extensor mechanism isn't violated with a hamstring harvest there is often less initial quadriceps atrophy.With a quicker return of knee quadriceps strength some surgeons are allowing their fully recovered patients to return to sports a month or two earlier than they might for a patellar tendon BTB graft.. However there have not been any scientific studies examining the tensile strength to failure of a human ACL graft at three months after implantation that would support this approach. Certainly the animal research done on patellar tendon tensile strength in rhesus monkeys suggested that the graft was actually weakest at 3 months out before maturing at 6 months post-surgery.However the truth is that soft tissue-to-bone healing occurs at a slower rate than bone-to-bone healing. A number of surgeons are concerned that this fact is being ignored when patients are placed into an accelerated rehab without allowing extra time for the gr aft ends to begin to heal to the bone tunnels another disadvantage of hamstring tendon grafts is that harvesting them is a technically demanding procedure that requires considerable surgical experience. Pitfalls such as transecting (cutting in half) a tendon or injuring nerves or ligaments in the area of dissection are possible during the stripping process.There is also a different technique for tensioning the hamstring tendon in the knee once the femoral end has been secured. The graft needs to be pre-tensioned and it's important that each of the four graft ends be individually tensioned during the tibial fixation for best results. Allographs Another alternative available however is to use tissue from a cadaver that is called an allograft. Patellar tendon, hamstring tendon, and even Achilles tendon allografts can be used as ACL graft tissues and are inserted and fixed with the same techniques that are used for autografts.The advantages of using cadaver graft tissue are obvious; no risks, pain, or scars from the donor site. Surgical time is quicker and because there is considerably less discomfort postoperatively, the incidence of joint stiffness and atrophy of the quadriceps muscle is significantly reduced. Allografts are a good choice when there are limitations in a patient's own tissue availability. Complicated multiple ligament reconstructions needing several grafts routinely require the use of allograft tissue in addition to an autograft.Revision ACL reconstructions where an autograft has already been harvested are also an indication for using a cadaver grafts.. The biggest concern with using allografts is the risk of contracting a serious infection from the cadaveric tissue. Hepatitis and HIV can be transmitted through these tissues with potentially fatal outcomes. Bacterial infections are also a possibility and although not usually life threatening, can result in loss of the graft and cause subsequent arthritis. The dilemma with allografts is that they can't be 100% sterilized without altering or even destroying the tensile strength of the graft tissue.Imagine what happens to any food that is pressure-cooked at temperatures over 270 ° F under pressure for 10 minutes and you'll understand what happens to a patellar tendon graft sterilized in an autoclave. Similarly, radiating grafts with high enough doses to kill viruses has been shown to alter the collagen tissue and reduce the graft's tensile strength. Currently the preferred allograft treatment technique is a fresh frozen graft; the tissue is harvested, cleaned and then frozen in liquid nitrogen.The cadaver is screened extensively with hepatitis and HIV testing as well as a life style analysis to identify any high-risk behavior for these illnesses. Blood tests for HIV, however, are not infallible because they can lag 6 months between the time of infection and the conversion to a positive test. Nevertheless, the process is fairly safe and the published rate of contracting HIV f rom these tissue allografts is between 1 in 1. 2 to 2 million. There are some graft procurement companies who are able to do actual direct HIV viral testing on their tissues which lowers the risks even more.And several companies have developed proprietary cleaning techniques that they claim can guarantee sterility of their graft tissues. Some grafts are also treated with low dose irradiation (1-2 Mrads) in a compromise attempt to provide some degree of sterilization without damaging the tissue characteristics. Unfortunately there are some studies indicating that ACL reconstructions using these tissues may stretch out over time so non-irradiated grafts would be the ideal structural choice if infection were not a concern.Unlike organ transplants, allografts aren't usually at risk for tissue rejection by the host. This is because there's very little protein antigen in these washed grafts (the bone ends are completely cleansed of any marrow elements). The majority of the grafts are prim arily made up of collagen, which has very low antigenicity. Laboratory studies have shown that there is universally a low grade immune reaction to insertion of these foreign tissues, but this doesn't appear to be clinically significant in terms of achieving a successful outcome.Bone tunnel widening is sometimes seen with the use of allografts, but similar to the case of hamstring grafts, doesn't seem to have any significance in terms of functional problems. There are some early studies suggesting that allografts take longer to heal in the knee than comparable autograft tissue. At the same time the patient is recovering from the surgery quicker because of the reduced pain and morbidity of not having donated their own graft tissue. Typically allograft patients will feel like they're ready to get back into sports in just 3 or 4 months since their full strength and joint mobility are often achieved at that point.The combination of delayed allograft incorporation with an accelerated reco very can obviously spell disaster in terms of the ACL graft stretching or rupturing altogether. So patients with allografts must completely understand the healing process and comply with the temporary restrictions even though they may think their bodies are telling them it's OK to be doing more athletically. It takes a lot of mental discipline. And obviously it's a misconception that an athlete can return to sports earlier using an allograft in view of the above. The last disadvantage of allografts relates to the practical issues of cost and availability.There has been a national shortage of patellar tendon allografts due to increasing demand combined a low supply of suitably qualified cadavers. This shortage has been created in part by physicians who routinely use allografts as their first choice for ACL reconstruction grafts in spite of the fact that autograft tissues work wonderfully. Other cadaveric tissues such as hamstrings, Achilles tendons, and even anterior tibialis and pos terior tibialis tendons (some of the ankle tendons) are often being used instead of patellar tendons due to this availability issue.Some surgeons simply don't have ready access to the facilities that procure and process allografts. And allografts are expensive, running anywhere from $2000 to $10,000 depending on the tissue type and your geographic location My Choice If I needed to go into surgery for an ACL reconstruction surgery and I had to choose from one of these graft options, I would choose to go with the semitendinosus graft. I would shy away from the allograft mainly because I am uncomfortable with the whole idea of donor replacements being implanted in my body.Along with the great threat of infection the allograft also tends to be hard to obtain with a nationwide shortage of acceptable cadavers, therefore making them very expensive. When comparing the patellar graft and the semitendinosus graft its hard to find much of a difference in the results, both offer good knee stabi lity with minimal adverse effects after surgery. However, the semitendinosus graft affects a much different and less major tendon group, in return providing less knee related problems after surgery therefore giving it the advantage over the patellar graft in my eyes.

Eight O’ Clock

Eight O’Clock What happens when the church bell tolls your final hour? Does your party dress turn to rags and your beautiful carriage revert back into a pumpkin? What do you do when your last sixty minutes are up? Many people pray to their God for salvation, and many others wish to go back and correct the wrongs in their lives. Many, though, await death’s embrace by cursing fate and dreading their moment of death, just as the man in A. E. Housman’s poem, â€Å"Eight O’Clock† does. The man in the poem is on death’s row and, rather than repenting and hoping for forgiveness from on high he laments his fate and angrily awaits his doom.It is apparent that the man awaits death because he is â€Å"strapped, noosed, [and] nighing his house. † To be strapped means that there is no way out, presumably from his situation, and he most certainly is for his situation is quite dire, and at this point he has no real chance of survival. To be noosed me ans one has a noose – a rope for hanging – tied around one’s neck so that he may be hanged which only adds to the fact that he’s certainly strapped. To nigh one’s hour means to near it, and the man must be nearing his final hour for he is certainly ready for his hanging and he continues to count down until his doom.Time is emphasized several times in the poem, showing just how close to death the man is. â€Å"[He] heard the steeple sprinkle the quarters on the morning town,† which is to say, he heard the bell toll each quarter of an hour as though it were raining down upon him just to mock him. The man counted them one-by-one until, on the final ring before he met his fate, â€Å"the clock collected in the tower its strength, and struck†. The clock’s strength refers most probably to how heavily it must ring. To the man, on that final quarter hour toll, it must have sounded as heavily as he had ever heard it.For, truly, it would be the last time he ever heard it. Rather than accepting his fate, the man sits and curses it instead. To accept what is happening to him would be to admit that what he did to deserve his fate was wrong, that he was truly guilty of sin. To feel that guilt, to repent for what he had done, would be to ask forgiveness, which in all rights is the smarter path to follow. Yet, for some reason, the man asks not for forgiveness, but for the wrath of God. The man does this because it is most likely he has committed no actual crime, his fate is not deserving of the punishment bestowed upon him.He has either been framed, or the punishment placed upon him much more severe than his transgression would merit, why else would he not ask forgiveness for what he had done? It is easy to curse one’s fate. It is easy to blame others for what has occurred. It is easier, still, to believe oneself innocent even when he is not. It is not easy, however, to stand and wait for death to arrive knowing t hat the path one chose should not have lead them there, that he should not be on his way out.

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Human Resource Strategies - Case Study Example It has Discount Stores, Supercenters (for one-stop shopping), and Neighborhood Markets (convenience stores). It also operates Sam's Club, America's leading members-only warehouse club (Our Retail Divisions 2007). Being the leader not just in a particular industry but to the whole business world as a whole in terms of revenues is a result of effective policies, plans, and strategies against its competitors. In case of Wal-Mart, their competitive advantage lies on how well and effective they make their principles into reality. Wal-Mart considers its corporate culture as one of the keys for its outstanding success. Walton was able instill his inspiring and motivating beliefs and principles that is being abided and taken by heart by his employees then, until now. Wal-Mart has retained the culture based on tested principles for a successful business and life (The Wal-Mart Culture 2007). The cornerstones by which Wal-Mart stands on are its Three Basic Beliefs. These three main thrust play an important role in decision making and other activities the company does. They are also the standards by which the accomplishments and performances of individual personnel or of the entire organization is measured. Respect the Individual - Wal-Mart believes that they are a group of dedicated, hardworking and ordinary individuals who are united "to make extraordinary things." Being an organization as such is no easy task. One of the essentials of making this happen goal happen is to treat each individual member within and outside the organization with respect and dignity. Service to our Customers - The retail giant knows that they are nothing without their customers. Because of this the company strives to ensure that each of the hard-earned dollar spent by their customers to their service is compensated accordingly by offering quality merchandise at the lowest price while providing outstanding service to them. Strive for Excellence - Wal-Mart's amazing success is a product of innovative and trailblazing ideas and goals that stretch their horizons further. For Walton, it is not enough that Wal-Mart offers low prices or high quality. He believed that striving for excellence by incorporating fresh and innovative ideas that will get them ahead of the pack. Accomplishing a feat is not enough. Complacency is never attained at Wal-Mart as the company takes each accomplishment as a stepping stone for another success. Sustainable improvement is what Walton wants for his organization (Three Basic Beliefs 2007). Sam's Rules for Building Businesses Perhaps still unsatisfied with the brevity of his three basic beliefs, Walton elaborated ten rules that would rev up his business steps higher. Together with the three basic beliefs, he had revealed much of his secrets before his death in April 1992. Commit to your business - The unwavering passion for making the business a phenomenal success is what Walton instilled in the minds and the hearts of his employees. For him the love for work and the desire to excel in it is needed in this fiercely competitive world. Share your profits with all your associates, and treat them as partners. - For Walton encouraging his associates to hold a stake in a company is important for them to accompany Wal-Mart in pursuing their dreams. By offering them discounted

The study of the hip-hop culture Essay Example | Topics and Well Written Essays - 1750 words

The study of the hip-hop culture - Essay Example The study of the hip-hop culture Some of the professional fields concerned with the study of the hip-hop culture include musicology, literature, African-American studies, linguistics, and so forth (Leach, 9; Alridge and Stewart, 190). In academic and professional conferences, hip-hop culture topics are receiving a wider attention as people strive to understand this culture. Equally, hip-hop materials are currently being sought after by research institutions (including Harvard and Schomburg Center for Research in Black Culture) to provide researchers with adequate materials in the analysis of the hip-hop culture (Leach, 9). This essay compares Eminem’s video for â€Å"The Real Slim Shady† with N.W.A.’s video for â€Å"Straight Outta Compton†. In the analysis of these different rap videos, the essay constructs an argument about how hip-hop has changed since its formation in the 1970s. Defining and Understanding Hip-hop and Rap Numerous people (including knowledgeable hip-hop writers and lis teners) do not understand the meanings of rap and hip-hop; particularly, many of these individuals think that the two are interchangeable. Nonetheless, hip-hop is a cultural movement originating from South Bronx, New York. It has four main/primary elements that include rap, graffiti, DJing (also known as turntablism), and break dancing. Other elements that are also part of the hip-hop culture include language, beat boxing, and fashion. Among these elements, rap is the most popular and the most celebrated element of the hip-hop culture. ... Rapping is also known as emceeing. In this hip-hop element, the rapper or the performer speaks rhythmically to a musical beat; his/her words rhyme from one sentence to the other. In the modern hip-hop perspective, an MC is different from a rapper. An MC is an individual with superior lyrical ability; on the other hand, a rapper focuses less on lyrical prowess. Particularly, this characteristic is evident in many of the mainstream rappers today (Aces and Eighths). Although it originated in New York, hip-hop has its roots in African-American and West African music. Griots are a group of West African singers and poets whose musical style is similar to that of the hip-hop culture. They have an oral tradition similar to the one in rap music; however, theirs dates back to hundreds of years. In the City of New York, griot-like musical performances from artists such as Mansur Nuriddin and The Last Poets influenced the post-civil rights era culture in the 1960s. In the 1970s, block parties be came common creating the humble beginnings of the hip-hop culture (Aces and Eighths). â€Å"The Real Slim Shady† by Eminem â€Å"The Real Slim Shady† is a hip-hop song done by Marshall Bruce Mathers III who is popular by the name Eminem. In the process of writing this song, Eminem sought assistance from Andre Romelle Young (popular by the name Dr. Dre) and Thomas Joseph Coster Junior (popular by the name Tommy Coster Jr). Eminem was writing this song for his third studio album â€Å"The Marshall Mathers LP† released on 23 May 2000. This song was the lead single in this album. The song was highly successful as it reached number one in UK (United Kingdom) and number four on the â€Å"Billboard Hot

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. Project - Research Paper Example When relating this to personal life, it is evident that the world created a lot of pollution that has resulted in climatic changes. However, with the induction of such businesses, the world has been recording impressive performance in regard to pollution. As a matter of fact, this has heightened the activities which are geared towards improving the world. This has taught people that they can have different approaches in accomplishing their missions. For example, many businesses have enhanced their sustainability though they are engaging in society responsibility. Similarly, it has taught people to embrace better ways of production while reducing pollution and environmental hazards. The most common business formation in the recent times is the Benefit Corporation. This is a business that is formed by entities whose first objective is not to realize financial profits but to fulfil ethical goals such as transparency and accountability. These businesses are formed to consider the good of the society as well as the environment. Benefit corporations have redefined what is considered as being a successful company in the present climate that supports transparent and ethical business practices. With such preparations, the corporation is likely to reflect a positive impact on the community and the society (Pakroo 12). In terms of the impact on society, a benefit corporation is accountable to general public and issues an annual benefit report. The consumers and the general public then use the results of the corporation to determine if the benefit company has had a positive impact on its society (Lyons 10). After these, the public has to agree or disagree if there has been positive impact on the community. On the other hand, there has been formation of the low profit limited liability corporations in the world. This type of business aims to limit the gap between for-profit business and non-profit business entities. There are some businesses that are solely formed make prof its, while others are formed without any interest in realizing profits. However, low profit limited liability companies have structured investments in an environment that is socially beneficial. Consequentially, they factor benefits of profitability while complying with the revenue collecting bodies which reinforce the national government's revenue generation while also functioning in the capacity of debt collectors. The only difference is that, L3c’s do not seek to consolidate their revenue. Therefore, they will work under the legal frame work and tax acceptance to run the businesses. Most of these corporations rely on market positions, branding, and the positivity accrued from social enterprising methods such as advertising. There are a number of reasons for formation of these corporations. First, there are limited numbers of companies that are formed solely to provide social benefits. Therefore, there is a limited supply of such services, yet, they are vital in running an economy. Apparently, most companies are formed for the sole purpose of realizing profits. As such, they will maximise their revenue and not participate in activities that bring social benefits to the society. Therefore, supporting the formation of such companies is of greater benefit to the society (Lyons 9). So, they will be able to benefit from the products and services of these upcoming companies. Without such an approach, it is possible that there will be no social

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Graffiti as Art Research Paper Example | Topics and Well Written Essays - 1750 words

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Impact of Gay Marriage on Children Essay Example for Free

Impact of Gay Marriage on Children Essay Take a look at the picture of a gay and a lesbian couple (see Figure 1). Long ago people would have raised their eyebrows and glared at such obvious display of affection between two men and two women. They would have scurried away and cursed them who engaged in activities that compromise morality. They would have felt anger to know that a man would even think of marrying another man or a woman to another woman. But years later, this picture has become normal. Wherever people go, they see gay and lesbian couples. They are everywhere. And the government has also come to accept this phenomenon, although there are still debates whether gay marriage, or same-sex marriage, should be legalized and accepted. Gay marriage has been one of the critical issues still not resolved and still plagued lots of people today. There are debates and protests whether this should be legalized or accepted in the society. Many are strongly against gay marriage because of their various beliefs about marriage itself. On the other hand, many are also for gay marriage because they think that marriage is all about equality and freedom to choose and decide. However, we must look at what gay marriage does to the children, because they are also adversely affected by this. This paper will show that gay marriage (the term will be used interchangeably with same-sex marriage in this paper), has a negative impact on children. In 1989, Denmark granted â€Å"registered partnership† to same-sex couples; Norway, in 1993; Sweden, in 1994; and Iceland, in 1996. Other countries in Europe, such as France, Germany, Finland, the Netherlands and Belgium also did the same (Lee Badgett 2). Meezan and Rauch reported that gay marriage (or same-sex marriage) is a reality in the United States and other parts of the world. They added that for the advocates of same-sex marriage, it is a civil rights issue. For the opponents, it is a matter of morality. Both sides are correct, but most importantly, it is a family-policy issue which has not been regarded with the right amount of attention in the American scene (97). The most important question to be considered is: How will same-sex marriage affect the well-being of children? The statistics showed significant trends. In 2007, Craft reported that in 1976 alone, there were about 300,000 to 500,000 gay and lesbian parents. In Bahamas alone, the number of homosexuals is increasing. Many of these, who keep their homosexuality secret, have positions in companies and in governments. The Rainbow Alliance of The Bahamas showed that gay individuals makes up five percent while bisexuals make up 29 percent of The Bahamas population (see Chart 1). Additionally, there are about eight to 10 million children living in gay and lesbian households. It is estimated that the number of gay and lesbian people who are interested to adopt children is nearly two million. The highest concentration of adopted children living with homosexual parents could be found in California. These children tend to be younger. Gates, Lee Badgett, Chambers and Macomber estimated that there were about 65,000 adopted children living in a gay or lesbian household. Moreover, out of the estimated 3. 1 million gay and lesbian households in U. S. , 1. 6 percent includes an adopted child under the age of 18 (7) (see Table 1). In the Frequently Asked Questions article by The American Civil Liberties Union (ACLU) marriage is all about love, commitment, sharing and compromise. It should not be denied to couples just because of their sex; marriage is a personal choice. However, many believed that the purpose of marriage is procreation; producing children is the natural end of marriage (Cline). Since gay marriage is unnatural (it can’t produce children), Cline said that it would violate this very idea. It would undermine marriage because it is a moral institution for promoting and protecting procreation. Although this paper posits that gay marriage has positive impact on children, it is still important to look at both views about the same-sex marriage in order to make light of the things which are significant for the welfare of the children. Impact on Children Why should the children be considered when it comes to same-sex marriage? Children are helpless, according to Kurts. They rely upon adults. They need the society to provide them with institutions that keep them safe from chaos. Additionally, they cannot articulate their needs and cannot even vote. But, they are society. They are the future of the world. These are just some of the reasons why children’s well-being must be supported and encouraged. Baskerville is right in saying that the impact of gay marriage on children wasn’t paid much attention because the focus was on the debate over gay marriage. It is important to recognize the needs of the children because they deserve to grow in an environment where they have two legally recognized parents (Committee on Psychosocial Aspects of Child and Family Health). Their relationship with their parents, the Committee furthered, must be stable and recognized. This must apply to all, whether the parents are of the opposite or of same sex. For those who advocate gay marriage, they said that gay marriage will have positive impact on the children. In an article by Sara Miles, she argued that banning gay marriage will deny children justice since marriage is good for kids. It is true that marriage is good for kids. Most of the literature about marriage would indicate that marriage brings positive outcomes for the children as it provides them with warm, close relationships with their parents. Advocates of gay marriage believe that these reasons must be taken into consideration and let someone marry whoever he wants to marry. Cline reported that those who oppose gay marriage will do anything to keep it from being legalized. However, there will come a time when gay marriage will be legal and recognized. In fact, there were actions taken in other countries to make this possible. With the rise of the issue of gay marriage in America, other areas were also considered, such as adoption of children. Baskerville quoted what Democratic state Sen. Therese Murphy. She believed that almost half of all adopted children in Massachusetts live in households with homosexually-behaving adults. Baskerville added that allowing gay couples to â€Å"have† children, or to give them the right to adopt, is nearly the same as granting them the right to claim the children of a couple. The question here is whether the biological parents will agree to be separated from their children. This is made easy by the government’s initiative to give other people’s children to gay or lesbian couples. The government also has the power to take back the children from their biological parents even though the parents did not do something that would make the government take back the children. This is because the government now had the incentive and the means to take children from their parents with no due process. Baskerville reported that the 1974 Child Abuse Prevention and Treatment Act (CAPTA) gives financial incentives to the states to remove children from their original parents. As a result, CAPTA became instrumental in tearing children away from their parents. Additionally, the federal funds went to the foster-care providers. Even now, there are still children removed from their families despite the fact that foster homes were more abusive than the children’s original families. This problem existed for a long time until the government thought of another program. The government provided another program to solve the problem created by CAPTA, which is the 1997 Adoption and Safe Families Act. It provided more financial assistance to transfer children from foster care to adoption. This expanded the client base of stakeholders who had vested financial interest in available children. Gay marriage, it seemed, made this even worse. Baskerville reported that through having kids adopted by gay couples, the government officials can take advantage of the adoption. These government officials can very well benefit through the funds that are set for the Act. Rekers provided three reasons on why Arkansas has prohibited homosexually-behaving adults from being given license to be foster parents. First: The inherent nature and structure of households with a homosexually-behaving adult uniquely endangers foster children by exposing them to a substantial level of harmful stresses that are over and above usual stress levels in heterosexual foster homes. (Rekers 2) This means that those children entering foster care usually have high incidence of psychological disorder. Rekers explained that if homosexual parents adopted those children, they (the children) are likely to be at risk of psychological harm and maladjustment. This happens when the children are exposed in greater stress brought upon them by the mere presence of a homosexual in a foster home. Moreover, Rekers believed that the children are affected in such a way that they are at risk of depression or psychological disorders (2). Second, Rekers reasoned out the relationships between homosexually-behaving adults tend to be less stable and short-lived, unlike the relationship between a married man and woman. Therefore, this would not be appropriate for children because they will be easily influenced. Furthermore, Rekers believed that suicidal attempt, substance abuse, psychological disorders and breakups happen most often with homosexual partners. Thus, they are incapable of providing a secure and stable home that foster children needed. And if children are to be adopted by these homosexually-behaving adults, it would mean that children will be removed and transfer to another home. Sometimes the transition is traumatic for these children. Third, the household structure of foster-parents consisting of one or more homosexually-behaving members denies children their needs for adjustment that can be found in heterosexual foster homes. Rekers backed this third reason by explaining that unlike heterosexual households, a household with homosexually-behaving adults lack the concrete role of a mother and a father, which is necessary for the growth and development of children. Additionally, homosexual households lack the role of a mother and a father in raising children. Also, the children have no chance to witness a husband/wife relationship, which the society thinks is socially stable and healthier for the children. Rekers said that the children who live with a married man and woman are better adjusted compared to those who live in households with homosexually-behaving adults. Children in foster care must be placed with heterosexual married couple because this will provide them with their needed benefits and leads to better child adjustment. A study presented by Jacobs in her article showed that nearly all 50 studies done on the children of gay and lesbian couples (between six and 14 million in the United States) showed no significant difference between children raised by heterosexual or homosexual couples. However, those who oppose gay marriage argued that most of the studies done were small, there were methodological flaws, and mostly were politically biased. Jacobs reported a study which showed that there’s no significant difference whether a child is raised by a gay or lesbian parents. In short, a child with gay or lesbian parents does not necessarily make him different from his peers. However, Jacobs presented some interesting findings from other researches regarding these differences. She mentioned that in 2001, Judith Stacey, a sociologist, and her colleague, Timothy Biblarz, found out that there are, in fact, some differences. They said that although gay and lesbian parenting is not harmful for children, those who have gay parents differ in some ways from those who have heterosexual parents. For instance, a study headed by Susan Golombok concluded that having homosexual parents does not encourage their children to become homosexuals. However, the daughters of lesbians were more open to the idea of being attracted to the same gender than the daughters of heterosexual mothers. Another finding was that out of the 25 children of lesbians, six of them had had relationship with someone of the same gender. The 21 children of heterosexual mothers did not have a relationship with the same gender. Kurts countered that gays have special case because the difficulties and challenges they experience are not from â€Å"discrimination† of marriage. The challenges and difficulties are due to the problem of sexual difference. He added that marriage is just a consolation for the challenges that are usual in situations faced by gays. Although gays are much tolerated in the United States, using marriage for the wrong purpose will not change the situations of gays. Instead, it will be the end of marriage, and the protection it provides for the children who are helpless. Gay marriage will also have an effect on heterosexual marriage. Supporting gay marriage, according to Gallagher (qtd. in Darby), would mean that the courts will not fully support the views of those who advocate heterosexual marriage. Moreover, if heterosexual marriage is confirmed as a special institution that must be protected and upheld, the number of fatherless children will decrease. Heterosexual marriage will prevent the incidences of children born outside marriage. Kotulski (qtd. in Darby) contradicted this by saying that there will still be fatherless children. There will be factors that would continue to break families, such as poverty and violence. Other Effects Pawelski et. al have noted some other effects of same-sex marriage to children. These effects, as noted, were experienced at different levels. In the psychosocial level, gay and lesbian individuals usually undergo peer rejection, harassment, depression or isolation. In fact, Pawelski et. al reported that almost half (47%) of gay and lesbian teens have thought about committing suicide while 36% actually attempted. Oftentimes, these individuals experience rejection from their loved ones, maltreatment in schools, homelessness, and violence. As adults, they experience discrimination, marginalization and violence. Various debates over the issue of same-sex marriage intensified the unstable environment for the homosexuals in the society. Lack of support and acceptance for them and their children will have effects on their physical and psychosocial health and safety. The children of gay or lesbian couples may, in the same way, experience marginalization and discrimination by those who do not approve of gay or lesbian parenting. More often, these children do not know how or where to find support. Even alliances in schools that admit straight gays can make the situation worse. Pawelski et. al reported that children are brought into long-term partnerships with gay and lesbian parents through surrogacy, adoption and alternative insemination. Their study also delved into the attitudes and behavior, personality and adjustment of parents when it comes to parenting. The authors found out that there were only few differences recorded regarding the comparison between lesbian and heterosexual mothers’ psychological adjustment, self-esteem and attitudes about child rearing. Lesbian mothers, the study showed, passed the psychological assessments and interviews. Furthermore, the study showed that the attitudes of lesbian mothers did not differ much from those of heterosexual mothers. In the same way, gay fathers did not differ much from nongay fathers. In fact, there are more similarities than differences. However, there is concern over the effect of the parent’s sexual orientation on the children because this might lead to embarrassment and thus keep the children from interacting with their peers. It was found out that the children of divorced lesbian mothers experienced more teasing from peers during childhood than the children of divorced heterosexual mothers. It is of interest that Pawelski et. al mentioned that the children who grew up with gay or lesbian parents were more tolerant of diversity and more nurturing than those children with heterosexual parents. Pawelski et. al mentioned another study which showed that children of heterosexual parents considered themselves more aggressive. Their parents and teachers regarded them as more domineering, bossy and negative. On the other hand, the children of lesbian parents considered themselves as more lovable. Their parents and teachers regarded them as more responsive, affectionate and protective of other younger children. Another study showed that the self-esteem, aggressiveness and sociability of children with lesbian parents and those with heterosexual parents have similarities. There were also studies conducted which showed that children of lesbian parents who were satisfied with their relationships have fewer behavioral problems and were better adjusted. There was also a study by the National Longitudinal Study of Adolescent Health wherein the population consisted of 12105 adolescents in the United States. The authors found out that 44 adolescents, ranging from 12 to 18 years old, who were living with two women, were similar to others who have heterosexual parents when it comes to measures of anxiety, depression, self-esteem and school success. There were also similarities regarding family relationships, care from others, neighborhood integration, regardless of whether the children come from opposite-gender or same-gender families (Pawelski et. al). Since the legalization of same-sex marriage in Massachusetts back in 2004, researches today showed that it may have positive impact in strengthening the ties between couples, their children and extended families. It is interesting to note, however, that a large number of young people in America seemed to support gay and lesbian issues. Olander, Kirby and Schmitt mentioned a survey done by the Council for Excellence in Government (CEG) and CIRCLE which asked young people from 15 to 25 years old their perspective about the rights of homosexuals. The survey found out that youths supported gay and lesbian issues such as protection in housing, employment and hate crime, legal partnerships or civic unions and the ability to adopt children (2). There are others who view gay marriage on a positive note. Carpenter believed that gay marriage helps children. He said that gay parenting nowadays is very common in the United States, and that there are children in every gay and lesbian household. He did not seem to agree that children are better raised by a married man and woman. He furthered that gay marriage will not take away children from their biological parents. Although there is no reported shortage of children, the number of married couples is not enough to raise these children. And this is the reason why singles and unmarried couples are allowed sub-optimal parenting. Carpenter thought that this arrangement is better than foster care where the effects on children are unfavorable. Brinkmann countered Carpenter’s views. She believed that if a child is exposed to both sexes in a household, it will have positive effects on his developmental needs. She explained that this aids them in forming their sexual identity. Since the breakdown of marriage in the country had negative effects especially on children, it must be considered that a heterosexual marriage will provide the children stability with regards to family relationships. Brinkmann furthered that without heterosexual marriage, the society will disintegrate. Times have changed and more changes will manifest in the future. Amidst these changes, the welfare of children who are affected by gay marriage must be the utmost consideration. This means that supporting heterosexual marriage will be beneficial for these children. The government and families must make sure that every step of the way, these children will be encouraged and supported. Their needs must be met in order for them to grow as responsible citizens in our society.

Management of Post-Traumatic Piriformis Syndrome: Case Study

Management of Post-Traumatic Piriformis Syndrome: Case Study Diagnosis and Chiropractic Management of Post-Traumatic Piriformis Syndrome: A Case Study Chief complaint A 37-year-old male patient presented himself at a local chiropractic clinic with a chief complaint of persistent low back pain that was radiating into his left buttock, all along the posterolateral aspect of his left thigh and calf, and to the lateral aspect of the foot. History of the patient illness The pain initiated 2 years ago. The patient reported a blunt trauma of his left buttock in a motorcycle accident 8 months before his symptoms were first noticed. The patient was presented with low back pain, radiating from sacrum and gluteal region to the lateral aspect of the foot, all along the posterolateral aspect of his left thigh and calf. The pain was occasionally accompanied by paresthaesia and burning sensation. When asked to rate his pain with a numeric rating scale (NRS), he noted his low back pain to be 3/10 at best and 7/10 at worst. Prolonged sitting and car driving aggravated his symptoms. And standing up and walking a few steps for a moment would make the pain partially relieved. The patient also noted that prolonged external rotation of the affected hip (sitting posture) made the symptoms more intense. He avoided sitting in a cross-leg posture due to the pain. The patient had a transient relief of his pain after treatment of physiotherapy. However, the pain came back after a few days. Other than the traumatic fall on his left hip in a motorcycle accident, the patient’s medical history was not remarkable. Relative family history, social and environment history Both of the patient’s parents were diagnosed with disc herniation of the lumbar spine in their 50s. The patient went to gym 4 times per week, doing cardiovascular and weight bearing training. And he used to play soccer once a week. However he had to stop playing since his low back pain and leg pain started to bother him. The patient was an attorney and his job required him to sit in front of his desk for more than 6 hours per day. He reported that he had to stand up and walk a few steps in the office every 30 minutes due to the pain. Relevant medications The patient’s symptoms were partially relieved by taking Panadols. He was not taking any other prescribed or non-prescribed medications. List of possible diagnoses from the patient history Lumbar disc herniation The patient was presented with symptoms and signs of radiculopathy including sensation disturbance of the lower limb, pain shooting to the foot, and pain worsened by sitting and relieved by walking. According to the dermatome, the nerve roots of L5, S1 or S2 were possibly affected. Considering that both of the patient’s parents are diagnosed with lumbar disc herniation, it should be on top of the differential diagnosis list, for recent studies have suggested that lumbar disc herniation may be attributed more to genetic factors than to environmental and constitutional risk factors. The patient’s occupation which kept him sitting for a prolonged time increases the chance of lumbar disc herniation. The history of blunt trauma could also be a factor of developing lumbar disc herniation. Sciatic nerve irritation of other origins The patient’s altered sensation on the lower extremity is in the distribution of sciatic nerve. Sciatica should be taken into consideration. However, the underlying cause of compression or irritation of sciatic nerve should be revealed with further examination and investigation. Piriformis syndrome Piriformis syndrome is an uncommon form of sciatica in which the sciatic nerve is compressed and irritated by piriformis muscle. It usually occurs in people who are middle-aged (mean age 38 years old). Robinson described 5 significant manifestations of piriformis syndrome in 1947, including: (1) history of trauma in the gluteal region; (2) pain in the sciatic nerve distribution; (3) symptoms relieved by traction and aggravated by sitting or stooping; (4) palpable tenderness or mass over piriformis muscle; (5) positive straight leg raise test. This patient was presented with the first 3 features of piriformis syndrome, whereas the 4th and 5th need further examination. Sacroiliac joint syndrome Sacroiliac joint syndrome is the dysfunction of sacroiliac joint that is attributed to either hypermobility or hypomobility, causing low back pain, buttock pain and sciatic lower limb pain. Lower abdomen, groin and medial thigh are occasionally affected as well. The symptoms of sacroiliac joint syndrome and sciatica are often similar. Hamstring syndrome Another possible differential diagnosis is hamstring syndrome. Hamstring syndrome is caused by entrapment of the proximal sciatic nerve by the hamstring tendons (1). It usually occurs associated with trauma such as hamstring tears or strain (2). However, in many cases, not significant history of trauma is noted (1, 2). Patients with hamstring syndrome present with lower gluteal pain and radiate down to posterior thigh and knee (2). The symptoms are similar to sciatica of other origins. Results of the neurological exams Observation, static palpation and range of motion Observation and static palpation are performed to look for any degree of antalgic posturing, any deviation from a normal spinal curve, pelvic position, and muscle spasm or bulks. Characteristic findings of each differential diagnosis are listed below. Lumbar disc herniation Possible hyper-lordosis of lumbar spine in an antalgic posture; Significant decrease in lumbar active and passive range of motion, especially in lumbar flexion and unilateral lateral flexion; Possible limited hip range of active motion due to muscle weakness; Possible palpable restricted lumbar vertebral segments; Hypertonic or tender lumbar muscles on static palpation, especially erector spinae (ES) muscles; Piriformis syndrome Possible limping or walking with the assistance with crutches due to pain and lower extremity muscle weakness; Possible hip external rotation on the affected side due to excessive piriformis muscle contraction, which is also known as â€Å"piriformis sign† (3); Significant decrease in hip active and passive range of motion, especially in hip internal rotation and adduction; Ipsilateral short leg (3); Tenderness at the sciatic notch on palpation; Possible hypertonic gluteal muscles (3); Sciatica Findings depend on the causes of sciatica such as lumbar disc herniation, piriformis syndrome and hamstring syndrome. Sacroiliac syndrome The posterior superior iliac spines (PSIS) on both sides are not at the same horizontal level; Possible redness and swelling at the affected sacroiliac joint; Possible leg length discrepancy; Significant decrease in sacroiliac joint mobility; Possible local tenderness on static palpation; Hamstring syndrome The pain is more localized, but possibly radiating; Tenderness of hamstring tendons or over ischial tuberosity on static in palpation; Significant decrease in hip active range of motion, especially in hip extension; On observation, static palpation and range of motion assessment, the patient was noticed for: Positive piriformis sign (hip external rotation) on the ipsilateral (left) side; A relatively shorter left leg compared with the right leg; Tenderness over contralateral (right) sacroiliac joint; A palpable â€Å"sausage-shaped† mass in the ipsilateral (left) gluteal region (3); Hypertonic left hamstrings; Tenderness over left sciatic notch on static palpation; Limited hip active and passive range of motion, especially internal rotation; Decrease in sacroiliac joint mobility; Other findings were not remarkable. The results of the assessment suggested that piriformis syndrome and sacroiliac syndrome were most possible diagnoses. Coordination and gait analysis Coordination and gait should be examined before other assessments are done, for this test provides us a big picture of the patient’s lower extremity function including motor function, joint integrity and coordination. Any gait dysfunction or antalgic gait should be recognized and further tests should be performed to look for the causes. No abnormal movement or disturbance of the patient’s gait was observed. He also reported a partial relief of symptoms when he was walking. The insignificant findings made lumbar disc herniation less likely, however, there was still a possibility. Sensory exam Sensory exams of peripheral nerves were performed to look for any sensation change on the symptomatic lower limb, which would lead to localization of the lesion. Assessments included fine touch, pain, temperature, and proprioception. Decrease in two-point discrimination and light touch was noticed over the lateral aspect of the left leg and foot. Motor exam Lower extremity muscle strength was tested to identify which nerve roots were affected according to myotomes. On examination, no significant findings were noticed. deep tendon Reflex Abnormal deep tendon reflex may be seen in lesions of muscles, sensory neurons, lower/upper motor neurons, neuromuscular junction and mechanical factors such as joint disease. On examination, the patient’s Achilles reflexes were normal (+2) on both sides. An abnormal Achilles reflex suggests a tibial nerve lesion (S1-2). Neurodynamic assessment Straight leg raise The test is designed to look for any impingement of the dura and spinal cord or nerve roots of the lower lumbar spine, especially in sciatic nerve (L4, L5, S1). The patient’s result was negative (70 °), suggesting less possible lumbar disc herniation. Bonnet’s test Bonnet’s test is a variant of straight leg raise and used to test for entrapment of sciatic nerve by piriformis muscle. The patient’s result was positive, indicating possible piriformis syndrome. Bowstring test Bowstring test is another variant of straight leg raise and used to test for entrapment of sciatic nerve by hamstrings. The patient’s result was negative, suggesting less possible hamstring syndrome. Orthopaedic examinations Valsalva maneuver Valsalva maneuver was done to look for any disc herniation causing radiculopathy. This would increase intrathecal pressure which may reproduce the patient’s symptoms. The patient’s result was negative, indicating less possible lumbar disc herniation. Lumbar compression-distraction test This test is also designed to look for disc herniation. When the compressive force is applied, it increases the intrathecal pressure and replicates symptoms if the patient has disc herniation. And the symptoms are relieved by distraction. The patient’s result was negative, suggesting it was less likely to be disc herniation. Gaenslen’s test Gaenslen’s test is to assess sacroiliac joint involvement. The patient’s result is negative. Yeoman’s test Yeoman’s test is designed to assess the integrity of the sacroiliac joint. The patient’s result is negative. Squat test Squat test is designed for quick screening of lower limb pathologies including joint disease, motor and sensory neuron lesions. The patient’s result was positive. Supported belt test Supported belt test helps to determine whether the pain is of lumbar origin or pelvic origin. The patient was noticed for having pain only without supported belt, suggesting his symptoms were caused by pelvic dysfunction. List of possible diagnoses from the neurological exam Piriformis syndrome Sacroiliac syndrome Further blood and radiological tests At this stage, no further imaging or other tests are needed, for the diagnosis can be made based on the patient’s history and results of neurological and orthopaedic examinations. It is recommended that the patient should be treated for piriformis syndrome at the start. A conservative treatment plan should be designed to reduce pain intensity, stretch hypertonic muscles and increase lumbar and sacroiliac joint mobility. However, if the patient does not respond to the treatment or the symptoms are worsened after the treatment, further investigations should be done. Considering a large extent of soft tissue and nerve involvement, magnetic resonance imaging (MRI) would be the most effective imaging method. A lumbopelvic view should be taken. This does not only demonstrate possible hypertrophied piriformis muscle and sciatic nerve entrapment, but also helps to rule out other differential diagnoses such as lumbar disc herniation. Nevertheless, many studies failed to show consistence of radiographic abnormalities in piriformis syndrome. Therefore, no significant findings on MRI do not necessarily exclude piriformis syndrome. CT and ultrasound are also used to look for abnormality of piriformis muscle, but they are not as sensitive as MRI. EMG is an investigation to assess abnormal spontaneous activity of muscles which are innervated by sciatic nerve, thus differentiating sciatica and lumbosacral radiculopathy; however, EMG findings are often normal in piriformis syndrome. Local injection of anaesthetics or steroid can be applied for both diagnostic and therapeutic purposes (4). This technique is widely used after initial evaluation. However, the specificity and efficacy is not well determined by clinical trials (4). A certain portion of patients with piriformis syndrome do not respond to piriformis muscle injection (5). Final diagnosis Based on the patient’s history, the results of neurologic and orthopaedic examinations, and likely radiographic findings, piriformis syndrome is the most likely diagnosis. Chiropractic management Conservative treatment is recommended at this stage, for 79% of patients with piriformis syndrome showed a significant improvement with use of non-steroid anti-inflammatory drugs (NSAIDs), muscle relaxants, thermo-therapy and rest (fishman, osteopathic approach). The aim of the chiropractic treatment is to reduce the intensity of pain, relax piriformis muscle, increase the range of motion of the hip joint, and increase mobility of lumbar and sacroiliac joint. The tone and length of the left piriformis muscle and other affected muscles (hamstrings, other lateral rotators, gluteus muscles) should be assessed with chiropractic muscle test and static palpation. Any trigger point, tenderness, hypertonia are noted. Stretching exercise and muscle release are introduced first to help the patient relax the hypertonic piriformis muscle. The patient needs to receive the muscle release training daily for 2 weeks until the muscle tone is assessed again and any improvement of his symptoms is seen. Stretching of other affected hypertonic muscles is also required. The mobility of the patient’s lumbar spine and sacroiliac joint should be assessed with orthopaedic examinations and chiropractic motion palpation. Any restricted segment is adjusted with high-velocity low-amplitude (HVLA) spinal manipulation. Chiropractic adjustments help to relieve pain, increase joint mobility and re-establish biomechanical stability of the body. References 1.Saikku K. Entrapment of the proximal sciatic nerve by the hamstring tendons. Acta orthopaedica belgica. 2010 06;76(3):321-4. 2.Puranen J. The hamstring syndrome. A new diagnosis of gluteal sciatic pain. The American journal of sports medicine. 1988;16(5):517-21. 3.Boyajian-ONeill LA. Diagnosis and management of piriformis syndrome: an osteopathic approach. The Journal of the American Osteopathic Association. 2008 11;108(11):657-64. 4.Jankovic D. Brief review: Piriformis syndrome: etiology, diagnosis, and management Article de synthà ¨se court: Le syndrome du muscle piriforme – à ©tiologie, diagnostic et prise en charge. Canadian journal of anesthesia. 2013 10;60(10):1003-12. 5.Martin HD, Martin H. Diagnostic accuracy of clinical tests for sciatic nerve entrapment in the gluteal region. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 2014 04;22(4):882-8.

Introduction To Communalism In India

Introduction To Communalism In India Communalism is a pervasive phenomenon in the public life of India and communal riots are the ugliest expression (Krishna, 1985). Communal riots have become an integral part of communalism in India. An event can be classified as a communal riot on two grounds. Firstly, if there is violence. Secondly, if two or more communally identified groups confront each other or the members of the other group, at some point during the violence (Varshney, 2002). The reason behind such communal riots can be superficial and trivial; though deep within there are political reasons behind such events (Varshney, 2002). India is not new to communal riots; the first recorded riots were in the year 1714, 1715, 1716 and 1750 in Ahmedabad (Rajeshwari, 2004). Bipin Chandra in his book Communalism in Modern India writes that the maximum communal riots in India took place during 1923-26. Communal riots in India are not spontaneous and are rarely due to any religious animosity. They usually arise due to conflicting political interests, which are often linked to economic interests (Rajeshwari, 2004). During the 1960s till the late 1980s, the local political and economic factors played a significant role in instigating the riots in major parts of India (Engineer, 2002). However, since then the emergence of Hindtuva politics, it has been the major cause of communal riots (Engineer, 2002). The role of news media in reportage of communal riots in India is a major area of concern. Everything is reported in the media, so are communal riots. The role of the news media has grown in recent years, perhaps because of the centrality of the news media in communal violence and conflicts (Wolfsfeld, 2007). Even the most casual of observers wont deny the increasing significance of news media under such crisis situations. The influence of the news media in peace processes is more subtle, in part because what is not reported in the media is in some ways more important than what is reported. This paper would look at the way Indian media covered and reported the two most horrific incidents of communal violence in India the 1984 Sikh riots in New Delhi and the 2002 Gujarat (Godhra) riots. On both occasions the media drew criticisms. The paper would discuss if the media has been objective in covering both riots and also as to what should be medias role in coverage of such future communal riots in India, if any. The Changing Face of News Media The global media sphere is changing with each passing second. New communications technologies such as camera enabled mobile phones and laptop computers are giving journalists an opportunity to gather and disseminate information with normal ease. This digitization of the news industry has led to compression of time and space and thus enabled us to see news and images of conflicts as and when they happen. The images broadcasted in our living rooms are not only informing the global audience of the horrific happenings but might also instigate further violence in an existing violent situation. As a result, the medias reporting of a conflict situation has become as central to the unfolding of the conflict itself. With the evolution in technology the tyranny of distance might have reduced but various hidden realities and factors still affect the reporting of conflicts. This is proved by a study done by Virgil Hawkings, who explains that the conflict in Africa which has been in the post-Cold war world responsible for nearly 90% of the worlds war deaths suffered a complete media blackout. Similarly, the coverage of the massive war in the Democratic Republic of the Congo (DRC), which resulted in over one million deaths in the year 2000, was almost insignificant (Hawkins, 2008). Since the media has a powerful ability to reach large number of people. It ignites the opinion building process and impacts the political decisions and audience reactions in the society. This eventually shapes the course of prevalent crises and conflicts (Ballantine, 2003). The Media, Religion and Politics With the planes hitting the Twin Towers on 11 September, 2001 the relationship between media and religion changed forever. Karim (2003) suggested that religion would become an important topic for the media and the way media covers events would be influenced by the religious undertones. It is arguable if the world and its religions have changed or not, but the media coverage of the same surely has. Within India, religion has a large impact on the personal lives of millions of people. The country practices almost every other religion known to the world and this is one of the most important facets of the country, so is politics. The politicians play on the religious issues every now and then, and media is used as the platform. The politicians communicate with the common mass through the mass media. The way in which we know and find about our politicians is through the media. It is the media that serves as the main channel of communication between the politicians and the public. Religion is one of the subjects in India which the politicians intelligently use to their advantage. Academic literature has covered the representation of conflict in religion as well as media and religion but not much has been researched on media, religion and conflict situations in context with each other, especially within an environment like India. It would be difficult to understand the relationship between religion, its construction, presentation and conflict situations covered in the media, without some reference to the broader political context within which it takes place, because in a nation like India, religion is certainly driven by political motives. In order to understand the role media plays and should play during communal clashes in India, let us analyze the two worst communal riots India has ever seen the 1984 Sikh riots and the 2002 Gujarat riots. The 1984 Sikh Riots in New Delhi 4.1 The Events On 31st of October 1984, the Indian Prime Minister, Indira Gandhi was assassinated by two of her Sikh bodyguards. What followed was a complete mayhem and it led to a lethal anti-Sikh riots in India. Sikh homes were systematically singled out in the capital and brutally destroyed (Tatla, 2006). The Sikhs were hounded, tyres were put around their neck, and petrol doused on their faces and bodies set ablaze to brutal death (Mohanka, 2005). More than 3,000 Sikhs were killed in New Delhi itself. Two hundred Gurudwaras, the place where Sikhs worship, were burnt down and many Sikh owned shops were looted. 1 The situation worsened when the newly elected Prime Minister Rajiv Gandhi, the son of Indira Gandhi was quoted, When a big tree falls, the ground beneath is sure to rumble. This gave a sense as if Rajiv Gandhi was giving a boost to the killers who were assassinating hundreds of Sikhs in the streets of New Delhi (Mohanka, 2005). Mrs. Gandhis assassinators were avenging Operation Bluestar. In the June of 1984, Mrs. Gandhi, wanted to flush out few terrorists, led by Jamail Singh Bhindranwale, who were hiding in the precincts of the Golden Temple, the holiest shrine for Sikhs in India. On the 3rd of June, 1984 a 36 hour curfew was imposed in the Sikh dominated state of Punjab. All methods of communication and travel were suspended. Electricity supplies were interrupted, a total black out was created and Punjab was cut off from India and rest of the world (Brar, 1992). On the night of 5th of June, the Indian Army under the command of Major Gen. Kuldeep Singh Brar stormed into the Golden Temple. By the morning of the 7th of June the Indian Army had full control of the temple. The militant leaders were killed in the two day battle but along with it a large number of pilgrims, civilians and children were also killed (Ahmed, 1996). The Sikh community were agitated. Their holiest shrine was turned into a bloody battlefield and innocent lives were lost. Saran Singh, a retired bureaucrat and a famous member of the Sikh community in India quotes It was sacrilege to send troops inside, open fire and in the process kill innocent devotees gathered to observe the martyrdom (Mohanka, 2005). From June to September 1984 most members of the Sikh community nursed a festering wound only to blurt out in Indira Gandhis assassination. 4.2 The Indian Medias Coverage of Operation Bluestar and the Sikh Riots Media by its nature plays an extremely important role for any socio-political situation irrespective of the boundary it holds (Mohanka, 2005). The medias role in the riots of 1984 is an interesting case. Scholars believe that media can play a role in focussing on a cause much before it takes an ugly turn. In the case of Punjab in 1984, the local media was not supportive of the Sikh causes. Moreover, since of beginning of the problems in Punjab, the government had a strict control on the media and imposed a heavy censorship. Since independence until the invasion of cable television in India, the electronic media has served as the mouthpiece of the government (Das, 2009). Similar was the role of the electronic media in Punjab during the riots. The Government had such tight control over the media that the foreign correspondents trying to capture the horrific events were not even allowed in the local land. The Indian Government acted as a strict visible gatekeeper and made it impossible to approve journalist visas for foreign correspondents. The events of the 1984 riots thus suffered not only from biased media coverage but also selective coverage which projected one sided selected perspective (Das, 2009). The media blackout during the Operation Bluestar is a prime example of the same. The day before the actual invasion by the Indian Army, the Government ordered all press out of the state and restricted press coverage in Punjab. The press was allowed only a week later on special organised guided tours. The aftermath was later described by the press, as involving a small gang of criminals disliked by the majority of Sikhs and Indians. The press described the militants as petty political agitators, rather than leaders of a movement for a greater Punjab autonomy, as believed by a majority of Sikhs. Similarly, during the reportage of the 1984 riots there were discrepancy between the press release of data and images and the actual severity of the violent situation that prevailed in the streets of New Delhi (Das, 2009). This usage of selective information in the Indian media only contributed to the ambiguous image of Sikhs throughout the nation and failed to bring out their plight in the light. During the Sikh Movement the Government of India had passed the National Secu rity Act (1980), the Punjab Disturbed Areas Ordinance (1983), The Armed Forces Special Powers Act (1983) and the Terrorists Affected Areas (Special Courts Act of 1984). These acts provided the police and army with sweeping powers. They could charge and curtail to the right to life under specific situations. The approach of the media during the crisis had been partisan to take into account all types of multidimensional problem, historical, political, socio-economic and ideological. The media only focussed on special restricted information and ignored a careful examination of all the issues and processes that had led to the mayhem, the riots. During 1984, Indian leaders were free to make up non-existent stories and broadcast through Government controlled radio and television channels. Since there was a major restriction on the foreign press, all foreign news correspondents were left with no choice but to take the twister news of the local government controlled media. The United States of America, The House of Representatives had a view point on the same. It said: As a result the outside world receives a biased one side view of what goes on in Punjab because the Indian Government has control over most of the domestic media. This contributes to the stereotype that all Sikhs are extremist radicals who are terrorising the predominantly Hindu nation and that is just not the fact. If the Indian Government has nothing to hide it should remove the news blackout and permit outsiders into Punjab. The free flow of information is essential to the prevention of rights and liberties in a democratic society and India claims to be the worlds largest democracy. So, they should act as the worlds largest democracy. This is the foundation for a democratic nation and is not too much to ask of India to respect the rights of all its people and not just the Hindu majority. It is not right for any government to deny 16 million of its own people the basic political and civil rights. India has a moral obligation to protect the Sikh community The national newspapers reporting on the Sikhs made no distinction between a regional political party, a handful of militants, and the entire Sikh community. Even the senior editors and columnists of the national newspapers considered all Sikhs accountable for the assassination of Indira Gandhi and provided no sympathy to the community during the riots. Through the critical years of political crisis in Punjab before the horrific riots, the national dailies had not help resolve the issue. The Times of India, one of the leading national dailies and The Hindustan Times did more to incite hostility between Hindus and Sikhs than perhaps any other national English language newspaper (Das, 2009). The media was a part of the misinformation carried out in the public. The best example of the same would be when a national newspaper carried out an article reporting that huge quantities of heroin and drugs had been recovered within the Golden Temple complex and the same had been used by the militants to illegally fund their operations. Since, the foreign press was banned in Punjab; they picked up the story based on the 14th June Press Trust of India (PTI) news report from the government sources. This news was carried out in the major international newspapers. One week into the incident, the government retracted the official report on the grounds that the drugs had been recovered from the India-Pakistan border and not the Golden Temple complex. This retraction by the government was not picked up by most international news agencies and the damage done by the initial report falsely remained amongst the mass. 3 Many scholars believed that the Indian media forgot to prioritize issues and failed to act upon them. Senior Indian journalist, Manoj Mitta along with H. S. Phoolka in the book When a Tree Shook Delhi writes that the media focussed on the assassination of Indira Gandhi and did not care enough about the Sikh murders during the riots. Mitta says: The media by and large went by the official line on the carnage. It focused on the happenings at Teen Murti Bhawan, where Indira Gandhis body lay in state and where from people around the world had come to pay respect. So photographers were flocking to that place and the killings that were simultaneously going on in the capital did not get recorded at all. Its bizarre but true. Not all were pleased by the Indian medias coverage of the riots. The 2002 Gujarat Riots The Events On the 27th of February 2002, the Ahmedabad bound Sabarmati Express train reached a small town in Gujarat named Godhra (Yeolekar, 2002). Instead of the usual stoppage for 5 minutes the train stopped for 25 minutes and then moved out of the platform. Before the train could run at its normal speed, the alarm chain was pulled to stop the train at Signal Falia, a Muslim inhabited locality. No one clearly knows what really happened but after few minutes the compartment S-6 was on flames. 58 passengers including 26 women and 12 children were burnt to death (Yeolekar, 2002). Among the passengers were the Kar Sevaks travelling from Ayodhya. There have been different theories believing that Muslims were behind this barbaric act. If this wasnt barbaric enough, what followed in the days to come shook the entire secular nation of India. During the next three days, from the 28th of February to 2nd of March, 2002 Muslims were butchered, massacred and burnt alive. Out of the 24 districts in Gujarat, 16 were entangled by organized mob attacks in which over 2,000 Muslims were killed, 200 mosques and religious and cultural monuments were sent to rumbles (Sawant et al, 2002). The Muslim community of Gujarat suffered an enormous economic blow with an overall loss of Rs 35 billion. 5.2 The Indian Medias Coverage of the Riots 5.2.1 The Television Coverage For the first time in the history of communal clashes in India, violence was carried live on television (Ninan 2002) as the television cameras brought across the horrific images to viewers home in Gujarat and elsewhere. There was no live coverage of the attacks against the Sikhs back in 1984 or the Babri Masjid fiasco in 1992. Those were the era of print media and television was limited to Doordarshan, a state owned channel. It was only in 1996 when, Rupert Murdoch ventured into India with the STAR network and STAR News happened Indias first 24 hour news channel 4. This addition to the television spectrum of India added a new visual dimension to politics, violence and public sphere in India. In 2005, the television newscape had turned dense with a large number of players entering the market; several 24 hour news channels were launched. This led to intense competitive brand of journalism, which was evident during the Gujarat riots. There were a large consortium of journalists and tel evision crews from various channels on the streets in Gujarat, each trying to outdo each other. When the Gujarat violence happened, the private television in India had been broadcasting for about 8 years and was easily accessible by 40 million amongst the 81.6 million Indians who owned television sets (5 notes). This option offered by the private television gave the Indian viewers unprecedented access to independent broadcasting. When the first pictures of Gujarat riots were telecast on Indian screens on 27 February, the three major news networks in India Star News, Aaj Tak and Zee News did not follow the guidelines formulated by the Press Council of India, a quasi-judicial watchdog organization (Mehta, 2006). The guidelines mentioned not to reveal the identity of victims or attackers in the news reports but all the news networks carried blaring headlines about the killing of the Kar Sevaks 6. The guidelines were against the mentioning of victims or attackers as Hindus or Muslims because they feared it could inflame passions and lead to revenge attacks. The television news networks with its striking visual images made this guideline redundant. While covering the riots in Gujarat, the television journalists openly identified the victims and the attackers. Varadarajan argues for the naming of communities. He states that not naming the communities increases a sense of suspicion and anxiety amongst the ordinary citizens not only in the riot affected area but throughout the nation. Then people tend to assume that the victims are their own while attackers are the other (Varadarajan, 1999). Famous Indian journalists, Rajdeep Sardesai and Barkha Dutt of STAR News justified their stand of naming the communities. Barkha Dutt stated, Naming the community under siege in Gujarat was moot of the story. In fact it was the story, revealing as it did a prejudice administrative and political system that was happy to just stand by and watch. (Mehta, 2006). The bold and independent media coverage by the television media during the riots invited flak from the political actors in powers who were shown in bad light. Criticizing the Bharatiya Janata Party (BJP) and the Hindutva approach in the riots got STAR News and English newspapers like The Times of India and Indian Express bad press (Sonwalkar, 2006). The BJP was in power in the state of Gujarat and at the centre in New Delhi. After the initial violence, when the news coverage of the attacks against the Muslims in Gujarat started to reflect badly on the state and central government, the leaders came down heavily on the journalists and media personnel. The Prime Minister, Atal Bihari Vajpayee addressed the nation a day after the attacks, regretting the disgraceful violence. He later on added that the news media were presenting an exaggerated account of the situation in Gujarat (The Times of India 2002a check book). The BJP and the state government under Narendra Modi singled out STAR News and banned cable operators from showing the channel in the state. The viewers in Ahmedabad, one of the worst affected regions in the riots, were left with blank television screens, unaware from the reality happening on the streets (Mehta, 2006). Cable operators received calls from local officials in Ahmedabad and other cities to completely black out STAR News, Zee News, CNN and Aaj Tak (The Times of India 2002a). Dossiers and hitlists on journalists were reportedly prepared while the channels which dared to reveal the truth and were critical of the Chief Minister and his plan of actions were not invited to the press conferences and hence were denied the basic right to information by the state itself (Sardesai 2004). The main complaint of the BJP and its allies were that the news media did not cover and criticize those who were responsible for the Godhra train tragedy in which 58 Kar Sevaks were victims. This however remains untrue as the every news channels and major newspaper had covered the Godhra train tragedy exclusively, but the follow ups did not remain as the story of the day because the Union Budget followed on 28 February. The budget coverage was pushed aside when the mass killings and large scale retaliation against Muslims started in various parts of the state (Sonwalkar, 2006). Another criticism was that, the national media inflamed communal passions by providing graphic television coverage of the dreadful events. The journalists and the news professional came out against the criticism and said that the level of violence would have been much worse if only the news media brought out the real picture by the graphic images. The BJP and its allies also christened the media as Marxist-Mullah combine and the Secular Taliban for criticising the attacks against the Muslims. Members of the Editors Guild of India visited the affected regions in Gujarat and were told by a group of Hindutva supporters that the Hindu community has been defamed with the coverage only being from the Muslim perspective: They only listen to Muslims and ignore the Hindus (Patel et al, 2002). Sardesai explains the predicament faced by journalists in covering the riots: (If ) any reporter, whether print of television, sees large-scale violence being committed, is the journalist to ignore the hard reality and merely present the facts as seen through the government binoculars? If the Chief Minister says that the situation is returning to normal even while reports are streaming in of continuing violence in several parts of the state, are not the lies to be exposed? And if the government insists that the army is out on the street when the fact is that the army has been kept on stand-by and is waiting for transport trucks, whose version is to be broadcast? (Sardesai, 2002) 5.2.2 The Press Coverage If the graphic coverage by the television channels hit the headlines and created criticisms, the nature of the press coverage also came under the hammer. The coverage by the print media makes an interesting study. There were two different approaches followed by the local and the national media. The local section of the press, including the Gujarati dailies Sandesh and Gujarat Samachar, covered the events from a pro-Hindutva stand and justified the killings of hundreds of Muslims. While the national media, including The Times of India and the Indian Express, were overtly critical of the channelized attacks against the Muslims (Sonwalkar, 2006). The team of Editors Guild of India met several journalists, correspondents, editors, Chief Minister Narendra Modi and others to conclude that the English-language national press played an exemplary role in coverage of the riots. BJPs allegations of media playing an aggravating role in coverage of the riots have been dismissed by many scholars. Patel argues that the allegation was specious, self-serving and must be dismissed (Patel et al. 2002). The Editors Guild of Indias team observed that: Our finding is that the prompt and extensive portrayal by the national media of the untold horrors visited on innocent people in the wake of the Godhra carnage was a saving grace. The exposure of the supine is not complicit attitude of the State and manifest outpourings of communal hatred, stirred the conscience of the nation, compelled remedial action, howsoever defensively and belatedlyHowever, the role of the sections of the Gujarat media, specially the Gujarat Samachar and more notably Sandesh, was provocative, irresponsible and blatantly violative of all accepted norms of media ethics. This cannot be lightly passed over. (Patel et al, 2002) Gujarat Samachar is the largest selling daily in Gujarat with a circulation of nearly 810,000 followed by Sandesh with 705,000 (Sonwalkar, 2006). These two newspapers have a large readership and dominate the print market in Gujarat. A study by PUCL in 2002 found that there were several instances of distorted and false reporting in these two newspapers and also the circulation of Sandesh rose by 150,000 due to its pro-Hindutva stand. The coverage analysis found that when Muslims were at fault, their names were clearly mentioned and the perpetrators identified. However, when the Muslims were the victims of murders, loots, arsons, and other heinous crimes the attackers were unnamed. The study concluded: No sources were quoted for headlines, even when they were simply lifted from speeches by Vishwa Hindu Parishad (one of the Hindutva polical parties in the state). Headlines were also misleading, and often followed up by reports that did not substantiate, and even negated the headlines completelyThe anti-minority stand was obvious in the slant in news reporting. (PUCL, 2002). Sandesh was extremely provocative in its reporting. PUCL states Sandeshs usage of headlines was to provoke, communalize and terrorise people (PUCL 2002). On the 28th of Februrary, Sandesh carried a headline saying, 70 Hindus Burnt Alive in Godhra. Another report on the front page read, Avenge Blood with Blood, which was a quote from a statement made by one of the Vishwa Hindu Parishad leaders, but the newspaper used the words as a headline without mentioning the leader (Sonwalkar, 2006). On the 6th of March, the headline read, Hindus Beware: Haj Pilgrims return with a Deadly Conspiracy, when the fact remains that hundreds of Haj pilgrims were terrified by the happenings in the state and had retuned under police protection. PUCL emphasized in its study that most news in Sandesh post-Godhra violence began with the sentence, In continuing spiral of communal rioting that broke out as a reaction to the demonic/barbaric, etc Godhra incident. The comminatory adjectives used in describing the Godhra incident were strikingly absent when covering the post Godhra Muslim annihilation (PUCL 2002). One of the reports mentioned that the breasts of two Hindu women had been chopped off by Muslim mobs during the crisis. This report turned out be false and the editor countered by saying that the information had been provided by the police. The papers editor told that it was against the policy of the newspaper to carry out corrections and clarifications for previously published articles (Patel et al, 2002). The Press Council of India later censured the newspaper for the fault (Prerna 2003). Gujarat Samachar also heightened the tension through its pro-Hindutva stand in coverage of the events. Gujarat Chief Minister Narendra Modi openly praised Sandesh for its work, which was publishing false and rumoured reports with a pronounced pro-Hindutva and an anti-Muslim stance. In a letter to the newspapers editor, Modi writes: The newspapers of the state played a decisive role as a link between the people and the government. You have served humanity in a big way. It is the state governments primary duty to restore peace and security. It is noteworthy that the newspapers of Gujarat gave their full support to the state government in undertaking this difficult task.I am grateful to you. (Varadarajan, 2002: 286) The one regional newspaper that stood out amidst the Hindutva ideology was the Gujarat Today, notably started by few liberal Muslims in the state. The report suggested Gujarat Today regularly carried out positive news items highlighting interdependence of the communities involved (PUCL 2002). The two English-language national newspapers in India, The Times of India and the Indian Express were critical of the state government in their articles. However, these two newspapers also publish editions from Gujarat and a clear divide was evident between the two English-language dailies and the two regional editions (Sonwalkar, 2006). While the English-language version was sharp in its criticisms of Chief Minister Narendra Modi and his policies, the two Gujarati dailies propagated the need of Hindutva. Desai, an Ahmedabad-based correspondent of the Indian Express writes: Today, all the people who once used to look at me with respect question me and abuse me. They do this because I represented a publication whose medium is English and because I reported human misery in its right perspective.A friend said: All of you from the English language media have tarnished the image of Gujarat. Today, the common man in Gujarat hates the English language media. Even a section of the English language media hates the English language media. (Desai 2004: 228) (Need to conclude) The Role of the Media During Communal Riots: An Analysis The result of multiple and complex interests of regions, states and/or various types of groups within them leads to economic, social and political conflicts. Such conflicts are difficult to handle and requires negotiations between the parties involved and in this amorphous age of media the governments are finding extremely difficult to handle such situations (Terzis, 2008). Despite the increased importance of communication, very few governments can speak about successful communication during conflicts because they fail to take into consideration the perception of the conflict in the minds of the common mass, the scientific analysis of the causable factors, the agendas of the parties involved and the changing nature of the conflict itself (Ballantine, 2003). The role of mass media in covering and resolving conflicts, especially those involving religious differences that leads to frequent communal riots in India, is extremely crucial. We are in the age where the basic principles of reportage of facts are sacred, comment free, get both sides of the story, double check your facts before writing, are not enough in reporting communal riots. There are enough challenges faced by a journalist and media personnel in such a situation. The guidelines for a reporter in covering communal riots should be to lookout for detailed background information, not continue with the stereotyping of communities, find residents who deal with both the communities, talk to victims from both sides, corroborate victims as well as polices accounts, discover the role of the police, the politicians and the media and highlight stories where communities have helped each other. If we analyse the way Indian media covered the 1984 Sikh riots, we