Cutaneous Tuberculosis Disease: Challenges of Treatment

Cutaneous Tuberculosis Disease: Challenges of Treatment CHAPTER -1 CUTANEOUS TUBERCULOSIS INTRODUCTION: In this innovative world while progress in medicine has helped up to deal with many diseases Tuberculosis and Cutaneous Tuberculosis is still a challenge for doctors. A resurgence of Cutaneous Tuberculosis in areas of high HIV incidence, drug resistant present in patients with pulmonary tuberculosis and in immunosupressed patients are the main challenges for clinicians. (6) Cutaneous TB is caused by Mycobacterium tuberculosis, Mycobacterium bovis, Bacillus Calmette-Guerin (BCG) vaccinations and the Tuberculids whose pathogenesis is poorly understood. Cutaneous TB is very variable in its clinical presentation, significance prognosis. Factors which effect on variability are: The pathogenesity of the organism involved. The Previous treatment given. The Immune status of the patients which can be related to the presence of Acquired Immunodeficiency Syndrome (AIDS) or Immunosuppressive therapy. The Port of infection. Any Local factors like, the recent Trauma, the lymphatic drainage, the vascularity of area and the proximity to lymph nodes). PREVALANCE: Thirty years ago it was assumed world wide that tuberculosis would be eradicated in the developed countries, as its incidence increased only on by average 6 % in the United States and 10% in Europe between the years 1953 and 1985. However, in 1983 tuberculosis was declared a global emergency by the world Health Organization because of a sharp increase in incidence. (9) Among infectious diseases, Tuberculosis is an important cause of death. Tuberculosis was responsible for 6% of deaths worldwide. Global prevalence of TB currently is greater than 32%. More than 50% of new patient occurrences were in 5 Asian countries, i.e. India (largest worldwide patient load), China, Indonesia, Bangladesh, and Pakistan(ref ?) The current global burden of Tuberculosis is mind boggling. In 1997, the incidence of new Tuberculosis patients approached 8 million in addition to more than 16 million patients already diagnosed. Around 2 million people died of Tuberculosis in 1997 with a global fatality rate of 23%, fatality rates exceed 50% in some African countries in which there is a high HIV incidence. Approximately 8% of tuberculosis patients are HIV infected. (2) Prevalence of tuberculosis infection in 1985, 1995 and 2005 (10) Prevalence of tuberculosis has increased between 1985 and 2005.According to the World Health Organization case reports statistics, in 1985 there were around 3 million patients of tuberculosis of all types with the highest no of cases in Asia and Africa. In Asia the highest numbers of cases were in India, Pakistan, China, Philippines, Bangladesh, Afghanistan and Vietnam. In Africa the highest number of case were in Ethiopia, Nigeria, South Africa, Congo, Morocco and Tanzania. (10) During the last two decades the number of cases increased all over the world. In 1995 the total number of cases increased to 4.6 million and in 2005 to 7.5 million worldwide. In Asia in 2005 the highest numbers of cases were in India, China Pakistan. In Africa in 2005 the highest numbers of cases were in South Africa, Ethiopia Congo. (10) There is an increasing rate of tuberculosis in the developing countries is approximately 500/100,000/y. Great alarm has been the progressive increase in numbers of strains of tuberculosis that are resistant to antibiotics. Since 1984, that incidence of extra pulmonary tuberculosis has increased at even faster rate than that of pulmonary tuberculosis and is considered to be a diagnostic criterion in the case definition for AIDS. Because immunocompromised individual are at increased risk of extra pulmonary tuberculosis, so dermatologist are renewing their historic role in the diagnosis of cutaneous lesions of tuberculosis. (11) EPIDEMIOLOGY: Epidemiological analysis is used to detect the changing trends in the incidence and prevalence of mycobacterial disease in the community. The main objectives of these methods are to determine the natural behavior of disease and factors which affect his behavior and to calculate future trend if possible to help in the design of any control measures and to assess the usefulness of these measure.(8) Even though 1 of 3 individuals on this planet is infected with tubercle bacillus, the incidence of Cutaneous TB appears low. In areas such as India or China where TB prevalence is high, cutaneous manifestations of TB (overt infection or Tuberculids) are found in less than 0.1% of persons seen in dermatology clinics. The frequency of patients with Cutaneous Tuberculosis seen between 1980 and 1993 in a hospital dermatology clinic in Madrid was 16 per 10,304 which was 0.14%. In a ten year retrospective survey of patients seen in governmental dermatology clinics in Hong Kong between 1983 and 1992, the detected incidence of Cutaneous Tuberculosis among patients was 179 per 267,089 which was 0.07%. Among patients with Cutaneous Tuberculosis only15% had classic Cutaneous Tuberculosis and 85% had tuberculids. In that classical cutaneous tuberculosis approximately 5% had lupus vulgaris, 5% had Tuberculosis Verrucosa cutis and 5% had scrofuloderma. (2) In a tertiary-care hospital in northern India, 0.1% of dermatology patients seen between 1975 and 1995 had Cutaneous Tuberculosis. Lupus vulgaris was the most common manifestation around 55%, followed by scrofuloderma 27%, TB Verrucosa cutis 6%, tuberculous gumma 5%, and tuberculids occurred in 7%. (2) FREQUENCY: USA: In the United States, tuberculosis cases decreased from 84,304 cases in 1953, when national reporting was first began, to 22,201 in 1985.   This represented fairly steady decline of about 5.8% per year. However, the turn down in tuberculosis cases stopped in between 1985 and 1992. In 1992 the annual number of cases increased by 20% to 26,673 cases. (12) The increases were concentrated geographically in several states, with over 90% of the 14,871 cases in California, Florida, New Jersey, New York, and Texas and demographically tuberculosis occurred in racial and ethnic minorities, in people aged 25 to 44, males and in those born abroad. Especially troubling, and indicative of increasing transmission of new infections, was a 36% increase in tuberculosis among children 4 years old or younger. Tuberculosis appears to be on the decline again in the United States as numbers with only 14,871 cases in 2003. (12) Reported tuberculosis cases in United States, 1982-2002 (12) The percentage of Tuberculosis patients who were born abroad individuals was 42%. People born in Mexico, the Philippines, and Vietnam account for one half of born abroad Tuberculosis patients in the United States. The Tuberculosis rate among born abroad people was 4 to 6 times higher than for US-born peoples. Minimum estimates of the proportion of TB patients with coincident HIV infection were approximately 10-15%. Among people aged 25-44 years, this proportion increased to 20-30%. (12) The fundamental origin of this new Tuberculosis epidemic in troubled states reflects a minimum of four major factors including (1) the involvement of Tuberculosis with the HIV epidemic, (2) the increased migration from countries where Tuberculosis is common, (3) the spread of Tuberculosis in congested settings (health-care facilities, prisons, homeless shelters), and (4) the worsening of the basic health-care infrastructure. (2) Molecular typing of Mycobacterium tuberculosis isolates in the United States in a restriction fragment-length polymorphism study suggests more than one third of new patient incidence results from people-to-people transmission, and the remainder result from reactivation of latent infection. Approximately 1 of 13 Mycobacterium tuberculosis isolates currently shows a form of drug resistance. (2) The modern introduction of biological agents that block tumor necrosis factor-alpha in the treatment of rheumatoid arthritis, psoriasis, and several other autoimmune disorders has additional raised about the necessity of the identification of patients with latent Tuberculosis. At present, several hundred cases of Tuberculosis have been reported in patients who receive these tumor necrosis factor-alpha antagonists. (2) HISTORY: Tuberculosis has an ancestry which can be traced to the earliest history of mankind. It was recognized as a contagious disease by the time of Hippocrates and Aristotle in 350 BC. Signs of skeletal Tuberculosis were identified in Europe since Neolithic times and in ancient Egypt around 3700 BC in mummified bodies. Evidence of TB appears in Biblical scripture, in Chinese literature dating back to around 4000 BC, and in religious books in India around 2000 BC. (5) During1600s and 1800s tuberculosis was known ass the Great White Plague in Europe.   Other names for Tuberculosis were Phthisis which was from Greek term phthinein, meaning to waste away, scrofula which were used for swellings of the lymph nodes of the neck and consumption which were used as progressive wasting away of the body.(2) In 1826 Laennec first reported cutaneous tuberculosis which he called PROSECTOR WART. Following Laennec, Rokitansky and Virchow described the histological features in detail comparing them to those of visceral tuberculosis. (6) The Incidence of TB increased with population density and urban development so that by the Industrial Revolution in Europe in 1750, it was responsible for more than 25% of adult deaths. Indeed, in the early 20th century, TB was the leading cause of death in the United States. In 1882, a German biologist ROBERT KOCH presented his discovery of the organism that caused TB. NEIL FINSEN won the Nobel Prize in Medicine in 1903 for introducing UV light into the treatment of skin TB. (2) With the help of better living conditions and the introduction of the antibiotic streptomycin on 20th November 1944, the number of reported TB patients in the United States steadily declined around 126,000 TB patients in 1944, 84,000 in 1953, 22,000 in 1984, and 14,000 in 2004.(2) MODE OF TRANSMISSION: Tuberculosis is an airborne contagious disease that occurs after inhalation of infectious droplets expelled from patients with laryngeal or pulmonary Tuberculosis during coughing, sneezing, or speaking. Each cough can generate more than 3000 infectious droplets. Droplets are so small around 1 to 5 micro meter, that they remain airborne for hours. (2) The likelihood that disease transmission will occur depends upon the infectiousness of the tuberculous patient, the environment in which exposure takes place, and the duration of exposure. Roughly 20% of people in the infected household contact develop infection. Micro epidemics have occurred in closed environments such as transcontinental flights and submarines. Tuberculin sensitivity develops 2 to 10 weeks after infection and usually is lifetime. (2) Because Tuberculosis induces a powerful immune response, individuals with positive tuberculin reactions are at a considerably lower risk of acquiring new tuberculous infection. In HIV-infected individuals, active Tuberculosis is more likely to occur from reactivation of existing disease than from superinfection with a new mycobacterial strain. (2) Without treatment, an estimated 10% lifetimes possibility exists of developing active disease after tuberculous infection, 5% occurs within the first 2 years and 5% thereafter. An Increased risk of acquiring active disease occurs during HIV infection, Intravenous drug abuse, diabetes mellitus, silicosis, immunosuppressive therapy, cancer of the head and neck, hematological malignancies, end-stage renal disease, intestinal bypass surgery or gastrectomy, chronic malabsorption syndromes and low body weight. Infants younger than two years are associated with increased risk. (2) 1) DIRECT INHALATION: The most common mode of entry via portal in to the lungs usually resulting from the Inhalation of airborne droplets containing a few bacilli, expectorated by individuals with â€Å"open† pulmonary disease.(8) 2) INDIRECT INHALATION: A) Ingestion: Less often bacilli may be swallowed and lodge in to the tonsil or in the wall of the intestine. These infections are chiefly related to the consumption of contaminated milk products. (8) 3) INOCULATION: Cutaneous tuberculosis manifestations depend upon the method of cutaneous inoculations, which may be exogenous that is from an out side source, may occur by autoinoculation, or may be by endogenous .Direct exogenous inoculation in an individual not previously infected with tuberculosis causes primary tuberculosis infection, will led to the tuberculous ‘chancre or to tuberculosis Verrucosa cutis depending upon the immune status of the patient. Another example of exogenous transmission is lupus vulgaris at the site of BCG vaccination. (9) Endogenous transmission can occur by continuous extension of tuberculous process underlying the skin as in scrofuloderma, by the way of lymphatic as in lupus vulgaris and by hematogenous spread as in acute miliary tuberculosis or lupus vulgaris. (9) Infrequent mode of transmission is direct implantation in to the skin through cuts and abrasions. These troubles usually in persons, working with infected material or cultures of tubercle bacilli. These skin lesions were called as â€Å"Prosector warts† (8) CLASSIFFICATION OF CUTANEOUS TUBERCUCLOSIS: Cutaneous tuberculosis clinical manifestations comprise a considerable number of skin changes, usually sub classified in to more or less distinct disease forms. Classification depends on morphology more recently mode of transmission or the immunological state of host, but none of them satisfies completely. 1)INOCCULATION TUBERCUCLOSIS (Exogenous Source) Tuberculosis chancre Warty tuberculosis(Verruca cutis) Lupus vulgaris(some) 2) SECONDARY TUBERCULOSIS (Endogenous source) A) Contiguous spread Scrofuloderma B) Auto-inoculation Orifical tuberculosis 3)HAEMATOGENOUS TUBERCULOSIS Acute miliary tuberculosis Lupus vulgaris(some) Tuberculous gumma 4)ERUPTIVE TUBERCUCLOSIS (Tuberculids) A) Micropapular Lichen scrofulosorum B) Papular Papular/Papulonecrrotic TB C) Nodular Erythema induratum(Bazin) Nodular Tuberculids (CLASSIFICATION OF TUBERCULOSIS, MODIFIED FROM beyt et al) (4) CHAPTER-2 CLASSIFICATION OF MYCOBACTERIA: Tuberculosis is an infectious disease which is caused by the Mycobacterium species. Mycobacteria are acid fast, non-sporulating, non-motile weakly gram positive organisms. TEM micrograph of Mycobacterium tuberculosis Table 3: Kingdom Bacteria Phylum Actinobacteria Order Actinomycetales Suborder Corynebacterineae Family Mycobacteriaceae Genus Mycobacterium Scientific classification by Lehmann Neumann. (3) In 1950s Runyon classified the atypical mycobacteria according to their ability to form pigment, their rate of growth colony characteristics. This classification also includes obligate human pathogens and facultative human pathogens. (1) Today more then 60 species of mycobacteria are identified. Around 41 of these were included in the approved lists of bacterial names in 1980. (9) 30 species of mycobacterium are known that can cause disease in humans. The most common causative organism includes: Mycobacterium tuberculosis Mycobacterium Leprae. Atypical mycobacteria. The species which produce disease in tuberculosis primary complex include: Mycobacterium tuberculosis. Mycobacterium Bovis. Mycobacterium Africanum. Sometimes Bacillus Calmette Guerin (BCG) may also cause disease. (1) MEDICAL CLASSIFICATION: For the purpose of diagnosis treatment mycobacteria can be classified in several major groups. Mycobacterium tuberculosis complex, which can cause tuberculosis by the pathogens Mycobacterium tuberculosis, M Bovis, M Africanum M microti. Mycobacterium Leprae, which causes Hansens disease. Nontuberculous mycobacteria are the mycobacteria which can cause pulmonary disease, lymphadenitis, and skin disease disseminated disease. SLOW GROWING MYCOBACTERIA RUNYON GROUP 1)Obligate human pathogens M. tuberculosis-bovis group including bacillus Calmette-Guerin(BCG) M Africanum (not included in runyon classification 2)Facultative Human pathogens M. kansasii I M. marinum I M. simiae I M. scrofulaceum II M. szulgai II M. gordanae II M. avium-intracellualr complex III M. haemophilum III M. Ulcerans III M. xenopi III 3) Nonpathogens M. flavescen II M. terrae complex III M. trivale III M. gastri III RAPIDLY GROWING MYCOBACTERIA 1))Facultative Human pathogens M. fortuitum I V M. chelonae I V M. abscessus I V 2) Nonpathogens M. smegmatis I V M. phlei I V M. vaccae I V others STAINING CHARACTERISTICS OF MYCOBACTERIA: Mycobacteria are aerobic, facultative, intracellular non-spore forming and non-motile curved rods measuring 0.2- 0.5 by 2-4 um. Mycolic acid rich long chain glycol lipids and phospholipoglycans, a mycocides present in the cell wall of mycobacteria protect them. (2) Mycobacteria do not gram stain readily but their most valuable staining characteristic is Acid Fastness. This ability retains carbol fuchin dye after washing with acid or alcohol occurs because of the high content of cell wall mycolic acids, fatty acids other lipids. Other staining methods used include Dietrele, auramine-Rhodamine and phenolic acridine orange stains. Nocardia rhodococcus, legionella dadei, isospora cryptosporidium also share acid fastness. (1) The Ziehl-Neelson acid-fast stain, while highly specific for mycobacteria, is relatively insensitive, and recognition requires at least 10,000 bacilli per mL; most clinical laboratories currently use a more sensitive auramine-rhodamine fluorescent stain (auramine O). Routine culture uses a nonselective egg medium called Lowenstein-Jensen or Middlebrook 7H10 and often requires more than 3-4 weeks to grow because of the 22-hour doubling time of mycobacterium tuberculosis. Radiometric broth culture, BACTEC radiometric system of clinical specimens significantly reduces time 10 to 14 d for mycobacterial recovery. DNA probes specific for mycobacterial ribosomal RNA categorize species of clinically significant isolates after recovery. In tissue, polymerase chain reaction (PCR) amplification techniques can be used to detect Mycobactereria tuberculosis-specific DNA sequences and thus, small numbers of mycobacteria in clinical specimens. (2) The cell wall of mycobacteria consist of: (3) Outer lipids Mycolic acid Polysaccharides(arabinoglactan) Peptideglycan Plasma membrane. Lipoarrabinomannan(LAM) Phosphatidylinositol mannoside. Cell wall skeleton. PATHOGENESIS: The most common site for Tuberculosis disease is lungs and 85% of TB patients present with pulmonary symptoms. The most common sites of extrapulmonary disease are mediastinal, retroperitoneal, and cervical lymph nodes, vertebral bodes, adrenals, meninges, and the GI tract. Pathology of these lesions is similar to those in the lung. Extrapulmonary TB can occur as part of a primary or late generalized infection or as a reactivation site that may, coexist with pulmonary reactivation. (2) Mycobacterium tuberculosis is an obligate pathogen. It is a slender aerobic rod, characterized by high lipid content. This lipid is responsible for resistance to phagocytosis. Identification of organism is easy in tuberculous chancre, scrofuloderma, orificial lesions and the miliary variant. This may be difficult to find or absent in lupus vulgaris, gummata and warty tuberculosis. The organism is highly resistant to drying to drying and therefore can retain infectivity by inoculation or contamination of minor wounds. (19) The reaction of the bacterium depends on: the size of inoculum. the virulence of organism. <

What Is Your Definition of Leadership?

In my opinion, leadership is the ability to inspire and motivate people enough for them to be willing to participate and get involved towards the achievement of a common goal. I see leadership as a process which can be improved over time and experience, but only by someone who has some innate leadership competences. In determining what leadership means to me, I decided to analyse two different leadership cases. I will firstly discuss and analyse Nelson Mandela’s leadership style, which appeared to be mainly transformational.I will try to demonstrate how Nelson Mandela proved that leadership was a two-way process between the leader and his followers, and how crucial it is for a leader to be respected and admired by his followers in order for him to be effective. In addition, a leader needs to be trustworthy, passionate and devoted to achieving a shared objective. More importantly, a good leader will abandon his subordinates once he achieved a personal goal. Throughout this essa y, I will try to support my opinion being that, efficient leadership lies somewhere in between the trait and the style approaches whilst taking into account the situational approach.In my opinion, not everyone can be a leader, but if someone is meant to be one, leadership skills need to be learned and improved over time and adapted according to different situations. If not born a leader, one can only become one to a certain and limited extent, as we will see in Barack Obama’s case. President Obama first started as an acknowledged inspirational and passionate leader, who people admired, respected and wanted to join. However, a few years after his election, it seems like his glory days are behind him, and that he isn’t the leader he used to be anymore.It might appear that once he was elected president, and his personal goal has been achieved, Obama didn’t fight as hard for his subordinates as he did for his personal satisfaction. His lack of communication and insp irational speeches seem to have considerably damaged his reputation as a leader. It appears that Obama gave Americans too high hopes that he wasn’t able to keep up with and fulfil, creating a wave of disappointment among his supporters. It seems to me that Barack Obama was a great leader throughout his campaign, but that once elected, he was lacking some crucial leadership skills required as a President.In fact, one could argue that he wasn’t born a leader. In contrast to Nelson Mandela, he was only able to be a leader to a certain extent, his apogee being during his presidential campaign. By fighting vigorously against apartheid, Nelson Mandela rapidly became an iconic figure of resistance in South Africa, and was thereafter acknowledged as the most significant black leader South Africa had ever known. He devoted his life to fighting against racism and apartheid in South Africa and for peace.However his life objectives were not personal satisfactions, but satisfaction s of his supporters. He fought for their freedom and well-being before fighting for his own. In fact, he never compromised his political position even to regain his freedom. He could have backed down after being released from the Robben Island prison in 1990 (after 27 years of cruel imprisonment), after being awarded the Nobel Peace Prize in 1993 or even after becoming president in 1994. Yet he didn’t, and continued to fight for his people’s freedom and rights.Nelson Mandela has always demonstrated some legendary listening skills which are essential to being an efficient democratic leader. Indeed, he learned at a very young age from his guardian how listening to others was a vital skill in effective leadership. In fact, his guardian used to listen to everyone’s opinions first while remaining silent, before guiding the group to reach a consensus (Stengel, 1994). Therefore, one could argue that Mandela’s effective democratic or participative leadership styl e was greatly inspired by his childhood experience.Throughout his life as a leader, Nelson Mandela always encouraged people to share their ideas and opinions, to which he carefully listened before making the final decision. This way, he managed to get people to be more engaged and devoted to a particular cause, leading to higher productivity towards their goals’ achievement (Lewin, K. , Liippit, R. and White, R. K. 1939). Moreover, by entering the debate and being the last one to speak, he also gains a considerable advantage, as he is the one to close the argument.He also cultivated other leadership skills through his personal experience of being a cattle herder: â€Å"When you want to get a herd to move in a certain direction, you stand at the back with a stick. Then a few of the more energetic cattle move to the front and the rest of the cattle follow. You are really guiding them from behind. That is how a leader should do his work† (Stengel, 1994, Nelson Mandela: Th e making of a leader, Time Magazine, May 9th 1994). Thus, even before being in any position of leadership, Nelson Mandela revealed himself as a born leader.We can consequently assume that the Traits approach is relevant to efficient leadership. Indeed, Mandela seems to have been â€Å"born† with some essential traits that characterize a leader. Known as the â€Å"main-man† in South Africa, he was charismatic, influential, sociable, intelligent, alert, persistent, responsible, self-confident, and ready to assume the consequences of his decisions, as he did by going to jail. Thus Mandela innate leadership style clearly corresponds to Stogdill’s characteristics of the Traits approach (Stogdill, 1948).Moreover, Nelson Mandela was also widely accepted as a transformational leader, as he was able to inspire and motivate his supporters to work towards a common goal through the power and persuasiveness of his vision and personality. He strongly engaged with his follower s, and made them aware of what achieving a particular goal meant (Barbuto, 2005; Barnett, McCormick & Conners, 2001; Gellis, 2001). As James MacGregor Burns (1978) firstly introduced it, transformational leadership is when â€Å"leaders and followers maker each other to advance to a higher level of moral and motivation. † In addition, according to Bernard M.Bass’s Transformational Leadership Theory (1985), transformational leaders are trusted, respected and admired by their followers. Thus, as Nelson Mandela clearly gathered trust, respect and admiration among his supporters, we can say that his leadership style also corresponded to the transformational one. In fact, Nelson Mandela didn’t sharpen his leadership skills from anywhere, he was a natural leader and his skills came intuitively. He was born a leader and refined his skills with the personal experiences he gained over the years, which enabled him to effectively adapt to various situations.He strongly bel ieved in consensus and knew how to empower his subordinates and motivate them to achieving a common objective. His legendary success as a leader was also mainly due to the fact that he was seen as approachable compassionate and honest. Yet, he was undeniably respected and admired for his courage, his wisdom and his determination. On the other hand, Barack Obama, whose presidential campaign aroused unrecorded enthusiasm, hope and inspiration, seems to have unexpectedly disappointed his followers once elected President of the United States of America.Indeed, during his campaign, Barack Obama astonished everyone with his unpredicted inspirational, passionate and enthusiastic speeches. Who doesn’t remember his â€Å"Yes we can† speech given in New Hampshire in 2008? At the time, it seemed like Obama had all it took to be a great leader, he had a strong charisma, was motivated, inspired and seeking to achieve a common goal, thus showing many aspects of a Transformational as well as Charismatic leader. However, soon after his election, his supporters found themselves disillusioned by their President’s leadership skills.They felt like his motivation and enthusiasm had faded away, and that he wasn’t the inspirational leader he used to be. Obama was effective as a leader during his campaign, at one place and time, but became unsuccessful as soon as the situation and the factors around him changed, due to his rigidity and inability to adapt to contextual changes. Thus, Obama can clearly be related to Fiedler’s Contingency theory, as he became ineffective as soon as the factors around him changed.Unlike Nelson Mandela, Barack Obama seems to be more of an educated leader, who cultivated most of his leadership skills from Columbia and Harvard universities, therefore embracing the style approach which suggests that his behaviour of leader is distinct from his personality. In fact, Obama never appeared as a â€Å"born† leader, with i nnate leadership skills, and had no particular leadership experience, when he became President. Critics of Barack Obama emphasize the fact that his lack of leadership has already been demonstrated in various scenarios.Most of his supporters criticize his lack of communication and his â€Å"invisibility†. They feel somehow deserted and let down by the man who not long ago, aroused their highest hopes. Even the Democrats now acknowledge his lack of presence â€Å"Dems say privately Obama is invisible, not a leader. † (Joe Scarborough, 2011). One would have thought that Barack Obama’s leadership skills would have had improved as he gained in experience as a President, yet it looks like his apogee as a leader what during his campaign and that since then the leadership part of him is disappearing.In fact, Barack Obama brought only a few, if any, leadership skills into his presidency, and has deceivingly developed none after almost 3 years of experience (Kelly OConnel l, 2011). As a President, Obama has espoused a delegating and passive leadership style, which wasn’t the best style to adopt in a period of deep crisis, when perseverance and prompt decision-making skills were required, thus clearly lacking some situational leadership skills (David Brooks, 2011). Barack Obama consequently appeared as the wrong man for the situation, and not the erson America needed, due to his lack of toughness, imagination and determination. The Presidential candidate who was known for his grand enthusiasm and his passion seems to have vanished to make room to a President who got overwhelmed by his job and ran out of ideas shortly after taking office (David Frum, 2011; David Brooks, 2011). It became vague in Obama’s supporters’ minds whether he was the â€Å"turnaround leader† America needed or not (Michael Watkins, Thursday January 22, 2009, â€Å"Can Obama lead the Great American Turnaround? Harvard business review). According to Mich ael Watkins, Obama demonstrated more Steward Attributes than Hero Attributes, which were vital considering the depth of the crisis. Undoubtedly, President Obama was more conservative, diplomatic and supportive than visionary, directive and charismatic. To conclude, we can say that the difference between Nelson Mandela’s and Barack Obama’s leadership style is striking.Nelson Mandela, can be acknowledged as a â€Å"born† leader who improved his leadership skills throughout his experience as a country’s leader, whereas Barack Obama tends to be more of an â€Å"educated† leader, who couldn’t keep up with his status’ expectations. One was able to adapt to situational changes and prove himself as a true leader fighting for his people when the other disappointed his followers by suddenly disappearing through a lack of communication and perseverance to achieve the set common goals, thus generating a common feeling of abandonment.In my opinion , these two cases reinforce my proposition of a leader’s definition, as we clearly saw that leadership skills should be innate and improved through time to make an effective leader. Moreover, by observing Mandela’s and Obama’s leadership cases, we saw how an efficient leader must constantly motivate and inspire his followers to achieving a common objective that should be kept in mind and should remain the main focus of the leader as well as the followers.Clearly, without the support of his followers, a leader cannot achieve anything. Thus, as I suggested it, leadership is a two-way process in which the nurture of relationships between the two parties is essential, as recognized by Peter Northouse (2010). References: Barbuto, 2005; Barnett, McCormick & Conners, 2001; Gellis, 2001 Bass,B. M,(1985). Leadership and Performance. N. Y,: Free Press Brooks, David (June 28, 2011), Convener in Chief, The New York Times, N. Y edition pA23. Burns, J. M. (1978). Leadership. N. Y: Harper and Raw.Fiedler, F. E. (1967) A Theory of Leadership Effectiveness, New York: McGraw-Hill Frum, David (June 28th 2011), Obama is his own worst Enemy, http://www. frumforum. com/obama-is-his-own-worst-enemy, accessed the 07/01/12 Lewin, K. , Liippit, R. and White, R. K. (1939). Patterns of aggressive behavior in experimentally created social climates. Journal of Social Psychology, 10, 271-301 Northouse, P. G. (2010), Leadership: theory and practice (5th edition) Thousand Oaks, Sage. OConnell, Kelly, Sunday, July 31, 2011 , www. canadafreepress. om â€Å"obama’s leadership style is classic liberalism: no vision+ utter incompetence = total failure† accessed the 05/01/12 Stengel, 1994, Nelson Mandela: The making of a leader, Time Magazine, May 9th 1994 Stogdill, R. M. , 1948. â€Å"Personal factors associated with leadership: A survey of the literature. † Journal of Psychology. 25: 35-71. Watkins, Michael (Thursday January 22nd, 2009), â€Å"Can Obama lead the Great American Turnaround? † Harvard business review, http://blogs. hbr. org/watkins/2009/01/the_great_american_turnaround. html, accessed the 07/02/12

Polysystem Theory Essay

The book consists of a set of articles in which the centre of attention is the notion of Polysystem. The article The Function of the Literary Polysystem in the History of Literature is mostly connected with the notion of Polysystem. Language is heterogeneous, so it is labeled as a polysystem, where highly codified stratification prevails, any minor move from one stratum to another may be taken as a major offense. Polysystem is subdivided into â€Å"canonized† (usually considered â€Å"major† literature: those kinds of literary works accepted by the â€Å"literary milieu† and usually preserved by the community as part of its cultural heritage) and â€Å"non-canonized† literature (those kinds of literary works more often than not rejected by the literary milieu as lacking â€Å"aesthetic value† and relatively quickly forgotten, e. g. detective-fiction, sentimental novels, westerns, pornographic literature, etc. ). Translation plays a great role in Polysystem and in the synchrony and diachrony of a certain literature. Epigonic† literature is kind of a literature where diachronic shifts create a situation in which norms previously known as dominant become peripheral within â€Å"the new phase of literature,† but they are still in use. Canonized literature tries to create new models of reality and attempts to illuminate the information it bears, non-canonized literature has to keep within the conventionalized models which are highly automatized. In synchrony, canonized and non-canonized systems manifest two various diachronic phases, the non-canonized overlapping with a previous canonized phase. The oppositions between the various literary systems create an ideal literary and cultural balance within the literary polysystem. This is the only way for non-canonized literature to settle in literature when canonized literature succeeds in gaining ground. The article The Relations between Primary and Secondary Systems in the Literary Polysystem distinguishres between primary and secondary systems – to what extent a certain system or type plays a major role within the literary polysystem. The Polysystem hypothesis gives us possibility to a more adequate analysis of intra- and interrelations. It is also a functional concept. It is concerned with dynamic complexes. The functions it may detect are conditioned by complex inter- and intrarelations within a hypothesized multileveled system. â€Å"Primary† type: the pre-condition for its functioning is the discontinuity of established models. Change occurs only when a primary model takes over the center of a system. Sometimes we can have the process of â€Å"secondariztion’ of the primary, what means that new elements are retranslated, into the old terms, inconsequence imposing previous functions on new carriers but not changing the functions. The Polysystem Hypothesis Revisited. Many scholars, including Evan-Zohar considered that literature within the historical context can be conceived of as a polysystem, that is a stratified whole, where the various strata function as systems. But it became clear that no literature really overfunctions as a non-stratified whole and if the correlation between the strata within it disintegrates for some reason, a sort of stagnation takes over. The result of such process is that the system collapses. The methodological hypothesis which presumed literature to be a polysystem could now be reversed and reformulated in terms of a universal: all literary systems strive to become polysystemic. The article Universals of Literary Contacts distinguishes source literature (SLt) and target literature (TLt) and draws the difference between two major types of literary contact: first – contacts between relatively established systems which are con-sequently relatively independent (for instance the situation of English and French languages over the past two years); and second – contacts between non-established or fluid systems which are partly or wholly dependent upon some other system(s) – these are the cases with Ukrainian and Russian, for instance. Some examples of possible universals of literary contact are provided: – Literatures are never in non-contact, because of some social reasons. These contacts are the rule rather than the exception. – A prestigious literature may function as a literary superstratum for a TLt. – Literature may be selected as a SLt when it is dominant due to extra-literary conditions, for example the political domination of English and French during colonial periods. – Contacts are also favored/non-favored by a general attitude of a potential TLt. Due to some nationalistic view, works of some writers could not be possible considered as appropriate for the national literature. – We may observe interference when a TLt cannot resist it or has a need for it – is when a certain type evolved in a certain literature is lacking in another, for example, thrillers and detective stories undoubted-ly migrated from English literature to practically all the others. – Items are not transplanted from a SLt to a TLt, but â€Å"needs† determine and guide the selection and the function also changes. – A TLt tends to behave like a secondary system with respect to a SLt. This means that a TLt, under the conditions mentioned above, makes contact with a diachronic phase of a SLt which is wholly or partly outdated, and disregards a contemporary SLt phase. Interference in Dependent Literary Polyssytems. A literature may become dependent only if it is weak. But this â€Å"weakness† means the inability of a system to function by confining itself to its home inventory only and the extreme of such a state would then denote a situation where a literature can function only because it has the opportunity of using some other literature. Russian literature was for Hebrew as a part of it on all levels, but due to the equivalency policy adopted by Bialik and his contemporaries, there was a very strong illusion of domestic â€Å"originality. † When the condition of weakness is not marked, even physical contacts and pressures may not result in interference; when it is marked, a state of dependency is very likely, especially if simultaneously accompanied by accessible contacts even in the absence of physical contact and pressures. The next article Russian and Hebrew: The Case of a Dependent Polysystem first of all tries to show ways in which Yiddish and Hebrew developed through the centuries. The fact that many Jews lived among Slavs is of high importance because this is the reason why the language was influenced by European languages. Only in the 19th century the great development of both languages began. This period is called â€Å"The Revival Period. † The most noticeable is the influence of Russian languge. Russified items penetrated most easily into domains where the Hebrew repertoire was weakest. Hebrew separated from Yiddish only in Palestine. The last article Israeli-Hebrew Literature: A Historical Model is about historical interrelation of Hebrew and Yiddish literature. The first period of the development can be characterized by its multiterritorial base (if the writer lives outside his country his works can be aknowledged of the country he lives in – this was common for Hebrew) , and its existence as a defective polysystem within symbiotic structures, which is the function of the first one (for instance Hebrew which influenced some other languages, mainly, where Jews lived). Due to some political reasons Israeli-Hebrew Literature didn’t have a stable centre. Only in 19th century it moved to Palestine, however a lot of publishing houses were situated in all over the world. Yiddish literature functioned for a long time as Hebrew’s non-canonized system, but after the separation the audience increased. Translations are very important in Israel Literature, because they are also a part of Israel Literature, mostly these are the translations from English, German and Russian Literatures. Despite all the pressure that Israeli underwent, the literature develops as well as researches on Translation Studies.

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