Analysis of Liver Disease in Europe

Analysis of Liver Disease in Europe To what extent does alcohol contribute to liver disease in Europe? Alcoholic liver disease is the major complication of chronic alcohol abuse, with cirrhosis (with or without portal hypertension), being the most common end-point of the spectrum of complications. This association is seen throughout virtually all populations, demographic groups and clinical sub-sets. (Walsh K et al. 2000) It is notable that the incidence of the disease process is changing on a world-wide consideration, with countries such as India and Japan recently seeing a rapid escalation in numbers of cases of cirrhosis, from their traditionally low baseline of prevalence of the disease. This essay however, will primarily consider the situation in Europe. Considerations of safe limits to alcohol consumption have to be prefaced with the comments that they are controversial, and that there is no common agreement on a minimum safe level. In the UK, the Royal College of Physicians suggest a weekly limit of 21 units (210 g) of alcohol in men and 14 units in women as being the upper limit of â€Å"safe† use. This has to be seen in the context that the Office of Population Censuses and Surveys General Household Survey found that 27% of men and 13% of women in the UK were found to be exceeding these limits in 2004 (OPCS 2004) This can be contrasted with the findings of an Italian study (Bellentani S et al. 1997) which suggested that the â€Å"significant risk threshold† for the subsequent development of alcoholic liver disease in an Italian population was only 30g of ethanol per day and that the risk escalated with progressively higher levels of intake. The authors also noted that, for a given level of intake, women had a significantly higher risk of developing alcoholic liver disease than did age-matched men. On a critical note, one must concede that this was a prospective non-randomised study with a moderate (6,500) entry cohort. This can be compared with a larger Danish study (13,000 entry cohort) which demonstrated a statistically significant increase in the risk of alcoholic liver disease at levels of intake above 14 27 units per week in males and 7 13 units in females. (Becker U et al. 1996) One cannot conclude, from this data, that different European populations have different susceptibility to alcoholic liver disease. One of the major practical difficulties in mounting a major prospective study of this nature is the control of the huge number of variables that may influence the outcome, not least of which is the fact that no individual person drinks a uniform quantity of alcohol per day over many years. There are also considerations of the possibility of variation of effect of different proprietary brands of alcohol-containing drinks as well as the (largely under researched) area of the long term effect of binge drinking. Virtually all studies however, demonstrate a steep dose dependent increase in alcoholic liver disease above a threshold level of alcohol intake with women having a greater incidence of the disease than men at a given age range and level of intake. The reasons for this sex difference is not completely clear with Kwo et al. demonstrating that if one adjusts for body mass and liver size, then both men and women have equivalent biological rates of alcohol degradation. (Kwo P Y et al. 1998) A number of authorities (viz. Teli M R et al. 2005) suggest that these gender differences in susceptibility to alcoholic liver disease may be due to primarily to pharmacokinetic reasons including differences in the rates of ethanol absorption or alternatively, differences in the degree of response of the liver to alcohol induced injury such as that caused by oxidative by-products of ethanol metabolism in the liver. If one accepts the difficulties inherent in trying to define the lower margins of â€Å"safe† levels of alcohol drinking, then it is also appropriate to consider the problem from the other end of the spectrum. There are many studies in the literature which have considered the incidence and natural history of alcoholic liver disease in a population of heavy drinkers who, by definition, will show a much higher prevalence of the disease process. A comparatively old study by La Vecchia et al. showed a Europe-wide reducing trend in alcoholic liver disease in the recent past (La Vecchia, C et al. 1994) and this should be compared with data which shows that the deaths from alcoholic liver disease are actually increasing in the UK (CMO 2001). More specific recent data shows that this increase is disproportionately represented by the young adult and middle aged population in the UK showing an 8-fold rise since the 1970s (Leon, D. A et al. 2006) There is a general perception that end-stage alcoholic liver disease (in the form of cirrhosis) is only seen in those patients who demonstrate alcohol dependence syndrome (viz. Smith et al. 2004 and Luca A et al. 2007). There is a growing body of evidence which suggests that this may not actually be the case. If one considers one of the landmark papers on alcohol dependence and related disease processes, one could cite the classification of Jellinek who categorised five â€Å"sub-species† of alcoholism in his authoritative work in the area. (Jellinek, E. M. 1960 A). The current significance of his initial classification is that he identified two specific types of â€Å"alcoholics†, the ‘ß alcoholics’ who are not alcohol dependant, but who have a disproportionately high incidence of alcohol-related diseases, such as cirrhosis and contrasted this to the gamma alcoholics who were typically highly physically dependent, demonstrated frequent behavioural problems and had a high incidence of sociological complications. Jellinek made deductions about why these groups had different drinking patterns suggesting that the tendency towards heavy drinking in the ß alcoholic group was related to the customs and peer pressures within their social group, whereas gamma alcoholism was characterised, in part, by drinking to relieve a psychological craving and a physical addiction. (Jellinek, E. M. 1960 B). In the context of this examination, one can intuitively suggest that the customs, peer pressures and social groupings may be one of the more salient causes of different patterns of alcohol use across the various national cultures of Europe. There is a further difficulty in that, a brief overview of the literature on the subject of alcoholic liver disease shows that, in the context of Jellinek’s theoretical framework, which describes the population of drinkers who present to healthcare professionals with liver disease as a distinctly separate (although overlapping) population from those who present with alcohol dependence, there is a comparative paucity of studies which look at the drinking patterns, social factors and attitudes in patients with alcoholic liver disease when one compares it with the wealth of literature on alcohol dependence. This may seem to be an academic inference, but one can cite the authority of the often quoted Wodak study which identified significant differences between the population of typical patients with alcoholic liver disease and a population of patients who were recruited from an alcohol treatment centre for dependence, presenting evidence that only 18% of patients who had clinical alcoholic liver disease were severely dependent on alcohol and this contrasted with 56% of the attendees at the alcohol treatment centres. The authors also found that 63% of the patients who were found to have alcoholic liver disease had only a mild or moderate dependence on alcohol. (Wodak, A. D. et al. 1983). If one looks beyond the confines of Europe, one can cite the authority of an Indian study (Sarin, S. K et al. 1998) which found broadly similar results. More recent studies using liver transplant patients (viz. Burra, P. et al. 2000) have also produced similar results, although there is an obvious source of potential selection bias in such studies in the desire of certain patients to be accepted onto a transplant programme and this bias will (intuitively) vary between the different patterns of medical care provided across Europe. The problem confronting many researchers is the difficulty in clinically defining alcoholic liver disease. Many patients may be unaware that they are developing significant problems until the time of presentation. The first presentation may be with acute upper gastrointestinal tract haemorrhage or with alcoholic hepatitis. Both conditions frequently present in the absence of warning signs of a developing alcohol dependence. (Vorobioff J et al. 1996). The Harry et al. study reporting that the first presentation of alcoholic liver disease may actually be fatal with uncontrollable bleeding oesophageal varices carrying an immediate 25% mortality rate, (Harry, R. et al. 2002), a finding also found in the Brett study. (Brett, B. T. et al. 2001). Mathurin suggests that in patients who present with severe alcoholic hepatitis, over 50% may die. (Mathurin, P et al. 1996) If one considers data from other European centres, the Italian Loguercio study considered the pattern of drinking in indigenous Italians who had Hepatitis C. (Loguercio C et al. 2000). This is particularly significant in the Italian population as their prevalence of Hepatitis C is the highest in Europe. (De Bac, C. et al. 2004). It is well known that Hepatitis C infection is associated with a higher incidence of hepatocellular carcinoma, but it is not know the extent to which subsequent alcohol intake influences the natural progression of the disease process. The Loguercio study sought to explore this feature and makes the observation that only 4 5% of all manuscripts submitted to â€Å"Hepatology† deal with alcohol-related liver disease, which exemplifies the point made earlier. In direct consideration of the thrust of this examination, the extent to which alcohol contributes to liver disease is modified by the presence of complicating factors such as Hepatitis B and C. Loguercio et al. suggest that there is a direct interaction between alcohol and the viruses, other authorities (viz. Ostapowicz, G et al. 1998) suggest that an additional mechanism of disease modification is that the presence of alcohol affects the response to interferon therapy (IFN). The latter belief has a poor evidence base as Mabee points to the fact that, without exception, none of the controlled trials published thus far on the efficacy of IFN treatment of Hepatitis C-related liver disease have determined the alcohol intake levels prior to therapy. ((Mabee, C. L. et al. 2008) Lieberman has shown that chronic alcohol intake levels correlate well with gamma-glutamyl transpeptidase (GT) levels. (Lieberman, M. W. et al. 1995) and these levels have been shown by Camps to be extremely predictive of treatment (Camps, J. et al. 1993). In this way it is possible to make the direct connection that alcohol intake clearly directly influences the rate of progression of hepatic pathology, a claim that has been further strengthened by the large retrospective analysis by Pol et al. who examined and correlated the rate of progression of the disease process (in Hepatitis C and HIV/AIDS hepatitis, with the overall intake of alcohol. (Pol, S. et al. 1998). The authors demonstrated that alcohol intake of the patient directly influences their gamma-glutamyl transpeptidase (GT) plasma levels and the rate of progression of the disease process. There is further evidence of the degree to which alcohol influences liver disease, at a histological level, in the form of the Scheuer paper. (Scheuer, P. J. et al. 2001). In congruence with the thrust of this segment of the paper, we can cite the authority of Scheuer who correlated the degree of fibrosis and steatosis with the average levels of alcohol intake and Pessione who noted that the degree of fibrosis in patients with Hepatitis C chronic hepatitis was related to the history of alcohol intake. (Pessione, F. et al. 1998) To return to the Loguercio study, the authors comment that the Italian cohort was typical for the country, (but atypical for Europe) as there is known to be a high alcohol intake per head of the population in Italy, even after making allowances for the fact that alcohol intake has fallen in the last decade (SPE 2004). In an attempt to evaluate the effects of alcohol on the population with alcoholic liver disease the study considered three important markers namely : (1) To estimate how many subjects in our country misused alcohol before and after being diagnosed as having HCV-related chronic liver disease (2) To determine if their drinking habits affected the principal aspects of this disease: routine laboratory data (particularly GT plasma levels), histological pattern (particularly liver steatosis and fibrosis), HCV RNA levels, and response to IFN therapy; (3) To compare results from this and a previous study (Aricà ² et al., 1994) to determine if CLD subjects have modified their drinking habits since a decrease was observed in the general population. (Loguercio C et al. 2000). The study is both long and complex, with rigorous statistical analysis. In essence, the authors were able to demonstrate that the majority of patients with Hepatitis C liver disease still regularly drank significant amounts of alcohol. Patients with hepatitis were more likely to drink alcohol than those with cirrhosis. They were also able to confirm that there were significantly higher levels of gamma-glutamyl transpeptidase (GT) and greater levels of fibrosis associated with higher levels of alcohol in male subjects. Interestingly, women had higher levels of fibrosis than men even if they were total abstainers or less than 40 g/daily of alcohol, but their gamma-glutamyl transpeptidase (GT) levels did reflect the overall alcohol intake. This is very supportive of the hypothesis that women appear to have lower levels of defence against the oxidative insult produced by alcohol intake and may therefore develop a more marked fibrotic infiltration. We know, from other evidence that clinic ally, women appear to have more severe and rapidly progressive hepatitic disease processes than men. (Watson, R. R. ed. 2001) To consider a more general overview of the Europe-wide situation, one can consider the Rehm review paper which considers the implications of alcohol usage and mortality rates across the European continent. (Rehm J et al. 2007). The review itself is in commendable depth and provides an excellent evidence base for the area of investigation. The main points presented can be summarised. There is still a general all-cause mortality gradient from west to east across Europe which is more pronounced in males. (Zatonski W et al. 2000). In statistical terms, the western (old EU) countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden and UK) had a male life expectancy of 75.7 yrs and a female life expectancy of 81.5 yrs. In the central European countries (Czech Republic, Hungary, Poland, Slovakia, and Slovenia) these expectancy figures have fallen to 70.9 and 78.7 respectively. In the new Baltic states (Estonia, L atvia, and Lithuania) it is 65.3 and 76.8 yrs respectively and in the Russian Federation it was 58.3 for men and 71.8 for women. It can be seen from these figures that the life expectancy for men varies by 17.4 years and 9.7 yrs for women. It should be noted that a later, but less exhaustive, study by Vagero demonstrated that by 2005, while life expectancies were slightly higher, the overall gradient and pattern of mortality remained unchanged. (Vagero D 2007). A number of authorities (viz. Men T et al. 2003 and McKee M et al. 2001) have highlighted the levels of alcohol consumption, in addition to smoking and poor nutrition, as being the main determinants of this gradient. Rhem has also identified alcohol as being the prime determinant of premature mortality in the Russian federation. (Rehm J et al. 2003 A) Rhem presents a systematic analysis of alcohol-attributable mortality and disease burden by country, and considers two major aspects in each case namely, both the level of consumption and the patterns of drinking, the latter mainly referring to irregular heavy drinking occasions. (Rehm J et al. 2007). These two aspects are not straightforward, as an illustrative example of France and Sweden demonstrates. France has a traditional wine drinking culture with overall high levels of alcohol consumption but a relatively low proportion of people drinking to intoxication, Sweden, by contrast, has an increasing, but still relatively low level of overall alcohol consumption but a social tradition of irregular heavy drinking. The study highlights Hungary as being notable for having the highest mortality rates in the EU for several alcohol-related pathologies such as liver cirrhosis, together with malignant neoplasms of lip, oral cavity and pharynx. It is reported that for the age range 20 64 yrs, alcohol plays a part in premature deaths of 25% of the population of Hungary. Cirrhosis is particularly high in Hungary and it is postulated that the high consumption of home made spirits may be a relevant factor. (Szucs S et al. 2005). It is also recognised that the culturally acceptable pattern of drinking in Hungary to a high level of alcohol intake with many heavy drinking occasions. The study gives a graphic breakdown of alcohol-related indices across the continent thus: New EU member states Old EU member states Czech Republic Hungary Lithuania Poland France Sweden UK Russia Adult per capita in l pure alcohol 17.0 14.9 17.2 11.7 14.5 9.9 13.4 15.5 Recorded in l pure alcohol 16.0 11.9 12.3 8.7 13.5 6.9 11.4 10.6 Unrecorded in l pure alcohol 1.0 3.0 4.9 3.0 1.0 3.0 2.0 4.9 Patterns of drinkinga 2 3 3 3 1 3 3 4 Preferred beverage beer wine/beer/spirits beer/spirits spirits/beer wine beer beer spirits Men % abstention/very light drinking 9.0 12.0 10.0 16.4 7.3 10.0 9.2 13.8 % >40 g/dayb 59.4 47.0 41.0 38.5 50.8 18.3 38.6 53.1 Women % abstention/very light drinking 19.1 27.0 28.0 34.3 11.1 16.0 14.3 27.5 % >40 g/day 7.0 16.0 8.0 9.0 7.0 3.8 10.3 8.4 aEstimated average pattern of drinking (1–4 with 4 being the most detrimental pattern; see text for more explanation and13 for the full algorithm used). b>40 g/day on average correspond to more than 3–4 drinks on average per day (1 drink is one can of beers of 0.33 l or one small glass of wine or one shot of spirits). (After Rehm J et al. 2007). There is considerable discussion surrounding the issue of alcohol-attributable mortality and death rates in the various European regions with Russia yielding the highest figures (29.0/10,000 person-years). An unexplained anomaly was found in that France and the UK show consistently higher rates of alcohol-attributable mortality in women than the general trend in the other countries when compared to the equivalent male rates. The overall alcohol-attributable mortality is greater in the male population with the ratio difference being much greater in the new EU member states, where the culture dictates that a smaller proportion of the alcohol produced is consumed by women Alcohol has been defined as only one of the causes of premature mortality (see above). Rehm suggests that alcohol is the major factor as, if the alcohol-related mortality is removed and the mortality figures adjusted, then the premature mortality rates between the highest and lowest rated countries become much more similar. Premature alcohol-attributable deaths in eight European countries by sex and age groups as proportions (in %) of all deaths, for the year 2002 New EU member states Old EU member states Age group Czech Republic Hungary Lithuania Poland France Sweden UK Russiab Men 20–44 28.5 39.4 38.4 26.0 22.9 19.2 22.2 30.7 45–64 14.0 22.2 16.4 10.2 16.6 7.1 7.6 11.9 20–64 16.3 25.2 22.8 13.6 18.0 9.3 10.7 17.9 Women 20–44 14.2 19.5 21.4 10.7 10.9 6.9 12.5 19.9 45–64 4.5 12.7 10.1 2.1 9.6 2.2 4.6 4.9 20–64 5.8 13.7 12.4 3.6 9.9 2.9 6.0 8.5 The estimates for Russia are underestimates, as several disease categories could not be included because of the different classification system of diseases (After Rehm J et al. 2007). It has to be acknowledged that with all of the papers cited in this examination, there are a number of potential shortcomings as data from different countries is inevitably subject to different categorisations and different modes of collection. Equally, differential rates of confounding factors such as Hepatitis C, HIV/AIDS, smoking and nutritional differences, all of which impact on the clinical presentation of the alcoholic liver disease process are difficult to completely isolate and account for. An additional complicating factor is that it has long been recognised that small amounts of alcohol have a cardio protective effect (Rehm J et al. 2003 B), irregular heavy drinking occasions (binge drinking) adding up to the same average volume of drinking over a period of time are associated with increased risk of vascular events. This increased risk is hard to separate from the increased risk of mortality from alcoholic liver disease. This is particularly the case with the Russian experience where drinking typically follows irregular heavy drinking patterns and the cardioprotective effect is probably negligible on a population-wide assessment. (Nicholson A et al. 2005) In overview, one can conclude that alcohol plays a substantial, and geographically variable role in premature adult mortality across Europe with 15% of all deaths in the 20 64 yr age range being attributable to this risk with men comprising a higher proportion than women in this total. (Rehm J et al. 2006). References Aricà ², S., Galatola, G., Tabone, M. and Corrao, G. (1994) Amount and duration of alcohol intake in patients with chronic liver disease. An Italian Multicentric Study. Italian Journal of Gastroenterology 26, 59 – 65. Becker U, Deis A, Sorensen T I A, et al. (1996) Prediction of risk of liver disease by alcohol intake, sex and age : a prospective population study. Hepatology 1996; 23 : 1025 1029 Bellentani S, Saccoccio G, Costa G, et al. (1997) Drinking habits as cofactors of risk for alcohol induced liver damage. Gut 1997; 41 : 845 850 Brett, B. T., Hayes, P. C. and Jalan, R. (2001) Primary prophylaxis of variceal bleeding in cirrhosis. European Journal of Gastroenterology and Hepatology 13, 349 – 358 Burra, P., Mioni, D., Cillo, U. et al. (2000) Long-term medical and psycho-social evaluation of patients undergoing orthotopic liver transplantation for alcoholic liver disease. Transplant International 13, S 174 – S 178 Camps, J., Crisostomo, S., Garcia-Granero, M., Riezu-Boj, J. I., Civeira, M. P. and Prieto, J. (1993) Prediction of the response of chronic hepatitis C to interferon alfa: a statistical analysis of pretreatment variables. Gut 34, 1714 – 1717 CMO (2001) Chief Medical Officer. On the State of the Public Health: Chief Medical Officers Annual Report 2001. Department of Health, HMSO : London; De Bac, C., Stroffolini, T., Gaeta, G. B., Taliani, G. and Giusti, G. (2004) Pathogenetic factors in cirrhosis with and without hepatocellular carcinoma: a multicenter Italian study. Hepatology 20, 1225 – 1230 Harry, R. and Wendon, J. (2002) Management of variceal bleeding. Current Opinions in Critical Care 8, 164 – 170. Loguercio C, Di Pierro M, Di Marino M P, Federico A, Disalvo D,, Cradta E, Tuccillo C, Baldi F, Del Vecchio Blanco C (2000) Drinking habits of subjects with Hepatitis C virus related chronic liver disease : Prevalence and effect on clinical, virological and pathological aspects. Alcohol and Alcoholism Vol. 35, No. 3, pp. 296 301, 2000 Jellinek, E. M. (1960a) Alcoholism, a genus and some of its species. Canadian Medical Association Journal 83, 1341–1345 Jellinek, E. M. (1960b) The Disease Concept of Alcoholism, pp. 36 – 41. Hillhouse Press, New Haven, CT. Kwo P Y, Ramchandani V A, OConnor S, et al. (1998) Gender differences in alcohol metabolism: relationship to liver volume and effect of adjusting for body mass. Gastroenterology 1998; 115 : 1552 1557 La Vecchia, C., Levi, F., Lucchini, F. et al. (1994) Worldwide patterns and trends in mortality from liver cirrhosis, 1955 to 1990. Annals of Epidemiology 4, 480 – 486. Leon, D. A. and McCambridge, J. (2006) Liver cirrhosis mortality rates in Britain from 1950 to 2002: an analysis of routine data. Lancet 367, 52 – 56 Lieberman, M. W., Barrios, R. and Carter, B. Z. (1995)Gamma -Glutamyl transpeptidase. What does the organization and expression of a multipromoter gene tell us about its functions? American Journal of Pathology 147, 1175 – 1185. Luca A, Carles Garcia-Pagan J, Bosch J, et al. (2007) Effects of ethanol consumption on hepatic hemodynamics in patients with alcoholic cirrhosis. Gastroenterology 2007; 112 : 1284 1289 Nicholson A, Bobak M, Murphy M, Rose R, Marmot M. Alcohol consumption and increased mortality in Russian men and women: a cohort study based on the mortality of relatives. Bulletin of the WHO (2005) 83 : 803 Mabee, C. L., Crippin, J. S. and Lee, W. M. (2008) Review article : interferon and hepatitis C-factors predicting therapeutic outcome. Alimentary Pharmacology and Therapeutics 12, 509 – 518. Mathurin, P., Duchatelle, V., Ramond, M. J. et al. (1996) Survival and prognostic factors in patients with severe alcoholic hepatitis treated with prednisolone. Gastroenterology 110, 1847 – 1853 McKee M, Shkolnikov V. (2001) Understanding the toll of premature death among men in eastern europe. Br Med J (2001) 323 : 1051 – 55 Men T, Brennan P, Boffetta P, Zaridze D. (2003) Russian mortality trends for 1991 – 2001 : analysis by cause and region. Br Med J (2003) 327 : 964. OPCS (2004) Office of Population Censuses and Surveys General Household Survey : HMSO London 2004 Ostapowicz, G., Watson, J. R., Locarnini, S. A. and Desmond, P. V. (1998) Role of alcohol in the progression of liver disease caused by hepatitis C virus infection. Hepatology 27, 1730 – 1735 Pessione, F., Degos, F. and Marcellin, P. (1998) Effect of alcohol consumption on serum hepatitis C virus RNA and histological lesions in chronic hepatitis C. Hepatology 27, 1717 – 1722 Pol, S., Lamorthe, B. and Trinh Thi, N. (1998) Retrospective analysis of the impact of HIV infection and alcohol use on chronic hepatitis C in a large cohort of drug users. Journal of Hepatology 28, 945 – 950 Rehm J, Room R, Monteiro M, et al

Analyse the policies of the Japanese towards Essay

Analyse the policies of the Japanese towards the civilians in East and Southeast Asia between 1937 and 1945, including their implementation and impacts. Evaluate two sources in your answer. Identify components and the relationship between them; draw out and relate implications Hashimoto once said ‘Japan’s national structure is the highest principle of mankind. All the countries must form an organic unity, with Japan as brains, growing and developing as a living being under the supreme guidance of His Excellency the Emperor’ This quote best summarises the policy of the Japanese during this period of time. Japanese expansionist policies and how they were implemented and impacted upon civilians will be further explained throughout the essay. The two sources that will be evaluated are ‘Higher than Heaven’ by Rick Tanaka and Tony Barrel and Group Psychology of the Japanese in War Time, by Iritani. The official Japanese policy was to â€Å"ensure self preservation and self defence of the Empire and to create a new world order. † This was outlined in the Greater East Asia Co-Prosperity Sphere which aimed to create an Asian society with Japan being the leader. They wished to see the countries revolt against their colonial powers and hoped to fill the void left by the colonial power. However, when this did not happen the Japanese military leaders decided to impose their ideology by force. Japanese domination would only be possible if the other nations embraced and eventually assimilated into Japanese culture. Hence, most of Japanese policy was directed towards the assimilation of cultures. Official policies outlined in the ‘The Japanese blueprint for South East Asia, instructions of the Japanese military’ published in August 1942, include guiding the civilians so that they accept the empires policies. If civilians were not accepting the policies then political and economic pressures were to be applied to the various governments to ensure the execution of Japanese policies under strict supervision, as was done in China. Cultural assimilation was to be ensured through control over customs, religions and education. A broad aim with these was to create an atmosphere respectful of labour and to spread the Japanese culture through the empire. Eventually symbols of significance and geographical sites were to assume Japanese names (as was done by Manchuria being changed into Manchunko), a true symbol of Japanese imperialism. However, Japan lacked in raw materials so some of their policies were aimed at getting resources such as oil so that they could continue the war. Policies were aimed at rapidly securing resources of the southern areas so that the war potential of the empire would be strengthened. This caused some adverse policies towards civilians. Although the official line for the treatment of civilians was to be neither â€Å"too lenient nor too harsh†, which was supported by a document called ‘Read this and the war is already won’ which outlined that Japanese soldiers were to be humane to civilians as they were fighting the war to liberate the Asian people from colonial rule, a document called ‘Lessons for the Battlefield’ explained the treatment of civilians that occurred during the period of 1937-1945. Westerners are attacked for surrendering and it warns that death is preferable to surrender, it outlines that civilians who surrender are to be treated as below human as only lowly creatures surrender. It also calls for the Japanese soldiers to be single minded in achieving their aims. Japan had ratified the Hague Treaty but did not comply with it, instead they followed government instructions outlined in ‘Lessons for the Battlefield’. The implementation and impacts of Japanese policies caused tsunamis of shock to flow all around the world, American media reports of the atrocities caused anti-Japanese feelings to develop all over the world. In China policies were implemented with the policy of â€Å"kill all, burn all, destroy all’ to gain control. This was especially true in Nanking as outlined by ‘The rape of Nanking. ‘ Here buildings were burnt, women were raped and innocent citizens were murdered in various gruesome ways including ripping the stomachs, digging out the heart, boiling people and beheading victims. Iritani believes that this occurred due to the incredibly harsh fighting conditions in China which elevated the abnormal psychological state of the soldiers. Other historians believe that it was done in order to gain control and create a puppet regime in Nanking where Japanese assimilation could begin. In Nanking alone the impact of this policy caused the deaths of approximately 300,000 people in just six weeks. Women were captured and sent to ‘comfort stations’ to act as sex slaves although geisha houses were banned in Japan. As the war in China became longer and supply lines became inefficient Japanese soldiers began to confiscate crops and other agricultural goods, which led to food shortages and ultimately a failing of the economy. Manchunko, formerly Manchuria, became the centre of Japanese military and economic power, however the ultimate failure of Japanese economic policies caused the downfall of the Manchurian economy by 1945. The implementation of policies in Korea was the epitome of the attempt at Japanese civilisation. The Japanese language was to be used in schools and all were required to attend Shinto services although the population was mostly Buddhist. Forced labour was implemented to help achieve the aims of the Japanese, usually worked in factories making ammunition for the Japanese. Forced conscription was enforced and Koreans filled the lowest positions of the Japanese army to â€Å"show their patriotism. † Here too, women were forced to become comfort women. Nationalist movements were suppressed to ensure Japanese control. The impacts on Korea, apart from the large amounts of deaths that occurred to civilians that opposed the regime was the ultimate division of Korea along the 38th parallel. The USA and USSR government divided Korea for the purpose of accepting the surrender of Japanese troops. It was the harsh Japanese policies and their implementation that caused opposition forces to rise, including the rising of the communist anti-Japanese guerrillas in Dongbei. The conflict between North and South Korea still continues today, showing the lasting impact of the implementation of Japanese policies. The Japanese invasion of the Philippines in 1941 brought with it the implementation of Japanese policies including the â€Å"three all† policies brought widespread destruction to the Island, especially in Manilla where many civilians were killed. Although a ‘co-operative government’ was established in 1943, the failure of Japanese economic policies caused such devastation to the Philippines that several hundred million dollars were needed to recover the economy at the end of the war. In French Indo-China rice paddies were converted to jute for the war effort and forced labour was imposed. In Burma workers were forced to work on the Burma-Thailand railway, conditions were so harsh that 90,000 workers were killed. These harsh conditions caused the formation of the Anti-Fascist People’s Freedom League which resisted the weak Japanese installed government. In Malaya and Singapore all Chinese civilians were arrested immediately as they were suspected of supporting Chiang Kai-shek, implementation of the Japanese policy of total control. The Japanese saw the importance of Singapore as a military base and maintained strict control of it by the Japanese military and secret policy. Malay workers were also forced to work on the Burma-Thai railway. The worsening of working conditions and the extremely harsh requisitioning of men and materials caused the eventual rise of opposition including the group led by Lim Bo Seng. The Dutch East Indies was seen as a ‘jewel’ by the Japanese as it contained oil, and hence the control of this was particularly important. Assimilation attempts included the forced study of the Japanese language and the forced singing of the Japanese national anthem to show patriotism. Impacts have included the death of up to four million people and Japanese training of young military men formed the nucleus of the post war independence army. Japanese policies also caused economic hardships. All countries occupied by Japan during the war had similar impacts such the mistreatment and subsequent death of civilians and adverse economic impacts. All nations also suffered a substantial psychological impacts from the years of harsh oppression, as described by Lai Yeo, who was a comfort woman to the Japanese. â€Å"The impact of Japanese policies did not end with their rule, the emotional scars will be something I will have to bear forever†¦ † Source Evaluation Wantanabe Shoichi – claimed that the harsh treatment of Japanese did not occur, the Nanking massacres were fictional A Japanese nationalist Doesn’t match other sources Saburo Inega – Campaigned against the censorship of Japanese textbooks that omitted out the atrocities Book written to show the Japanese policies the nake realities of the pacific war More reliable Iritani – 3rd generation Japanese American Useful as provides both perspectives and reasons for acts of atrocities Delves into the psyche Matches with other sources Lai Yeo – article on the internet First hand experience of Japanese brutality Matches with other sources although it seems to be a bit exaggerated Psychological state seems fragile, memories may be disrupted.

American Education vs Asian Education Essay

In the past twenty years the United States school system has been accumulating a bit of criticism. Studies have shown that the United States has been lagging exponentially compared to almost all the industrialized countries. This specifically refers to Asian countries that are statistically blowing the U.S. out of the water. In his article â€Å"New Math-Science Study Rates U.S. Students Mediorce At Best† William S. Robinson decusses survey results after students from around the world have taken a science and math test.The survey results in the universal subject of math show us that the U.S. eighth graders have fallen behind, while the twelfth grade level showed only slight improvement.We would potentially look at these education systems as extremes of each other. Each education system being on the different side of the spectrum. Both systems having faults and advantages. Taking the positive aspects from both sides and merging them together, a harmonious education system could be established . In the article â€Å" Strengths, Weaknesses, and Lessons of Japanese Education† James Fallows tells us that in an Asian classroom students will feel an incredible amount of pressure starting from grade school and up, while U.S. teachers are too afraid to raise the bar because of potential discouragement of the student(201). In Japan, University admissions as opposed to grades earned in university, determines what kind of career you can have in Japan. Japanese students will spend most of their time studying in cram schools, unlike American students who spend most of their time socializing. A negative of the Asian school system, is the conformity that must be upheld. This achieves better education because it becomes the â€Å"thing to do†. When everybody is on the same curriculum there is no other choice but to follow the herd. While conformity creates better math students, it demises the aspect of creativity and individuality. The U.S. places a much bigger emphasis on creativity and choice. Thus providing students with opportunities that help them learn about them selves, and develop original ideas. An important characteristic that the U.S. education system lacks, is the idea of effort being directly correlated to success. In her article â€Å" Why Are U.S. Kids Poor In Math† Barbara Vobejda says that the American and  Asian mothers have a diffrent view on what determines their child’s success in school. An American mother thinks that her child’s academic achievement comes from innate ability, while an Asian mother thinks that her childs academic achievement comes from hard work and effort. An Asian mother would demand her child spends hours after school doing homework and studying. An American mother would just say that her child is not good in their subject.Vobeja says that a study has shown that Asian students spend more time in their seats than American students do. American students were out of their seats 21 percent of time, compared to Chinese and Japanese students who were out of their seats 2 percent of the time. Though the American student may think that they work hard, we find that the Asian student is at a much greater level of pressure. As we saw in the previous passage, serious pressure is put on the Asian student. In further examination of the article â€Å"Japan’s School System†, a supporter of the catalytic pressure theme, we find many contrasts to the U.S. views of putting pressure on students . Japanese students attend school six days a week. The school year consists of 220 days compared to the 180 days in the U.S. A third grade Japanese school week consists of eight hours of Japanese, five of arithmetic, three of science, social studies and physical education, two hours of music and art. For an U.S. student this might seem like hell. Yet the only reason this might seem like to much pressure, is because we are judging their system with an ethnocentric point of view. Japanese students think it’s quite OK. Humans are a very dynamic and adept species. We always look at things from our conditioned point of view. Thus, if pressure is increased on the U.S. students, the only ones who would have any complaints are current students. Being dynamic and adept, they too would be able to fulfill the new requirements asked of them. The eastern ideas of pressure could be used as a catalyst for results in the U.S. While as much as we are in need of more pressure on the students, we must retain the creative individual factor at all costs. We are not machines that have identical downloaded brains. In the article â€Å"We Should Cherish our Children’s Freedom To Think†, Kie Ho provides a critical question. He asks, â€Å"If American education is so tragically inferior, why is it that this is  still the country of innovation?† Looking back at the regular Japanese school week, we find that not much attention is brought to music or art. Creativity forms individuality, expression of ideas, and self-fulfillment. This could ruin all the conformity and control of ideas in the Asian student. Our Asian friends could never have that happen now could they. Ho provides an example of an U.S. student taking a role of Lyndon Johnson and debating a student in the role of Ho Chi Minh. An Asian student would never be given a chance to look at things from a different point of view. In all their mathematical glory they have missed the essential human need to express individuality. Most likely that is done with intent. While many Americans yell and scream about their children’s math abilities, they have overlooked the fact why most immigrants come here. This fact is freedom. Which would not be possible without all the creative outlets provided by our school system. In merging these two fundamental ideas of both of the education systems, many new positive effects are felt by the students. An increase of pressure to motivate and accelerate education. The development of ideas and creative outlets, which lead to self-discovery and formation of original and innovative ideas which, fuel our nation. This guarantees freedom and a mind to use it. Americans complain about the core subject of education. That will change with a harder curriculum and more emphasis being placed on effort. We will also continue providing our students with individuality. Asian education can also see positive effects from the development of choice and move away from conformity. The students who do cannot or will not participate in the hard curriculum will now have a choice to develop their creative side. These changes will be hard to make. U.S. students adjusting to a faster harder education. Asians might start to loose control of the masses. In the end it will be beneficial fo r both.

Module a - 961 Words

Whilst texts may be fictitious constructs of composers’ imaginations, they also explore and address the societal issues and paradigms of their eras. This is clearly the case with Mary Shelley’s novel, Frankenstein (1818), which draws upon the rise of Galvanism and the Romantic Movement of the 1800’s, as well as Ridley Scott’s film Blade Runner (1992), reflecting upon the increasing computing industry and the predominance of capitalism within the late 20th Century. Hence, an analysis of both in light of their differing contexts reveal how Shelley and Scott ultimately warn us of the dire consequences of our desire for omnipotence and unrestrained scientific progress, concepts which link the two texts throughout time. Composed in a time of†¦show more content†¦Moreover, Shelley stresses her warning through the protagonists’ connections with nature, where Victor’s â€Å"insensibility to its charms†, arising from his immersion in science, results in his â€Å"deep, dark and deathlike solitude†, with the heavy alliteration exemplifying his degraded sense of humanity. Conversely, the monster possesses greater â€Å"benevolence† and a more intimate connection with â€Å"the pleasant showers and genial warmth of spring†, with such characterisation capturing Shelley’s reflection of Romanticism’s idolisation of nature, cautioning us against the dehumanising effect of unrestrained scientific advancement. Blade Runner is no different, with Scott’s reflection of the explosion of technological progress during the 1980’s, including the rise of computing giants IBM and Microsoft, highlighting the dangers of such unrestrained progress. 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