Is Realism realistic as an approach to understanding contemporary Essay

Is Realism realistic as an approach to understanding contemporary global politics - Essay Example Neo-realism ideologies however suggest that the states may not be entirely in control as there is a layer above the states which may be dominating in terms of defining the overall behavior of states at the global level. neo-realism therefore differs quite significantly from the realism as it views the states and the overall global political order as a system based upon complex relationships. As per the system thinking, states may not be entirely in charge of determining their own behavior and moves. Though realism may seem a realistic approach theoretically but it may not be entirely a realistic approach in terms of implementing the same. Issues such as globalization, changing economic preferences, dominance of terrorist and other pressure groups as well as the influence of super powers may be some of the key issues which may not allow States to actually design and develop strategies based on their own self interest. The first part of the essay will discuss the theoretical background about the realism and neo-realism whereas in the second part of this essay, it will be argued as to whether the realism remains one of the realistic approaches to deal with the issues of contemporary global politics. Realism – A General Introduction Realism is one of the most important concepts with wide ranging applications both in international relations and politics. Political realism outlines that national interests are always above any other moral obligations. Realism therefore outlines the need for nation-state and suggests that nation-states are motivated by the national interests of the states and these interests are often disguised in the moral concerns for the nation-states. Realism is an opposite of liberalism which advocates the use of cooperation in the international relations. Realists however, on the other hand believe that the principal actors in international arena are the states themselves wh ich decide based on their own interests and other considerations. There is therefore an inherent dichotomy within realism which outlines that the politics at the domestic level must be governed by the rule of law and ethics however, at the international level it must not be engaged into any ethical considerations and therefore should only focus on its self-interests while dealing at the global level. (Harrison, 2002) It is also however, important to note that the classical realism does not actually discard the ethics entirely within international politics. As such realism therefore is not entirely based upon the Machiavellian notion of everything is fair in the interest of the State. Realism is also not inclined towards any conflict or War Between the States however, it only points out to the assumption that the international relationships between the states should be based upon securing the interests of the state first. However, the ability to secure the interests of the State firs t largely depends upon the ability of the State to have power both in terms of economic as well as military. If the State cannot have sufficient economic and military power, it is unlikely to secure or safeguard its interests in the international politics. It is therefore important to understand that realism or classical realism as it is often referred to gives preferences to national interest

Competitive Gaming College Essay - How to Write a Good One That Will Get Your Name Out There

Competitive Gaming College Essay - How to Write a Good One That Will Get Your Name Out ThereIt's not really all that difficult to write a competitive gaming college essay, provided you're in the know about the basics of game writing. Just know that there is more to it than just listing game stats or knowing what a character's going to do next. You have to write a piece that has a very high level of factual accuracy, and is written in a way that allows the reader to engage with the essay on several different levels.The first and most important thing to remember is that it should be short, crisp, and to the point. You don't want to cram an essay down the reader's throat, but you also don't want it to be long and overly complex. The best ones are between 100 and 150 words. A lot of this is about flow, and how the reader is able to follow along with the flow of the essay.Another thing to keep in mind is that not only does the writing have to be fast, but it has to be good. There are some programs out there that are able to speed up the essay a great deal. Don't take this as a bad thing; just make sure that this isn't at the expense of accuracy. Also, you don't want to cheat by just posting a keyword search or word list in the margins of the paper.If you want to find the right key word or phrase, there are quite a few great programs out there that will help you out. You can get free sample tests that can help you see if you have a good idea of what you're talking about. This is not cheating in any way. It's simply a way to ensure that you can get the exact work done at a high level of accuracy.When you start the piece, make sure that you get to the point where you are going to stop and actually think about your readers. Be clear and concise. Be factual and not just listing game stats or just explaining what happens next. Just make sure that you set the tone in the beginning so that you can begin to build interest later on. Make sure that the essay flows and is easy to follow.It is vital that you have a good connection with the game that you're writing about. You may have to let them know about your education in game writing, or you may need to take them through a bit of a tutorial. Also, make sure that you know what the game really needs in order to maintain its integrity, and then do your research for it.Keep in mind that the game itself can make or break the essay. You don't want to just trot out stats and numbers, but you do want to describe the player's viewpoint. This allows the reader to get involved with the story, and it allows you to incorporate the importance of gaming into your own life.

Essay Topics Are Worth Watching Out For

Essay Topics Are Worth Watching Out ForThe best informative essay topics are found at the beginning of the topic to start it all off. These topics can range from an overview of a certain topic to explaining a particular issue or idea or can explain a word, concept, event, or situation.One of the most common topics for any essay is a summary of the topic. This can be taken from a newspaper article, a research book, information from a single article, or even a book you read and understood and have some thoughts on.There are many other interesting essay topics that can be considered by finding your favorite topics and then putting them together to have one big cohesive theme. Some topics are merely too broad to use as a topic in an essay but some may require a topic from several sources.A popular topic to research for your own purposes is the majority of Americans do not eat a full meal at least three times per day. Consider a topic on this and you will have a place to start if you want to express what it feels like to be on a diet.Topics are interesting because they can vary in terms of subject matter and topic. Depending on the topic chosen, there will be general and specific rules for usage and other topics are listed here as well.Best explained topic ideas also include problems in public policy, and how society can solve those problems. Whether you are writing an essay to send to a professor or want to write for your own self, the best topics are easy to locate and require a little research. Whether you want to earn an A in English, or teach college-level writing, a good topic is essential to success.If you feel you are lacking in interest or you have your own subject, it is possible to add more by searching online for your own subject, orusing topics listed below. Some have seen a dramatic increase in their essays, while others have said they wrote an essay the day before a test!

Unusual Article Uncovers the Deceptive Practices of Writing Essay Is Not That Hard Book

Unusual Article Uncovers the Deceptive Practices of Writing Essay Is Not That Hard Book Now you know how to write a college essay, we've got a great deal more specific resources for you to excel. Writing children's fiction isn't as straightforward as you may imagine, it should be carefully thought out and structured or it is not going to be accepted by editors. If your teacher instructs you to compose a five-paragraph essay, then compose a five-paragraph essay! Poetry permits you to express yourself or your beliefs in a brief selection of words. Writing a book is fun but it may also be a good deal of work. Write an essay won't have a difficulty. Writing an essay might not be easy. Although your book review essay isn't an overview of what the book is all about, you will want to supply a brief analytical paragraph or two to explain it. The reviews at our site will allow you to play it safe. After you gather basic info and you've decided on the subject, you will need to create a comprehensive plan. Nowadays you own a list of possible topics, but probably no clue where to get started. You see, the conventions of English essays are somewhat more formulaic than you may think and, in a variety of ways, it can be as easy as counting to five. College term papers are more complex than a normal school essay. Teachers and professors don't need to find that you comprehend the plot of a story. New Step by Step Roadmap for Writing Essay Is Not That Hard Book Keep in mind your deadlines and don't forget that a few schools may require more than 1 essay or request short paragraphs as well as the principal personal statement. Likewise lots of students feel as though they need to write about an important life event or their most impressive achievement. It's beneficial for students in regards to using the internet writing solutions, since they may enhance their college progress concentrating on other assignments or exams. Today, all college students, wherever they come from in the Earth, have to compose essays on a standard basis. Writing a great paper is not a simple task particularly as soon as the difficulty level is high. One of the greatest regions to begin in the writing process is by making a thesis. Perhaps you feel more comfortable sitting down and writing the entire draft from beginning to finish in 1 go. The secret to writing your very first draft isn't to be concerned about whether it's any good just get something on paper and go from that point. The History of Writing Essay Is Not That Hard Book Refuted Writing a thesis is really quite simple if you follow a fundamental formula. You may also takemanagementassignment help to compose your assignment and to design the bibliography. There isn't a way to teach a history major to write as a historian or maybe to teach a biology major to write as a biologist. Students start to acquire more assignments and not as much time to study and complete them. The Secret to Writing Essay Is Not That Hard Book Next, you will determine the way to make an in triguing essay that shows off your distinctive perspective and write a number of drafts as a way to hone your structure and language. The citation or bibliography is an essential part of an essay structure that comes after the conclusion and states all of the material you have referenced. Another thing to remember about assumptions is that the quantity of assumptions you're ready to make depends in large part on the scope and duration of your paper. If you would like to understand how to compose an essay introduction for a book, there are a couple things you have to be aware that. The next thing to do is to go through your thoughts and determine which one is going to result in the strongest essay. If you are operating out of time and there appears to be no one who'd write an essay for you, we've got a solution available. Since the introduction is among the absolute most important facet of your essay, you need to be mindful whilst writing one. You must keep practicing as a way to include things like a good thesis in your introduction for a book. Always compose an outline for the introduction and especially when you have a lot of information you need to add to it. After that, examine the essay again, line by line, checking every word to ensure that it's accurate.

The Practice of Sharing Housework Among Spouses Essay

The Practice of Sharing Housework Among Spouses - Essay Example According to Selle (2002), â€Å"The Family: A Proclamation to the World teaches that fathers and mothers have specific, God-ordained responsibilities within an equal partnership, with neither husband nor wife seeking to dominate the other.† (par. 1) It is actually a matter of taking the time to talk about the equal division of housework to ensure a smooth, stronger, happier and positive long-range relationship within the family. In USA Today (1998, 1), the discourse proffered that â€Å"while the roles of females outside the household have changed dramatically as more women get jobs, responsibilities in the home have shifted only slightly, maintains Vicki Fitzsimmons, a professor of family economics.† A survey of 450 married university employees and their spouses revealed that â€Å"women are reluctant to give up territory to spouses or to lower their standards of cleanliness. Thus, the view of a wife as homemaker continues even though many women are the primary or co-breadwinners.† The dilemma can actually be addressed by the spouses’ participation in the decision making regarding the division of housework. It is actually not a matter of the number of household tasks divided, but the quality of tasks both spouses agree to do. Further, commitment is tested on both parties’ ability to perform their responsibilities to the best of their abilities. After all, marriage is a longtime commitment in life to supplement and complement each other – especially in sharing housework.

What You Dont Know About Startong College Essay with a Quote Could Be Costing to More Than You Think

What You Don't Know About Startong College Essay with a Quote Could Be Costing to More Than You Think Because the college essay isn't the exact same sort of essay that you write for your high school English teacher, it doesn't need to have the standard essay introduction, which gives you a thesis statement. Check different articles on our blog at which you can get a list of the greatest argumentative essay topics for college students. At the close of the day, colleges wish to accept someone who's going to graduate, be effective in the world and have the university connected with that success. Every student wishes to be prosperous. Startong College Essay with a Quote Fundamentals Explained When you're thinking how to commence an essay, you ought to take steps to generate your readers fully understand why they may want to continue reading. Readers are going to want to carry on reading your essay to be able to discover the reply. They already know what happiness means. Choosin g Startong College Essay with a Quote At times you won't understand how to start until you've finished. In some instances, you might be assigned a quote that you have to research concerning the author's background. Ruthless Startong College Essay with a Quote Strategies Exploited It's a good idea to comprehend how to quote your dialogue since if you create an error whilst quoting it may change the full meaning and bring misunderstanding in your essay. If you have made the decision to use a lengthy quotation, look at paraphrasing, as it usually works better. Rather than the paraphrase, if you take advantage of an immediate quotation, you will avoid misrepresentation. The Chronicles of Startong College Essay with a Quote The essays act as a glimpse into how your mind works, how you see the world and supplies perspective. Therefore, in case you have some really excellent life stories to share, don't hesitate to do it. You must locate a way to capture the interest of the read er from the very start and give them a reason to keep on reading the essay. To start with, you should attempt to concentrate on your own personal life experience. Why Almost Everything You've Learned About Startong College Essay with a Quote Is Wrong Supply an intriguing fact about something you're likely to talk about in your essay's body and your audience might want to keep reading in order to find out more. Once you brainstorm, you are going to know what you would like to say, but you have to decide how you're likely to say it. You should have your reasons, and our principal concern is that you wind up getting an excellent grade. The Key to Successful Startong College Essay with a Quote Avoid tacking a quote on at the beginning of your paper just so that you can say you have one. The most important question of all students who must compose a reflective or private essay is whether it's possible to develop such kind of academic paper without sounding too egotistical. For example, a humorous quote does not establish a paper on slavery well. So as to incorporate a quote in your paper, you will also have to create a corresponding reference page at the conclusion of the essay. The important thing is to make sure you clearly show the way the quote is related to your essay. A quote can frequently be perceived as such. Thus, it should provide evidence of that. You will possibly think about picking an inspirational quote to base your whole essay on. The Tried and True Method for Startong College Essay with a Quote in Step by Step Detail A shocking fact or credible statistics is the very best explanation to the way to begin a persuasive essay. There's no particular approach that students may utilize to compose the introductory essay paragraph. Your essay should offer admission officers with new details. As you're planning an essay, you shouldn't ever underestimate the significance of the opening paragraph. The Little-Known Secrets to Startong Col lege Essay with a Quote You can produce your essay beautiful by giving thought to some things. If you don't have an idea what an essay depicting your person should include, you might get inspired by someone else. When you have gathered many ideas, you will work on figuring out your principal idea. If you are in possession of a good idea and you would like to be straightforward and introduce it immediately because it's unique, do what you would like. Startong College Essay with a Quote - What Is It? The rules for writing a great essay are not any different. A great introduction will be dependent on your familiarity with the topic accessible. If you're in the center of your essay writing procedure, you will want to see our suggestions on what essay pitfalls to prevent. Among the basics of how to begin an essay that we're taught from the moment we begin writing such articles is first to make an outline. The Hidden Truth on Startong College Essay with a Quote There is nothin g more hooking that a question that interests tons of individuals. The range of the webpage, which needs to be placed at the close of the quote, doesn't have to be accompanied by the letter p or some other symbol. Based on the context of your essay, or the essence of your topic, there are instances once an inspirational quote may be the glue that you have to tie it all together. Let's look at a good example. The Appeal of Startong College Essay with a Quote When you proceed through the job of different writers, you are going to learn about various quotes offered for application. Some students select a cute quotation first, and attempt to plug it in their essay. There being a number of quotes, by going through samples and templates you'll be in a position to comprehend how to apply unique formats of the quotations. They should support your arguments, so you need to find information from sources that actually do that. Provide a definition or fact about the topic or arguments you are likely to discuss in your essay, and that is going to make people wish to keep on reading and learn more. Whether there are lots of mistakes in your essay, it cannot be pretty. Don't hesitate to get in touch with us and describe the problem you've got. Why Almost Everything You've Learned About Startong College Essay with a Quote Is Wrong Thus, let's take a peek at how to begin a narrative essay. There are an infinite number of methods to begin a great essay. The ideal first line of your essay might not be simple to come by, but don't concentrate on that first. As you see, writing high-scoring essays can be challenging and time-consuming but we hope our simple suggestions about how to begin a great essay can help you succeed in creating impressive beginnings for your admissions, argumentative, persuasive and other kinds of essays. Take a look at our article on the most frequently made mistakes in college essays for more tips to make sure your essay reads well. Last, you've got to create an outline of your upcoming essay. Generally, an autobiographical sketch is only an easy essay.

Naked Eye Single Tube Osmotic Fragility Test

Naked Eye Single Tube Osmotic Fragility Test The effectiveness of one tube osmotic fragility screening in detecting BTT was first introduced by Kattamis C. in 1981.(56) NESTROFT is the rapid simple and cost effective screening test. 2.15.1 Principle The principle of NESTROFT is based on the limit of hypotonicity that the red cell can withstand. There is a pronounced decrease in osmotic fragility of red cells in ÃŽÂ ²-thalassemia(57) Cells with a decreased surface/volume ratio, have a limited capacity to expand in low osmolarity solutions and lyse (rupture) at a higher concentration of sodium chloride than do normal biconcave red cells. Therefore, thalassaemic cells that are hypochromic and fLatter have a greater capacity to expand and thus have decreased osmotic fragility. (58) 2.15.2 Clinical Implications The different saline concentration is used in NESTROFT test to detect spherocytosis and BTT. Positive test is due to reduced osmotic fragility of red cells at 0.36% buffered saline. Manglani M et al in 1997 studied 165 cases (with MCV Recent published data has shown that the NSTROFT can be a very useful screening tool for ÃŽÂ ²-thalassemia Trait. (5, 63-66) Different studies show that NESTROFT with 0.36% saline could detect 96-100% of heterozygotes with ÃŽÂ ²-thalassemia. Study published in Indian J Pathol Microbiol, 2002 concludes NSTROFT to be 92.5% sensitive and 95.2% specific for screening of red cell microcytosis.(67) The test proves to be simple, cheap, easy to perform and adaptable for mass screening coming close to an ideal screening test. According to a recent study conducted at PNS Shifa Hospital Karachi, NESTROFT has a Positive Predictive Value of 85.38% and Negative Predictive Value of 97.66%, this correlates to international published data. The diagnostic accuracy was 94.6 % (63) NESTROFT done with 0.36 % buffered saline solution provides more accurate results compared to the other concentrations tested.(5) Routine use of haematological data from automated cell counters may complement the result s of the NSTROFT.(64) 2.16 Supravital Stains Supravital stains are a group of special stains for demonstration of intracellular inclusions in the living tissues. Common supravital stains used are methylene blue, new methylene blue, brilliant cresyl blue (BCB), methyl violet, crystal violet and azure B. Supravital stains in thalassemia are done for the demonstration of reticulocytes and Hb H inclusions as and when indicated. In thalassaemia carrier screening reticulocyte count does not have a diagnostic value. However in the detection of ÃŽÂ ±-thalassaemia, especially Hb H disease, the brilliant cresyl blue stain will detect the characteristic Hb H inclusion bodies. Supravital stains (brilliant cresyl blue or new-methylene blue) are able to stain residual mRNA in immature red blood cells. There are now several automated electronic cell counters able to perform a reticulocyte count using specific RNA staining.(68) Reticulocyte numbers and maturation levels have been studied in different haemoglobinopathies and the results have been correlated with the degree of ineffective erythropoiesis. Laura C. et al in 2003 studied 219 samples from patients with Sickle Beta-thalassemia (n=7), HbSC disease (n=11), BTT (n=33) and IDA (n=47) and non-anaemic individuals(n=60). They found patients with HbS trait (0.83%), IDA (1.18%) and BTT (1.53%) showed Reticulocyte parameters similar to non-anaemic group (1.18%). A non-responsive bone marrow does not release reticulocytes in sufficient numbers to compensate for the degree anaemia. The authors concluded that the absolute number and immaturity fraction were higher in BTT than normal individuals, but without statistical significance.(69) 2.17 Haemoglobin Electrophoresis Hemoglobin electrophoresis (also called Hgb electrophoresis), is a test that measures the different types of hemoglobin in the blood. The method used is called electrophoresis, a process that causes movement of particles in an electric field, resulting in formation of bands that separate toward one end or the other in the field. 2.17.1 Types of Electrophoresis 2.17.1.1 SDS-PAGE SDS-PAGE (Sodium Dodecyl Sulfate Polyacrylamide Gel Electrophoresis) is a common type of electrophoresis used for analyzing proteins, which separates proteins according to their size. The SDS is a protein denaturing detergent that causes unfolding of protein molecule. The detergent binds to the polypeptide in a 1:1 ratio with each segment of the protein to give it a charge. The movement of protein polypeptides through the gel occurs at different rates depending on size. 2.17.1.2 Agarose Gels Agarose gels electrophoresis is used for separation of RNA and DNA molecules. Like SDS-PAGE, this separates the molecules based on charge and size. DNA molecules are negatively charged, so they move through the gel quickly depending on size. Smaller DNA fragments move more quickly than larger ones due to friction resistance. 2.17.1.3 Electrofocusing Electrofocusing analyze the charge and pH values of proteins. A container is filled with a gel solution that has an increasing pH gradient. The amino acids that form polypeptides have different acidic or basic charges. The protein travels through the gel, obtaining or losing protons depending on its charge. As the protein particle moves through the gel, it eventually becomes neutral and gets stuck in an isoelectric position. 2.17.1.4 Capillary Capillary electrophoresis is a method similar to SDS-PAGE. It separates molecules based on their charge and mass. Molecules are placed in rows called capillaries filled with conductive, electrolyte fLuid. The analytes move in a speed relative to their charge and mass. This method is an older technique introduced in the 1960s. SDS-PAGE is usually preferred in labs. 2.17.1.5 Native Gels Native gels are similar to SDS-PAGE, except the detergent (SDS) is not used to denature proteins. Native gels are only able to separate proteins up to 2,000 kDa in size. Because the proteins are left folded, the dyes used are also different than SDS-PAGE. Hemoglobin electrophoresis is the method for identification and quantification of variant Hbs. Electrophoretic methods have been developed that allow for separation at alkaline pH 8.4 on cellulose acetate and at acidic pH 6.2 on agarose gels. These provide a clear background, allowing for quantification of the Hb present by densitometric scanning.(47) Cellulose acetate electrophoresis may be used for qualitative identification of variants, but also with elution for quantitation of the haemoglobins, A2, A, S, D, Lepore, ÃŽÂ ±-chain variants, Hb H and Hb Barts. Agarose gel electrophoresis is not a satisfactory screening technique because it cannot distinguish many abnormal haemoglobins from Hb A. However it can separate the C group into three fractions: HbC, O-Arab, and Hb E plus HbA2. The method can also distinguish Hb S from Hb D, Hb F from Hb A, Hbs Little Rock, Rainier and Bethesda from Hb A, and Hb H from Hb I. (68) The diagnosis of BTT relies on an accurate estimation of HbA2 levels.(69) Raised HbA2 level (>3.5%) is the gold standard for the diagnosis of BTT. Subjects found to be positive in preliminary screening tests by Red cell indices, DFs and NESTROFT are confirmed for thalassemic carrier status by various methods such as cellulose acetate electrophoresis, microcolumn chromatography, capillary isoelectrofocussing and HPLC (high performance liquid chromatography). Subjects with HbA2 levels of 3.5% and above are considered to have BTT. However precautions have to be taken when HbA2 levels fall between 3.3 and 3.7%. In such cases it is recommended to repeat the assay to rule out technical error or treat the patient for IDA before the analysis is repeated.(60) According to the Thalassemia working party of BCSH General haematology Task force both electrophoresis and elution from cellulose acetate or microcolumn chromatography are recommended. They suggested that precision and accuracy of automated scanning densitometry was inadequate for HbA2 estimation. (70) 2.18 Isoelectric focusing (IEF) IEF is another popular method used by laboratories that have a large number of specimens or very small sample volumes that perform newborn screening. This electrophoretic method utilizes carrier ampholytes, small proteins that are able to carry both current and pH (Zwitterions). When the current is applied to the support medium, the ampholytes will gradually establish a pH gradient throughout the gel (for example, a pH range of 6 to 8 for Hb analysis). IEF gives better separation of Hb variants that show similar mobilities on alkaline electrophoresis, which are much sharper. Hb variants such as Hb-Malmo, show separation from HbA which is not seen on alkaline electrophoresis. Minor bands such as HbH, Hb-Barts and Delta chain variants are easily seen.(71) Figure 2.6 Examples of many hemoglobin variants and their migration patterns on Isoelectric focusing. 2.19 Capillary isoelectric focusing (CIF) CIF is a useful analytical technique for characterization of protein mixtures and determination of protein isoelectric points. It is particularly useful in separation of protein glycoforms, characterizing protein microheterogeneity, and resolution of charge variants. The capillary focusing process is analogous to conventional isoelectric focusing in gels, while the requirement for zone mobilization is unique to the capillary format with on-tube detection. A variety of mobilization methods have been described, and the selection of the mobilization method for a particular application depends on the capillary type, the instrument configuration, and the type of proteins to be analyzed. Capillary IEF is generally successful for proteins with a molecular weight up to about 150,000 that exhibit good solubility in aqueous buffers, but may be unsatisfactory for large or hydrophobic proteins.(72) 2.20 Globin chain electrophoresis It is an ancillary procedure in which haemoglobin lysate with mercaptoethanol and 8mol/L Urea to dissociate the globin chain is used. It is run both at alkaline and acid pH. It gives additional information on haemoglobin variants that have similar mobilities by other methods.(71) Globin chain electrophoresis is run at both alkaline and acid pH because some hemoglobin variants show slight differences in mobility at the two pHs. This method often gives additional information on hemoglobin variants that have similar mobilities by other methods. In confusing cases, this method may be useful to document the presence of both an ÃŽÂ ± and a ÃŽÂ ² chain variant Examples of different hemoglobin variants on globin chain electrophoresis are shown in Figure 2.6. (www.cap.org/apps/docs/cap_press/hemoglobinatlas_intro.pdf) Figure 2.7.Examples of hemoglobin variants on both acid (pH 6.2) and alkaline (pH 8.9) globin chain electrophoresis. Source: Adopted from hemoglobin atlas. (www.cap.org/apps/docs/cap_press/hemoglobinatlas_intro.pdf) 2.21 High-Performance Liquid Chromatography (HPLC) HPLC is a method that has been available for many years. Cation-exchange HPLC is emerging as the method of choice for the initial screening of Hb variants.(56) Run lengths have been shortened from more than 20mins to 6 to 7mins. These instruments are approved by U. S. Food and Drug Administration (FDA) for the measurements of HbS, A2 and F. These instruments generally utilize a weak cation exchange column. Gradually increasing the ionic strength of the eluting solution causes the Hb protein to come off the column at a particular retention time. This method has a advantage that HbC does not coelute with HbA2, however HbE and HbO-Arab still coelute with HbA2 with this method.(71) 2.22 DNA Analysis The DNA analysis is gold standard for detection of carrier state of ÃŽÂ ²-thalassemia. The prenatal diagnosis of affected couple should be carried out to prevent the birth of thalassemic child by selective abortion of affected foetuses. It is essential to characterize the DNA mutations of the parents for prenatal diagnosis of affected couple. The methods available to study DNA mutations are allele specific oligonucleotide (ASO) screening, (73) reverse dot blot, and restriction endonuclease allele recognition.(74) The ASO method is for detection point mutations, nucleotide insertion or deletion in genomic DNA. In this method ASO probes of 18-20 per sequence are used. DNA is denatured and dot blotted on to a nylon membrane and then hybridized to different probes. In reverse dot blot probes are attached to the membrane and DNA hybridizes with dot corresponding to the mutation. A recent method is amplification refractory mutation system (ARMS) technique in which specific primers against normal and mutant sequences are used.(60) More than 150 mutations causing beta-thalassemia have been reported from different parts of the world.(74) Studies conducted in Pakistan show the five most common mutations are IVS1-5 (G-C), IVS1-1 (G-T), Fr 41-42 (-TTCT) Fr 8-9 (+G) and deletion 619 bp.(75) Ahmed et al found that there are important ethnic and regional differences in the prevalence of mutations. The five most common mutations, IVSI-5 (G-C) (37.3%), Fr 8-9 (+G) (25.9%), del 619 (7.0%), Fr 41-42 (-TTCT) (6.7%) and IVSI-1 (G-T) (5.4%), constitute 82.3% of the total. Fr 8-9 (+G) is the most common mutation in Northern Pakistan (41.3%), whereas IVSI-5 (G-C) is the most frequent mutation in Southern Pakistan (52.2%). (76) 2.23 Prenatal Diagnosis The availability of prenatal diagnosis added a new option to couples at risk for major haemoglobinopathy, leading to a significant change in the effectiveness of screening and counseling in hemoglobinopathy prevention. Prenatal diagnosis of both ÃŽÂ ±- and ÃŽÂ ²-thalassemia was carried out for the first time in the 1970s using globin chains synthesis analysis in fetal blood, obtained by fetoscopy or placental aspiration around the nineteenth week of gestation. The advent of DNA analysis and the introduction of chorionic villi sampling resulted in a notable improvement in prenatal diagnosis because it could be performed generally at 10 to 12 weeks of gestation. Fetal DNA can be obtained also from aminocytes at 15 to 17 weeks of pregnancy. The reported risk of fetal loss with this procedure ranges from 0.5 to 4.5%. After sampling, fetal DNA analysis is performed by the PCR-based methods mentioned for carrier detection procedures. In general, the mutation to be detected in the fet us is first identified in the parents. The results of DNA analysis are very accurate, but misdiagnosis may occur for several reasons (failure to amplify the target DNA fragment, mispaternity, maternal contamination, and sample exchange). However, the risk of misdiagnosis can be significantly reduced using a number of precautionary measures, such as fetal DNA analysis for selected polymorphic markers.(35) Fetal cells, known to be present in the maternal circulation, represent an attractive, noninvasive approach to prenatal diagnosis. Fetal cells, immunological isolated for their low purity, can only be used for prenatal diagnosis of ÃŽÂ ²-thalassemia in women whose partners carry a different mutation. Recently, this problem has been overcome by development of a technique able to isolate single fetal erythroblasts from maternal blood by microscopic micromanipulation, making possible the analysis of both fetal genes in a single cell. However, this procedure is associated with several technical and biological problems and it is not widely applicable.(35) The discovery of free fetal DNA in maternal plasma provided the basis for developing another method for noninvasive prenatal diagnosis. However, because free maternal DNA is also present, the application to prenatal diagnosis of thalassemias would be possible only to exclude paternally derived pathologic alleles different from the mot hers mutation.(35) The advent of DNA amplification has made it possible to define the geneotype of a single cell biopsied from cleaving embryos (preimplantation diagnosis) and to analyze the polar body obtained during the maturation of the oocyte (preconceptional diagnosis). These procedures avoid the need to terminate affected pregnancies and permit the transfer of only healthy embryos established from in vitro fertilization. Successful experiences in many couples with this approach have been reported in hemoglobinopathies. However, preimplantation genetic diagnosis is a technically challenging, intensive procedure, which requires the close collaboration of a team of specialists. (35) To date, programmes for ÃŽÂ ²-thalassemia prevention based on carrier screening, genetic counseling, and prenatal diagnosis are on-going in several areas at risk in Mediterranean countries, with a marked decline in the incidence of thalassemia major. Effective preventive programs have also been established in countries such as United Kingdom, where thalassemia is a rare disorder that affects diverse minority ethnic groups. Special attention should be given in these programmes to the different religious and social issues and to the different attitude towards prenatal diagnosis of the various ethnic minorities. In case the mutations are not identified linkage studies using restriction fragment length polymorphisms (RFLP) or globin chain synthesis by cord blood sampling are the other options used for prenatal diagnosis. (60) In 1999, Maheshwari M and colleagues suggested fLow chart for carrier detection and prenatal diagnosis of thalassemia. (Figure 2.7) In 1994 the thalassemia working party of British Society of Hematology suggested guidelines for investigation of the ÃŽÂ ± and /ÃŽÂ ² thalassaemia traits. (Figure 2.8) Figure 2.8. FLow chart for carrier detection and prenatal diagnosis of thalassemia. Source: Adopted from Maheshwari M, Arora S, Kabra M, Menon PSN. Carrier screening and prenatal Diagnosis of Beta-thalassemia. Indian Pediatr 1999; 36: 1119-1125. Figure 2.9. FLow chart for thalassemia carrier detection suspected on red cell indices Source: adopted from Guidelines for investigation of the ÃŽÂ ± and /ÃŽÂ ² thalassaemia traits, The Thalassaemia Working Party of the BCSH General Haematology Task Force J Clin Pathol 1994;47:289-295 Prevention is better than cure. It is important to develop prevention programmes for thalassemia prevention where there is high frequency, to avoid fatalities from untreated thalassaemia cases, the expense and difficulty of providing optimum treatment for patients which creates a burden on patients, families and national health services. Thalassaemia patients may be left untreated (indeed, they often die without a diagnosis) or grossly under-treated. At the same time, quality of treatment is firmly linked to both survival rates and quality of life. (Thalassemia International Federation, 2003). The countries where prevention programmes are effective resulting in increased survival of thalassemia major patients in comparison to countries where preventive strategies do not exist. (Figure 2.6) Graph A Graph B Figure 2.10. Graph A: Age distribution of thalassemics in a country without prevention Patients are mostly infants (non-prevention) and children (early deaths) Graph B: Age distribution of thalassemics in a country with full prevention treatment. There is gap in early years with patients mostly in their mid-twenties. Source: Adopted from Prevention of thalassemia other hemoglobinopathies, Thalassaemia International Federation, 2003.