A True Story of Crime and Punishment Essay Example for Free

A True Story of Crime and Punishment Essay A true story of how a man was tried, convicted, and sentenced to death, May God Have Mercy exposes the imperfections in the criminal justice system and how it led to the death of an innocent man. Roger Colemans case became the main story on nightly newscasts and prominent television shows such as Larry King Live, Nightline, Good Morning America, and the Today Show. Many crucial, yet harmful decisions were made that ultimately resulted in an innocent mans execution at the death house in Greensville, Virginia. The police, the prosecutor, and the Judge can all be held responsible for Colemans death. However, the reason Roger Coleman was not acquitted of the murder of Wanda McCoy in the first place and thus in a position to be executed was because his original lawyers, Steve Arey and Terry Jordan, did not provide him with adequate representation, as required by the Constitution of the United States of America. Steve Arey and Terry Jordan were young, inexperienced lawyers who should have never even been considered for a capital case. Judge Persin, the presiding Judge in the case, however, decided on these two gentlemen because other more experienced lawyers refused to take the case because of the huge financial sacrifice it would require. Albeit public speculation that Judge Persins previous profession as a prosecutor had led him to heavily favor the prosecution, his decision stood. The two prosecutors who Arey and Jordan would be opposed by were Mickey McGlothlin and Tom Scott. Both prosecutors had far more experience than the defense lawyers, but that didnt stop Judge Persin from appointing Arey and Jordan to the case. It was an obvious mismatch, intentional or not, and was just the beginning of many problems that would arise for the defendants case. The murder of Wanda McCoy took place in Grundy, a small town in Virginia. The year was 1981, and Brad McCoy, Wandas husband, arrived home from work to find his wife dead, the apparent victim of a brutal rape and murder. The police investigated the crime scene, recorded witness reports, and searched for suspects. When they identified their prime suspect, Roger Coleman, the police made the arrest. Due to the negative public opinion that had generated following the arrest, Coleman demanded that his lawyers file for a change of venue with the court. Since Grundy was such a small town, it would  be very difficult to pick an impartial jury to give Coleman a fair trial. Every person in the town had to have read or seen something on the murder. The fact that the police provided supposed conclusive evidence against Roger Coleman and made it public, many of Grundys residents wanted to see Coleman sentenced to death. Steve Arey had been preparing the case to present to Judge Persin, but at the last minute, he notified Terry Jordan that he would not be able to attend due to a prior engagement. Areys lack of respect for Coleman and the case in general left Terry Jordan with a crucial decisionwhether to seek a continuance or to argue the motion himself. He chose to present the case himself. The defenses decision to argue the motion was a terrible decision. Not only should Jordan have sought a continuance because he was not prepared to argue the case, but neither of the defense lawyers had done any research or made any effort to obtain evidence to support their case for a change of venue, except for a couple of newspaper clippings and a picture of the hanging-tree sign. The prosecution, on the other hand, had gotten approximately fifty affidavits from members of the town claiming that they did not have any biased feelings about the case. As expected, Judge Persin denied the change of venue request, a nd effectively set the tone for Roger Colemans trial. The beginning of every trial begins with opening statements, which provide the jury with a preview of the evidence they will provide and what it will effectively show. A lawyers opening statement is probably the most important part of the entire trial, and usually puts the jurors leaning favorably towards the side with the more convincing performance. Like any other criminal case, the burden of proof lies with the prosecution. They are required to prove beyond a reasonable doubt that the defendant committed the crime. Mickey McGlothlin presented an organized and persuasive opening statement that gave the jury the impression that Roger Coleman was guilty based on the significant amount of evidence against him. The defenses opening statement should have attacked the evidence that the state provided, and also attacked McGlothlins credibility. The defenses  opening statement should have consisted of a description of the friendly relationship that existed between Roger Coleman and the McCoys. It also should have also included Colemans alibiPhilip VanDykeand the fact that VanDykes time card reinforces the time that he said he was with Coleman and the time that he clocked into his job. Arey and Jordan also had an opportunity to smear McGlothlins credibility by referring to evidence that he failed to mention in his opening argumentthe pry mark on the door, the broken fingernails on the victim but no scratches on Coleman, and that the substance found on the victim was soil, not coal dust, which had been on Colemans clothes. The defense counsel didnt refer to any of those facts. No scientific evidence was brought up, and it failed to respond to McGlothins statement that there was evidence that Coleman had in fact admitted to committing the crime. The opening statement was a complete disappointment for Coleman. It started to raise questions inside of Coleman of whether his own defense lawyers thought he was guilty and therefore were not putting the time or effort in to prove his innocence. In either case, his defense lawyers had presented a completely inadequate opening statement, and it left the jury with the feeling that Roger Coleman was guilty. In addition to failing to present a solid and influential opening argument, another major problem with the defense counsel was their extreme lack of preparation for the trial (their own witnesses and the states witnesses). Before the Coleman case, Terry Jordan had never tried a murder case, a rape case, any case involving blood or hair analysis or a criminal case of any kind that lasted more than one day (112). Being from Grundy, Jordan should have interviewed most if not all of the local witnesses, but that did not happen. He did not interview all of police officers that were investigating the crime nor did he interview Dr. McDonald, who was the first one to examine Wanda McCoys body and who estimated her time of death. He did not interview Hezzie McCoy, Dr. Oxley (the doctor who performed the autopsy), or even Elmer Gist, who was the states blood and hair expert. In fact, Jordan cross-examination of Elmer Gist was solely based on Gists report about hair comparisons and one on blood analysis. He had not read anything about blood or hair analysis, because if he had, he would have been more capable of performing an effective cross-examination of the states most crucial  witness. Terry Jordan also failed to carefully examine the physical locations that could have led to Colemans innocence and acquittal. He never actually went inside the house where the murder took place, nor did he examine the door to see if there was any evidence of forced entry. He never examined the bathhouse where Coleman said his pants got wet from, and he did not go to the mine where Roger worked. The route that Coleman supposedly took that night was never gone over to see how long it took and to see if there was time for him to commit the crime given the stops that he made prior to the murder. Jordan did not look for other witnesses who the state had not identified, and he did not ever ask for VanDykes time card, an essential piece of evidence. No photographs were taken at any point, making everything that was presented in court non-visual. Visuals would have made the defenses case much stronger. Steve Arey had interviewed most of the same witnesses that Jordan interviewed, along with a couple other defense-alibi witnesses. The state was heavily favored in the case to begin with because of their experience in criminal cases, as opposed to the defense counsels lack of experience in such cases. As expected, Judge Persin ruled in favor of the state and Roger Coleman was sentenced to death. Many criminal cases are appealed after their conclusion, and this case was no different. The defense has thirty days to file a Notice of Appeal with the Court. The defense prepared their appeal and mailed it to the Court. However, the attorney generals office told the defense that they had filed the appeal one day late and that it would not be accepted. This was another huge mistake by the defense. Although a legal technicality should not be the cause for an innocent mans evidence to be withheld, the law specifically stated that a Notice of Appeal must be filed within thirty days of the Judge signing the order that rejected all of the defenses arguments. The defense had missed a crucial deadline and Roger Coleman would b e punished because of it. The defense would not be able to get the Court to listen to their case again and this would eventually lead to Colemans death. The fact remains that neither Terry Jordan nor Steve Arey conducted a thorough enough investigation to really present a strong case to oppose the prosecution. Roger Coleman was never really given a fair trial, and it ultimately led to his conviction and death. His lawyers failed to use the evidence that was available to get their client acquitted. Their inexperience and lack of motivation resulted in an innocent mans death. There were many opportunities for the defense counsel to question witnesses, to seek experts opinions on the forensic evidence, and to insert new evidence to support Roger Colemans case, but they did not do so. Jordan and Arey should have never been appointed as Colemans counsel, and that alone made Colemans chances of acquittal slim to none. Roger Coleman was never given a fair chance, even later on in the process before he was executed, however, his defense lawyers performed well below the standards that a man on trial for his life deserves. Their terrible mista kes and decisions led to the death of an innocent man.

Theoretical Study and Computational Modeling :: Graduate Admissions Essays

Theoretical Study and Computational Modeling    As the science of theoretical chemistry has matured, its focus   has shifted from analytically solvable problems, such as the   atomic structure of hydrogen, to more complex problems for which   analytical solutions are difficult or impossible to specify.    Important questions about the behavior of condensed phases of   matter, the electronic structure of heavy atoms and the _in   vivo_ conformation of biological macromolecules fall into this   class.   The powerful, highly-parallel supercomputers that have   evolved from recent advances in computing technology are ideally   suited to the mathematical modeling of these complex chemical   phenomena.   Simulations in which the trajectories of a large   number of interacting bodies must be computed simultaneously,   such as statistical-mechanical Monte Carlo studies or molecular   dynamics simulations, are particularly appropriate for   implementation on parallel machines.   I plan to devote my   graduate and postgraduate work to the theoretical study and   computational modeling of these many-body systems.      In preparation for this work, I have developed a strong   background in mathematics and computer science in addition to my   coursework in chemistry.   Given the current demand for increased   computing capacity, this background should prove beneficial.   For example, while recent advances in computer hardware alone   promise potential tenfold increases in speed, truly significant   jumps in computing power (speedups of, say, a thousandfold) will   require changes in currently available programming environments   and the reformulation of popular simulation algorithms.   Furthermore, until highly-parallel machines become widely   available, even modest increases in capacity will depend in part   upon the innovative use of existing hardware through the   continued modification of available software and the development   of new algorithms.   My elective work in computer science and   mathematics should prove useful for both the revision of   existin g programs and the eventual development of new programs   and languages specifically designed for the parallel   architecture of tomorrow's supercomputers.      After completing my doctoral work, I plan to seek employment as   a university professor.

Three Ways of Being with Technology

Three Ways Of Being-with Technology by Carl Mitcham Introduction: Mitcham talks about the relations between technology and humanity. He starts with the chicken-and-egg question â€Å"Which is primary-humanity or knowledge? † What exactly is happening? Is it that we influence the technology or is it so happening that the technology is shaping our morals and us? At this point he quotes one of the Winston Churchill quotations that â€Å"We shape our buildings and thereafter they shape us â€Å".Then he tries to answer this question by saying it is a mutual relationship in between these two but even the mutual relationship take different forms. He then proposes a three ways of being with the technology and takes the whole document on structural analysis of the three forms. Ancient Skepticism: The articulation of a relationship between humanity and technics in the earliest forms when stated boldly is â€Å"technology (that is, the study of technics) is necessary but dangerousâ⠂¬ .Technics, according to these myths, although to some extent required by humanity and thus on occasion a cause for legitimate celebration, easily turns against the human by severing it from some larger reality – a severing that can be manifest in a failure of faith or shift of the will, a refusal to rely on or trust God or the gods, whether manifested in nature or in Providence. Ethical arguments in support of this distrust or uneasiness about technical activities can be detected in the earliest strata of Western philosophy.Socrates considered farming, the least technical of the arts, to be the most philosophical of occupations. This idea of agriculture as the most virtuous of the arts, one in which human technical action tends to be kept within proper limits, is repeated by representatives of the philosophical tradition as diverse as Plato, Aristotle, Thomas Aquinas, and Thomas Jefferson. Socrates argues that because of the supreme importance of the ethical and political issues, human beings should not allow themselves to become preoccupied with scientific and technological pursuits.Socrates argues that human beings should determine for themselves how to perform their actions and therefore should not depend on god for help in â€Å"counting, measuring or weighing† whose consequences are nonetheless hidden. In the Intellectual Auto Biography of Socrates, he explained how he turned away from natural science because of the cosmological and moral confusion it tends to engender. Never did he speculate on the ‘cosmos ‘of the sophists or the necessities of the heavens but declared those who worried about such matters were foolish.The classical greek culture was shot through with a distrust of the wealth and the affluence that the technai or arts could produce if not kept within strict limits. Socrates explains what is important is moderation. He explains that under the condition of affluence human beings tend to become accustomed to eas e and thus to chose less over the more perfect. He explains â€Å"Once drugs are available as palliatives, for instance, most individuals will choose them for the alleviation of pain over the more strenuous paths of physical hygiene or psychological enlightenment. Which is very true in the modern con text than to that current in athens that scarcely need to be mentioned. Another aspect of this tension between politics and technology is on the dangers of technical change. In the words of Adeimantus, with whom Socrates in this instance evidently agrees, once change has established itself as normal in the arts, â€Å"it overflows its bounds into human character and activity and from there issues forth to attack commercial affairs, and then proceeds against the laws and political orders†.Technological change, which undermines the authority of custom and habit, thus tends to introduce violence into the state. This should be taken more serious with the experience in the 20th centu ry. Eros or love, by contrast, is oriented toward the higher or the stronger; it seeks out the good and strives for transcendence. â€Å"And the person who is versed in such matters is said to have spiritual wisdom, as opposed to the wisdom of one with technai or low-grade handicraft skills† It’s the person with the spiritual wisdom that the love is oriented to.The ancient critique of technology thus rests on a tightly woven, fourfold argument: (1) the will to technology or the technological intention often involves a turning away from faith or trust in nature or Providence; (2) technical affluence and the concomitant processes of change tend to undermine individual striving for excellence and societal stability; (3) technological knowledge likewise draws human beings into intercourse with the world and obscures transcendence; (4) technical objects are less real than objects of nature.This pre-modern attitude looks on technics as dangerous or guilty until proven innoce nt or necessary – and in any case, the burden of proof lie’s with those who favor technology not those who would restraint it, because this way of being with technology views it with skepticism. Enlightenment Optimism: This is a radically different way of being with technology; it shifts the burden of proof from those who favor to those who oppose the introduction of inventions in the name of enlightenment.Aspects of this idea or attitude are not without pre-modern adumbration. This idea is first fully articulated in the writings of Francis Bacon at the time of renaissance. Unlike Socrates Bacon maintains that God has given humanity a clear mandate for the change i. e. the technical change. Technical consequences are all cut loose with an optimistic hope and the consequences of such actions are treated as mere accidents. We all deemed to form in the image of god are all expected to create and the art plays the primary role in this.Formed in the image and likeness of Go d, human beings are called on to be creators; to abjure that vocation and pursue instead an unproductive discourse on ethical dilemmas. Bacon indeed claims that not applying new remedies must expect new evils. The kingdom of man founded by sciences is none other than the kingdom of heavens. It is important to understand that Bacon and Socrates relates to each other in pro- and anti- technology partisans. Technical action is circumscribed by uncertainty or risk.Bason doesn’t evaluate technical projects on their individual merits, but simply asserts/affirms the technology. It is important to pursue technological action irrespective of the dangerous consequences. The uncertainty of the technological actions is jettisoned in the name of revelation. Bacon argues that the inventions of printing, gunpowder, and the compass have done more to benefit humanity than all the philosophical debates and political reforms have done to the human kind throughout history.The distinctly modern w ay of being-with technology may be articulated in terms of four interrelated arguments: (1) the will to technology is ordained for humanity by God or by nature; (2) technological activity is morally beneficial because, while stimulating human action, it ministers to physical needs and increases sociability; (3) knowledge acquired by a technical closure with the world is more true than abstract theory; and (4) nature is no more real than artifice – indeed, it operates by the same principles.Romantic Uneasiness: The pre modern way of being with technology effectively limited the rapid technical expansions in the west for approximately 2000 years. The proximate causes of this radical transformation were, of course, legion: geographic, economic, political, military and scientific and the author questions then what brought all such factors together in England to engender a new way of life. Romanticism is what came out from this yelling for change.This paved the way for the new way of being with the technology, one that can be identified as with ancient skepticism or modern optimism but tries to be neutral by accepting change but showing uneasiness towards the change. Mitcham argues that the Romanticism is a form of questioning. On the ancient view, technology was seen as a turning away from God or the gods. On the modern view, it is ordained by God or, with the Enlightenment rejection of God, by nature. With the romantics the will to technology either remains grounded in nature or is cut free from all extra-human determination.In the former instance, however, nature is reconceived not just as mechanistic movement but as an organic striving toward creative development and expression. William Wordsworth tries to demonstrate the same thing through his poems. In which he first shows exult over intellectual mastery and inventions and then in the following poems looks back and grieves over the great change that happened because of inventions and the outrage done t o the nature. Then he writes how unpropped are these arts and high inventions.Rousseau argues the need for actions, not words, and approves the initial achievements of the Renaissance in freeing humanity from a barren medieval Scholasticism. He argues that the destruction is better than inaction. He then points out to a paradox that: turning against technology – but in the name of ideals that are at the heart of technology. In with the way of romantic way of being with technology, there is a paradox. There is a certain ambivalence built in to this attitude. The attitude itself has not been adopted whole-hearted way by the modern culture.

Sickle-Cell Disease (SCD) or Sickle Cell Anemia - Free Essay Example

Sample details Pages: 8 Words: 2382 Downloads: 4 Date added: 2017/06/26 Category Medicine Essay Type Essay any type Level High school Did you like this example? Sickle-cell disease Sickle cell disease (SCD), or sickle cell anemia, is a group of genetic conditions, resulting from the inheritance of a mutated form of the gene coding for the ? globulin chain of the hemoglobin molecule, which causes malformation of red blood cells (RBCs) in their deoxygenated state. Specifically, this single point mutation occurs at position 6 of the ? globulin chain, where a valine is substituted for glutamic acid (Ballas et al. 2012). Don’t waste time! Our writers will create an original "Sickle-Cell Disease (SCD) or Sickle Cell Anemia" essay for you Create order This abnormal hemoglobin causes a characteristic change in the RBC morphology, where it becomes abnormally rigid and sickle-like, rather than the usual biconcave disc. These cells do not flow as freely throughout the circulatory system as the normal phenotype, and can become damaged and hemolysed, resulting in vascular occlusion (Stevens and Lowe 2002). SCD is an autosomal recessive condition, thus patients with SCD will have inherited a copy of the mutated gene from each of their parents (homozygous genotype). Individuals who only inherit one copy (heterozygous genotype) are termed sickle cell (SC) carriers, who may pass on the affected gene to their children (Stevens Lowe 2002). The severity of SCD varies considerably from patient to patient, most likely as the result of environment or other unknown genetic factors (Bean et al. 2013). Patients with SCD are typically of African or African-Caribbean origin, but all ethnic groups may be affected. In 2014 the National Inst itute of Clinical Excellence (NICE) estimated that between 12,500 and 15,000 people in the UK suffer from SCD (NICE quality standard 58, 2014), with more than 350 babies born with SCD between 2007 and 2008. Patients in developed countries typically live into their 40s and 50s. However in developing countries, it is estimated that between 50% (Odame 2014) and 90% of children die by the age of 5 (Gravitz and Pincock 2014). SCD is more prevalent in the ethnic African population because SCD carriers exhibit a 10-fold reduction in severe malarial infection, which is common in many African countries and associated with significant mortality. One proposed mechanism for this is that on infection with the malarial plasmid, RBCs in SCD carriers become sickle shaped and are then removed from the circulation and destroyed. Consequently, it is genetically beneficial to be a SCD carrier, thus more SCD carriers survive to reproduction age, in turn increasing the incidence of the SCD mutat ion in the population. (Kwiatkowski 2005). SC patients experience periods of acute illness termed â€Å"crises† resulting from the two different effects of SCD; vaso-occlusion (pain, stroke and acute chest syndrome) and those from hemolysis (for example, anemia from RBC destruction and inefficient oxygen carrying capacity) (Glassberg 2011). The frequency of these may be several times a week, or less than once a year. Patients typically present with anemia, low blood oxygen levels and pyrexia (NICE quality standard 58, 2014). There are 3 classifications of crises: 1. Sequestration crisis (rapid pooling of RBCs in organs, typically the spleen, which may result in patient death from the acute reduction in available red cells for oxygen transportation). 2. Infarctive crisis (blockage of capillaries causing an infarction). 3. Aplastic crises (where the spleen is damaged from 12 which compromises RBC production (Stevens Lowe 2002). The result of these cri ses can be irreversible damage to a wide range of organs from the spleen to the retina which can cause extreme pain (Stevens Lowe 2002). However, patients not currently experiencing a crisis can also present with anemia as the result of poor oxygen transport function, loss of RBCs due to sequestration in organs such as the spleen and reduced red cell production as the result of impaired spleen function (Ballas et al. 2012). Typically, patients will initially present with an enlarged spleen in early childhood (due to pooling of malformed RBCs), which then becomes hypertrophied, ultimately resulting in a state of almost complete loss of function (autosplenectomy). Several complications of SCD are recognised, including impaired neurocognitive function, which is most likely the result of anemia or silent cerebral infarcts (Ballas et al. 2012). In the UK, SCD is usually diagnosed antenatally or in the first few weeks of life. Prenatal screening is offered to parents who may be at risk of carrying the SCD causing gene. NICE recommend that screening is offered early in pregnancy for high risk groups (ideally before 10 weeks gestation) or via a family origin questionnaire in low risk groups. Full screening can then be offered if family history is suggested. In the case of a positive test, counselling should be offered immediately, and the parents offered the option of termination of pregnancy (NICE Clinical Guideline 62, 2014). However, if screening has not occurred, SCD is one of the diseases screened for by the newborn heel prick test in the first week of life (NICE quality standard 58, 2014). In older patients or those not in countries where screening is offered, patients present with anemia or acute crisis. Histological analysis of blood samples can also reveal sickle shaped RBCs and the characteristic abnormal hemoglobin can be identified by high performance liquid chromatography or electrophoresis (Glassberg 2011). There are three approaches to treatment of SCD. The first is to manage the condition prophylactically in the hope of reducing the incidence of complications and crises. The second is to effectively manage crises, both to reduce the risk of organ damage and life threatening events, as well as control the severe pain associated with a SCD crisis. The third approach is to target the cause of the condition itself. Penicillin (de Montalembert et al. 2011) and folic acid are usually offered to patients in order to prevent complications by bacterial disease and are associated with a significant increase in survival and quality of life (NICE quality standard 58, 2014). Children are also vaccinated against pneumococcal infection. Transcranial doppler imaging of the cerebral vessels can be used to identify children at risk of stroke (de Montalembert et al. 2011). As previously discussed, SCD carriers are conferred some protection from malarial infection. Paradoxically, SCD sufferers display an increased sensit ivity to malarial infection and should also be treated with anti-malarial prophylaxis where appropriate (Oniyangi and Omari 2006). Hydroxyurea has been used in the treatment of SCD, as it appears to increase the production of fetal hemoglobin (HbF), thus reducing the proportion of abnormal hemoglobin although the exact mechanism of this is unclear (Rang et al. 1999). Suggested mechanisms include induction of HbF by nitric oxide, or by ribonucleotide inhibition. Other suggested mechanisms include the increasing of RBC water content and reduced endothelial adhesion, which reduces the incidence of infarction (Charache et al. 1995). Blood transfusion is an important tool in treating SCD, especially in children. It almost immediately improves the capacity of the blood to transport oxygen, and in the longer term as the â€Å"healthy† donor RBCs are not as destroyed as quickly as the sickle shaped RBCs, repeated transfusion is associated with a reduction in erythropoiesi s (RBC production) in the SCD patient, thus reducing the proportion of sickle shaped RBCs in circulation, which in turn reduces the risk of a crisis or stroke. Exchange transfusion is also possible, whereby abnormal sickle RBCs are removed from the circulating volume prior to transfusion with donor blood. However there are drawbacks to transfusion, namely the inherent safety risks such as immunological sensitivity, contamination of blood products with infectious disease and a lack of available donated blood (Drasar et al. 2011). The severe pain of a crisis must be controlled, most often with opioid analgesics. These are effective analgesics which act by binding to  µ, ? and ? receptors. The common approach is intravenous infusion of morphine either by continuous drip or patient controlled analgesia (PCA) pump infusion. Non-opioid drug options, including paracetamol, tramadol and corticosteroids may also be considered, but these drugs have a limit to the analgesia they can produce, whereas opioid drugs are more often limited by their side effects, such as respiratory suppression, vomiting and itching (Ballas et al. 2012). Bone marrow transplant is currently the only curative therapy for SCD. However it is dependent on locating a suitable donor with a HLA tissue match, usually from a healthy sibling. It is associated with some risks and complications including grant rejection, but generally is associated with a very positive prognosis (Maheshwari et al. 2014). As SCD is an autosomal recessive disease with one well identified causative gene, gene therapy to replace one copy of the faulty gene with a normal copy is of great interest to researchers. However this is very much still in development in humans and a 2014 review of SCD clinical trials found no trials of gene therapy as yet (Olowoyeye and Okwundu 2014) In addition to the acute effects of SCD, patients are also at risk from a number of potentially fatal consequence of SCD such as acut e splenic sequestration. In this condition, which often occurs after an acute viral or bacterial infection (classically parvovirus B19), the malformed RBCs become trapped in the sinuses of the spleen causing rapid enlargement. Patients will present with often severe abdominal pain and enlargement, pallor and weakness and potentially tachycardia and tachypnea. Patients may also suffer from hypovolemic shock from the significant reduction of available hemoglobin (acute aplastic crisis). This is managed by emergency treatment of the hypovolemia and transfusion of packed RBCs. Because the rate of recurrence for splenic sequestration is high (approximately 50%), a splenectomy may be performed after the patient has recovered from the event (NICE quality standard 58, 2014). Acute chest syndrome is also a serious complication of SCD and may be fatal. It is characterised by the occlusion of the pulmonary blood vessels during an occlusive crisis. Patients typically present with chest pain, cough and low oxygen levels (Ballas et al. 2012). It is also associated with asthma, and it is recommended that asthma in patients with SCD be carefully monitored. Treatment of acute chest syndrome is usually by antibiotics, bronchodilators if indicated and transfusion or exchange transfusion also considered (de Montalembert et al. 2011). Another consequence of rapid turnover of the abnormally shaped RBCs is the increased production of bile, which may cause hepatobiliary disease, specifically gallstones and vascular conditions of the liver. Liver pathology can result from ischemia-reperfusion injury following a crisis, endothelial dysfunction and overloading with iron as the result of the liver sequestering iron from the destroyed RBCs (Ballas et al. 2012). SCD patients are also at significant risk of ischemic stroke, resulting from a cerebral infarctive crisis, with one study suggesting that 11% of patients will suffer a stroke by 20 years of age, and 24% by 45. Chi ldren who suffer stroke may also go on to develop moya-moya syndrome, which is associated with s significant decrease in cognitive function and increased risk of further stroke (Ballas et al. 2012). SCD is a complex condition and is associated with significant challenges in treatment as it requires the use of a multi-disciplinary team to cover the wide range of its affects and significant prophylactic treatments. As discussed, the effects of these potential complications can be life threatening and have life changing consequences. An additional difficulty is that while screening, prophylactic and curative treatments are available in the developed world, they are not in the developing world where rates of the disease are in fact highest. In sub-Saharan Africa mortality is estimated to be between 50% (Odame 2014) and 90% (Gravitz Pincock 2014) yet in developed counties life expectancy ranges from 40s to 50s (Gravitz Pincock 2014). Currently, laboratory diagnosis and scree ning is prohibitively expensive in developing countries thus there is a need for the development of low cost techniques. The Gavi Vaccine Alliance also endeavors to make prophylactic treatment more available, specifically the pneumococcal vaccine. Of the therapies discussed here, hydroxyurea is likely to be the most affordable and increasing the availability of this would be of significant benefit and clinical trials have commenced in Africa in 2014 (Odame 2014). References Ballas, S.K., Kesen, M.R., Goldberg, M.F., Lutty, G.A., Dampier, C., Osunkwo, I., Wang, W.C., Hoppe, C., Hagar, W., Darbari, D.S., Malik, P. 2012. Beyond the definitions of the phenotypic complications of sickle cell disease: an update on management. ScientificWorldJournal., 2012, 949535 available from: PM:22924029 Bean, C.J., Boulet, S.L., Yang, G., Payne, A.B., Ghaji, N., Pyle, M.E., Hooper, W.C., Bhatnagar, P., Keefer, J., Barron-Casella, E.A., Casella, J.F., Debaun, M.R. 2013. Acute chest syndrome is associated with single nucleotide polymorphism-defined beta globin cluster haplotype in children with sickle cell anaemia. 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