The Hamlet In Me Essays - Fiction, Characters In Hamlet, Literature

The Hamlet in Me Whether we are planning to build a boat or hoping to write a good essay, the only way to go about these tasks is to make a detailed plan of all the steps that need to be taken in order to get the desired result. If you spontaneously decide to build a boat, the result may be a plywood tub that leaks from all sides, let alone hold anyone in it. Hamlet, a seventh century story put to life through the amazing writing of Shakespeare, is a play that shows how meticulous and well thought out plans will bring about the desired result. The plays main character, Hamlet, is a Renaissance man that struggles with the corrupt world around him. He must deal with such issues like "blood for blood revenge" when his own uncle kills his father and takes his place as king. A ghost king appears to Hamlet and catalyzes the events that follow in the play. Hamlet must devise a plan to take revenge for his father and bring to justice all the people who have marred the situation. Though the church mandates through its moral code that Hamlet not take revenge, Hamlet tries to find the worst fate for his devious uncle possible: "Now might I do it, now he is a-praying, And now I'll do't and so he goes to heave?When he is drunk asleep, or in his rage, or in th' incestuous pleasure of his bed?Then trip him?And that his soul may be as damned and black As hell, whereto it goes" (3.4.77-100). Hamlet finally gains the nerve to kill his uncle, but sheaths his sword when he realizes that if he kills him while he is praying, his uncle will ascend to heaven. He ultimately decides to kill his uncle when he commits a sin, so that his soul "may be as damned and black as hell." He goes through a meticulous thought process, which shows him both his options and when to act to give his uncle the most cruel and horrible death he deserves. His actions also bring in a conflict between church and the revengeful calls of his families past. If he revenges his father's death then he wil l be damned to hell according to the church. Without Hamlet's patient and meticulous thought process he would not be able to outwardly expose the king of his wrong doings to Horatio: There is a play tonight before the King. One scene of it comes near the circumstance Which I have told thee of my father's death. I prithee,?Observe my uncle. Hamlet devises a well thought out plan of exposing the King's fault in his father's death. Hamlet uses the advantage of having a wonderful acting troop with him to put on a play for the King and other nobility that greatly resembles the circumstances in which Hamlet's father was killed. Hamlet's hard work is rewarded when the King storms out of the performance as a result of his own guilt and wrong doings. Hamlet also devised this plan to fully prove to himself that the ghost was a trustworthy advocate and not a damned spirit from hell, trying to disrupt and corrupt the Danish court. The through well thought out plans of Hamlet ultimately give him his revenge but also bring the consequence of death by the treachery he creates through the story. Like Hamlet, I use often a long thought process to plan projects that I wish to do. We both are not quick to act, but rather devise a plan to attain our goal. Spontaneous thinking can bring about undesired and sometimes deadly results. A careful thought process is a safer, but not as exhilarating and self-fulfilling way of confronting life without being spontaneous. A balance between the two thought processes would produce the most desirable result.

Mr. and Mrs. and More

Mr. and Mrs. and More Mr. and Mrs. and More Mr. and Mrs. and More By Mark Nichol This post details the permutations of abbreviations for courtesy titles. As mentioned in this post, mister developed as a variant of master. (Interestingly, the newer title came to pertain to married men, while master, once a title of respect for a social superior, was reserved for unmarried men and boys.) Originally, both master and mister were abbreviated Mr. before a person’s name as a courtesy title, but as master fell out of use, Mr. came to be applied solely as an abbreviation for mister. Mrs. was originally a generic abbreviation of mistress before a name, but it developed into a courtesy title specifically for a married or widowed woman, while Miss, with no abbreviation, was adopted as an honorific for unmarried women. Ms. began as a variant abbreviation of mistress as a courtesy title in the 1600s but fell out of favor. (At the turn of the twentieth century, it was proposed as a substitute form of address for a woman whose marital status is unknown, but the idea did not gain traction, nor did the abbreviation catch on fifty years later when a couple of business publications brought the issue up again. However, after feminist and journalist Gloria Steinem adopted the abbreviation as the title of a new magazine for women in 1972, its use quickly spread.) Because no native plural form of Mr. or Mrs. developed in English, the French abbreviations Messrs. (Messieurs) and Mmes. (Mesdames) were borrowed; Mses. developed in imitation, and the plural form of Miss, Misses, like the singular form, did not acquire an abbreviation. Because of the decline in use of such honorifics, the plural forms are rarely seen anymore. As a reference to a man who embodies a certain quality, Mr. appears in such references as â€Å"Mr. Right† (the ideal man for a woman to marry) or â€Å"Mr. Big† (a man of significant authority and/or status). Missus, a derivative of mistress based on a casual pronunciation of the latter word, and Miz, a spelling based on the pronunciation of Mrs. or Miss in the southern United States, should generally be used only in dialogue in historically or geographically appropriate fiction. However, â€Å"the Mrs.† or â€Å"the missus,† spelled as shown as humorous references to one’s wife, are appropriate in informal writing. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Style category, check our popular posts, or choose a related post below:100 Mostly Small But Expressive Interjections"Confused With" and "Confused About"The Difference Between "Phonics" and "Phonetics"

A persuasive postion paper on Fast food, burger king VS McDonalds Essay

A persuasive postion paper on Fast food, burger king VS McDonalds - Essay Example Others would counter that the discerning diner will detect real differences between fast food franchises when flavor, promotions and dining experience are considered. As one of these discerning consumers, I feel considerable differences can be found when comparing two fast food franchises such as Burger King and McDonalds. McDonalds is truly a ground –breaking enterprise. Global in scope and backed by decades of success, this fast food giant has set the standard for all others for many years. This fact is apparent in McDonald’s popularity and profits (Associated Press). But like an old shoe that’s been worn too much, McDonald’s has a sole that is wearing thin. The greatest problem is flavor of the food. True, it has been consistent for many decades, but that’s the problem. While other eateries have been innovative in positive ways, McDonalds seems to be stuck in a flavor rut. They are constantly introducing new items, like burritos and iced coffee, but they just seem to taste like everything else they already sell. Perhaps this can be attributed to the predictability of the promotions McDonalds tend to run. Cheap plastic gizmos of the latest blockbuster movie for the kids and sweepstakes games like monopoly are old and tired. They just add to a dated feeling present on the menu and in the store. McDonalds seems to have kept none of the nostalgia that has made it a traditional favorite while at the same time not really moving forward with anything truly innovative for years. Burger King, on the other hand, has made great strides in producing outstanding flavor results on its menu. The best innovation isn’t really an innovation at all. They simply offer fresh tomatoes, lettuce and onions on all of their burgers as a standard feature. They haven’t started making new products. Instead, they focus on doing a better job on giving their existing products the best flavor possible. Burger King also offers fewer promotional items and the

The Woman's Role in the Islam Religion Essay Example | Topics and Well Written Essays - 2250 words

The Woman's Role in the Islam Religion - Essay Example val of Islam. Similar to other religious, Islam has stipulated a certain position of women in society including their role and social status. The Islam tradition goes back to the 7th century when the revelations transmitted to the Prophet Muhammad who emphasized Islam’s continuity with earlier Semitic traditions. During this period of time, the patriarchal nature of most Islamic societies reinforced the pervasive belief that Muslim women were more subject to the control of men than were women in most other societies. This control was dramatic in the case of Muslim women during the 7-10 centuries. They were secluded immediately upon marriage; that was, they were removed from contact with men (other than relatives) and rarely allowed to move about in public. Islam stated that "marriage is the only road to virtue and that in marriage wives must be submissive and obey their husbands† (Roded 1999, p. 57). Girls generally married between the ages of ten and twelve. Scholars have argued that the definition of power should be broadened to include the invisible control of events by women, which gave them a certain stat us and position. In Muslim societies, kinship and lines of descent were important, and consequently women's power was most visible as they matured and developed the ability to influence the lives of others in their immediate kin and descent groups. In these societies, high-status aristocratic women in particular had power in their ability to influence the actions of their sons, husbands and other male relatives (Roded 1999). Quran and its laws had the profound impact n position and status of women in society and their relations with men. In general, Muslims affirm the Quran to be God's actual words; Muhammad is neither author nor editor, for no human agency influenced the formation of the text. Muhammad does not, therefore, function in the way, for example, the Evangelists do in Christianity. The Islamic tradition is reluctant to allow even this modicum of human involvement in the production of the Quran. Muhammad is not a partner but a go-between, chosen from among men to transmit verbatim God's Word communicated to him through the angel Gabriel. The role of women is to listen and obey, to live the life outlined for them in the revelation and the traditions, and made specific in the law. During the Middle Ages, the role of women in society did not change greatly affected by strict social laws and religious traditions. A blend of Islam and local cultural prescriptions shaped women's lives. In Muslim societies, the local culture was clearly patriarchal, making it difficult to distinguish what part of current culture came from Islam and what pre-Islamic influences remained (Roded 1999). The pre-Islamic record in Iran, Afghanistan and Iraq suggested important public and political roles for royal women. It was clear from historical accounts that the incorporation of Islam into the society profoundly changed the cultural, political, and social conditions under which women lived and worked. Prior to the coming of Islam, women of aristocratic origin had participated in public affairs (Nashat and Beck, 2003). Since the inception of the Islam religion, women were instructed to dress simply and modestly, while all men

Abnormal Psych DQ Questions Essay Example | Topics and Well Written Essays - 500 words

Abnormal Psych DQ Questions - Essay Example The low functional levels due to the profound mental retardation makes it difficult to assess for the key characteristics of autism and so diagnostic instruments are likely to throw up spurious results. This makes diagnosis of autism a challenge and calls for clinical experience (Brasic, 2006). Autism was initially believed to be associated with higher social classes, but is now known to afflict all social classes in an equal manner. Motion abnormalities are a striking feature of autism and may provide the means for the identification of autism in early infancy, prior to the other manifestations. In children the motion anomalies demonstrated are also highly characteristic and can be easily identified. An example of such an abnormal motion typical to autism is the placing of the hand with fingers outstretched by the child before the eyes, with rapid back and forth movement. This action of the child is considered as self-stimulation, as it produces a visual sensation. Many of such abnormal motions typical to autism appear like attempts to provide sensory input to the self in barren environments (Brasic, 2006). The cause of autism still remains unknown, but there are several hypotheses that include exposure to toxic agents and infections, and possibly vaccinations for diseases like measles, mumps and rubella. The treatment of autism is essentially directed towards the associated behavioral problems and so includes intensive behavioral, educational, and psychological components. The use of serotonin in the treatment of autism is under investigation. The earlier the diagnosis and use of intervention strategies the more favorable the outcome and so regular screening of infants and toddlers for signs and symptoms of the disorder is useful (Brasic, 2006). The definition of oppositional defiant disorder (ODD) provided by the American Psychiatric Association’s Diagnostic and Statistical Manual, Fourth Edition (DSM IV) is that it is â€Å"a recurrent

Aetiology of Gestational Diabetes Mellitus

Aetiology of Gestational Diabetes Mellitus Abstract Gestational Diabetes is a condition present in the later stages of pregnancy where the mother has insulin resistance leading to glucose intolerance. The aetiology of Gestational Diabetes Mellitus is largely unknown but several theories include autoimmune destruction of the beta cells, monogenic mutations and insulin resistance. In pregnancy it is normal for there to be some levels of insulin resistance and it is thought that the products of the placenta contribute to the state of insulin resistance as GDM usually subsides after pregnancy. GDM in pregnancy can lead to an increased risk of cardiovascular disease in the offspring such as hypertension and atherosclerosis. This is due to the increased levels of oxidative stress and inflammatory mediators present during pregnancy. The placenta is very important as it is able to control and buffer the amount of glucose that is delivered to the fetus but if this level is too high then it is out of the placentas control and the fetus may have increased rate of growth due to this extra glucose. The current focus of research in this area seems to be into finding ways to diagnosis GDM earlier in the pregnancy and to try and reduce the amounts of oxidative stress. Gestational diabetes: consequences for fetal programming of vascular disease in adulthood Introduction Gestational Diabetes Mellitus (GDM) occurs when there is a glucose intolerance that is first detected during pregnancy. It is a form of hyperglycaemia (Buchanan and Xiang 2005). The aetiology of the condition is unknown but there have been many suggestions as to the cause of it, including autoimmune destruction of the ß pancreatic cells and the possibility of a genetic predisposition to the condition. Hormones that are produced in pregnancy help contribute to the insulin resistant state which characterises diabetes. In recent years, there has been an increase in the cases of Obesity and this is a risk factor for both Diabetes Mellitus and Cardiovascular Disease. The intrauterine environment can affect fetal programming and development. This essay will look into how the placenta and its products can affect the insulin resistant state and how this resistance effects programming as well as the role of oxidative stress and inflammation in making the offspring more susceptible to cardi ovascular disease. Gestational Diabetes Mellitus (GDM) GDM is a state of insulin resistance which disturbs the intrauterine environment and can lead to accelerated fetal growth (Radaelli et al 2003).It effects approximately 7% of pregnant women with approximately 200,000 cases seen each year (Schillan-Koliopoulos and Guadagno 2006). The term GDM is applicable when the onset is during the second and third terms of the pregnancy, but it does not exclude the possibility that the insulin resistance was undiagnosed before the pregnancy. If this is the case and is found to occur in the earlier stages of pregnancy then the mother should be treated the same as mothers who are known to have diabetes before pregnancy (Metzger, Coustan 1998). There is a degree of insulin resistance in normal pregnancy which begins towards the middle of the pregnancy but during the later part of the second and the final trimester these can increase to levels of insulin resistance that are associated with type 2 diabetes (Yogev et al 2008 Chapter 10). Insulin resista nce is when the tissues do not produce a response to insulin due to problems with the secretion of insulin or where the tissues are desensitised to insulin and therefore lack the ability to produce a response (Catalano et al 2003). In a normal pregnancy, the mother changes her metabolism to allow a constant supply of nutrients to reach the fetus to support its rapid growth. Among these nutrients is glucose, which is the main energy source used by the fetus. During the later stages of pregnancy the mother becomes hypoglycaemic and although there is increased gluconeogenesis, the hypoglycaemia still occurs because there is a high rate of transport of glucose to the fetus (Herrera 2000 cited in Herrera and Ortega 2008). GDM can have effects that impact the development of the fetus such as hypoglycaemia and macrosomia, which is an increase in body weight and has the possibility of leading to problems when giving birth, such as shoulder dystocia (Schillan-Koliopoulos and Guadagno 2006). During the second trimester of pregnancy there is peripheral insulin resistance but there is also the possibility that hepatic insulin sensitivity is altered in pregnancy, although few studies confirm this. By the end of the pregnancy the levels of insulin that are circulating are thought to be double those at the start (Redman 2001). Insulin Resistance Insulin resistance in GDM can occur in two forms. The first is where it develops in late pregnancy and it has been postulated that there is a post-receptor mechanism that may influence the insulin signalling pathway which leads to a reduced glucose uptake. The second form is where there is already a degree of resistance before the pregnancy but the changes that occur in normal pregnancy aggravate this (Metznger et al 2007). The insulin resistance that develops in pregnancy is much needed to allow the flow of nutrients, from the mother, directly to the fetus to allow for growth (Radaelli 2003). Increased insulin resistance leads to an increase in insulin secretion by the ß pancreatic cells (Buchanan and Xiang 2005). The insulin resistance is thought to be caused by increased adiposity and as the insulin resistance usually stops after pregnancy this suggests that there is a possibility that the products of the placenta are a potential cause of the resistance. During the course of th e pregnancy the actual changes in glucose levels are very small. It would be assumed that the glucose levels would rise due to the increased insulin resistance but the pancreatic ß cells increase their secretion of insulin to maintain homeostatic glucose levels (Yogev et al 2008 Chapter 10). GDM occurs because there is an increased demand for insulin which under normal circumstances can be met unless there are problems with the secretion of insulin leading to the development of hyperglycaemia. The majority of mothers who develop GDM have been discovered to have a degree of insulin resistance before they became pregnant. Therefore, with the insulin resistance that occurs in normal pregnancy it can be said that GDM occurs with a greater insulin resistance than normally present in gestation (Yogev et al 2008 Chapter 10). Insulin resistance causes a decreased uptake of glucose into skeletal muscle, adipose tissue and liver as well as a decreased production of hepatic glucose. (Catala no et al 2003). One suggestion for insulin resistance looks into the possible role of the mitochondria. Studies using Magnetic Resonance Spectroscopy (MRS) have shown that in normal offspring of parents with type 2 diabetes, there is an increased amount of intramyocellular lipid. This has been shown to cause a reduced function in mitochondria which suggests that mitochondrial dysfunction may play a part in insulin resistance (Petersen et al 2004 cited in Morino et al 2005). It has been suggested that this increase in intramyocellular lipid activates a serine kinase cascade which causes an increase in the Insulin Substrate Receptor 1 (IRS-1), which inhibits insulin receptor phosphorylation on tyrosine sites. This can cause a decrease in the effects and utilisation of glucose. One study showed that in the insulin resistant offspring the mitochondrial density was reduced by just over a third to that of a normal offspring. This suggests that offspring who are insulin resistant may inher it a condition that causes a reduction in rate oxidative phosphorylation in mitochondria (Griffin et al 2009 cited in Morino et al 2005). Detection of GDM Diagnosis of GDM helps to identify pregnancies that are at risk of fetal morbidity as well as obesity and glucose intolerance in the offspring (Buchanan and Xiang 2005). GDM is hard to diagnose as it is asymptomatic. Normal diabetes could be diagnosed by glycosuria but in pregnancy the renal threshold to glucose is lowered so that glycosuria doesnt give a true representation of hyperglycaemia (Redman 2001). There are several risk factors of GDM which can be classified into three groups and help in the screening process. Low risk factors include women who are younger than 25, normal weight at conception, no known family members with diabetes and no history of glucose intolerance. High risk factors include obesity of the mother, diabetes in close relatives, a history of glucose intolerance, current glycosuria and previous pregnancies with GDM (Metzger and Coustan 1998 Chapter 25). Causes of Diabetes There are several theories as to why diabetes occurs and this has been thought to be similar to the underlying mechanisms that cause gestational diabetes. Diabetes is a result of pancreatic beta-cell dysfunction which can present in three main ways: autoimmune, a genetic cause and on top of already present insulin resistance (Buchanan and Xiang 2005). Autoimmune diabetes accounts for approximately 5-10% of all diabetic cases (American Diabetes Association 2010). There are circulating antibodies to the ß cells of the Islet of Langerhans. In GDM, there are a small number of women who have with these antibodies present in their circulation. It is thought that these cases present with GDM due to problems with insulin secretion caused by destruction of the Islets by the autoantibodies (Buchanan and Xiang 2005). This form is similar to type 1 diabetes. The Islet Cell Autoantibodies (ICA) have been shown to have four major molecular targets: Insulin, Glutamic acid decarboxylase (GAD 65), Insulinoma-associated antigen-2 (IA-2) and Zinc Transporter 8 (ZnT8) (Tree 2010). Monogenic diabetes has 2 general forms, one where there are mutations in autosomes and the other where there are mutations in the DNA of mitochondria. The first form is commonly referred to as Maturity Onset Diabetes of the Young (MODY). In both cases onset tends to be at a young age and the patient doesnt present with insulin resistance or obesity (Buchanan and Xiang 2005). Mutations that cause MODY have been found in some women with GDM and commonly occur in genes coding for glucokinase, hepatocyte nuclear factor and insulin promoter factor, MODY is associated with beta cell dysfunction (Weng et al 2002). Chronic insulin resistance with beta-cell dysfunction seems to be the most common cause of GDM. As mentioned before there is an increase in insulin resistance in normal pregnancy but if this develops with background insulin resistance then there is an even greater insulin resistance which can lead to GDM. An established suggestion is that women who are unable to increase their secretion of insulin to cope with the insulin resistance developed in late pregnancy are more susceptible to developing GDM (Buchanan and Xiang 2005). However there could be various environmental processes that are involved in the underlying pathophysiology of GDM. The products of the placenta may also have a role in increasing or decreasing insulin resistance and these will be discussed later. Placental Function The placenta is an organ that has many roles during the development of the fetus. One of these functions is that it acts as a barrier to separate the maternal and fetal surfaces such that the syncytiotrophoblast surface exposes the placenta to the maternal circulation and the endothelium is exposed to the fetal circulation. This position between the two circulations means that the placenta is influenced by molecules from both circulatory systems, including cytokines, hormones and growth factors. The placenta produces molecules which can separately affect the maternal and fetal circulation and it expresses a large number of cytokines including leptin, resistin and tumour necrosis factor. However it has been discovered that these molecules are also produced by adipocytes. All molecules that are going from the mother to the fetus have to cross the placenta. Here they are either modified, for example lipids or like glucose, they are metabolised for placental purposes (Desoye et al 2008). The placenta plays an important role in fetal growth and the regulation of pregnancy (Giachini 2008). The placenta acts to sustain normal homeostatic levels and to carry out the functions of the vital organs. It also provides an immunological defence to the fetus and allows the exchange of molecules vital to its development (Jansson and Taylor 2007). Placental Development Approximately 4-5 days after conception, the process of cleavage causes rapid cell divisions and one of the groups of cells to form are called trophoblast cells. Further developmental processes form the blastocyte which is surrounded by an outer layer of the trophoblast cells. As the pregnancy progresses, the trophoblast cells develop into the placenta while the inner parts of the blastocyte form the embryo and umbilical cord (Huppertz 2008). The blastocyte implants itself onto the epithelium of the uterus where it differentiates into a syncitiotrophoblast which is able to implant itself in the epithelium leading to it being embedded into the decidual part of the uterus (Huppertz 2008). After the attachment of the blastocyte, the trophoblast layer divides very quickly and changes into 2 layers; the inner cytotrophoblastic layer and the outer syncytiotrophoblastic mass (Gude et al 2004).The whole implantation process takes 12 days to complete and after this the fetus is fully embedded into the endometrial layer (Huppertz 2008). The chorionic plate is the surface of the placenta that faces the fetus and this is where the umbilical cord inserts. The basal plate is the surface that faces the mother which contains many types of cells including immune cells such as macrophages and killer cells to carry out the placentas immunological function. The maternal basal plate and the fetal chorionic plate converge to form the smooth chorion which is composed of three layers (Huppertz 2008). When the trophopblast invades the endothelium there is a remodelling of the uterine spinal arteries which is necessary to ensure that the fetus and the placenta receive an adequate blood and nutrient supply and is able to remove any waste materials. This direct supply of blood and nutrients to the placenta can define it as being haemochorial villous organ (Gude et al 2004). After the rapid divisions of the trophoblast and development into 2 layers there are two pathways that can occur, th e villous and extravillious pathways. The extravillious pathway results in the trophoblast being able to invade into the decidua and cause the remodelling of the uterine arteries to increase blood supply to the placento-fetal unit. The villious pathway has a transportation function as well as having endocrine and protective functions (Gude et al 2004). Normal Placentation Placentation involves the structure and function of the placenta. The process of placentation is helped by the composition and arrangement of the extracellular matrix (ECM) of the endometrium. Studies on rats induced with diabetes provided results that showed that diabetes has an effect on the distribution of the ECM molecules. This study by Giachini et al illustrates that Types I and III collagen as well as other molecules, such as proteoglycan molecules decorin and biglycan were distributed throughout normal and diabetic placentas. It was shown that diabetes affects the expression of fibronectin and an increase in deposition of fibronectin may cause changes to the ECM structure which could affect the transfer of molecules from the mother to the fetus. One way in which changes in the ECM can be overcome is to test blood glucose levels frequently during the pregnancy and if kept in normal ranges this can dramatically decrease the prevalence of diseases and disorders present in the fe tus (Giachini et al 2008). As the pregnancy progresses the size of the placenta increases which also means an increase in the amount of products that the placenta produces therefore increasing in the insulin resistance (Schillan-Koliopoulos and Guadagno 2006). This is because the net effect of the products of the placenta is to increase insulin resistance. The increase in size of the placenta means that it needs an increased blood supply. Failure of the mother to increase its blood supply to the placenta can lead to placental insuffiency which if exacerbated can be attributed to be a cause of intrauterine growth restriction (IUGR). This growth restriction is more related to poor maternal nutrition rather than to a cause of GDM. GDM have been associated with an increased fetal and placental weight (Jansson and Taylor 2007). One of the reasons why GDM and increased insulin resistance affects the fetus is that while glucose can cross the placenta, insulin is unable to. This means that the fetal pancreas has to compensate by producing more insulin to prevent high blood glucose levels. The fetal pancreas is capable of doing this and the liver responds to the higher levels of insulin by increasing its production of glucose (Schillan-Koliopoulos and Guadagno 2006). Offspring who have an increase in birth weight have been shown to be at risk of developing cardiovascular disease and diabetes later in life. The main risk factor for this is poor transfer of nutrients via the placenta (Jansson and Taylor 2007). How dramatic these changes are depends on how good the control of blood glucose levels have been during the development of the placenta, if any treatment has been received and if there were any periods of away from normal glucose levels (Desoye 2006). How does diabetes affect Placentation? Diabetic insults at the beginning of the pregnancy can have long last effects of the placenta. One of the roles of the placenta is that it is able to buffer excess maternal glucose which can help to keep the fetal glucose levels within range However if the insult lasts longer than the placenta is able to compensate for then excessive fetal growth may occur (Desoye Mouzon 2007). In diabetes there is endothelial dysfunction which can lead to vascular disease. The endothelial cells help to control the vascular tone of the smooth muscle lining the vasculature. They do this by producing substances that help to vasodilate the smooth muscle including Nitric Oxide, Prostacyclin and Endothelium-Derived Hyperpolarising Factor (EDHF). There have been several studies to suggest different mechanisms of how diabetes affects the endothelium including impaired release of these vasodilating molecules, faults with signal transduction and increased release of constricting mediators of the endothelium. The dysfunction of the endothelium in diabetes is thought to be caused by activation of protein kinase C (PKC) as well as increased oxidative stress, non-enzymatic glycation and an increased activation of the polyol pathway (De Vries et al 2000).The main reason why these effects occur is thought to be due the activation of the protein kinase C pathway and the increased oxidative stress. This can cause early damage to the development of vascular vessels (Roberts and Raspollini 2008). These mechanisms will be discussed later. The effect of hormones produced in pregnancy Pregnancy causes changes in the circulating hormones and cytokines which can all have different effects on insulin resistance and this may help explain the mechanism underlying the resistance that is found in pregnancy and in GDM. Cytokines produced in pregnancy, such as TNF-a, Adiponectin and Leptin have been found to cause an increase in the insulin resistance (Gao et al 2008). In early pregnancy, the levels of oestrogen and progesterone rise but no net effect is seen as the two have antagonistic effects. Oestrogen increases the binding of insulin to its receptor whereas progesterone reduces the ability of insulin to bind (Ryan and Enns 1988). Cortisol levels in pregnancy increase so that by the end of the pregnancy the levels are three times that of what they were at the beginning (Gibson and Tulchinski 1980 cited in Yogev et al Chapter 10). Studies have shown that with increased amounts of cortisol there was a decrease in insulin sensitivity causing insulin resistance (Rizza et a l 1982 cited in Yogev et al 2008 chapter 10). During pregnancy the levels of prolactin increase up to ten times the normal amount (Yogev et al 2008 chapter 10). Studies have shown that in a culture of pancreatic beta cells, prolactin can cause an increase in levels of secreted insulin (Sorenson et al 1993 cited in Yogev et al 2008 Chapter 10). However, high levels of prolactin are not seen to be a pathological cause of GDM (Yogev et al 2008 chapter 10). Human placental lactogen (HPL) is a hormone, and its levels rise during the second trimester of pregnancy. This causes a decrease in the phosphorylation of insulin receptor substrate (IRS1) which can lead to significant insulin resistance (Ryan and Enns 2008 cited Yogev et al 2008 ch 10). Leptin is associated with obesity and concentrations of leptin have been shown to be related to the concentration of insulin in the plasma. In pregnancy the leptin levels increase dramatically. During pregnancy the mother uses her fat stores to supp ort fetal growth and it is thought that the leptin levels increase with the mobilisation of these fat stores. Leptin levels relate to the body mass of the individual (Sattar et al 1998). Placental Leptin is the same in structure and charge to the one produced by adipose tissue (Ashworth et al 2000). One study showed that high leptin concentrations in the umbilical cord increased the likelihood of developing fetal macrosomia (Wiznitzer et al 2000). It is also thought that leptin effects insulin sensitivity by effecting glucose metabolism in both skeletal muscle and in hepatocytes. Rats that received an external source of leptin were found to have an increase in gluconeogenesis which accounted for the majority of hepatic glucose production (Rossetti et al 1997). In GDM there is a greater secretion of TNF-alpha in response to glucose. TNF-alpha functions to regulate metabolism of glucose and lipids as well as being involved in insulin resistance. Many studies suggest that TNF-alpha is involved in the progression to GDM. They found that an increase in glucose cause the placenta and adipose tissue to increase production of TNF-alpha in some cases up to 4 times more than non-diabetic pregnant(Coughlan et al 2001). One study showed that the increases in the levels of TNF-alpha during pregnancy increased consistently with increases in body weight (Catalano et al cited in Yogev et al 2008). Adiponectin is a protein derived from adipose tissue and its function is to regulate insulin resistance and maintains levels of glucose. During pregnancy it has been found that its levels drop and could therefore lead to the increase insulin resistance found in GDM (Gao, Yang, Zao 2008). Adiponectin has also been found to decrease the secretion of TNF-alpha which as stated above can lead to insulin resistance (Hotamisligil 1999 cited in Yogev et al Chapter 10 2008). Adiponectin may cause increased insulin sensitivity as its concentration decreases throughout the gestational period ( Desoye and Mouzon 2007). Resistin is a protein that is produced by adipose tissue and is thought to be involved in insulin resistance in diabetes and is associated with obesity (Steppan and Lazar 2002) In pregnancy, resistin is secreted by the placenta and this secretion reaches its peak by the last trimester (Yura et al cited in Megia et al 2008). Studies show that TNF-alpha is an important factor in insulin resistance during pregnancy and with inputs from leptin and cortisol there is altered glucose metabolism whereas inputs from oestrogen, progesterone and prolactin had little significant effects (Kirwan and Mouzon 2002). There are many hormones produced during pregnancy, mainly by the placenta and adipose tissue that have varying affects but with the overall impact being insulin resistance. Inflammation in Diabetes There are genes in the placenta which regulate reorganisation of the endothelium and inflammatory responses and in GDM these were found to be altered. The increase in leptin receptors suggests that in the placenta this can cause proinflammatory responses (Radaelli 2003). One of the current theories is that the abnormal metabolic environment in GDM can lead to increased production of cytokines and inflammatory mediators. Molecules such as TNF-alpha, Resistin and Leptin increase during pregnancy and these increases in these inflammatory mediators produce metabolic changes by increasing insulin resistance (Desoye and Mouzon 2007). Leptin and TNF-alpha activate phospholipase A2 which are a family of eicosanoid precursors that go on to produce essential fatty acids such as w3 polyunsaturated fatty acids (Desoye Mouzon 2007). There has been a recent investigation which found that with increased adiposity at birth there has been an increase in w3 fatty acids in the placenta (Verastehpour et al 2005 cited Desoye and Mouzon 2007). As stated before, the placenta produces cytokines but it is also a site of action of the cytokines. It is the location of the receptors for these cytokines will influence if the cytokines act on the mother, the placenta or the fetus. With cytokines there is very little transfer across the placenta from mother to fetus and the origin of the cytokines in the fetus can be from either the placenta or from the fetus itself (Desoye and Mouzon 2007). Fetal Programming Many studies have highlighted the fact that events that occur while the fetus is developing can alter its developmental pathway and have adverse outcomes in later life. Fetal programming describes how the environment can affect certain developmental events of which the effects are permanent and can affect processes such as metabolism and the organisms physiology. Women with GDM have an increased risk of the fetus developing macrosomia (Catalano 2008 Chapter 11). The main factor that effects the growth of the fetus is the maternal environment and there is a strong association with the weight and height of the mother and the growth of the fetus such that mothers who are heavier and taller will produce heavy babies. (Love and Kinch 1965 cited in Catalano 2008 Chapter 11). The placenta and fetal programming The placenta is very important to the developmental processes of the fetus as it is able to change the quantity of signals and nutrients that the fetus receives. Deviation from normal would alter the fetal programming, thus making it more susceptible to disease in later life. Pregnancies that are complicated by GDM have excessive oxidative and nitrate stress which has been found to change the activity of certain proteins. Oxidative and nitrate stress alter the placentas function and may cause changes in the fetal programming. Nutrient transfer depends largely on the normal development of the vasculature to allow blood flow and this can be affected by GDM which can cause a decrease in the flow of substrates and is a mechanism in which fetal programming can be affected (Myatt 2006). Fetal programming involves a large amount of development plasticity and interruptions to this development may cause abnormalities in the development of certain cells which may progress to structural differe nces in organ development (Gluckman and Hanson 2004 cited in Jansson and Powell 2008 ref 16). Effects to the fetus exposed to GDM If a fetus is exposed to a diabetic environment during pregnancy then there can be certain long term effects. These effects can be classified into three groups; Anthropometric, Metabolic or Vascular and Neurological or Psychological. Anthropometric changes are concerned with the rates of growth for both height and weight and in a diabetic environment these can be excessive leading to macrosomia and obesity in later life. Metabolic and vascular changes that occur are abnormal glucose tolerance which can eventually lead to diabetes mellitus. Finally the neurological and psychological changes that can occur are usually minor but development of psychological and intellect can sometimes be deficient (Dabelea and Pettitt 2008). Potential problems that may arise with the fetus from an exposure to maternal diabetes include abnormal organ mass, altered angiogenesis and increased levels of fetal insulin (Fetita 2006). It has also been found that if there is an increase in weight during pregnan cy then there is usually a higher birth weight of the fetus (Humphreys 1954 cited in Catalano 2008 Chapter 11). The developing fetus cannot synthesise glucose and is dependent on the mother to produce it where it is transported to the fetus via facilitated diffusion through the placenta (Aerts et al 1996 cited in Mello, Parretti and Hod 2008). The result of decreased insulin sensitivity is that there is more glucose available to the developing fetus which can lead to a greater birth weight (Mello, Parretti and Hod 2008). Using animal models, it has been shown that exposure to high levels of glucose in utero can lead a diminished number of nephrons in the offspring (Amri et al 1999 cited in Fetita 2006 ref 68). This is important as nephrogenesis only occurs in the fetus and stops after birth (Gomez, Norwood 1999). It has been shown that a reduction in the numbers of nephron may affect the rate of progression of renal disease in adults due to an inability to secrete sodium. This may l ater develop into salt-sensitive hypertension (Brenner et al 1988). The mechanisms of reduced organ mass, high levels of fetal insulin and defects in angiogenesis may help explain how the fetus programs abnormal glucose tolerance in adulthood as a result of exposure to GDM (Fetita 2006). Transmission of diabetes from mother to offspring Exposure to gestational diabetes mellitus increases the risk of the fetus developing abnormal glucose tolerance which may develop into type 2 diabetes. (Fetita et al 2006). The association between greater incidences of the offspring having diabetes with a mother with GDM is greater than what would be predicted that could be passed on by maternal genetics (McLean et al 2006). One study showed that the phenotype for GDM/T2D was more common in daughters of mothers who were diabetic rather than daughters of fathers who were diabetic suggesting that the transmission is from mothers with GDM to their daughters. However there were limitations of the McLean study. Patients may not be aware of their fathers diabetes status due to men having lower inclinations to report symptoms and share illnesses with the family. One study showed that the mass of the pancreatic beta cells is relatively fixed by the end of fetal growth and this can be influenced by an intrauterine environment of hyperglycaema (McLean et al 2006). Congenital defects are more common in babies born to diabetic mothers (Farrel et al 2002 cited in Fetita et al 2006). There are many factors that can influence the prevalence of these malformations including the duration, severity and age of onset of GDM (Kousseff 1999). If the onset of GDM is at the beginning of development then development of some organs may be affected. However as said before, the majority of GDM develops during the second trimester. This can then lead to embryopathy which includes defects such as failure of neural tube closure and malformations in the Renal, Cardiac and Gastrointestinal systems which present in childhood (Fetita 2006). In diabetes the hexosamine pathway is activated and inhibits the pentose shunt pathway which decreases the production of antioxidants and therefore leads to an increase in oxidative stress. This oxidative stress has been found to disrupt gene expression and may contribute to congenital defects. One example is that oxidative stress inhibits a gene called pax-3 which is needed for neural tube closure and in diabetes there is an increased risk of neural tube defects (Horal et al 20 Aetiology of Gestational Diabetes Mellitus Aetiology of Gestational Diabetes Mellitus Abstract Gestational Diabetes is a condition present in the later stages of pregnancy where the mother has insulin resistance leading to glucose intolerance. The aetiology of Gestational Diabetes Mellitus is largely unknown but several theories include autoimmune destruction of the beta cells, monogenic mutations and insulin resistance. In pregnancy it is normal for there to be some levels of insulin resistance and it is thought that the products of the placenta contribute to the state of insulin resistance as GDM usually subsides after pregnancy. GDM in pregnancy can lead to an increased risk of cardiovascular disease in the offspring such as hypertension and atherosclerosis. This is due to the increased levels of oxidative stress and inflammatory mediators present during pregnancy. The placenta is very important as it is able to control and buffer the amount of glucose that is delivered to the fetus but if this level is too high then it is out of the placentas control and the fetus may have increased rate of growth due to this extra glucose. The current focus of research in this area seems to be into finding ways to diagnosis GDM earlier in the pregnancy and to try and reduce the amounts of oxidative stress. Gestational diabetes: consequences for fetal programming of vascular disease in adulthood Introduction Gestational Diabetes Mellitus (GDM) occurs when there is a glucose intolerance that is first detected during pregnancy. It is a form of hyperglycaemia (Buchanan and Xiang 2005). The aetiology of the condition is unknown but there have been many suggestions as to the cause of it, including autoimmune destruction of the ß pancreatic cells and the possibility of a genetic predisposition to the condition. Hormones that are produced in pregnancy help contribute to the insulin resistant state which characterises diabetes. In recent years, there has been an increase in the cases of Obesity and this is a risk factor for both Diabetes Mellitus and Cardiovascular Disease. The intrauterine environment can affect fetal programming and development. This essay will look into how the placenta and its products can affect the insulin resistant state and how this resistance effects programming as well as the role of oxidative stress and inflammation in making the offspring more susceptible to cardi ovascular disease. Gestational Diabetes Mellitus (GDM) GDM is a state of insulin resistance which disturbs the intrauterine environment and can lead to accelerated fetal growth (Radaelli et al 2003).It effects approximately 7% of pregnant women with approximately 200,000 cases seen each year (Schillan-Koliopoulos and Guadagno 2006). The term GDM is applicable when the onset is during the second and third terms of the pregnancy, but it does not exclude the possibility that the insulin resistance was undiagnosed before the pregnancy. If this is the case and is found to occur in the earlier stages of pregnancy then the mother should be treated the same as mothers who are known to have diabetes before pregnancy (Metzger, Coustan 1998). There is a degree of insulin resistance in normal pregnancy which begins towards the middle of the pregnancy but during the later part of the second and the final trimester these can increase to levels of insulin resistance that are associated with type 2 diabetes (Yogev et al 2008 Chapter 10). Insulin resista nce is when the tissues do not produce a response to insulin due to problems with the secretion of insulin or where the tissues are desensitised to insulin and therefore lack the ability to produce a response (Catalano et al 2003). In a normal pregnancy, the mother changes her metabolism to allow a constant supply of nutrients to reach the fetus to support its rapid growth. Among these nutrients is glucose, which is the main energy source used by the fetus. During the later stages of pregnancy the mother becomes hypoglycaemic and although there is increased gluconeogenesis, the hypoglycaemia still occurs because there is a high rate of transport of glucose to the fetus (Herrera 2000 cited in Herrera and Ortega 2008). GDM can have effects that impact the development of the fetus such as hypoglycaemia and macrosomia, which is an increase in body weight and has the possibility of leading to problems when giving birth, such as shoulder dystocia (Schillan-Koliopoulos and Guadagno 2006). During the second trimester of pregnancy there is peripheral insulin resistance but there is also the possibility that hepatic insulin sensitivity is altered in pregnancy, although few studies confirm this. By the end of the pregnancy the levels of insulin that are circulating are thought to be double those at the start (Redman 2001). Insulin Resistance Insulin resistance in GDM can occur in two forms. The first is where it develops in late pregnancy and it has been postulated that there is a post-receptor mechanism that may influence the insulin signalling pathway which leads to a reduced glucose uptake. The second form is where there is already a degree of resistance before the pregnancy but the changes that occur in normal pregnancy aggravate this (Metznger et al 2007). The insulin resistance that develops in pregnancy is much needed to allow the flow of nutrients, from the mother, directly to the fetus to allow for growth (Radaelli 2003). Increased insulin resistance leads to an increase in insulin secretion by the ß pancreatic cells (Buchanan and Xiang 2005). The insulin resistance is thought to be caused by increased adiposity and as the insulin resistance usually stops after pregnancy this suggests that there is a possibility that the products of the placenta are a potential cause of the resistance. During the course of th e pregnancy the actual changes in glucose levels are very small. It would be assumed that the glucose levels would rise due to the increased insulin resistance but the pancreatic ß cells increase their secretion of insulin to maintain homeostatic glucose levels (Yogev et al 2008 Chapter 10). GDM occurs because there is an increased demand for insulin which under normal circumstances can be met unless there are problems with the secretion of insulin leading to the development of hyperglycaemia. The majority of mothers who develop GDM have been discovered to have a degree of insulin resistance before they became pregnant. Therefore, with the insulin resistance that occurs in normal pregnancy it can be said that GDM occurs with a greater insulin resistance than normally present in gestation (Yogev et al 2008 Chapter 10). Insulin resistance causes a decreased uptake of glucose into skeletal muscle, adipose tissue and liver as well as a decreased production of hepatic glucose. (Catala no et al 2003). One suggestion for insulin resistance looks into the possible role of the mitochondria. Studies using Magnetic Resonance Spectroscopy (MRS) have shown that in normal offspring of parents with type 2 diabetes, there is an increased amount of intramyocellular lipid. This has been shown to cause a reduced function in mitochondria which suggests that mitochondrial dysfunction may play a part in insulin resistance (Petersen et al 2004 cited in Morino et al 2005). It has been suggested that this increase in intramyocellular lipid activates a serine kinase cascade which causes an increase in the Insulin Substrate Receptor 1 (IRS-1), which inhibits insulin receptor phosphorylation on tyrosine sites. This can cause a decrease in the effects and utilisation of glucose. One study showed that in the insulin resistant offspring the mitochondrial density was reduced by just over a third to that of a normal offspring. This suggests that offspring who are insulin resistant may inher it a condition that causes a reduction in rate oxidative phosphorylation in mitochondria (Griffin et al 2009 cited in Morino et al 2005). Detection of GDM Diagnosis of GDM helps to identify pregnancies that are at risk of fetal morbidity as well as obesity and glucose intolerance in the offspring (Buchanan and Xiang 2005). GDM is hard to diagnose as it is asymptomatic. Normal diabetes could be diagnosed by glycosuria but in pregnancy the renal threshold to glucose is lowered so that glycosuria doesnt give a true representation of hyperglycaemia (Redman 2001). There are several risk factors of GDM which can be classified into three groups and help in the screening process. Low risk factors include women who are younger than 25, normal weight at conception, no known family members with diabetes and no history of glucose intolerance. High risk factors include obesity of the mother, diabetes in close relatives, a history of glucose intolerance, current glycosuria and previous pregnancies with GDM (Metzger and Coustan 1998 Chapter 25). Causes of Diabetes There are several theories as to why diabetes occurs and this has been thought to be similar to the underlying mechanisms that cause gestational diabetes. Diabetes is a result of pancreatic beta-cell dysfunction which can present in three main ways: autoimmune, a genetic cause and on top of already present insulin resistance (Buchanan and Xiang 2005). Autoimmune diabetes accounts for approximately 5-10% of all diabetic cases (American Diabetes Association 2010). There are circulating antibodies to the ß cells of the Islet of Langerhans. In GDM, there are a small number of women who have with these antibodies present in their circulation. It is thought that these cases present with GDM due to problems with insulin secretion caused by destruction of the Islets by the autoantibodies (Buchanan and Xiang 2005). This form is similar to type 1 diabetes. The Islet Cell Autoantibodies (ICA) have been shown to have four major molecular targets: Insulin, Glutamic acid decarboxylase (GAD 65), Insulinoma-associated antigen-2 (IA-2) and Zinc Transporter 8 (ZnT8) (Tree 2010). Monogenic diabetes has 2 general forms, one where there are mutations in autosomes and the other where there are mutations in the DNA of mitochondria. The first form is commonly referred to as Maturity Onset Diabetes of the Young (MODY). In both cases onset tends to be at a young age and the patient doesnt present with insulin resistance or obesity (Buchanan and Xiang 2005). Mutations that cause MODY have been found in some women with GDM and commonly occur in genes coding for glucokinase, hepatocyte nuclear factor and insulin promoter factor, MODY is associated with beta cell dysfunction (Weng et al 2002). Chronic insulin resistance with beta-cell dysfunction seems to be the most common cause of GDM. As mentioned before there is an increase in insulin resistance in normal pregnancy but if this develops with background insulin resistance then there is an even greater insulin resistance which can lead to GDM. An established suggestion is that women who are unable to increase their secretion of insulin to cope with the insulin resistance developed in late pregnancy are more susceptible to developing GDM (Buchanan and Xiang 2005). However there could be various environmental processes that are involved in the underlying pathophysiology of GDM. The products of the placenta may also have a role in increasing or decreasing insulin resistance and these will be discussed later. Placental Function The placenta is an organ that has many roles during the development of the fetus. One of these functions is that it acts as a barrier to separate the maternal and fetal surfaces such that the syncytiotrophoblast surface exposes the placenta to the maternal circulation and the endothelium is exposed to the fetal circulation. This position between the two circulations means that the placenta is influenced by molecules from both circulatory systems, including cytokines, hormones and growth factors. The placenta produces molecules which can separately affect the maternal and fetal circulation and it expresses a large number of cytokines including leptin, resistin and tumour necrosis factor. However it has been discovered that these molecules are also produced by adipocytes. All molecules that are going from the mother to the fetus have to cross the placenta. Here they are either modified, for example lipids or like glucose, they are metabolised for placental purposes (Desoye et al 2008). The placenta plays an important role in fetal growth and the regulation of pregnancy (Giachini 2008). The placenta acts to sustain normal homeostatic levels and to carry out the functions of the vital organs. It also provides an immunological defence to the fetus and allows the exchange of molecules vital to its development (Jansson and Taylor 2007). Placental Development Approximately 4-5 days after conception, the process of cleavage causes rapid cell divisions and one of the groups of cells to form are called trophoblast cells. Further developmental processes form the blastocyte which is surrounded by an outer layer of the trophoblast cells. As the pregnancy progresses, the trophoblast cells develop into the placenta while the inner parts of the blastocyte form the embryo and umbilical cord (Huppertz 2008). The blastocyte implants itself onto the epithelium of the uterus where it differentiates into a syncitiotrophoblast which is able to implant itself in the epithelium leading to it being embedded into the decidual part of the uterus (Huppertz 2008). After the attachment of the blastocyte, the trophoblast layer divides very quickly and changes into 2 layers; the inner cytotrophoblastic layer and the outer syncytiotrophoblastic mass (Gude et al 2004).The whole implantation process takes 12 days to complete and after this the fetus is fully embedded into the endometrial layer (Huppertz 2008). The chorionic plate is the surface of the placenta that faces the fetus and this is where the umbilical cord inserts. The basal plate is the surface that faces the mother which contains many types of cells including immune cells such as macrophages and killer cells to carry out the placentas immunological function. The maternal basal plate and the fetal chorionic plate converge to form the smooth chorion which is composed of three layers (Huppertz 2008). When the trophopblast invades the endothelium there is a remodelling of the uterine spinal arteries which is necessary to ensure that the fetus and the placenta receive an adequate blood and nutrient supply and is able to remove any waste materials. This direct supply of blood and nutrients to the placenta can define it as being haemochorial villous organ (Gude et al 2004). After the rapid divisions of the trophoblast and development into 2 layers there are two pathways that can occur, th e villous and extravillious pathways. The extravillious pathway results in the trophoblast being able to invade into the decidua and cause the remodelling of the uterine arteries to increase blood supply to the placento-fetal unit. The villious pathway has a transportation function as well as having endocrine and protective functions (Gude et al 2004). Normal Placentation Placentation involves the structure and function of the placenta. The process of placentation is helped by the composition and arrangement of the extracellular matrix (ECM) of the endometrium. Studies on rats induced with diabetes provided results that showed that diabetes has an effect on the distribution of the ECM molecules. This study by Giachini et al illustrates that Types I and III collagen as well as other molecules, such as proteoglycan molecules decorin and biglycan were distributed throughout normal and diabetic placentas. It was shown that diabetes affects the expression of fibronectin and an increase in deposition of fibronectin may cause changes to the ECM structure which could affect the transfer of molecules from the mother to the fetus. One way in which changes in the ECM can be overcome is to test blood glucose levels frequently during the pregnancy and if kept in normal ranges this can dramatically decrease the prevalence of diseases and disorders present in the fe tus (Giachini et al 2008). As the pregnancy progresses the size of the placenta increases which also means an increase in the amount of products that the placenta produces therefore increasing in the insulin resistance (Schillan-Koliopoulos and Guadagno 2006). This is because the net effect of the products of the placenta is to increase insulin resistance. The increase in size of the placenta means that it needs an increased blood supply. Failure of the mother to increase its blood supply to the placenta can lead to placental insuffiency which if exacerbated can be attributed to be a cause of intrauterine growth restriction (IUGR). This growth restriction is more related to poor maternal nutrition rather than to a cause of GDM. GDM have been associated with an increased fetal and placental weight (Jansson and Taylor 2007). One of the reasons why GDM and increased insulin resistance affects the fetus is that while glucose can cross the placenta, insulin is unable to. This means that the fetal pancreas has to compensate by producing more insulin to prevent high blood glucose levels. The fetal pancreas is capable of doing this and the liver responds to the higher levels of insulin by increasing its production of glucose (Schillan-Koliopoulos and Guadagno 2006). Offspring who have an increase in birth weight have been shown to be at risk of developing cardiovascular disease and diabetes later in life. The main risk factor for this is poor transfer of nutrients via the placenta (Jansson and Taylor 2007). How dramatic these changes are depends on how good the control of blood glucose levels have been during the development of the placenta, if any treatment has been received and if there were any periods of away from normal glucose levels (Desoye 2006). How does diabetes affect Placentation? Diabetic insults at the beginning of the pregnancy can have long last effects of the placenta. One of the roles of the placenta is that it is able to buffer excess maternal glucose which can help to keep the fetal glucose levels within range However if the insult lasts longer than the placenta is able to compensate for then excessive fetal growth may occur (Desoye Mouzon 2007). In diabetes there is endothelial dysfunction which can lead to vascular disease. The endothelial cells help to control the vascular tone of the smooth muscle lining the vasculature. They do this by producing substances that help to vasodilate the smooth muscle including Nitric Oxide, Prostacyclin and Endothelium-Derived Hyperpolarising Factor (EDHF). There have been several studies to suggest different mechanisms of how diabetes affects the endothelium including impaired release of these vasodilating molecules, faults with signal transduction and increased release of constricting mediators of the endothelium. The dysfunction of the endothelium in diabetes is thought to be caused by activation of protein kinase C (PKC) as well as increased oxidative stress, non-enzymatic glycation and an increased activation of the polyol pathway (De Vries et al 2000).The main reason why these effects occur is thought to be due the activation of the protein kinase C pathway and the increased oxidative stress. This can cause early damage to the development of vascular vessels (Roberts and Raspollini 2008). These mechanisms will be discussed later. The effect of hormones produced in pregnancy Pregnancy causes changes in the circulating hormones and cytokines which can all have different effects on insulin resistance and this may help explain the mechanism underlying the resistance that is found in pregnancy and in GDM. Cytokines produced in pregnancy, such as TNF-a, Adiponectin and Leptin have been found to cause an increase in the insulin resistance (Gao et al 2008). In early pregnancy, the levels of oestrogen and progesterone rise but no net effect is seen as the two have antagonistic effects. Oestrogen increases the binding of insulin to its receptor whereas progesterone reduces the ability of insulin to bind (Ryan and Enns 1988). Cortisol levels in pregnancy increase so that by the end of the pregnancy the levels are three times that of what they were at the beginning (Gibson and Tulchinski 1980 cited in Yogev et al Chapter 10). Studies have shown that with increased amounts of cortisol there was a decrease in insulin sensitivity causing insulin resistance (Rizza et a l 1982 cited in Yogev et al 2008 chapter 10). During pregnancy the levels of prolactin increase up to ten times the normal amount (Yogev et al 2008 chapter 10). Studies have shown that in a culture of pancreatic beta cells, prolactin can cause an increase in levels of secreted insulin (Sorenson et al 1993 cited in Yogev et al 2008 Chapter 10). However, high levels of prolactin are not seen to be a pathological cause of GDM (Yogev et al 2008 chapter 10). Human placental lactogen (HPL) is a hormone, and its levels rise during the second trimester of pregnancy. This causes a decrease in the phosphorylation of insulin receptor substrate (IRS1) which can lead to significant insulin resistance (Ryan and Enns 2008 cited Yogev et al 2008 ch 10). Leptin is associated with obesity and concentrations of leptin have been shown to be related to the concentration of insulin in the plasma. In pregnancy the leptin levels increase dramatically. During pregnancy the mother uses her fat stores to supp ort fetal growth and it is thought that the leptin levels increase with the mobilisation of these fat stores. Leptin levels relate to the body mass of the individual (Sattar et al 1998). Placental Leptin is the same in structure and charge to the one produced by adipose tissue (Ashworth et al 2000). One study showed that high leptin concentrations in the umbilical cord increased the likelihood of developing fetal macrosomia (Wiznitzer et al 2000). It is also thought that leptin effects insulin sensitivity by effecting glucose metabolism in both skeletal muscle and in hepatocytes. Rats that received an external source of leptin were found to have an increase in gluconeogenesis which accounted for the majority of hepatic glucose production (Rossetti et al 1997). In GDM there is a greater secretion of TNF-alpha in response to glucose. TNF-alpha functions to regulate metabolism of glucose and lipids as well as being involved in insulin resistance. Many studies suggest that TNF-alpha is involved in the progression to GDM. They found that an increase in glucose cause the placenta and adipose tissue to increase production of TNF-alpha in some cases up to 4 times more than non-diabetic pregnant(Coughlan et al 2001). One study showed that the increases in the levels of TNF-alpha during pregnancy increased consistently with increases in body weight (Catalano et al cited in Yogev et al 2008). Adiponectin is a protein derived from adipose tissue and its function is to regulate insulin resistance and maintains levels of glucose. During pregnancy it has been found that its levels drop and could therefore lead to the increase insulin resistance found in GDM (Gao, Yang, Zao 2008). Adiponectin has also been found to decrease the secretion of TNF-alpha which as stated above can lead to insulin resistance (Hotamisligil 1999 cited in Yogev et al Chapter 10 2008). Adiponectin may cause increased insulin sensitivity as its concentration decreases throughout the gestational period ( Desoye and Mouzon 2007). Resistin is a protein that is produced by adipose tissue and is thought to be involved in insulin resistance in diabetes and is associated with obesity (Steppan and Lazar 2002) In pregnancy, resistin is secreted by the placenta and this secretion reaches its peak by the last trimester (Yura et al cited in Megia et al 2008). Studies show that TNF-alpha is an important factor in insulin resistance during pregnancy and with inputs from leptin and cortisol there is altered glucose metabolism whereas inputs from oestrogen, progesterone and prolactin had little significant effects (Kirwan and Mouzon 2002). There are many hormones produced during pregnancy, mainly by the placenta and adipose tissue that have varying affects but with the overall impact being insulin resistance. Inflammation in Diabetes There are genes in the placenta which regulate reorganisation of the endothelium and inflammatory responses and in GDM these were found to be altered. The increase in leptin receptors suggests that in the placenta this can cause proinflammatory responses (Radaelli 2003). One of the current theories is that the abnormal metabolic environment in GDM can lead to increased production of cytokines and inflammatory mediators. Molecules such as TNF-alpha, Resistin and Leptin increase during pregnancy and these increases in these inflammatory mediators produce metabolic changes by increasing insulin resistance (Desoye and Mouzon 2007). Leptin and TNF-alpha activate phospholipase A2 which are a family of eicosanoid precursors that go on to produce essential fatty acids such as w3 polyunsaturated fatty acids (Desoye Mouzon 2007). There has been a recent investigation which found that with increased adiposity at birth there has been an increase in w3 fatty acids in the placenta (Verastehpour et al 2005 cited Desoye and Mouzon 2007). As stated before, the placenta produces cytokines but it is also a site of action of the cytokines. It is the location of the receptors for these cytokines will influence if the cytokines act on the mother, the placenta or the fetus. With cytokines there is very little transfer across the placenta from mother to fetus and the origin of the cytokines in the fetus can be from either the placenta or from the fetus itself (Desoye and Mouzon 2007). Fetal Programming Many studies have highlighted the fact that events that occur while the fetus is developing can alter its developmental pathway and have adverse outcomes in later life. Fetal programming describes how the environment can affect certain developmental events of which the effects are permanent and can affect processes such as metabolism and the organisms physiology. Women with GDM have an increased risk of the fetus developing macrosomia (Catalano 2008 Chapter 11). The main factor that effects the growth of the fetus is the maternal environment and there is a strong association with the weight and height of the mother and the growth of the fetus such that mothers who are heavier and taller will produce heavy babies. (Love and Kinch 1965 cited in Catalano 2008 Chapter 11). The placenta and fetal programming The placenta is very important to the developmental processes of the fetus as it is able to change the quantity of signals and nutrients that the fetus receives. Deviation from normal would alter the fetal programming, thus making it more susceptible to disease in later life. Pregnancies that are complicated by GDM have excessive oxidative and nitrate stress which has been found to change the activity of certain proteins. Oxidative and nitrate stress alter the placentas function and may cause changes in the fetal programming. Nutrient transfer depends largely on the normal development of the vasculature to allow blood flow and this can be affected by GDM which can cause a decrease in the flow of substrates and is a mechanism in which fetal programming can be affected (Myatt 2006). Fetal programming involves a large amount of development plasticity and interruptions to this development may cause abnormalities in the development of certain cells which may progress to structural differe nces in organ development (Gluckman and Hanson 2004 cited in Jansson and Powell 2008 ref 16). Effects to the fetus exposed to GDM If a fetus is exposed to a diabetic environment during pregnancy then there can be certain long term effects. These effects can be classified into three groups; Anthropometric, Metabolic or Vascular and Neurological or Psychological. Anthropometric changes are concerned with the rates of growth for both height and weight and in a diabetic environment these can be excessive leading to macrosomia and obesity in later life. Metabolic and vascular changes that occur are abnormal glucose tolerance which can eventually lead to diabetes mellitus. Finally the neurological and psychological changes that can occur are usually minor but development of psychological and intellect can sometimes be deficient (Dabelea and Pettitt 2008). Potential problems that may arise with the fetus from an exposure to maternal diabetes include abnormal organ mass, altered angiogenesis and increased levels of fetal insulin (Fetita 2006). It has also been found that if there is an increase in weight during pregnan cy then there is usually a higher birth weight of the fetus (Humphreys 1954 cited in Catalano 2008 Chapter 11). The developing fetus cannot synthesise glucose and is dependent on the mother to produce it where it is transported to the fetus via facilitated diffusion through the placenta (Aerts et al 1996 cited in Mello, Parretti and Hod 2008). The result of decreased insulin sensitivity is that there is more glucose available to the developing fetus which can lead to a greater birth weight (Mello, Parretti and Hod 2008). Using animal models, it has been shown that exposure to high levels of glucose in utero can lead a diminished number of nephrons in the offspring (Amri et al 1999 cited in Fetita 2006 ref 68). This is important as nephrogenesis only occurs in the fetus and stops after birth (Gomez, Norwood 1999). It has been shown that a reduction in the numbers of nephron may affect the rate of progression of renal disease in adults due to an inability to secrete sodium. This may l ater develop into salt-sensitive hypertension (Brenner et al 1988). The mechanisms of reduced organ mass, high levels of fetal insulin and defects in angiogenesis may help explain how the fetus programs abnormal glucose tolerance in adulthood as a result of exposure to GDM (Fetita 2006). Transmission of diabetes from mother to offspring Exposure to gestational diabetes mellitus increases the risk of the fetus developing abnormal glucose tolerance which may develop into type 2 diabetes. (Fetita et al 2006). The association between greater incidences of the offspring having diabetes with a mother with GDM is greater than what would be predicted that could be passed on by maternal genetics (McLean et al 2006). One study showed that the phenotype for GDM/T2D was more common in daughters of mothers who were diabetic rather than daughters of fathers who were diabetic suggesting that the transmission is from mothers with GDM to their daughters. However there were limitations of the McLean study. Patients may not be aware of their fathers diabetes status due to men having lower inclinations to report symptoms and share illnesses with the family. One study showed that the mass of the pancreatic beta cells is relatively fixed by the end of fetal growth and this can be influenced by an intrauterine environment of hyperglycaema (McLean et al 2006). Congenital defects are more common in babies born to diabetic mothers (Farrel et al 2002 cited in Fetita et al 2006). There are many factors that can influence the prevalence of these malformations including the duration, severity and age of onset of GDM (Kousseff 1999). If the onset of GDM is at the beginning of development then development of some organs may be affected. However as said before, the majority of GDM develops during the second trimester. This can then lead to embryopathy which includes defects such as failure of neural tube closure and malformations in the Renal, Cardiac and Gastrointestinal systems which present in childhood (Fetita 2006). In diabetes the hexosamine pathway is activated and inhibits the pentose shunt pathway which decreases the production of antioxidants and therefore leads to an increase in oxidative stress. This oxidative stress has been found to disrupt gene expression and may contribute to congenital defects. One example is that oxidative stress inhibits a gene called pax-3 which is needed for neural tube closure and in diabetes there is an increased risk of neural tube defects (Horal et al 20

Faulkners Light in August - Hightowers Epiphany Essay -- Light Augus

  Light in August - Hightower's Epiphany  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚   Most criticism concerning Faulkner's novel, Light in August, usually considers the character of Joe Christmas. Christmas certainly deserves the attention paid to him, but too often this attention obscures other noteworthy elements of the complex novel. Often lost in the shuffle is another character, the Reverend Gail Hightower, who deserves greater scrutiny. A closer examination of Hightower reveals Faulkner's deep concern for the South and the collective suffering of its people. Hightower, through his own personal epiphany, transcends the curse under which the South has suffered for so long.    Of course, the central character of Joe Christmas has dominated criticism of the novel, primarily because he represents the problematic and touchy issue of racism. Those who wish to prove that Faulkner either was or was not a racist often turn to Christmas--who is abandonded as a baby outside an orphanage and found on Christmas day (hence his name); called a "nigger bastard" (LIA 135) by the dietitian at the orphanage when he catches her with a young doctor; and ever after suspects that he might possess some Negro blood. All this prompts many readers to see in Christmas a symbol of racial tensions and conflict. For instance, in his italicized amendments to the excerpt from the novel he used for The Portable Faulkner, Malcolm Cowley refers to the character as "Joe Christmas, the mulatto" (51). Unfortunately, such readings assume facts not in evidence. Cowley's additions do more than provide a necessary context; they resolve a question about which Faulkner was definitely non-committal. He said of Christmas' background, or lack of one: I think that was his tragedy--he ... ... Douglas Day. New York: Vintage, 1973. ------. Light in August. 1932. New York: Vintage, 1987. ------. The Unvanquished. 1938. New York: Vintage, 1959. Gwynn, Frederick L., and Joseph Blotner, eds. Faulkner in the University. Charlottesville: University of  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Virginia   Press, 1995. King, Richard B. A Southern Renaissance: The Cultural Awakening of the American South, 1930-1955.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   NewYork: Oxford University Press, 1980. Longley, John L., Jr. "Joe Christmas: The Hero in the Modern World." Faulkner: A Collection of Critical  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Essays. Ed. Robert Penn Warren. Englewood Cliffs:   Prentice-Hall, 1966: 163-174. Runyan, Harry. A Faulkner Glossary. New York: Citadel, 1964. Snead, James. Figures of Division. New York: Methuen, 1986. Taylor, Walter. Faulkner's Search for a South. Urbana: University of Illinois Press, 1983.    Faulkner's Light in August - Hightower's Epiphany Essay -- Light Augus   Light in August - Hightower's Epiphany  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚   Most criticism concerning Faulkner's novel, Light in August, usually considers the character of Joe Christmas. Christmas certainly deserves the attention paid to him, but too often this attention obscures other noteworthy elements of the complex novel. Often lost in the shuffle is another character, the Reverend Gail Hightower, who deserves greater scrutiny. A closer examination of Hightower reveals Faulkner's deep concern for the South and the collective suffering of its people. Hightower, through his own personal epiphany, transcends the curse under which the South has suffered for so long.    Of course, the central character of Joe Christmas has dominated criticism of the novel, primarily because he represents the problematic and touchy issue of racism. Those who wish to prove that Faulkner either was or was not a racist often turn to Christmas--who is abandonded as a baby outside an orphanage and found on Christmas day (hence his name); called a "nigger bastard" (LIA 135) by the dietitian at the orphanage when he catches her with a young doctor; and ever after suspects that he might possess some Negro blood. All this prompts many readers to see in Christmas a symbol of racial tensions and conflict. For instance, in his italicized amendments to the excerpt from the novel he used for The Portable Faulkner, Malcolm Cowley refers to the character as "Joe Christmas, the mulatto" (51). Unfortunately, such readings assume facts not in evidence. Cowley's additions do more than provide a necessary context; they resolve a question about which Faulkner was definitely non-committal. He said of Christmas' background, or lack of one: I think that was his tragedy--he ... ... Douglas Day. New York: Vintage, 1973. ------. Light in August. 1932. New York: Vintage, 1987. ------. The Unvanquished. 1938. New York: Vintage, 1959. Gwynn, Frederick L., and Joseph Blotner, eds. Faulkner in the University. Charlottesville: University of  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Virginia   Press, 1995. King, Richard B. A Southern Renaissance: The Cultural Awakening of the American South, 1930-1955.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   NewYork: Oxford University Press, 1980. Longley, John L., Jr. "Joe Christmas: The Hero in the Modern World." Faulkner: A Collection of Critical  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Essays. Ed. Robert Penn Warren. Englewood Cliffs:   Prentice-Hall, 1966: 163-174. Runyan, Harry. A Faulkner Glossary. New York: Citadel, 1964. Snead, James. Figures of Division. New York: Methuen, 1986. Taylor, Walter. Faulkner's Search for a South. Urbana: University of Illinois Press, 1983.   

Basic Ecclesial Community Essay

The same can be said of the various theologies of liberation. Although in one or another versChristianity,ion they may not dovetail exactly with the theological frontiers of Puebla, liberation theologies are a meaningful and important way to approach and understand BECs. WHAT ARE THE BASIC ECCLESIAL COMMUNITIES? For the sake of precision, let me make clear what BEC means in the context of this article. The currently so-called Basic Communities, Basic Christian Communities, Grassroots Christian Communities, oasic Ecclesial Communities in different parts of the world share some common and fundamental features. However, at the present level of ecclesiological awareness as it is mirrored in the specialized theological literature, we can hardly talk about the current phenomenon of BECs in a general, univocal way. They are a diversified reality from which we can draw an analogical concept. They offer a certain unity in their diversity. Even within a more homogeneous scenario such as Latin America, there are significant differences between the BECs in Brazil, in Peru, in El Salvador, or Nicaragua, for instance, which prevent us from talking of them without further specification. To write on the BECs in a scholarly fashion, therefore, we need a concrete point of reference. Here this will be the BECs in the Roman Catholic Church in Brazil. From such a specific point of reference it is possible then to relate to other analogical cases. I do not pretend to give a clear-cut definition or even a description of the Brazilian BECs. This would deprive them of one of their fundamental traits, namely, flexibility, openness to change and to reverse patterns, something which is very much linked to real life. Let me make explicit some of their major characteristics. First, they are communities. They are trying to set a pattern of 601 602 THEOLOGICAL STUDIES Christian life which is deliberately in contrast with the individualistic, self-interested, and competitive approach to ordinary life so inherent in the Western, modern-contemporary culture. As a result of their own unfolding evolution in the last 25 years or so, BECs in Brazil have been aiming at living the two dimensions of communion and participation. By stressing communion, the BECs want to live faith not as a privatized but as a shared, real experience which is mutually nurtured and supported. Such a deep level in faith sharing is at the roots of an attempt to improve interpersonal relationships within the community. This then makes possible the dimension of participation especially in the decision-making process, in contrast with a rather passive attitude of the faithful or a too vertical orientation in exercising power or authority by the clergy or by the laity. Secondly, the BECs are ecclesial. The catalysts of this ecclesiality in the Brazilian BECs have been the unity in and of faith and the linkage to the institutional Church. Even when BECs are ecumenically oriented, experience has proven that the sharing of a specific, common faith was a crucial element for fostering the internal growth of the community. This is particularly important because of the paramount significance of the Word of God and biblical-prayer sharing in BECs life. By linking themselves to the institutional Church, BECs want to reverse the confrontational and/or hostile approach to the hierarchy that used to be a hallmark of Basic Communities in the sixties, especially in Italy and France or in the so-called â€Å"underground church† in the United States. This does not mean that the BECs must be started by a clerical initiative, although many have indeed been. It means, though, that however originated, the BECs look for recognition and support by the pastors or by the bishops, even when enjoying a fair amount of internal autonomy. Thirdly, BECs are basic (de base). Being predominantly a gathering of active lay people, they are said to be â€Å"at the base† of the Church, from an ecclesiastic point of view, as related to the hierarchical Church structure. Moreover, in Brazil and in many Third World countries, the BECs are â€Å"at the base† of society as well. In fact, most of the thousands and thousands of BEC members are poor. This is not an exclusive option but an understandable fact. The poor feel in a stronger way the need for community, for mutual support. They are less sophisticated in shaping their interpersonal relationships because they have less to lose. They are more open to participation because more pressed by common needs. Finally, they are more sensitive to the gift because they realize their personal and societal needs. Thus they hardly take things for granted or as if deserved. This opens their hearts to faith, which is part of the gifteconomy of salvation and liberation. Moreover, being at the base makes BASIC ECCLESIAL COMMUNITIES 603 it easier for BECs to link faith and real, everday life. On the grounds of the gospel demands, they realize the need for the transformation of a society whose organization is in itself unjust in many aspects and very much the source of their own poverty. Thus faith is not locked in the mind and even less within the private, individual horizon. Faith is a dynamic factor of personal conversion and societal transformation. In an earlier stage the BECs in Brazil were thought of as a way to improve the life of parishes. Progressively it became clear that such a model of communion and participation, such a quality of interpersonal relations, were not possible in a large-scale group or at a highly developed level of social organization. Without losing the linkage to the parishes, BECs multiplied within each parish, keeping their spontaneity and flexibility. Today there is no pretense of making of a parish a community in the terms of BECs. This would hardly be possible in sociological terms. The life of a parish, however, can be significantly improved by the presence of many BECs that gather between 20 and 50 people in general and can occasionally interact for common purposes within the parish. For historical and sociological reasons, Brazil has been a land chronically short of priests (a situation that is starting to loom elsewhere too). In previous times people would confine their active church life to the periodic and scarce presence of the ordained minister. With BECs the growing awareness of the diversity of vocations and of their respective responsibility in the Church led them to consider the priest as a part of the BEC and not above it. In his absence, however, the community goes on in its ordinary life, be it at the level of internal church affairs (prayer and biblical groups, preparation for the sacraments, attention to the sick, renewal and ongoing formation programs, and so on), be it in the field of concrete commitments to action in the social and political realm. Links to the parish or the diocese are kept, of course, and they remain the main source in the preparation of written material for several projects (biblical papers, liturgy of the word, etc. ). But life does not rest upon the initiative of the clergy and even less on the need for its constant involvement or required approval. This leads to a growing decentralization of church life which, however, fits within the parameters of a broad and all-embracing planning by the parishes, the dioceses, and even a very active and wellorganized Bishops Conference at a national level or in each one of its 15 regions in the country. The further elaboration of this article will provide the reader with more detailed information on what BECs mean in this precise context. It is important to bear in mind that taking Brazil as a case study for methodological reasons should not turn out to be an exclusive or narrowing focus. Having a specific point of reference helps us to have a context 604 THEOLOGICAL STUDIES for thinking, to be precise on what we are talking about, and to make possible a concrete comparative approach to our own ecclesial situation or perspective. BEC: A WAY OF BEING CHURCH The growing literature on BECs has accustomed us to think of them mainly, if not exclusively, in terms of Latin American ecclesiology; and one of the postulates of this ecclesiology is that the BECs are not simply a movement or association in the Church but rather a way of being Church. I start from this position, which I myself share, but in this article I would like to look at the issue from a different angle. It may help to broaden ecclesiological perception vis-a-vis our BECs, as well as their scope and significance for the Church as a whole. If indeed the BECs are a way of being Church, then they, like the Church, can be read and interpreted by distinct ecclesiologies. The reading will be more or less adequate in a given case, particularly when it has to do not so much with a more or less abstract concept of the Church but rather with its concrete embodiment in a given local area: the Brazilian Church, for example. I intend in this article to link up the BECs with several major ecclesiologies of European-American extraction in the last 30 years or so. Those ecclesiologies were not thought out in terms of BECs, so the linkup may serve two purposes. First, on the basis of premises that are not just Latin American, it will check out the proposition that BECs are truly a way of being Church. Second, it will show that such ecclesiologies can be enriched and opened to new horizons in the light of BECs. Let me mention two further points. First, we clearly have a wide and varied multiplicity of ecclesiological standpoints. Each one, taken individually, brings out the richness of the aspect it highlights, while at the same time leaving other possible dimensions in impoverished silence. The very plurality of ecclesiologies reveals the inability of any given one to exhaust the mystery of the Church. Understanding the Church, and BECs as a mode of embodying the Church, will always entail the meeting and linking up of various ecclesiological intuitions. It can never be a linkup with one exclusively. Indeed, in principle it should embrace them all, though of course with differing tones and stresses. My second point has to do with the present level of ecclesiological awareness, in which difference of focus is not due solely to difference in the aspect treated. It also depends on the historical frame of reference that serves as the backdrop for the reflection process. Theology carried on in the First World or inspired by it has been less explicit about that context, but it nevertheless bears the marks of it. For Third World theology in general, BASIC ECCLESIAL COMMUNITIES 605 and Latin American theology specifically, that frame of reference is inescapable, clearly putting its mark on theological method and its final product. This article may help us to see that these ways of doing theology are not mutually exclusive. By the same token, the Church, reflecting consciously on the mystery that it is, can derive benefit from this plurality. It can again take up the problem of its unity on the basis of presuppositions that do not rest upon uniformity in its process of theological reflection. The BECs may serve here as a focus and means for verifying this proposition. Among possible methodological options, I would like to single out three that are embodied in works of comparative ecclesiology. The first identifies the ecclesiological perspective, organizing the thought of each author around a dominant tendency in his works; this was the approach used by Batista Mondin. 1 The second defines a theoretical frame at the start and then uses it to compare distinct ecclesiologies, authors, or â€Å"schools†; such was the approach used by Alvaro Quiroz Magana in his thesis. 2 The third inductively works out ecclesiological models on the basis of various authors, suggesting the viability and even necessity of using different models to articulate an ecclesiology; that has been the approach of Avery Dulles in several works. Since it does not focus mainly on authors as Mondin does, or anticipate any theoretical grid as does Quiroz Magana, Dulles’ method lends itself best to my objective here. I want to verify whether and how BECs bear the chief marks of the Church that have been underscored in recent ecclesiologies outside Latin America, and how BECs can amplify and shed light on the content of those ecclesiologies in a different way. Taking my inspiration from Dulles’ method, then, I will try to expand the content of his analysis in ModeL · of the Church by focusing specifically on BECs. In his later work, A Church To Believe in, Dulles really ends up proposing a sixth model (the Church as a community of disciples), but I shall not consider that model specifically here. Its syntheticintegrative character is less adequate to my analytic-comparative purpose here. In Models of the Church Dulles proposes the following ecclesiological 1 Batista Mondin, Le nuove ecclesiologie: Un’imagine attuale della Chiesa (Rome: Paoline, 1980). 2 Alvaro Quiroz Magana, Eclesiologia en la teologia de la liberacion (Salamanca: Sigueme, 1983). Avery Dulles, Models of the Church: A Critical Assessment of the Church in All Its Aspects (Garden City, N. Y. : Doubleday, 1974); A Church To Believe in (New York: Crossroad, 1982). 606 THEOLOGICAL STUDIES models: Church as institution, communion, sacrament, herald, and servant. I shall briefly present the fundamentals of each model, reflecting on the relationship of BECs to the model in question. Church As Institution This is the model to whi ch we have been traditionally accustomed. It solidified over the centuries, and we were evangelized and theologically educated in it until the 1950s. Its main thrust lies in understanding the Church as a society, indeed as a perfect society. Its underlying Christology views Christ as prophet, priest, and king, with the threefold function of teaching, sanctifying, and ruling. That mission is carried out by virtue of the power which Christ received from God, and which he confers on those who in fact possess authority and jurisdictional power in the Church: the pope, bishops, and priests. Thus the ecclesiological accent is on the organization and dispensation of power, hence on the juridical dimension. This stress shows up on the three planes of doctrine, sacrament, and administration, which are explicitly linked up with their divine origin. The logical result is the excessive growth in the Church of the clerical and institutional dimension and the relative atrophy of the charismatic element as well as of the significance of the People of God, particularly the laity. Proper membership in the Church is defined as acceptance of the same doctrine, communion in the same sacraments, and obedient subjection to the same pastors—all that being visibly verified. Obviously the relationship of this paradigm to EECs is remote, by virtue of the characteristics of both the model and BECs. The predominantly vertical conception of power, the resultant structural organization, and the primacy and hegemony accorded to clerical initiative and activity represent something very different from what BECs are actually seeking andfleshingout in their way of being and living the reality of the Church. By the same token, however, BECs in Brazil, as I said, do contrast with basic communities that have arisen in the First World, particularly with those that arose in the 1960s. Brazilian BECs almost always arise through the initiative of the hierarchy and are sustained by their support. Working alongside lay pastoral agents, priests and religious also provide inspiration and motivation. Bishops and priests exercise jurisdictional power over Brazilian BECs, and the latter recognize and accept this because they consciously regard themselves as an integral part of the institutional life of the Church as a whole. Thus Brazilian BECs are not resistant to the Church as institution, they do not pose an alternative to it, nor do they absolutize their own way of being Church. Instead they see themselves as a vital part of the Church, without which they would have no meaning. BASIC ECCLESIAL COMMUNITIES 607 Taking all these factors into account, we can see that, from an analytical point of view, the Church-as-institution model hardly serves as the dominant ecclesiological inspiration or perspective in the rise of BECs and their actual working. Church As Sacrament â€Å"The Church exists in Christ as a sacrament or sign and an instrument of intimate union with God and of the unity of the whole human race† (Lumen gentium, no. 1). With these words Vatican II summarily echoes and ratifies a theme that was much in evidence in the Church Fathers (Cyprian and Augustine) and in the age of scholasticism (Thomas Aquinas). Its elaboration in terms of a more general ecclesiological perspective, however, is fairly recent. This newer perspective views the Church as a sacrament. One felicitous effort of this sort was by Otto Semmelroth, and his work inspired many others. 4 Henri de Lubac also made a significant contribution to this approach by using patristic and medieval sources. 5 He linked up two dimensions: the Christological—for us Christ is the sacrament of God; and the ecclesiological—for us the Church is the sacrament of Christ. All the sacraments are essentially sacraments of the Church. The sacraments derive their power of grace from the Church, and through them the Church becomes the sacrament it is. Here we have a linkage between the model of the Church as institution (which stresses the visible reality of the socio-ecclesiastical dimension) and the model of the Church as communion (which stresses the socio-ecc/esiai dimension rooted primordially in the inner union of faith, hope, and love). In the Church-as-sacrament model the whole congregation of the faith comes together in all its diverse vocations and functions. That explains the fecundity of this approach, which has been explored ecclesiologically by many theologians, particularly since World War II. A sacrament is a sign of something really present, the visible form of an invisible grace. It is an efficacious sign, producing or intensifying the reality it signifies. The sacraments, then, contain the grace they signify and confer the grace they contain. In tradition the sacraments have always been associated with the social dimension of the Church, not with the isolated individual, even though they are administered and rec eived by individuals. For the human being, then, the sacraments bring together Otto Semmelroth, Die Kirche als Ursakrament (Frankfurt/Main: Knecht, 1953). Henri de Lubac, Catholicisme (Paris: Aubier, 1948). See the following works by way of example: Leonardo Boff s doctoral dissertation, Die Kirche als Sakrament im Horizont der Welterfahrung: Versuch einer Legitimation und einer struktur-funktionalistischen Grundlegung der Kirche im Anschluss an das IL Vatikanische Konzil (Paderborn: Bonifatius, 1972); Yves Congar, â€Å"L’Eglise, sacrement universel du salut,† in Cette eglise que j’aime (Paris: Cerf, 1968) 41-63; P. Smulders, â€Å"L’Eglise, sacrement du salut,† in G. Barauna, ed. , L’Eglise de Vatican II2 (Paris: Cerf, 1967) 331-38. 5 6 4 08 THEOLOGICAL STUDIES and link the visible and invisible orders as well as the individual and social planes. We can sum this up by saying that Christ is a sacrament and so is the Church. Christ is the sign and visible presence of the invisible God, the efficacious power of salvation for the individual and the whole People of God. As institution and communio n, the Church is the sign and visible presence of Christ: accepted by faith and lived both really and mystically by the ecclesial community in the unity of the same faith. Indeed, the Church is even more sacrament than sign. Through its visible actions the Church not only signifies but dynamically produces and makes visible the reality of salvation that it represents and announces. The Church, then, is a grace-happening, and not just in the sense that it effects and administers the sacraments. It is a grace-happening as well because in the life of believers, who are the Church, we see operating and unfolding faith, hope, love, freedom, justice, peace, reconciliation, and everything else that establishes human intercommunion and humanity’s communion with God. Now let us see how the BECs look in the light of this model, the Church as sacrament. 1. From our examination of the Church-as-institution model, there is no doubt that the BECs see themselves as Church, as part of the visible, institutional, sociological body of the Church, and that they are a specific way of living as such. We also find Church as sacrament in the BECs. They are it within the Church itself insofar as they better embody the ecclesial range and presence of lay people, or the poor, in the Church— two features less evident in the Church’s concrete structures and functions in recent centuries. Lay people and poor people share a core reality. They are both of the grass-roots level, of the base: lay people in the Church, poor people in the world. Consequently we get thereby a visible, ecclesial sign of Christ’s own kenosis, a fundamental Christological dimension (Phil 2:5-11), which had not found suitable expression in the Church-as-institution model as lived in the past few centuries. This Christological tie-in, which is lived intensely in BECs, serves as an instrument of grace for bishops, priests, and religious who accept, recognize, or even share the BEC way of being Church. . The BECs have emerged from within a traditional Catholicism. In Brazil that Catholicism was centered around sacramentalization; little effort was put into clear-cut evangelization and explanation of the faith. Both in pedagogical intent and in actual practice, BECs put less stress on the traditional approach of sacramentalization. This is obvious insofar as the older focus on administering and receiving the sacraments signified and reaffirmed the hegemony of ordained authority and power. This was characteristic of the earlier pastoral BASIC ECCLESIAL COMMUNITIES 09 approach or flowed naturally from it. In the cities it took the form of regular administration of the sacraments. In rural areas and the interior it took the form of rapid discharge of various sacramental obligations (baptism, confirmation, marriage, penance, and Eucharist) in a very short period, on those rare or sporadic occasions when ordained ministers of the sacraments were on hand (the Brazilian-coined word to say it is desobriga, literally â€Å"discharge of obligation†). In both cases the tenor was more individual than communitarian. Administration of the sacraments frequently took place without proper doctrinal preparation and without rightly establishing the inner dispositions required for meeting the ethical and ecclesial prerequisites for participation in the sacraments. Thus sacramentalization was not tied into a clear ecclesial awareness of the scope and significance of the sacraments. The forms of sacramental expression and preparation for them were associated mainly, indeed almost exclusively, with the ordained minister, who was and still is scarce and much overworked in Brazil. Through their functions and services, current BECs have been filling in for ordained authority insofar as they can. Church as sacrament, in the terms indicated by Lumen gentium, finds expression in many ways. The overwhelming growth of sacred authority and power (the first model) had led historically to exclusive attribution of all that to the clergy. Today lay people, in BECs and other ecclesial areas, are serving as ministers to the sick and Eucharistie ministers. They are preparing individuals and communities for baptism, confirmation, and the Eucharist. And they are performing other functions for the immediate human and Christian well-being of individuals and communities. All these activities are clear signs of the Church as sacrament and its efficacious presence, which is not restricted to the seven sacraments alone. The fundamental change is the fact that this whole complex is seen in an ecclesial context. Without denying the vocational and ministerial role and importance of the clergy, BECs have ceased to be wholly dependent on them. The ordained minister takes his place once again within a community growing increasingly aware of its diverse vocations and functions, which are the presence of grace in the world, for the lowly in particular. 3. Insofar as the seven sacraments as such are concerned, BECs cannot fully realize the Church as sacrament in the anointing of the sick and two other basic points. They are promoters of reconciliation at the level of interpersonal relations between their members, but they cannot effect reconciliation as sacrament. Builders of communion as the only viable root of community, their members cannot realize the full significance of the mystery of the Eucharist. These sacraments, which are an indispensable part of Christian life, are bound up with the ordained minister. 610 THEOLOGICAL STUDIES Given the current discipline of the Church and the envisioned requisites of formation and life style, there is no way of providing BECs with such ministers. BECs are multiplying rapidly and sporadically in rural areas and urban peripheries. There are not enough priests for them either quantitatively or qualitatively. By â€Å"qualitatively† here, I am not so much referring to the ministerial qualifications of the priest or his fulfilment of the juridical requisites for exercising his pastoral ministry. I am referring to the suitable adaptation of the priestly type to the BEC way of being Church. For the BEC has its own proper form of communion and participation, integrating various vocations into a more decentralized overall pastoral design based on subsidiarity. This is the present situation, and in the foreseeable future there does not seem to be any thought on the part of the Church as institution to give BECs, or the rest of the Church for that matter, any alternative to the present form of the sacrament of holy orders or to the prerequisites for its reception and exercise. This is a very serious problem affecting churches that are heavily nurtured by the word of God and that consolidate the bonds of communion between their members by fostering ecclesial awareness. In traditional Catholicism and the desobriga paradigm, the Eucharistie question was relativized in one or another way: either the ecclesial significance of the sacrament of the Eucharist was not perceived, or the pertinent law of the Church was fulfilled, not very often but enough to be considered satisfactory. In the living Church embodied by BECs we see, first and foremost, a keen awareness of the structural significance of the Eucharist in the Church as sacrament. They are acutely aware of the necessity of the Eucharist, but also of the actual impossibility of their having the Eucharist with its full meaning and reality. This problem cannot be solved adequately by allowing for exceptions or by occasional casuistic interpretations. It will have to be faced by the Church as part and parcel of its overall pastoral responsibility. The latter must take into account the concrete, diversified reality of the ecclesial body in the world as well as the salvific function of the Church as sacrament, whose core is the Eucharist. Placed at the disposal of human beings, the Eucharist is meant to be the efficacious font of communion between believers, and of their communion with God in Jesus Christ. Church As Herald In this model the Church is seen primarily as the bearer of the word of God. Receiving that word, it is to pass it on to human beings. Its proclaiming is also a convoking, bringing together those who hear and accept the word in faith and who are maintained in faith and union by the strength of the word. Thus the word is constitutive of the Church. BASIC ECCLESIAL COMMUNITIES 611 The Church is the herald of the word, however, not its ultimate addressee. The Church receives the word to announce it. Thus the word emerges as the crucial axis of an ecclesiological perspective that is kerygmatic, prophetic, and missionary. The two preceding models sprouted on Catholic soil and are cultivated there. This model, on the other hand, was nurtured by Protestant reflection. In this century it has been cultivated by Karl Barth and Rudolf Bultmann in particular. Some of its intuitions share a common subsoil with more ancient Catholic tradition, however, and they emerged again in Vatican II to find theological expression in a Catholic and ecumenical way. In the work of Barth, the Church is the living community of the living Christ. 7 God calls it into being by His grace and gives it life by means of His Word and His Spirit, with a view to His kingdom. Thus the Church is not a permanent fact, an institution, much less an object of faith. It comes about by God’s action. It is an event constituted by the power of the word of God in Scripture, made real today and announced to human beings. This proclaimed word gives rise to faith, a gift from God that is outside human control. There is no authority in the Church except the word of God, which is to be left free to call into question the Church itself. Through God’s word the Church is renewed and, above all, urged on to its mission: constant proclamation of the salvific event, Jesus Christ, and of the advent of God’s kingdom. This is the core of Barth’s message. The word and its proclamation are not meant to reinforce confessional, institutional, social, or political positions, or to abet the expansion of the Church as a society. In the work of Bultmann8 two crucial points must be considered with regard to ecclesiology. First, there is his nonhistorical conception of the Church. The result is the absence of any solid sociological or institutional dimension for the Church, and indeed the absence of any intention in Christ himself to establish or build it. Hence the identification of the Church with a historical datum or phenomenon remains ever paradoxical. Second, for Bultmann the word of God remains central, along with its proclamation as call, appeal, and invitation. But his view here is not the same as Barth’s. Let us look at it a bit more closely. Bultmann, more exegete than systematic theologian, sees the Church 7 Karl Barth, Kirchliche Dogmatik 4/3 (Munich: Kaiser, 1935 and 1967). For a systematic presentation of Barth’s ecclesiology vis-a-vis Catholic ecclesiology, see the work of Colm O’Grady published by G. Chapman in London: Vol. , The Church in the Theology of Karl Barth (1968); Vol. 2, The Church in Catholic Theology: Dialogue with Karl Barth (1969). 8 Rudolf Bultmann, â€Å"Kirche und Lehre im Neuen Testament,† in Glauben und Verstehen 1 (Tubingen: Mohr, 1966) 153-87; Theologie des Neuen Testaments (Tubingen: Mohr, 1948). Both works have been translated into English: Faith and Understanding; A Theology of the New Testament 612 THEOLOGICAL STUDIES as a Pauline creation. It is so on three levels. It is a community of worship, an eschatological community, and a community with a vocation. In the first, the word is proclaimed. In the second, God is made present in the acceptance of Jesus by human beings. In the third, the first becomes prophetic vocation, kerygma that calls for a decision. The ecclesial event emerges in this kerygmatic tension of summons and response that the word brings with it, always assuming someone with credentials who proclaims it and/or a community that hears it and takes on the commitment. The Church comes to be in this faith-happening, which frees the context from any institutional, normative, or legitimating instance. The Church is actuated whenever the kerygma unleashes the summons of God and the response of human beings. There are clear differences between Barth and Bultmann. But they also have a basic affinity with regard to the significance and active role of the word in constituting the Church as a happening. These two theologians assume the importance of the community to which the word is addressed. The word is the glue around which the community gathers. The response of faith given to the word by the community is what gives the latter its meaning and reason for being. Here we can see the clear difference between the Protestant and the Catholic perspective vis-a-vis this model. Vatican II stresses that the Word became human, became flesh. Christ lives on in history through the Church, manifesting in it his message and saving activity; but there he also shares his own being with humans. In the Catholic version the Church-as-institution model is also brought into relationship with the word. The Church as a whole—and some in it by specific function—has the responsibility of watching over the proclamation and interpretation of the word. The Church’s magisterium is not above the word, as Barth claimed. It is under the word, deriving from that word its starting oint, its norm, and its nourishment. In and for the community, the magisterium is the instance of Christ’s power and authority with regard to the fidelity and continuity of his message. The community that hears and accepts it is not just called to proclaim it and bear witness to it; it must also translate it into real-life action on both the individual and the social levels. The word of God is central in the ecclesiological outlook of BECs. For them it is the immediate point of reference, the source of inspiration, nourishment, and discernment. Quite often it is the primary catalyst of community. Unlike the sacraments, which are not always accessible, the word is always within their reach. But there are profound differences between the BEC focus on the word and that to be found in the ecclesiologies of Barth or Bultmann. BASIC ECCLESIAL COMMUNITIES 613 1. In BECs the word is received within the Church and as Church insofar as the BEC is a way of being Church, or insofar as it is located in the bosom of the Church as institution and united with it. This implies the permanent reality of the Church to which the word is addressed. It also implies acceptance of the magisterium, the function in the Church that watches over the interpretation of the word and our fidelity to it. 2. In BECs the word naturally is conveyed through Scripture, which is read, prayed, and reflected upon; but all this is done in direct relationship with life. One could put it the other way and say: in BECs the everyday life of the members, the Church, and the world are read, prayed over, and reflected upon in relation to the word of God. If it is true for BECs that the Bible is the word of God, it is no less true that God also speaks to us in the language of real life. Bible and life shed light on each other for those who look to them for meaning in faith. The faith and spirituality of BECs are grounded on this foundation. 3. In BECs the symbiosis of word and life is the key to the process of evangelization. In the earlier pastoral paradigm, and particularly in the quick discharge of sacramental obligation (desobriga), there was little space for the word. The faithful received the word in a largely passive way. Their faith was receptive, but it did not feel summoned to commitment and radiation. There was no urgency toward a lasting conversion, on both the individual and social level, as a radical consequence of hearing and assimilating the word. This sort of profound transformation (metanoia) and the proclamation of the word to others characterize the BECs insofar as they embody Church as herald, Church of the word of God. Unlike Barth’s view, however, this proclamation is not dissociated from the world and its problems; it is in solidarity with them. Nor is it turned in on the Church and the community of believers, who are exclusively focused on an eschatological kingdom of a future sort. In BECs the word is a summons to lives being lived in the Church and already preparing the kingdom. It summons them to call into question both the individual person and the world, in order to shape a just society that will turn the word into reality and embody the gospel project in a coherent way. 4. In BECs, then, the word is kerygmatic and prophetic, as it was for Bultmann. It is that insofar as it is the center of a community of frequent de facto non-Eucharistic worship, which lay people can celebrate without the ordained minister they lack. The word is also kerygmatic and prophetic insofar as it belongs to a community focused on the definitive kingdom. Contrary to Bultmann’s position, however, this kingdom is tied to the historical Jesus, the Word made human being. Through his word and presence in the Church, this kingdom is already beginning to take 614 THEOLOGICAL STUDIES on shape in the course of history. In BECs the word is kerygmatic especially insofar as it calls for living commitment and a coherent response on both the individual and societal planes. Bultmann requires someone accredited to proclaim the kerygma. In BECs this accreditation is not primarily rooted in human wisdom or qualifications, though of course such factors are not ruled out. In BECs the crucial factor is the faith lived by the vast majority of the members in uprightness, simplicity, and poverty as they see their salvation and liberation in spirit and in truth. 5. All this is realized in BECs through the ongoing improving of interpersonal relationships, which give visibility to ecclesial community rooted in the prior communion in faith, justice, and love. In that sense community is not just the initiative of a God who summons and brings together. It is also the persevering laborious response of human beings journeying day by day through time and facing the problems and conflicts of life. The limits and benefits of BECs vis-a-vis the word have been well brought out by Carlos Mesters, to whom they are indebted for a notable service of the word. Officially and scholarly accredited as a minister to proclaim the kerygma, he knew how to listen well to the word that God continues to utter in the hearts of the lowly, opening their hearts and minds to an understanding of both God and the human being. Mesters warns us about the risk of subjectivistic interpretation, about the failure to do a judicious, historically situated reading of the text, about the danger of a selective, ideological approach that seeks only confirmation of one’s own initial position. He stresses the importance of a solid exegesis that will help the common people to get beyond those problems and also respond to the questions they themselves raise. He insists on the viability of a reading that will take into account the physical and material reality of the biblical folk without reducing the biblical message to just that. Finally, he tries to make it possible for an urban, industrial world to get closer to the rural book that the Bible is. 9 Church As Servant The ecclesiological models considered above are markedly centripetal. They prefer to focus on the internal reality of the Church, affirming its vitality and self-sufficiency in relation to the world. The Church teaches, offers a salvific presence, issues ethical norms, and enunciates values. For the far from naive use of the Bible in BECs, see the article by Carlos Mesters in John Eagleson and Sergio Torres, eds. , The Challenge of Basic Christian Communities (Maryknoll, N. Y. : Orbis, 1981). For a sample of his own ability to relate biblical exegesis to real human problems, see Carlos Mesters, God, Where Are You? Meditations on the Old Testament (Maryknoll, N. Y. : Orbis, 1977). 9 BASIC ECCLESIAL COMMUNITIES 615 The advent of modernity and the growing autonomy exercised by the world drew it further and further away from dependence on the Church and acceptance of it. The Church, in turn, reacted by taking up a defensive, indeed often aggressive, position vis-a-vis the world. Church and world took up hard lines in opposing trenches. 10 Vatican ^1 reversed this tendency. It led the Church to see the modern world as an interlocutor with its own identity. This focus can be described as a belatedly optimistic view of the world. Nevertheless, the Church continues to cherish the hope that it will be able to continue its mission vis-a-vis the world. That mission to the world will be one of service primarily. The important thing for the Church is not to withdraw into itself and attract a small group that keeps its distance from this world. Instead, it must take its rightful place in the world and then open itself up as a place for dialogue, constructive action, and liberation. Paralleling the whole conciliar thrust in the Catholic Church, various theologies of secularization have taken shape in Protestant circles by stages. Their impact on the way to read world and Catholic theology was felt most keenly in the decade of the 1960s. The basically positive thrust of the process of secularization (taken as the human autonomy with regard to the explanation of the immanent reality) clearly took an increasingly immanentist turn, often enough degenerating into an undesirable secularism (which is the negation of any transcendent dimension or reality). Despite some unacceptable turns and developments, the Western Church has clearly taken an uncontestable step in reformulating its own reality vis-a-vis the world. The disposition of the whole Church is one of universal service to humanity as such, which is now seen as one big family or indeed as the People of God. Service (diakonia) becomes the central inspiration of ecclesiology.  · Though very aware of its frailty and inconsistency, the Church will not retreat into itself. On the basis of its theological anthropology, it will offer the world answers that the world itself has not found, or that the world has missed and perverted in its dizzying drive toward immanentism and reductionism. This focus of the Church as servant is, however, still sharply confined. It was the theological perspective of the North and West immediately following Vatican II. Today, even in those hemispheres, it is being sharply contested, and its limitations are being recognized. It is from different angles that the BECs translate and embody the new diakonia of the Church vis-a-vis the world. In Brazil and the rest of 10 See Marcello Azevedo, Modernidade e Cristianismo (S. Paulo: Loyola, 1981); Inkulturation and the Challenges of Modernity (Rome: Gregorian Univ. , 1982); J. B. Libanio, A volta a grande disciplina (S. Paulo: Loyola, 1983). 616 THEOLOGICAL STUDIES Latin America, there can be no naively positive view of the modern world. The achievements of science and technology are admitted, and so is the heightened human awareness of such basic elements as human rights, individual freedom, participation in public life, recognition in principle of the equality of all human beings, and other features of modern contemporary culture. But it is impossible not to notice the gap between these theoretical ideals and their actual realization in history, not to mention the actual frustration and perversion of these ideals in many areas. Medellin and Puebla, as well as papal and episcopal postconciliar documents, underline the aberrations embodied in injustice, poverty, hunger, oppression, and structural stigmas that mar our reality. In such a context the poor are the ones who suffer most, along with those who are discriminated against and marginalized, crushed and destroyed beyond any hope of repair. These are the people who predominantly make up the BECs. Hence this is the concrete way that the Church as BEC manifests its status as servant. In itself it again takes on and lives Christ the Servant: in the mission of the suffering people and in the witness it bears in faith, even to the full embodiment of the message in martyrdom. New life is thus given to a Christological component that has long been forgotten or left buried in obscurity. Here we have a Church that serves and fulfils itself in service to the world. It does this through the diakonia of a faith, conscious of the gift given to us in Jesus Christ. This gift is not, however, the privilege of a chosen few; it is the responsibility of all. This responsibility is lived in the urge to denounce and call into question the sociostructural organization that has produced such an unjust society. It does this by identifying clear-cut forms of institutionalized violence in all their shapes. It does this by insisting on radical changes through relations of communion and participation among human beings. Moreover, in BECs the Church becomes a servant by serving the common people without replacing them in either the Church or the world in a paternalistic way. It recognizes that they too have the right to take the initiative in carrying through their own process of maturation and liberation, both religious and civil, after centuries of denial, tutelage, or marginalization. In this perspective of active ecclesial participation, BECs are a Church that eminently serves the other forms of being Church as well as the other vocations and charisms in the Church. 1 11 This model, which stresses the urgent necessity of service as a consequence of faith, spells out the specific nature of Christian faith in full consistency with the tradition of ancient Israel and with the Gospel message. Both stressed the necessity of fleshing out in reality what one believed. Faith, then, cannot be understood solely in terms of assent or conviction; it must be translated into real-life action. There is a strong echo of the Gospel message (Mt 25 and Lk 10:25-37) in the insistence on a theology of service as an underlying BASIC ECCLESIAL COMMUNITIES 17 Church As Communion/Community The model of Church as community founded on communion is the one that emanates most directly from the explicit ecclesiology of Vatican II. It stands in marked contrast to the hegemonic model (Church as institution) that was regarded as the primary interpretation of the mystery of the Church for ten centuries as least, and that was practically the dominant interpretation in the last five centuries. Nevertheless, the communitarian conoeption of the Church goes back to Scripture itself and was vigorously upheld in the patristic era. It threads through many phases of church history with regard to the ecclesial body as a whole and with regard to specific vocations within the Church, particularly in the evolution of the religious life. Thus in its ecclesiological perspective Vatican II taps roots grounded in tradition and the Bible and rediscovers one of the most fruitful facets of ecclesial inspiration throughout church history. 12 Here the Church is the community that is established in communion with God and between human beings. It embraces and pervades the part of an unmistakably Christian praxis. The term â€Å"praxis† is not synonymous with â€Å"practice† insofar as the latter term simply means action or behavior; nor is â€Å"praxis† the opposite of â€Å"theory. † Praxis is a concrete form of historical commitment and involvement, stemming from a twofold awareness: that history is made in time and that it is the result of human actions stemming from concrete choices. Praxis, then, is the conscious making of history, and Christian praxis is the concrete living out of the historical dimensions of the faith. Christian praxis is the daily, long-term embodiment and direction given to the service that faith demands. See F. Taborda, â€Å"Fe crista e praxis historica,† Revista Eclesiastica Brasileira 41 (1981) 250-78. This notion of praxis has been much discussed by various liberation theologians, including Gustavo Gutierrez, Juan Luis Segundo, Leonardo Boff, and Jon Sobrino. For a sophisticated and penetrating examination of the complexities of modern historical reality in the industrialized nations and Latin America, see chapters 1013 of Juan Luis Segundo, Faith and Ideologies (Maryknoll, N. Y. : Orbis, 1984) 249-340. 12 See Pier Cesare Bori, Koinonia: L’Idea della comunione neU’eclesiologia recente e nel Nuovo Testamento (Brescia: Paideia, 1972); id. , Chiesa primitiva: L’Immagine della comunita delle origini—Atti 2:42-47; 4:32-37—nella storia della chiesa antica (Brescia: Paideia, 1974); Yves Congar, L’Eglise de saint Augustin a l’epoque moderne (Paris: Cerf, 1970); Jerome Hamer, L’Eglise est une communion (Paris: Cerf, 1962); Emil Brunner, Das Missverstandnis der Kirche (Zurich: Zwingli, 1951); id. Dogmatik 3: Die christliche Lehre von der Kirche, vom Glauben, und von der Vollendung (Zurich: Zwingli, 1960). For Brunner, the Church is pure fraternal communion bearing witness to love. The antithesis between communion and institution is the core and guiding thread of his ecclesiology. In Dulles’ first model (Church as institution), the Church stands above the faithful, as it were; it is extrinsic to them in a certain sense. In Church-as-communion ecclesiologies, the Church is the community of all the faithful living a life of communion. Bellarmine opposed institution to communion. Brunner opposes communion to institution. Hamer sees communion lived out only in the institution. BECs start from communion as experiential living in the light of faith to reflect consciously on their ecclesial participation in the Church as institution, which they would never imagine to be adequate without the living experience of communion. 618 THEOLOGICAL STUDIES People of God in the multiplicity of their gifts, vocations, services, and functions. It embraces the Church at every level, particularly in its appreciation of episcopal collegiality and local churches. It is no less open to other Christian denominations, non-Christian religions, and all human beings who sincerely search for love, truth, and justice. There have been frequent manifestations of this spirit, from the first encyclical of Paul VI (Ecclesiam suam) to the outlook underlying the basic structure of the new Code of Canon Law. It might be assumed that all this was inspired and dictated merely by sociological imperatives. That is not the case. The People of God, the image of the Church most esteemed by Vatican II, is a great community; but it is so under the action of the Holy Spirit. The members of this People, who are seen in terms of equality, dignity, and freedom, receive the very same Spirit and act under that Spirit: hearing and proclaiming the word of God in the unity of the same faith and mission. In this model of the Church as communion/community, both Medellin and Puebla will find their common basis and their great mediation for an evangelization that is humanizing, transforming, and liberating. The BEC is indicated as the primary and proper scenario for the concrete embodiment of this communion. Sociologically, it implements a new pattern of personal and social relationships. Ecclesiologically, it is a common center for reading and interpreting life and for hearing the word of God, for union among those who believe, and for service to all through the various ministries that arise out of the needs of the community and dovetail with ito varied vocations and charisms. The BEC amalgamates and integrates the conscious, subsidiary coresponsibility of all, under the action of one and the same Spirit, into the total body of one and the same Church. Here again we come across a central element that sheds light on the whole complex. These BECs have been in fact ecclesial communities of poor people, marked by a structural poverty stronger than the poor themselves. In a glaring way it bears witness to the absence of communion and solidarity between human beings in our current societies, to the prevailing power of injustice that destroys the human being and nullifies God’s plan for humanity. Thus the BECs are a call to conversion of heart and to the re-establishment of justice in love, which will make possible communion in faith and mission. As a community that unites hearts, the BECs are no less a force for the transformation of a world that divides and crushes. They are insofar as they try to extend to the world and the Church the reality of communion that they themselves are already trying to live as communities. The little patch of the People of God that is living in each BEC, an â€Å"initial cell† as Medellin puts it, is a sign and BASIC ECCLESIAL COMMUNITIES 619 sacrament of the People of God that Vatican II sees as the Church, and that it would like to project over the world as a whole. In BECs, then, the ecclesiological model of Church as communion/ community ceases to be a theoretical variable of ecclesiological analysis. It becomes the existential witness to a reality of the Church, which is growing in communion and participation to become a community. In the BECs this model is a promising prototype of the necessary, ongoing process of historical becoming that is to culminate in the eschatological kingdom, where community is to be lived in full, definitive communion. THE SOTERIOLOGICAL COMPONENT In discussing these various ecclesiological models, I mentioned several times their underlying Christological component. I do not want to end this article without also alluding briefly to the importance of the soteriological conception these models may derive from their association with BECs as a way of being Church. The mystery of the Church is intimately bound up with the mystery of Jesus Christ, and no less with the understanding of his mission. This, in turn, is reflected in the conception of the ecclesial mission. Thus ecclesiology, Christology, and soteriology shed light on one another and help to explain one another. The salvation and redemption given to us by the Father in and through Jesus Christ (the meaning of his life and mission) is to be realized on at least three levels. They can be distinguished from one another analytically, but they are interwoven in reality. For the historical destiny of humanity must be oriented in line with its eschatological destiny, in the indissoluble unity of the proclamation and realization of the kingdom, which is to be initiated here but find its ultimate culmination only in the eschaton. The first level is the redeeming and saving liberation from sin that marks the human race as a whole and the individual human person. The second level has to do with sin in terms of its interpersonal and social projections, insofar as it expresses the perversion of God’s plan as manifested in the concrete human organization of social, economic, and political realities that have been created by human beings and that affect humanity. The third level has to do with liberation from sin as the latter is incorporated into the gestation of culture and history over centuries, which in turn is often the wellspring of sin on the two other levels and vice versa. These three levels of salvation, redemption, and liberation are a replica of God’s activity with the people of Israel, hence of the history of our salvation as designed by God. Salvation, redemption, or liberation cannot be understood solely from the divine side, i. e. , as our ransom from sin through God’s initiative and His new openness to a covenant of love with human beings in and 620 THEOLOGICAL STUDIES through Jesus Christ. Neither can it be understood solely in a directly anthropological sense that is not sufficiently existential, i. e. salvation as the fulness of human liberty and total opening up to the absolute, as a teleological orientation to the definitive, eschatological future of humanity. Salvation, redemption, and liberation must further be understood as the Pauline exigency that human beings also respond to, and ally themselves with, God and His project to liberate humanity with respect to the consequences of sin (Romans 2 and 7). Throughout history th ose consequences leave their mark not only on the life of the individual but also, and even more so, on the social context of the world. In the BECs we do find the soteriological key of the various ecclesiological models mentioned, a key that tends to stress the first level of redemption just noted. But everything I have been saying about the BECs with respect to the ecclesiological dimension of these models implies a twofold emphasis in the soteriological perspective, which is paramount in the ecclesial awareness of our day. The first says that human beings are, by the saving power of Jesus Christ, an active party in carrying on the process of salvation and liberation in history. Just as they were agents in the deformation of God’s plan through their human sin, so they express the new life given to them in Jesus Christ through their real-life embodiment of the love and justice that he has re-established. It is the realization of the Word, made Salvation: a biblical exigency throughout the two Testaments. A second emphasis is also affirmed in the BECs, communities of poor people. They see themselves as the primary subjects in setting in motion and actuating this process of realizing salvation through the transformation of sin’s consequences. In fact, they are the real-life victims of injustice-made sin in the world in which we live. Hence it is they who can best perceive the rupture between such injustice and God’s project. To be or become poor is to perceive this from the standpoint and condition of the poor whatever our social and economic condition might be. Here is picked up the primary inspiration of Jesus’ own life and mission (Lk 3:18-21), which must necessarily be reaffirmed in the life and mission of the Church. 3 13 In a forthcoming book, Basic Ecclesial Communities in Brazil, which is to be published in English by Georgetown University Press, I examine the origin and formation of Brazilian BECs, their evangelizing potential, and the rich novelty of their pastoral paradigm. I also explore them as a theological topic, and the challenges they may pose to the overall process of evangelization. A Portuguese version of the present article is being published by the Brazilian journal Perspectiva teologic a (Sept. -Dec. 1985).