Disease Specific Program

In this paper, we would be discussing the application of self-management concepts involved in improving the health and quality of life for people with chronic Diabetes Mellitus. Diabetes Mellitus is a complex disorder of carbohydrate, protein, and fat metabolism in which a relative or absolute insulin deficiency is the essential feature, Drury (1986). Diabetes is recognized as a model of broader based communicable disease control programs, WHO (1991 – 1998).The metabolic derangement is frequently associated with permanent and irreversible functional and structural changes in the cells of the body, those of the vascular system being particularly susceptible. The changes lead in turn to the development of well-defined clinical entities, the so-called ‘complications’ of Diabetes which most characteristically affect the eye, the kidney and the nervous system. Introduction It is not too distant past one of the critical tests of the skill of a nurse was the ability to m eet the needs of a patient with an acute infectious disease such as Typhoid fever or pneumonia.When the patient recovered, the nurse could rightly take credit for having made an important contribution. As infectious diseases have been brought under control, the incidence of chronic illness has risen so that they now account for a significant portion of morbidity and morality. Chronically ill patients often have a wider range of problems and need a greater variety of services than are needed to meet the needs of the acutely ill.Res ¬toration of the patient to optimum status and preven ¬tion of progress of the illness often demands the con ¬tinued efforts of the patient, family, nurse, physician, and other health and welfare personnel as well as the members of the community. With patients in whom progress toward recovery is slow and in whom control or prevention of the progression of disease is the goal rather than complete recovery, the nurse may not be able to see immediate re sults of her or his efforts. Instead of a relatively brief and intense relationship in which the patient is dependent on the nurse, the nurse often has a more or less pro ¬longed relationship.This relationship with the pa ¬tient changes from time to time, from dependence to independence to interdependence. To meet the needs of the patient, the nurse should be able to identify clues indicating the type of relationship best suited to the needs of the patient at a given time and to adapt her or his behavior accordingly. A Clinical Nurse Specialist (CNS) is described as an administrator, leader, manager, collaborator, practitioner, advanced clinician, consultant, educator and researcher (Wilson-Barnett, 1994; Dunne, 1997; McCarthy, 1996).Literature Review Today the test of the skill of the nurse is the ability to meet the needs of the chronically ill patient. If a single disease was to be selected as the modern day test of nursing knowledge and skill, diabetes mel ¬litus would und oubtedly receive many votes. There are many reasons that this is true. Diabetes mellitus has a relatively high incidence. It affects all age groups. Its complications are many and serious. There are, however, effective means for its detec ¬tion, diagnosis, and treatment.With modern methods of therapy, persons with diabetes mellitus can live almost as long as those who do not have diabetes. Even more important, they can have full and useful lives with few restrictions on their activi ¬ties. Persons with diabetes mellitus have been Rhodes scholars, mountain climbers, hockey players, television stars and statesmen. They marry, bear and rear children, and can lead successful, vigorous, productive, lives-a far cry from the predictable fate of the diabetic before the era of insulin therapy. The nurse is always concerned about the epide ¬miology of disease.Understanding the distribution and dynamics (epidemiology) of a disease serves as a basis for meeting objectives of disease detec tion and for education of patient, family, and community. Because diabetes and other chronic diseases are not reportable, they are not subjected to the type of surveillance used for communicable diseases. As sur ¬veys and techniques of detection and diagnosis im ¬prove, reporting will increase and it may be possible to identify and to improve preventive measures.According to the 1975 National Health Interview Survey, a rate of 20.4 per 1,000 population or an estimated 4. 8 million persons in the United States reported diagnosed dia ¬betes. Between 1965 and 1975, the prevalence of diabetes increased by 50 per cent in the United States (Guthrie & Guthrie, 2002; Flarey & Blancett, 1996). There is some question if there is a true in ¬crease in the frequency. The data may represent an increase in recognition due to increased use of automated blood chemistry laboratory techniques.Diabetes mellitus occurs in all age groups and in both sexes. The prevalence rate increases with age, from 1.3/1,000 (1 in 77) for persons under 17 years of age to 78. 5/1,000 (1 in 12) in persons over the age of 65. Diabetes is reported more frequently in females (2. 4 per cent) than in males (1. 6 per cent). Females have a prevalence rate of 24. 1/ 1,000. This is a 50 per cent increase from 1965 data when it was 16. 1 /l, 000. The prevalence rate for males is 16. 3/1,000. The most dramatic changes in preva ¬lence of reported diabetes is the increase of diabetes in nonwhites under the age of 45. This group has a percentage change of 150 per cent.Non ¬whites are 20 per cent more likely than whites to have diabetes (Dunning, 2003). Incidence is the frequency of new cases of a disease developed during a specified time period. In 1963, 17 years after the first Oxford study, 65. 7 per cent of the residents aged 34 to 55 years who lived in Oxford during the first study were re ¬studied. The percentage of diabetics was found to be the same in the second as in the first study (O†™Sulli ¬van, 1969). In the 1930s and 1940s there was marked improve ¬ment in the life expectancy of diabetics. Since that time, there has been little improvement.This may be due to the fact that Diabetes patients are living long enough to develop the more dangerous concomitants (Kessler, 1971). Reasons for failure to prevent the concomitants of Diabetes are one of the problems being studied intensively today. The Management of Diabetes Mellitus The ideal treatment for diabetes would allow the patient lead a completely normal life to remain not only symptom-free but in positive good health, to achieve a normal metabolic state, and to escape the complications associated with long-term diabetes.Nowadays diabetic patients rarely die in ketoacidosis in any number, but the major problem which has emerged is the chronic invalidism, due to disease of both large and small blood vessels, of many of those whose duration of life has been extended. It is well known that diabetics show an i ncreased propensity to fall due to visual impairment and neuropathy, as well as foot problems (Wallace et al, 2002; Keegan et al, 2002) and presumably accelerated cognitive decline (Gregg et al, 2000).Data from clinical studies strongly suggest that although genetic factors affect the susceptibility to develop complications, the incidence of serious retinopathy is related to the degree of diabetic control achieved (Clark & Cefalu, 2000). It is therefore incumbent on all those who are involved in looking after diabetic patients to strive in every way to achieve as good control as is practicable in terms of blood glucose concentration. The management of diabetes demands a broad range of professional skills, which include communication, counseling, leadership, teaching and research to name but a few.The Diabetes Nurse Specialist has the expertise and specialist knowledge to incorporate these skills into practice and so develop standards of care that benefits the patient (Daly, 1997). T he Diabetes Nurse Specialist (DNS) plays a pivotal role within a multidisciplinary team. The recognition of the contribution of the Diabetes Nurse Specialist in helping patients achieve good diabetes control highlights his/her essential role in diabetes care, (DCCT,1995; UKPDS, 1998). Metcalfe (1998) states that a Diabetes Nurse Specialist works in collaboration with a team to ensure continuity of care, lends towards more successful management.Types of Treatment There are three methods of treatment, namely diet alone, diet and oral hypoglycemic drugs and diet and insulin. Each obliges the patient to adhere to a life long dietary regimen. Approximately 60% of new cases of diabetes can be controlled adequately by diet alone, about 20% will need an oral hypoglycemic drug and another 20%, mainly younger patients, will require insulin (Long, et al, 1995). A patient may pass from one group to another – temporarily or permanently. Role of the Nurse in Prevention and DiagnosisNurses have numerous opportunities to assist the identification of persons who either have diabetes or are potential diabetics. The CNS is prepared beyond the level of a generalist (The Report of The Commission on Nursing, 1998). Review of the etiologic factors gives the nurse clues as to the target populations. In addition she or he, regardless of the field of practice, must always be alert to the signs and symptoms of diabetes. Any individual with symptoms suggesting diabetes mellitus should be encouraged to seek medical attention. The Suspicion of the school nurse should be aroused when a child develops polyuria and polydipsia.The public health nurse who visits in the home should be alert to the possibility of diabetes in family members. Some patients are discovered to have diabetes after they are admitted to the hospital. Most hospitals have a rule that before a patient can undergo any type of surgical procedure, the urine must be checked for glucose. The nurse can also assist in commu nity screening programs. In addition to opportunities for the nurse to participate in programs for the identification of persons who have diabetes mellitus, nurses have a role in the prevention of the disease.Because of the frequency with which diabetes in the middle-aged person is associated with obesity, individuals are encouraged to avoid overweight by diet and exercise. The preventive aspects related to genetic counseling are less clear. Persons with diabetes or persons with families in which there is a known history of diabetes should be acquainted with the risks involved when planning marriage. Psychological Aspects Fink (1967) has proposed a model of the processes of adaptation to stressful situations. He proposes that psychological phases follow a sequential pattern as follows:Stage 1: Shock; in this phase the person's cognitive structure is characterized by disorganiza ¬tion. There is inability to plan or to reason. Stage 2: Defensive retreat characterized by denial. Stag e 3: Acknowledgment, giving up the past, and starting to face reality. Stage 4: Adaptation, acceptance. of the modification in health. Planning to care for self and to prevent complications. When a person learns that he or she has diabetes mellitus, even when its presence was suspected, he or she experiences disbelief and then grief. The degree of shock will depend on the individual and what the diagnosis and treatment mean to him or her.Any preexisting problem can be expected to be intensified. The pa ¬tient and family can be expected to react to knowl ¬edge of the diagnosis as they do to other crisis situa ¬tions in life. The patient compares dia ¬betes with health and prefers health. The nurse can usually be of more help to the patient if she or he can help in identifying and expressing feelings rather than telling the patient how lucky he or she is. During the period immediately following diagnosis, the patient and family require psychological support. This should start with the patient’s admission to the office of the physician, to the clinic, or to the hospital.The type and amount of support will vary with each individual. Both the patient and family have a right to expect professional personnel to try to understand their feelings and to accept their behavior as having meaning (Otong, 2003). The nurse should try to convey to the patient that, while understanding or trying to understand his or her feelings, the patient will be able to learn to do what must be done and will be provided with the necessary assistance. Control of Diabetes Mellitus Successful management of diabetes mellitus depends on the intelligent co-operation of the patient and the family.Unlike recovery from an acute infectious disease, recovery from Diabetes does not follow a period of acute illness. Diabetes Mellitus is permanent. Remissions can and do occur, but even these patients should not think of themselves as cured. The fundamental methods used in the treatment are diet, insulin or hypoglycemic agents, exercise, and education. The continued management and con ¬trol of diabetes mellitus depend on the patient. Edu ¬cation as to the nature and behavior of the disease is required so that the patient understands the rea ¬sons for what he or she must do and develops the skills required for it.Diet The keystone for management of the diabetic is dietary control. In most respects the goals of the diet for the diabetic patient are similar to those for the non-diabetic. They are to provide sufficient calories to establish and maintain body weight. The number will vary with the age, sex, body size, activity, and growth and development requirements along with an adequate intake of all nutrients, including minerals and vitamins. Modifications in amounts and types of foods as required in the control of complications of diabetes and other diseases.Meal spacing so that absorption coincides with peak levels of insulin in the blood and protects from hypog lycemia during the night. For patients on intermediate-acting insulin, food is usually dis ¬tributed in five meals-three main meals with a small meal about 4 P. M. and another at bedtime. For the patient who is taking insulin, it is essential that a regular meal schedule be observed. Integration of exercise and diet with medications is essential. Most diabetic diets contain 50 to 60 per cent carbohydrates with 10 to 15 per cent in the form of Disaccharides and monosaccharide.Fats should comprise no more than 35 per cent of the total calories. The remaining calories are protein (Arky, 1978). Patients are encouraged to select unsatu ¬rated fats as recommended by the American Heart Association. Concentrated sweets and refined sugars should be avoided. Insulin Treatment with exogenous insulin is indicated in the following situations: diabetic ketoacidosis, juvenile diabetes, diabetes developing before the age of 40, unstable diabetes, oral hypoglycemic failure, diet therapy failures , and during stress of pregnancy, infections, major surgery.For the ketosis-prone individual and the unstable adult an exogenous insulin supply is always required. For the others it may be an intermittent requirement (Bonar, 1977) that is required during periods of stress. In the non-diabetic, insulin is released in response to food intake. The beta cells have the ability to release approximately 40 units daily, and there are another 200 units stored for emergency (Ellenburg et al, 2002). The diabetic does not have an endogenous supply, and an exogenous form is provided. Various types of insulin preparations have been developed.They fall into three general categories: fast-acting (regular and semilente), intermediate (NPH and lente), and long-acting (PZI and ultra lente). The actions of each preparation vary as to time of onset, duration of action, and peak activity time. Hypogly ¬cemic reactions are most likely to occur at time of peak action. Regular insulin is the only form giv en intravenously, and it has a clear appearance. The other insu ¬lin preparations have a turbid appearance. Each type of insulin comes in three concentrations; U-40, U-80, and U-I00. This refers to the concentration of insulin per milliliter.U-40 has 40 units per ml, U-80 has 80 units per ml, and U-100 has 100 units per ml. Syringes are specially calibrated for each concentration. Eventually, the only concentration available will be the U-100 strength (Joshu, 1996). This will decrease confusion and cut down on errors. The objective of insulin therapy is to enable the individual to utilize sufficient food to meet nutri ¬tional needs and, within limits, the desire for food. For many patients this objective can be achieved by a single injection of protamine zinc insulin or one of the intermediate-acting insulin, either alone or in combination with crystalline insulin.The ideal preparation of insulin would be one in which the insulin is released in response to hyperglycemia. At this time there is no such preparation. Persons who require less than 40 units of insulin per day often do very well on a single injection of Protamine Zinc Insulin. Insulin-Equipment and Administration The patient must know the type of insulin, concen ¬tration (U-80, U-100), and the prescribed dosage. It is essential that the appropriate syringe be used for the insulin concentration prescribed.Diabetic pa ¬tients on insulin may use either disposable or reusa ¬ble syringes. The former are used one time only and then discarded. Patients find them highly desirable because they do not require sterilization. Although minimal, cost may be considered a disadvantage. If reusable syringes and needles are used they should be sterilized by boiling before each injection. Boiling is simplified by placing the separated barrel and plunger of the syringe and the needle in a metal strainer. The strainer is placed in a saucepan of cold water and boiled for 5 minutes.When the syringe is removed fro m the water, care should be taken not to contaminate any part of the needle or syringe that comes in contact with the insulin or is intro ¬duced into the patient. When the syringe and needle are kept in alcohol, the alcohol container should be emptied, washed, and boiled at the time the syringe is sterilized. Before the syringe is filled with insulin, alcohol should be removed from the barrel by mov ¬ing the plunger in and out of the barrel a number of times. The skin over the site of injection should be clean, and just before the injection is made, it should be cleansed with alcohol.The hour at which the patient takes the insulin will depend on the type of insulin, the severity of the diabetes, when blood sugar is highest, and the practices of the physician. The most common time is 20 to 30 minutes before breakfast for patients re ¬ceiving one injection a day. Modified insulin con ¬taining a precipitate should be gently rotated until the sediment is thoroughly mixed with th e clear solu ¬tion. Vigorous shaking should be avoided to prevent bubble formation. Insulin, though usually called a protein, is a poly ¬peptide and is digested in the alimentary canal. It must therefore be administered parenterally.The usual method is by subcutaneous injection into loose subcutaneous tissues. Because daily, or more fre ¬quent, injections are required over the lifetime of the individual, care should be taken to rotate the sites, so that one area is not used more often than once each month. Conclusion The nurse has major responsibilities in the care of the diabetic patient. She or he must provide instruction, guidance and understanding for the control and management of the condition. The nurse must be prepared to provide nursing care for the patient if acute or chronic complications should occur.Last but not least, the nurse must recognize that the diabetic is not exempt from other diseases. She or he must be prepared to evaluate the impact of a concurrent illn ess on the diabetes and the impact of the diabetes on the concurrent illness. The sick diabetic has all the problems of any person who is ill and they are compounded by the diabetic state. The special needs of the diabetic must be recognized and met. The nurse who assists in the care of the diabetic patient has the satisfaction of knowing that the quality of life of the diabetic can be improved by intelligent nursing care. References Arky, R.A. 1978. â€Å"Current Principles of Dietary therapy of Diabetes Mellitus,† Med. Clin. North Am., 62, 655-62. Bonar, J. 1977. Diabetes: A Clinical Guide, Flushing, N.Y.: Medical Exam Publishing Co, pp.20-22. Clark, Nathanial Goodwin & Cefalu, William T. 2000. â€Å"Medical Management of Diabetes Mellitus,† CRC Press. Daly F. 1997. â€Å"The Role of the Diabetes Nurse specialist,† Irish Medical times, 14(17), 18. Diabetes Control and Complications Trial (DCCT). 1995. â€Å"Annals of Internal Medicine,† 122: 561-568. Drury. 1986. â€Å"Diabetes Mellitus,† 2nd Ed, Blackwell & Scientific Publications. Dunne L.1997. â€Å"A literature review of advanced clinical nursing practice in the United States of America,† Journal of Advanced Nursing, 25: 814-819. Dunning. 2003. â€Å"Care of People with Diabetes: A Manual of Nursing Practice, p.65-69.† Ellenberg et al. 2002. â€Å"Ellenberg and Rifkin's Diabetes Mellitus,† McGraw-Hill Professional, p.82. Fink, SL. 1967. â€Å"Crisis and Motivation: A Theoretical Model,† Arch. Phys. Med. Rehab., 592–97. Flarey, Dominick L & Blancett, Suzanne Smith. 1996. â€Å"Case Studies in Nursing Case Management: Health Care Delivery in a World of Managed Care,† Jones and Bartlett Publishers. Gregg et al. 2000. â€Å"Is diabetes associated with cognitive impairment and cognitive decline among older women?† Study of Osteoporotic Fractures Research Group, Arch Intern Med, 160:174–180. Guthrie, Richard A & Guthrie, Diana W. 2002. â€Å"Nursing Management of Diabetes Mellitus: A Guide to the Pattern Approach,† Springer Publishing. Joshu, Debra Haire. 1996. â€Å"Management of Diabetes Mellitus: Perspectives of Care across the Life Span,† Mosby, 2nd ed. Keegan et al. 2002. â€Å"Foot problems as risk factors of fractures,† Am J Epidemiology, 155:926–931. Kessler, IJ. 1971. â€Å"Mortality experience of diabetic patients,† Am.J.Med., 51, p.724. Long, Barbara C et al. 1995. â€Å"Adult Nursing: A Nursing Process Approach,† Elsevier Health Sciences. McCarthy. 1996. â€Å"Advantages and Disadvantages of Specialism in nursing,† Paper presented to An Bord altranais Conference, Continuing Education for Nurses. Metcalf L. 1998. â€Å"Ensuring continuity of care for diabetic patients attending hospital,† Journal of Diabetes Nursing, 2(5):135-138. O’Sullivan, JB. 1969. â€Å"Population re-tested for diabetes after 17 years: New Prevalence Study,† Diabetologia, 5:4, 211-14. Otong, Deoborah Antai. 2003. â€Å"Psychiatric Nursing: Biological and Behavioral Concepts,† Thomson Delmar Learning. Report of the Commission on Nursing. 1998. â€Å"Government Publications,† Section 6.33, page 105. United Kingdom Prospective Diabetes Study (UKPDS). 1998. British Medical Journal 317(7160): 703-713. Wallace et al. 2002. â€Å"Incidence of falls, risk factors for falls, and fall-related fractures in individuals with diabetes and a prior foot ulcer,† Diabetes Care, 25:1983–1986. Wilson-Barnett J & Beech S. 1994. â€Å"Evaluating the Clinical Nurse Specialist: A review,† International Journal of Nursing Studies, 13 (6): 561-571. World Health Organization Publications.1991-1998.

Is it possible to identify who is to blame for the debt crisis Essay Example

Is it possible to identify who is to blame for the debt crisis Essay Example Is it possible to identify who is to blame for the debt crisis Essay Is it possible to identify who is to blame for the debt crisis Essay Essay Topic: Economics The debt crisis, a term used for discussing the situation of third world debt, is an extremely complex issue, with multiple factors affecting the constantly fluctuating and increasing problem that many of the least developed countries (LDCs) are still facing today. One of the key aspects of the debt crisis is not necessarily the loans themselves all countries have some deficit, but rather the sustainability of the debt; that is whether or not a country can afford to repay the loans it has taken out (if a debt is over 40% of a countries GDP it qualifies as nsustainable). Questions that comes to mind when looking at the debt crisis today, and indeed the crisis that has been developing since the 1960s, is how can creditors be happy to lend money to developing countries whose situation indicates a high improbability of being able to repay the loans without immense damage to their economy for which the loans are meant to be beneficial? Are these decisions calculated? And why are the loans harming not helping? It is the nature of a capitalist, consumerist economy for loans to be encouraged whether on a huge scale uch as those faced by LDCs in the debt crisis, or small scale loans such as credit cards and mortgages. (I feel that it should be noted that loans between countries is not a new concept and has a history of over 175 years (Sachs, 1989:4) around the same time as capitalism took stronghold across the world). Although theoretically these debts are supposed to be an investment which will be beneficial in the long term, it has become the case in many countries that loans can in fact prohibit the scale of progress that can be made due to the many restrictions of repaying the ebts (which are often crippling amounts), meaning LDCs find it very hard to catch up to more developed countries no matter the amount they loan. Within the modern culture of international super powers and a macroeconomic climate that feeds off the economic situation of all the countries involved in trade, it is difficult to assign blame to a single element or financial body, as is often the case when trying to pinpoint responsibility for crisis. Indeed as many of the readings emphasise (Sachs, Whaites, Jain) it is the creditors blame the debtors for having bad economic olicies, whilst the debtors blame the creditors on the unfair advantage the bankers hold. However, this is a very oversimplified view of assigning blame, and in this essay will explore the variety of explanations of how such a debt crisis emerged and who, if anyone, can be thought of as responsible. To understand more fully the origins of the debt crisis it is essential that we understand the economic situation at the time of the first loans, in other words why did certain countries need to borrow huge amounts of money which would come to cripple their hopes for successful development. Many of the first loans to LDCs were made in the 1960s following the economic robbery (Whaites, 1991) that was colonialism. Following their independence after years of exploitative and self-interested policies implemented by colonial powers (which included the countries that would become the creditors), many of todays LDCs were granted freedom without the consideration of how they would proceed to successfully develop after so many of their resources had been taken without re investment from colonial power; the tools needed for significant development had been taken and used before these countries had reedom and the opportunity to set up an infrastructure capable of achieving economic and social progress, for example countries such as Zambia were unable to tackle problems such as health and education amongst others, many of which are still prominent problems today (see list of MDGs on UN website). However, in the wake of finally being given freedom many countries facing these troubles decided borrowed huge amounts to fund highly ambitious goals, and also to get over the holes within the economy (World Ban k website) such as the need to import goods such as petroleum and iron due to lack of industrialisation. This, in turn led to a high dependency on basic commodity exports (Whaites 1991), which would have been ok so long as the economy continued to be prosperous and there remained buyers for the exports. These factors led to the point at which a number of countries faced critical situations (Easterly, 2002:2) in regards to their debt service payments. However a serious crisis did not emerge until the 1970s, when the price of oil had an untold effect on the next 40 years of debt. In the early 70s and again later in the decade oil prices rose dramatically, leading to mass amounts of oney being loaned to many LCDs with oil reserves, who obviously thought economic successes would be made rapidly. However the economic situation took a turn for the worse and soon inflation and interest rates rose and those creditors who had raced (Eichengreen Lindert 1992:1) to lend money for potential petro dollars (Whaites 1991), left many countries not only with a much higher debt and much higher interest rates, but also a world market facing a recession, meaning economies that relied on highly on trade would find fewer buyers and lower prices for their exports. Countries that had invested all their hopes and borrowed inance in the oil trade now faced debts that were completely unsustainable and those without reserves faced economic growth that was too slow to repay the money that had been borrowed. This situation has been viewed in two different ways, the creditors see such rash investments as a bad choice of economic policy, placing the blame on the debtors for their economic situation, whereas the debtors point the finger at the banks that were so keen to lend copious (Sachs 1989: 2) amounts of money out even after prices for oil had dropped for they were preoccupied with the large returns they were etting from previous loans, one leading bank was looking at 72% of the overall earnings coming from international operations in 1976 (Sachs 1989:8), meaning lenders were blind sighted to the fact that it was dim that the debt incurred in the 1970s ver paid back in full (Eichengreen Lindert 1992:3). The events in the 1970s set the precedent for the next 20+ years, in which problems were faced largely by a variety of cause and effect situations, meaning blame could be circulated over and over, there is no clear cause. However some countries such as Indonesia and South Korea success fully managed to gain some economic prosperity hrough loans, raising the question of whether they made wise investments opposed to the so called bad economic policies of some indebted countries, or whether their investments were lucky and caught the economy at the right time, highlighting again the difficulty of assigning blame. Whilst OECD states recovered from the recession reasonably easily, the heavily indebted countries fell further and further behind. In the case of Latin America the financial situation reached such a severe problem that Mexico defaulted on their loan, having a massive knock on effect on the willingness of creditors to lend. Leaving struggling ountries with no money to invest, no substantial demand for the export products they relied on so heavily and a disadvantage in the trade market, due to OECD states adopting protectionist policies, driving a wedge between market and shadow prices (Sachs 1989:13) and resulting in LDCs having little or no money for investment and development of welfare as it was being used for consumerism. Creditors had lost faith temporarily in lending out money (although lending was restored within a few short years) feeling debtors had dug themselves in a hole they could not get out of, with no escape from the service debt they were struggling to afford. Perhaps it is possible that ill thought out, unrealistic economic policies were applied in this period that did nothing but further widen the gap LDCs were desperately trying to close, various bad investments were made, which resulted in little economic benefits from the large loans undertaken. I feel it is debatable whether or not the banks had been ignorant to the massive risk they were taking through lending money (perhaps they even felt they had to do so as to give countries a chance? or whether the risk was always expected to end badly meaning the LDCs remained subordinated to rich owerful countries that already existed, the former colonial powers that had given countries freedom only due to the impossibility of retaining their empire successfully, ensuring more cheap labour and opportunities for cheap trade and exploitation of the third world countries who were trapped in their economic situation. Even recent debt relief programs that have been set up have to be questioned, whilst it is too soon to tell what effect the multilateral debt relief initiative will have, as Easterly comments, the last 3 years have seen debt ratios drop and per capita ncome rise in countries that had been deemed at completion point in the HIPC initiative of which the benefits are still as yet unclear. In order to gain help HIPC countries must comply with strict fiscal disciplines (Jubilee USA brief 2008) and allow the IMF to control key policies regarding financial spending supposedly to insure avoidance of any more bad policies being made. However, policies implemented by the IMF have prolonged austerity, reduced public spending and even driven the price of cotton in Mali down to an artificially low price in order to compete with other arkets with a variety of advantages, meaning little profit is being made (Jubilee USA brief 2008), contradictory of this information of the IMF website which claims to be increasing social spending amongst many other successes. However it is evidently resulted in less change to the debt than expected suggesting therefore that whilst blame may be tricky to assign for such huge debts, the solution is even harder to pin point. However whilst both the creditors and the debtors are eager to assign the blame to the other party, it is commonly the case that corruption is to blame for the extreme levels of the debt crisis. Jain (1998) talks extensively about corruption in economics and the power of that to destroy even a prosperous economy whether it be corruption amongst the creditors or debtors. Kremer and Jayachandran (2002) call this type of debt odious debt by which they mean illegitimate debt, which occurs through corrupt leadership taking out debts; never having intended to invest it in the country, but to keep it for themselves. A recent example of a case such as this is Mubarak, who is reported (BBC news 2011) to have up to $70 billion dollars that he has stolen over time from the Egyptian people, an mount twice as much as their countries entire debt which stands at $34. 46 billion. This huge injustice shows that the blame for huge economic crisis can sometimes lie with a corrupt leader good at concealing what he is doing (the HIPC initiative aims to tackle problems such as this) money taken in this way will never see any investment back into the country as it is often hidden where it will yield stable and lucrative (Whaites 1991) returns, in a phenomenon known as flight capital. Although is not always a case of illicit money being taken out of a country, but sometimes ore innocently a consequence of a bad economy, investors want to store their money where they will see the highest return, resulting in a vicious circle of low investment, low growth and continuing capital flight (Whaites 1991), once more highlighting that a solution is as hard to discover as placing blame for the start of the situation. After examining some of the origins of the debt crisis, as well as looking at how the situation has progressed in the last 40 years, it is still hard to see who exactly is to blame for the crisis, and no party is prepared to accept esponsibility as that could have serious repercussions, such as the banks being forced to call off the debts, or the LDCs being denied extensive aid. Whilst Eichengreen Lindert (2002) feel that circumstances such as this have happened in history before due to the nature or the international economy, Easterly (2002) highlights the impact irresponsible lending has had in what is described as violation of prudential standards of creditworthiness i. e. lending money to a source that can quite clearly not pay the money back, at least not without serious sacrifice. For whatever motives, the banks have made serious errors resulting in uncontrollable amounts of debt. However, many miscalculations have been made on the side of the debtors too, including both accepting unrealistic loans and harbouring overambitious goals (though can they be blamed for this? ). One of the key issues surrounding this debate is that the loans were not forced by either party, encouraged unwisely perhaps, or accepted too eagerly, but not forced. Therefore blame cannot be assigned, perhaps even, it is just the uncontrollable nature of our economy that is behind the crisis reaching the level it is at today. In cases where odious debt exists however it is much easier to pin point the driving force behind unsustainable debt unconceivable selfishness, corruption and complete disregard for the country they are supposed to be in charge of. Unfortunately whatever is to account for the situation today, it is clear who it is suffering the most from it, and sadly, those who are hit the hardest by the debt crisis are also the ones with the smallest influence on how it will shape out. Sadly it seems that economic capital is more valuable than human life and development.

Free Essays on Natural Evil

â€Å"Natural Evil† â€Å"Natural Evil† refers to injury and suffering caused by diseases, accidents, earthquakes, fires and floods. When seeing these events on the television or hearing them on the radio we either think nothing of it or feel bad for the victim or in most cases the victims. This begs us to ask â€Å"Why do bad things happen to good people?† or if we are unfortunate enough to experience these events firsthand we ask ourselves â€Å"Why?† or Why me?† As human beings, all of us feel that we are good people and that these courses of events are unjust and wrong. This gives us a general notion that bad things really don’t happen to good people, never have and never will. This notion has absolutely no clarity though, because bad things do happen to good people every day. It is these people with this notion that bad things don’t happen to good people that put the blame of tragic events on God’s shoulders. These same people are one’s who faith is threatened when a young boy dies of leukemia but only feel sorrow for a man who dies â€Å"in good old age and full of years.† (Gen 25:8) According to Migliore, it is no more just that a young boy of leukemia than a man die of old age, because as he says it is god’s natural order and not that of â€Å"infinite creatures.† Creaturely life is Transient; it has a beginning and an end (Ps. 90:10). This quote out of psalms states that life is simple you are born and you die. According to Migliore, â€Å" God has created a world in which there is both birth and death, both rationality and contingency, both order and freedom, both risk and venerability.† Migliore uses this to explain natural order. He is explaining that God has no set natural order of death or order in which people die. According to Migliore, it is all freedom; we are in somewhat control of when we die. If you die from lung cancer because you are a smoker that is your own fault, god has no control over it. Na... Free Essays on Natural Evil Free Essays on Natural Evil â€Å"Natural Evil† â€Å"Natural Evil† refers to injury and suffering caused by diseases, accidents, earthquakes, fires and floods. When seeing these events on the television or hearing them on the radio we either think nothing of it or feel bad for the victim or in most cases the victims. This begs us to ask â€Å"Why do bad things happen to good people?† or if we are unfortunate enough to experience these events firsthand we ask ourselves â€Å"Why?† or Why me?† As human beings, all of us feel that we are good people and that these courses of events are unjust and wrong. This gives us a general notion that bad things really don’t happen to good people, never have and never will. This notion has absolutely no clarity though, because bad things do happen to good people every day. It is these people with this notion that bad things don’t happen to good people that put the blame of tragic events on God’s shoulders. These same people are one’s who faith is threatened when a young boy dies of leukemia but only feel sorrow for a man who dies â€Å"in good old age and full of years.† (Gen 25:8) According to Migliore, it is no more just that a young boy of leukemia than a man die of old age, because as he says it is god’s natural order and not that of â€Å"infinite creatures.† Creaturely life is Transient; it has a beginning and an end (Ps. 90:10). This quote out of psalms states that life is simple you are born and you die. According to Migliore, â€Å" God has created a world in which there is both birth and death, both rationality and contingency, both order and freedom, both risk and venerability.† Migliore uses this to explain natural order. He is explaining that God has no set natural order of death or order in which people die. According to Migliore, it is all freedom; we are in somewhat control of when we die. If you die from lung cancer because you are a smoker that is your own fault, god has no control over it. Na...

The Great Sphinx of the Giza Plateau

The Great Sphinx of the Giza Plateau Free Online Research Papers On the Giza plateau stands the one and only great sphinx. The Sphinx was carved from the bedrock of the Giza plateau, the Sphinx is a mysterious marvel from the days of ancient Egypt. With the body of a lion and the head of a king or god, the sphinx has come to symbolize strength and wisdom. From the north side of the Sphinx reveals the proportion of the body to the head. It would appear as though the head is small in proportion to the body. Because of the changing desert terrain, the body of the Sphinx has been buried over the past several thousand years. Most recently in 1905, the sand has been cleared away to expose the magnitude and beauty of the entirety of the Sphinx. The paws themselves are 50 feet long while the entire length is 150 feet. The head is 30 feet long and 14 feet wide. Because certain layers of the stone are softer than others, there is a high degree of erosion that has claimed the original detail of the carved figure. Although the head of the Sphinx is badly broken in some places, traces of the original paint can still be seen near one ear. Originally it is believed that the Sphinx was painted and was quite colorful. Since then, the nose and beard have been broken away. The nose was the unfortunate victim of target practice by the Turks in the Turkish period. It is often erroneously assumed that the nose was shot off by Napoleons men, but 18th century drawings reveal that the nose was missing long before Napoleons arrival. In between the paws of the Sphinx is a stela, now called the Dream Stela, which is inscribed with a story. The 18th Dynasty story tells of the time that Thutmosis IV fell asleep under the Sphinx which was covered to the neck in sand. Thutmosis had a dream that the Sphinx spoke to him and promised that if he would free the Sphinx from the sand, Thutmosis would be destined to become king of Egypt. During the 18th Dynasty, Thutmosis IV probably did clear the Sphinx at that time. But it is more likely that the story about the dream was created for a ancient propaganda story to help prove the legitimacy of the king. This type of story could support the validity of a kingship, asserting and assuring the power of the pharaoh as designated by the gods, or in this case, the Sphinx itself. About 12500 years ago the great sphinx was built carved right from the bedrock of the Giza plateau. Built with the head of a pharaoh and the body of a lion its meant to show power strength and wisdom, but it was destroyed in the 18th century by napoleons men but still stands to this very day because of its authority and stability. associatedcontent.com/article/19568/a_history_of_the_great_sphinx_of_giza.html. Research Papers on The Great Sphinx of the Giza PlateauCanaanite Influence on the Early Israelite ReligionMind TravelThe Spring and AutumnThe Masque of the Red Death Room meaningsThe Hockey GameTrailblazing by Eric AndersonBringing Democracy to AfricaHip-Hop is ArtEffects of Television Violence on ChildrenHonest Iagos Truth through Deception

Self Magazine critic Essay Example | Topics and Well Written Essays - 750 words

Self Magazine critic - Essay Example The articles were usually based on elements that seemed quite fictional when considered to be applicable in real life. Needless to say, the cover page article on Keri Russell (Bried)was quite entertaining and one could not help but admit that the interview did indeed hold quite a degree of authenticity to it and a breath of fresh air when compared to a certain sense of artificialness that prevailed across the rest of the magazine (SELF Magazine). Articles such as Make good sex great (Pamela)and More Joy, Less Stress appeared to be amongst the major highlights of the issue and while one cannot feel that such article names are quite clichà © when considered in the backdrop of the modern day article names that are scattered across magazine covers, an brief overview of the articles proved that they were in fact quite unique in their narration and held a certain sense of honesty about them as if the author had not written them for mere commercial value and had not acquired the data used in the articles from a few second grade websites. Rather there was an undeniable feeling that no matter which perception the authors had kept in mind while writing the articles, one could not disagree on the fact that the knowledge of the writers regarding the subject matter of their articles was not something that one could doubt. Moving further on into the December issue of the much acclaimed magazine there was a pleasant picture that the magazine continued to present with articles such as 31 minutes to solve any shopping dilemma which was perhaps one of the few in the magazine that held a solid sense of reality and application in them. Other articles that were observed to possess a similar degree of applicable utility also included 8 One minute relaxers and 77 Easy ideas for doing good which were based upon a particular perception that was observed in not only this issue of the magazine but also in other issues of the magazine. The magazine ensured that not a single

Hypo-kinetic diseases and physical activity Essay

Hypo-kinetic diseases and physical activity - Essay Example 2014). Apart from genetics, excess weight in young children results from overeating of unhealthy junk, oily and sugary foods combined with under-exercise which leads to fat accumulation below body tissues (Erlichman, J.et al, 2002).To some children, overeating has been associated with esteem issues. Hypo-kinetic diseases cause adverse health issues like cardiovascular disease and type 2diabetes which are highly linked to increased rates of morbidity and mortality. As such, obesity in young children needs to be handled before they can be transferred into adulthood. To reduce obesity and overweight issues in children, in addition to a healthy lifestyle, children should be engaged in physical activity and cardio-respiratory fitness (Hills, A. P.2013). However, physical exercise should be regulated to avoid accidents. Over-exercise in young women combined with prolonged starvation can cause brittle bones which fracture leading to skeletal risk. Some symptoms of over-exercise could includ e; missing or irregular menstrual cycle, extreme thinness, extreme weight loss and loss of appetite among such behaviors. Such signs should be adequately treated by consuming enough calories to sustain the level of physical activity and also moderating the level of exercise to match the age, energy consumption and sex (NIH,

Cold and Green in Gawain and the Green Knight. How does the season and Essay

Cold and Green in Gawain and the Green Knight. How does the season and the color green convey some of the themes in Gawain and the Green Knight - Essay Example This goes well on the first two days, but on the third, the Lady hands him a girdle which will prevent Gawain from being harmed during the return blow. Gawain is tempted into keeping the girdle, when he should have handed it over, and when the Green Knight comes to give the blows, makes two feints with the axe, and then strikes Gawain with the blunt end of the axe. The Green Knight reveals himself as the Lord of the Castle, and explains that the two feints stood for the two days when Gawain kept his promise, and the small cut was for the third day, when Gawain was tempted into keeping the girdle. The poem itself contains a number of symbolic sequences, the most commonly noted being the number three (three nights at the castle, three kisses, and three swings with the axe). The beheading game itself is part of an older tradition which celebrates the symbolic killing of the Holly King by the Oak King, and the Holly King's return of the favour with the next season. Indeed, although this is an outwardly Christian allegory, there are plenty of references to pagan and nature religions as well. Many commentators have associated the Green Knight with one element of nature worship, the Green Man. Traditionally, this figure is a 'wild man' deity, closely tied in to nature and the changing seasons. The Green Man represents all that is wild and awesome in nature. The Green Knight clearly symbolises this element when he gatecrashes the King's Christmas party to lay down his challenge: The butterflies and birds embroidered thereon In green of the gayest, with many a gold thread For much did they marvel at what it might mean That a horseman and a horse should have such a hue Grow green as the grass, and greener, it seemed Than green fused on gold more glorious by far. (Abrams, page 237-239) However, as well as nature, ancient texts associated green with death and magic, two other unpredictable forces which the medieval audience would be familiar with. The Green Knight's association with Morgan Le Fay emphasises his connection with magic, as does his appearances during the Christmas period: During the twelve days of Yule the forces of death and chaos Were unleashed upon the earth.We see himas the force Of both, life and death which intrudes into the human world. (Rowan 1995) In this interpretation, the beheading contest is a test of Gawain's courage and mettle, a knightly adventure which ends with Gawain's symbolic death and rebirth - a ritual with meanings in European societies far into the Christian period. Green is mentioned more than fifty times in the poem, and is the most frequent colour used by the poet. The Green of the Green Knight would bring to mind all of these issues to medieval listeners; and his role as a tester of Gawain in order to initiate him into the mysteries of life and death. Gawain returns to Arthur's court wearing a green sash, emphasising that he has passed the test and become a member of the Green Knight's court. In this interpretation, the meaning of Gawain's journey through the winter wastelands is clearly associated with the test. If the Green Knight is the lord of Life and Death, then the wasteland is the symbol of Gawain's moving from the reality of