Acute Exacerbation Of A Diabetic Foot Ulcer Nursing Essay

Acute Exacerbation Of A Diabetic Foot Ulcer Nursing Essay This paper will critically analyse the care of a patient with an acute exacerbation of a long term condition. It will address the importance of carrying out a holistic assessment and will seek to justify the care plan put in place to manage the patients condition. Confidentiality has been maintained in accordance with the Nursing and Midwifery guidelines (NMC 2008). Tom is a 72 year old gentleman who was diagnosed with type 2 diabetes 15 years ago. He was started on medication to manage his diabetes 7 years ago but due to his worsening blood glucose control he has since been converted to insulin one year ago. Tom had been independent with the management of his diabetes with support from his local GP surgery. Recently he developed an ulcer on his right foot with resultant wound infection which made him unable to attend his surgery. Due to the wound infection he had been finding it difficult to keep his blood sugar levels within acceptable limits so he was referred to my caseload for diabetes and wound management. Managing long term conditions has become a priority in healthcare particularly due to the increasing prevalence of diseases such as diabetes which requires a heavy use of resources (DoH 2007a, Singh Armstrong 2005). There is a need to encourage patients to be as active as possible in their care which will help reduce the need for hospital admission through empowering patients and promoting self care. There is evidence that patients who understand their condition through support from healthcare professionals and are allowed to contribute fully in their care will result in less incidence of acute exacerbation (DoH 2006). However there has been difficulty in providing the on-going support and care co-ordination in the community that could prevent crisis events from occurring in the first place. This has lead to a key focus on the ways that this can be achieved in practice through such services as community matrons, rapid response and 24 hour district nursing services (DoH 2007b). Relating this specifically to diabetes; the implementation of expert patient programmes and DESMOND (Diabetes education and self management for ongoing and newly diagnosed) have sought to reduce the incidence of acute exacerbations and diabetes related complications through patient education and empowerment (NHS Choices 2011a, DoH 2001a). The government have placed the care required for those with long term conditions into three main groups; case management, disease management and self care (DoH 2007b). In this case, Tom required disease management of his diabetes and self care interventions. Acute exacerbation can be defined as a medical crisis of a chronic illness (Strauss et al 1984). More recently it has been described as an acute presentation of an existing major illness (The Kings Fund 2010). In this situation Toms existing illness was diabetes and the acute presentation was the development of a diabetic foot ulcer that had become infected and affected his blood sugar control. Recent statistics show that the number of people with diabetes has risen from 1.4 million to 2.9 million since 1996 and it is expected to rise significantly over the next 15 years (Diabetes UK 2011). The research also shows that diabetic foot problems account for more hospital stays than all other diabetic related problems put together and affect between 4-10% of diabetics (NHS Diabetes 2012, DoH 2001). Preventing foot problems in diabetics has been a priority in the UK over the past 10 years which has been highlighted in government publications such as NICE guidance and the National Service Framework for Diabetes (NICE 2008, NICE 2004, DoH 2001a). Despite these publications a survey carried out in 2007 found that 23% of diabetics did not receive a foot check which has contributed to the introduction of the Putting Feet First Framework emphasising the need for appropriate assessment and management of diabetic feet (Diabetes UK 2011b). Mason et al (1999) indicate that patients who are at high risk of foot complications must be identified. The National Service Framework for Diabetes supports this view and indicates that patients must have annual foot checks and access to specialist foot care clinics with timely referrals (DoH 2001b). In my area of practice we have an integrated care pathway in place for diabetic foot wounds that aims to provide the patient with optimal care. An integrated care pathway involves a multidisciplinary approach for a specific condition that aims to ensure a seamless approach to care and helps healthcare professionals make clinical decisions (Middleton, Barnett Reeves 2001). As soon as Tom was under my caseload, I referred him straight away to the local diabetic foot clinic as the NICE guidance for foot care states that patients with an ulcer should be referred within 24 hours (NICE 2004). It was important that Tom received specialist input quickly as he currently had a localised infection which placed him at risk of systemic infection and amputation if the infection was not resolved (Edmonds Foster 2006). The foot clinic consisted of a team of podiatrists, Clinical Nurse Specialists in Diabetes, a Dietician and a Diabetologist. When Tom came back from his first appointment, he had already started on the integrated care pathway which we used as our primary documentation between services. This benefited Toms care as it improved the continuity and quality of the documentation (Roberts Middleton 2000, Renholm, Leion-Kilpi Suominen 2002). Also, due to having diabetes nurse specialists at the clinic this meant that his medication regime could be reviewed a s well as receiving specialist foot care. The aim was to reduce his blood sugar levels as the hyperglycaemia was preventing his ulcer from healing and there is a general consensus that improving glycaemic control improves wound healing and prevents the risk of acute complications (Mcintoish 2007, Meyer 1996). Through Tom seeing the multidisciplinary team in one environment and by utilising the ICP, this prevented his care from becoming fragmented. Also due to having access to specialist clinicians in the field of diabetic foot management this enabled him to receive expert advice and care. This was evident in the management of his wound infection where judicious prescribing of antibiotics took place by specialist clinicians (Timmons et al 2009). This was vital in preventing any further deterioration in Toms health and managing the acute exacerbation. Tom visited the foot clinic once a week and a wound care plan was constructed until a review needed to be carried out. This is where the importance of a holistic assessment took place taking into consideration the social, physical and psychological factors that impacted on the situation (Higgleton et al 1999). The research also indicates that the quality of holistic assessment is enhanced by ensuring the patient participates at all times (RCN 2004). By allowing Tom to contribute to the assessment process it enabled the care provided to become personalised and reflected his needs and not what we assumed them to be. Firstly it was vital that we carried out a physical wound assessment on each visit to Tom using the assessment tool in the integrated care pathway. It was important that we used the same assessment tool with an effective understanding of its use as studies have shown that nurses fail to assess wounds effectively (Dowsett 2009, Mcintosh Ousey 2008). Through using the integrated pathway it meant that all nursing staff were using the same assessment tools which ensured effective continuity of care. Nixon et al (2006) found that those who had a diabetic foot ulcer were 5.1 times more likely to have been wearing poorly fitting shoes and this was evident in Toms assessment with the Podiatrist. In the integrated pathway it was documented that he had a high degree of peripheral neuropathy after an assessment was carried out and his shoes were ill fitting. The presence of neuropathy had contributed to the formation of the ulcer as Tom was not able to feel the damaging pressure on his foot caused by inappropriate footwear. This situation needed intervention so he had full assessment of his feet and given choices on available footwear that took into account his preferences. Holistic assessment was a key factor in ensuring concordance as the footwear that the Podiatrist wanted him to wear may not have been agreeable to Tom and he may have refrained from wearing them continuously as directed. This would have lead to a further deterioration in the ulcer condition but through effective par tnership working they were able to come to a joint decision that was acceptable to Tom and the Podiatrist. This ensured that the assessment took into account his physical, social and psychological needs. Preventing deterioration in the foot ulcer had started with the assessment of his feet and footwear but it required more intervention in the form of patient education. Valk et al (2005) found that providing patients with information and education positively influences their behaviour to take responsibility for their foot health. This meant ensuring that Tom carried out things such as regular skin care and nail care and empowered him to take ownership of his care (DoH 2001).The only difficulty with checking his feet daily was that he was unable to bend down to apply any moisturising cream to his feet which was dealt with by assessing his social support network. He did not have any close relatives but he made the decision to obtain a private carer to help him with this twice a week. Toms current active foot ulcer and increased education from the multi-disciplinary team on the high risk of amputation had enabled him to make an informed decision to prevent further deterioration. Central to promoting the healing of diabetic foot ulcers is ensuring adequate nutrition (Thompson Furhrman 2005) but often the quality of nutritional assessments carried out in practice are poor (Johnstone 2006, Cartwright 2002). NICE guidance clearly states that diabetics with foot problems should receive specialist dietary advice (NICE 2008). In the foot clinic Tom was able to be seen by a dietician who was able to carry out a comprehensive assessment and plan of care that would help improve his dietary lifestyle with the aim to improve his blood sugar control. A significant factor in the nutritional assessment was that it was ongoing whereby he would see the dietician every other week to determine his progress. Tom had been managing his diabetes independently prior to his foot ulceration and it was vital that he carried on doing so where possible. Promoting self care was not simply providing Tom with relevant information and education about his condition; it was also about increasing his confidence (DoH 2009). Due to the uncontrolled blood sugars he had to be started on new insulin and he felt that he needed some support and supervision. A survey found that only 38% of diabetics received any psychological support during their care (DoH 2008) so it was at this point that we needed to provide him with the psychological and social support to sustain his self care. Together we were able to form a care plan that would be reviewed on a weekly basis. The district nursing team would visit him when his insulin was due to provide support and ensure he was injecting correctly. The support given to Tom needed to be tailored to his requirements by ensuring that information was given in the correct format (Mcintosh 2008). Those patients who have lived with diabetes for many years often have some form of reduced eyesight secondary to diabetic retinopathy or maculopathy (NHS choices 2011b). In Toms care he had reduced eyesight but he was still able to read with prescription glasses. This assessment showed that he would benefit from written leaflets but this needed to be followed up with verbal consultations. I gave him the necessary leaflets on diabetic foot care but ensured that we enabled him to ask questions if he felt this was necessary when we visited him at home. The primary aim was to meet his needs effectively and create optimal self care through education and empowerment. This assignment has critically examined the management of an acute exacerbation of diabetes with the assistance of a specialist foot clinic. Through timely referral processes, multidisciplinary input and the use of an integrated pathway it allowed the exacerbation to be controlled and managed in the community without the need for hospital care. This is particularly pertinent when the research describes the prevalence of diabetes and the intensive resources it frequently requires from secondary care to manage the acute complications of this condition. This episode of care has shown the positive effects of a specialist diabetic foot clinic which emphasises the need standardised care and access to this service across the UK. It has demonstrated how joined up care in the community helps to ensure a seamless approach to patient care in relation to a long term condition. This paper has also identified the importance of holistic assessment in the management of diabetic foot ulceration which ensures patients needs are fully addressed and assists them in achieving optimal self care. There needs to be an emphasis on educating and empowering patients but this must be provided in the correct format taking into account the patients requirements and literacy needs at all times.

The UK Property Market

The UK Property Market Residential Property The United Kingdom enjoyed serious property boom for over a decade. The property boom slowed down when the economic meltdown commenced in 2008. During the boom years the value of property in the United Kingdom soared, and in some cases the value of properties rose by over 200 percent (Cameron, 2005:5). One of the main factors for the boom was that the economy had a long period of sustained growth, furthermore the interest rates were regulated by the government and kept low. Added to these factors was an upsurge in property investments fuelled by both local and foreign investors. Finally the government kept a tight control on the number of new houses built during that period, so that effectively demand outstripped supply (Cameron, 2005:5). Currently, the bubble in the property market in the United Kingdom has burst and the market is currently undergoing some reforms. Prices are no longer rising as fast as they were some years ago and there is now an oversupply of houses in the property market as home owners are reluctant to sell in this current state. The effect of this is that supply of properties out stripes demand in residential property (Ruddick and Moore, 2010:1). The economic slowdown affected all sectors of the property market, however the price of houses in London are slowly picking up and this is due to the weak pound that has made a lot of foreign investors to come in to the UK and invest in properties (Evening Standard, March 30, 2010). Stake holders are arguing that the Carlsberg review of residential properties should be the bench mark for carrying out reforms in the residential sector as well as all the other sectors of the property market. Furthermore, the reforms currently going on is aimed at producing better and more information to customers, this lead to the introduction of the Home Owners Information Package (HIPs). The government plans to regulate the property market, especially the estate agents so that it will no longer be an all comers affairs. Finally, there is now a standards board in the property industry, although they have limited powers. On the other hand, the residential property market in Europe is different from the property market in the UK. The residential property market in the UK encourages people to buy their own homes, unlike in Europe, where the emphasis is more on long term renting (Oswald, 1999:10). Credit is readily available in the UK in order to assist home owners to buy properties, unlike in Europe where it was not easily available (Oswald, 1999:10). However all this has changed as the residential property market in Europe is undergoing some reforms that has had a great effect on the residential, commercial and industrial properties all over Europe. It appears that most European nations are copying the UK model and are now encouraging its citizens to be home owners instead of renting. Spain is a good example (Oswald, 1999:7). Furthermore, with the opening up of the EU, Europeans can now move to any EU country and acquire property, this factor has greatly affected the property market in the EU, because capital can now be moved easily and investors in one part of the EU can take advantage of cheap properties in any other part of the EU. Finally, it appears that for eight years starting from 1990, the reforms and gains of the real estate market in the United Kingdom were modelled on the system of the United States; however for six years starting from 1998, the property market in the United Kingdom appeared to be harmonized with that of its European neighbours (Lee, 2009:32). Commercial Property and Industrial Property Commercial properties are scarce in the UK and demand exceeds supply. This among other factors led to a boom in the commercial property sector. However there appears to be a slump at the moment as Commercial property in UK was also affected by the global economic down turn. However current reports indicate that the commercial property sector in the UK is picking up and investors are starting to snatch up prime commercial properties (Evening Standard, March 30, 2010). The commercial property yield in the UK is quite impressive and high compared to its European neighbours. On the other hand, commercial properties in Europe also appear to be booming. The European economy is recovering and a lot of foreign investors are investing in commercial properties in Europe (Oswald, 1999:7). The economic meltdown has also affected the growth of commercial property in Europe and the sector is also undergoing reforms just like the market is undergoing in the UK. Most EU countries have put legislation in place in order to allow real estate investment trusts (Oswald, 1999:27). This legislation will make it easier for foreign investors to invest in the commercial property sector and inject the much need funds in order to keep the commercial property sector booming. Finally the demand for industrial property is low in the UK. This is due to the fact that a lot of industries are closing down due to high cost of labour and the strong Pound Sterling. Companies are moving their operations to Europe and other areas where it will be cheaper for them to operate. While in Euro pe the demand for industrial property is booming, due to the stability of the Euro as well as the economic prosperity in the Euro Zone. Furthermore due to some recent EU Directives, setting an industry in some EU countries is now a lot cheaper and easier than it used to be. (B) The five major skills that I acquired in the university are as follows: communication skills, multi-tasking, organizing skills and time management skills, IT skills and interpersonal abilities. The main purpose of communication is to convey ones message to recipients. Good communication takes many forms such as speaking, writing and listening (Heller, 1998:6). I gained my communication skills in the university through course work presentations, seminar discussions, formal training sessions and face to face meeting with my course leader. These range of activities helped me to acquire my verbal and communication skills in the university. I improved my verbal and communications skills in the university by devoting time to the three key elements of effective communication, which are, effective initial preparation, effective structuring of my material and effective delivery of my material (King, 1992: 14). Finally, the art of getting ones message across effectively is a vital part of being a good manager (Heller, 1998:1). Communication skill will help me in future because no matter my status within an organization I will be giving instructions to my colleagues, superiors or juniors and these instructions can range from simple instructions or requests to complex instructions. I also gained IT skills and interpersonal abilities while studying in the university. We had a specialized IT unit in the university that offered training and support to students. I went for many lectures and training that the IT unit organized on campus. We had a large IT laboratory on campus and each student had a password that allowed the student access to any of the personal computers in the IT laboratory and there was always an IT specialist to offer technical support to any student that was experiencing difficulties. Inter personal abilities is basically about getting on well with your colleagues. I was in a university with people from different cultures and backgrounds. I also lived in the hostel and I had three flat mates all from different cultures and backgrounds and we to share the same living room and kitchen. These are the factors that helped me gain inter personal skills while studying in the university. The explosive growth of information technology in recent years highlights the need and importance of IT skills (Pearlson Saunders, 2006:7). In future if I work in an organisation I could be asked to take on any tasks that require different skills at different times. Finally, most organisations are now a mix of people from different cultures and backgrounds, therefore my interpersonal skills as well as communications will benefit me, if I find myself working in such multinational organisations in the future. One other skill that I gained while studying was multi-tasking and organizing skills. These two skills are essential skill (Crenshaw, 2007:15). I gained this skill by taking part in different activities in the university. As an undergraduate you are introduced to many different activities and some of them have no relationship with one another. I was introduced to so many different activities that involved different tasks to accomplish. I gained organising skills by been involved in many societies on campus. The effect of this was that I had to organise my time effectively and efficiently between my course work and my other activities on campus. This skill will help me in future due to the fact that I can cope in a busy working environment. Furthermore, I can be versatile and engage in different activities that are not related. Finally, I will be able to organize and balance my personal life and my working life. The last key skill that I acquired while in the university was time management skills. Time management is all about determining ones priorities. There is usually a lot to accomplish in the university. When you acquire this skill you can then be able to determine your priorities. I gained this skill my making a daily ‘to do list the day before and I usually organized my list in accordance with three criteria: the importance/urgency of the task, the amount of time available and the quality of time available (Morris, 1996:73). This skill enabled me to be in control of my personal life and academic life. This skill will help me function well under pressure and make me be in control of my work load in any organisation I find myself working for in future. Bibliography Cameron, G (2005) The UK Housing Market, Economic Review, University of Oxford Journal, Oxford Crenshaw, D (2007) The Myth of Multi-tasking, Key Organisations System, London Heller, R (1998) Communicate Clearly, Dorling Kindersley, London King, A.G (1992) Effective Communication, Blackstone Press, London Lee, S (2009) Is the UK real estate market converging with the rest of Europe? Journal of European Real Estate Research, Vol.2, Issue 1, 18-32 Morris, B (1996) First Steps in Management, Library Association Publishing, London Oswald, A.J (1999) The Housing market and Europes Unemployment: A Non-Technical Paper, Economic Department, University of Warwick, Warwick Ruddick, G and Moore, M (2010) UK Housing Market: Double Dip Fears, Telegraph on line can be assessed at http://www.telegraph.co.uk/finance/economics/houseprices/7539267/UK-housing-market-double-dip-fears-subside-slightly.html > Scott, P (1996) The property Masters: a History of the British Commercial Property Sector, Spon E FN, London

Robert Frost Home Burial - The Three Tragedies of Home Burial Essay

The Three Tragedies of Home Burial  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Robert Frost’s "Home Burial" is a narrative poem that speaks of life’s tragedies. The theme of "Home Burial† centers around the death of a child. During the time period in which the poem is set, society dictated that men did not show their feelings. Therefore, men dealt with conflicts by working hard and being domineering. "Home Burial" demonstrates how one tragedy can cause another to occur. The unnamed couple in this poem has lost a baby to death. The mother grieves openly, and it could be said that she has never recovered from this loss; bereaved parents never forget, but most people in this position gradually work out a way of dealing with their grief, and go on with their lives. This the young mother cannot do. The baby is buried in the family graveyard, which is visible from an upstairs window of their house. Day after day she goes to the stairway window looking out upon the nearby family plot. The sight of the raw mound where her child lies buried reopens her grief. But, another emotion wells up as well – anger and bitterness at her husband, which is at first unexplained. The first hint of the rift between them shows up on lines twelve to thirteen, she "refused him any help, with the least stiffening of her neck and silence." Their dialogue is cold and antagonistic. "What is it—what? /Just that I see. / You don’t, she challenged. /Tell me what it is."(18-19). The death of child, which should bind husband and wife closer in their common grief, pries them apart instead (Gerber 128). In the husband’s first two lines as wells his last one, his attitude toward his wife is domineering and seems insensitive. First he tells her " he wants to know" what she keeps looking at ... ...n the mind’s eye one could see the gravel sliding back into the hole. We could actually visualize the mound getting higher. There were three different tragedies that transpired throughout this poem. The burial of the child was first; second was the burial of the marriage and finally the most symbolic and ironic tragedy is the burial of the home. Because of unfortunate circumstances these three things became closely associated with the home being buried. All of these tragedies occurred as a result of the child’s burial. The couple’s marriage could not survive such an emotional loss. Therefore the marriage becomes buried. When the marriage became buried the home became its own burial spot for this family’s life. Works Cited: Frost, Robert. 1972. "Home Burial." Robert Frost’s Poetry and Prose. Ed. Edward Connery Latham and Lawrence Thompson. New York: Holt.

Stephen Crane and Walt Whitman: The Natural and the Language of Social

Stephen Crane and Walt Whitman: The Natural and the Language of Social Protest      Ã‚  Ã‚  Ã‚   Though in his short life Stephen Crane was never a soldier, his novel The Red Badge of Courage was commended by Civil War veterans as well as veterans from more recent wars not only for its historical accuracy but its ability to capture the psychological evolution of those on the field of battle (Heizberg xvi). Walt Whitman, on the other hand, served as a field medic during the Civil War. He was exposed perhaps to the most gruesome aspect of the war on a daily basis: the primitive medical techniques, the wounded, the diseased, the dying and the dead. Out of his experiences grew a collection of poems, "Drum Taps" , describing the horrors he had witnessed and that America suffered. As literary artists, a wide chasm of structure and style separates Crane and Whitman. The common cultural experience, the heritage of the Civil War connects them, throwing a bridge across the darkness, allowing them, unilaterally, to dispel notions of glorious battles and heroic honorable de aths. By examining Crane's Henry Fleming and the wound dresser from 'Whitman's poem of the same name, both fundamental literary differences and essential thematic consistencies emerge.    In The Red Badge of Courage, Henry Fleming was drawn to enlist by his boyhood dreams. His highly romanticized notion of war was eclectic, borrowing from various classical and medieval sources. Nevertheless, his exalted, almost deified, conception of the life of a soldier at rest and in combat began to deflate before the even the ink had dried on his enlistment signature. Soon the army ceased to possess any personal characteristics Henry had once envisioned, becoming an unthinking, dispas... ...  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Eds. New York: W.W. Norton, 1962. Hartwick, Harry. The Foreground of American Fiction. New York: American Book Co, 1934, p. 17-44 Rpt in Crane,   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Stephen. The Red Badge of Courage. Sculley Bradley, Richard Beatty, and E. Hudson Long Eds. New York: W.W. Norton, 1962. Schroeder, John W. "Stephen Crane Embattled," University of Kansas City Review, XVII (Winter 1950), 119 Rpt. in   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Crane, Stephen. The Red Badge of Courage. Sculley Bradley, Richard Beatty, and E. Hudson Long Eds. New York: W.W. Norton, 1962. Walcutt, C.C. American Literary Naturalism, A Divided Stream. Minneapolis: University of Minnesota Press, 1952, p.66-82 Rpt in Crane, Stephen. The Red Badge of Courage. Sculley Bradley, Richard Beatty, and E. Hudson Long Eds. New York: W.W. Norton, 1962. Whitman, Walt. Leaves of Grass. New York: Bantam Books, 1983.

Tour de France Drug Abuse Essay -- Substance Abuse Essays

The question of drug use among athletes in what was previously considered by the unknowing public to be a rather pristine sport, cycling, is important in that it will affect all future Tours and will place them and the athletes under scrutiny. To begin with, in Europe until the 1998 scandal occurred, despite a few exceptions, cycling was considered a drug free sport. The 1998 drug scandal tarnished the Tour de France and the reputation and image of other sports. The media response to the scandal took differing positions on what should be done next to clean up cycling. The scandal also affected advertisements, sales, and without question the 1999 Tour and Lance Armstrong. Since even the most naà ¯ve fan no longer trusts the cyclists, drug-testing procedures have been instituted. Also, the question now arises regarding medications used by seriously ill cyclists. Certainly, future Tours will be significantly affected. The Union Cycliste Internationale and other sports officials are left with several burning questions; do they seek a better testing system? Clearly, they must protect athletes and the image of sports even though it is costly. Do they perform uniform versus random drug tests? Both are necessary to keep athletes and trainers accountable. In fact, the 1999 Tour promoted both forms of testing (Fife 208). If they do random tests, how do they enforce them? On this point, committees and sports federations are still debating. For years cycling, a grueling, yet glamorous sport in Europe, has been fighting drug use and abuse. Despite a few exceptions, cycling had the reputation, in Europe and in France, of being a clean, pure sport, compared to others, until the 1998 scandal occurred. The question of drug use among athletes in what was previously considered by the unknowing public to be a rather pristine sport, cycling, is important in that it will affect all future Tours and will place them and the athletes under scrutiny. A Clean Reputation: The History of Drugs in the â€Å"Tour de France† In 1967, Tommy Simpson, a British cyclist, died during the Tour de France because of the amphetamines that he took. Succeeding years brought embarrassments: In 1978, the Belgian Michel Pollentier was suspended while leading the Tour de France after he was caught concealing a clean urine sample to trick testers. Furthermore, in 1988, the Spaniard Pedro Delgado won the T... ...cess Story: Tour de Lance; Armstrong’s miraculous comeback from cancer to a Tour victory is worthy of an exclamation point, not a question mark.† The Los Angeles Times; Los Angeles, Calif.; 26 Jul. 1999: 1. Lemonick, Michael D. â€Å"Le Tour des drugs.† Time; New York; Aug 10, 1998: 76. MacAuley, Domhnall. â€Å"Drugs in Sport.† BMJ: British Medical Journal, 313.7051, 7/27/96, 211. Online. EBSCOhost. 16 Nov. 1999. http://www.EBSCOhost.com. Neff, Craig. â€Å"Drug sweep.† Sports Illustrated; New York, 9 Aug. 1999: 71 Pelkey, Charles ed. â€Å"Etxebarria takes Pau; Armstrong answers drug charge.† Velo-News, 21 July 1999. Phillips, Ian. â€Å"Armstrong Extends Tour Lead U.S. Star Bristles at French Media’s Drug Innuendos.† Seattle Post- Intelligencer; Seattle, Wash.; 15 Jul. 1999: E2. Velo-News. The sensational 1998 Tour de France: Conquests and Crisis. Boulder, Colorado: VeloPress, December, 1998. â€Å"Virenque admits to seeking drugs.† Velo-News Interactive. Velo-News; 11 May 1999. â€Å"Virenque released after admission.† Velo-News Interactive. Velo-News, 11 May 1999. Wilson, Stephen. â€Å"Doping Incidents Shake Sports from Swimming to Track & Field.† Seattle Post- Intelligencer, Seattle, Wash.,.1 Aug. 1998: E6.

Saving Sourdi Summary Essay

Analysis character †Nea of Saving Sourdi† by May-Lee Chai â€Å"Saving Sourdi† by May-Lee Chai, theme discusses a classic plot of the metamorphosis from childhood to adulthood. In her story, the two main characters Sourdi and Nea develop in stark contrast to one another. Nea, the younger sister, has difficulty growing up and maturing as her own life, as well as her sister’s life, progresses. Her naivety, aggression, and anxiety influence her decisions throughout the story in a negative way. Chai’s character is easily believable and relatable, everyone has had a point in their lives where they didn’t want to grow up, handled a situation poorly, or realized that their relationship with someone has changed drastically to the point of no repair. Nea, the protagonist in â€Å"Saving Sourdi†, is a tragic hero. We experience her attempts at protecting her sister and watch as they fail time and time again. Nea is a flat and static character. Throughout the story she does not change, she remains childish in her act ions and decisions. Their mother addresses this issue early on by saying, â€Å"You not thinking. That your problem. You always not think!† (Chai 70) Chai does not show us another side to Nea making her a flat character. We see her in the same light despite the life lessons she experiences in this short story. Nea is the same drastic, hardheaded child in the beginning as she is in the end. Growing and maturing is crucial in life. Some people, however, suffer from a sort of Peter Pan Syndrome. Nea can be described as an impulsive, strong-willed, and selfish adolescent who will never truly grow up. The family has never had it easy, always having to work and tolerate prejudice due to their foreign culture. Nea was forced to become a fighter early on no matter the situation. If she was a mature character, she could distinguish between when it was most sensible to simply avoid confrontation and back down. Nea is extremely protective of Sourdi. Her desire to fend for her â€Å"China Doll† sister (69) is the stem of all her decisions throughout the story. Sourdi is the prettier and more desirable sister. Chai highlights the incongruity of the sisters’ looks by solely depicting Sourdi’s beauty. By depicting Sourdi  as a China Doll so early in the story when the two men are harassing her in the family’s restaurant, Chai sets us up to believe that she needs defending and isn’t strong enough to do it herself. Nea thoroughly believes that is her role in life. As the plot progresses, however, it is easy to see that Sourdi is in fact quite strong and unbreakable. As Nea interacts with the other characters, she is always brash and rarely takes the time to understand their side of a situation. In many cases, she lies to manipulate people and her situation to achieve her selfish goals. Nea fakes her remorse about attacking the customer just to please her sister: â€Å"I was glad I’d stabbed that man. I was only crying because life was so unfair.† (72) When Nea needs to find a way to Sourdi’s home she lies to Duke about the severity of the situation because she knows deep down that it is not as bad as she wants to believe. If Sourdi was in trouble, it would ultimately mean that Nea could get her sister back. Nea fabricates this story to make up for the loss she felt when Sourdi moved on and abandoned her. She would rather believe that it was someone else who caused her sister to mature and move on than to believe it was her own fault or that it was Sourdi’s choice. â€Å"I would stay awake all night pinching the inside of Sourdi’s arm, the soft flesh of her thigh, to keep my sister from falling asleep and leaving me alone.† (72) Although her overall purpose at a glance is for Sourdi’s safety, her true ambition is wanting to keep her sister all to herself. During the story, May Lee Chai Saving Sourdi paints a picture of two extremely close sisters who have been put to the test. The pair has been relocated, put to work, and expected to mature quickly in their harsh new world. Nea is the narrator of the story, and she shares: â€Å"We used to say that we’d run away, Sourdi and me.† (72) The sisters would whisper their secrets back and forth at night, and lock themselves in the bathroom together and hide away together. As children the girls were inseparable but soon the age difference comes between them. Sourdi finds comforts in her first romance with a dishwasher, Duke, and slowly but surely Nea is left by the wayside. This distance is increased when Mr. Chhay is introduced and Nea quickly realizes that her sister is being severed from her life: â€Å"It was the beginning of the end. I should have fought harder then. I should have stabbed this man, too.† (75) In America, everyone is supposed to be equal. People are s upposed to be able to have the â€Å"American Dream† and have a successful career as well as support  a family without any trouble despite race, age, gender, or any other factors. In Ma and Sourdi’s eyes, however, they have seen their traditional culture and are still tied to those beliefs instead. Nea is much more Americanized than the other two women. Ma works very hard to support her children and in an effort to give Sourdi a better life, she makes sure she marries someone who can support her financially instead of someone like Duke who may not be as financially successful. Although she is unhappy, Sourdi understands her role and obeys her elders. Nea, who has been exposed to mostly American culture with little memories of their true roots does not understand this arrangement. As a result, she acts out and rebels against her entire family. The climax of the story occurs when Nea makes a daring attempt at saving her sister’s life. Nea’s irresponsible actions lead to an awkward situation for everyone. Nea refuses to believe that Sourdi is simply a busy woman with a child and a home to care for and immediately jumps to the conclusion that her husband is hurting her in some way. Her over active imagination gets her into trouble. She leaves home without telling her mother, lies to Duke about her true ambitions, blames Mr. Chhay for something he did not do, and creates a huge conflict over a slightly distraught phone call from Sourdi. The moment when Duke punches Mr. Chhay is the cultivation of Nea’s ill thought out plan crumbling before her eyes. Her immaturity caused an easily avoidable confrontation. Near the very end of the story, Chai shares Nea’s insight on her situation. â€Å"Sourdi looked at me then, so disappointed. I knew what she was thinking. She has grown up, and I had merely grown unworthy of her love.† (83) Nea finally realized she was being foolish the whole time. Chai’s protagonist in â€Å"Saving Sourdi†, Nea, is naà ¯ve, impulsive, and brash. She is unchanging and narrow-minded. Nea’s journey seems solely based on saving her sister when in actuality she is trying to find excuses to avoid growing up. The tragic hero fabricates false dangers to compensate her desire to be needed by her sister who has moved on with her life. Nea feels abandoned becausen Sourdi matures while she remains a child. Ma and Sourdi remain connected with traditional customs that Nea simply cannot understand due to her exposure to American culture. Her over active imagination, anxiety, and aggression get her into trouble. When Nea tries to rescue Sourdi from her husband, it is the last straw and she knows that she has lost her dear older sister for good. â€Å"She had made her choice,  and she hadn’t chosen me.† (84) Sourdi has matured and moved on while Nea is stuck in the memories of her childhood. Works Cited Chai, May-Lee. Dragon Chica: a Novel. Boston, Gemma, 2011. Fichter, M. M. et al. â€Å"Anorexia Nervosa in Greek and Turkish Adolescents.† European Archives of Psychiatry and Neurological Sciences, vol. 237, no. 4, 1988, pp. 200–208.

Nazism vs. Fascism Essay

R.Q. To what completion were the German and Italian regimes at a lower place Hitler and Mussolini Totalitarian?i. wherefore?With this uncertainty I want to ascertain whether Hitler and Mussolini alter Germany and Italy, respectively into Totalitarian regimes. In my discretion this played a study role when looking for at traditions, re impersonateability of countries and reputations of countries. Such emotions do-nothing alike set off wars, as we so in WWII. Initi to each hotshot(prenominal)y, I feel that Dictatorships having absolute personnel e veryplace a country can cook many inconveniences for the citizens of it. Hence, I want to guess their motives and ambitions. Also, I figure that this is a very important time period in which milestones and new dimensions drive home been opened. Thirdly, I distinct on this topic beca implement I am a German citizen, who is naturally interest in the gutsground and history of ones go country.ii. What?I am discharge to i ntent a series of books written in antithetical time periods by different writers from different countries. This shows a certain im time of viewpoints, which makes the get along to this question more objective. I am as well going to use the Internet as one research option of my internal assessment.iii. I mean my essay. This can be seen in the appendix, 1) test Plan. This plan shows how I am going to attempt to accomplish my Taski. delimit national kindistsma. national socialistsm is the soundbox of g all overnmental and sparing doctrines held and put into effect by the National Socialist German Workers fellowship in the Third Reich including the totalitarian normal of government, tell apart hold back of all industries, predomination of groups assumed to be racially superior, and victory of the Fhrer1.ii. decide Fascisma. Fascism is a political philosophy, movement, or regime (as that of the Fascisti) that exalts nation and ofttimes race above the individualist a nd that stands for a centralized autocratic government headed by a dictatorial leader, severe economic and social regimentation, and forcible suppression of op panorama2.iii. Define Totalitariana. Totalitarian is defined as of or relating to centralized view by an autocratic leader or hierarchy. Of or relating to a political regime found on subordination of the individual to the state and strict incorporate of all aspects of the smell and productive capacity of the nation peculiarly by coercive measures (as censorship and terrorism)3iv. each(prenominal) these definitions above atomic number 18 essential in effect to understand how totalitarianism is ab initio linked with Nazism and Fascism. These terms, Nazism Fascism and absolutism have all got the subordination of the individual to the state and the control of mind etcetera of the individual in common. The difference amongst them, moreover is that Totalitarian is purely a term describing a situation, a veritable stat e of something. Nazism and Fascism on the opposite hand, describe an ideology that developed over centuries and correcttually rule a country.When we are looking at these definitions, we discover, that both ideologies have a feature of totalitarianism innate. Therefore, initially we would say that they the states, Germany and Italy, both are totalitarian be receive the autocracy by which they are ruled is totalitarian. This must mean that the sight reckon in it because they elected this system of government, and wherefore the system must be totalitarian. This, however, is debatable. In the ongoing lines I go out question the above statement by looking closer at the two ideologies and how they became elected.i. variation of Minoritiesa. Germanyi. Minorities, such as Jews, Blacks, Gypsies and women were discriminated widely. Anything non of Indo- Aryan derivation, was inferior. Women, for example, were judge to behave just the like K,K,K-meaning Kinder, Kirche, Kche. Transl ated, Children, Church, Kitchen. In other words, they were expected to have as many infantren as viable to expand the Aryan race, buy at the religion and cook well. Jews, of course, were treated the worst, i.e. minginess camps.b. Italyi. Fascist Policy towards women was condescending. Women were non put equal to men. It was in any case anti-urban and anti-consumerist. There was kindred control and additional taxes on unmarried. This, in a way, was similar to Nazi Germany, where at that place were incentives to bear as many children as possible. It aimed to promote the superior race. Fascist polity was at the beginning not racially c at one timerned. However, when relations with Germany amendd, Mussolini adopted some anti-foreign steps. This aimed to mother the hoi polloi a feeling of favorable position over other nations and should promote the will to fight for the cause of the nation. Employment conditions for womanly workers were restricted. They were excluded from s everal workplaces.ii. Churcha. Germanyi. Germany was almost only a Christian country. Hitler realised this and did not underestimate the power the perform, as a single institution, could have on the peoples minds. Therefore, he knew it would not be wise to bang the church during his campaigns. Hence, he do an compact with the church, the Concordat, which granted the church religious freedom. This, however was only superficially. In reality, any division of the church speaking bad astir(predicate) Hitler or his party, NSDAP, was prosecuted or sent to a concentration camp. Even Church schools were influenced by Hitler the bible was replaced by Mein Kampf and the cross by the swastika.b. Italyi. In Italy the church played a more important role than in Germany because of the Pope and the Vatican being situated in Italy. Hence, Mussolini tried, aft(prenominal) 1922 when coming to power, to include the church as much as possible in the fascistic state in order to stabilise and ens ure power for his party, PNF. Catholicism was also seen as a possible threat to the emerging fascist state. Hence, a concordat was attempted to improve church-state relations. Catholicism was con gradientred the religion of most Italians, which was so deeply rooted in Italian life that could directly endanger the position of the fascist might.iii. bringing upa. Germanyi. Education in Germany was largely controlled by the Nazis. The main subjects were history, biological science and physical education. maxly of course indoctrinated and change to shine a good blowzy on the Nazi party and its expression of rule. Special schools were build for the most capable. This meant that from a very young age onwards, children in Germany were pore on the Nazi ideology, similar to the Youths, which I will piffle about in the next paragraph.b. Italyi. Education was focused on Fascist ideas and ideology. Children were improve in physical education and array training. These are just exampl es to illustrate what Mussolini treasured to achieve.iv. Youthsa. Germanyi. Various youths existed in Nazi Germany, all aiming to control the mind of German children. Hitler once described his views concerning the purpose of youths When an opponent declares, I will not come your side, I calmly say Your child belongs to us alreadyIn a goldbrick time, they will know nonentity else but this comm unit of measurementy. These programs existed for boys and girls. Boys camps were more physical, preparing for war. Girls camps were aiming to make them ardent to bear many healthy children.b. Italyi. From 1929 onwards, Mussolini focused more intensely on the control of children in his regime. He cherished to control them by education, which he stated as a right of the leading body in a totalitarian state. The Ministry of in the public eye(predicate) Instructions was changed to the Ministry of National education (ONB) in 1929. This new organisation provided pre-military training, drill an d gym. all told measures to convey a more aggressive and disciplined way of live. This program was even merged into the school curriculum. Recruitment was thusly made very easy and numerous. The Fascists valued to create an Italy were there were young chivalric men willing to fight for the cause of the nation. Their motto was Believe, Obey, Fight. This displays exactly what Mussolini was after. especially during the cracking depression, Mussolini tried to give his people a cause to turn over in. He created groups or fixed mass coming upon so that the people would experience a way of unity.v. Propagandaa. Germanyi. Minister of Propaganda in Nazi Germany was Goebbels. He was an able man, with enormous aims. non only wanted he the people to accept the regime. He wanted them to alienate to them, grasping the ideology. He, for the first time in history, effectively made use of the radiocommunication and press. He seized control over both. By 1932 less then 25% of the existen ce owned a radio. Hence, he made provisions for producing cheap sets of wireless radios. He called it the Volksempfnger, translated, nation-receptionist. The press seemed harder to control. The Nazi publisher-Eher Verlag-bought many of the 4,700 exist newspapers. Goebbels held a daily press throng and eventually, the Editors Law, made the seizure of the press complete. Via the radio, the Aryan race was emphasized. Jewish music was not played. People were constantly bombed with Nazi propaganda, their ideology.b. Italyi. Mussolini wanted to create an film of the new Italian. This image should be aggressive and patriotic. He also used heroic figurers from the wars to illustrate the asseverate superiority of the Italian nation.vi. Police allegea. Germanyi. The party seemed to be well nonionised and structured. Hitler himself, however, rejected any document work. at a time the question appears, how it was so sufficient? The answer is that a powerful force was performing behind the scenes. This force was the army. It consisted of the SS, short for Schutz-Staffel, the SA, short for Sturm-Abteilung, the Gestapo, known for its untamedity and posterior the SD, Sicherheitsdienst, the party internal police force. All these acted in order to maintain or restore order. The SS was once created to be Hitlers personal bodyguard. It evolved to be a unit with incredible power over, economic, political and social matters. It turned out to be an exceedingly useful tool for Hitler.b. Italyi. The military was also guaranteed a supreme status in Italy. However, the German army had become a political power whereas the Italian had not. afterwards the death of Hindenburg, Hitler was able to benefit from an exclusive oath. Mussolini never had such an opportunity under the still existing Monarchy. The Italian force acted with divided loyalties. The Italian army did not face any threats form party-army-type organizations, as opposed to the German SS and SA.vii. Power of the at tractera. Germany/Italyi. Both, der Fhrer and il duce, were charismatic and pushful men. They had a set aim which they wanted to achieve no matter what the terms was. They managed to elate masses so that they would nigh believe anything they said. These are, among others, characteristics a strong attractor must have in order to be successful. Hitler was not only ordained chancellor but became President after Hindenburgs death. He also name himself Chief-Commander of all armed forces. This gave him the mere control over many bodies.i. Weigh factors against each othera. Germany vs. Italyii. Conclusiona. When looking back at my research and all the study I collected during it, I conceive of it is fair to say that both ideologies and those implementing it, varyed the respective countries to a large extent into totalitarian regimes.Although, I would say that this phenomena did not occur in the conventional way. By definition, a totalitarian regime controls either aspect of life . When looking at the importee they came to power and the day they left, a great difference in many senses can be seen. Especially, when looking at how they controlled the peoples minds. Propaganda, Force, Speeches, youths and contrast are all factors, which increased their influence. This integrated so quickly into the respective countries roots, so that it was inevitable that people would eventually believe what they heard.They would also obey by it because they the how brutal their measures could be. Power conveyed and achieved by force was one feature in these regimes. The other intend was propaganda. New technology, new innovations enabled them to convey their messages and slogans whenever they wanted. They could also reach every member of their partnership. They not only controlled adults. One of their ideas was to transform the young so that their ideology would be carried further with the next generation.1 http//www.m-w.com/cgi-bin/ dictionary?book=Dictionary&va=Nazism2 http//www.m-w.com/cgi-bin/dictionary?book=Dictionary&va=fascism3 http//www.m-w.com/cgi-bin/dictionary?book=Dictionary&va=totalitarian