Effective Study Skills Essay

Why it is so hard to concentrate while studying, or even to study effectively? The hardest part of studying is concentrating on the material at hand. Memorizing everything is nearly impossible, but with a better understanding of effective memorization skills you can improve your memorization skills surely. Did you know that the most effective method of studying is to use notes, or note-cards? Some people actually have trouble taking notes, due to improper note taking methods. Although there are many different methods for effective study skills, there are three that have been proven to be the most effective: concentration, memorization, and ote taking skills. Have you ever found yourself reading a paragraph, and when you finish you think to yourself, â€Å"What did I Just read†? Well 10 and behold; it happens to the best of us. One proven method of concentration is to get yourself into a quite, but not completely silent to where you hear yourself think, environment. Also if you will adjust yourself to where you are not slouching or hunching over, as these positions tend to make you ache or get sleepy. The next step is to read at a steady pace, not too fast to where you forget and not to slow to where you read the same thing over and If you’re like me then you probably forget a lot of things you read on a daily basis. I sometimes find myself wishing I was like a computer and I could Just store anything and everything, except for viruses. We, as human beings, cannot and will not ever be able to remember everything; however we can remember key items, but only with the proper techniques. The key to remembrance is to review more than once, and take breaks in between your study sessions. Also be sure to prioritize what you plan to study and how you plan to conduct your study sessions. Another proven memorization technique is to take notes, which we will discuss next. Proper note taking is probably the hardest of the three steps, due to most people not knowing what to take note of. Many people can take notes great, but some have trouble knowing what to write down, or if the note they Just wrote is even note- worthy. Any form of note-taking that requires compilation of information by categories, rather than in narrative form is best done using index cards. Index cards are a life saver when it comes to taking notes, and the best part is you can use them for Q ; A, highlights, key points, or even paraphrasing. One of the best pieces of advice is that if the note doesn’t sound note-worthy, it’s probably not. Effective study skills can mean the difference between an A and a B. In most cases it can make a world of difference in your school of choice or even your life long career decisions. Many people today think that they had it rough when they went through school, well in my young age, we too have it rough and the only way to stay on top is through self improvement. Just remember the next time you sit down for a study session; concentration is the key, memorization will help you unlock the door, and taking notes will hopefully keep you from forgetting to lock it behind you. Effective Study Skills By hahaitsmine

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Choose two misunderstandings you experienced and fill out the chart for these. Respond to questions 1 and 2 shown under the chart for each example of a misunderstanding. In your response, include the following: Cite a meaningful misunderstanding rather than a general or less material misunderstanding. Use business- or work-related examples rather than personal ones. Identify the roles of the sender and receiver, such as manager, peer, subordinate, client, vendor, and so forth Who was the sender?Client Who was the receiver? Myself (Client Service Manager) What was the message? The client asked for two checks to be sent to the Custodian, one with a mistake (contributions did not add up) and one that was correct (all contributions matched). What channel was used to send the message? E-mail was the channel used. What was the misunderstanding that occurred? The client thought that by sending two checks it would fix the issue with check number one which had a negative amount for a contribu tion.I had told the client in order to resolve the issue with check number one she needed to void said check and re-issue another one. How could the misunderstanding been avoided? The misunderstanding could have been avoided had we spoke on the phone with the Custodian conference in as they are the ones who rejected check number one. 1. What did you learn about the communication process from this activity?From this activity I learned that the message can be misunderstood if the communication is not correct, meaning the way the message is conveyed (e-mail, phone call, fax, etc. ). 2. What seemed to be the main causes of this misunderstanding? It seemed as if the Client was confused when I told her she needed to void one check an re-issue another one. Perhaps if we spoke on the phone she would have understood this and not told me to send both checks in 3. What tips can you suggest for preventing misunderstandings in communication?

A Streetcar Named Desire – A Tragic Hero

There are nine types of heroes in this world, each of them with their own unique stories, plots, cliches etc. Among those is the classic tragic hero, one who is destined to fail no matter what. In a Streetcar Named Desire, the tragic hero is Blanche Dubois, an aging Southern Belle living in a state of perpetual panic about her fading beauty. In this essay it will be discussed what makes Blanche a tragic hero and how she compares to a typical tragic hero.A typical tragic hero is first and foremost, born of noble stature. This gives the hero something to fall from, so they can â€Å"fall from grace† (Avril Lavigne, Nobody's Home). Blanche Dubois born in Laurel, Mississippi, to a wealthy family. She is a former schoolteacher who had been evicted from Belle Reve (a family home) after being declared a woman of loose morals. This was because years earlier, Blanche's husband committed suicide after she expressed her distaste on his sexuality. She later had many affairs trying to numb her grief on the death of her husband.The second condition for a tragic hero is what is called Hamartia, a tragic flaw that causes the downfall of the hero. Blanche's tragic flaw is that she is dependant on men, so much so that she makes choices and does things that are morally questionable. She manipulates and lies to potential suitors to make herself seem more attractive and younger-which in her mind is the only way a man will love her. She does this with Harold â€Å"Mitch† Mitchell and it seems to be working until Mitch is informed of all the lies he's been fed, at which point Mitch breaks up with Blanche and leaves her vulnerable for Stanley to rape.The reversal of fortune, peripeteia, is when the fortunate hero is down on his luck. In Blanche's case, she loses Belle Reve, her husband is a homosexual and dead, she is evicted from her own town and is losing her beauty. She used to be a wealthy and beautiful Southern belle with a loving family and kind husband but her luc k changed directions and she lost everything she held dear.One of the most obvious conditions of a tragic hero is nemesis, the fate that  cannot be reversed. In other words, no matter what the hero tries or does their fate is sealed. Blanche's fate is inevitable, all people can do is watch as she falls deeper and deeper into her delusions and misconceptions of reality.In the end of the tragedy, the audience should be left feeling pity or fear after witnessing the downfall of the tragic hero, catharsis. This is because the punishment dealt to the hero is not wholly deserved, the punishment far exceeds the crime. Blanche was a sad and confused woman who was looking for comfort and someone to take care of her.She lied and manipulated people to try and get the happy life she wanted but that did not mean she deserved to be raped, abandoned by her own sister and publicly humiliated. Blanche herself said â€Å"It [deliberate cruelty] is the one unforgivable thing in my opinion and it is the one thing I have never, never been guilty of.† (Williams, Scene 10 Pg 126)Anagnoririsis is the recognition or discovery made by the tragic hero, the point in time when the hero realizes what went wrong and why. Most other tragedies like Hamlet and Mcbeth feature this but this does not happen to Blanche.In the end Blanche was sent to a mental institution, she never gained any knowledge of what truly happened and why. In this way, it could be said that Blanche is not your typical tragic hero because she does not meet this point but that is not a bad thing. Blanche is a unique tragic hero who will never know what went wrong as she has submerged herself in her own little world.A typical, yet unique, tragic hero, Blanche did her best to be happy, her only goal. Unfortunately for her, she did not go about the right way of doing it. The wrong people were angered and others tried to force Blanche to face reality.Blanche was unable to let go of the walls that protected her from th e harsh truth, and so she fell from grace. The final scene in which Blanche utters her most famous line â€Å"†¦I have always depended on the kindness of strangers.†, is the sad culmination of Blanche's vanity and total dependence on men for happiness.A typical tragic hero is first and foremost, born of noble stature. This gives the hero something to fall from, so they can â€Å"fall from grace† (Avril Lavigne, Nobody's Home). Blanche Dubois born in Laurel, Mississippi, to a wealthy family.She is a former schoolteacher who had been evicted from Belle Reve (a family home) after being declared a woman of loose morals. This was because years earlier, Blanche's husband committed suicide after she expressed her distaste on his sexuality. She later had many affairs trying to numb her grief on the death of her husband.The second condition for a tragic hero is what is called Hamartia, a tragic flaw that causes the downfall of the hero. Blanche's tragic flaw is that she is dependant on men, so much so that she makes choices and does things that are morally questionable.She manipulates and lies to potential suitors to make herself seem more attractive and younger-which in her mind is the only way a man will love her. She does this with Harold â€Å"Mitch† Mitchell and it seems to be working until Mitch is informed of all the lies he's been fed, at which point Mitch breaks up with Blanche and leaves her vulnerable for Stanley to rape.The reversal of fortune, peripeteia, is when the fortunate hero is down on his luck. In Blanche's case, she loses Belle Reve, her husband is a homosexual and dead, she is evicted from her own town and is losing her beauty. She used to be a wealthy and beautiful Southern belle with a loving family and kind husband but her luck changed directions and she lost everything she held dear.One of the most obvious conditions of a tragic hero is nemesis, the fate that cannot be reversed. In other words, no matter what the her o tries or does their fate is sealed. Blanche's fate is inevitable, all people can do is watch as she falls deeper and deeper into her delusions and misconceptions of reality.In the end of the tragedy, the audience should be left feeling pity or fear after witnessing the downfall of the tragic hero, catharsis. This is because the punishment dealt to the hero is not wholly deserved, the punishment far  exceeds the crime. Blanche was a sad and confused woman who was looking for comfort and someone to take care of her.She lied and manipulated people to try and get the happy life she wanted but that did not mean she deserved to be raped, abandoned by her own sister and publicly humiliated. Blanche herself said â€Å"It [deliberate cruelty] is the one unforgivable thing in my opinion and it is the one thing I have never, never been guilty of.† (Williams, Scene 10 Pg 126)Anagnorsis is the recognition or discovery made by the tragic hero, the point in time when the hero realizes w hat went wrong and why. Most other tragedies like Hamlet and Mcbeth feature this but this does not happen to Blanche.In the end Blanche was sent to a mental institution, she never gained any knowledge of what truly happened and why. In this way, it could be said that Blanche is not your typical tragic hero because she does not meet this point but that is not a bad thing. Blanche is a unique tragic hero who will never know what went wrong as she has submerged herself in her own little world.A typical, yet unique, tragic hero, Blanche did her best to be happy, her only goal. Unfortunately for her, she did not go about the right way of doing it. The wrong people were angered and others tried to force Blanche to face reality.Blanche was unable to let go of the walls that protected her from the harsh truth, and so she fell from grace. The final scene in which Blanche utters her most famous line â€Å"†¦I have always depended on the kindness of strangers.†, is the sad culminat ion of Blanche's vanity and total dependence on men for happiness.

Architecture And The Everyday Essay Example | Topics and Well Written Essays - 2500 words

Architecture And The Everyday - Essay Example Thus, although politics dictated a small budgetary allowance for the construction of a large building and current design practices place a great deal of emphasis on the engineering rather than the aesthetics of a particular work, the architects of the Jubilee Library in Brighton were able to mesh all of these concepts with a design that served the common man and his need for aesthetic beauty, proving Upton’s point that the everyday architecture should not be and perhaps cannot be separated from the concepts of aesthetic Architecture as a serious venture. The library can be seen to strongly grasp the importance of showing the structure in engineering and materials used as it proudly displays its support columns, glass and tile curtain walls and concrete slab supports. It meets with the budgetary constraints of the political powers that be in its use of inexpensive and locally acquired materials even as it focuses attention on the need to create ‘Green Architecture' that r educes the building's impact on the environment through a variety of means that also function to reduce the cost of daily operation. Yet, even as it accomplishes all of these feats, it remains an aesthetically beautiful building that inspires the creativity and the imaginative use of the structure by the local population, encouraging thought and reflection by its simple existence and meeting the requirements of the more aesthetically minded Architects in their need for adhering to theory, philosophy and the principles of design.

Write a critical review (2500 words) of a health or social care issue Essay - 2

Write a critical review (2500 words) of a health or social care issue currently facing East London - Essay Example The East End of London is the East London’s subset, which corresponds to the regions that are nearer to the ancient city. Nevertheless, the development of the city towards the east was as a result of the growth of industries that were lined or associated with River Themes like the docks and the building of the ships. Since these industries started declining during the later part of the twentieth century, now the area of East London is a region of regeneration. This has actually reached the advanced stages in the London Docklands, however, it is still continuing in the East London parts that fall within the Thames Gateway, like the Stratford’s redevelopment which is linked to the Summer Olympics of the year 2012 (Barts and East London, 2011). The areas that fall further east were developed during the Edwardian and Victorian periods as a result of the railways expansion during the nineteenth century. The development of the suburban residences for the purposes of private sale later came to be matched by the offering of social housing on large scale in the 1920s at Becontree and Harold Hill after World War I. Nevertheless, we find that the constraining of the urban footprint was done by the protection or preservation of the Epping Forest in the year 1878 and later the Metropolitan Green Belt’s implementation. The intensity of development rose in the period of interwar and new companies developed in Dagenham like Ford. The population in the Tower Hamlets reached its highest in the year 1891 and then the population growth was limited to the outer boroughs. The population had peaked in each borough and the whole region was experiencing a fall in the population growth. According to the census of the year 2011, this was s een to be reversed and each borough has seen some increase in the population. The region of East London evidently has a rich history but has not lacked some setbacks in many aspects

Civil Committment and the Mentally Ill Essay Example | Topics and Well Written Essays - 500 words

Civil Committment and the Mentally Ill - Essay Example In criminal trials, insanity defense refers to the defense plea adopted by the defendant as a plausible argument that exempts them from criminal liability as they were legally insane during the commission of the crime. According to a study quoted in Waterloo Cedar falls Courier about 1% of the defendants, who are charged with a felony use the Insanity Defense in order to evade punishments or any legal repercussion as a result of the crime in the United States. And out of this 1%, only one-fourth of the people are successful in getting exempted from legal trial. After the defendant raises the insanity defense, the judge commits them to a competence examination, in order to check the validity of their claims. These evaluations are carried out in proper medical and psychological facilities and the individual is put through countless tests and the defendant’s social history is assessed. (Greene et.al, 2006, p. 222) Over the years, the insanity defense has attracted a huge amount c riticisms and controversies regarding its applicability and due to lack of development in this area. The most critical aspect that is raised by the insanity defense is the fact that it does not incarcerate dangerous criminals but send them off to a hospital facility, where they are given treatment and eventually frees them.

Commentary on quotations Essay Example | Topics and Well Written Essays - 2250 words

Commentary on quotations - Essay Example the rights to equality to black citizens but in modern day America, there are other problems created by the inability that still exists to resolve racial tensions and build more empathy and understanding between races. The quotations from famous works below explore some aspects of freedom and independence for all races. In this extract from a latter, John Winthrop is actually speaking of the privations endured on a ship and the relief that they were able to receive. But in these words that speak of Heaven, a Heaven that can be attained although it is necessary to pass through Hell to get to it, there is an underlying symbolism that indicates happiness and godly ends can only be achieved after much struggle and suffering. The heaven that is described in the Declaration of Independence and the Constitution of the United States, which aims to bring equality and liberty to every individual, can only be achieved after much upheaval and turmoil. This is especially notable in the civil rights movement and the long struggle endured by the slaves in achieving their freedom; they have literally passed through Hell and fought for the equality promised in the Constitution, so that successive generations would not have to endure the privations they did. These poignant words, drawn from the American National hymn, express the spirit of the unity and equality that the nation’s forefathers desired when they framed the Declaration of Independence. These lines clearly state the ownership of American soil is not restricted to any particular race or class, it belongs to every American, irrespective of age, sex or race. The practice of segregation which was practiced in America would therefore rise in contravention to the spirit of equal ownership of land, because it declared certain territories off bounds for slaves. Any practice that seeks to isolate members of particular group within a particular geographical terrain and refuse to let them be free would also rise in

Argument essay for or against the DREAM Act (Development, Relief and

Argument for or against the DREAM Act (Development, Relief and Education for Alien Minors) - Essay Example Therefore, they share a lot in common with second generation Americans since for most of their life has been spent in the USA. Having grown up here, they would have little or no attachment to their country of origin. Usually, they are bicultural and sometimes bilingual; however, they speak fluent English (65). A good number do not have an idea they are actually undocumented immigrants. The situation is so until they apply for college or a driver’s license. Once they apply for these legal documents, they realize they do not have Social Security numbers and other documents that are needed. This paper offers an in-depth analysis of the DREAM Act and supports it. The experiences these youths go through can be discouraging. They represent broken dreams, shattered hope and lost ambitions. Since most of them have lived in the U.S almost all their lives, they complete their education here. In school, they take roles of athletes, valedictorians, class presidents and honor roll students (Perez 115). They are aspired to be teachers, doctors, scientists and engineers like all other children in America. However, the fact that they are documented immigrants, their lives change dramatically. Their day-to-day lives took a completely different course and their futures are no longer certain. They can neither work nor vote. As a matter of fact, something as ordinary as driving is a pleasure they cannot enjoy. At times, some are deported to a country they do not know at all. They are a direct result of economic and political significance. Sadly, only about 5-10% of these undocumented young high school graduates make it to college (110). This is usually because they cannot afford to pay their tuition or because they are not allowed to enroll. Typically, they do not even finish high school and thus end up in gangs and other illegal activities. The Development, Relief and Education for Alien Minors (DREAM Act) has however to the rescue of these helpless high school graduates. The DREAM Act offers a pathway for them to attain legal status for undocumented high school graduates every year. The DREAM Act was introduced by Representative Howard Berman and Senator Richard Durbin on May 11th, 2011. Today, the DREAM Act has 2 co-sponsors in the House and an overwhelming 32 in the Senate. Organizations from States in the United including California, Kentucky, Oklahoma and New York have come together in order to support the DRAM act (American Immigration Council). Many undocumented students and their classmates as well as teachers have met up with their members of congress, held rallies, sent letters and even staged hunger strikes in the hopes of making this act a reality. In June 2010, an undocumented student who studies in Harvard was held in detention. After this incident, Harvard president Drew Faust stated that these children need to be given a chance to pursue their post secondary education in their country. The DREAM act has more advantages than disadvanta ges. The DREAM act will boost the economy of the United States as well as the labor in the US. Additionally, the Act will jumpstart the process to citizenship (American Immigration Council). This will be a huge investment on human capital and service to the US. Since DREAM act beneficiaries are all high school graduates, it means that they will get decent jobs. This way, there will be more taxable income in the country and thus in return more revenue for the government. On average a college graduate earns $750,000 throughout their lifetime more than the high school graduate (American Immigration Council). In addition, the Dream Act allows talented individuals to remain in the United States (Arnold 95).

Motivation, Stress and Communication Essay Example | Topics and Well Written Essays - 1500 words

Motivation, Stress and Communication - Essay Example Job Design Considerations as Human Resources Manager As a human resource manager in Home Depot, the a job design involves, which planning directing, and coordinating human resource management activities in the organization in order to increase the strategic use of human resource and maintenance of function like employee recruitment, compensation, personnel policies and regulatory compliance. The human resource manager has been charged with the responsibility of identifying staff vacancies and recruiting, interviewing and selecting applicants, allocating human resource, ensuring appropriate matches between personnel and providing current and prospective information to the employee concerning job duties, working conditions, wages, opportunities for promotion and benefits. Moreover, the HRM performs the duties of staffing, which include understaffing, refereeing, firing, administering disciplinary procedures, advising managers on matters related to equality in employee opportunity and recommending changes. Use of Goal Setting to Motivate Performance Goal setting can be applied for motivating performance through the Goal-setting theory of motivation, which was developed in 1960’s Edwin Locke, whereby it states that setting of goals is related to task performance (Lunenburg, 2001). The theory explains the specific and challenging goals and appropriate feedback that facilitates improvement in performance, since the goals offer guidance to employees concerning their needs, and the efforts that are required to achieve these objectives. These goals increase the willingness to work, thus making them a source of motivation, though there is a need for clear, particular and sophisticated goal as a motivating factor, instead of general, basic and vague goals. Therefore, the specific and clarification in the goals results to an increased performance, and goals are associated with deadlines for completion in order to avoid delays and misunderstanding. On the other hand, the goals are expected to be realistic and challenging, and it gi ves individuals a feeling of pride and triumph after attaining the set objectives, thus setting them up to achieve the next goal. In this case, a challenging goal is a substantial reward, and there is a passion associated with achieving, through appropriate feedback that guides the employees behaviors and contribute to increased performance is needed. Clarification, regulation of difficulties and attaining reputation are the purposes of feedback, and these assists the employees to work to facilitates more job satisfaction. There is a need to reinforce the increased performance through facilitates the sustenance of desired behaviors, thus creating the need for borrowing ideas from the Reinforcement theory of motivation that was proposed by BF Skinner and his associate. The theory states that the individual’s behaviors are functions their consequences and this is based on law of effect, whereby there are behaviors with positive consequence that are repeated others have negative effects, and they tend not to be repeated. The positive behaviors contribute to achievement of organizational goals while the negative behaviors reduce the efforts towards

Assignment 2 Essay Example | Topics and Well Written Essays - 500 words - 10

Assignment 2 - Essay Example The insole and outsole are fitted with cork, allowing foot to form its own foot-bed for custom support. The shoes are durable and very fashionable. The advantage of buying the shoes was that it was worth the price, it was comfortable and available in a range of colours. The newspaper covered the topics that I liked reading. The disadvantage of the phone was that it was slightly expensive with poor camera quality. I was satisfied with the The Wall Street Journal newspaper because of how widely it featured its news from political scenes, business news and entertainment. However, I was dissatisfied with the purchase of the Samsung Galaxy S4 phone because the camera was not good for low-light shots, it had no Fm radio and the internal storage was limited because of the many applications. I intend to continue with the purchase of the newspaper and the shoes but for the phone, I will try another model like Nokia. My dad has one and its camera is great with low-light shots, it also has different designs, which give it exciting looks. According to Ramaswamy (2012), the first stage is needing identification. When I needed a phone, I choose the Samsung Galaxy phone after listening to my classmates. There were different phone models, but most of them recommended the Samsung phone because of its features. Thereafter, I started to process the information, which was further stimulated by watching television that evening, featuring an advert of the phone. Seth (2011) refers to this stage as information search and processing. I engaged in elaborate processing, by paying attention to the information available about the phone. I thought about the likely advantages and disadvantages of using it. When the information was processed and secured, I figured out other phone models, their features and where possible to get them. According to Ramaswamy (2012), this stage involves identification and evaluation of

History Essay Example | Topics and Well Written Essays - 750 words - 9

History - Essay Example When the continued governance of the Province of Canada under the terms of the 1840 Act of Union had become impracticable, a Great Coalition of parties was formed to reform the political system. The first Confederation was held at Charlottetown in 1864 followed by the second at Quebec City where the idea of a confederation was explained. Confederation of Canada was the process under which Canada was formed as a confederation on July 1, 1867, when Queen Victoria gave royal assent to the British North America Act on March 29, 1867 (Wikipedia). This Act united the Province of Canada with the colonies of New Brunswick and Nova Scotia. While the BNA Act gave autonomy to Canada, foreign policy remained with the British. This was supposed to improve relations and make the economy stronger. Conscription in WWI worsened the French-British relations. In times of difficulty and dispute law gives a direction. In 1917, The Military Service Act placed restrictions on who could be called for mandatory military service (Alberta, 2002). Farmers were exempted, as their service was required to produce food. This was known as the conscription. The French did not want to go to the war but Canada was drawn into it being a part of the British Empire. Most French Canadian voted against the conscription but the conscription was evoked nevertheless. Later, when due to rising casualties during the war, people kept away from enrolment, the exemptions were removed. This upset the French in Canada and further strained the French-English relations. Front de Liberation du Quebec (FLQ) was founded in 1963 with a view to gain independence for Quebec even if terrorism had to be resorted to (Historica). The FLQ abducted the British Diplomat James Richard Cross and then the Provincial Minister Pierre Laporte on October 5 and 10 respectively. Negotiations between the FLQ and the Quebec government did not make

Influence to the Indian populace Essay Example for Free

Influence to the Indian populace Essay His influence to the Indian populace was so great that when he met an accident while filming the movie, Coolie, the whole nation prayed for his recovery. There was also a great number of Indians who donated blood for the actor. During the taping for the movie, Bachchan wanted a scene to be realistic so he suggested how the punch should be undertaken unfortunately, the acting got so intense that he ended up in pain. For several days, the doctors cannot find the source of Bachchan’s hurt, until one day, a doctor was able to detect a dark spot on his intestine. The dark spot was his undigested when the punch in his abdomen was made. After seventy-two hours of pain, the undigested food could have turned into poison (Mishra 142-143). His intestine was also ruptured as a result of his fall on the steel table after the punch administered by the stuntman (Chopra n. pag. ) The doctors opted for an immediate operation, however, while he was in the operating table, he lost signs of life. He was declared clinically dead until his wife, Jaya shouted that he saw him move his toe. After this remarkable statement of his wife, the doctors were able to revive him (Mishra 142-143). Throughout the period that he was in the hospital, his supporters speculated that the punch that he received was real and intentional—that it was meant to hurt him. However, no proof was established to back up the claim. After the recovery, Bachchan continued filming the movie to where he left off. He also thanked those who offered prayers for his recovery and the support that the entire nation devoted to him. To date, he is the only movie actor who received such sympathy. People from all walks of life showed all the support they can give and it was as if life in India stopped for Bachchan. Life only returned to its normal shape when it was declared that he is already safe (Mishra 142-143) Aside from acting, Bachchan also tried his luck in politics after he was swayed by his friend Rajiv Gandhi, whose mother was assassinated and won by sympathy vote. Bachchan was elected to a Parliamentary seat, however, this prestigious position did not prove beneficial to him as his name was included to a political controversy. Bachchan, his brother and Rajiv were accused with bribery. It was rumored that the Boffors company bribed Indian politicians to ensure that the government will buy tanks and other military equipment from them (Mishra 144). This hullabaloo seriously injured the name that Bachchan was able to established through time so he decided to quit politics two years after he first explored it. After his flop in the field of politics, Bachchan returned to his first love—film making. Bachchan is well loved by the Indians and his acting widely accepted, however, these love and acceptance were not enough to keep his star shining after the political controversy he faced. Mishra, however, points out that his breakdown in politics is not the direct cause of his collapse as a star. Just like the period when he started his sensational career as an actor, the people then were looking for variety, for something new to watch, the Indians also felt this way at some point when Bachchan was the king of the charts. The people were worn-out with the constant revenge and anger theme in his movies and were looking for something new—for a new approach in movies. This was the time when the need to revive Romanticism was felt. The revival of romance in the films brought back the idea of a character and once again motivation replaced generic predictability, something which Bachchan turned his back on (Mishra 138). For Bombay cinema to survive, the romantic twist had to return. And so, as Bachchan’s star waned, romance returned (Mishra 138). After his political stint and cinema flops, Bachchan shifted his attention to a new venture. He created a multi-faceted commercial enterprise known as the Amitabh Bachchan Corporation Limited or ABCL. The company delved in production and distribution of films and other ventures that involved the movie industry. For sometime, the company enjoyed success in producing movies and even catered the Miss World pageant in India in 1996. However, in its latter years, it faced so many debts that it reached bankruptcy (Indiaoye). His failure both in the political and business worlds, prompted him to go back to where he established his name—the entertainment industry. At 55, he filmed his comeback movie, Mrityutada. It was not as successful as his previous movies but it was enough to sustain him in the entertainment field. Two years after his comeback film, he was named in a BBC poll as the Superstar of the Millennium. This title placed him in equal footing with Sir Lawrence Olivier, Charlie Chaplin and Marlon Brando. Aside from this, he is also the first Asian actor to be included in Madame Tassaud’s wax museum (hindi lyrix n. pag. ). According to Mishra, Bachchan’s success in his career is not only because of his talent in acting but also because of his skill in building his image outside the theater houses. The author suggests three stages in the life of Bachchan that moulded his image as an actor. First is his relationship with his leading ladies, particularly Rekha. Rekha, the daughter of the Hindi actor Ganeshan, is a tall and good looking woman who exhibited real acting talent. She was one of the few actors then who brought â€Å"real sense of character to the films†. She was suspected by journalists to have established a romantic relation with Bachchan and this suspected relationship was â€Å"extensively documented in the fanzines†. Mishra suggests that this added to the growth of the â€Å"quietly sanctioned counternarrative† by the actor himself. However, Bachchan imposed censorship when journalists began to pester him (Mishra 140). The affair of Rekha and Bachchan was better revealed in the movie Silsila (Continuity, 1981). In this movie the actors showed what they could not reveal in real life—depicting the love triangle that exists between Jaya, the wife; Bachchan, the husband; and Rekha, the mistress (Mishra 141).

The Perceived benefits of a Pupil Referral Unit

The Perceived benefits of a Pupil Referral Unit In todays society it is widely accepted that every child has the right to an education. Therefore, even children who show signs of challenging behaviour in schools should be entitled to the same attention from staff and the same standard of education as other children in the school. However, there are some children who cannot be educated within the confines of a mainstream school for a variety of different reasons. Sodha and Margo (2010) have produced data that suggests ; 7.4% of children may have ADHD; 15% of 15 year olds have conduct problems; around 15% of children who start school at age five have troublesome behaviour that might make it difficult to learn; and research suggests that up to 5% of pupils display challenging behaviour at some stage in their school career. In response to these problems Pupil Referral Units (PRUs) were set up. They provided a service which operates outside of mainstream schools and is designed to support children with challenging behaviour and address their behaviour in a more nurturing environment so as to meet their often very complex needs. Get the Right School, (2000-2011) Challenging Behaviour Challenging behaviour can be thought of as being a conflict between a child and the environment according to Loreman (2005). Loreman explains that these conflicts can occur when a child responds to his or her educational environment in ways that differ significantly from age-appropriate expectations and interfere with his or her own learning. This definition appears to suggest, however, that these conflicts are due to an inherent fault within the child that necessitates the removal of that child from a mainstream school. A more reasonable explanation is that these conflicts occur not only because of the child, but also due to the reaction of the professional or service in response to their behaviour, and it is this reaction, therefore, that determines whether the behaviour is challenging of not. (Clark, and Griffiths 2008). This suggests that there is a fundamental need that the service or member of staff, should possess a particular level of ability to enable them to understand and recognise the needs of the child, and it is this ability, therefore, that would determine whether the behaviour of the child was actually challenging or not. There is a whole range of reasons why young people may be required to attend a PRU. Cohen and Hughes, (1994) for example, suggest that these children fall into two distinct categories. Firstly, children who have recognised learning disabilities and particular emotional and behavioural problems, and secondly, those whose behaviour is so disruptive that the mainstream schools decide they cannot offer the appropriate care and help. However in many cases both categories can apply to a child even though the causative and associative factors may differ. However there are a rising number of children who have none of these specific problems but are required to attend a PRU, children who just find it hard to adjust to mainstream schools and also pregnant girls. (DCSF 2008) It can be seen that there is a widely varying mix of children attending these centres. Importance of a Pupil Referral Unit The latest national statistics on permanent and fixed period exclusions from mainstream schools in England produced by the the Department for Education (2010), suggests that that there was an estimated 6,550 permanent exclusions from primary, mainstream secondary and all special schools in 2008/09. The DfE also stated that there were 12,800 young people attending Pupil Referral Units in 2010. Additionally, permanent exclusion from a school has been linked to wider exclusion from society and in order to overcome this, the education system needs to work towards achieving a school which is inclusive for all young people by adopting a culture, pedagogy and curriculum which will support all learners who attend schools which are in areas that have been characterised by social exclusion. (Hayton, 1999) It has also become apparent that there are increasingly mixed views within education as a whole, and even the professionals working within the Pupil Referral Units themselves, disagree on how to deal with young people that actually have more complex needs. Sonia Sodha (2010) makes the point that PRUs are being seen increasingly as sin bins or dumping grounds that schools use to remove problem children from their responsibility. Additionally, the resultant enforced association with anti-social peers, may be counterproductive and actually increase behavioural problems. However, the benefits of a PRU may be perceived very differently from different peoples perspectives. Management and employed staff working within PRUs have just as high a responsibility as any other teacher in mainstream schools, to enable the young people to achieve their full potential in their education and support them in preparing and furthering their personal understanding of what is expected of them within their working life after school. (Ofsted 2005) The Annual Report of Her Majestys Chief Inspector of Schools (2004) states that the number of PRUs has steadily increased. The report states that 25 out of 38 PRUs inspected in 2004/05, were `good` or `better`, providing effectively for the young people they serve. The report also stated that in almost all units, the pupils behaviour and attitudes to learning were judged to have improved since the pupils joined them after moving from their previous schools. It is therefore apparent that for the majority of its children, PRUs do provide an essential and relevant service that cannot be provided in a mainstream school. But is this service based on a `one size fits all` basis? For as we have seen many children have very different problems and needs and it is the sheer diversity of pupils for whom provision within a PRU must cater, that presents the main obstacle to the perceived success of this type of setting. (DCSF 2008). Indeed, according to Gray, (2002), a number of PRU staff would argue that many young people are wrongly placed within PRUs and in actual fact should be placed in more suitable settings for their particular needs e.g. in day or residential special schools. They also argue that reintegration rates would be higher if these pupils within the provision, had less complex needs, and those with much more complex needs should be placed elsewhere for a more appropriate provision in relation to those needs. However, budgetary limitations may well prevent this type of provision emerging. Gray, (2002), explains that the costs per place for these kind of special school provisions are typically more expensive then PRUs probably being for greater than existing financial provision within the LEA. Barriers to Learning Exclusion and truancy are a fundamental challenge in all areas of education and the numbers of truanting and excluded children every day is in the tens of thousands which will have far reaching and serious implications on their education. Rendall, and Stuart (2005). For this reason Local Authorities are actively working together with schools to enable the process between the transfer of a young person from a mainstream school to PRU to be as quick as possible, as well as ensuring they follow all the correct procedures. However the period between pupils being referred to a PRU and actually beginning their time there can often be quite a lengthy period and result in a significant amount of education time being lost. DCSF (2008) Ofsted,( 2007), identified particular challenges that a large variety of different PRUS were now facing, when providing children and young people with a good education. They cited a number of factors, such as pupils with diverse needs and who are of differing age groups, and many pupils arrive with no planning or preparation for those special needs. Staffing issues were also highlighted regarding the limited number of specialist staff who could broaden the curriculum. They also state the difficulties PRUs faced regarding the reintegrating pupils back into mainstream schools. Poor accommodation is also a major factor which can seriously limit the scope of the curriculum available to be taught due to inadequate space. This is particularly relevant in relation to physical education, ICT design and technology, art and music. Therefore Local Authorities have to take this on board when managing education building assets by surveying buildings regularly and prioritising building work including Pupil Referral Units in their plans. DCSF (2008) Longman, and Agar, (1999), also make reference to similar barriers of learning within PRUs, and suggested that many PRUs were physically very small ,with limited staff and facilities. This they suggested, made the provision of expertise and the wide range of practical apparatus that was essential for the success of the PRU, very problematical. The success of PRUs is essentially down to the way they respond to challenges set and the help and support they receive from their Local Authorities (LAs). The LA`s therefore have a specific responsibility in relation to these problems and are required to intervene and take action particularly regarding resources and building issues. (Ofsted, 2007). The Governments policy which is set out under The Childrens Act 2004 aims to improve the outcomes for all children and young people. However many children and young people who attend PRU`s are vulnerable or disadvantaged, and therefore may face more barriers to learning compared to other young people and are at much higher risk of failure as a result. (Department for Education and Skills, 2007), PRU`s and Reintegration into Mainstream Education Hayward, (2006), also makes the point that in theory temporary or part time placements in pupil referral units are available. However, as they are rapidly filling up this is not actually the case, and many young people are continuing their stay into long term placements, which is a real cause for concern as there is no availability for the young people who need short term placements within them. Therefore, it would appear on this evidence that PRUs are in actual fact, not fulfilling their purpose of supporting young people, specifically within the process of reintegrating children and young people back into mainstream schools. Within the actual process of reintegration, there are a large number of different supporting roles designed to help support the pupils that attend, by enabling them receive a good education and help them to achieve their full potential with regard to their social and emotional development during their time in the setting. Kyriacou, (2003), discusses a number of studies that have taken place over the years which highlight the important role that needs to be played by inter agency cooperation both in supporting pupils and schools when a pupil is at risk of exclusion and in helping to support a pupil returning to school after a fixed period exclusion or moving to a new school after a permanent exclusion. One particular study carried out by Normington and Kyriacou (1999) emphasises the importance of communication between agencies. Within this study a number of professionals, such as education psychologists, education welfare officers and teachers to name but a few, were interviewed and asked to focus on the interdisciplinary work that follows permanent exclusions for a sample of pupils who were based at a pupil referral unit. The overall outcome from all professionals involved, suggested that the interagency cooperation is often hampered by heavy case loads and by difficulties in the different agencies keeping each other fully informed. Normington and Kyriacou (1999) cited in Kyriacou, (2003). The professionals taking part in the study also mentioned how improved resources were key, to becoming more successful in this area of interagency cooperation. Conclusion While the need for a PRU is becoming more essential, the findings of Ofsted (2007), reflect a very disappointing situation, with many Pupil Referral Units described as offering an uninspiring curriculum and with a lack of clear vision. The report stated these points as the reason for the failure to reduce days lost as a result of exclusion and failure to improve pupils attendance. It is therefore apparent that while many Pupil Referral Units are an essential struggling to fulfil their responsibilities, particularly in reintegrating young people back into mainstream education. It should be remembered that this was the purpose they were specifically set up to fulfil. All the PRUs made sure personal and social development was emphasised: it was integrated into all lessons and activities, as well as being taught well at discrete times. The PRUs generally monitored personal development well but academic progress less so. I am currently in the process of researching one particular Pupil Referral Unit, which I attended as part of my placement, and I am particularly interested to listen to the views of both the staff and students of this PRU and focus on what they perceive as the benefits, if any, of attending the PRU A number of the staff at this PRU have expressed their opinion that many of these children would benefit more from being referred to a separate provision such as a special school, which focuses on their particular needs in more depth. New Initiatives The DCSF report (2008) maintains that due to the challenges posed by these particular children it is important that PRU`s are constantly assessing their procedures and instigating new systems and initiatives to support the ever changing demands presented by the young people in their provision. For example the PRU where I have been on placement is currently rolling out the practice of Restorative Justice. Wright (1999 cited in Hopkins, 2004) states that restorative justice is not about stating who is to blame and what the punishment will be as a result of a persons harmful actions, but to explore deeper into what happened and being able to put more time into repairing harm done to relationships. The process involves asking questions such as: Who has been affected by what happened? How can we put right the harm? What have we learnt from what has happened and how to make different choices next time? In basic terms restorative justice is a new approach for dealing with situations in a more effective and positive light, enabling young people to move forward in their relationships and learn from what they have done. Wright, (1999), cited in Hopkins, B, (2004).

Patient with Congestive Heart Failure

Patient with Congestive Heart Failure Patient S.V. is a 54 years old female. She is a postmenopausal housewife and her family history is not being recorded. She is a non-smoker and does not drink alcohol at all. She has no-known drug allergic. The past medical history showed us that Madam S.V. is having, rheumatoid arthritis (RA), hypertension (HPT) for 10 years and diabetes mellitus (DM) for 7 years. She was admitted to the hospital on few weeks ago due to congestive heart failure. Madam S.V.s drugs history include: T. furosemide 40mg od Oedema HF T. perindopril 4mg od HF HPT T. spironolactone 25mg od HF T. Losec (Omeprazole) 20mg bd Duodenal ulceration P. Calcium lactate 1 puff od Calcium supplement T. Rocatriol 0.25mg bd Vitamin D supplement T. Metformin 500mg bd DM T. folate 5mg od Folate deficiency T. Methotrexate 20mg/week RA Clinical data The abnormal result of FBC may due to folate deficiency that caused by side effect of methotrexate. Besides that, patient was having high neutrophil number for his differential count which is 8.7 k/ µL (normal range 1.9-8.7 k/ µL). This may due to the long-term use of corticorsteroid. Patients total carbon dioxide in the blood was two times higher than normal range (23-27 Vol%). Prothrombin time and INR of the patient was low: PT =11.1 sec (normal range = 11.9-14.5 sec), INR = 0.82 (normal range 2-4). However, the reason is unknown. Diagnosis ECG and chest X-ray were carried out and the results showed that patient was having sinus tachycardia and cardiomegaly. Cardiovascular system of patient also had been checked. It found that the patient was having a 3rd heart sound. Hence, the patient was diagnosed with congestive heart failure (CHF). Clinical progress DAY 1 Patient is admitted to the hospital at 10.30am by ambulance. She is weak but conscious and alert. The patient complains that she is shortness of breath (SOB) and her sleep has been interrupted due to SOB. It can also be considered as paroxysmal nocturnal dyspnoea (PND) which is sudden, severe SOB at night that awakes a person from sleep, often coughing and wheezing. At the same time, she also experiences from chest discomfort and swelling leg. Besides that, the patient also shows the symptoms of cushings syndrome such as moonface and hirstuism. The blood pressure (BP) and pulse rate (PR) of Madam S.V. are found to be quite high as well, which is 118/87mm/Hg and 146b/min respectively. Test ordered include FBC, RP, LFT, ABG, Coagulation test, UE, CXR, ECG and random glucose test. Nebulizer is given to patient once she is admitted. She is also on high flow mask oxygen 15L/min at the same time to ease the problem of SOB. Salfasalazine 1g bd is added to patient. The management plan is to carry out lung function test, continue to on the face mask for oxygen supply, revise all test results, restrict fluid and continue with old medications. DAY 2 Patient still complain of minimal SOB and minimal chest pain. Another new complain, headache, has been recorded. Her BP and PR have been slowly decreased but they are still not within the normal range. T. bisoprolol 2.5mg od is added for a better control of HPT and HF. Management plan include restrict fluid DAY 3 Patient is no longer complaining for anything. She has no chest pain and SOB anymore. Her PR has back to normal range. However her BP is still slightly higher than normal range. Management plan is same as day 2. Sulphasalazine since the condition of RA is improved. DAY 4 Patient is feeling well, comfortable and tolerating orally. Her BP and PR are within the normal range. The management plan is to perform a CRX report, patient can be discharged if normal result is obtained and continue old medications. Pharmaceutical care issues There are few things need to be taken care of in this case. Firstly, the patient is having the problem of nausea and vomiting and no action is taken to solve this problem. Antiemetic drug (H1 receptor antagonist, cyclizine; D2 receptor antagonist, halopiridol) should be given. At the same time, underlying cause of nausea and vomiting has to be identified if possible. This may caused by side effect of perindopril. Secondly, patient is having cushings syndrome due to long-term usage of steroids for her rheumatoid arthritis. However, there is no any record about the steroids intake for patient in clinical notes. Hence, we have to ask GP or patient to make sure that whether she has stopped taking steroids or still continue with it. According to CSM, long-term corticosteroids therapy should be withdrew gradually. Abrupt discontinuation of corticosteroids therapy may cause severe symptoms because normal production of steroids by the body has been affected. The dose may be reduced rapidly down to physiological doses (prednisolone 7.5mg daily). Then, the progress of dose reducing can be slowed down. The patient is hirudism which is one of the symptoms of cushings syndrome. This problem can be overcome by local measures such as shaving, or depilation such as using wax or cream (eg: eflornithine). The dose of T.folate for patient which is 5mg once daily is indicated for treatment of megaloblastic anemia. However, the FBC test result does not show any symptoms of megaloblastic anemia. The dose of T.folate should be 5mg once daily if it is indicated for folate deficiency induced by mehtotrexate. Blood film should be carried out to make sure that whether the patient is having megaloblastic anemia or not. FBC, serum folate and serum B12 are reliable indicator of folate status. Real indication of T.folate has to be clarified with doctor before dispense the drug. Oedema problem never been improved since the day patient been admitted into the hospital. Restrict fluid intake and strict I/O charting is carried out. However, patient is not compliance to it. Some simple self-care techniques can be taught to patient to reduce the build up of fluid. Counsel the patient about the importance of following Strict I/O chart. Dose of furosemide can be increased if oedema doesnt improve. The blood pressure of patient is still not stable yet. Patient has to be counseled to improve her diet and lifestyle. It is also necessary to monitor BP of patient regularly. Increasing dose of ÃŽÂ ²-blocker can be considered if BP is not reducing. However, due to its negative inotropic effect, ÃŽÂ ²-blocker should be started in very low dose and increase gradually. Lastly, upon discharge, ensure all appropriate medications are prescribed and patient is counseled appropriately. We have to tell patient that Perindopril is added in and ensure patients compliance with medication. Patient should be told to avoid alcohol and cranberry juice and consult GP if anything goes wrong. Disease overview Incidence Heart failure (HF) affects 0.3-2% of general population. In 2001, officially there are 11500 deaths are recorded in the UK due to HF. The incidence rate increase by double each decade from age 45. It affects 3-5% of those over 65 years and 8-16% of those over 75 years. The Rotterdam study shows that prevalence is higher in men compared to women. Pathophysiology Heart failure can be defined as inability of the heart to supply sufficient blood flow to meet the bodys needs. HF can result from any disorder that reduces ventricular filling (diastolic dysfunction) and myocardial contractility (systolic dysfunction). The leading causes of HF are coronary artery disease and HPT. As cardiac function decreases after myocardiac injury, the heart relies on few compensatory mechanisms. Although those compensatory mechanisms can initially maintain the cardiac function, they are responsible for HF symptoms and contribute to disease progression. An initiating event such as acute MI can cause the HF state becomes a systemic disease whose progression is largely mediated by neurohormones and autocrine/paracrine factors such as agiotensin II, norepinephrine, aldosterone, natriuretic peptides, and so on. Some drugs may exacerbate HF due to their inotropic, cardiotoxic and sodium-/water- retention properties. Diagnosis A complete history, physical examination and appropriate lab testing are essential in initial evaluation of patients suspected from having HF. The signs and symptoms are the key for early detection. Breathlessness, angina, fatigue and wheeze are common signs and symptoms. Patient complains that she is having SOB and PND. Electrocardiogram (ECG) and B-type natriuretic peptides (BNP) are essential tests for every patient with suspected HF. ECG is carried out once the patient is admitted into the hospital. Madam S.V. was detected to have sinus tachycardia by ECG which is one for the common ECG abnormalities in HF. Others common ECG abnormalities include sinus bradycardia, atrial fibrillation, ventricular arrhythmias and so on. Plasma BNP is not measured in this case. Chest X-ray (CXR) is also an essential component of diagnostic work-out in HF. It is very useful for detection of cardiomegaly, pulmonary congestion and pleural fluid accumulation. It also demonstrates the presence of any pulmonary disease or infection that will lead to dyspnoea. Via CXR, patient is detected from having cardiomegaly which is also one of the abnormalities for HF. Echocardiography (ECHO) should be performed shortly if one or both ECG and BNP get an abnormal result. ECHO is widely available and safe and provides essential information on aetiology of HF. However, ECHO is not carried out in this case. Some other tests such as FBC, RP, LFT, ABG, UE and random glucose test have been carried out to exclude others possible conditions. Pharmacology basis of drug therapy Diuretics The most important function of diuretic drug is to act by decreasing Na+ reabsorption. Diuretic drugs can inhibit Na+ reabsorption by actions on different transport mechanism, which are located at different sites in nephron. All diuretics are acting on the luminal surface of the nephron. They are protein bound in blood and reach the tubular fluid by secretion into proximal convoluted tubule utilizing the organic acid transport mechanism. They are mostly used to control symptoms of breathlessness and fluid retention. However, they do not alter disease progression or prolong survival. Thus they are not considered mandatory therapy for patients without fluid retention. Loop diuretics for example furosemide is most widely used if compared to other thiazide. It produces diuresis with NaCl loss. It also has vasodilator action which is partly mediated via prostaglandin. This will increase blood flow in the medulla and hence contributes to their natriuretic effect. Unlike thiazides, loop diuretics maintain their effectiveness in the presence of impaired renal function, although higher doses may be necessary. Thizide diuretics are relatively weak diuretics and used alone infrequently in HF. However, thiazide like metolazone can be used in the combination with loop diuretic to promote effective diuresis. Angiotensin-Converting Enzyme Inhibitors (ACEIs) ACE is binding to the plasma membrane and can also exist as a soluble enzyme. The ACEIs act by substrate competition by binding in the Leu-His binding pocket on ACE. Thus, action of angiotensin-I is inhibited. They also decrease the concentration of angiotensin II and aldosterone and attenuating many of their deleterious effects, including reducing ventricular remodelling, myocardial fibrosis, vasoconstriction and sodium and water retention. In addition, they also very helpful in reducing blood pressure due to arterial vasodilation. However, they will inhibit the breakdown of bradykinin which contributes to strong hypotensive action and cough. There are currently 11 ACEIs available for clinical use with similar structure and properties, including captopril, enalapril, lisinopril and others. ACEIs are indicated in all grades I to IV of heart failure which stated in NYHA. Potassium sparing diuretics should be stopped before starting ACEI. ACEIs may increase the risk of renal failure in patient with high dose diuretics, elderly, those with existing renal dysfunction and patients with grade IV HF. Hence regular renal function monitoring is required once patient has stabilized on drug. ÃŽÂ ²-blockers ÃŽÂ ²-blockers can be either selective for ÃŽÂ ²1-adrenoceptor which is cardioselective such as atenolol, bisoprolol and metoprolol or non-selective which can act on both ÃŽÂ ²1-and ÃŽÂ ²2-adrenocepors such as propranolol and timolol. Blockade of ÃŽÂ ²1-receptors will decrease rate and force of contraction of heart. Meanwhile, ÃŽÂ ²2-adrnoceptor blockade inhibits adrenaline-induced vasodilatation mediated by these receptors. Via these mechanisms, heart rate and cardiac output can be reduced. Beneficial effects of ÃŽÂ ²-blockers may result from antiarrhythmic effects, slowing ventricular remodelling, decrease myocyte death, improving LV systolic function, decreasing heart rate, and ventricular wall stress. The use of ÃŽÂ ²-blockers is not suitable for patients who have unstable HF. Patients should receive a ÃŽÂ ²-blocker even if symptoms are mild or well controlled with ACEI and diuretic therapy. Because of negative inotropic effects of ÃŽÂ ²-blockers, they should be started in very low doses with slow upward dose titration to avoid any symptomatic worsening. ÃŽÂ ²-blockers may worsen HF in the short term, but if use with caution they may be very useful in preventing long-term deterioration. Aldosterone antagonists Aldosterone antagonists such as spironolactone and eplerenone also can be called as potassium sparing diuretics. They act on aldosterone-sensitive portion of nephron (last part of distal convoluted tubule and first part of collecting tubule. They block the mineralcorticoid receptor and inhibit Na+ reabsoption and K+ excretion. Spironolactone can be added to ACEI, diuretic and digoxin to improve morbidity and mortality in patient with severe HF. Eplerenone is more specific compared to spirinolactone as inhibitor of aldosterone receptors and has been shown to reduce morbidity and mortality in patient with left ventricular dysfunction post-MI. However, the diuretic effects of aldosterone antagonists are minimal. Combination of aldosterone antagonist with thiazide or loop diuretics will potentiate the effect of thiazide or loop diuretics. This is a more effective alternative compared to potassium supplement. Angiotensin receptor blockers (ARBs) and Digoxin ARBs may be used as an alternative to ACEIs (eg: losartan) when patient is intolerant to ACEIs or may be used as adjunct therapy (eg: valsartan and cadesartan) in patient who remains symptomatic despite the dose of ACE and ÃŽÂ ²-blockers have been optimised. However, ARB is not given to the patient since she is well tolerated to ACEIs. Digoxin is one of the main drugs for HF treatment. However, digoxin is not recommended in this case. Digoxin can only been given if patients HF is worsening or patient is having atrial fibrillation at the same time. Hence, it is reasonable to exclude digoxin from treatment in this case. Evidence for treatment of the conditions Diuretics Diuretic is a very important drug for heart failure treatment especially for symptoms of fluid retention. A meta-analysis which includes 18 randomised controlled trials (RCT), n=982, had been carried out to study the role of diuretics (loop diuretics and thiazides) in patient with congestive heart failure (CHF). 8 trials were placebo-controlled and another 10 were comparison between diuretics and other drugs such as ACEIs, digoxin and ibopamine. The results had shown that diuretics reduce the risk of deterioration of disease and mortality compared to placebo group. When compared to active controls, diuretics also showed significant improvement in patients exercise capacity. The beneficial effects of diuretics are further supported by Cochrane database which also indicated that diuretics cause significant reduction rate and improvement in patients morbidity. Another study also proved that the withdrawal of furosemide will cause increase in volume load and right ventricular pressure. There will lead to deterioration of CHF which include impaired quality of life, weight gain and walking distance reduced. Higher dose of furosemide will have more desirable effects such as increasing general well-being and reducing symptoms of disease. However, the inappropriate high dose of furosemide will lead to hypotension. The risk of hypotension will be increased if patient on ACEIs or vasodilators at the same time with diuretics. According to NICE guidelines, low dose should be prescribed for the initiation of therapy and titrated up according to patients condition. Furosemide is the most commonly used loop diuretic. However, some patients are more responsive to other loop diuretic such as torasemide. This may due to its longer duration of action and high absorption. Some pharmacoeconomic analyses also proved that torsemide reduces hospitalisation for patient with CHF. Hence, overall treatment costs are reduced although torasemide is more expensive than furosemide. Patients that treated with torasemide have improved their quality of life. The data also suggest torasemide to be used as first-line treatment for patients with CHF and for those who are not response to furosemide. Besides that, according to a double-blind study, n= 1663, additional of aldosterone antagonist, spironolactone with furosemide had significantly reduced mortality and morbidity rate of patients with severe HF Hence from the evidences above, we can conclude that furosemide 40mg od is rationale to be given to patient to treat the symptoms of her CHF. Angiotensin-Converting Enzyme Inhibitors (ACEIs) The patient is taking perindopril 4mg od for her HF. A clinical trial has been carried out to compare the effectiveness between ACEIs and placebo in patients with symptomatic CHF. The overall results showed the significant reduction in total rate of mortality and risk hospitalisation. The benefits of ACEIs are further supported by five long-term randomised trials which had recruited 12763 patients with heart failure or left-ventricular systolic dysfunction (LVSD) to compare the effectiveness between ACEIs and placebo. Results showed that mortality rate has been reduced by 23%, readmission rate of heart failure reduced by 35% and re-infarction rate had been reduced by 26% for the patients who assessed ACEIs compared to placebo group. The benefits of ACEIs were observed at the beginning of therapy and it persisted long term. In SOLVD investigation, n=4228, ACEIs (enalapril) reduced the rate of hospitalisations and also incidence of heart failure in patients with reduced left ventricular ejection fractions compared to placebo group. Some randomised controlled trials proved that ACEIs also improve the exercise capacity and quality of life in majority of the patients. Not all the patients with heart failure due to left-ventricular systolic dysfunction experienced the improvement of exercise capacity. However, ACEIs alone is not enough for the treatment of heart failure with pulmonary oedema. Diuretic is needed to maintain sodium balance and prevent any fluid retention. ACEIs are more often to be prescribed compared to vasodilators and angiotensin receptor blockers due to more evidence supports. ACEIs will cause hyperkalaemia, cough and deterioration of renal function. Hence, renal function and serum potassium level need to be checked before the treatment is initiated. The SOLVD data, a randomised, double-blind and placebo controlled trial with 3379 patients, proved that enalapril caused 33% increased in deterioration of renal function compared to control group (P = 0.03). There is another study (n=191) showed that 44% of patients taking ACEIs suffered from persistent cough compared to controls which is only 11.1% (P The studies above showed that ACEIs are rationale to be used as first-line treatment HF. ÃŽÂ ²-blockers ÃŽÂ ²-blockers should be included in the treatment of HF even though the patient is already well controlled by diuretics and ACEIs. The European Journal of Heart Failure suggested that ÃŽÂ ²-blockers should be prescribed to all patients with stable HF and when left-ventricular ejection fraction à ¢Ã¢â‚¬ °Ã‚ ¤ 40%. A lot of meta-analyses showed that ÃŽÂ ²-blockers play a role in increasing life expectancy in patients with HF due to LVSD. In a meta-analysis which includes 21 trials (n= 5894), ÃŽÂ ²-blockers showed a significantly reduction of overall and cardiovascular mortality by 34-39%in patients with severe HF. Another meta-analysis of 16 clinical studies also showed the reduction of 24% for patients who were taking ÃŽÂ ²-blockers for their HF treatment rather than placebo. An interesting meta-analysis had been carried out to test the efficacy of ÃŽÂ ²-blockers in the patients with diabetes mellitus (DM) and CHF. The result of this meta-analysis showed that ÃŽÂ ²-blockers had reduced the mortality rate of patient with DM and CHF. However, the reduction was not significant (P=0.11) compared to CHF patients without DM. Most of the survival benefits for patient with NYHA class II and III are well documented. There is a meta-analysis had proven that ÃŽÂ ²-blockers are having the same improvement of survival rate among the patients with severe HF compared to patients with NYHA class II and III. However, further studies need to be carried out to evaluate overall benefits versus risks of treatment in NYHA class IV. There are three main studies, nà ¢Ã¢â‚¬ °Ã‹â€ 9000, had been carried out to compare the efficacy between ÃŽÂ ²-blockers (bisoprolol, metoprolol succinate CR, carvedilol) and placebo. Almost 90% of patients involve in there three randomised trials were on ACEIs or ARB. Most of them also took diuretics and digoxin. All trials showed the improvement of mortality rate (RRR= 34%), risk of hospitalisation (RRR= 28-36%) and self-reported well being. So far, there are no significant differences between selective and non-selective ÃŽÂ ²-blockers and those with or without vasodilating propert ies. In one randomised controlled trial (COMET), n=3029, carvedilol was used to compared with the efficacy and clinical outcome of metoprolol tartate. The result has shown that carvedilol reduced the mortality rate significantly among the patients compared to short-acting metoprolol tartate (P=0.0017). However, there is no any clinical trial about comparison between carvedilol and long-acting metoprolol succinate. There is little economic evidence can be found for ÃŽÂ ²-blockers. NICE guidelines suggested that ÃŽÂ ²-blockers are cost effective due to reduction of hospitalisation rate. Bisoprolol 2.5mg od had been added to the patient on second day since patient was admitted. The evidences above do support that the usage of ÃŽÂ ²-blocker should be included in patient with HF. Aldosterone antagonists Spironolactone is the most common aldosterone antagonist used in treatment of HF. In a double-blind study (RALES), 1663 patients with severe HF (NYHA class III and IV), left ventricular ejection fraction à ¢Ã¢â‚¬ °Ã‚ ¤ 35% and being treated with diuretics, ACEIs or digoxin were recruited to test the effectiveness of spironolactone on their morbidity and mortality. The result showed 30% reduction in mortality rate and 35% reduction of frequency of hospitalisation compared to placebo group. Addition of spironolactone to ACEIs, diuretics or digoxin had reduced the mortality rate in patients with severe HF. Additional of spironolactone may lead to hyperkalaemia. However the problem of hyperkalaemia can be solved by closing monitoring the potassium level of patients. Another study also showed that spironolactone reduced 30% mortality rate in patients with HF when it has been added to ÃŽÂ ²-blockers and digoxin. A selective aldosterone antagonist, eplerenone, has fewer side effects compared to spironolactone. A randomised controlled trial (EPHESUS), n=6633, proved that morbidity and mortality rate among patients with left ventricular dysfunction after acute myocardial infarction had been reduced with the addition of eplerenone compared to placebo group. There is no relevant economic evidence of aldosterone antagonist. Eplerenone is mostly used when patients cannot tolerate with spironolactone. Hence, spironolactone 25mg od is appropriate to used as adjunct to diuretics, ACEIs or maybe ÃŽÂ ²-blockers for patient in this case. Since the patient does not suffer any side-effects from spironolactone, it is not necessary to change to eplerenone. Conclusion As a conclusion, patients CHF has been appropriately treated by following the guidelines and also supported by numerous of clinical studies. From the clinical process, we can see that the condition of patient was gradually improved day by day. A ÃŽÂ ²-blocker, bisoprolol was added in the second day in order to achieve a better control of patients HF and also HPT. According to guidelines, the dose of bisoprolol should be initiated with 1.25mg, not 2.5mg. The potassium levels need to be monitored regularly due to the concomitant use of perindopril and spironolactone which may cause hyperkalaemia. ARB and digoxin are not prescribed to the patient because she is well tolerated with ACEIs and she does not have AF. Other treatment for HF such as vasodilators (hydrazine and ISDN) will only be considered when all of the treatment options above have failed to this patient. Non pharmacological treatment such as life-style modification, healthy diet, restrict fluid intake and salt intake als o play a very important in controlling patients HF and HPT for long-term.

F. Scott Fitzgeralds The Great Gatsby :: essays research papers

The Value of Jay Gatsby Jay Gatsby, who is one of the main characters of the Great Gatsby, is a man with a mysterious background and an unknown personality. He doesn't mention too much about his past except certain fabricated highlights of his life which were designed to impress others. The strange and humorous thing is that he carries articles of evidence that back up most of his lies to prove that he isn't lying. Gatsby is also the kind of man that is used to getting what he wants no matter what the consequences are, causing him to be a very determined man that once has an idea in his mind won't let it go until he accomplishes it. The things that Jay Gatsby values the most is money, to impress others and gain acceptance and most of all, having things his own way. In a manner, these are some of the characteristics of the American Dream and what people strive for when they come to America. Gatsby is a man that is out to impress others and he tries dearly to gain acceptance from others but he is not always successful at this. This is clearly shown when he hosts these immense parties that he creates to impress others but to mostly lure in Daisy so that he can meet her again and finally show off his social status to her. But before this could happen, Nick, Gatsby's new neighbor and cousin of Daisy, meets Nick. As they began to talk, Gatsby starts to discuss portions of his past to Nick and he seems the need to shows proof to back up his claims. For example when Nick was with Gatsby in his car heading toward New York, Gatsby boasts how he had gone to Oxford University and how he had been promoted to major and was given a momento from Montenegro. What was odd was that he had evidence to back up both of these claims. From his pocket he pulled out 'a souvenir of Oxford days. It was taken in Trinity Quad…'; 'It was a photograph of a half a dozen men in blazers loafing in an archway through which were visible a host of spires.'; (71) And then again he reached into his pocket and pulled out his war momento,'To my astonishment the thing had an authentic look.'; (71) showing that he was obviously trying to impress t Nick and prove himself correct so that he could fit in and look like a man with a normal past. F. Scott Fitzgerald's The Great Gatsby :: essays research papers The Value of Jay Gatsby Jay Gatsby, who is one of the main characters of the Great Gatsby, is a man with a mysterious background and an unknown personality. He doesn't mention too much about his past except certain fabricated highlights of his life which were designed to impress others. The strange and humorous thing is that he carries articles of evidence that back up most of his lies to prove that he isn't lying. Gatsby is also the kind of man that is used to getting what he wants no matter what the consequences are, causing him to be a very determined man that once has an idea in his mind won't let it go until he accomplishes it. The things that Jay Gatsby values the most is money, to impress others and gain acceptance and most of all, having things his own way. In a manner, these are some of the characteristics of the American Dream and what people strive for when they come to America. Gatsby is a man that is out to impress others and he tries dearly to gain acceptance from others but he is not always successful at this. This is clearly shown when he hosts these immense parties that he creates to impress others but to mostly lure in Daisy so that he can meet her again and finally show off his social status to her. But before this could happen, Nick, Gatsby's new neighbor and cousin of Daisy, meets Nick. As they began to talk, Gatsby starts to discuss portions of his past to Nick and he seems the need to shows proof to back up his claims. For example when Nick was with Gatsby in his car heading toward New York, Gatsby boasts how he had gone to Oxford University and how he had been promoted to major and was given a momento from Montenegro. What was odd was that he had evidence to back up both of these claims. From his pocket he pulled out 'a souvenir of Oxford days. It was taken in Trinity Quad…'; 'It was a photograph of a half a dozen men in blazers loafing in an archway through which were visible a host of spires.'; (71) And then again he reached into his pocket and pulled out his war momento,'To my astonishment the thing had an authentic look.'; (71) showing that he was obviously trying to impress t Nick and prove himself correct so that he could fit in and look like a man with a normal past.

Sarkar-Singer Hypothesis Essay -- International Trade

Sarkar-Singer Hypothesis Introduction Since terms of trade deterioration hypothesis was proposed by Prebisch and Singer in 1950, comparative advantage was doubted. Due to the export structure of developing countries (DCs) is dominated by primary products, and the export structure of industrialised countries (ICs) dominated by manufactured products; they compared primary products export of DCs and manufactured products export of ICs, and indicated that the terms of trade trend to deteriorate over time. This hypothesis is supported by many studies, such as Grilli and Yang (1998) and Spraos (1980); therefore the widening gap like existed. This hypothesis is confronted the traditional view, international trade and specialisation may not be better off. The Prebisch-Singer hypothesis also impacts on the trade policy of the majority of DCs to become inward looking. However, many studies appeal that the defected of Prebisch-Singer hypothesis, Sarkar and Singer analysis is the important appeal. Due to Singer (1958) views that the export structure of the DCs was dominated by primary products; export structure of the ICs by the manufactured products. Therefore, theearly studies use the terms of trade between primary products and manufactures as a proxy. Sarkar (1986) express that the growth of manufactured sectors, however, Singer (1987) proposes that even the change in the commodity composition of exports, the disadvantages in DCs lead the deterioration be continuous. Sarkar and Singer (1991) focuses on this subject, examines the impact of the shift in the commodity composition of exports of DCs. They proposed that the changes in commodity composition of exports are the important factor, as the primary sectors of DCs have a lower rat... ...ent, Vol. 19, No. 4, Page 333-340 Singer, H. W. (1950) The distribution of gains between investing and borrowing countries, American Economic Review, Vol. 40, No. 2, Page 473-485 Singer, H. W. (1958) Comment, Review of Economics and Statistics, Vol. 40, Page87-88 Singer, H. W. (1987) Terms of trade in John Eatwell, Murray Milgate and Peter Newman (Eds), The New Palgrave: A Dictionary of Economics, London: Macmillan, Page 626-628 Singer H. W. (1998) The Terms of Trade Fifty Years Later – Convergence and Divergence, The South Letter (30) Sproas, J. (1980) The Statistical Debate on the Net Barter Terms of Trade Between Primary Commodities and Manufactures, Economic Journal, Vol. 90, Page 107-128 United Nations Conference on Trade and Development (2005) Trade and Development Report Chapter III: Evolution of the Terms of Trade and its Impact on Developing Countries

Is it Constitutional to Bare Arms? Essay -- History

Is it Constitutional to Bare Arms? â€Å"A well regulated militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.† These are the words of the second amendment as written by our forefathers. The question weather it is constitutionally legal or not has been debated for many years. In order to understand the true meaning of the above statement one must look back at the history surrounding it. The Bill of Rights was written over two hundred years ago, and much has changed over that period of time. Therefore, one must examine the language of the text again keeping in mind when it was written. I believe that it is constitutionally legal for individual citizens who are cable of bearing arms have the right to do so. To support my claim lets look back to our history books and we can see that after the Revolutionary War the Framers of the Constitution and the Bill of Rights were very leery of a strong government. One of the Public Affairs Director for the Second Amendment Foundations, states, â€Å"The Framers of the Constitution disturbed the national government enough to create the Bill of Rights. Why would they turn around and put so much faith in the stat governments? The Framers more likely distrusted all levels of government. This would be more consistent than trusting some level and not others† (LaCourse) At the time when the constitution was written Founding fathers just came out from the Revolutionary War ...

A radical democrat: King’s Last Campaign

The task of this paper is two-fold; first, this paper will trace and explain the evolution of Martin Luther King, Jr.’s belief that war, racism and economic injustice are all intertwined and can be dealt with the restructuring of society’s priorities and addressed the necessity of a revolution of values; second, this paper will also explain how he carried out his beliefs in the Memphis Strike and the Poor People’s Campaign in 1968 [what the author and University of Washington professor, Michael K. Honey called â€Å"Martin Luther King’s Last Campaign†]. At the onset of this paper, it is important to note that King’s ‘background’ [which includes his race, habituation, education and religion among many others] is crucial in his struggle against racial discrimination, violence and economic injustice as experienced by blacks in the United States of America. The son of a minister, he was habituated in the teachings of Christianity and was able to attend and complete his formal education with degrees in sociology, theology and divinity. King was a pastor himself at Dexter Avenue Baptist Church in Montgomery, Alabama in the year 1953 prior to finishing his doctoral degree in systematic theology from Boston University on 1955. What prompted the Memphis Strike? Memphis in 1968 was ruled by a paternalistic â€Å"plantation mentality† embodied in its good-old-boy mayor, Henry Loeb. Wretched conditions, abusive white supervisors, poor education, and low wages locked most black workers into poverty (Honey, 2007). This characterization of the political, economic and social conditions of the blacks in Memphis in 1968 by Honey may be cited as cases of â€Å"manufactured and institutionalized oppression†. By manufactured and institutionalized oppression, I mean oppression which involves the mechanisms of law and power relations the basis of which is against the ‘natural law’. Natural law theorists, following the thoughts of St. Augustine that â€Å"an unjust law is not a law at all† and Aquinas’ notion of â€Å"law as an ordinance of reason†, view morality as essentially tied up with the very essence of law. How does King figure in all of this? How can we explain the evolution of King’s ideological perspective? The point is clear: Oppression and unfair treatment of individuals is not morally valid nor is it morally permissible most especially if the basis of such is the individual’s ethnicity or race. As the Kantians believed, each person has a capacity for rational deliberation and choice and as such, an autonomous being with dignity and therefore, ought to be respected by virtue of being human persons. The evolution of King’s ideological perspective may therefore be construed in such way that it is a product, both of his experiences as a black living in a white-dominated society and his philosophical and political development and this may be inferred from Fairclough’s book, â€Å"Martin Luther King, Jr.†, 1995. King’s speeches very clearly communicate his views: â€Å"I believe that unarmed truth and unconditional love will have the final word in reality†¦.I have the audacity to believe that peoples everywhere can have three meals a day for their bodies, education and culture for their minds, and dignity, equality, and freedom for their spirits[†¦] (as cited by Carson, 1998). Three important points about King and his political thrusts, philosophical orientation and as to why he may be called a â€Å"radical democrat† may be inferred from the aforementioned quotation. First, as a leading figure in â€Å"civil rights movement† King believed in the tenets of democracy and liberalism in the sense that he believed that both white and black Americans must have fair treatment in the realm of the law, for the purpose of law itself is the administration of social justice. Second, he believed in the â€Å"non-necessity of violence†. Influenced by Mahatma Gandhi’s â€Å"civil disobedience†, he believed that there are peaceful ways in and through which the problem of political and economic injustice may be resolved. It may further be inferred that for him, political, economic and social change can best be achieved not through violence [and that the government should not keep itself busy from going to war, as in the case of the Vietnam War] nor by transforming a portion or a sector of society but what is needed is a restructuring of the society as a whole. King believed that a â€Å"revolution of values† is a matter of strict necessity. King’s views may be identified as â€Å"radical† in this sense. He emphasized the need to restructure even how we think about black Americans or African Americans. It may be inferred that racism, the feeling of being superior over another race or ethnic group or nationality is grounded on the wrong premises; wrong modes of thinking and reasoning. It is by transforming our psyche and by appealing through reason and conscience that society as a whole may chart its rightful path towards genuine social change. Third, he believed and fought not only for civil rights but also for economic changes especially labor rights and lobbied for law reforms to be enacted to protect Negroes from exploitation and oppressive schemes adopted by employers. These include fair treatment and equal work opportunity, just compensation, etc. This is how he carried out his beliefs in the Memphis Strike and the Poor People’s Campaign. King served as a voice crying for the emancipation not only of black Americans but also of other human beings from the chains of oppression. Based on the above discussion, we can see why King believed that the problems and conflicts brought about by war, racism and economic injustice are all intertwined. What we can infer from his views is the interweaving and interconnecting patterns brought about by racism itself. But racism is not in itself the root of the problem; it is merely an effect of a traceable cause. This cause, this root of racism, is none other than a distorted value system, a wrong frame of mind resulting to feelings of superiority and even contempt and hate which further results to taking an unfair advantage of other human beings, plus a very materialistic market essentially driven by capital. The fault is, at bottom, deeply embedded with the minds of persons and a wrong value system, a wrong sense of pride and nationality, for it fails, in the Kantian sense, to respect persons for the sake of being human persons, not as mere means and tools that another person or race may use but as ends-in-themselves, possessing the capacity for rational thought, capable of making rational choices and thereby, beings that are autonomous and dignified and for the aforementioned reasons, deserve to be respected. References: Carson, C. A Call to Conscience: The Landmark Speeches of Dr. Martin Luther King, Jr.: Warner Books; Reprint edition (January 1, 2002). Fairclough, A. Martin Luther King, Jr.: University of Georgia Press, c. 1995. Honey, M. Going Down Jericho Road: The Memphis Strike, Martin Luther King's Last Campaign: W. W. Norton (January 15, 2007).   

Is Foreign Debt a Problem for Bangladesh?

Is unknown Debt a occupation for Bangladesh? Part-A abroad debt in Bangladesh Introduction kayoed-of-door debt is one of the sources of financing capital organisation in any economy. Developing countries corresponding Bangladesh be characterized by inadequate insepar adequate to(p) capital formation collectible to the heavy-handed circle of execrable productivity, emit income, and misfortunate nest egg. Therefore, this situation c boths for technical, managerial, and financial endure from western sandwich countries to bridge the resource gap. On the otherwise hand, immaterial debt acts as a major constraint to capital formation in developing nations.The burden and dynamics of external debt show that they do non yield signifi stick disclosetly to financing stinting evolution in developing countries. In almost cases, debt accumulates because of the aid waitments and the principal itself. In assure of the above, external debt becomes a self-perpetuating me chanism of impoverishment aggravation, work over-exploitation, and a constraint on developing in developing economies. macrocosm adoption put up be seen by unavowed investors as a specimen signal of the organisation becoming let out within the foreseeable future.They may in addition fear that judicature go out inflict laid-backer taxes in future in order to facilitate the re acceptment and ope come in of the loan. In that case sequestered investors leave become less(prenominal) enthusiastic to invest. However, insurance ca-cars beat to know whether earthly concern adoption is fol paltryed by any crowding- out put on enthronisation, through whatever channel, and to what tip and whether the detrimental achievement of such actions outweighs the expediency coming from the use of borrowed cash, as is argued by the classical. What is prevalent debt? everyday debt is the entry records of additive total of all governing borrowings less re leavements that atomic number 18 denominated in a verdants seat currency. Public debt should not be at sea with external debt, which reflects the inappropriate currency liabilities of both the private and common heavens and essential(prenominal) be payd out of distant supplant earnings. Government debt is one method of financing governance operations, however it is not the solely(prenominal) method. Governments rat excessively create bullion to monetize their debts, in that respectby removing the need to pay saki.But this practice simply reduces political relation interest costs rather than truly canceling brass debt and can result in hyper lump if employ unsparingly. Governments usually borrow by in the public eye(predicate)ation securities, government bonds and bills. Less creditworthy countries some quantifys borrow despairingctly from a inter subject fieldistic organization (e. g. the mankind Bank) or international financial descentaments. Sources of public debt A. Internal Sources. I. get from individual by issuing govt bond, notes, etc.II. acceptation from commercial bank III. Borrowing from aboriginal bankIV. Borrowing from nan-bank Financial institution B. remote Sources I. outside Government II. Foreign private institution III. International financial institution like IMF, WB etc. wherefore Bangladesh economy is dependent on Public debt? To utilize natural resources Economic t each(prenominal)ing Financing deficit budget severe social and economical structure of import economic contingencies Implement annual education Program Import financing murder of fiscal indemnity To grueling national defense Modernization of agriculture help oneself quick industrialization.Factors Which Influence How Much a Government Can Borrow internal Savings. If consumers cause a high savings ratio, in that respect leave be a greater ability for the private celestial sphere to purchase bonds. Relative Interest lays. If government bond s pay a relatively high interest rate compared to other investments, whence ceteris paribus, it should be easier for the government to borrow. Sometimes, the government can borrow large measurements, even with low interest rates because government bonds are seen as more invokeive than other investments. Lender of Last Resort.If a kingdom has a Central Bank instinctive to bargain bonds in case of a runniness shortages, investors are less belike to fear a liquid shortage. If there is no lender of last vivify (e. g. in the Euro) then markets learn a greater fear of runniness shortages and so are more reluctant to buy bonds. Prospects for Economic result. If one unsophisticated faces face of recession, then tax revenues allow for fall, the debt to gross domestic product ratio exit rise. Markets will be ofttimes more reluctant to buy bonds. If there is forecast for higher maturation. This will make it much easier to reduce debt to gross domestic product ratios.The irony is that cutting government spending to reduce deficits, can lead to visit economic growth and increase debt to gross domestic product ratios. Confidence and Security. Usually, governments are seen as a safe investment. Many governments obligate never defaulted on debt payments so sight are willing to buy bonds because at least they are safe. However, if investors feel a government is too stretched and could default, then it will be more difficult to borrow. Foreign Purchase. A country like the US attracts tangible contrasted buyers for its debt (Japan, China, UK).This foreign demand makes it easier for government to borrow. However, if investors feared a country could experience inflation and a rapid devaluation, foreigners would not insufficiency to let in securities in that country. Inflation. Financing the debt by increasing the notes supply is barbaric because of the inflationary effect. Inflation reduces the veri circuit board pry of the government debt, bu t, that implys people will be less willing to hold government bonds. Inflation will require higher interest rates to attract people to keep bonds.In theory, the government can print money to reduce the real number value of debt but existing savers will lose out. If the government creates inflation, it will be more difficult to attract savings in the future. Is foreign debt a task to Bangladesh? Excessive reliance on debt, whether domestic or external, carries macroeconomic risks that can embarrass economic and social increment. Countries macro-economic is thus confused by this factor alone. Scarcity of resources has already compelled the government to borrow afresh and/or impose new taxes on the masses to meet debt service obligations.High domestic public debt pushes up interest rates and crowds out private investment, which is much needed to leaven economic growth. When most government revenues are devoted to debt serving, fiscal policy cannot be used to provide basal go , such as education, health, safe drinking pee supply and housing. Unfortunately, the national budget annual line of reasoning of the governments income and usance does not recognize the gravity of the situation characterized by its serious problem to finance the external debt servicing at the cost of staple fibre human services.Every course Bangladesh pays, on an add up $ 1070 million, to its foreign creditors. A 2003 teach (SUPRO 2003) merely revealed the fact that for every sawhorse in foreign grant aid received, the government spends over $1. 5 in debt service to foreign creditors annually. While there is no denying that Bangladesh is heavily dependent on foreign aid and loans to finance its annual budget, it is also square(a) that aid agencies and multilateral lenders in the West have to carry a lions share of the turn on for Bangladeshs burden of debt. Between 1980 and 2012, Bangladeshs total outstanding international debt quadrupled.The mickle of this surge in lending to the despotic regimes came from the International Development Association, the soft-loan window of the cosmos Bank. Can the World Bank and the IMF chastely impose the burden of this debt on the Bangladeshi people, when in fact that money provided valuable succor to an autocratic regime that the people were struggling to topple at the time? How sustainable Bangladesh Debt is? Bangladesh is classified as a low-income country and is home to the third highest self-colored number of scant(p) people in the world, after China and India.Despite the huge amounts it spends servicing debt ($1551. 3 million in 2011), the World Bank describes it n all as bad nor even moderately indebted, but sooner classifies Bangladesh as less indebted. sooner of rewarding Bangladesh for its track record of breathe in debt servicing, the World Bank has interpreted this to hold still for that Bangladeshs debt essentialiness(prenominal) be sustainable. compulsory thresholds on indicators like debt/exports made Bangladesh unentitled for the Heavily Indebted Poor Countries (HIPC) hatchway or the Multilateral Debt Relief Initiative.Bangladesh will not receive through either of these initiatives the debt ministration that it desperately needs to finance public expenditures on school and hospitals among other elementary necessities. One of the Bangladeshi development experts remarked that- Bangladesh has regularly salaried its debts, expanded exports and are now being punished for its achievement (Bhattacharya 2006). The whole argument is that, since these countries are able to repay they mustiness have sustainable levels of debt.The sustainability of debt is primarily measured on the economic matrix called Debt Sustainable abstract (DSA) introduced by the World Bank and IMF, which lays too much emphasis on the countrys exports and does not aboundingy reflect the true nature of the debt burden on government expenses. How can Bangladeshs debt be sustainable esp ecially when it pays back on an clean $1070 million to its foreign creditors in universal and $870 million to its so-called benevolent development partners (multi-lateral and bi-lateral conferrers) annually?For a poor country like Bangladesh, would it be realistic to organize debt sustainability without looking at how much money it spends on schools, hospitals and roads, on teachers, medicines, clean water and on everything else that is needed to combat the dire poverty blighting so many lives? If a country cannot afford to meet the prefatorial needs of its own people, then how can one argue that giving money to the rich world is affordable or sustainable? How can its debt be sustainable when the cost of external debt servicing exceeds the public spending on health and education, for workout?In what criteria, the Bangladesh external debt can be measured as sustainable when it clear demonstrates that MDG mount is being seriously hampered due to the excesses of debt servicing? Presumably, the international commwholey has leftover a oneness choice for Bangladesh servicing external debt at the cost of basic services let alone the MDG progress Why Bangladesh deserves full debt cancellation? Undeniably, Bangladesh cannot afford to pay on average $1060 million a year to foreign creditors.Even though the country is making some progress with find to the death penalty of the MDGs, it is still home to 70 million people living in poverty. It has the highest incidence of poverty in South-Asia. In fact, Bangladesh cannot afford to pay a mavin dollar in debt service. If debt sustainability is based on the financing needs for the MDGs, Bangladesh would receive full debt cancellation. Bangladesh needs US$ 7. 5 billion a year to finance the implementation of the MDGs. A growing number of NGOs, governments and analysts have come to the conclusion that debt cancellation should be expanded.As single-handed expert Bernards Mudho explained earlier this year (2007) in a report commissioned for the fall in Nations There is a need for however comprehensive solutions to the debt problems of poor countries, including further debt relief by other multilateral institutions and for changeless solutions to the problems of bilateral and commercial debts. Bangladesh Debt must be turned, because ? Debt costs too much to Bangladeshi people in general and poor and marginalized in particular. People need a healthy and prosperous life that requires change magnitude government spending on basic services such as health, education, water-sanitation etc. ? Bangladesh needs to achieve the MDG targets in time. To finance the Millennium Development Goals, every year a staggering US7. 5 billion in external budget support is needed. This is about four times the amount of aid and concessional loans currently provided by foreign donors and creditors. ? At this juncture, Bangladesh can no bimestrial afford to pay a single dollar for debt servicing. Because.. Every d ollar paid in debt service is a dollar lost for the MDGs. Part-B Impact of Foreign debt on Bangladesh 1. cause on Economic growth 2. Effects on NNP 3. Effects on Inflation 4. Effects on enthronement 5. Effects on consumption 6. Effects on Production 7. Effects on Distribution 8. Effects on Risk, uncertainty, liquidity Part-C Statistical Analysis 1. Trend Analysis of Foreign Debt Trend Analysis of orthogonal debt of last 10 years is inclined below Y=1714. 5+0. 8647x R? = 0. 9247 Appendix instrument panel 1 shows the abbreviation of motility equation and r2 of external debt of Bangladesh.The cause equation of Foreign debt is, Y=1714. 5+0. 8647x and the square of correlation coefficient coefficient (r2) = . 9247. Interpretation The kink equation indicates that during the catch from 2003 to 2012 debt increase at the rate of . 8647 billion per year and 1714. 5 is the average external debt of Bangladesh. It is reflected from the table that trend equation of foreign debt are op timistic and goodness of fit of all the equations are very high. 2. descriptive Analysis of Foreign Debt Descriptive Statistical Analysis of External debt of last 10 years is give below (All amounts are in billions) Descriptive Statistics N Range Minimum uttermost Mean Std. Deviation Variance skewness Kurtosis Statistic Statistic Statistic Statistic Statistic Statistic Statistic Statistic Std. Error Statistic Std. Error Foreign_Debt 11 8. 7200 16. 5000 25. 2200 2. 103273E1 2. 9825127 8. 895 -. 169 . 661 -1. 108 1. 279 legitimate N (listwise) 11 Interpretation This table provides statistical information about the info set, such as showing mean value of foreign debt individually and its deviation.For this information, for typesetters case we found that minimum value of the protean is 16. 5bill, Maximum value is 25. 22billon, its mean 2. 103273e1 and cadence deviation is 2. 9825127. 3. Correlation Analysis Table shows the correlation matrix for estimating inter kinships between chosen economic parameters of Bangladesh. Variables GDP real produce Amount of Foreign Debt Inflation rate Investment Amount Remittance influx Import exportation Amount Foreign throw GDP real Growth Rate 1 . 635 . 638 . 748 . 427 . 457 . 485 . 352 Amount of Foreign Debt . 35 1 . 819 . 555 . 919 . 901 . 920 . 846 Inflation rate . 638 . 819 1 . 518 . 686 . 742 . 763 . 494 Investment Amount . 748 . 555 . 518 1 . 406 . 433 . 468 . 222 Remittance Inflow Amount . 427 . 919 . 686 . 406 1 . 915 . 935 . 920 Import Amount . 457 . 901 . 742 . 433 . 915 1 . 994 . 888 Export Amount . 485 . 920 . 763 . 468 . 935 . 994 1 . 885 Foreign Reserve Amount . 352 . 846 . 494 . 222 . 920 . 888 . 885 1 From the correlation matrix we have observed the undermentioneds GDP real Growth has moderate correlation with foreign debt, inflation rate, investment and low spirit level of correlation with remittance, import, export and very low correlation with GDP per capita. Foreign de bt has strong correlation with. Inflation rate have strong correlation with. Investment have strong correlation with. Remittance influx has moderate correlation with Import has strong correlation with Export has low correlation with Foreign exchange Reserve has low correlation with Part-D recommendation & Conclusion Recommendation The international community including the G-8 must name necessary steps immediately to correspond full Debt cancellation for Bangladesh Debts must be cancelled as a matter of judge creditors must accept their share of responsibility in creating the current debt crisis, and cancel debts on this basis A MDG-consistent frame-work of Debt Sustainability should be apply and cancellation must be available to all that need it The issue of Climate transfer and its adverse effect must be taken into account and additional fund should be released to overcome the adversity linking it with MDG lick The governments of indebted countries must demonstrat e to their citizens that they are spending money well and accountably.But this must not be used as an excuse to impose economic policy conditions or to limit those countries receiving debt cancellation by the donor community Rich countries, institutions and commercial creditors must cancel all illegitimate and un-payable debts being claimed from all poor countries Total Debt stocks must be cancelled, not just attend debt service cancellation for a limited period is not enough. Debt cancellation of any kind must not be conditional and it must not be considered again as ODA Conclusion The study has been conducted with a public opinion to examining the front of crowding- out effect of public borrowing on the private investment in the Bangladesh economy.To accomplish the task, a exercise for investment function has been specified and estimated considering public borrowing, GDP and interest rate as independent shiftings. A long -run relationship has been estimated and analyzed b y performing unit root establish, co integration test and an error correction model. The main findings of the study confirm with statistical significance that there is no crowding- out effect in Bangladesh, rather, the crowding- in effect is evident. This result is and then somewhat nonsensical in toll of conventional wisdom. The study has attempted to introduce a rationale for this seemingly paradoxical finding from a macroeconomic shoot of hitch.In doing so, it has analyzed a couple of macroeconomic issues and ended up with the conclusion that the presence of crowding- in instead of crowding out effect can be attributed to such factors as excess liquidity in the banking system, imperceptible government competition with the private sector, relatively sustainable public debt scenario, government expenditure for transfer payment weapons platform , significant development expenditure for producing those goods and services which has the potential to discharge positive externa lities, government microcredit programs and ADP -black money linkages. The results of the study have important implications for the fiscal management.Existence of excess liquidity and possibility of crowding in effect together put the fiscal effectiveness in a position to nourish private investment and hence economic growth through expanding borrowing plunk for public expenditure. However, the overall criteria that public expenditure authority ought to ensure is the transparency and efficacy in its programs. Moreover, government can repress unnecessary inflation and external obligation by reducing reliance for bullion on Bangladesh Bank and foreign sources as long as excess liquidity in the banking system prevails. In view of the perceived limitations inherent in this study, the following aspects may be taken up by future researchers Decomposing private investment by category and pickings each of them as separate dependent variable quantity Segregating borrowing by governm ent itself and borrowing by other public sector corporations, and considering them as separate explanatory variables change integrity public borrowing by sources (not only banks, NBDC or general public but also Bangladesh Bank and external sources) and taking all of them as explanatory variable s Incorporating a dummy variable for capturing the issue of economic reform and structural variation between after and originally 1990 periods and Finally, if possible, carrying on the whole study on the basis of quarterly data to make the analytical framework parsimonious. pic 10