Intervention to Reduce Progression of Diabetes

Intervention to Reduce Progression of Diabetes Developing an Intervention to Reduce Progression and the Development of Complications from Diabetes Mellitus in Adults in Glasgow. Introduction Type 2 diabetes is a serious medical condition that is increasingly prevalent in developed countries (International Diabetes Federation, 2013) and the most common variants of the condition are Types I and II. Type I patients have a deficiency in their pancreatic beta cells which leaves them unable to produce insulin. Thus in these individuals, some control over the condition can be achieved using insulin therapy (Schilling, 2007). Type II diabetics, have cells that have become resistant to the effects of insulin resulting in a delayed reduction in blood glucose (Skrha et al., 2010). There are additional types of diabetes; gestational, and a variety of Type III diabetes, however, the overwhelming majority of cases are of Type II with a significant minority of type I cases (Hardt et al., 2008). Complications of Diabetes Regardless of the underlying aetiology, the long-term complications of diabetes are similar. Excess blood glucose is thought to drive increases in oxidative stress both directly and via the derangement of mitochondrial energy pathways (Cade, 2008). Long term macrovascular damage will inevitably increase the risk of coronary heart disease (CHD), and ischaemic heart disease, with diabetics estimated as having a 3 and 5-fold increased risk of CHD mortality for men and women respectively (Loveman et al., 2008). Cerebrovascular disease is also a consequence of the chronic macrovascular damage with similar increases in stroke risk (Naci et al., 2015) Since each organ has its own microvascular supply, chronic hyperglycaemia also results in diffuse and widespread damage to a variety of body organs. As a result, diabetic complications include visual disability due to diabetic retinopathy; the leading cause of blindness in working age adults in the UK (Fowler, 2008; Kempen et al., 2004). In addition, patients suffer end stage renal disease from diabetic nephropathy (Adler et al., 2003), diffuse impairments of autonomic and somatic neural function, including pain perception, due to diabetic neuropathy (Stirban, 2014; Voulgari et al., 2013). Furthermore, the combination of microvascular damage, and reduced pain sensation, usually in the lower limb, results in many patients developing ulceration and necrosis of the inferior surface of the foot, the most common cause of non-traumatic amputations in the UK (Elraiyah et al., 2016). Costs of Diabetes In addition to the significant cost to the individual suffering with diabetes in terms of reduced personal health and quality of life, there are significant financial costs in treating the condition. In 2010-11, the total cost of diabetes to the UK was estimated at  £23.7bn (Hex et al., 2012). This was comprised of  £9.8bn in direct costs related to treating the disease, and  £13.9bn in indirect cost (e.g. lost productivity through absenteeism, early retirement or unemployment, (Hex et al., 2012)). More recently, the direct costs were estimated at  £13.7bn in 2012 (Kanavos et al., 2012). Within these direct costs, only around a quarter is directly spent on treating diabetes its self, and the remaining three quarters is spent on treating the complications following from the disease, (e.g. CHD, retinopathy, liver failure, diabetic foot, neuropathy (Kanavos et al., 2012)). Risk Factors for Diabetes There are a variety of factors that have been identified that places individuals at risk of developing type II diabetes, these include; having a family history of diabetes, obesity assessed using body-mass index, hypertension, visceral adiposity, adverse blood lipids, smoking, and impaired fasting glucose control (Lyssenko et al., 2008). Notably, several of these risk factors, including blood lipids, BMI, hypertension and visceral adiposity, are shared risk factors for CHD, which may in part explain the elevated risk of CHD in diabetics (Haffner et al., 1998). Indeed the clustering of these risk factors has been shown to be predictive of both CHD and diabetes (Haffner et al., 1998) and are collectively referred to as the metabolic syndrome. Moreover, these risk factors, appear to primarily be related to obesity in general, and excessive visceral adiposity in particular (Wozniak et al., 2009). Early work by West and colleagues (1978) demonstrated a strong positive association between rates of obesity and rates of diabetes with a variety of populations. Since then, the epidemiological link between excess body fat and risk of developing type II diabetes in particular has been repeatedly supported. For example, in the Nurses Health Study (Chan et al., 1994) females who had a BMI of greater than 35 kg.m-2 had a risk of diabetes 95 fold higher than those with a BMI of less than 21 kg.m-2 . Epidemiology of Diabetes The incidence and prevalence of diabetes have increased dramatically in the last two decades. Currently, the World Health Organisation estimates that diabetes effects around 9% of the adult global population (International Diabetes Federation, 2013) with variations in prevalence ranging from 26.4% in Kiribati to 1.54% of the population in Manin (International Diabetes Federation, 2013). Overall the UK ranks relatively favourably; in the same data from 2014, the UK had a prevalence of 3.9% (172nd out of 193 countries). Despite this relatively low ranking, the UK, in line with many developed countries, has experienced a rapid growth in the proportion of the population suffering with diabetes. Between 2007 and 2015 the number of patients diagnosed with diabetes increased by 75% from two to three and a half million cases (Diabetes UK, 2015). There are also an estimated half a million undiagnosed individuals at any one time. Indeed, the absence of overt symptoms in the early stages of the disease means that it is not uncommon for patients to have had the disease for several years prior to diagnosis, and confounds attempts to accurately calculate prevalence rates. Scotland has experienced similar increases, with the number of individuals diagnosed with diabetes increasing markedly over the last decade. The Scottish Diabetes survey (2014) demonstrated that the number of individuals with diabetes doubled from approximately 100,000 to 200,000 individuals between 2002 and 2007 despite a stable population of 5 million. Currently estimates for Scotland indicate that there are 276,500 diabetics in Scotland resulting in an overall prevalence that is a third higher than the UK average at 5.2% (NHS Scotland, 2014). Diabetes and Deprivation While the reasons that link indices of deprivation to diabetes are likely multifactorial, they undoubtedly exist. Individuals living in the most deprived areas of the UK are 2.5 times more likely to suffer from diabetes than those in the least deprived areas (Diabetes UK, 2006). Moreover the complications arising from diabetes such as CHD and stroke are more than three times higher in the lowest socio-economic groups and those with lowest educational achievement are twice as likely to have heart disease, retinopathy and poor diabetic control (Diabetes UK, 2006; International Diabetes Federation, 2006). The cause of the increased risk is not clear, however many of the risk factors such as obesity, smoking and physical inactivity, are also higher in those areas with the greatest degree of deprivation (Diabetes UK, 2006; International Diabetes Federation, 2006). From the data outlined above, the development of diabetes is a serious chronic medical condition that can result in early morbidity and mortality and is associated with significant personal and healthcare costs. Despite many of the risk factors for its development being modifiable, it remains a significant and increasing health risk that has a disproportional focus on the areas of greatest deprivation. Given that there is strong evidence that Glasgow has higher rates of both deprivation and type 2 diabetes than the rest of the UK, the aims of this paper are to discuss methods of describing the degree of the problem in Glasgow, as well as identifying, implementing and evaluating initiatives designed to reduce the burden of Type 2 diabetes within that area. Epidemiological Investigation of Diabetes in Glasgow The Centre for Disease Control defines public health research as consisting of four phases, public health tracking, public health research, health intervention programmes, and impact and evaluation (CDC, 2015). Thus before designing and implementing a diabetes focused health initiative, it is necessary to first establish that there is a public health need within Glasgow. This can be undertaken using primary or secondary data sources. Although secondary data sources are repositories of data that have been collected for some purpose other than the investigators main research question, Bailey et al. (2012) suggest that secondary sources also have several advantages. Typically, they are large data sets, and their use is highly cost efficient, as the data collection has already taken place. In terms of this investigation into Diabetes prevalence in Glasgow, there are a number of possible secondary data sources. The most directly relevant data is from the Scottish Diabetes Survey, the most recent data for which covers 2014 (NHS Scotland, 2014). In the most recent report, there is evidence that diabetes is a specific public health concern in Glasgow. For example, while it is not surprising is that Glasgow has the highest number of diabetics, around 22% of Scotlands diabetic population, since it is also the most densely populated region. However, this also translates to the region having the highest age adjusted prevalen ce of diabetes within Scotland at 5.8%. Furthermore the Greater Glasgow and Clyde (GGC) NHS board is criticised as falling behind other NHS health boards within Scotland, in its system of managing and screening its diabetic population in order to limit the progression of the disease. In addition, the Scottish Public Health Observatory (SPHO) provide a number of secondary data sources which may be valuable in triangulating conclusions and include; mortality rates, primary care information from GP practices, the Quality Outcomes Framework (QOF) detailing the performance of GP practices in dealing with key health issues, the Scottish Diet and Nutrition Survey, and the Health Education population survey (Scottish Public Health Observatory, 2015). In addition, both English and Scottish governments produce databases of indices of multiple deprivation (IMD), which can be useful when attempting to standardise the degree of a public health issue by deprivation level. This secondary data should be supported with primary evidence of the population of interest. While there are a number of research designs that could be used to collect primary data on Glasgow residents with diabetes, in this instance a cross-sectional observational design would be most useful. This method has several advantages, it is cost effective, requires only a single group, and each participant is only required to be assessed at a single time-point. This means that it becomes feasible to assess relatively large numbers of people (Bailey Handu, 2012). The limitations of this method are that it represents a single point in time and as a result, cannot be used to determine the sequence of events for a given set of exposures and outcomes. Therefore, it is not possible to infer causality from cross-sectional data. This type of research is most useful for determining prevalence rates for a specific condition (Bailey Handu, 2012).. An ecological study design might also be used, however, in this case, there are wide variations in income levels and deprivation levels within specific postcodes. Thus the possibility for the data to be affected by unknown confounding variables is significant. Similarly a case control study design has some additional control regarding possible confounders, but is again limited in being retrospective in nature and is predominantly used for rare diseases, which type 2 diabetes is not (Greenfield, 2002). Experimental designs such as prospective cohort studies or randomised control trials are the most internally valid designs to attribute causation of a condition to a specific exposure. However, they would not be appropriate in this instance, as they time consuming, expensive, and typically include far fewer individuals. Thus in order to use this type of study, the cost would be greater than the cost of any proposed intervention. In addition, while such designs are internally valid, they often lack ecological validity. That is, while the exposure and outcome can be linked in the study, at the population level, individuals may experience exposure to several predicating factors, and several protective factors. Thus, it is not always straightforward to transfer the findings from a highly controlled study to individuals (Peat et al., 2008). In order to undertake the cross-sectional survey, would require defining a series of areas (e.g. roads or school catchment areas) within specific post-codes to act as the sample frame. The survey data would be collected on these areas. The main problem with collecting this kind of data is a low response rate (Levin, 2006), and the possibility that individuals may responder or not due to the influence of some other factor introducing some systematic bias into the data. The main protection from this is to maximise the response rates. This is best done using face-to-face interviews with individuals in the sample frame (Levin, 2006). Diabetes Interventions The evidence for the type of behaviours that are useful in limiting the adverse complications of diabetes, have been the subject of several large scale epidemiological studies. In the UK the UK Prospective Diabetes Study (UK Prospective Diabetes Study, 1998) and its 10 year follow up (Holman et al., 2008) evaluated the effect of managing type II diabetes through diet alone, versus aggressive management aimed at restricting blood sugar concentrations. The data from the study indicated that while both the aggressive intervention only lowered blood sugar for one year, this translated into significantly lower rates of complications at the 10-year follow up. In the US, the Diabetes Control and Complications Trial (DCCT, 1993) and its 10 year follow up (the Epidemiology of Diabetes Interventions and Complications EDIC (Nathan et al., 2005)) also demonstrated that limiting increases in blood sugar, by maintaining concentrations within strict individualised limits, reduced the incidence of c omplications at the 10 year follow up by 57%. Similar reductions in adverse outcomes have also been found when diabetics have measures of blood lipids, blood pressure, nephropathy, retinopathy and diabetic foot complications assessed at regular intervals. It is also noteworthy that the Greater Glasgow and Clyde NHS region regularly performed in the lowest quartile of Scottish NHS authorities for implementing each of these evaluations (Scottish Diabetes Survey 2014). In long-term conditions such as Type 2 diabetes, the most appropriate strategies to control and manage the condition is for patients, to recognise themselves as stakeholders in their own treatment and to take ownership of the critical aspects of their care such as pharmacological treatment, dietary modifications and physical activity recommendations (National Institute for Health and Care Excellence, 2015). There have been several interventions that have aimed to use patient education to allow for a greater degree of self-management with a resulting closer control of risk factors for diabetic complications. Most recently Minet et al. (2010) evaluated the efficacy of 47 RCT studies aimed at improving diabetic patient education, and found that there was a significant reduction in the degree of hyperglycaemia experienced by the patients at the 6 and 12 month follow up time points. Similar meta analyses have supported the role of education in reducing the incidence of nephropathy and dia betic foot (Elraiyah et al., 2016; Loveman et al., 2008). Given that the UKPDS (1998) demonstrated that even short term reductions in blood glucose can reduce the numbers of patients who progress to sever complications, and given that the majority of the financial burden in treating type 2 diabetes is related to complications rather than the disease its-self. It seems clear that patient education could significantly improve the prognosis of diabetics as well as reduce the costs of future treatment. Implementing an Intervention in Glasgow Having identified a suitable educational intervention, the next stage is to ensure its faithful and appropriate replication within patients with Diabetes in Glasgow. A limitation of much of the available research is that interventions are predominantly applied in academic settings, and the effectiveness of interventions in community and primary care settings are frequently lower than anticipated from the scientific literature. This is a continuing challenge for implementing evidence-based strategies for public health issues. Kilbourne et al. (2007) recommend the REP framework, which although originally devised for faithful implementations of HIV educational programmes has been evaluated and found to help improve the effectiveness of other public health interventions. In order to use the REP framework for educational programmes aimed at Diabetics in Glasgow, the four stages of the REP framework would be developed. Pre-condition requires the identification of a suitable educational intervention. In this phase it is important that the chosen intervention is both feasible and appropriate for the setting in which it will be used. Pre-implementation requires that all staff involved in the intervention undergo training not only in the interventional educational curriculum, but also in the underpinning theories that shaped the original intervention. Implementation requires the educational programme is rolled out to diabetics within Glasgow, and that feedback is sought from stakeholders including patients undergoing the education. In this way it is possible to modify the intervention to better fit the situation, while still remaining faithful to the initial conceptual design. Finally, maintenance and evaluation requires further feedback regarding the effe ctiveness of the intervention, as well as ongoing support for partners who are delivering or helping ensure the continuation of the intervention. Monitoring an Evaluation For the proposed educational intervention, the evaluation would use the RE-AIM framework. This is the most widely adopted model for evaluation of public health interventions originally proposed by Glasgow and Colleagues (1999). This framework proposes the evaluation of five key elements of the intervention. Reach assess the number of individuals from the target population who received the interventions. Efficacy evaluates the degree to which the education intervention improved patients ability to manage their condition (e.g. better control of blood glucose, maintained or lowered blood pressure). Adoption would focus on the number of patients receiving the educational intervention whose behaviour was altered as a result. Implementation attempts to assess the degree to which the intervention was faithful to the evidence base upon which it was designed or was there pragmatic or other issues that meant the interventions was poorly delivered, or delivered in a manner not originally envisa ged. Maintenance attempts to quantify the degree to which the intervention becomes self-sustaining. This can be at an institutional level, i.e. does the health authority feel the programme is sufficiently successful to continue its development. However, it can also be at the individual level, were patients value the intervention and it becomes part of the persons habitual processes. Conclusion The aim of this paper was to investigate an intervention aimed at reducing the complications of type 2 diabetes in individuals diagnosed with the condition, living in Glasgow. It has established that in order to implement any such strategy, it is necessary to evaluate the degree of the problem using secondary and if required primary sources of data. In addition, any intervention should be evidence based, and attempt to replicate those interventions that have been demonstrated to be successful. This should be attempted in a strategic and structured manner in order to ensure high fidelity conversion from research evidence to intervention. The intervention its-self needs robust evaluation to determine if it was effective, and if not was it because of a failure of the underpinning theories or a failure in delivery. Unless they are well managed, individuals with Type 2 diabetes are at a significant risk of serious and life threatening complications. Educational interventions may be one wa y to provide effective strategies to enable better outcomes and reduced personal and financial costs. References ADLER, A.I., et al., 2003. 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IV Lawsuit Essay -- Medicine Healthcare Nursing

Most patients who enter the hospital for care have some form of intravenous therapy during their stay, whether it is in the emergency room or on inpatient floors. IV catheters are vital and are the fastest way to administer life saving medications. At times inserting or replacing a peripheral IV catheter can be challenging especially when the patient has poor circulation or poor venous access. In healthcare today Peripheral IV insertion lawsuits are on the rise due to its invasive character and unanticipated outcomes. In a lawsuit by Sheivia Graves against Brookwood Medical Center in Birmingham â€Å"alleges that a difficult and painful IV start performed by a nurse at Brookwood Medical Corner caused permanent Nerve damages.† (Steinriede (2010) Steinriede (2010) found the following: The nurse who started the infusion first tried the left arm, then the left hand and finally the back of the right hand. As soon as the infusion started, Ms. Graves "began experiencing severe pain in her right hand and [it] caused her to start crying," according to court documents. When Ms. Graves complained to the physician who began infusing anesthetics through the IV, he told her "they were already behind and that she would just have to endure it. Just after the GI exam, Ms. Graves looked at her hand and noticed that it was swollen "like a boxing glove,"(Steinriede, 2010) The hospital was able to argue effectively that other factors that the patient was experiencing at the time such as iron deficiency anemia, ulcerative colitis and fact that patient had received blood transfusions could have also cause nerve damage. (Steinriede, 2010) Also documented by the nurse was that the right arm was swollen prior to the peripheral IV insertion and that she ... ...ws, the awards are based on the determination of the percentage of fault of both parties.† (Evan, M. & Aiken, T., 2009, pp 184) Works Cited Evan, M. & Aiken, T., (2009): Nursing Law and Liability. J.T. Catalano (5th ed.) Nursing Now! Today’s Issues Tomorrows Trends .Philadelphia, PA: F.A.Davis Masoorli, S., (2008) Extravasation: Prevention is the Best Treatment. Nursing Spectrum retrieved from http://news.nurse.com/apps/pbcs.dll/article?AID=2008304080015 Spader, C., (2006, May 8) IV Insertion-Still a Special Skill. Nursing Spectrum retrieved from http://news.nurse.com/apps/pbcs.dll/article?AID=2006605080330 Steinriede, K., (2010, November 5) Lawsuit: Did a Painful IV Start Cause Nerve Damage? Patient’s hand was swollen like a boxing glove during GI procedure. Outpatient surgery Magazine retrieved from http://www.outpatientsurgery.net/news/2010/11/5

GROWING CALAMITY: AN IN-DEPTH REPORT ON GLOBAL FOOD INSECURITY In The 21st Century Essay

Food prices and the global demand for food have been on the rise in recent years. The catalyst for riots worldwide and food insecurity has caused widespread disturbances in agricultural industries. Food insecurity exists when people do not have adequate physical, social or economic access to food (FAO, United Nations 2009). It is captivating and noteworthy to mention that there is enough food to feed twice the earth’s population yet, food is not being equally distributed. This renders a high percentage of the world’s population poverty-stricken and hungry. Local governments, food rights activists, international trade institutions, and non-governmental organizations are becoming increasingly concerned with food distribution and food sovereignty (Schanbacher, 2010). Neoliberal processes that control  distribution and consumption are dominating policies regarding food production. International trade institution and multinational corporations dominate the entire food chai n, and as a result the global food system has encountered a crisis. The food crisis that persists today is by no means a sudden disaster that has struck the agricultural industry. It is the manifestation of a long-standing crisis in agriculture. Neoliberal global food systems have significantly modified the dynamics of agricultural production and farmers no longer have control over the food they produce and are subjected to volatile markets (Borras, 2009). Data collected by the United Nations Food and Agricultural Organization between 2004 and 2006 shows that the number of undernourished people in the world has been steadily increasing for almost two decades. The report showed that there was little or no progress being made towards World Food Summit targets to reduce hunger and that most of the countries were suffering from undernourishment (FAO, United Nations, 2009). While lesser-developed countries do benefit from some aspects of neoliberal globalization, it must be said that the same processes put marginalized societies at risk; impoverished farmers are no exception. These vulnerable farmers endure diminished technological resources and face stiff competition from capital-intensive foreign producers (Friedman, 2005). For decades the food industry’s hegemonic agents have perpetuated liberalized and unsustainable food systems that have resulted in many countries to falling victim to food insecurity. Such a grave and widespread problem warrants an in-depth exploration, to be carried out within this report. Beginning with a probe into the historical and contemporary challenges of food insecurity, this paper contends that structural changes at an international level are necessary to improve global access to sustenance. Case studies and multifaceted conceptualizations of the issue culminate in the identification of viable solutions to eradicat e food insecurity forever. HISTORICAL CONTEXT Although food insecurity is not a new phenomenon, the term was only coined in the mid-1970s, following a food crisis in 1972, which lasted for one year (Fulton, 2012). The magnitude of that crisis caused many to remark it, as the advent of food insecurity itself. Although it is often thought that  food insecurity is a result of food scarcity, Friedmann (1982) explains that food insecurity should be conceptualize as â€Å"a structural turning point† in the globe’s food production and distribution. Friedmann considers this first global food crisis to be the initial breakdown of the world’s food economy; which sustained grain surpluses and depressed prices (1982). Fulton also attempts to draw our attention to the heart of the matter by referring to the paradigm shift within the international food security discourse. Fulton (2012) contends that the analytical focus of the issue changed from food supply management, to the assessment of people’s ability to saf ely and consistently access food in a timely manner. In retrospect, the invention of new seed technologies, investments in rural agriculture, modern fertilizers and irrigation, caused many to be surprised by the catastrophe (Timmer, 2010). A variety of complex events, such as the oil crisis, rendered developing nations vulnerable and triggered the 1972 food crises (Friedmann, 1993). While some scholars regard oil’s radical price increases as the key catalyst to the food crisis, others interpret it differently (Fulton, 2012). Timmer for example, suggests that the high food prices led to soaring crude oil prices and that environmental catalysts were at the core of the 1972 food crisis (2010). Timmer goes on to explain that during the dry season in 1972 a severe drought, caused by El Nino, caused rice crops in Indonesia, Thailand and, the Philippines to be drastically reduced (Timmer, 2010). Soon after, domestic prices and demand for rice skyrocketed. To meet domestic demand Tha iland, the world’s leading rice exporter, banned rice export in April 1973. What followed was a nine months standstill in world rice markets. Countries were left to depend on rice imports to fulfill domestic demand for food. Residual effects of El Nino spread far across the globe and had devastating ramifications. In 1972 the world’s grain production decreased by 16 million metric tons (mmt), rice production dropped by14mmt and, wheat production diminished by 8mmt. Cumulatively, the total shortfall in world grain supply amounted to approximately 70 tons and represented an 8% reduction in global food supply. As a result of the shortage of food grains, prices rose. As a means of guranteeing their domestic food supply, oil-rich food-importing nation-states, reacted with an oil embargo against the United States and the former Soviet Union. Following the increase in oil prices, fertilizer  prices also went up. The international community responded to the crisis and the countries in dire straits, by formulating what Friedmann terms a â€Å"temporary, elegant and dangerous† solution (1993). The solution was to offer lavished transnational bank loans, financed by oil-rich nations (Friedmann, 1993). The global food crisis originated due to severe weather conditions that were exacerbated by financial turmoil. Together with the Cold War, these issues aggravated the socio-political and economic conditions which eventually lead to explosive grain prices. CONTEMPORARY CHALLENGES: CASE STUDIES Since the food crisis in the early 1970s, humanity has witnessed a variety of countries declaring food emergencies, such as famine. In the year 2006 alone, twenty-five of the thirty-nine serious food emergencies were caused by the aftermath of violent conflicts, natural hazards or, a combination of the two (Alinovi, 2007). Of these thirty-nine serious food traumas, several of these crises were on-going for years and, in some cases for decades (Alinovi, 2007). The intensity and severity of a nation’s political conflicts dictates the impact that that conflict has on the food security. In certain instances it is impossible for some developing nations to overcome such dismal conditions. Since 1986, at least five African countries have been in a constant state of food insecurity for fifteen years, or more. A country that best embodies this is Somalia. Recent occurrences in the Horn of Africa, where hundreds of thousands of people died due to starvation, have been well publicized an d are well-known by the general public. Without looking at the broader context, the mainstream media was quick to assert that the famine in Somalia was caused by severe drought. While it is correct that the region received the lowest rainfall that it had in sixty years, the famine was compounded by neglect. Two years prior to the famine, Islamist rebels prohibited most aid agencies from working in Somalia and the rebels only rescinded the ban when the food situation there was officially labeled a ‘famine’. Famines are declared when, a third of the child population is acutely malnourished and when two adults or four children per 10,000 people die of hunger each day (Chossudovsky, 2011). Before and during the famine in Somalia, the atmosphere was one of lawlessness, gang warfare and anarchy; all of which  contributed to the famine (Chossudovsky, 2011). It is noteworthy to mention that this was not the first time that conditions were severe in Somalia. In fact, in 1992 t housands of citizens starved to death and far-reaching famines prompted international intervention. When President Siad Barre was overthrown in 1991, Somalia effectively became a failed state and politically driven civil-wars led to impoverishment. United Nations peacekeeping forces were eventually pulled out of the country after two American Black Hawk helicopters were shot down in 1993. Another nation that exemplifies contemporary food insecurity is Sudan. In the case of Sudanese, the major catalyst for the crisis was the conflict between the central government and a rebel group, the Sudan People’s Liberation Army (SPLA) (Alinovi, 2007). When a country endures a civil war, an extraordinary amount of stress is placed on the civilian population. Not only are hospitals, clinics, schools and agriculture services diminished, or closed altogether, trade links and communication networks are disrupted indefinitely (Dodge, 1990). The policies enacted by the Sudanese government are directly related to the level of food insecurity experienced in the country’s Nuba Mountains. The Unregistered Land Act of 1970 resulted in a grab for farming land and displaced peaceful Nuba villagers. In addition to disrupting the Nuba people’s agro-ecology, humanitarian aid in SPLA controlled areas was blocked (Pantuliano, 2007). These measures successfully disrupted the vil lager’s conventional farming systems in favour of large-scale mechanized corporate agriculture (Pantuliano, 2007). These two case studies are prime examples of nations that have suffered from food insecurity due to political conflicts, lawlessness and anarchy. It is clear that given the multidimensional nature of the problem, short-term humanitarian aid will not yield successful results. Consequently, a complex issue such as food insecurity requires multifaceted solutions. EXPLORING FOOD INSECURITY The causes of food insecurity are as unique as the countries that are impacted; therefore conceptualizing the issue requires that it be examined from varying angles. An inability to access adequate and nutritious food inevitably results in malnourishment. This section will examine whether  the Malthusian theory can assist in obtaining a greater understanding of the emergence and persistence of food insecurity. The Malthusian Theory of Population refers to works by Robert Malthus. Malthus’ theory relies on the premise that two fixed factors are the driving forces of human existence: food and passion between the sexes. Further, Malthus contends that unchecked populations grow exponentially, while food supplies increase arithmetically. These differing growth rates are what Malthus believed caused populations to grow faster than their food supply; according to him, this in turn causes food insecurity. Appendix A represents this concept visually. Malthus believed that when a high population is strained due to a lack of food, naturally occurring ‘preventive checks’ keep the population from getting out of control (Drysdale, 1878). Essentially he believed that food insecurity itself was caused these checks (Drysdale, 1878). There are however many critics of the Malthusian Theory. Ester Boserup believed that a small population actually restrains technological innovations and keeps agriculture at subsistence levels. Boserup asserts that major innovations in agriculture only occurred when food insecurity was a factor because it forced large populations to find any means of sustaining its populace. Julian Simon was equally as critical of Malthus and regarded people as resource creators rather than, resource destroyers. Simon believed that population growth has a positive, and not a negative impact on development. Both Boserup and Simon contend that the Malthusian Theory of Population fails to sufficiently explain the causes of food insecurity (Malthus ian Crisis, 2009). Critics go on to highlight another of Robert Malthus’s shortcomings; he did not take into account human ability to intentionally control birth rate. The Malthusian theory states that food insecurity results in population controls such as: food shortages, epidemics, pestilence and plagues. It is therefore possible for humans, given a lack of food, to simply decide to limit their reproduction. Malthusian theory also underestimates the possibility that food can increase at an exponential rate. Scientific advancements in the last few centuries have made the exponential growth of food production a reality (International Society, 2009). Neo-Malthusian theory, despite accepting human being’s ability to control fertility and therefore the population growth rate, still fails to account for the progress being made towards increasing global food supplies  (Acselrad, 2006). Many of the areas that experience food insecurity are in third world countries, which are characterized by very high birth rates. The concern now is to find out why food insecurity continues to exist. If Malthus’ theory has been disproven and there truly is enough food for everyone in the world it is extremely important, now more than ever, to examine other possible causes of continued international food imbalances. EXPLORING FOOD INSECURITY: THE ROLE OF CORPORATIONS While Malthus was correct in his emphasis on technology and the environmental burdens associated with food production, in relation to the effects of food insecurity, he could not have conceptualized the far-reaching impact of large multinational agribusiness corporations. Contemporary industrialized society’s agricultural economies are characterized by the commodification of food products, engineered from the farm to the dinner table (Drabenstott, 1995). This industrialized approach applies principals of economic efficiency to cultivation and, has resulted in a slippery slope of revenue prioritization achieved through the technological alteration of food itself. Biotechnology has enabled the food industry to increase crop yield and revenues through the isolation and incorporation of specific traits from other plants or animals, into food products (Drabenstott, 1995). While Genetically Modified Organisms or GMO foods superficially appear to be reducing shortages, and by extrapo lation food scarcity related deaths; environmental damage caused by intense corporate farming and the high toxicity of GMO foods, actually work to undermine the world’s food security. Intensive farming by agribusinesses degrades the soil and increases the industry’s reliance on chemicals. Fiscally sound, the application of pesticides during the food cultivation process produces greater yield and assures better storage and distribution of the product (Court, 2006). Generally applied aerially using helicopters or airplanes, herbicides such as Atrazine are estrogen disruptors and increase the risk of Parkinson’s disease (Aiyelaagbe, 2011). Herbicides often transported via surface runoff, leeches into the ground where it contaminates distant water sources and, can cause cancer after increased exposure (Aiyelaagbe, 2011). Toxins applied during production are inevitably transferred to the produce and have adverse effects on human populations worldwide. Genetically eng ineered or  modified foods have similar, unpublicized, adverse effect. Global leader in agribusiness ingenuity, Monsanto Corporation’s modified â€Å"Bt† corn was engineered with a bacteria bacillus thuringiensis. This bacterium produces the pesticide Bttoxin aimed at killing insects during production. Appendix B illustrates this process. Monsanto Corporation told the public that the Bttoxin was entirely safe because it would be completely destroyed in the human digestive system; however that was not a true statement. Studies have shown the pesticide to be present in the fetal blood of 80% of pregnant Canadian women tested (Smith, 2013). The full effects of the toxin are still unknown nevertheless preliminary research indicates that ‘Bt’ may cause deformities in unborn children (Smith, 2013). Without speaking to the morality of the subject, technological changes to alter the biological processes of plants and animals for the purposes of increasing crop yield, is actually counter-productive to the goal of sustaining life. Corpo rations such as Monsanto facilitate modern industrial society’s commodification of life sustaining nourishment. In short, the western corporatization of agriculture has left the world with a food system that no longer functions to provide safe, wholesome and nutritious food for all people. SOLUTIONS & CONCLUSIONS Food insecurity can be found in every corner of the globe and is usually caused by drought, famine, natural disasters, war, political instability, economic upheaval and most recently, global warming. Although developed and developing countries alike suffer from varying degrees of the problem, the former suffers less often than the latter. As is the case in the aftermath of Hurricane Katrina in New Orleans, USA; food insecurity can be a short-term problem, that if effectively tackled, can be rectified (Huffingtonpost, 2012). Food insecurity can also spiral into a long-term problem, as is the case in Sudan North Africa where political instability has fostered food insecurity in the region (Mensah, 2013). Food insecurity in most cases is caused by natural disasters (ie. earthquake in Haiti, tsunami in Thailand) where there is little or no warning. Natural disasters destroy infrastructure and food supplies; therefore it is a necessity that nations be ready in the event of any emergency. The first step to take when the problem of food insecurity arises is to evaluate local needs. Need is  determined by the causal factors of the crisis in a particular area. Conducting a comprehensive evaluation, by examining key data on local assets, resources and, livelihood strategies is key to minimizing damage. For example, response teams could be sent out to meet directly with community members to better understand local conditions and create a collaborative plan of action to end food insecurity. The solutions to food insecurity can be classified into two categories: short-term and long-term solutions. Short-term solutions usually precede long-term solutions; and are the first responses to emergency situations. Short-term strategies include the distribution of food, cash and other items to prevent food insecurity in smaller timeframe. An example of this can be observed among the poor in the United States on food stamps and as well as in Haiti. Haiti received food aid and cash gifts from organizations and people around the world after an earthquake struck the island nation. Haiti has had a long history of food insecurity, brought about by political instability and poor governance. Long-term solutions to food insecurity are devised with a more stable future in mind. Technological innovations have proven to be the main source of hope for future food security. Through technological innovation we can and have been able increase crop production to fight food insecurity and build stability internationally. Through sophisticated methods like genetic engineering, scientists have been able to modify the DNA of crops in order to increase agricultural output. ‘’An example [of this] can be observed in the case of an apple; ‘’an apple is about the size of a little pea, it started somewhere in Russia and it was inedible at the time of discovery. The domestication of the plant has resulted in twenty thousand different varieties of the fruit, all originated from one plant species (Despommier, n.d.). This report, above all things, demonstrates that augmented crop yield does absolutely nothing to increase marginalized people’s access to food. Technologically driven agriculture is unsustainable and damages poorer populationsâ€⠄¢ only tool of self-determinism: the land. Genetically modified foods and seeds contain diminished nutritional value and are toxic to human beings. Food insecurity in actuality, directly relates to socio-political issues that exacerbate the neo-liberal dilemma of unfair food distribution. Each country must therefore resist hegemonic policies and take their population’s survival into their own hands. This report  calls for return to subsistence farming. Importing food to meet domestic need, in constantly fluctuating and volatile markets, adds to the problem of unreliable food supplies. Neither entirely correct nor incorrect, Malthus had no way of accounting for globalizations’ impact on absolutely every facet of contemporary life. Unless the international community abandons â€Å"equality† in favor of equity, rampant food insecurity will continue. WORKS CITED Abandon the Cube (2011). Seven Billion†¦ and Counting. Abandon the Cube. Retrieved from http://www.abandonthecube.com/blog/tag/malthusian-crisis/. Acselrad, H. (2006). Neo-Malthusianism: A Narrow Theory Exceeds Its Carrying Capacity. Political Environments, (5). Action Against Hunger. Food Security & Livelihoods. Retrieved from http://www.actionagainsthunger.org/impact/food-security-livelihoods. Alinovi, L., Hemrich, G., & Russo, L. (2007). Addressing food insecurity in fragile states: case studies from the Democratic Republic of the Congo, Somalia and Sudan (No. 07, p. 21). ESA Working Paper. Borras, S. M. (2008). Transnational agrarian movements confronting globalization. M. Edelman & C. Kay (Eds.). Chichester: Wiley-Blackwell. Chossudovsky, M. (2011). Somalia: The Real Causes of Famine. Global Research, 4-17. Despommier, D.(n.d.). The Key to Population Growth and Food Production [Video File]. Retrieved from http://www.businessdictionary.com/videos/?294043623. Dodge, C. P. (1990). Health implications of war in Uganda and Sudan. Social Science & Medicine, 31(6), 691-698. Drabenstott, M. (1995). Agricultural industrialization: Implications for economic development and public policy. Journal of Agricultural and Applied economics, 27, 13-20. Drysdale, C. R. (1878). The population question according to T.R. Malthus and J.S. Mill. London: W. Bell. FAO: Food and Agriculture Organization of the United Nations, for a world without hunger. Friedmann, H. (1982). The Political Economy of Food: The Rise and Fall of the Postwar. Hall, H. (2005). Bt Corn: Is It Worth the Risk?. The Science Creative Quarterly, Issue 2. Retrieved from http://www.scq.ubc.ca/bt-corn-is-it-worth-the-risk/. International Food Order. American Journal of Sociology, 88, 248-286. Friedmann, H. (1993).The Political Economy of Food: A Global Crisis. New Left Review, 197, 29-57. Friedmann, H. (2009). Feeding the empire: The pathologies of globalized agriculture. Socialist register, 41(41). Fulton, M. Food Security: What Does It Mean for Canadian Food and Agricultural Policy? April, 2012. Growing Our Future: Making Sense of National Food Strategies. Lecture conducted from University of Guelph’s Institute for the Advanced Study of Food and Agricultural Policy, Guelph, ON. Mensah, J. (2013). Malthusian theory of Population. Class Presentation. Lecture Conducted from York University, Toronto, ON. Pantuliano, S., Alinovi, L., Hemrich, G., & Russo, L. (2008). Responding to protracted crises: the principled model of NMPACT in Sudan. Beyond relief: food security in protracted crises, 25-63 Schanbacher, W. D. (2010). The politics of food: The global conflict between food security and food sovereignty. Westport, CT: Praeger Security International. Science Daily(2009). One Billion Hungry People: Multiple Causes of Food Insecurity Considered. Retrieved from http://www.sciencedaily.com/releases/2009/06/090625113857.htm Smith, J. M. (2011). GMO toxins in women and fetuses. Expanded Academic ASAP, 16, 1- 12. Timmer, C. P. (2010). Reflections on food crises past. Food policy, 35(1), 1-11. Young, L., Ram, R. S., & Cort, S. G. (1996). Industry Corner: The Pesticide

Attributes in Mathematics

In mathematics, the word attribute is used to describe a characteristic or feature of an object—usually within a pattern—that allows for grouping of it with other similar objects and is typically used to describe size, shape, or color of objects in a group. The term attribute is taught as early as kindergarten where children are often given a set of attribute blocks of differing colors, sizes, and shapes which the children are asked to sort according to a specific attribute, such as by size, color or shape, then asked to sort again by more than one attribute. In summary, the attribute in math is usually used to describe a geometric pattern  and is used generally throughout the course of mathematic study to define certain traits or characteristics of a group of objects in any given scenario, including the area and measurements of a square or the shape of a football. Common Attributes in Elementary Mathematics When students are introduced to mathematical attributes in kindergarten and first grade, they are primarily expected to understand the concept as it applies to physical objects and the basic physical descriptions of these objects, meaning that size, shape, and color are the most common attributes of early mathematics. Although these basic concepts are later expanded upon in higher mathematics, especially geometry and trigonometry, its important for young mathematicians to grasp the notion that objects can share similar traits and features that can help them sort large groups of objects into smaller, more manageable groupings of objects. Later, especially in higher mathematics, this same principle will be applied to calculating totals of quantifiable attributes between groups of objects like in the example below. Using Attributes to Compare and Group Objects Attributes are especially important in early childhood math lessons, where students must grasp a core understanding of how similar shapes and patterns can help group objects together, where they can then be counted and combined or divided equally into different groups. These core concepts are essential to understanding higher maths, especially in that they provide a basis for simplifying complex equations—from multiplication and division to algebraic and calculus formulas—by observing the patterns and similarities of attributes of particular groups of objects.   Say, for instance, a person had 10 rectangular flower planters that had each had attributes of 12 inches long by 10 inches wide and 5 inches deep. A person would be able to determine that combined surface area of the planters (the length times the width times the number of planters) would equal 600 square inches. On the other hand, if a person had 10 planters that were 12 inches by 10 inches and 20 planters that were 7 inches by 10 inches, the person would have to group the two different sizes of planters by these attributes in order to quickly determine how much surface area all the planters have between them. The formula, therefore, would read (10 X 12 inches X 10 inches) (20 X 7 inches X 10 inches) because the two groups total surface area must be calculated separately since their quantities and sizes differ.