Combined Pulmonary Fibrosis and Emphysema (CPFE)

Combined Pulmonary Fibrosis and Emphysema (CPFE) Ong Wei Jun Dan The Causes, Consequences and Differences Between Pulmonary Fibrosis or Emphysema Alone   Abstract Combined pulmonary fibrosis and emphysema (CPFE) is a complicated disease and untreated disease which consists of two diseases. It is difficult for respiratory therapists or respiratory physicians to differentiate between CPFE versus idiopathic pulmonary fibrosis (IPF)/emphysema alone. There is an increased recognition of the coexistence of emphysema and pulmonary fibrosis in individuals. The association of two diseases results in chronic dyspnea, upper-lobe emphysema and lower lobe fibrosis, and severely diminished diffusion of gas exchange with preserved lung volumes. CPFE is also frequently complicated by pulmonary hypertension, lung injury and even lung cancer. This causes CPFE patients to feel have a low quality of life and a low 10-year survival rate. Currently, there are no known treatments for CPFE patients with the exception of lung transplantation. Thus, clinical evaluations are needed to differentiate between chronic obstructive pulmonary disease (COPD) and pulmonary fibro sis, and to recognize that CPFE is a unique entity by looking at the difference in radiological, pathological and metabolism features in order to find better treatment for CPFE. Introduction About 11 million Americans have Chronic Pulmonary Obstructive Disease (COPD) and out of these, most are diagnosed with pulmonary emphysema. The etiology of emphysema found that 80% of cases are caused by cigarette smoking, which causes alveolar membranes to break down, creating huge alveoli (called blebs) that lesser surface area and weaker walls than normal alveoli. This causes the low perfusion of oxygen due to decrease in surface area. In addition, approximately 50,000 new cases of Idiopathic Pulmonary Fibrosis (IPF) are diagnosed each year.   IPF is a restrictive respiratory disease, and it is the most common of the idiopathic lung diseases. IPF causes thickening of the alveolar capillary membrane, which results in minimal gas exchange between the alveolar and the blood capillaries. Both diseases lead to the decreased efficacy of oxygen delivery. CPFE is a combination of both IPF and emphysema. However, it is usually treated as IPF and ignored or excluded in the diagnosis of emphysema.   COPD and pulmonary fibrosis have different pathologies, metabolic pathways and radiological characteristics, and were therefore regarded as separate entities for a very long time. However, in recent years, there is some recognition of the coexistence of pulmonary fibrosis and emphysema in patients. As such, it is very important to know the differences between CPFE versus emphysema or pulmonary fibrosis alone in order to find a treatment or prevent the patients conditions from further deteriorating. In the following years, studies had shown that CPFE patients have a coincidental occurrence of early emphysema and at later age of IPF, especially for smokers with many pack years.1   However, in recent studies there is a correlation between the occurrence of the combination between lower lobe pulmonary fibrosis and upper lobe emphysema. These two diseases have been observed coexisting in greater frequencies which are therefore called combined pulmonary fibrosis and emphysema (CPFE) and there is a need to distinguish them as distinct entities. There are some studies taking place to better understand the pathophysiology of the condition and find the possible causes of CPFE such as genetic factors or any biological metabolism pathways which may encourage its development. CPFE is normally caused by heavy smoking, exercise hypoxemia, upper lobe emphysema and lower lobe pulmonary fibrosis, unexpected lung volume and severe reduction of carbon monoxide transfer.2 Whether the combination of both emphysema and pulmonary fibrosis is a unique clinical entity still remains unknown. For some of the population in the medical community, it is a coincidental occurrence of two smoking-related diseases on one person, versus the coexistence of the similarities of COPD and lung cancer. However, many different studies have shown and suggested that interstitial lung abnormalities, which are normally caused by IPF, have are inversely related to emphysema in smokers. In fact, based on the chest X-Ray images, most patients who have many pack years with IPF do not have any signs of having emphysema. Similarly, most patients who have emphysema do not have any signs of IPF in their chest X-Ray. Hence, the combination of both pulmonary fibrosis and emphysema may be a direct result of heavy smoking or many pack years which reflects the uniqueness in individual susceptibilities. Even though medical professionals tend to use chest X-Rays for any respiratory distress, as it is inexpensive and considered a fast diagnostic tool, it is unable to properly diagnose the CPFE syndrome. Another alternative would be to use High-Resolution Chest Computed Tomography (HRCT), which is the only tool to diagnose the syndrome. The CPFE syndrome consists of heterogeneous syndromes, in which syndromes differ from one individual to another and resulting in no actual definition of the syndrome for CPFE. This makes it difficult to diagnose CPFE with the current pulmonary function test, as CPFE patient results look similar to those of patients diagnosed with pneumonia. From past research and observations, CPFE is frequently complicated with pulmonary hypertension, acute lung injury and the possibility of lung cancer, resulting in very poor prognoses. Treatments for CPFE patients with severe pulmonary hypertension have not been found and have largely proven ineffective in curing the disease apart from a wholesale lung transplant. The identification of patients with CPFE is needed due to the uniqueness and complication of the diseases history. Since CPFE has not yet attracted the attention of researchers and healthcare practitioners, there have not been many studies focused on finding the differences between pulmonary fibrosis, emphysema and CPFE. Currently, there is no consistent way to differentiate the factors, signs and syndromes when diagnosing CPFE patients from other obstructive respiratory diseases. This has resulted in many medical practitioners failing to immediately recognize CPFE in patients diagnoses. Population distribution of Emphysema, IPF and CPFE The prevalence of the disease emphysema was reported to be at about 24.5 per 1,000 in America, while the prevalence of IPF varied from 14 to 42.7 cases per 100,000. Therefore, emphysema is a more common disease as compared to IPF. However, there are no studies that account for the prevalence of CPFE. Some of the reported observations show that the proportion of patients with CPFE detected on HRCT scans range from 8% to 51% in IPF patients. On the other hand, the proportion of pulmonary fibrosis found in patients with emphysema is less than 10% using the HRCT. This variation of proportion of prevalence in CPFE may be due to the different types and complications arising from the diagnosis of emphysema when evaluated by chest X-Ray and HRCT. Patients with CPFE tend to be older men who tend to have many pack years of smoking. Previous studies have shown that there is no significant difference when varying the number of pack years against the occurrence of COPD such as emphysema and CPFE. However, patients with CPFE and those with COPD usually have a long history of smoking as compared to patients with IPF.   Many studies have reported that male have higher prevalence then female in having respiratory disease syndrome, and could be due to men tending to have more pack years as compared to females. It may also be due to the genes of men which predispose them to succumbing to COPD or CPFE. Even though both IPF and emphysema have proven to be more common in male smokers than female smokers, it does not necessarily mean that gender plays an important risk factor in the contraction of CPFE. More studies are needed to determine how gender differences affect this syndrome. Pathology pathway of CPFE Till now, there are no conclusive findings for pathogenies of CPFE. There are no clear conclusions on the development of CPFE, whether emphysema and or pulmonary fibrosis progress independently or whether there are synergistic qualities between the two. There may be some mechanisms involving cytokines, beta receptors or signaling pathways which have not been discovered. Thus, both pulmonary fibrosis and emphysema may tend to occur in genetic susceptibility individuals with from exposure to environmental factors such as smoking or occupational hazard and chemicals. Case Study of a CPFE patient (Occupational exposure) A case study journal report on a male patient aged 73 years old in 2015 gives one of the more detailed analysis of Microscopic Polyangiitis (MPA), a disease that precedes by CPFE. The patient worked as a metalworker and had 25 pack years. He was admitted to the hospital due to progressive dry coughing and he was later diagnosed with CPFE. He eventually died due to complications from CPFE, which resulted in severe pneumococcal pneumonia with acute lung injury. His arterial blood gas result was normal with a fairly abnormal range in his pulmonary function test (PFT). There were clear signs of emphysema and IPF from his CT scan and Chest X-Ray (Kyoko Gocho, 2015). MPA is a systemic necrotizing vasculitis of small vessels associated with numerous types of antibodies in particular myeloperoxidase- antineutrophil cytoplasmic antibody (MPO-ANCA). Oxidation induced by MPO-ANCA may trigger pulmonary fibrosis due to alveolar hemorrhage, resulting in pulmonary capillaritis (an inflammation of p ulmonary capillary). This causes pulmonary fibrosis as the alveolar capillary wall thickens (Kagiyama, 2015) Correlation of smoking with CPFE patients A common etiology factor for CPFE is smoking. Tobacco smoke contains 4000 chemical substances, including Kaolinite or aluminum silicate, an organic industrial material. Studies show that inhalation of this organic industrial substance will result in hyperactive macrophages, which in turn will lead to respiratory bronchiolitis and emphysema (King, 2005). Currently, there are no studies for the association of tobacco smoking resulting in IPF, other factors such as environmental factors in genetically-predisposition individuals may play a key role in resulting IPF. The association between CPFE and lung cancer may reflect the susceptibility linked to long term smoking which causes chronic smoking-induced inflammation. These were done on several other studies on the relationship between emphysemaand IPF.3,4 Pathological findings (Diagnostic Imaging) Patients who have acute respiratory distress syndrome such as COPD, pulmonary fibrosis or even CPFE, will tend to have more difficulty breathing due to the use of accessory muscles and the need to constantly supply supplemental oxygen to meet the oxygen level demanded by the body. For some of the patients, a high flow of oxygen is required (flow rate of more than 60L/min) to meet their inspiratory demand. Patients with CPFE have a confused and undetermined ventilation/ perfusion ratio due to emphysema causing low perfusion and IPF having low ventilation. This results in both ventilation of oxygen to the alveoli and perfusion of capillaries to be diminished, leading to dead space and shunt. Emphysema results in the reduction of alveoli-capillary surface membrane by forming a bleb that causes air-trapping, whereas pulmonary fibrosis scars the alveolis tissue, creating a shunt that causes ventilation of the oxygen to the alveoli to be inefficient, resulting in the patients body tissue b eing unable to get a sufficient amount of oxygen. Other remarkable syndromes found in COPD patients are chronic cough and sputum production in volume greater than one shot full glass due to inflammation of bronchi and impairment of the mucociliary clearance, presumably due to the effects of smoking. Patients with IPF may show progressive shortness of breath, loud expiratory wheezing sounds and if the condition is worse cyanosis may appear on the patient. CPFE from previous clinical studies shows that it is similar to IPF. On close physical examination, by doing chest auscultation, it was found that more than 80% of CPFE patients will emit inspiratory dry crackles sounds due to the underlying pulmonary fibrosis. About 40 to 50% will have digit clubbing and poor capillary refill. As of now, there is no consistent definition for CPFE. However, it is very important to diagnose it early. Diagnostic criteria for CPFE include radiological findings by using either chest X-Ray or HRCT these images will appear as upper-lobe emphysema with fibrosis like blebs, lower-lobe honeycombing with subpleural reticular opacities, thick wall cystic lesions, and sometimes ground glass opacities.2 Table 1: Comparison of clinical characteristics difference between CPFE, emphysema and IPF patients group (measures of Framingham variables) CPFE IPF Emphysema p-value Sample size 22 8 17 Age (in years) Median 73.5 74 78 0.7 Range 59-96 56-89 48-86 Number of pack years Median 64 43 75 0.64 Range 20-50 30-80 15-65 Table 2: Comparison of clinical characteristics difference between CPFE, emphysema and IPF patients group (Pulmonary Function Test) CPFE IPF Emphysema p-value Vital capacity 2.52 ±0.72 2.34 ±0.86 2.85 ±0.61 0.52 Vital capcity (%) 83.1 ±22.1 68.0 ±27.7 87.0 ±12.4 0.29 FEV1 2.01 ±0.19 1.60 ±0.24 1.57 ±0.22 0.28 FEV1/FVC(%) 76.8 ±3.31 81.8 ±4.45 55.6 ±4.06 70%, this results being emphysema to be ignored or overlooked. Physician, healthcare workers and respiratory therapists should be aware of its existence. More autopsies should be recognized such as thick-walled cystic lesion and idiopathic interstitial pneumonia should be recognized as both of these can be found in CPFE patients but are seldom found in emphysema/IPF alone patients. A deeper understanding of the pathophysiology is needed for CPFE and the factors that causes the syndrome of CPFE should be explored further with more clinical studies so as to develop effective treatments or therapeutic strategies for CPFE patients. References       Hiwatari H., S. S. (1993). Pulmonary emphysema followed by pulmonary fibrosis of undetermined cause. Respiration, 60(6). Cottin V., H. N. (2005). Combined pulmonary fibrosis and emphysema: a distinct underrecognised entity. European Respiratory Journal, 26(4). Kaplan R. M. (2015). Quality of Well-being Outcomes in the National Emphysema Treatment Trial. Chest Journal, 147(2). Kagiyama C., N. T. (2015). Antineutrophil cytoplasmic antibody-positive conversion and microscopic polyangiitis development in patients with idiopathic pulmonary fibrosis. BMJ Open Respiratory Research, 2(1). Inomata M., A. M. (2013). An autopsy study of combined pulmonary fibrosis and emphysema: correlations among clinical, radiological, and pathological features. BMC Pulmonary Medicine, 104(14). King, C. G. (2005). COPD: a dust-induced disease? Chest Journal, 128(4). Kyoko G. (2015). Microscopic polyangiitis preceded by combined pulmonary fibrosis and emphysema. Respiratory Medicine Case Reports, 10(2). Papaioannou A. I., E. A. (2016). Combined pulmonary fibrosis and emphysema: The many aspects of a cohabitation contract. Respiratory Medicine, 117(10). 9.  Ã‚   Portill K., J. M. (2011). Combined Pulmonary Fibrosis and Emphysema Syndrome: A New Phenotype within the Spectrum of Smoking-Related Interstitial Lung Disease. Pulmonary Medicine , 2012(1).

Project Management Conflict Resolution Essay

Overview: Shirley was the manager of new products division at an e-commerce company. She and Maggie, one of her team members, interviewed Jesse for a new position on their project team. Maggie did not feel Jesse was the right fit for the position and strongly opposed his candidature. Shirley felt differently and hired Jesse. Six months after Jesse was hired, Shirley left the project to start her own company and recommended that Jesse and Maggie serve as joint project leaders. Maggie agreed reluctantly-with the stipulation that it be made clear she was not working for Jesse. The General Manager consented; Maggie and Jesse were to share the project leadership. Within a month of this development, Maggie was angry when she felt that Jesse was representing himself to others as the leader of the entire project and giving the impression that Maggie was working for him. She called for a meeting with the General Manager to see if he could clarify the issue again and resolve the conflict between them. Maggie said to the General Manager, â€Å"Right after the joint leadership arrangement was reached; Jesse called a meeting of the project team without even consulting me about the time or content. He just told me when it was being held and said I should join them. At the meeting, Jesse reviewed everyone’s duties line by line, including mine, treating me as just another team member working for him. He sends out letters and signs himself as project director, which obviously implies to others that I am working for him.† Jesse replied: â€Å"Maggie is all hung up with feelings of power and titles. Just because I sign myself as project director doesn’t mean she is working for me. I don’t see anything to get excited about. What difference does it make? She is too sensitive about everything. I call a meeting and right away she thinks I’m trying to run everything. Maggie has other things to do-other projects to run-so she doesn’t pay too much attention to this one. She mostly lets things slide. But when I take the initiative to set up a meeting, she starts jumping up and down about how I am trying to make her work for me.† How is the General Manager going to resolve this conflict? The issues: * Personality clashes * Lack of respect * Authority * Egos * Disagreements about the right way to manage. Problems: Major – Project delay, Client dissatisfaction, Miscommunication, Effectiveness Minor – Confusion, Rumours, Low morale Tying theory to the issue Conflict is defined as a disagreement of persons or groups of persons considering a situation as inconsistent with their own interests (Boulding 1963, Robbins 1974, Putnam & Wilson 1982, Hocker & Wilmot 1985). A conflict can oppose somebody to himself or herself (internal conflict), to other persons, groups of persons or to institutions (Thomas 1992). Several definitions synthesis made in organization theories (Putman & Poole 1987), psychology (Thomas 1992) or information systems (Barki et coll. 2001) considers three properties of interpersonal conflicts: interdependence, interference and disagreement. By itself, each property cannot be considered as a sufficient condition. Interpersonal conflicts are more dependant of their overlapping. †¢Interdependence exists when each party reaches a specific goal, at least because of the actions of the other party. In essence, interdependence is a structural condition for conflicts in a professional context because of respective consequence s of the way the other party acts. †¢Interference is a behavioral condition for conflict and occurs when one or several parties oppose the other party’s attainment of its interests, objectives, or goals. Interference thus represents the central behavioral node of any conflict (Barki et coll. 2001 p.198). †¢Disagreement is a cognitive condition for conflict and corresponds to divergence of interpretations toward values, objectives, needs, methods, etc. Disagreement refers to disputant behaviors and is considered as the central process associated to conflict (Wall & Callister 1995). In the above context, these causes can be task (or process) oriented versus affective (or relational) oriented (Deutsch 1969). Conflicts about tasks are issue oriented and arising from differences between activities to be performed, whereas affective conflicts refer to personalized disagreements or individual disaffections. The first ones can be considered as differences of  points of view rarely assorted of negative emotions while the second ones can raise frictions and tensions which can affect team performance (Jehn & Mannix 2001). The 4 different conflict types drawn from task and affective orientations are: Conflicts about task definition and execution are caused by the way organizational processes have to be adapted or transformed to fit with IT process requirements (for examples: how invoices and orders must be established, new data codification, signature validation process). These conflicts can be â€Å"internally initiated† when users compare the way they achieve their tasks and perceive organizational inconsistencies (Besson 1999). They can also be â€Å"externally initiated† because of the process constraints imposed by information technology to be implemented. Value conflicts are psychologically based. They refer to ideology by which some people share beliefs and make sense of their worlds (Trice & Beyer 1993). Firm subunits may have their own subculture varying in their ideological content (Stewart & Gosain 2006). In IS, value conflicts may arise on inconsistency between cultural principles of users or group of users and the perceived underlying strategic objectives assigned to IT implementation (Leidner & Kayworth 2006). Power conflicts concern the way individual autonomies and capabilities of influence are likely to be distributed among employees. A Analysis and Solution: In this case, there are several issues between Maggie and Jesse. First and foremost, Maggie feels that Jesse is incompetent, thus her perceptions of his capabilities are skewed and has little respect for Jesse. On the other hand, Jesse feels that Maggie seems to have an issue with titles and  placement of authority. There appears to be a clear lack of teamwork and trust. There is also the appearance of self-promotion and miscommunication. This conflict did not originate from conflicting goals, but is related to the individuals involved. It is due to personality clashes between the individuals and some of the reasons are: * Lack of respect for each other * Power conflict * Value conflicts * Working styles * Incorrect perceptions formed due to lack of personal interaction. * Personal dislike. The General Manager needs to meet with them and explain to them how the personal conflict between them is affecting the project and the team as a whole. The goal here is to get them to at least communicate with each other to get everything out in the open. Confidentiality is key here, but it is also important that they are really listening and hearing each other. Remind them that what is discussed in the room does not leave the room. During the meeting: * Inquire as to what (are) the issue(s)? Get it all out on the table – let them vent. * What are their perspectives?  * Work with them to develop criteria for solutions to their conflict. * Ask them their ideas on how to move forward with resolving the issue based on the criteria agreed to, that may help to resolve the conflict. * What alternatives can they come up with to work together effectively? * Can they come to consensus on any of the alternatives? * Ask them to think about what they can do to get past the issue, or put it aside, in order to move forward with working together. What alternatives exist? This should happen overnight – let them sleep on it. * Provide feedback on their working styles as it is hindering team spirit. * Set up off-site sessions to get the team together to improve bonding and overcome personal biases. * Emphasize on the need to separate personal prejudices from the task at hand. The General Managers role here will be to get them talking to each other about their ideas to resolve the conflict and, ideally, coming to a consensus on how to resolve it. It is important to remember that the manager cannot resolve it for them; they need to do so themselves. He is  just facilitating the discussion for them. Help them work toward coming to consensus on resolving the conflict by asking questions, probing for details, etc. If one comes up with an idea, see how that idea might be tweaked so that it is acceptable to the other individual. How can the other add to the idea so that it might work for his/her also? Remember also that sometimes consensus cannot be reached and the conflict is not able to be resolved, but you still need these individuals to work together. How might they do so? What do they need to work together professionally and cordially toward the successful conclusion of the project? Once a consensus has been reached – or there is agreement on how to work together in spite of the conflict between them – review what was agreed and get their commitment that they will continue to work on the resolution of the conflict (as we know it won’t go away immediately!) and abide by the plan they developed to resolve it. The General Manager should also: * Clearly define the responsibilities and set guidelines for both. * Make the dependencies between Jesse and Maggie clear and ensure that their goals are aligned to take care of the dependencies. * Take a commitment that key decisions are taken jointly. * Create a communication plan, escalation mechanism and set up ground rules. * Ensure that both Jesse and Maggie promote project interest over self interest. * Take steps to build mutual trust, as it is key to minimizing unhealthy conflict Advantages: It is important that the team members involved in a personal conflict take ownership of their issues and work constructively to resolve them. This will ensure that the project is not in jeopardy and all the stakeholders have confidence in the team leadership. Once the power conflict is resolved, a collaborative and consultative environment can be created which is conducive to productivity and efficiency. In such an environment, projects are one time and on budget. Disadvantages: A possible disadvantage is that to maintain a balance of power and effective collaboration wherein there is no perception of subterfuge, substantial time commitment is required. Also, even with the time commitment, there no absolute guarantee that the feeling of distrust will eliminated entirely. Recommendations: Follow up with them both individually and together to check on how things are going over the next few weeks and months, and provide them the support they need to continue to head in the right direction of an improved working relationship. References: Barki H. & Hartwick J. (2001), â€Å"Interpersonal Conflict and Its Management in Information SystemDevelopment.†, MIS Quarterly. Besson P. (1999), â€Å"Les ERP à   l’à ©preuve de l’organisation†, Systà ¨mes d’Information et Management. Boulding K. (1963), Conflict and Defense, New York, Harper & Row. Deutsch M. (1969), â€Å"Conflicts: productive and destructive†. Dans F. E. Jandt, à ©d. Conflict resolutiontrough communication. New York, Harper and Row. Hocker J.L. & Wilmot W.W. (1985), Interpersonal Conflict, Dubuque. Jehn K.A. & Mannix E.A. (2001), â€Å"The dynamic nature of conflict: A longitudinal study of intragroup conflict and group performance†, Academy of Management Journal. Leidner D.E. & Kayworth T. (2006), â€Å"Review: a Review of Culture in Information Systems Research: Toward a Theory of Information Technology Culture Conflict†, MIS Quarterly. Markus M.L., Tanis C. & Fenema P.C.V. (2000), â€Å"Multisite E RP implementations†, Association for Computing Machinery. Communications of the ACM. Putnam L.L. & Wilson C. (1982), â€Å"Communicative Strategies in Organizational Conflict: Reliabilityand Validity of a Measurement Scale†. Dans M. Burgoon, à ©d. Communication Yearbook. Putman L.L. & Poole M.S. (1987), â€Å"Conflict and negociation†. Dans Handbook of Organzational Communication. Newbury Park, CA, Jablin, F. M., Putman, L. L., Roberts, K. H., Porter, L.W., Robbins S.P. (1974), Managing Organizational Conflict, Englewood Cliffs, NJ: Prentice Hall Robey D. & Taggart W. (1981), â€Å"Measuring Managers’ Minds: The Assessment of Style in Human Information Processing†, Academy of Management. The Academy of Management Review, Stewart K.J. & Gosain S. (2006), â€Å"The Impact of Ideology on Effectiveness in Open Source Software Development Teams†, MIS Quarterly. Thomas K.W. (1992), â€Å"Conflict and Conflict Management: Reflections and Updateâ⠂¬ , Journal of Organizational Behavior Trice H.M. & Beyer J.M. (1993), The Cultures of Work Organizations, Englewood Cliffs, PrenticeHall. Wall J.A.J. & Callister R.R. (1995), â€Å"Conflict and its Management,†, Journal of Management

The Challenges African States Faced at Independence

One of the most pressing challenges African states faced at Independence was their lack of infrastructure. European imperialists prided themselves on bringing civilization and developing Africa, but they left their former colonies with little in the way of infrastructure. The empires had built roads and railroads - or rather, they had forced their colonial subjects to build them - but these were not intended to build national infrastructures. Imperial roads and railways were almost always intended to facilitate the export of raw materials. Many, like the Ugandan Railroad, ran straight to the coastline. These new countries also lacked the manufacturing infrastructure to add value to their raw materials. Rich as many African countries were in cash crops and minerals, they could not process these goods themselves. Their economies were dependent on trade, and this made them vulnerable. They were also locked into cycles of dependencies on their former European masters. They had gained political, not economic dependencies, and as Kwame Nkrumah - the first prime minister and president of Ghana - knew, political independence without economic independence was meaningless.   Energy Dependence The lack of infrastructure also meant that African countries were dependent on Western economies for much of their energy. Even oil-rich countries did not have the refineries needed to turn their crude oil into gasoline or heating oil. Some leaders, like Kwame Nkrumah, tried to rectify this by taking on massive building projects, like the Volta River hydroelectric dam project. The dam did provide much-needed electricity, but its construction put Ghana heavily into debt. The construction also required the relocation of tens of thousands of Ghanaians and contributed to Nkrumahs plummeting support in Ghana. In 1966, Nkrumah was overthrown.   Inexperienced Leadership At Independence, there were several presidents, like Jomo Kenyatta, had several decades of political experience, but others, like Tanzanias Julius Nyerere, had entered the political fray just years before independence. There was also a distinct lack of trained and experienced civil leadership. The lower echelons of the colonial government had long been staffed by African subjects, but the higher ranks had been reserved for white officials. The transition to national officers at independence meant there were individuals at all levels of the bureaucracy with little prior training.  In some cases, this led to innovation, but the many challenges that African states faced at independence were often compounded by the lack of experienced leadership. Lack of National Identity The borders Africas new countries were left with were the ones drawn in Europe during the Scramble for Africa with no regard to the ethnic or social landscape on the ground. The subjects of these colonies often had many identities that trumped their sense of being, for instance, Ghanaian or Congolese. Colonial policies that privileged one group over another or allocated land and political rights by tribe exacerbated these divisions. The most famous case of this was the Belgian policies that crystallized the divisions between Hutus and Tutsis in Rwanda that led to the tragic genocide in 1994. Immediately after decolonization, the new African states agreed to a policy of inviolable borders, meaning they would not try to redraw Africas political map as that would lead to chaos. The leaders of these countries were, thus, left with the challenge of trying to forge a sense of national identity at a time when those seeking a stake in the new country were often playing to individuals regional or ethnic loyalties.   Cold War Finally, decolonization coincided with the Cold War, which  presented another challenge for African states. The push and pull between the United States and the Union of Soviet Socialist Republics (USSR) made non-alignment a difficult, if not impossible, option, and those leaders who tried to carve third way generally found they had to take sides.   Cold War politics also presented an opportunity for factions that sought to challenge the new governments. In Angola, the international support that the government and rebel factions received in the Cold War led to a civil war that lasted nearly thirty years. These combined challenges made it difficult to establish strong economies or political stability in Africa and contributed to the upheaval that many (but not all!) states faced between the late 60s and late 90s.

Elizabeth Bathory Mass Murderer or Victim

Elizabeth BÃ ¡thory is famed as the ‘Blood Countess,’ an Eastern European aristocrat who tortured and murdered over six hundred girls. However, we actually know little about both her and her alleged crimes, and the general trend in modern history has been to conclude that her guilt may well have been overplayed, and that she was, perhaps, the victim of rival nobles who wished to take her lands and cancel their debts to her. Nevertheless, she remains one of Europe’s most (in)famous criminals and has been adopted by modern vampire folklore. Early Life BÃ ¡thory was born into the Hungarian nobility in 1560. She had powerful connections, as her family had dominated Transylvania and her uncle had ruled Poland. She was relatively well educated, and in 1575 married Count NÃ ¡dasdy. He was the heir to a rival Hungarian aristocratic family, and was widely viewed as a rising star of the nobility and, later, a leading war hero. BÃ ¡thory moved to Castle ÄÅ'achtice and, after some delays, gave birth to several children before NÃ ¡dasdy died in 1604. His death left Elizabeth the ruler of vast, strategically important estates, whose governance she took on actively and unyieldingly. Accusations and Imprisonment In 1610, the Count Palatine of Hungary, Elizabeth’s cousin, began to investigate allegations of cruelty by Elizabeth. A large number of potential witnesses were questioned, and a range of testimonies gathered implicating Bathory in torture and murder. The Count Palatinate concluded that she had tortured and executed dozens of girls. On December 30th, 1610, BÃ ¡thory was arrested, and the Count claimed to have caught her in the act. Four of Bathory’s servants were tortured, tried, and three were found guilty and executed in 1611. Meanwhile, BÃ ¡thory was also declared guilty, on the basis she had been caught red-handed and imprisoned in Castle ÄÅ'achtice until she died. There was no official trial, even though the King of Hungary pushed for one, just the collection of several hundred statements. Bathory’s death, in August 1614, came before the reluctant Count Palatine could be forced into organizing a court. This allowed Bathory’s estates to be saved from confiscation by the King of Hungary, thus not tipping the balance of power too much, and allowed the heirs—who petitioned, not for her innocence, but for their lands—to keep the wealth. A substantial debt owed by the King of Hungary to BÃ ¡thory was waived in return for the family’s right to look after her while in prison. Murderer or Victim? It may be that Bathory was a sadistic murderer, or that she was a simply a harsh mistress whose enemies turned against her. It could also be argued that Bathory’s position had become so strong thanks to her wealth and power, and a perceived threat to leaders of Hungary, that she was a problem who had to be removed. The political landscape of Hungary at the time was one of major rivalries, and Elizabeth appears to have supported her nephew Gabor Bathory, ruler of Transylvania and rival to Hungary. The act of accusing a wealthy widow of murder, witchcraft, or sexual impropriety to seize her lands was far from unusual during this period. Some of the Alleged Crimes Elizabeth Bathory was accused, in the testimonies gathered by the Count Palatine, of killing between a couple of dozen and over six hundred young women. These were almost all of noble birth and had been sent to the court for learning and advancement. Some of the more repeatable tortures include sticking pins into the girls, tearing at their flesh with heated tongs, dousing/submerging them in freezing water and beating them, often on the soles of their feet. A few of the testimonies claim Elizabeth ate the girls’ flesh. The alleged crimes were claimed to have taken place at Elizabeth’s estates across the region, and sometimes on the journey between them. Corpses were supposed to have been hidden in a variety of places—sometimes getting dug up by nosy dogs—but the most common method of disposal was to have bodies secretly buried in churchyards at night. Adaptation Bram Stoker tipped his hat to Vlad Tepes in Dracula, and Elizabeth has also been adopted by modern horror culture as a figure of almost equal ghoulish importance. There is a band named after, she has appeared in many films, and she has become a kind of sister or bride to Vlad himself. She has an action figure (well, at least one), involving blood, perfect for the fireplaces of the morbid. All the while, she might not have done any of this at all. Examples of the more skeptical, historical view are now filtering into common culture. It seemed almost impossible to find the latter when this article was first written, but now a good few years later there is a small current.