Sunday, January 26, 2020

Diabetes A Major Public Health Issue Health Essay

Diabetes A Major Public Health Issue Health Essay According to current estimates about 366 million people have diabetes in 2011 all over world. It has been projected that by 2030 this will have risen to 552 million. The number of people with type 2 diabetes is increasing throughout the globe. Among them about 80% of people with diabetes live in low- and middle-income countries. The majority of people with diabetes lie in the age group of 40 to 59 years of age. Almost half of this population, 183 million people (50%) is undiagnosed. Diabetes caused 4.6 million deaths in 2011. 78,000 children develop type 1 diabetes every year. India has become the global capital for both the kinds of disease- Communicable as well as NCD or life-style diseases. There is this double burden of disease. The major diseases in the NCDs are Diabetes, CHD and Hypertension. These three diseases alone cause more than 400 deaths per million population in a year. Among them Diabetes demands the major concern because it is intricately related to the development of the two other factors (increases the risk of) CHD and Hypertension. There is also an increasing trend of obesity world-wide which also adds to the development of Diabetes as a risk factor. It is the fourth or fifth leading cause of death in the most high-income countries and it is taking the form of an epidemic in many developing as well. Diabetes has become one of the most challenging health problems of this century. There have been many studies since the last two decades which confirm that the low and middle income countries are going to face the greatest burden of this disease. The governments and public health planners of many developing countries including India still remain ignorant of this upcoming health evil. The magnitude of this disease has serious implications in terms of its economic burden in its treatment and loss in terms of wage and deteriorated quality of work by people affected by Diabetes. This can drastically influence the growth of a country especially developing countries like India. Global Prevalence of Diabetes and projection till 2030global-diabetes.png Numbers of people with diabetes (in millions) for 2000 and 2010 (top and middle values, respectively), and the percentage increase wed.png Source- Nature | Vol. 414 | 13 December 2001 | www.nature.com There have been reports of increasing cases of Myocardial Infarction even in very young patients among the Juvenile diabetes cases. It is a far more disabling than generally considered, it drastically decreases ones stamina and working capacity. As it is a multisystem disorder it influences other sensory functions as well such as Diabetic retinopathy (hampering vision), Diabetic nephropathy (causing renal disease and failure), Diabetic neuropathy (including diabetic foot) and many other complications. The presentation of classical symptoms of polydypsia, polyphagia, polyuria is not always the picture of diabetes. It is only seen in few classical cases. So, it is often diagnosed during routine test or examination done when patient had presented for some other disease or illness. The lack of awareness among people about this disease is of major concern. Due to this many cases go undetected. India has imitated the Western ways of lifestyle and hence illnesses such as obesity and diabetes are increasing day by day. In 2011, India had 62.4 million people with type 2 diabetes, compared with 50.8 million cases in 2010, according to the International Diabetes Federation (IDF) and the Madras Diabetes Research Foundation. The nationwide prevalence of diabetes in India now tops 9%, and is as high as 20% in the relatively prosperous southern cities. By 2030, the IDF predicts, India will have 100 million people with diabetes. Another matter of great concern is the fact that the onset of type 2 diabetes tends to affect people in the West in their 40s and 50s, whereas the disease strikes Indians at a much younger age. Even young people of 25 years of age are being diagnosed with the disease, a trend that threatens to seriously hamper the countrys economic development. The rise of type 2 diabetes in India was in fact foreseen by some scientists and health experts. Till1980s, the urban prevalence of diabetes was at least double the rural prevalence. But this picture of diabetes has changed significantly over time and has spread out of urban cities into the countryside and majority of rural areas. Type 2 Diabetes constitutes more than 90 % of the whole diabetes cases in any country including India. It has a wide variety of determinants and risk factors associated with it, which need to be known and focused during policy formulation to address Diabetes. Aetiological determinants and risk factors of type 2 diabetes Genetic factors Genetic markers, family history, thrifty gene(s) Demographic characteristics Sex, age, ethnicity Behavioural- and lifestyle-related risk factors Obesity (including distribution of obesity and duration) Physical inactivity Diet Stress Westernization, urbanization, modernization Metabolic determinants and intermediate risk categories of type 2 diabetes Impaired glucose tolerance Insulin resistance Pregnancy-related determinants (parity, gestational diabetes, diabetes in offspring of women with diabetes during pregnancy, intra-uterine mal or over nutrition) Source- Nature | Vol. 414 | 13 December 2001 | Www.Nature.Com Villages in wealthier southern states like Tamil Nadu and Kerala are seeing prevalence hit double digits, which is enormous. If it was confined to affluent India, you could still put a lid on it, but now its rising quickly all over the country. as per Nikhil Tandon, an endocrinologist at the All India Institute of Medical Sciences in New Delhi. There is also a considerable genetic propensity towards Diabetes in the Asian population particularly in India. india diabtes.png AIMS OBJECTIVES Diabetes has yet not been recognized in our country as a major public health issue, although the morbidity and mortality and hence economic burden and loss due to it is much higher than that caused by many other communicable or other diseases such as AIDS or STDs, for which there are well formulated programs. But there are no such programs or targeted approach to tackle this very prominent deterrent of health in our country, Diabetes. There is almost no health care accessibility and availability dedicated in this regard in public scale. They are primarily excluded from government policies and decision making process. Not much work or studies have been conducted on the prevalence of Diabetes in India, especially rural India. There is a need to assess the real magnitude of this urgent problem which demands special concern in form of targeted policies and programs and screening. The aim of my study is to highlight the immediate need of recognition of Diabetes as a major public-health co ncern and formulation of strategies, Policies and programs concerning Diabetes in India. RECOMMENDATIONS (1) Studies need to be conducted to determine the level of awareness and knowledge about diabetes at the community level in different parts of India. As we know IEC is very important for any community or mass scale program to be successful. It is also important in view of the Sickness behavior and the sick role played by the individuals. Creating awareness among the people will make them come up for the screening and a better turn up for treatment in early stage which will significantly reduce the loss due to the disease to the person and state as a whole. (2) More studies and research required to identify the risk factors for diabetes, the relationship between anthropometric measures and diabetes risk and estimate the burden of diabetes in this rural Indian population with an objective to identify target areas for future healthcare planning. (3) Screening programs need to be formulated in the mass scale and many rounds of such screening will be required to assess the real magnitude of the problem in Indian population, so that, resources are used accordingly for planning of policies and programs. These data will be extremely important for planning the public health policies especially the envisaged National Diabetic Control Program. (4) Tracing the exact pattern of the disease in the population and its demographic pattern is essential. Some of the recent studies have identified increasing cases of juvenile diabetes and there is detection of more and more cases in the lower marginalized and poorer section of population (Diabetes was once believed to be disease of elites, those of the rich sections of population associated with over eating, obesity etc). Now the picture of disease is changing which needs to be traced and addressed in the following policies for diabetes control and prevention. Research should also be directed in the direction to identify the most appropriate test for screening purpose, as the results depend on the test employed to a significant degree, especially when employed for mass screening. (5) Clear cut policy outlines to tackle with the complications of Diabetes- The complications due to Diabetes can be even more disabling and in some cases even fatal. So it is very important to make clear cut policy outlines to tackle with the complications of Diabetes and its prevention. Measures should aim at intensive control of blood glucose to prevent the retinal, renal and neuropathic complications of diabetes. There is a concealed burden of Impaired Glucose Tolerance. The possibility of preventing type 2 diabetes by interventions that affect the lifestyles of subjects at high risk for the disease have focused on people with impaired glucose tolerance (IGT). It affects at least 200 million people worldwide. Approximately 40% of subjects progress to diabetes over 5-10 years, but some revert to normal or remain IGT. So, it is very essential to take this group of individuals into consideration. (6) Formation of a separate body under Ministry of Health and Family Welfare as Diabetes Control Organization or so to tackle with Diabetes in an integrated and comprehensive way throughout the country. Formulation of Control and Prevention Programs to be implemented in each state. Prior to this there should be formation of an Expert group to assess the actual prevalence and exact demographic characteristics of Diabetes in different regions of India. (7) Reinforcing legislative changes such as increased taxation of certain unhealthy foods to promote healthy diet. Although it is difficult but such steps may help to a great extent. CONCLUSION A much more integrated approach is needed to have a significant impact on the diabetes epidemic in India. Type 2 diabetes is not merely a disease but reflection of a much bigger problem, that is, the effect of environmental and lifestyle changes on human health. We need well integrated policies for education of the mass through IEC. The major proportion of Diabetes cases in India is Type-2 which is preventable. It is a huge threat to public health and in absence of interventions there would be great loss. Thus prevention of diabetes and its micro- and macro-vascular complications should be an essential component of future public health strategies for all nations. An essential and immediate need is the formation of multidisciplinary national encompassing all parties that can help address and control the underlying socioeconomic causes that have led to the diabetes epidemic. ANNEXURE Recent studies have highlighted the potential for intervention in IGT subjects to reduce progression to type 2 diabetes. One such study is the recently completed Diabetes Prevention Program in the United States. Diabetes education is necessary to control Diabetes. It includes diabetes self-management education (DSME) and diabetes self-management training (DSMT). It helps people to modify their behavior and hence mange the disease. Healthy People 2010 objective regarding diabetes education- At least 60 percent of persons with diabetes should receive formal diabetes education in order to attain considerable level of awareness in the community as per the American Association of Diabetes Educators. List of Stake holders- Govt. of India, Ministry of health and Family Welfare. State Governments. NGOs and other organizations Media for awareness. Family of Diabetic patients.

Saturday, January 18, 2020

The Return: Nightfall Chapter 6

â€Å"Isaid,get out ,† Meredith repeated to Caroline, still quietly. â€Å"You've said things that never should have been said in any civilized place. This happens to be Stefan's place – and, yes, it's hisplace to order you out, too. I'm doing it for him, though, because he never would ask a girl – and a former girlfriend, I might add – to get the hell out of his room.† Matt cleared his throat. He'd stepped back into a corner and everyone had forgotten about him. Now he said, â€Å"Caroline, I've known you way too long to be formal, and Meredith's right. You want to say the kind of things you've been saying about Elena, you do it somewhere faraway from Elena. But, look, there's one thing I know. No matter what Elena did when she was – was downhere before† – his voice dropped a little in wonder, and Bonnie knew that he meant, when Elena was here on Earth before – â€Å"she's as close to an angelnow as you can get. Right now she's†¦she's†¦completely†¦Ã¢â‚¬  He hesitated, stumbling for the right words. â€Å"Pure,† Meredith said easily, filling in the blank for him. â€Å"Yeah,† Matt agreed. â€Å"Yeah, pure. Everything she does is pure. And it's not like any of your nasty words could stain her, anyway, but the rest of us just don't like hearing you try.† There was a low â€Å"Thank you† from Stefan. â€Å"I was already going,† Caroline said, now through her teeth. â€Å"And don't youdare preach atme about purity ! Here, with all this going on! You probably just want to watch it going on yourself, two girls kissing. You probably – â€Å" â€Å"Enough.† Stefan said it almost expressionlessly, but Caroline was swept off her feet, up and out of the door, and deposited there by invisible hands. Her purse trailed after her. Then the door quietly shut. Fine hairs rose on the back of Bonnie's neck. This was Power, in such amounts that her psychic senses were stunned and temporarily paralyzed. Moving Caroline – and she wasn't a small girl – now that took Power . Maybe Stefan had changed just as much as Elena had. Bonnie glanced at Elena, whose pool of serenity was rippling because of Caroline. Might as well take her mind off it, and maybe make herself worthy of athank you from Stefan, Bonnie thought. She tapped Elena's knee, and when Elena turned, Bonnie kissed her. Elena broke the kiss very quickly, as if afraid to set off some holocaust again. But Bonnie saw at once what Meredith had said about it not being sexual. It was†¦more like being examined by someone who used all her senses to the fullest. When Elena moved away from Bonnie she beamed at her just as she had at Meredith, all the distress washed away by – yes, thepurity of the kiss. And Bonnie felt as if some of Elena's tranquility had soaked into her. â€Å"†¦should have known better than to bring Caroline,† Matt was saying to Stefan. â€Å"Sorry about butting in. But Iknow Caroline, and she could have gone on ranting for another half hour, never actually leaving.† â€Å"Stefan took care of that,† Meredith said, â€Å"or was that Elena, too?† â€Å"It was me,† Stefan said. â€Å"Matt had it right: she could keep on talking forever without actually leaving. And I'd just as lief nobody run Elena down like that in my hearing.† Why are they talking about those things? Bonnie wondered. Of all people, Meredith and Stefan were least inclined to chatter, but here they were, saying things that didn't really need to be said. Then she realized it was for Matt, who was moving slowly but with determination toward Elena. Bonnie got up as quickly and as lithely as if she could fly, and managed to pass Matt without looking at him. And then she was joining Meredith and Stefan in small talk – well, medium-small talk – about what had just happened. Caroline made a bad enemy, everyone agreed, and nothing seemed to teach her that her schemes against Elena always backfired. Bonnie would bet that she was hatching a new scheme right now against all of them. â€Å"She feels lonely all the time,† Stefan said, as if trying to make excuses for her. â€Å"She wants to be accepted, by anyone, on any terms – but she feels – apart. As if nobody who really got to know her would trust her.† â€Å"She's defensive,† Meredith agreed. â€Å"But you'd think she'd showsome gratitude. After all, we did rescue her and save her life just over a week ago.† There was more to it than that, Bonnie thought. Her intuition was trying to tell her something – something about what might have happenedbefore they had been able to rescue Caroline – but she was so angry on Elena's behalf that she ignored it. â€Å"Why should anybody trust her?† she said to Stefan. She sneaked a peek behind her. Elena was definitely going to know Matt anywhere, and Matt looked as if he were fainting. â€Å"Caroline's beautiful, sure, but that's it. She never has a good word to say about anybody. She plays games all the time – and – and Iknow we used to do some of that, too†¦but hers are always meant to make other people look bad. Sure, she can take mostguys in† – a sudden anxiety swept over her, and she spoke more loudly to try to push it away – â€Å"but if you're a girl she's just a pair of long legs and big – â€Å" Bonnie stopped because Meredith and Stefan had frozen, with identicalOh-God-not-again expressions on their faces. â€Å"And she also has very decent hearing,† said a shaking, threatening voice from somewhere behind Bonnie. Bonnie's heart leaped into her throat. That was what you got for ignoring premonitions. â€Å"Caroline – † Meredith and Stefan were both trying for damage control, but it was too late. Caroline stalked in on her long legs as if she didn't want her feet to touch Stefan's floorboards. Oddly, though, she was carrying her high heels. â€Å"I came back in to get my sunglasses,† she said, still in that trembling voice. â€Å"And I heard enough to know now what my so-called ;;friends' think of me.† â€Å"No, you didn't,† Meredith said, as rapidly eloquent as Bonnie was stunned mute. â€Å"You heard some very angry people letting off steam after you'd just insulted them.† â€Å"Besides,† Bonnie said, suddenly able to speak again, â€Å"admit it, Caroline – youhoped you'd hear something. That's why you took off your shoes. You were right behind the door, listening, weren't you?† Stefan shut his eyes. â€Å"This is my fault. I should have – â€Å" â€Å"No, you shouldn't,† Meredith said to him, and to Caroline she added, â€Å"And if you can tell me one word we said that isn't true, or was exaggerated – except maybe for what Bonnie said, and Bonnie is†¦just being Bonnie. Anyway, if you can point to one word of what the rest of us said that isn't true,I'll beg your pardon.† Caroline wasn't listening. Caroline was twitching. She had a facial tic, and her lovely face was convulsed, dark red, with fury. â€Å"Oh, you'regoing to beg my pardon all right,† she said, wheeling to point her long-nailed forefinger at each of them. â€Å"You'reall going to be sorry. And if you try that – that witchcraft-vampire type thing on me again,† she said to Stefan, â€Å"I have friends – real friends – who'd like to know about it.† â€Å"Caroline, just this afternoon you signed a contract – â€Å" â€Å"Oh, who gives a damn?† Stefan stood up. It was dark now inside the small room with its dusty window, and Stefan's shadow was thrown before him by the bedside lamp. Bonnie looked at it and then poked Meredith, as the hairs tingled on her arms and neck. The shadow was surprisingly dark and surprisingly tall. Caroline's shadow was weak, transparent, and short – an imitation shadow beside Stefan's very real one. The thunderstorm feeling was back. Bonnie was shaking now; trying not to, but unable to stop the shivering that had come on as if she had been thrown into icy water. It was a cold that had gotten directly into her bones and was ripping layer after layer of heat off them like some greedy giant, and now she was beginning to shakehard†¦. Something was happening to Caroline in the darkness – something was coming from her – or comingfor her – or maybe both. In any case, it was all around her now, and all around Bonnie, too, and the tension was so thick that Bonnie felt choked, her heart pounding. Beside her, Meredith – practical, level-headed Meredith – stirred uneasily. â€Å"What – ?† Meredith began in a whisper. Suddenly, as if it had all been exquisitely choreographed by the things in the dark – the door to Stefan's room slammed shut†¦the lamp, an ordinary electric one, went off†¦the ancient rolled-up shutter over the window came rattling down, dropping the room into sudden and complete darkness. And Caroline screamed. It was an awful sound – raw, as if it had been stripped like meat from Caroline's backbone and yanked out of her throat. Bonnie screamed, too. She couldn't help it, although her scream sounded too faint and too breathless, like an echo, not the coloratura job that Caroline had done. Thank God that at least Caroline wasn't screaming any longer. Bonnie was able to stop the new scream building in her own throat, even though her shaking was worse than ever. Meredith had an arm around her tightly, but then, as the darkness and the silence went on and Bonnie's shaking only continued, Meredith got up and heartlessly passed her to Matt, who seemed astonished and embarrassed, but tried awkwardly to hold her. â€Å"It's not as dark once your eyes get used to it,† he said. His voice was creaky, as if he needed a drink of water. But it was the best thing that he could have said, because of all things in the world to fear, Bonnie was most afraid of the dark. There werethings in it, things that only she saw. She managed, despite the terrible shaking, to stand with his support – and then she gasped, and heard Matt gasp, too. Elena was glowing. Not only that, but the glow extended out behind her and far to either side of her in a pair of what were beautifully defined, and undeniablythere†¦wings. â€Å"She h-has wings,† Bonnie whispered, the stutter caused by her shaking rather than by awe or fear. Matt was clinging toher now, like a child; he obviously couldn't answer. The wings moved with Elena's breathing. She was sitting on thin air, steady now, one hand held out with her fingers all spread in a gesture of denial. Elena spoke. It wasn't any language that Bonnie had heard before; she doubted it was any language people on Earth used. The words were sharp, thin-edged, like the splintering of myriad shards of crystal that had fallen from somewhere very high and very far away. The shape of the wordsalmost made sense in Bonnie's head as her own psychic abilities were sparked by Elena's tremendous Power. It was a Power that stood tall against the darkness and now was sweeping it aside†¦making the things in the dark scamper away before it, their claws scritching in all directions. Ice-sharp words followed them all the way, dismissive now†¦. And Elena†¦Elena was as heartbreakingly beautiful as when she'd been a vampire, and seemed almost as pale as one. But Caroline was shouting, too. She was using powerful words of Black Magic, and to Bonnie it was as if the shadows of all sorts of dark and horrible things were coming from her mouth: lizards and snakes and many-legged spiders. It was a duel, a face-off of magic. Only how had Caroline learned so much dark magic? She wasn't even a witch by lineage, like Bonnie. Outside Stefan's room, surrounding it, was a strange sound, almost like a helicopter. Whipwhipwhipwhipwhip†¦ It terrified Bonnie. But she had to do something. She was Celtic by heritage and psychic because she couldn't avoid it, and she had to help Elena. Slowly, as if making her way against gale-force winds, Bonnie stumbled to put her hand on Elena's hand, to offer Elena her power. When Elena clasped hands with her, Bonnie realized that Meredith was on her other side. The light grew. The scrabbling lizard things ran from it, screaming and tearing at each other to get away. The next thing Bonnie knew, Elena had slumped over. The wings were gone. The dark scrabbling things were gone, too. Elena had sent them away, using tremendous amounts of energy to overwhelm them with White Power. â€Å"She'll fall,† Bonnie whispered, looking at Stefan. â€Å"She's been using magic so strong – â€Å" Just then, as Stefan started to turn to Elena, several things happened very fast, as if the room was caught in the flashes of a strobe light. Flash. The window shade rolled back up, rattling furiously. Flash. The lamp went back on, revealing it was in Stefan's hands. He must have been trying to fix it. Flash. The door to Stefan's room opened slowly, creaking, as if to make up for slamming shut before. Flash. Caroline was now on the floor, on all fours, groveling, breathing hard. Elena had won†¦. Elena fell. Only inhumanly fast reflexes could have caught her, especially from across the room. But Stefan had tossed the lamp to Meredith and was across the distance faster than Bonnie's eyes could follow. Then he was holding Elena, encircling her protectively. â€Å"Oh,hell ,† said Caroline. Black trails of mascara ran down her face, making her look like something not quite human. She looked at Stefan with unconcealed hatred. He looked back soberly – no,sternly . â€Å"Don't call on Hell,† he said in a very low voice. â€Å"Not here. Not now. Because Hell might hear and call back.† â€Å"As if it already hadn't,† Caroline said, and in that moment, she was pitiful – broken and pathetic. As if she had started something she didn't know how to stop. â€Å"Caroline, what are you saying?† Stefan knelt. â€Å"Are you saying that you've already – made some bargain – ?† â€Å"Ouch,† Bonnie said, suddenly and involuntarily, shattering the ominous mood in Stefan's room. One of Caroline's broken nails had left a trail of blood on the floor. Caroline had knelt in it, too, making things pretty messy. Bonnie felt a sympathetic throb of pain in her own fingers until Caroline waved her bloody hand at Stefan. Then Bonnie's sympathy turned to nausea. â€Å"Want a lick?† she said. Her voice and face had changed entirely, and she wasn't even trying to hide it. â€Å"Oh, come on, Stefan,† she went on mockingly, â€Å"youdo drink human blood these days, don't you? Human or – whatever she is, whatever she's become. You two fly like bats together now, do you?† â€Å"Caroline,† Bonnie whispered, â€Å"didn't yousee them? Her wings – â€Å" â€Å"Just like a bat – or another vampire already. Stefan's made her – â€Å" â€Å"I saw them too,† Matt said flatly, behind Bonnie. â€Å"They weren't bat wings.† â€Å"Doesn't anybody have eyes?† Meredith said from where she stood by the lamp. â€Å"Look here.† She bent. When she stood again she was holding a long white feather. It shone in the light. â€Å"Maybe she's a white crow, then,† Caroline said. â€Å"That would be appropriate. And I can't believe how you're all – all – fawning on her as if she were some sort of princess. Always everybody's little darling, aren't you, Elena?† â€Å"Stop it,† Stefan said. â€Å"Everybody's, that's the key word,† Caroline spat. â€Å"Stop it.† â€Å"The way you were kissing people one after another.† She gave a theatrical shudder. â€Å"Everyone seems to have forgotten, but that was more like – â€Å" â€Å"Stop, Caroline.† â€Å"Thereal Elena.† Caroline's voice had become pretend-prissy, but she couldn't keep the venom out, Bonnie thought. â€Å"Because anyone who knows you knows what youreally were before Stefanblessed us with hisirresistible presence. You were – â€Å" â€Å"Caroline, stop right there – â€Å" â€Å"A slut! That's all! Just a cheap, anybody'sslut !†

Thursday, January 9, 2020

The Fundamentals of Good Essay Introduction Samples Revealed

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Wednesday, January 1, 2020

Essay on Existentialism in Bill Watterson’s Comic Strips

Bill Watterson is an American cartoonist, author of the famous comic strips â€Å"Calvin and Hobbes† syndicated from 1985 to 1995. In these short-stories, Calvin is a creative kid full of childish pranks, and together with Hobbes, a deep-thinking stuffed tiger, they both stand as examples of existentialism in comic strips. Through Calvin’s desperate choices and decisions over many circumstances in the stories, he struggles against a continually changing world. The characters’ actions portray the humanity disorder; people who are controlled in a worthless way of life against a ruthless nature, a cruel world, and inevitable death. All through these modern comic strips, Bill Watterson created Calvin as a unique character contrasting with any†¦show more content†¦People are able to compare their own situations to Calvin’s, and understand the ironies of making a desperate forced decision. His incredible sarcasm and defiance appeal to people’s inner sense of injustice. Calvin makes people’s own desperate choices seem not so desperate (The Calvin and Hobbes Tenth Anniversary Book). The picture of life as being uncontrollable, brings people back into their own world, and makes them grateful not to be in Calvin’s existential condition (Calvin and Hobbes and the Moral Sense: A Farewell). Therefore, Calvin character’s judgment is strong; he knows he is stuck in a world of chain reactions (Calvin and Hobbes and the Moral Sense: A Farewell). It’s simple to follow, and to demonstrate, how large the existentialism influence is in Bill Watterson’s â€Å"Calvin and Hobbes† comics. In existentialism theory, this means that choices people make are a consequence their previous decisions, and each one’s decision determines the variety of the next choices people will face (The Humanism of Existentialism II). One great cartoon example is when Calvin is in his speedy red wagon tumbling down a hill, and randomly chooses to go left. Without a doubt, this sudden decision of him creates a chain reaction of choices, which ultimately causes Calvin to jump from the mountain into a river (The Calvin and Hobbes Tenth Anniversary Book). These