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A child with Dravet syndrome shakes family life to the core. Dravet syndrome usually has three phases: (1) up to 1-1½ years: with episodes of febrile status epilepticus but normal development; (2) age 1½ to ~6-10 years: with frequent seizures of varying types, developmental stagnation, behavioural and sleep problems; (3) after ~10 years: improvement in seizures, deteriorating gait, intellectual disability but some developmental gains. Complete seizure control is rare—simply prescribing medication is inadequate to help families. Based on structured interviews with 24 families and confirmed by more informal discussions with other families, we suggest strategies for coping with this catastrophe. A child with Dravet syndrome usually means that one parent cannot work—financial pressures should be anticipated. In Stage 1, the approach to status should include a written protocol. An indwelling catheter for rapid venous access may be helpful. In Stage 2, assistance finding qualified babysitters is required, and the extended family needs encouragement to help. Appropriate equipment, rescue medication and protocols should travel with the child. Siblings may benefit from a system of one parent “on call.” An internet support group provides an invaluable lifeline. In Stage 3, family isolation may be extreme—respite care and personal time for parents are important. Death from status, accidents and SUDEP (sudden unexplained death in epilepsy) occurs in 15%. Fear of SUDEP needs to be addressed. Moving from paediatric to adult care is frightening; an epilepsy transition clinic is useful. Attention to these realities may improve the quality of life for both child and family.
There is a growing body of literature describing the characteristics of patients who plan for the end of life, but little research has examined how caregivers influence patients' advance care planning (ACP). The purpose of this study was to examine how patient and caregiver characteristics are associated with advance directive (AD) completion among patients diagnosed with a terminal illness. We defined AD completion as having completed a living will and/or identified a healthcare power of attorney.
A convenience sample of 206 caregiver–patient dyads was included in the study. All patients were diagnosed with an advanced life-limiting illness. Trained research nurses administered surveys to collect information on patient and caregiver demographics (i.e., age, sex, race, education, marital status, and individual annual income) and patients' diagnoses and completion of AD. Multivariate logistic regression was employed to model predictors for patients' AD completion.
Over half of our patient sample (59%) completed an AD. Patients who were older, diagnosed with amyotrophic lateral sclerosis, and with a caregiver who was Caucasian or declined to report an income level were more likely to have an AD in place.
Significance of results:
Our results suggest that both patient and caregiver characteristics may influence patients' decisions to complete an AD at the end of life. When possible, caregivers should be included in advance care planning for patients who are terminally ill.
Chinese companies should expand their overseas presence at a faster rate, enhance their co-operation in an international environment, and develop a number of world-class multinational corporations.
—President Hu Jintao, Report to the 18th Party Congress, 8 November 2012
Throughout China's economic reforms since the 1980s the central plank of the country's industrial policy has been the attempt to transform its giant state-owned enterprises into globally competitive firms. A large fraction of the world's leading firms were supported in one way or another by their national governments at some stage in their development (see, e.g., Ruigrok and Van Tulder 1995, table 9A, 239–68). The avenues of state support included full or partial state ownership, protection from international competition through tariffs and import quotas, government procurement policy, government support for research and development, and preferential loans from state-owned banks. China's planners studied the experience of other countries and adapted their policies to its own situation. The structure and operational mechanism of the country's state-owned enterprises have been comprehensively transformed since the 1980s. The results have been remarkable. China's state-owned enterprises have grown at high speed and are highly profitable. China now has a large group of state-owned enterprises in the FT 500 and Fortune 500 global rankings.
However, behind this apparent success, there are deep problems that are widely acknowledged within the Chinese government. The success of China's SOEs has been based heavily on their privileged position within the fast-growing domestic market.
In a single generation, our financial system has been transformed…into a highly concentrated oligopoly of enormous, diversified, integrated firms. This revolution has gone largely unnoticed.
—Henry Kaufman, The Road to Financial Reformation (2009)
The development of capitalism has arrived at a stage when, although commodity production still ‘reigns’ and continues to be regarded as the basis of economic life, it has in reality been undermined and the bulk of the profits go to the ‘geniuses’ of financial manipulation. At the basis of these manipulations and swindles lies socialised production; but the immense progress of mankind, which achieved socialisation goes to the benefit of…the speculators.
—V. I. Lenin, Imperialism, the Highest Stage of Capitalism (1968 , 24)
Of all sectors, banking is the most strategic. This sector is at the centre of the supply and use of money. During the era of modern globalization, the strategic importance of the banking sector increased relentlessly as the global economy became ever more ‘financialized’. In the USA household debt rose from 60 per cent of household income in the 1980s to 120 per cent in 2004. The ratio of global financial assets to global GDP rose from 109 per cent in 1980 to 316 per cent in 2005. By the year 2000, the global stock of household wealth had risen to $125 trillion, around three times global GDP. By early 2007, the volume of outstanding derivatives ($516 trillion) stood at ten times global GDP.
The era of wild capitalist globalization has produced profound contradictions. Many of these involve potential conflict between the USA and China, including climate change, human rights, the struggle for access to natural resources and regulation of the global financial system. There has been increasing discussion in the West about the possibility of a new ‘Peloponnesian War’ between the United States and China. For example, Graham Allison of the Kennedy School of Government at Harvard University warned:
If leaders in China and the US perform no better than their predecessors in classical Greece, or Europe at the beginning of the twentieth century, historians of the twenty-first century will cite Thucydides in explaining the catastrophe that follows. The fact that war would be devastating for both nations is relevant but not decisive. Recall the first world war, in which all the combatants lost what they treasured most.
Much international attention has focused on the possibility that the South China Sea might be a key channel through which a US–China conflict develops. From the point of view of the USA, and indeed the West as a whole, this would be a ‘quarrel in a far-country between people about whom we know nothing’ (Neville Chamberlain, cited in Kagan 2003, 2). However, the region is one about which a great deal is known in China. There are deep connections between the people of mainland China and the 30 million or so descendants of Chinese migrants who settled in Southeast Asia over the centuries.
Pile the sandbags to save the dyke and prevent it bursting:
Zhu lei sha dai, 筑垒沙袋
Jia gu di ba, 加固堤坝
Fang zhi jue kou, 防止决口
1. The Global Macro Economy
Act I. The new age of boundless growth
During the era of capitalist globalization since the 1970s, there has been a long, slowly developing global asset bubble, which gathered pace in the new millennium. The mechanism is exactly the one predicted by Keynes, Kindelberger, Minsky and Galbraith. They each warned that deregulated financial markets have an in-built tendency to create asset bubbles. A vicious circle develops naturally in which credit expansion based on increasing asset values stimulates further increases in asset values. The intensity of such asset bubbles is increased by the wide sense that a ‘new age’ has arrived in which the prospects for growth and profits are boundless due to new technologies and markets. The era of capitalist globalization has nurtured such sentiments on an unprecedented scale.
The central mechanism of the financial crisis is the money-creation machine unleashed by financial market deregulation, led by Wall Street. Since the 1970s, under the leadership of the Washington Consensus institutions, driven by the interests of Wall Street banks, the United States promoted bank privatization and deregulation across the world. The period witnessed a growing ‘financialization’ of the economy, as credit expanded in all its various forms.
Part I analyses the impact of the global financial crisis upon China and the way in which China's policymakers responded to the crisis.
Chapter 1 (‘Re-balancing in the Face of the Global Financial Crisis (1): November 2008’) was written at the outset of the global financial crisis. In a world of weakly regulated financial institutions and freely flowing capital across national boundaries, the high-income economies were fundamentally susceptible to speculative activity. This was itself the consequence of structures created by their own governments, supported by the mass of the population. Government regulatory policies in the high-income countries were ‘captured’ by the giant global banks that had been created as the twin brother of the global business revolution (see Chapters 4 and 5). Deregulation was welcomed by households and voters. They watched happily as their paper wealth rose and they were able to steadily increase their debt based on their illusory increase in wealth. Across the high-income countries voters elected governments that pursued these policies.
The crisis caused enormous difficulties for China, exceeding even those of the Asian financial crisis. China's long-term policy of ‘reform and opening up’ had led China to be far more deeply integrated into the global economic system than other developing countries. It had moved from an exceptionally low foreign trade ratio at the start of the reform process, to an exceptionally high foreign trade ratio. Such an ‘unbalanced’ pattern of development carried high risks.
1. China: From the Asian Financial Crisis to the Global Financial Crisis
Impact of the Asian financial crisis
It is widely thought that the Asian financial crisis of 1997–98 had no substantial impact on China, due to the fact that China did not have capital account convertibility. In fact, China was highly vulnerable to financial contagion, which entered the Chinese domestic system through Hong Kong, and made its impact upon neighbouring Guangdong province.
During the course of China's economic reforms the economies of the Pearl River delta and Hong Kong became more and more closely interconnected. In the mid-1990s, a speculative ‘frenzy’ developed over the prospects that the region offered for capital from both within and outside China. Behind the speculative boom lay the lure of explosive growth rates in Guangdong province, especially in the Pearl River delta. Foreign investors who bought into ‘red chip’ companies in Hong Kong, supported by mainland state ‘parents’, bought bonds of ‘government-backed’ mainland companies from Guangdong and provided them with commercial loans, as they considered that these investments offered a virtually risk-free method of achieving high returns. From within China also, capital poured into the region attracted by the ‘concept’ of local-governmentbacked investment vehicles in townships and cities in China's fastest-growing and most capitalistic province.
‘Moral hazard’ was involved in most aspects of the crisis. There was moral hazard in relation to the deposits made by Chinese investors in the non-bank financial institutions in Guangdong, which were thought to be supported by the local government.
'Re-balancing China' addresses three key sets of issues in China's political economy. Part One provides an analysis of the profound effect of the global financial crisis upon China's economy, as well as the positive impact of the massive rescue package that was implemented in response to the crisis. Part Two focuses on the challenge of globalization for China's industrial policy. After more than two decades of industrial policy, China still has a negligible number of large firms that are competitive in global markets. China's experience presents a fundamental challenge to traditional concepts of industrial policy and development. Part Three examines China's international relations - in particular, its relationship with the US and the interactions between the two countries in the East and South China Seas.
In the Western media China is widely perceived to be engaged in a statesponsored ‘resource grab’ in developing countries. It is also involved in a high-profile dispute with Japan over a group of tiny uninhabited islands, the Diaoyu (in Chinese) or Senkaku (in Japanese) Islands, which are on the edge of the South China Sea. The Western media are full of reports about China's claims to territory in the South China Sea and the fact that if the claims were successful this might bring China access to the natural resources that might be in or under the sea. The Western media routinely refer to China's alleged ‘bullying behaviour’ in the South China Sea. Some commentators have suggested that a new ‘Peloponnesian War’ might begin with the disputes in this sea. The territory in dispute is of great historical and strategic significance, and it may well possess substantial natural resources. However, the resources of the South China Sea are dwarfed in every sense by those involved in the United Nations’ ‘revolutionary’ decision of 1982.
In 1982 the United Nations enacted a ‘revolutionary’ piece of legislation, the United Nations Convention on the Law of the Sea (UNCLOS) which allows countries to establish an ‘exclusive economic zone’ (EEZ) of 200 nautical miles from their coastline. China is a signatory to UNCLOS and the dispute over the South China Sea revolves primarily around the extent of the EEZ that is claimed by China compared with that of the countries with which it is in dispute.