Psychological Distress Experienced by Medical Students

Psychological Distress Experienced by Medical Students INTRODUCTION The psychological distress of medical students is more commonly associated with stress, anxiety and depression [1]. It is a fact that tertiary medical education is highly stressful due to factors that include academic pressures, obstacles to their goal achievement, environmental changes, life challenges such as transition from school to university and the change in role from student to knowledgeable physician [2,3]. Even though there were studies suggested that some stress in medical school training involve stress, this stressful environment can exert a negative effect on the psychological and physical well-being of the undergraduates [5,6]. The stress can be defined as â€Å"a state of mental or emotional strain or suspense† and also as â€Å"a number of normal reactions of the body (mental, emotional, and physiological) designed for self-preservation† [7]. Stress is also defined as not just a stimulus or a response but rather, it is a process by which we perceive and cope with environmental threats and challenges [8]. On the other hand, anxiety can be defined as â€Å"an emotion characterized by feelings of tension, worried thoughts and physical changes. People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also experience physical symptoms such as sweating, trembling, dizziness or rapid heartbeat† [4]. While depression is more than just sadness. People with depression may experience a lack of interest and pleasure in daily activities, significant weight loss or gain, insomnia or excessive sleeping, lack of ener gy, inability to concentrate, feelings of worthlessness or excessive guilt and recurrent thoughts of death or suicide [4]. However, for the sake of simplicity, these three most common condition psychological issues are coined into one term that is ‘stress’ as all of them are closely related [9]. Several studies have revealed that the incidence of stress among medical profession are increasing day by day and medical students have been found to experience higher level of depression and anxiety compared to the general population and to their same age group individuals [10,11,12]. The top ten main stressors found by Yusuf et al. at Universiti Sains Malaysia (USM) based on scores given by the medical students were all related to academic matters while Wolf et al. listed examination, class-work and financial responsibilities as their main stressor [13,14]. Therefore, it is critical for medical educators to understand the prevalence and causes of student distress, potential adverse personal and professional consequences, and institutional factors that can influence student’s health. It is suggested that an intervention programs could be implemented to reduce the stress levels [14]. OBJECTIVES The review was carried out to address the following questions: What is the prevalence of psychological distress experienced by medical students’? What are the socio demographical factors associated with psychological distress experienced by medical students’? METHODOLOGY 10 keyword were chosen to do the search for this project. Keywords – Malaysia, Medical students, stress, psychological distress, anxiety, depression, emotional disorder, mental health, undergraduates and trainee Literature review was carried out using the following electronic databases: PUBMED, Medline, Science Direct, Up-to-Date and Google scholar databases for articles on medical student’s distress in Malaysia. It was a systemic review of the literatures carried out from October 2014 to February 2015. Inclusion and Exclusion criteria All articles that published data related to stress or psychological distress/health of Malaysian medical students and written in English were eligible for inclusion in this study. The latest articles published since January 2014 was included. From the search, 20 full text articles were retrieved based on the relevance in relation to the topic. In addition, the reference list of the articles retrieved were also checked to find similar articles. RESULT Instrument used There are variety of tools used to assess psychological distress. The tools used will be selected based on elements to be assess. The most common one used for assessment of stress in Malaysian based study is General Health Questionnaire (GHQ) using 12 items or 28 items. The questionnaire was developed by Goldberg in 1978 which measures two important elements. The first one is the inability to carry out normal functions and the appearance of distress. The second is to assess the well-being in a person [15]. Other tools for used includes Social Phobia Inventory (SPIN), Beck’s Depression Inventory (BDI) and Depression Anxiety and Stress Scale (DASS). Medical Student Stressor Questionnaire (MSSQ) was used to identify sources of stress or stressor [16]. Prevalence of psychological distress The overall prevalence rate of psychological distress among medical student in Malaysia are range from 14.3% to 56% [17,18]. The highest prevalence rate of 56% was obtained from Salina et al. where they did a survey on 101 medical students in University Malaya (UM). Based on SPIN scores, they conclude that 56% of the medical student who scored 19 or above have higher probability of having social anxiety disorder [18]. While the lowest prevalence of psychological distress with rate of 14.3% was documented by Yusoff et al. from the study among a cohort of University Sains Malaysia (USM) medical students where two cohorts of first year (2008/2009 and 2009/2010 intake) were compared. Cohort 1 was selected based on academic merit while cohort 2 was selected based on academic merit, psychometric assessment and interview performance. Based on GHQ scores, the results indicate that cohort 1 (prevalence rate of 26.3%) experienced more psychological distress compared to cohort 2 (prevalence rat e of 14.3%) indicating that stratification of student selection by using multimodal criteria might better identify medical students with good psychological health [17]. A study on psychological distress by using DASS scores was done by Nikmat et al. among 110 preclinical medical students of University Teknologi Mara (UiTM). The results were classified into mild, moderate, severe and extremely severe. It was further divided into two group which were ‘clinical’ for severe and extremely severe and ‘sub-clinical’ for mild and moderate. Out of 110 students, 5.5% of students had clinical depression, 24.5% clinical anxiety and 7.3% had clinical stress. Other remaining students experienced sub-clinical depression, anxiety and stress with prevalence of 36.4%, 35.5% and 30.0% respectively [21]. Yusoff et al. documented prevalence of depressive symptoms rate by using BDI scale among final year medical students stood at 21.7% [22]. Socio demographic variables Study years Stress among different years of students was studied by Sherina et al, Zaid et al and Yusoff et al. Cumulatively, They found that the stress prevalence for different years of study were varied. According to Sherina et al. based on the study in 2003, there was high prevalence of stress among 1st (48.6%) and 4th (41.4%) year medical students in comparison to students of second, third and final years. The most acceptable explanation was that 1st year student have to adjust to a new environment of medical educations. While the year 4 students whom just in their early days of clinical setting need to adjust their way with hospital setting and undergo clinical examinations which were totally different from pre-clinical years [23]. In addition to that, a study done by Zaid et al. in 2007 seems to support the findings of Sherina et al. with their results of having high prevalence of emotional disorder for the 1st (50%), but rather different for 5th (62.7%) year medical students. The extremel y high score documented by the final year students (5th year) was probably due to high expectations for them to become a competent doctors and to acquire good academic results, whereas the high score for the 1st year students might be because of the effect of stiff competition they faced to enter the medical schools and also due to process of adjustment to the medical education setting [24]. In contrary to that, in 2010 Yusoff et al. found lower stress prevalence in both 1st (26.3%) and final year (21.9%) students. Even other years of study also showed lower stress prevalence with 36.5% for 2nd year, 31.4% for 3rd year and 35.3% for 4th year medical students in comparison to result documented by Sherina et al. and Zaid et al. The probable reason was that 1st year students were at the beginning of their course, full of euphoria and still not yet face difficult subjects which make them less stressful. On the other hand, 5th year students possibly developed skills to manage their studi es and able to cope with stress. According to Yusoff et al. adaptation periods to the new phases of studies and impact of transition could be the reason of high prevalence in 2nd year and 4th year students [14]. Ethnics Although there was no documented significant association between ethnic and psychological distress, Johari et al and Sherina et al. managed to publish the prevalence of psychological distress between the 4 major ethnics in Malaysia. Sherina et al mention that Chinese and other ethnics had prevalence rate of 42.0% and 18.8% respectively, which was lower compared to Indian whom had the highest prevalence (48.1%) followed by the Malays (42.9%) according to Johari et al [23,25]. Gender To date, only few articles were found to study relationship of stress between male and female [14,18,23,24]. As expected, all studies indicate that female students have higher stress level compared to male, although only one; Yusoff et al. was able to achieve significant relationship statistically [20]. Financial problem There are two studies which was conducted inter universities (public universities) by Yusoff et al. and Johari et al. in 2009 and 2011 that highlighted the significant relation between psychological distress and financial difficulties [25,26]. While Radman et al. also obtained similar result in their investigation among private inter universities [27]. Apparently, Zaid et al. whom did similar research in one private medical school did not found any relation between financial issues and psychological distress [24]. Relationship problem Rather surprising fact found by Zaid et al. (2007) which stated that relationship problems with parent, siblings, friends and lecturers were not associated with psychological distress [24]. However, earlier research in 2003 by Sherina et al. did mention that there were significant stress level among medical students having relationship problems, and this fact was supported by Johari et al. in 2009 [23,25]. Apart from that, other types of relationship which can be consider a special relationship (marital and romantic relationship) might help to reduce stress level. As mentioned by Zaid et al. the students whom did not involve in special relationship were found having significantly more stress (51.7%) than (37%) in those who involved [24]. In addition, married students were proved by Johari et al. to be in significantly less stressed compare to single status [25]. Other factors Yusuf et al. in his study involving inter universities medical students, has found that there was a significant relationship between different universities and psychological distress. Perhaps different kind of modules, examination, environment, clinical structures do play a role [26]. While poor general health and younger also identified as significant factors for psychological distress [25,26]. Other factors such as types of school, number of siblings, religion and co-curriculum did not contribute to stress among medical student [14,18] REFERENCES N. Bayram and N. Bilgel, â€Å"The prevalence and socio-demo-graphic correlations of depression, anxiety and stress among a group of university students,† Social Psychiatry and Psychiatric Epidemiology, vol. 43, no. 8, pp. 667–672, 2008. M. S. Sherina, L. Rampal, and N. Kaneson, â€Å"Psychological stress among undergraduate medical students,† Medical Journal of Malaysia, vol. 59, no. 2, pp. 207–211, 2004. Habeeb KA. Prevalence of stressors among female medical students Taibah.University. J Taibah Univ Med Sci, 5, 110-119. 2010 Kazdin A. Encyclopedia of psychology. Washington, D.C.: American Psychological Association; 2000. Linn BS, Zeppa R. Stress in Junior Medical Students:Relationship to Personality and Performance. J Med Education. 59(1):7–12.1984 Mosley TH Jr., Perrin SG, Neral SM, Dubbert PM, Grothues CA, Pinto BM. Stress, coping and well-being among third year medical students. Acad. Med. 69:765–7.1994 PRINCETON UNIVERSITY (2001). Word Net Dictionary. USA. Myers DG. Stress and Health. In: Exploring Psychology. 6th edition. New York: Worth Publishers. p. 402. 2005 Ko SM, Kua EH, Fones CSL. Stress and the Undergraduates. Singapore MedJ 40(10): 627-30. 1999 Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med, 81, 354-373. 2006 Saipanish R. Stress among medical students in a Thai medical school. Med Teach, 25, 502-506. 2003 M. Dahlin, N. Joneborg, and B. Runeson, â€Å"Stress and depression among medical students: a cross-sectional study,† Medical Education, vol. 39, no. 6, pp. 594–604, 2005. Wolf TM, Faucett JM, Randall HM, Balson PM. Graduating medical students ratings of stresses, pleasures, and coping strategies. J Med Educ, 63, 636-642. 1998 Yusoff MSB, Abdul Rahim AF, Yaacob MJ. Prevalence and sources of stress among Universiti Sains Malaysia medical students. Malaysian J Med Sci. 2010;17(1):30–37. Goldberg D. Manual of the general health questionnaire. NFER Publishing Company.1978 Yusoff MSB, Rahim AFA, Yaacob MJ. The Development and Validity of the Medical Student Stressor Questionnaire (MSSQ). ASEAN J Psychiatry, 11. 2010 Yusoff MSB, Rahim AFA, Baba AA, Ismail SB, Esa AR. A study on psychological distress of two batches of first-year medical students underwent different selection admission processes. Malays J Med Sci. 2012 Salina M, Ng CG, Gill JS, Chin JM, Chin CJ, Yap WF.Social anxiety problem among medical students in Universiti Malaya Medical Center (UMMC): a cross-sectional study. Malaysian J Psychiatry. 2008 Ko SM, Kua EH, Fones CSL. Stress and The Undergraduate, Singapore Med J. 1999; 40:627–630. Yusoff MSB, Saiful M, Ahmad Fuad AR, Yaacob MJ. The prevalence of final year medical students with depressive symptoms and its contributing factors. International Medical Journal, 2011; 18, 305-309. Nikmat AW, Mariam M, Ainsah O, Salmi R. Psychological well-being, stress and coping style among pre-clinical medical students. Research management in state, University Teknologi Mara. 2010 Yusoff MSB, Saiful M, Ahmad Fuad AR, Yaacob MJ. The prevalence of final year medical students with depressive symptoms and its contributing factors. International Medical Journal, 2011; 18, 305-309. Sherina MS, Rampal L, Kaneson N. Prevalence of emotional disorders among medical students in a Malaysian university. Asia Pac Fam Med, 2003; 2, 213-217. Zaid ZA, Chan SC, Ho JJ. Emotional disorders among medical students in a Malaysian private medical school. Singapore Med J, 2007; 48, 895-899. Johari AB, Hassim IN. Stress and coping strategies among medical students international university of Malaysia, Malaysia University of Sabah and University Kuala Lumpur Royal College of Medicine Perak. J Community Health, 2009; 15, 106-115. Yusoff MSB et al. A study on stress, stressors and coping strategies among medical students. Int J Students Res, 2011; 1, 45-50.

Compare and Contrast the Baroque Music and Jazz

Compare and Contrast the Baroque Music and Jazz BY outwitted The Baroque period spanned from 1600 to 1750. The baroque period can be divided into three parts: early (1600-1640), middle and late (1680-1750). Although today most people recognize the latest part as the baroque music, the earliest part was one of the most revolutionary phases in music history. The early baroque composers rejected the polyphony texture of the late Renaissance music and favored homophobic texture.They also focused on harmony rather than the complexity of melodic lines. The growth of figured bass and counterpoint represents the development of harmony. However, by the late baroque period, polyphonic texture returned to favor. Famous Baroque composers: – Johann Sebastian Bach Popular work: Air on a G String – George Frederic Handel Popular work: The Messiah – Antonio Vivaldi Popular work: The Four Seasons It is difficult to define Jazz music, as there are many different styles and movemen ts.A brief definition of Jazz would be: American music that originated in New Orleans around 1900 and characterized by propulsive syncopated rhythms, polyphonic ensemble playing, improvisatory, virtuosic solos, melodic freedom, and a harmonic idiom ranging from simple diatonic through chromatics to atonality. 1 But this does not tell everything about Jazz. Jazz developed from Ragtime around 1900 and about 20 different styles were born since then. 2 Examples are swing, bebop, boss nova, free Jazz and soul Jazz.Famous Jazz musicians: – Luis Armstrong – Chuck Imagine – Charles Minus – Jon Chlorate – Mary Lou Williams – Miles Davis – Nat King Cole The main characteristic of this piece is unity of melody. This piece begins with Joyful elodea, which contains arpeggio and arch shape melody. [epic] Its mood of Joyfulness remains throughout the piece. Base chords are mostly based on chords l, IV and V. At bar 9, a melody changes a little but t he mood doesn't change. The rhythmic patterns of the beginning of this piece are repeated throughout.There are frequent uses of imitation in the melody. For example, from bar 9 after the perfect cadence, imitation begins as descending 4th. [epic] Melodic sequence also often occurs in the piece. Bar 6 is one of example of sequences contained. Melodic phrases are repeated one tone higher pitches. Another main characteristic of this piece is polyphonic texture, as more than 3 independent melodic lines are sounded together consistently. From bar 14, there is imitation again. The harmony is based on a circle of fifths. Each motive figure is decorated with triplet.In the melody line, the first figure starts with F, the next one starts with B and the next one starts with E and so on. Similarly, the chords of bass line go through cycle of fifth. Therefore, both melody line (flute and violin) and base line (cambial) are in circle of fifth. This makes the melodic like sound dutiful and natura l. This movement is in Reiteration form: one short section keeping returning, often creating â€Å"tutu-solo-tutu-solo† pattern. This movement opens with the reiteration, which consists of 1/16th notes.After the reiteration, there is short solo section, where the flute and violin imitate each other. This piece is performed in 12-bar structure in 4/4 time. This piece begins with piano solo in E major. [epic] In the beginning of this piece, we can see the chords progression: I – I – I I – V – V – l. This chords progression is repeated throughout this piece with a constant Hitachi pulse. Call and response is frequently used in this piece. We can see the example of call and response between voice and other instruments at 0:46. There is also call and response between main vocal and female chorus in 2:29.Swing rhythm is also remarkable in this piece. After 12 bars of short piano solo, drum joins and plays swing rhythm. There are also frequent uses of syncopation in the rhythm. For example, in the first part where the vocal Joins, after he sings one phrase â€Å"Hey, ma-ma don't treat me wrong†, there is â€Å"space† in melody between the first phrase and the second phrase humiliation. The beginning of this piece is mainly homophobic in texture as there is always one independent melody. When vocal sings the main melody, other instruments such as drum and piano play the bass lines.However, as the song gets close to the end, its texture becomes more like polyphonic. Imitation, Call and response and counterpoint abound. After repeating the main melody six times, there is call and response between trumpets and vocal. The vocal asks, â€Å"Tell me what'd I say' and trumpets answer. The same idea is repeated several times with different lyrics. After the part, there is call and response between the main vocal and chorus again. Melody in baroque music creates a feeling of continuity. The opening melody will be repeate d throughout a baroque piece.Although the melody is often repeated in an altered form using variation technique, its idea remains in a piece. Also, baroque melodies often sound elaborate and ornamental in baroque pieces. Baroque music also tends to have one basic mood. If a piece begins with Joyful mood, it will remain throughout the piece. The baroque composers often created mood by using a descriptive musical language. They favored word painting, which music enhances the meaning and emotion of the text. For example, they used dark and slow music in lyrics about death.This made music more expressive and powerful. The rhythm in baroque music is often constant. The rhythmic patterns in the opening of baroque pieces are repeated throughout. This contributes to creating a unity of mood. For example, as we can see from Concerto V by Bach, there are 1/16th notes constantly throughout. Texture in baroque music is mostly polyphonic: two or more voices or melodic lines playing independently to express complexity. Baroque composers tried to expand the size, range, and complexity of instrumental performance. Imitation is very common in baroque music. All you have do is touch the right key at the right time and the instrument will play itself† This is a famous quote by Bach. Baroque musicians try to play what is written on the music score. There is mainly three common baroque forms; three-part from (A B A), two-part form (A B A), and continuous or undivided form. A lot of concerto movements including concerto V by Bach are in Reiteration form. The word, â€Å"Reiteration†, meaner â€Å"return† in Italian. After Tutu section, solo section begins and Tutu section come back again after the solo section.The Same rhythmic patterns are repeated in Jazz, yet often syncopated; unexpected accents. The rhythm patterns heard in the begging of Jazz pieces will be repeated throughout. Swing rhythm is also main characteristic of Jazz. Jazz originally developed from ragtime music, whose main characteristic is â€Å"ragged† or syncopated rhythm. Improvisation is an important aspect of Jazz music. Jazz musicians improvise in melody, rhythm and bass lines. A Jazz musician plays what he wants to play. Therefore, they have a great deal of freedom when performing and the audience also can feel it.Melody in Jazz is often improvised and more complex than other music. There are frequent uses of blue notes. Here is an example of a blues scale: This is one of the aspects that make Jazz very distinguishable from other music. Although style, period and musical culture are widely different, there are some similarities between Baroque music and Jazz. The first similarity between the two is continuity of rhythm. In both pieces, the same rhythmic pattern is repeated from the beginning to the end. Another obvious similarity is the frequent use of call and response. In both pieces, call and response is used many times.In concerto v, for example, there is call and response between flute and violin from 1:15. There are call and response between vocal and other instruments, and between the main vocal and female chorus in What'd I say. For example, we can see call and response between the main vocal and other instruments from 0:46 and between the main vocal and female chorus from 2:20. Both baroque music and Jazz use improvisation, although the style is different. In Baroque music, the composers write numbers above the bass part (figured bass) so that the keyboard player can improvise chords.This gives the performers a feeling of freedom while playing. In Jazz, improvisation is more important than in baroque music and is more abound. Not only the bass line, but also melody and rhythm can be improvised. Many baroque and Jazz composers repeat the same melodic or rhythmic idea in one piece. In Bach's concerto v, for example, there are 1/16th notes constantly throughout and the same melodic ideas are repeated. This is same for Jazz music. F or example, in a Jazz piece â€Å"What'd I say', there are frequent uses of swing rhythm and the same melodies are repeated throughout.Unity of mood describes both baroque music and Jazz. If a piece of music opens with dark and slow melody its darkness remains throughout the piece. The unity of mood is created by continuous rhythm and melody. The chords of a lot of baroque and Jazz songs are mostly based on I, IV and V. For example, the chords structure of the first 8 bars in Bach's concerto v is I – I – I V- I – l. The twelve notes progression, which many Jazz musicians use, is I – I-I-IV- IV I -l -V -V- I and is very similar to the one used in concerto. Difference in time and culture also makes difference in music.We can find several differences between baroque music and Jazz. First, we can see that their styles are very distinguishable. Jazz musicians have more feeling of freedom while performing as they can improvise in many ways while baroque musici ans can only improvise in bass lines and they mostly play what is written on the score sheet. There is also difference in musical form and structure. The baroque composers tend o follow the certain forms such as reiteration form while Jazz composers favor minimum forms that allow maximum flexibility.In addition, the main concept or purpose of Baroque music and Jazz are different. Jazz's primary purpose was to entertain the people in bars, while baroque composers primarily worked to provide music for dance and church services. Early baroque composers rejected the complex polyphony of the late Renaissance and favored homophobic texture that maximizes harmony. But Jazz composers favored the complexity of melody. Melody in Jazz is often complicated and usually official to sing or play while melody in early baroque music is less complicated and easy to remember.In addition, the uses of instruments in the two periods are different. Despite that baroque music is mostly based on string grou ps, Jazz music is based upon brass and woodwind instruments. Although style, time, and history are different, there are some similarities between baroque music and Jazz. There are similarities in rhythm, melody, and texture. Music from the two different periods sound different, however, when we look at the two closely we see that they share musical technical similarities.

Pyramid Door Formal Case Final Draft Essay

As a privately owned regional manufacturer of residential and commercial steel garage doors, Pyramid Doors has managed to grow a distribution network in the Western and Southwestern United States of 350 distributors broken up into 300 non-exclusive dealers and 50 exclusive dealers. This strategy has allowed Pyramid Door to capture a market share of 2.6% with total sales in 2005 of $9.2 million. While executives agree that a growth in sales of 36% to $12.5 million is necessary to achieve critical mass to preserve its buying position with suppliers, opinions are split on the correct method to achieve this goal. An increase in the marketing budget of 20% over 2005’s budget has already been approved, but four alternative scenarios about how to handle the distributor base have been brought up by various executives. While some executives favored dramatically increasing the overall number of dealers, others suggested the opposite, cutting the overall number of non-exclusive, poorer performing dealers. Still other executives suggested a more targeted approach, leaning on more exclusive dealers at the expense of fewer non-exclusive dealers, while a final group suggested maintaining the status quo of dealers and letting the new marketing strategy carry them to the required number of sales. To determine the best strategy moving forward, we have put together a proposal outlining the pros and cons of each strategy, backed up with qualitative and quantitative data to back up our conclusions. Alternative 1: Increase number of independent dealers in markets currently served by the company by 100 Pros: Increases effective market coverage allowing customers to find Pyramid Doors at more dealers. Diversifies the distribution network so that the company is less dependent on exclusive dealers. Sets Pyramid Door up for future distribution expansion. Will significantly increase sales. Allow for market specific advertising to benefit more locations Cons: Adding 100 distributors will be very difficult in one year, given it has taken 10 years to add the most recent 50 distributors. Has the potential to cause channel conflict with current distributors by increasing the number of dealers they have to directly compete with within their markets. Distinct possibility of product cannibalization by saturating the market. Even with the increase in Net Sales, this plan would require an increase in Sales Representatives, decreasing our profit margin. Increased transportation costs to distribute to more low-volume locations.

The End Of The War - 1052 Words

In autumn of 1918, it all started. Desertion rates were dramatically rising in the German army, and civil strikes reduced protection of German cities. This was the beginning of the end of the war. While the German army was slowly collapsing, the Americans found the perfect chance to strike the German army. The Americans then launched the important Hundred Day Offense which was the concluding offensive of the war. The Hundred Day Offense pushed Germany out of France, therefore, forcing them to retreat beyond the Hindenburg Line where they landed their final attack of this war. The Hindenburg Line was built during the winter of 1916 as an important German defense position on the eastern front. Once the Germans retreated to the Hindenburg†¦show more content†¦Approximately a month after bargaining was over, the Treaty of Versailles was presented to Germany for â€Å"consideration.† Germany was given 3 weeks to accept the terms. If it was not accepted, continuation of the war would be inevitable. The Treaty of Versailles is widely known for its essentials to end the war, but it inflicted harsh terms on the Germans as well. Germany was forced to give up 13.5% of its 1914 territory (including land taken from Russia in the Treaty of Brest-Litovsk and a lot of vital industrial territory), its army was limited to 100,000 men, German use of heavy artillery, gas, tanks, and aircraft was banned, Germany s navy was restricted to shipping under 10,000 tons, Germans weren t allowed to use submarines, and Germany was forced to pay $55 billion in reparations. The $55 billion the Germans needed to pay was one of the harshest term of the treaty. After the Germans gave up this money, unemployment struck and Germany slowly collapsed as a whole, and the German people accepted Hitler’s rise to power under the motto that he was going to help Germany become a power and avoid war (he obviously didn’t). This treaty received mixed reactions. The most important politicians involved with the signing of this treaty were Georges Clemnà ©ceau of France, David Lloyd George of Britain, and, of course, the American Woodrow Wilson (28th President of the United States). Similar to Woodrow Wilson, David Lloyd George, pushed