Marketing Essay Example | Topics and Well Written Essays - 1000 words - 15

Marketing - Essay Example Just low fares would not attract the required customer level, and so value for money is another objective of Southwest Airlines. So though the service offered is a no frills one, Southwest Airlines has targeted excellence in customer service to provide an extra boost to the value of the service. This has paid rich dividends, as can be seen from the accolades that Southwest Airlines has received consistently received, and is the only business enterprise in its sector of industry to do so. The Fortune magazine in its annual ratings has consistently placed Southwest Airlines among the most admired companies in the United States of America. In essence it is the understanding, and utilization of the human asset in an organization that provides the capacity to an organization to maintain low cost levels in its operation. This factor of this strength of the human asset in Southwest Airlines enables it not just to maintain low cost levels, but also to meet the challenges that come with adverse times. Southwest Airlines has employee strength of approximately thirty-two thousand, and in keeping with the philosophy of their founder Kelleher, remain an asset that is accorded the highest priority. Kelleher believed that a high employee morale, reduces employee turnover, and that helps to maintain low costs. The employees of Southwest Airlines enjoy facilities of profit sharing and stock purchases, and are encouraged to make the working environment more pleasurable. The result of these actions could be seen in the aftermath of the September 2001, when the airline industry went through a crisis. The support of the employees enabl ed Southwest Airlines to be the only airline that did not cut the number of its flights and lay-off employees, and surprisingly offer lower fares too, despite the sharp drop in passenger traffic. By November of that year, while the airline industry reported a drop of sixteen percent in comparison to the previous year,

Lab report Essay Example for Free

Lab report Essay Osmosis is a process that occurs at a cellular level that entails the spontaneous net movement of water through a semi-permeable membrane from a region of low solute concentration to an area of high solute concentration in order to equalize the level of water in each region. Involved in this process are hypotonic, hypertonic and isotonic solutions. A hypotonic solution is one with a lower osmotic pressure, indicating that the net movement of water moves into the said solution whereas a hypertonic solution is one with a higher osmotic pressure, thus the net movement of water will be leaving the hypertonic solution. Lastly, an isotonic solution entails no net movement of water across a semi-permeable membrane as the two substances involved display osmotic equilibrium. AIM To observe the effect of solutions different levels of NaCl concentration on potatoes, considering the process of osmosis METHOD (see ‘Potato Osmosis’ – exercise document) Generally rigid in structure although slightly bendy Pale yellow in colour Moist All strips appear the same/similar in structure and size at this point Observations – Post-Extraction Strips immersed in 1. 0M NaCl Solution are very soggy, soft and appear shrunken Strips immersed in 100% H2O are very rigid, swollen, turgid and appear larger/longer they are slightly bent and cannot be straightened due to their rigidity Strips become progressively soggier as the solutions they are immersed in are higher in concentration of NaCl (Fig. 2) Potato strips from the same potato arranged in  descending order of concentration to demonstrate the differences in structure post-extraction. Thus, we can state that there appears to be a negative correlation between NaCl concentration and the mass and length of the potato strips, clearly evident in the above graph which shows an exponential decrease in both mass and length. This can also be initially seen in the post-extraction observations  where it is evident that the potato strips immersed in lower NaCl concentration were far more turgid than those immersed in 100% NaCl solution which were flacid and fragile (see strip-comparison in Fig. 2). This occurrence can be explained through the process of osmosis. As mentioned in the introduction, a hypertonic solution is one with higher osmotic pressure meaning that the net movement of water leaves the solution. This would explain the physical changes – the increase in mass and length as well as the increase in turgidity in the potato strips immersed in 100% H2O solutions or low NaCl-concentration solutions. Since the solution it is submerged in is higher in concentration in water molecules, or hypertonic, the water molecules will diffuse into the area of lower H2O-concentration (the potato strip) in order to achieve equilibrium. Alternatively, the decrease in mass and length in the potato strips submerged in highly concentrated NaCl solutions can be explained by its immersion in a hypotonic solution. Hypertonic solutions, as mentioned Potato Osmosis Biology SL ATh before, are described as those with lower osmotic pressure, indicating that the net movement of water moves into the solution. Therefore, as NaCl solution is less concentrated in H2O molecules than the potato strips, the decrease in mass and length and loss of turgidity results from the net movement of water leaving the potato strips, which is higher in osmotic pressure, and diffusing into the solution. Nevertheless, there are several possible sources of error that could have greatly or negligibly affected the outcome of the experiment. First, we must note the varying external factors resulting from an uncontrolled environment – the biology classroom. Primarily, these would include varying temperatures and humidity which could potentially affect the rate of osmosis as increased temperature results in increased diffusion while increased humidity results in an increased number of water molecules. Secondly, we must note the human errors involved, for example, miscalculations in experimental preparations. These would include the miscalculation of solutions leading to an inaccurate concentration of NaCl as well as the possibility of impurities in the NaCl concoction in the first place while imprecise cutting of the potato strips could’ve affected the surface area and thus the rate of osmosis. This leads us to the errors resulting from variances in the substances used. As already discussed previously, differences in surface area of each potato strip caused by imprecise cutting as well as the marks (lines and notches) imprinted would’ve affected the rate of osmosis while the concentration gradient between each potato strip is likely to differ as well. This stems from the differences in water content of each potato, as, for example, a potato with high water concentration in highly concentrated NaCl solution would have a faster rate of erosion. Further affecting factors could include barriers to diffusion such as the size of pores which would also determine the rate of osmosis. All the mentioned errors above hold the possibility of skewing the data. Subsequently, such errors could have an effect on the reliability of the results. The level of accuracy which has been used throughout this investigation would come into question as a combination of these errors would not permit such precision. Values of percentage change have been taken at two decimal places corresponding with the actual values of mass and length, however, this could be seen as far too precise. A better option would have been to take percentage change as whole numbers or at one decimal place. Nevertheless, we attempted to reduce the potential errors through several measures. With surface area, a cork borer was used in order to uniform the size of the potato strips while the varying concentration gradients were controlled through the completion of several trials (three trials with three potatoes) in order to limit error. Furthermore, to control the effects of the external environment, foil was secured over the beaker containing the submerged potato strips. However, if we refer to the graph, we can see the minimum and maximum spread for each data-point is generally close-set while the R2 value, which calculates the spread of the datapoints from the line of best fit, are both relatively high – both around 0. 9. This demonstrable trend indicates a limiting of the amount of error, and thus fairly reliable results despite possible errors. Overall, the results  ultimately seem reliable although it might’ve been even more reliable by reducing the level of precision (decimal places) when recording it. Ultimately, potential improvements will stem from attempting to reduce the amount of error in this investigation, particularly involving controlling the external environment and the miscalculations. To control the external affecting factors, the solution containing the potato strips can be kept overnight instead in a controlled environment with consistent temperatures and humidity. Limiting the human error would be difficult and time-consuming as this would involve Potato Osmosis Biology SL ATh highly-precise instruments or even more focus dedication from the experimenter during preparation. Finally, nothing can be done to uniform the response of the materials used, thus the completion of even more trials limits the potential error and allows the formation of generalizations. Despite the improvements proposed, those relating to limiting human error and completing more trials may prove to be futile as they are not only time-consuming, but the demonstrable trends resulting from this experiment indicate that no further improvements are necessary to reach the desired conclusion. Having established that there is no real need to pursue drastic improvements for the initial experiment, we can now proceed to discuss possible extensions to the investigation. While we already know the results of osmosis on a potato, we may now wish to better understand it. This can be done by recording the progress of the potato’s transformation either (a) over a period of time (perhaps 24 hours) or (b) until it has reached the point of equilibrium. The mapping of this progress would involve the periodic removal of the samples in order to measure its mass and length, after which it can be compiled into a graph to chart the transformation under osmosis. Alternatively, we could compare the progress of a potato to another type of vegetable or fruit in order to ascertain water content of each. Lastly, the submerged potato strips may be subjected to different kinds of environment, particularly, varying humidity and temperature, without the protection of a foil cap. This would reveal how much of an impact environmental factors would have on the osmotic process and how would the effects manifest. In relation to the question of the sailor, this could represent the life-span one would expect when trapped in certain climates.

Early Prevention is Key in Reducing Bullying at an Earlier Age Essay

Early Prevention is Key in Reducing Bullying at an Earlier Age Starting at very young ages there are bullies. They develop early and often never grow out of that stage, but rather it just increases with time and age so the crimes become more serious. This is why it is necessary to target children with their unkind or violent tendencies before it gets out of control. Children usually turn into bullies for reasons such as craving attention, wanting power, low self-esteem, inability to control anger, revenge, or even to be popular. Popularity comes to bullies in grade school because students who like and are liked by the bully will most likely not be bothered, so it becomes a safety issue. With this last point especially, it just encourages the bullying to continue. Victims of bullies usually have something unique about them that may seem like a reason to be ridiculed. This includes things as simple as having braces or glasses, being very shy, or even for being what students may consider to be 'too smart.' Not only are bullies the ones who grow up to cause problems, but the victims do as well. If a child is constantly picked on and made fun of, their self-esteem could plummet. This could cause them to turn into a bully just so as not to be bullied anymore, or they could be driven to innumerable actions that could very well affect schools. There was a case of an extremely intelligent boy named Nathan who was also overweight. He thought that once he entered middle school the kids would have grown up and he would meet new and nicer people. It turned out that it only got worse in middle school and he was pushed beyond his limit. He took a gun to school one day and shot himself in front of the other students (... ...etrieved April 22, 2009 from http://www.libertarianrock.com/topics/school/no_drug_test_after_fighting.html Zewe, C. (2008, August 4). Violent schools: perception or reality? Retrieved April 23, 2002 from http://www.cnn.com/US/9808/24/school.violence/ Jane?s Information Group (2001, April 19). Responding to school shootings. Retrieved May 2, 2002 from http://www.janes.com/security/international_security/news/jssh/jssh020429_1_n.shtml Information about the recent mass shooting in a German school by a 19 year old boy. Lemonick, M. D., Wallace, C. P. (2002, May 6). Germany?s columbine. Time, 36. Retrieved April 28, 2002 from Ebscohost. Kyl, J. (2008, June 1). American needs to jumpstart the war on drugs. Inside Tucson Business 8(10), 5. Retrieved April 28, 2002 from Ebscohost. Statistics on drug usage in high schools, showing we need to help it.

The Treatment Of Eating Disorders Health And Social Care Essay

Eating upsets are characterized by forms of perturbations in eating behavior frequently accompanied by feelings of hurt and/or concern about organic structure weight or form. Anorexia Nervosa ( AN ) , Bulimia Nervosa ( BN ) , Eating Disorders-Not Otherwise Specified ( ED-NOS ) are three classs by which eating upsets identified. The American Psychiatric Association ( APA ) ( 1994 ) foremost identified Binge Eating Disorder ( BED ) as a probationary feeding upset diagnosing in the DSM-IV. BED is frequently classified under the â€Å" catch all † of the ED-NOS diagnosing. The DSM-IV-TR ( APA, 2000 ) standard for AN, BN, and BED are listed in Table 1. Eating upsets have frequently been noted as one of the most hard psychiatric conditions to handle and hold been associated with increased mortality and self-destruction rates ( Crow et al. , 2009 ) . Other physical and psychosocial wellness effects include but are non limited to limb and joint hurting, concern, GI jobs, catamenial jobs, shortness of breath, thorax hurting, anxiousness, depressive symptoms, and substance maltreatment ( Johnson, Spitzer, Williams, 2001 ) . Despite legion co-morbid conditions, effectual behavioral and pharmacological interventions for eating upsets have been established. For illustration, family-based therapy ( i.e. , Maudsley Approach ) is deriving acknowledgment as an evidenced-based intervention for striplings with AN ( Wilson, Grilo, & A ; Vitousek, 2007 ) in both joint household Sessionss ( Lock, Agras, Bryson, & A ; Kraemer, 2005 ) and in â€Å" detached † format where person with AN and her household attend separate Sessionss ( Eisler et a l. , 2000 ) . Additionally, cognitive-behavior therapy ( CBT ; Hay, Bacaltchuk, & A ; Stefano, 2009 ) , dialectical-behavior therapy ( DBT ; Chen et al. , 2008 ) , and interpersonal therapy ( IPT ; Fairburn, 1997 ) have been successful in the intervention of BN. Research tends to back up CBT as the intervention of pick for both BN and BED ( Hay, Bacaltchuk, Stefano, 2004 ) . Table 1. DSM-IV-TR diagnostic standards for AN, BN, BED.Anorexia NervosaRefusal to keep organic structure weight at or above what is normal weight for age and tallness ( i.e. , & gt ; 85 % of what is expected ) . Intense fright of deriving weight or going fat, even though scraggy. Perturbation in the manner in which 1 ‘s organic structure weight or form is experienced, undue influence of organic structure weight or form on self-evaluation, or denial of the earnestness of the current low organic structure weight. In postmenarcheal female, amenorrhoea ( i.e. , absence of 3 back-to-back catamenial rhythms ) . Specify Type: Restricting Type – During current episode of AN, person does non regularly engage in binge-eating or purging behaviour. Binge-Eating/Purging Type – During current episode of AN, the individual has on a regular basis engaged in binge-eating or purging behaviour.Bulimia NervosaPerennial orgy eating episodes. Characterized by: 1 ) feeding, in a distinct period of clip ( e.g. , within a 2-hour period ) , an sum of nutrient that is larger than most would eat in a similar period of clip under similar fortunes and 2 ) a sense of deficiency of control over eating during the episode ( e.g. , a feeling that one can non halt eating or command what or how much one is eating ) . Recurrent purging/compensatory weight loss steps in order to forestall weight addition. Binge feeding and purging/compensatory behaviours present at least 2 times a hebdomad for 3 months. Self-image inexcusably influenced by organic structure weight and form. Absence of Anorexia Nervosa. Specify Type: Purging Type – During current episode of BN, the person has engaged in self-induced emesis or the abuse of laxatives, water pills, or clyster. Nonpurging Type – During the current episode of BN, the individual has used other inappropriate compensatory behaviours, such as fasting or inordinate exercising, but has non engaged in self-induced emesis or the abuse of laxatives, water pills, or clyster.Binge Eating DisorderRecuring orgy eating episodes. Characterized by: 1 ) feeding, in a distinct period of clip ( e.g. , within a 2-hour period ) , an sum of nutrient that is larger than most would eat in a similar period of clip under similar fortunes and 2 ) a sense of deficiency of control over eating during the episode ( e.g. , a feeling that one can non halt eating or command what or how much one is eating ) . The binge-eating episodes are associated with 3 or more of the followers: 1 ) eating more quickly than normal, 2 ) feeding until experiencing uncomfortably full, 3 ) eating big sums of nutrient when non physically hungry, 4 ) eating entirely because of being embarrassed by how much one is eating, 5 ) feeling disgusted with oneself, depressed, or really guilty after gorging. Marked hurt environing orgy feeding. The orgy feeding occurs, on norm, at least 2 yearss a hebdomad for 6 months. The orgy feeding is non associated with the regular usage of inappropriate compensatory behaviours ( e.g. , purge, fasting, inordinate exercising ) and does non happen entirely during the class of ANor BN. Pharmacological interventions have been used in concurrence with behavioural intervention or entirely ( Zhu & A ; Walsh, 2002 ) in the intervention of eating upsets. Research supports pharmacological intervention for persons with BN and BED ( Bacaltchuck, 2000 ) . Specifically, antidepressants have been found to hold short-run benefit in the decrease of binging and purge behaviours ( Walsh et al, 2000 ; McElroy et Al, 2003 ) . Unfortunately, pharmacological intervention tends to hold high disobedience rates and backsliding is frequently frequent ( Becker, 2003 ) . Presently, there is no empirical support for the usage of antidepressants among persons with AN ( Wilson, Grilo, Vitousek, 2007 ) . Behavioral and pharmacological interventions are most frequently used in combination with another in handling eating upsets due to legion co-morbid conditions. Unfortunately, the aforesaid behavioural interventions have a figure of restrictions when delivered outside a forte scene ( e.g. , outpatient mental wellness clinic, inpatient eating upset centre ) . For illustration, the bringing of family-based therapy for AN requires 10-20 hour- long household Sessionss over a 6-12 month period ( Lock, le Grange, Agras, & A ; Dare, 2001 ) , and manualized CBT for BN requires 15-20 Sessionss over five months ( Fairburn, 1989 ; 1993 ) . Treatments for AN and BN are non merely drawn-out and dearly-won, but eating upset forte suppliers are limited, and persons with feeding upsets are frequently immune to specialty attention ( Fairburn & A ; Carter, 1996 ) . Additionally, merely a little part of persons with feeding upsets are treated in mental health care ( Hoek & A ; van Hoeken, 2003 ) and are more likely to show with feeding disordered symptoms in a primary attention puting ( Hoek, 2006 ) . While primary attention doctors frequently recommend forte intervention on claim signifiers, there is small follow- through with referrals ( Hach et al. , 2005 ; 2003 ) . Therefore, the primary attention scene is frequently the chief intervention installation for those with a life-time eating upset diagnosing ( Hudson, Hiripi, Pope, & A ; Kessler, 2007 ) . Due to the fast-paced nature of a primary attention scene, interventions need to be brief, cost-efficient, and executable in application for bing staff. Therefore, development and designation of brief, effectual intercessions for eating upsets are necessary. A figure of surveies have tested the efficaciousness of specific brief intercessions for AN, BN, and BED outside of primary attention environment. Fichter, Cebulla, Quadflieg, & A ; Naab ( 2008 ) implemented a self-help constituent ( i.e. , self-help CBT manual ) to the pretreatment stage of forte attention for persons with AN giving significantly shorter inpatient attention. For intervention of persons with BN and BED, a stepped-care attack has gained support ( Laessle, 1991 ; Treasure, 1996 ; Carter, 1998 ) . This attack may suit good with the construction of primary attention, since persons with BN are offered brief intercessions and so reevaluated. Brief intercessions for BN are often in the signifier of abridged CBT frequently accompanied by a self-help constituent ( Treasure, 1996 ; Cooper, Coker, & A ; Fleming, 1994 ) . A figure of self-help CBT books have been published aimed at assisting persons with binging and purge ( e.g. , Cooper, 1995 ; Fairburn, 1995 ) . Brief executio n of CBT ( Leonard et al. , 1997 ) , self-help CBT ( Sysko & A ; Walsh, 2008 ) , telephone counsel ( Palmer, Birchall, McGrain, & A ; Sullivan, 2002 ) , internet bringing ( Pretorius et al, 2009 ) , and motivational sweetening ( Schmidt, 1997 ; Vitousek, 1998 ) are all illustrations of promising brief intercessions explored for the intervention of binging and purge symptoms. While primary attention has been identified as an ideal puting for handling BN and BED, few effectivity surveies using brief intercessions for eating disordered symptoms have been conducted in the primary attention scene. A figure of eating upset intervention guidelines for primary attention suppliers have been published ( e.g. , Carter & A ; Fairburn, 1995 ; Gurney & A ; Halmi, 2001 ; Pritts & A ; Susman, 2003 ; Williams, Goodie, Motsinger, 2008 ) . However, there is limited information about the effectivity or deductions of behavioural intercessions for eating upsets delivered in the primary attention puting. Therefore, the purposes of the current survey are to 1 ) place all surveies presenting a behavioural constituent for AN, BN or BED in a primary attention scene, 2 ) examine the features and intervention results of surveies identified, and 3 ) supply intervention deductions every bit good as waies for future research. Methods Literature Review The reappraisal of the literature involved multiple computing machine hunts and reappraisal of old reappraisal documents every bit good as surveies cited within these documents. Search databases included CINAHL, EMBASE, PsycARTICLES, PsychInfo, and PubMed utilizing the hunt footings â€Å" binge-eating syndrome nervosa † OR â€Å" orgy eating upset † OR â€Å" anorexia nervosa † AND â€Å" primary attention. † Figure 1 outlines the literature hunt and shows 314 abstracts of articles reviewed for inclusion every bit good as mentions cited in five eating upset intervention reappraisal documents ( i.e. , Berkman et al. , 2006 ; Hay, Bacaltchuk, Stefano, & A ; Kashyap, 2009 ; Kondo & A ; Sokol, 2006 ; Williams, Goodie, & A ; Motsinger, 2008 ; Wilson, Grilo, & A ; Vitousek, 2007 ) . If deficient information was provided in an abstract the first writer obtained the full article for reappraisal. Inclusion and Exclusion Criteria Primary care-based intercession surveies aiming AN, BN, and BED, were identified based on the undermentioned inclusion and exclusion standards. Inclusion standards included: 1 ) the survey incorporated a behavioural constituent to the intercession for persons with AN, BN, or BED ; 2 ) the intercession was conducted in a primary attention puting ( or the intercession was implemented in a scene explicitly intended to emulate primary attention, as stated in the survey ‘s â€Å" methods subdivision † ) ; 3 ) the survey was a ) published in 2009 or earlier, B ) in English, degree Celsius ) and included empirical informations ; therefore, qualitative and instance surveies were excluded. Exclusion standards included: 1 ) intercessions in scenes other than primary attention puting ( or non explicitly saying an purpose to imitate a primary attention puting ) ; 2 ) non-intervention surveies ( e.g. , surveies conducted in primary attention with ends of obtaining epidemiological inf ormations ) ; 3 ) intercession surveies concentrating on weight loss or including an obesity-oriented attack ; 4 ) non-behavioral intercessions ( i.e. , entirely medicative intercessions ) . International and domestic surveies were included in this reappraisal. Given the limited literature, surveies were non excluded on the footing of whether or non participants were randomized to intervention, type of behavioural intercession, sample size, continuance of intervention, or participant features ( e.g. , gender ) . A sum of five surveies met standards for the current reappraisal. All surveies included were on the intervention of BN and BED. No surveies were found on AN. 314* abstracts/full-text articles reviewed: CINAHL ( 45 ) Embase ( 83 ) PsychArticles ( 0 ) PsychInfo ( 86 ) PubMed ( 100 ) Mentions cited in 5 eating upset intervention reappraisal documents: Berkman et Al. ( 2006 ) Hay et Al. ( 2009 ) Kondo & A ; Sokol ( 2006 ) Williams et Al. ( 2008 ) Wilson et Al. ( 2007 ) 3 original surveies identified 2 original surveies identified 4 primary care-based intercession ( 3 randomized, 1 non-randomized ) 1 designed-for-primary attention intercession ( randomized )Entire: 5 original surveiesFigure 1. Flow chart showing designation procedure of selected primary attention articles. *Note: Overlap nowadays among articles showing in multiple databases. Consequences Features of the Studies Reviewed Of the five surveies that met inclusion standards, four of the surveies were randomized ( i.e. , Banasiak, Paxton, Hay, 2005 ; Carter and Fairburn, 1998 ; Durand and King, 2003 ; Walsh et al. , 2004 ) . Among randomised surveies, none of the surveies fulfilled all of the standards of the Consolidated Standards of Reporting Trials ( CONSORT ) , a criterion and minimal set of guidelines for describing randomized-controlled tests. All surveies included were self-described as effectiveness surveies. Therefore, feasibleness of intercession was paramount to the survey. Merely two of the five surveies recruited participants in the primary attention puting ( Durand & A ; King, 2003 ; Waller et al. , 1996 ) . The figure of participants in the five surveies ranged from 11 to 109 ( M = 70.2, SD = 36.9 ) . Primary attention suppliers ( PCPs ) were the exclusive supplier of the behavioural intercession in two of the five surveies ( i.e. , Banasiak et al. , 2005 ; Durand & A ; King, 2003 ) , and P CPs delivered behavioural intercessions in concurrence with nurses in two other of the five surveies ( i.e. , Waller et al. , 1996 ; Walsh et al. , 2004 ) . Minimally trained facilitators ( i.e. , former concert dance terpsichorean, medical secretary, and group leader ) delivered the behavioural intercession in the 1 survey ( Carter & A ; Fairburn, 1998 ) . Three of the five surveies provided at least 2-6 hours of preparation for doctors and/or nurses transporting out the intercession ( i.e. , Banasiak, Paxton, Hay, 2005 ; Waller et al. , 1994 ; Walsh et al. , 2004 ) . Two of the surveies did non supply separate preparation for those transporting out the intercession, but instead gave facilitators the same educational stuffs distributed to the participants ( i.e. , Carter & A ; Fairburn, 1998 ; Durand & A ; King, 2003 ) . One survey incorporated both behavioural and pharmacological intervention attacks ( Walsh et al. , 2004 ) . See Table 2 for extra survey features. Table 2. Features of surveies reviewed.SurveyParticipants & A ; CriteriaRecruitmentRandomized/Non-randomizedDelivery of Intervention/TrainingInterventionDurationBanasiak et al. , 2005 N=109 ( full or sub-threshold BN â€Å" modified † DSM-IV standards ) Community Ads: Newspaper: 61.4 % Primary Care: 21.1 % Community centre: 12 % ED centre referral: 5.5 % Randomized aˆ?16 PCPs aˆ?given manual & A ; attended a half-day workshop GSH utilizing Bulimia Nervosa and Binge feeding: A usher to recovery vs. delayed intervention control 17 weeks/1 30-60 minute initial contact & A ; 9 20-30 minute intervention Sessionss. Carter & A ; Fairburn, 1998 N=72 ( full BED DSM-IV standards, but non run intoing full BN standards ) Newspaper Ads Randomized aˆ?3 facilitators: Former concert dance terpsichorean Medical secretary Group leader aˆ?given manual & A ; intervention of 2-3 pilot participants. PSH vs. GSH utilizing Overcoming Binge Eating V. Wait list control 12 weeks/ 6-8 25-minute Sessionss. Durand & A ; King, 2003 N=68 ( BN symptoms ) Primary attention physician referral Randomized aˆ?32 PCPs aˆ?given manual, guidelines, & A ; phone no. for particular concerns GSH via Bulimia Nervosa: A usher to recovery vs. forte clinic intervention Duration of intervention varied GSH: ~ 5 visits with PCP Waller et al. , 1996 N=11 ( full BN DSM-IV standards ) Back-to-back series of primary Care patients Non-randomized aˆ? 4 Health professionals 1 nurse aˆ? 2 three-hour preparation workshops Abridged CBT & lt ; 8 20-minute Sessionss in hebdomadal intervals. Walsh et al. , 2004 N= 91 ( BN symptoms ) Newspaper advertizements and referrals Randomized aˆ? 7 Health professionals 8 nurses aˆ? brief 2-hour preparation & A ; intervention of a sum of 6 pilot patients aˆ? GSH + placebo vs. GSH + Fluoxetine vs. placebo-only vs. Fluoxetine-only. aˆ? GSH used Overcoming Binge Eating. 6-8 30-minute Sessionss over 4-5 months. Note: PCP – Primary Care Physician, GSH – Guided Self-Help, PSH – Pure Self-Help, ED – Eating Disorder Interventions Overall, this current reappraisal identified two chief attacks to handling BN and BED in primary attention. The first was for practicians to supply behavioural reding themselves, with an augmentation ( i.e. , self-help manual ) . The 2nd option used a collaborative attack in which a non-physician ( e.g. , nurse ) served as the primary intervention supplier with the doctor in a encouraging function with or without an augmentation ( i.e. , self-help manual, psychopharmacological medicine ) . A PCP was the exclusive supplier of the intercession in two surveies ( Banasiak et al. , 2005 ; Durand & A ; King, 2003 ) and a non-physician ( i.e. , nurse ) in two surveies ( Waller et al. , 1996 ; Walsh et al. , 2004 ) . A fifth survey used facilitators ( i.e. , concert dance terpsichorean, medical secretary, and a group leader ) to emulate primary attention suppliers ( Carter and Fairburn, 1998 ) . Guided Self-help versus Pure Self-help Among all surveies examined, four surveies implemented cognitive behavioural self-help in the intercession and incorporated the usage of a self-help manual ( i.e. , Banasiak, Paxton, Hay, 2005 ; Carter and Fairburn, 1998 ; Durand and King, 2003 ; Walsh et al. , 2004 ) . Get the better ofing Binge Eating ( Fairburn, 1995 ) , Bulimia Nervosa and Binge-Eating: A Guide to Recovery ( Cooper, 1995 ) , and Bulimia Nervosa: A Guide to Recovery ( Cooper, 1993 ) were the three manuals used. The add-on of the self-help manual came in two signifiers: 1 ) guided self-help and 2 ) pure self-help. Guided self-help pattern included a doctor or other supplier ‘guiding ‘ and directing the participants through the manual during scheduled visits and delegating specific reading in the manual to the participant. Pure self-help involved the supplier providing a manual to the participant and the instructions to read the manual over the class of the intercession. Treatment Results Three of the four surveies utilizing self-help found self-help methods to be good in relieving orgy eating episodes ( Banasiak, Paxton, & A ; Hay, 2005 ; Carter & A ; Fairburn, 1998 ; Durand & A ; King, 2003 ) . One survey comparing guided self-help and Prozac found no benefits of guided self-help used entirely or used in concurrence with the medicine ( Walsh et al. , 2004 ) . However, medicative benefits of diminishing bulimic symptoms were important. These consequences should be interpreted with cautiousness, since this survey yielded a 69 % abrasion rate. Another survey comparing the benefits of guided self-help, pure self-help, and wait-list control found those who received guided self-help and pure-self aid to hold significantly fewer binge-eating episodes at station intervention and three month followup ( Carter & A ; Fairburn, 1998 ) . While no important differences were obtained between guided self-help and pure self-help intervention groups at the terminal of intervention, t he guided self-help group attained significance over the pure self-help group across post-treatment clip points ( i.e. , 3 months and 6 months ) ( Carter & A ; Fairburn, 1998 ) . Waller et Al. ( 1996 ) was the lone survey non using a self-help constituent, but instead an abridged CBT intervention. This intervention yielded a 55 % betterment rate in bulimic symptoms. See Table 3 for result informations on each survey. Table 3. Outcome information on examined surveies.SurveyResultEffect SizeRestrictionsAbrasionBanasiak et al. , 2005 60 % decrease in nonsubjective orgy eating in GSH vs. 6 % decrease in DTC. 61 % decrease of purging behaviour in GSH vs. 10 % decrease in DTC. GSH V DTC: Gorging – Einsteinium: 1.96 Purging – Einsteinium: 1.47 aˆ? PCPs delivering intervention had involvement in eating upsets prior to analyze aˆ? Not all participants recruited from Personal computer 33 % dropped out Carter & A ; Fairburn, 1998 Decrease in frequence of orgy eating episodes important in both PSH & A ; GSH. GSH significantly lower in dietetic restraint than PSH at posttreatment & A ; 3-month followup. GSH V PSH in dietetic restraint posttreatment: *ES: -.71 3-month followup: *ES: -.66 aˆ?34 % decrease of orgy feeding in wait list control aˆ? deficiency of weight alteration aˆ? conformity poorer in PSH vs. GSH aˆ? Participants non recruited from Personal computer aˆ? survey simulated PC office 12 % dropped out Durand & A ; King, 2003 No clinical significance between self-help and forte clinic intervention result. Both self-help and forte attention yielded important betterment in bulimic symptoms indicated by BITE. Self-help at baseline V 6 month followup on BITE: *ES: .56 Forte at 6 month followup on BITE: *ES: .67 aˆ?Small sample aˆ?Outcome informations based on self-report graduated table aˆ?lack of specificity in magnitude of difference b/w intervention attention aˆ?23 % dropped out in GSH group aˆ?17 % dropped out in forte attention Waller et al. , 1996 55 % improved well, 45 % did non profit Not able to cipher ; Insufficient informations aˆ?Small sample aˆ?long preparation aˆ?inefficient intercession 18 % dropped out Walsh et al. , 2004 GSH had no important consequence on the decrease of bulimic symptoms compared to Fluoxetine. Fluoxetine had important decrease in bulimic symptoms. GSH vs. Fluoxetine: *ES: -.06 Fluoxetine V Fluoxetine w/GSH: *ES: .02 aˆ? Disobedience aˆ? 8 participants were reassigned conditions aˆ? Recruitment non in Personal computer. aˆ? No public-service corporation for GSH detected. 69 % dropped out Note: GSH – Guided Self-Help, PSH – Pure Self-Help, DTC – Delayed Treatment Control, PCPs – Primary Care Physicians, Personal computer – Primary Care, BITE – Bulimic Investigatory Test Edinburgh *Effect sizes ( ES ) calculated by article ‘s first writer utilizing the undermentioned computation: vitamin D = M1 – M2 / i?-iˆ [ ( i1A? +iˆ iiˆ iˆ?A? ) / 2 ] . vitamin D = M1 – M2 / i whereiˆ i = i?- [ iiˆ ( X – M ) A? / N ] . Discussion Persons with eating upsets have some of the highest mortality rates of all psychiatric conditions ( Crow et al, 2008 ) coupled with high physical and psychological co-morbid conditions. Because of these co-morbid conditions, persons with feeding upsets are likely to show in primary attention puting with co-morbid ailments ( CITE ) . PCPs and staff are in a alone place to supply early sensing and intervention. Due to clip restraints, primary attention suppliers frequently lack the experience and preparation to implement intercessions for persons with feeding upsets. Therefore, brief, evidenced-based intercessions with minimum required preparation are paramount to the acceptance and airing of eating upset intervention. Consequences of this reappraisal expose the limited sum of research that has been conducted on the intervention of AN, BN, and BED in a primary attention puting. The current reappraisal identified five surveies – four on BN, one on BED, and no surveies were found on the intervention of AN in a primary attention puting. Of the five surveies that met standards for inclusion, four were randomized-controlled tests ( RCTs ) , which are often recognized as the gilded criterion in efficaciousness research. Among the RCTs, none of the surveies fulfilled all of the suggested CONSORT criterions. Four of the five surveies reviewed enforced CBT self-help in the signifier of a manual with educational constituents aiming binging and purge behaviours. Three of the four surveies utilizing self-help intervention found the intervention to be good ( i.e. , Banasiak, Paxton, & A ; Hay, 2005 ; Carter & A ; Fairburn, 1998 ; Durand & A ; King, 2003 ) . Therefore, self-help intervention may be a good intervention for some patients showing in primary attention. Among surveies describing benefits, guided self-help proved to be more good than pure self-help ; nevertheless, pure self-help was still found to hold benefit ( Carter & A ; Fairburn, 1998 ) . In a scene comparing survey, guided self-help CBT intervention was deemed every bit effectual as forte clinic intervention ( Durand & A ; King, 2003 ) . Effectiveness and Feasibility While all surveies were conducted in a primary attention puting or in a scene that explicitly simulated a primary attention scene, merely two surveies recruited participants from this scene ( Durand & A ; King, 2003 ; Waller et Al. 1996 ) . The enlisting context may restrict the effectivity of the interventions examined given studies of persons showing in primary attention exhibit higher rates of somatization, mental unwellness, and chronic conditions ( Jyvasjarvi et al. , 2001 ; Toft et al. , 2005 ) . Besides, given this survey was an international reappraisal, primary attention scenes differ across wellness attention systems ; hence, non merely may community samples differ from primary attention samples, but primary attention samples may differ from state to state ( Bailer et al. , 2004 ) . Similarly, PCPs in different states may hold changing clip restraints with respects to preparation and intervention bringing. However, minimum preparation and bringing efficiency are of import features for PCPs ( CITE ) . In this reappraisal, two surveies required less than an hr of preparation for the primary attention suppliers presenting the intercession ( Durand & A ; King, 2003 ; Carter & A ; Fairburn, 1998 ) . Given PCPs clip restraints, developing necessitating more than an hr may non be executable for the typical supplier. Another restriction to generalising intervention to the primary attention scene is the continuance of intervention in the surveies examined. Duration of intercession ranged from 5-10 visits at 20-30 proceedingss per visit. The length of intervention could explicate the high rates of abrasion ( i.e. , 12-69 % ) found in the surveies reviewed. However, Waller et Al. ( 1996 ) noted the indicated intervention may non take every bit long as the prescribed interv ention, since participants dropping out prior to completion of intervention still benefitted. The long-run effects and backsliding rates of brief intercession interventions in this scene is unknown, since the none of the surveies collected follow-up informations six months post intervention. Deductions for Practice Brief intercessions may merely be effectual for a subset of patients with bulimia nervosa and orgy feeding inclinations. Most surveies reviewed excluded participants with co-morbid upsets. Therefore, findings may non be generalizable to the typical primary attention population. Identifying the subset of persons in which brief intercessions will be most effectual remains disputing. While evidenced-based, brief intercessions are considered the first line of intervention for persons showing in primary attention ( NICE, 2004 ) , it is ill-defined how patients neglecting to react to these intercessions should be treated. PCPs electing non to supply behavioural intervention to patients with BN or orgy feeding must still play a important function in measuring and handling the physical symptomatology of eating upsets. With the outgrowth of incorporate attention, psychologists and mental wellness suppliers are going more present in the primary attention puting. Therefore, persons with BN and orgy eating inclinations may be treated holistically in the primary attention scene. Directions for Future Research Future research should concentrate on honing self-help CBT intervention in the primary attention puting and including participants with co-morbid features. Expanding bringing of intervention beyond primary attention doctors to other suppliers, such as nurses, dieticians, societal workers, and staff workers, may let for more trim intervention for the single presenting with feeding disordered behaviour.

Discussion of Former Child Soldiers with Ptsd and the Available Treatments

In his magazine article describing the obscene violence that is currently going on in Uganda, Christopher Hitchenssits down with a boy named James at a rehab center. James was fortunate enough to escape being a slave to Kony, when he was marched all the way to Sudan, where an ambush ensued and James got away. Marching long distances was an initiation technique used by the Lord’s Resistance Army in order to herd out the weaker boys. If a boy was too tired to go on, the other slaves were forced to brutally beat him to death. Before the march, James was savagely flogged with a wire lash and spared from having to kill his own family which is a frequent method of registration practised by the Lord’sResistance Army. No doubt, these experiences would have a negative developmental affect on any child, perhaps developing PTSD. Hitchens writes that when he was speaking to James, the boy would sit perfectly still in his chair, stoic, but when it came time for James to share his story, he began twisting in his chair. Along with rubbing his eyes and making waving gestures with his arms, these restless and jumpy behaviours are common symptoms of PTSD. What is the impact on a child who was forced to kill someone? Are the outcomes of this experience just as severe as witnessing a murder or being raped? Future research must dissect these varying forms of war trauma and compare the severity of a specificexperience to the negative developmental outcomes. Though the analyses of the data collected from these smalls groups seems exhausting, it is vital in order to better understand the individual. Slowly but surely, the research gathered surrounding specific traumatic experiences, will uncover more sophisticated strategies in the rehabilitation of former child soldiers. Participants were taught to verbalize the traumatic Overwhelming Events and that these events and the accompanying emotions might no longer be processed on a conscious level and could produce psychological disequilibrium. They were then taught that these traumatic events and emotions are often encapsulated in their subconscious memory as a coping device and that encapsulating the events and emotions can cause physical symptoms – Somatisation. Participants learned to recognize the psychological and physical bondage of these traumatic events and to acknowledge that these were beyond their control. This was followed by selecting a Companion to Release the encapsulated events to and leads to greater freedom from the emotional bondage. Recognizing their own Resilience as based on their individual strengths leads to the emergence of a New-Self, which leads to Rebuilding their social structure. A final Commencement celebration serves to integrate the learning as well as to initiate a bridge between the former child soldiers and their community. The vulnerability of a child who has just witnessed the destruction of their village and possibly the murder of their family, allows warlords to brainwash them and force them to perform sinister acts of violence. While being enslaved, a child’s once innocent mind is often flooded with warped views by their captor, and turned into an irrational killing machine. The effects of this are devastating on several levels; psychological, emotional, social and physical. As the previously discussed studies prove, it is crucial for research to continue surrounding the mental health outcomes of child soldiers in any war torn country. References Bayer, C. P. , Klasen, F. , Adam, H. (2007). Association of Trauma and PTSD Symptoms WithOpenness to Reconciliation and Feelings of Revenge Among Former Ugandan and Congolese Child Soldiers. JAMA, 298(5), 555 – 559. Hitchens, C. (2006). Childhood’s End. Vanity Fair, Jan 2006, 58 – 64. Onyut, L. P. , Neuner, F. , Schauer, E. , Ertl, V, Odenwald, Shauer, M. , Elbert, T. (2005). Narrative Exposure Therapy as a treatment for child war survivors with posttraumatic stress disorder: Two case reports and a pilot study in an African refugee settlement. BMC Psychiatry, 5:7