Nazism vs. Fascism Essay

R.Q.: To what extent were the German and Italian regimes under Hitler and Mussolini Totalitarian? i. Why? With this research I want to discover whether Hitler and Mussolini transformed Germany and Italy, respectively into Totalitarian regimes. In my discretion this played a major role when looking at traditions, respectability of countries and reputations of countries. Such â€Å"emotions† can also trigger wars, as we so in WWII. Initially, I feel that Dictatorships having absolute power over a country can cause many inconveniences for the citizens of it. Hence, I want to understand their motives and ambitions. Also, I figure that this is a very important time period in which milestones and new dimensions have been opened. Thirdly, I decided on this topic because I am a German citizen, who is naturally interested in the background and history of ones father country. ii. What? I am going to use a series of books written in different time periods by different writers from different countries. This shows a certain scope of viewpoints, which makes the answer to this question more objective. I am also going to use the Internet as one research option of my internal assessment. iii. I planned my essay. This can be seen in the appendix, 1) Essay Plan. This plan shows how I am going to attempt to accomplish my Task i. Define Nazism a. Nazism is the body of political and economic doctrines held and put into effect by the National Socialist German Workers’ Party in the Third Reich including the totalitarian principle of government, state control of all industries, predominance of groups assumed to be racially superior, and supremacy of the Fà ¯Ã‚ ¿Ã‚ ½hrer1. ii. Define Fascism a. Fascism is a political philosophy, movement, or regime (as that of the Fascisti) that exalts nation and often race above the individual and that stands for a centralized autocratic government headed by a dictatorial leader, severe economic and social regimentation, and forcible suppression of opposition2. iii. Define Totalitarian a. Totalitarian is defined as of or relating to centralized control by an autocratic leader or hierarchy. Of or relating to a political regime based on subordination of the individual to the state and strict control of all aspects of the life and productive capacity of the nation especially by coercive measures (as censorship and terrorism)3 iv. All these definitions above are essential in order to understand how totalitarianism is initially linked with Nazism and Fascism. These terms, Nazism Fascism and Totalitarianism have all got the subordination of the individual to the state and the control of mind etc. of the individual in common. The difference between them, however is that Totalitarian is purely a term describing a situation, a current state of something. Nazism and Fascism on the other hand, describe an ideology that developed over centuries and eventually ruled a country. When we are looking at these definitions, we discover, that both ideologies have a feature of totalitarianism innate. Therefore, initially we would say that they the states, Germany and Italy, both are totalitarian because the autocracy by which they are ruled is totalitarian. This must mean that the people believe in it because they elected this system of government, and hence the system must be totalitarian. This, however, is debatable. In the ongoing lines I will question the above statement by looking closer at the two ideologies and how they became elected. i. Discrimination of Minorities a. Germany i. Minorities, such as Jews, Blacks, Gypsies and women were discriminated widely. Anything not of Aryan derivation, was inferior. Women, for example, were expected to behave just like â€Å"K,K,K†-meaning Kinder, Kirche, Kà ¯Ã‚ ¿Ã‚ ½che. Translated, Children, Church, Kitchen. In other words, they were expected to have as many children as possible to expand the Aryan race, support the religion and cook well. Jews, of course, were treated the worst, i.e.: concentration camps. b. Italy i. Fascist Policy towards women was condescending. Women were not put equal to men. It was also anti-urban and anti-consumerist. There was birth control and additional taxes on unmarried. This, in a way, was similar to Nazi Germany, where there were incentives to bear as many children as possible. It aimed to promote the ‘superior’ race. Fascist policy was at the beginning not racially concerned. However, when relations with Germany improved, Mussolini adopted some anti-foreign steps. This aimed to give the people a feeling of superiority over other nations and should promote the will to fight for the cause of the nation. Employment conditions for female workers were restricted. They were excluded from several workplaces. ii. Church a. Germany i. Germany was almost entirely a Christian country. Hitler realised this and did not underestimate the power the church, as a single institution, could have on the peoples’ minds’. Therefore, he knew it would not be wise to attack the church during his campaigns. Hence, he made an agreement with the church, the Concordat, which granted the church religious freedom. This, however was only superficially. In reality, any member of the church speaking bad about Hitler or his party, NSDAP, was prosecuted or sent to a concentration camp. Even Church schools were influenced by Hitler; the bible was replaced by â€Å"Mein Kampf† and the cross by the swastika. b. Italy i. In Italy the church played a more important role than in Germany because of the Pope and the Vatican being situated in Italy. Hence, Mussolini tried, after 1922 when coming to power, to include the church as much as possible in the fascist state in order to stabilise and ensure power for his party, PNF. Catholicism was also seen as a possible threat to the emerging fascist state. Hence, a concordat was attempted to improve church-state relations. Catholicism was considered the religion of most Italians, which was so deeply rooted in Italian life that could directly endanger the position of the fascist might. iii. Education a. Germany i. Education in Germany was largely controlled by the Nazis. The main subjects were history, biology and physical education. All of course indoctrinated and altered to shine a good light on the Nazi party and its style of rule. Special schools were build for the â€Å"most talented†. This meant that from a very young age onwards, children in Germany were focused on the Nazi ideology, similar to the Youths, which I will talk about in the next paragraph. b. Italy i. Education was focused on Fascist ideas and ideology. Children were educated in physical education and military training. These are just examples to illustrate what Mussolini wanted to achieve. iv. Youths a. Germany i. Various youths’ existed in Nazi Germany, all aiming to control the mind of German children. Hitler once described his views concerning the purpose of youths:† When an opponent declares, ‘I will not come your side’, I calmly say: ‘Your child belongs to us already†¦In a short time, they will know nothing else but this community.† These programs existed for boys and girls. Boys camps were more physical, preparing for war. Girls’ camps were aiming to make them strong to bear many healthy children. b. Italy i. From 1929 onwards, Mussolini focused more intensely on the control of children in his regime. He wanted to control them by education, which he stated as a right of the leading body in a totalitarian state. The Ministry of Public Instructions was changed to the Ministry of National education (ONB) in 1929. This new organisation provided pre-military training, drill and gym. All measures to convey a more aggressive and disciplined way of live. This program was even integrated into the school curriculum. Recruitment was thus made very easy and numerous. The Fascists wanted to create an Italy were there were young courageous men willing to fight for the cause of the nation. Their motto was: â€Å"Believe, Obey, Fight†. This displays exactly what Mussolini was after. Especially during the great depression, Mussolini tried to give his people a cause to believe in. He created groups or fixed mass meeting so that the people would experience a way of unity. v. Propaganda a. Germany i. Minister of Propaganda in Nazi Germany was Goebbels. He was an able man, with enormous aims. Not only wanted he the people to accept the regime. He wanted them to capitulate to them, grasping the ideology. He, for the first time in history, effectively made use of the radio and press. He seized control over both. By 1932 less then 25% of the population owned a radio. Hence, he made provisions for producing cheap sets of wireless radios. He called it the ‘Volksempfà ¯Ã‚ ¿Ã‚ ½nger’, translated, ‘nation-receptionist’. The press seemed harder to control. The Nazi publisher-‘Eher Verlag’-bought many of the 4,700 existing newspapers. Goebbels held a daily press conference and eventually, the Editors Law, made the seizure of the press complete. Via the radio, the Aryan race was emphasized. Jewish music was not played. People were constantly bombed with Nazi propaganda, their ideology. b. Italy i. Mussolini wanted to create an image of the ‘new’ Italian. This image should be aggressive and patriotic. He also used heroic figurers from the wars to illustrate the alleged superiority of the Italian nation. vi. Police State a. Germany i. The party seemed to be well organized and structured. Hitler himself, however, rejected any document work. Now the question appears, how it was so sufficient? The answer is that a powerful force was acting behind the scenes. This force was the ‘army’. It consisted of the SS, short for â€Å"Schutz-Staffel†, the SA, short for â€Å"Sturm-Abteilung†, the Gestapo, known for its brutality and later the SD, â€Å"Sicherheitsdienst†, the party internal police force. All these acted in order to maintain or restore order. The SS was once created to be Hitler’s personal bodyguard. It evolved to be a unit with incredible power over, economic, political and social matters. It turned out to be an extremely useful tool for Hitler. b. Italy i. The military was also guaranteed a supreme status in Italy. However, the German army had become a political power whereas the Italian had not. After the death of Hindenburg, Hitler was able to benefit from an exclusive oath. Mussolini never had such an opportunity under the still existing Monarchy. The Italian Military acted with divided loyalties. The Italian army did not face any threats form party-army-type organizations, as opposed to the German SS and SA. vii. Power of the Leader a. Germany/Italy i. Both, ‘der Fà ¯Ã‚ ¿Ã‚ ½hrer’ and ‘il duce’, were charismatic and ambitious men. They had a set aim which they wanted to achieve no matter what the cost was. They managed to elate masses so that they would virtually believe anything they said. These are, among others, characteristics a strong Leader must have in order to be successful. Hitler was not only appointed chancellor but became President after Hindenburg’s death. He also appointed himself Chief-Commander of all armed forces. This gave him the mere control over many bodies. i. Weigh factors against each other a. Germany vs. Italy ii. Conclusion a. When looking back at my research and all the information I collected during it, I think it is fair to say that both ideologies and those implementing it, transformed the respective countries to a large extent into totalitarian regimes. Although, I would say that this phenomena did not occur in the conventional way. By definition, a totalitarian regime controls every aspect of life. When looking at the moment they came to power and the day they left, a great difference in many senses can be seen. Especially, when looking at how they controlled the peoples’ minds’. Propaganda, Force, Speeches, youths and discrimination are all factors, which increased their influence. This integrated so quickly into the respective countries roots, so that it was inevitable that people would eventually believe what they heard. They would also obey by it because they the how brutal their measures could be. Power conveyed and achieved by force was one feature in these regimes. The other means was propaganda. New technology, new innovations enabled them to convey their messages and slogans whenever they wanted. They could also reach every member of their â€Å"community†. They not only controlled adults. One of their ideas was to transform the young so that their ideology would be carried further with the next generation. 1 http://www.m-w.com/cgi-bin/dictionary?book=Dictionary&va=Nazism 2 http://www.m-w.com/cgi-bin/dictionary?book=Dictionary&va=fascism 3 http://www.m-w.com/cgi-bin/dictionary?book=Dictionary&va=totalitarian

Limb Loss A Major Event Health And Social Care Essay

Amputation could be described as the remotion of a organic structure appendage or portion by surgery or injury. If taken as a surgical step, it is used to command hurting or disease procedure in the affected portion or limb. A individual with an amputation may experience mutilated, empty and vulnerable. Traumatic amputation is a ruinous hurt and frequently a major cause of disablement ( Wald 2004 ) . Furthermore, reduced self-pride, societal isolation, organic structure image jobs, and sense of stigmatisation have besides been associated with limb loss ( William et al. 2004 ) . In some state of affairss, amputation are ineluctable. Irrespective of the cause, amputation is a mutilating surgery and it decidedly affects the lives of these patients ( De Godoy et Al. 2002 ) . Amputation of limb is a common thing in this present society. The loss of a limb distorts the persons organic structure image taking to the idea of non being a complete human being. The loss of the maps performed with that limb renders him helpless for sometime.Apart from loss of physical maps, the amputee besides loses hopes and aspirations for the hereafter ; his programs and aspirations get shattered. Therefore, he loses non merely a limb but besides a portion of his universe and hereafter. A considerable figure of them remain disquieted and dying about their interpersonal relationship in the societal, vocational, familial and matrimonial surroundings. Those few who have an open mental dislocation will necessitate active psychiatric intervention. In others in whom the mental symptoms are non so obvious, a careful psychiatric interview is necessary to convey to the bow the interior convulsion whichmay need aid of a head-shrinker. Limb loss is a major event that can badly impact the psychological wellness of the person concerned. Surveies show that 20-60 % of the amputees go toing follow up clinics are assessed to be clinically depressed. Persons with traumatic amputation irrespective of the age are likely to endure subsequent troubles with respect to their organic structure image, but these are bit more dramatic in the younger age groups. The psychological reactions to amputation are clearly diverse runing from terrible disablement at one extreme ; and a finding to efficaciously restart a full and active life at other terminal. In grownups the age at which an person receives the amputation is an of import factor. Surveies by Bradway JK et Al 1984 [ 15 ] , Kohl SJ Et Al 1984 [ 30 ] , Livneh H 1999 [ 9 ] , on the psycho-social version to amputation has led to a overplus of clinical and empirical findings. Kingdon D et Al 1982 equated amputation with loss of one ‘s perceptual experience of wholenessA while Parkes CM 1976 [ 10 ] with loss of partner andA Block WE et al 1963 [ 16 ] , Goldberg RT et Al 1984 with symbolic emasculation & A ; even death.A The person ‘s response to a traumatic event is influenced by personality traits, pre-morbid psychological province, gender, peri-traumatic dissociation, drawn-out disablement of traumatic events, deficiency of societal support and unequal header schemes. The old researches on amputation has focused chiefly on demographic variables, get bying mechanisms, and outcome steps ; with there being a scarceness of literature on prevalence of assorted specific psychiatric upsets in the post-amputation period. Most patients with a limb loss irrespective of whether due to traumatic or surgical processs go through a series of complex psychological responses ( Cansever et al 2003 [ 6 ] ) . Most people try to get by with it, those who do n't win develop psychiatric symptoms ( Frank et al 1984 [ 7,8 ] ) .A Shukla et Al ( 1982 ) [ 4 ] A andA Frierson and Lippmann ( 1987 ) A note that psychological intercession in some signifier is needed in approximately 50 % of all amputees, andA Shulka and co-workers ( 1982 ) [ 4 ] A study depression to be the most common psychological reaction following amputation. The three major jobs faced by many amputees are anxiousness, depression and physical disablement ( Green 2007 ) Horgan & A ; MacLachlan ( 2004 ) found Anxiety to be associated with depression, low ego regard, poorer sensed quality of life and higher degree of general anxiousness. With increasing age both anxiousness and depressive symptoms are associated with greater physical disablement ( Brenes et al. 2008 ) . Body image may be defined as the combination of an person ‘s psychosocial accommodation, experiences, feelings and attitudes that relate to the signifier, map, visual aspects and desirableness of one ‘s ain organic structure which is influenced by single and environmental factors ( Horgan & A ; MacLachlan 2004 ) . Each individual holds an idealised image of the organic structure, which he uses to mensurate the percepts and constructs of his or her ain organic structure ( Fishman, 1959 ) . From another position, Flannery & A ; Faria ( 1999 ) see body image in a individual as a dynamic changing phenomenon, it is formed by feelings and perceptual experiences about a individual ‘s organic structure that are invariably altering. Harmonizing to Newell ( 1991 ) , attractive people post amputation will probably have less support from others ensuing in a lessening in self-esteem and a lessening in positive self-image. Jacobsen et Al ( 1997 ) survey supports this stating that amputation consequences in disfiguration which may take to a negative organic structure image and possible loss of societal credence. The relationship between disablement experience and stigma are interwoven and inter-dependent. The ground for the amputees subjective perceptual experience of being unfit for the society is likely that organic structure image non merely provides a sense of †self ‘ ‘but besides affects how we think, act and relate to others ( Wald 2004 ) . Harmonizing to Kolb ( 1975 ) , an change in an person ‘s organic structure image sets up a series of emotional, perceptual and psychological reactions. Fishman ( 1959 ) states a individual â€Å" must larn to populate with his perceptual experiences of his disablement † instead than â€Å" with his disablement. † Successful accommodation for the amputee appears to be in the incorporation of the prosthetic device into his or her organic structure image and his or her focal point on the hereafter and non on the portion lost ( Malone JM, Moore, WS, Goldston J, A et Al, 1979 and, Bradway JK [ 15 ] , Malone JM, Racy J, A et al 1984 ) . The psychiatric facets of amputation has received light involvement in our state, inspite of inadvertent hurts being common ( Shukla et al. , 1982 [ 4 ] ) . The commonest psychiatric upset seen in amputees is major depression. Randall et Al. ( 1945 ) have reported an incidence of 61 % in non-battle casualties, while Shukla et Al. ( 1982 ) [ 4 ] found depressive neuroticism ( 40 % ) and psychiatric depression ( 22 % ) as taking psychiatric upsets in amputees ; merely 35 % of the entire sample in the later survey had nil psychiatric upsets. The dearth of literature in this field has prompted us to analyze of amputation and its carbon monoxide morbid psychiatric conditions so that we may be after care & amp ; direction for these patients. The present survey was undertaken with the purpose of analyzing the psychiatric jobs particularly anxiety, depression and organic structure dysmorphic syndrome which may be associated with disablement or changed life fortunes in the immediate post-ampu tation period. A comparing was made with Stroke patients as these patients excessively frequently experience similar physical and societal disabilities to amputees. Depression is the most common temper upset to follow shot ( Starkstein & A ; Robinson, 1989 ) , with major depression impacting around one one-fourth to one tierce of patients ( Beekman et al. , 1998 ; Ebrahim, Barer, & A ; Nouri, 1987 ; Hackett, Yapa, Parag, & A ; Anderson, 2005 ; Pohjasvaara et al. , 1998 ) . Depression has an inauspicious consequence on cognitive map, functional recovery, and endurance. Diagnostic and statistical manual ( DSM ) IV categorizes station shot depression as â€Å" temper upset due to general medical status ( i.e. shot ) † with the specific depressive characteristics, major depressive-like episodes, frenzied characteristics or assorted features.Two types of depressive upset associated with intellectual ischaemias have been described from surveies done with patient informations from acute infirmary admittance, community studies, or out patient clinics. Major depression occurs in up to 25 % of patients ; and minor depression occurs in 30 % of patient. Prevalence clearly varies over clip with an evident extremum 3months after the shot and later worsen in prevalence at 1 twelvemonth. Robinson and co-workers surveies showed a self-generated remittal in the natural class of major depression happening station shot in the first to 2nd twelvemonth following shot . However in few instances depression may go chronic and persist for a longer period. While some propose that station shot depression is due to stroke impacting the nervous circuits concerned with temper ordinance therby back uping a primary biological mechanism, others in the scientific community claim it to be due to the resulting societal and psychological stressors happening as a consequence of shot. Though an incorporate bio- psycho- societal theoretical account is warranted, most surveies clearly suggest the biological mechanism to hold the upper manus in the ulterior station stroke period than in the immediate stage. In the same manner Anxiety was about every bit common as depression and extra patients became dying at each clip point. Around 20 per cent of people will develop an anxiousness upset, most normally in the first three to four months after the shot. While the literature on PSA remains in its babyhood, the literature has begun to analyze its relationship to similar demographic, hurt, cognitive, and physical features as those examined for PSD. In footings of hurt features, PSA correlates significantly with right hemisphere lesions, while co-morbid PSA and PSD are linked to go forth hemisphere lesions ( Astrom,1996 ) .A Castillo etal. ( 1993 ) A foundA anxietyA more prevailing in association with posterior right hemisphere lesions, whereas worry withoutA anxietydisorderA was associated with anterior lesions. ThoseA studiesA that have found relationships between PSA and age and gender study that adult females ( Morrison, Johnston, & A ; Walter, 2000 ; A Schultz, Castillo, Kosier, & A ; Robinson, 1997 ) and younger patients ( & lt ; 59 old ages ) are more susceptible to PSA ( Schultz et al. , 1997 ) , while others report no important relationship ( Dennis et al. , 2000 ) .Review literature:Amputation: Sociodemographic factors: Several surveies revealed that major depressive upsets and greater depressive symptomatology were more prevailing at lower degrees of socioeconomic position [ Bruce L et Al 1994, Stansfeld et al 1992 ] . However, income degrees of people with an amputa-tion were non related to depressive symptoms [ Behel J M et Al 2004 ] . Dunn used a 10-page questionnaire to determine a assortment of personal features such as matrimonial position, faith, instruction, and etiology, etc. about each of 138 topics recruited from the Eastern Amputee Golf Association.13 With a scope of points, the survey focused on those â€Å" related to the effects of positive significance, optimism, and perceived control on depression and self-pride. â€Å" 13 Depression was measured utilizing the CES-D while self-pride was assessed by the Rosenberg Self-Esteem Scale ( RSE ) . Sing physical factors, Dunn found that younger amputees were significantly more at hazard to develop depression than older amputees ( P & lt ; .05 ) . Mentioning Williamson and Schulz every bit good as Frank [ 7,8 ] et Al, the writer suggests that both activity restriction-perhaps more usual, accepted by older persons than young-and visual aspect anxiousness may account for the determination. Wald et al supported Dunn ‘s findings with a mention to Fisher & A ; Hanspal and Livneh ‘s articles that suggests immature individuals, with amputations secondary to trauma, are more likely to develop depression than older individuals with amputations secondary to disease.3 Wald et Al besides cites Cheung et al as demoing that individuals with upper appendage amputations had higher rates of depression than lower appendage amputees. Darnall et Al ‘s telephone cross-sectional study revealed some interesting physical hazard factors for depression. The survey found that comorbidities were a important hazard factor ( for one comorbidity, p=.007 ; for two comorbidities, pa†°Ã‚ ¤.001 ) . Anyone with terrible apparition hurting was 2.92 times more likely to develop depression than those without annoying pain.8 Other types of hurting such as residuary limb or back hurting were besides found to increase the opportunity of developing depressive symptoms. Hanley et al took 70 topics, 1 month post-amputation of the lower appendage, and asked inquiries about map, apparition limb hurting, header, etc. The patients were assessed once more at 12 and 24 months after the amputation.14 Phantom limb hurting was measured utilizing points adapted from the Graded Chronic Pain Scale ( GCPS ) and pain intervention was measured by portion of the Brief Pain Inventory ( BPI ) . Later, multiple arrested development analyses were used to find what factors at the initial appraisal may hold predicted the development of depression. Ultimately, the survey found the most certain physical factor to increase the hazard of depression was the presence along with the badness of apparition limb hurting. Using HADS with 105 topics at an amputation rehabilitation ward, Singh et al found none of the following to be risk factors for depression or anxiousness: age, gender, clip since amputation, degree or prosthetic bringing events.10 There was, nevertheless, a important correlativity between the presence of comorbidities and depression ( p & lt ; .01 ) every bit good as between life in isolation and anxiousness ( p & lt ; .05 ) . The writers offer small account for their findings. Dunn found ab initio that none of the following appeared to be risk factors for depression: gender, degree of amputation, matrimonial position, race, income degree, instruction, employment, or spiritual affiliation.13 Ultimately, nevertheless, the survey did find-as Wald et Al subsequently reported-that beyond young person as a physical hazard factor for depression, there were several emotional/psychological hazard factors.3 Subjects who were less optimistic-not needfully pessimistic-about their state of affairs were more likely to develop depression, as were those who could non happen significance in their amputation experience and anyone who felt they had small control over their intervention and position. It was the participants who reported missing a positive mentality, who could believe merely of the negative effects, and who felt out of control or unimportant that tended to show down symptoms as clip progressed. Wald et al went farther to mention Breakey and Rybarczyk et Al with findings proposing that missing a societal support system, holding issues with visual aspect, and uncomfortableness in society due to personal perceptual experiences about societal interactions all increased the likeliness of developing depression.3 This construct of hurt and depression issue from the amputee keeping certain beliefs about visual aspect and being sensitive to public uneasiness was echoed in the findings of Atherton et al.11 That survey explained the findings by proposing that individuals with high public uneasiness were by and large the type of individual to care a batch about societal contact and what is considered â€Å" normal † ; these individuals would be acutely cognizant of how they might now be perceived to be â€Å" different † and accordingly experience hard-pressed. Lack of societal support after an amputation was found to be a hazard factor in several of the reviewed surveies, including Darnall et al.8 The survey discovered that those topics who were, at the clip of or shortly after the amputation, either divorced or separated from a important other were more likely to develop depressive symptoms. Besides likely to increase depression rates was populating near the poorness degree ; depression, nevertheless, was buffered by the topic holding a higher instruction. Populating near the poorness degree and holding a higher instruction, although both are imaginable particularly sing the emphasis poorness topographic points upon individuals with medical conditions, was non confirmed in any of the other literature reviewed here. Previous depressive episodes and abnormal psychology was found to be a hazard factor for later depression in both Meyer and Ehde et al.5,9 Meyer ‘s survey suggested that pre-injury personality disfunction had the greatest influence on the prevalence of depression after an amputation, in this instance of the manus. Ehde et al discovered old depressive episodes-since the amputation but earlier in the survey of 24 months-to be more declarative, instead than pre-injury mental province. The survey besides suggests gender and societal support to be of import factors in the development of depression. Interestingly, Ehde et Al claims that pain catastrophizing by the topic while in the infirmary puting leads to modern-day and later increased rates of depression.9 Commenting on its contradiction to common cognition and other literature on this point, Hanley et al studies happening that hurting catastrophizing in patients decreased the prevalence of depression in survey subjects.14 The writers speculate that patient hurting catastrophizing, peculiarly in the ague attention puting, garnered more attending from wellness attention staff and household, with it possibly more of the psychological or physical attention they needed to retrieve. This suggests that, by being more demanding, the patients received support that other less-vocal patients did non. Last, beyond hapless hurting tolerance, both Seidel et Al and Desmond found that topics who avoided discussing or screening and were in denial about their amputation were more likely to develop depression both ab initio and long-term.6,7 Subjects who preferred to avoid admiting their new position as amputees besides tended to hold hapless credence of their prosthetic device. This became evident at the clip of prosthetic adjustments when topics frequently became progressively distressed, by and large going depressed.Depression and anxiousness:Most surveies agree that between 20 and 30 % of amputees qualify for MDD after amputation This depression is frequently associated with anxiousness and may or may non be attributable to posttraumatic emphasis upset. All surveies describing on the prevalence of depression in the amputee population found rates higher than those in the general population, peculiarly in the months and old ages instantly following the amputation. Grunert et al. , as cited in Wald et Al, found that, at the initial appraisal after manus hurt, 62.4 % of topics claimed depressive symptoms. Another reappraisal, Horgan et Al, cites Caplan et al as happening 58 % of topics to measure up for MDD at 18-months station amputation while mentioning Bodenheimer et Al ‘s findings of a 30 % depression rate. Meyer determined that the bulk of surveies on depression in amputees, on norm, found a prevalence of about 30 % , between three and six times higher than the world-wide rate. Seidel et Al found a similar rate of depression among individuals after the amputation of a lower appendage as opposed to the more socially noticeable upper appendage and custodies. In a three-part cross-sectional study administered to 75 patients seen at the Klinik und Poliklinik fur Technische Orthopade des Universitatsklinikums Munster, topics were asked inquiries and assessed harmonizing to the Hospital Anxiety and Depression Scale ( HADS ) , In this survey, 27 % and 25 % of the topics with a lower appendage amputation demonstrated increased depression or anxiousness, severally ; 18.3 % had both higher depression and anxiousness. Desmond determined that 28.3 % of the topics had tonss to bespeak possible MDD and 35.5 % qualified for clinical anxiousness. Darnall et al completed a cross-sectional study via telephone with 914 capable amputees.8 The topics were selected from a database of people who contacted the Amputee Coalition of America between 1998 and 2000 ; the sample was categorized per the topics ‘ etiologies but both upper and lower appendage amputations were included. Through informations analysis the survey found a depression prevalence of 28.7 % which the writers concluded was comparable to rates antecedently reported in surveies of depression in the amputee population. Singh et Al performed a cohort survey on 105 individuals with lower appendage amputation secondary to a assortment of etiologies who were admitted to an amputee rehabilitation ward.10 Upon admittance and discharge, each topic completed the HADS ; during the class of their stay, certain factors about each patient-such as gender, societal inside informations and found at admittance, 26.7 % of the topics were classified as down and 24.8 % as dying. Through a cross-sectional study of 67 new ( within the past five old ages ) adult lower appendage amputees who wear prosthetic devices, Atherton et al investigated the topics ‘ longer term psychological accommodation to amputation and found 13.4 % of the topics to be depressed and 29.9 % to be dying. Ziad M Hawamdeh et Al, have shown the prevalence of depressive and anxiousness symptoms to be 20 % and 37 % severally, which is consistent with several old surveies that confirmed high rates of anxiousness and depressive symptoms after amputation with prevalence up to 41 % ( Kashani et al 1983 ; Schubert et Al 1992 ; Hill et al 1995 ; Cansever et Al 2003 [ 6 ] ; Atherton and Robertson 2006 ; Seidel et Al 2006 ) . Most surveies have found no important relationship between the clip resulting amputation and psychological perturbations ( Rybarczyk et al 1992 ; Thompson et Al 1984 ) , ( Horgan and Maclachlan 2004 ) . Horgan and Maclachlan ( 2004 ) in their publication on amputations psychological accommodation concluded that depression and anxiousness seemingly are higher in the first 2 old ages post amputation and thenceforth worsen to degrees prevalent in the general population. Singh and Hunter 2007 in their recent survey concluded depression neodymium anxiousness symptoms to decide after in patient rehab for a short continuance. Gender is one of the sociodemographic factor that could be associated with result following amputation. In footings of psychological wellbeing following amputation, most surveies have found no difference in psychosocial result between work forces and adult females ( Bradway et al 1984 [ 15 ] ; Williamson 1995 ; Williamson and Walters 1996 ) . But surveies performed by Kashani and col-leagues ( 1983 ) , O'Toole and co-workers ( 1984 ) , and Pezzin and co-workers ( 2000 ) , have reported adult females to be more likely to see depression, and to execute more ill on a step that includes an appraisal of emotional adaptability. Fisher and Hanspal ( 1998 ) , Livneh and co-workers ( 1999 ) [ 9 ] suggested immature grownups with traumatic amputation to be at higher hazard of major depression in comparing to persons with surgical amputations. Other surveies analyzing the relationship between cause of amputation and psychosocial result have found no consequence of amputation on psychiatric symptoms ( Shukla et al 1982 [ 4 ] ) , anxiousness ( Weinstein 1985 ) , and depressive symptoms ( Kashani et al 1983 ; Rybarczyk et Al 1992 ; Williamson and Walters 1996 ) . Engstorm et Al ( 2001 ) , showed that the amputee ‘s current household reactions to hold a important consequence on accommodation. Williamson et Al ( 1984 ) , Thompson and Haran ( 1984 ) , Rybarczyk et Al ( 1992, 1995 ) , found depression to be more prevailing in those who are socially stray and with low sensed degrees of societal support. Harmonizing to Weinstein ( 1985 ) , although above articulatio genus amputations are associated with poorer rehabilitation results and higher activity limitation degrees, AK amputations were non found to be associated with increased degrees of anxiousness, societal uncomfortableness, general psychiatric symptoms ( Shukla et al 1982 [ 4 ] ) , depression ( Behel et al 2002 ) , or accommodation to amputation ( Tyc 1992 ) . O'Toole et Al ( 1984 ) found that persons with BK amputation to be more likely down than those with AK amputations because BK is less badly disenabling than AK in footings of operation.Body image perturbation:Few surveies have been reported in the literature in the country of research on organic structure image and the amputee. Fishman ( 1959 ) determined the amputee ‘s perceptual experience of his or her physical disablement has a greater influence on successful rehabilitation than the extent of the disablement. He states, â€Å" A figure of really specific psychological, societal and physiological homo demands are thwarted when one becomes physically handicapped as a consequence of amputation†¦ . The method of seting psychologically to an amputation is chiefly a map of the preamputation personality and psychosocial background of the individual. Each individual holds an idealised image of the organic structure, which he uses to mensurate the percepts and constructs of his or her ain organic structure ( Fishman, 1959 ) . From another position, Flannery & A ; Faria ( 1999 ) see body image in a individual as a dynamic changing phenomenon, it is formed by feelings and perceptual experiences about a individual ‘s organic structure that are invariably altering. Harmonizing to Kohl ( 1984 ) [ 30 ] , a individual who has lost a limb must see him- or herself every bit merely that ( a individual who has lost a limb ) and non burthen him- or herself with labels such as â€Å" amputee. † Kohl [ 30 ] suggests this attitude is the key to a positive accommodation to a new organic structure image after an amputation. Shontz ( 1974 ) suggests an person who is losing a limb has three organic structure images: the preamputation integral organic structure, the organic structure with limb loss and the organic structure image when have oning a prosthetic device. The weiss et Al ( 1971 ) studied 56 transfemoral amputees and 44 transtibial amputees utilizing a comprehensive battery of trials and a 50-item Amputee Behavior Rating Scale. The evaluation graduated table assessed the existent behavior of the amputees as observed by the members of the amputee clinic squad. This signifier was completed by the squad members: the doctor, healer, prosthetics and rehabilitation counselor. On about all measures the transtibial amputees obtained better tonss than the transfemoral amputees. The research workers wises et Al ( 1971 ) found â€Å" the degree of amputation was significantly related to legion facets of psychophysiological and personality working while aetiology was non. † They concluded that since transtibial amputees are less handicapped as a group, they by and large function better than transfemoral amputees. In add-on, they suggest the less-positive self-image of the transfemoral amputees besides can be attributed to a less-appealing p ace, frequently with a noticeable hitch ( wises et al 1971 ) .Post shot:Sociodemographic profile:The possible influences of socioeconomic position ( SES ) , age and gender on the development of depression following shot have all been examined, with inconsistent consequences ( Ouimet et al. 2001 ) . Although one could foretell intuitively that lower SES and increasing age are associated with the hazard for PSD, this is non needfully the instance. Andersen et Al. ( 1995 ) reported that SES had no influence on the hazard for post-stroke depression and recent surveies suggest that younger instead than older age is associated with increased hazard ( Eriksson et al. 2004 ; Carota et Al. 2005 ) . Given the well higher prevalence of depression among adult females when compared to work forces in the general population ( Wilhelm & A ; Parker 1994 ; Ouimet et Al. 2001 ; Salokangas et Al. 2002 ) , a higher prevalence of PSD among adult females might be expected. While the consequences from some surveies support the association between female sex and PSD ( Desmond et al. 2003 ; Paradiso & A ; Robinson 1998 ; Ouimet et Al. 2001, Eriksson et al. , 2004, Paolucci et Al. 2005 ) , others do non ( Ouimet et al. 2001 ; Berg et Al. 2003 ; Whyte et Al. 2004, Spalletta et Al. 2005 ) . However, there may be existent differences between work forces and adult females in footings of the comparative importance of hazard factors for PSD. Among work forces, physical damage may be a more influential hazard factor ( Paradiso & A ; Robinson 1998 ; Berg et Al. 2003 ) , while among adult females, old history of psychiatric upset may be more of import ( Paradiso & A ; Robinson 1998 ) .Depression and anxi ousness:Three possible accounts for the association between physical unwellness and depression have been sought. First, and least likely is a coinciding relationship. The 2nd is a negative temper reaction to the physical effects of the shot. The impact of the physical unwellness may exert its consequence through the losingss it causes to the person as a major negative life event ( losingss to selfesteem, independency, employment, etc. ) . The 3rd possible account is a neurotransmitter instability as a consequence of intellectual harm caused by the shot. Depression is a well-documented sequela of shot. Based on pooled informations from published prevalence surveies ( Robinson 2003 ) , the average prevalence of depression among in-patients in ague or rehabilitation scenes was 19.3 % and 18.5 % for major and minor depression severally while, among persons in community scenes, average prevalence for major and minor depression was reported to be 14.1 % and 9.1 % . Among patients included in outpatient surveies, mean reported prevalence was 23.3 % for major depression and 15 % for minor depression ( Robinson 2003 ) . Overall average prevalence ranged from 31.8 % in the community surveies to 35.5 % in the ague and rehabilitation infirmary surveies. A recent systematic reappraisal of prospective, experimental surveies of post-stroke depression ( Hackett et al. 2005 ) reported that 33 % of shot subsisters exhibit depressive symptoms at some clip following shot ( acute, medium-term or long-run followup ) . Estimates of prevalence may be affected by the clip from shot onset until appraisal. In fact, the highest rates of incident depression have been reported in the first month following shot ( Andersen et al. 1995, Aben et Al. 2003, Bhogal et Al. 2004, Morrison et Al. 2005, Aben et Al. 2006 ) . Paolucci et Al. ( 2005 ) reported that, of 1064 patients included in the DESTRO survey, 36 % developed depression of whch 80 per centum of them developed depression within the first three station stroke months ( Paolucci et al. 2005 ) . The incidence of major depression may diminish over the first 2 old ages following shot ( Astrom et al. 1993, Verdelho et Al. 2004 ) but minor depression tends to prevail or instead addition over the above mentioned clip period ( Burvill et al. 1995 ; Berg et Al. 2003, Verdelho et Al. 2004 ) . Berg et Al. ( 2003 ) reported about one-half of the persons sing depression during the acute stage station shot, to see it in the resulting one and half twelvemonth ; nevertheless, more adult females than work forces have been identified in the acute stage while there is a male predomination in the latter half period ( Berg et al. 2003 ) . The survey of temper upsets after shot has focused mostly on depression. Reported prevalence of PSD varies widely, though most surveies place prevalence between 20 and 50 % , and indicate that depression persists 3-6 months poststroke ( Fedoroff, Starkstein, Parikh, Price, & A ; Robinson, 1991 ; Hosking, Marsh, & A ; Friedman et al, 2000 ; Lyketsos, Treisman, Lipsey, Morris, & A ; Robinson, 1998 ; Parikh, Lipsey, Robinson, & A ; Price, 1988 ; Schubert, et al 1992 ; Schwartz et al. , 1993 ; Starkstein, Bryer, Berthier, & A ; Cohen, 1991 ; Starkstein & A ; Robinson, 1991a, 1991b ) . PSD has a negative impact on instance human death and rehabilitation ( Whyte & A ; Mulsant, 2002 ) , and functional results ( Herrmann, Black, Lawrence, Szekely, & A ; Szalai, 1998 ) . In contrast, PSA has merely late begun to be investigated ( Castillo, Schultz, & A ; Robinson, 1995 ; Castillo, Starkstein, Fedoroff, & A ; Price, 1993 ; Chemerinski & A ; Robinson, 2000 ; Dennis, O'Rourke, Lewis, Sharpe, & A ; Warlow, 2000 ; Robinson, 1997, 1998 ; Shimoda & A ; Robinson, 1998 ) with prevalence studies runing from 4 to 28 % ( Astrom, 1996 ; House et al. , 1991 ) . As with PSD, the class of PSA has been found to stay reasonably changeless up to 3 old ages post stroke ( Astrom, 1996 ; Robinson, 1998 ) . Co-morbidity of PSA and PSD is high, with every bit many as 85 % of people with generalized anxiousness holding co-morbid depression during the 3 old ages post stroke ( Castillo et al. , 1993, 1995 ) . Previously depression was found to be frequent in immature patients ( Neau et al. 1998 ) , while in some surveies ( Sharpe et al. 1994, kotila et Al. 1998 ) it has been related to old age. Lack or societal support and both functional and cognitive damage may increase the hazard of depressive upset in the elsderly ( Sharpe et al. 1994 ) . Robinson et Al in 1984 studied patients of shot in 2 groups in relation to onset of of depression, group of patients with acute oncoming of depression, within few hebdomads after shot and 2nd group with delayed oncoming of depression over 24 months and found no difference in clinical characteristics or class of depression in the two groups. In 1986 Lapse et al compared a group of patients with PSD with 43 platinums with functional depression that the two groups did non differ in the symptom profile of depression is the important determination in their survey. Although post-stroke depression ( PSD ) is a common effect of shot, hazard factors for the development of PSD have non been clearly delineated. In a recent systematic reappraisal, Hackett and Anderson ( 2005 ) included informations from a sum of 21 surveies ( Table 18.2 ) . Of the many different variables assessed, physical disablement, stroke badness and cognitive damage were most systematically associated with depression. In an earlier reappraisal of 9 prospective surveies analyzing post-stroke depression, the hazard factors identified most systematically as increasing an person ‘s hazard for post-stroke depression included a past history of psychiatric morbidity, societal isolation, functional damage, populating entirely and dysphasia ( Ouimet et al. 2001 ) . Since the clip of the Hackett et Al. ( 2005 ) and Ouimet et Al. ( 2001 ) reviews, more recent surveies have confirmed the importance of badness of initial neurological shortage and physical disablement as forecasters of the development of depression after shot ( Carota et al. 2005, Christensen et Al. 2009 ) . In add-on, Storor and Byrne ( 2006 ) examined post-stroke depression in the acute stage ( within14 yearss of shot oncoming ) and identified important associations between prestrike neurosis ( OR = 3.69, 95 % CI 1.25 – 10.92 ) and a past history of mental upsets ( OR = 10.26, 95 % CI 3.02 – 34.86 ) and the presence of dep ressive symptoms.Stroke Location and Depression:There have been 2 meta-analyses analyzing this relationship ( Singh et al. 1998, Carson et Al. 2000 ) . Singh et Al. ( 1998 ) conducted a critical assessment on the importance of lesion location in post-stroke depression. The writers consistently selected 26 original articles that examined lesion location and post-stroke depression. Thirteen of the 26 articles satisfied inclusion standard ( Table 18.3 ) . Six of those surveies found no important difference in depression between right and left hemisphere lesions. Two surveies found that right-sided lesions were more likely to be associated with depression and 4 surveies found that left-sided lesions were more likely to be associated with post-stroke depression. Merely one survey matched patients with and without depression for lesion location and size to place non-lesion hazard factors. Consequently, Singh et Al. ( 1998 ) were unable to do any unequivocal decisions refering shot lesion location and the hazard for depression. Carson et Al. ( 2000 ) undertook a systematic reappraisal to see the association between post-stroke depression and lesion location. All studies on the association of poststroke depression with location of encephalon lesions were included in the reappraisal. In entire 48 studies were included for reappraisal ( Table 18.4 ) . The writers of the reappraisal identified 38 studies that found no important difference in hazard of depression between lesion sites ; 2 reported an increased hazard of poststroke depression with left-sided lesions ; 7 reported increased hazard with right-sided lesions ; and one study demonstrated an association between depression and lesions in the right parietal part or the left frontal part. Robinson & A ; Szetela ( 1981USA ) : 18 patients with left hemispheric shot were compared to 11 patients with traumatic encephalon hurt for frequence and badness of depression, More than 60 % of the shot patients had clinically important depression compared with approximately 20 % of the injury patients. Hermann et Al. ( 1995 Germany ) : 47 patients with individual demarcated one-sided lesions were selected for survey. Clinical scrutiny, CT scan scrutiny and psychiatric appraisal were performed within a 2-month period after the acute shot. No important differences in depression tonss noted between patients with left and right hemisphere lesions. Major depression was exhibited in 9 patients with left hemispheric shots all affecting the basal ganglia. None of the patients with right hemispheric shots exhibited a major depression. Morris et Al. ( 1996a Australia ) : 44 first-ever shot patients with individual lesions on CT were examined for the presence of post-stroke depression, badness of depression and its relationship to lesion location. Patients with left hemisphere prefrontal or basal ganglia constructions had a significantly higher frequence of depressive upset than other left hemispheric lesions or those with right hemispheric lesions. Based on the consequences of a meta-analysis conducted by Bhogal et Al. ( 2004 ) , there appears to be some grounds that depression following shot may be related to the anatomical site of encephalon harm, although the nature of this anatomic relationship is non wholly clear ( Bhogal et al. 2004 ; Figure 18.1 ) . The John Hopkins Group ( Lipsey et al. 1983, Robinson & A ; Szetela 1981, Robinson & A ; Price 1982, Robinson et Al. 1982, 1983, 1984, 1986, 1987 ) carried out a series of surveies researching the relationship of post-stroke depression to the location of the lesion within the encephalon itself. They found that in a selected group of shot patients, similar to those admitted to a shot rehabilitation unit, depression appeared to be more frequent in patients with left hemispheric lesions ( Robinson & A ; Szetela 1981, Robinson & A ; Price 1982, Robinson 1986, Robinson et al 1987 ) . Among these patients, the badness of depression correlated reciprocally withthe distance of the lesion from the frontal poles ( Robinson & A ; Szetela 1981, Robinson & A ; Price 1982, Robinson et Al. 1982,1983, 1984, 1986, 1987, Starkstein et al. 1987 ) . Patients with subcortical, cerebellar or brainstem lesions had much shorter-lasting depressions than patients with cortical lesions ( Starkstein et Al. 1987,1988 ) . The correlativity of major depression to the propinquity of the lesion to the frontal pole has been confirmed by Sinyor et Al. ( 1986 ) and Eastwood ( 1989 ) . Right hemispheric lesions failed to show a similar relationship with depression. Interestingly, in one survey, patients who had both an anxiousness upset and a major depression showed a significantly higher frequence of cortical lesions, while patients with major depression merely had a significantly higher frequence of subcortical ( radical ganglia ) shot ( Starkstein et al. 1987 ) . Finally, the two big systematic reappraisals by Singh et Al. ( 1998 ) and Carson et Al. ( 2000 ) referred to antecedently, failed to happen a relationship between the shot lesion site and depression. Recent studies have suggested that psychosocial hazard factors including age, sex and functional damage or old history of psychiatric perturbation are greater subscribers to the development of PSD than lesion location ( Singh et al. 2000, Berg et Al. 2003, Carota et Al. 2004, Aben et Al. 2006 ) . While the literature on PSA remains in its babyhood, the literature has begun to analyze its relationship to similar demographic, hurt, cognitive, and physical features as those examined for PSD. In footings of hurt features, PSA correlates signii ¬?cantly with right hemisphere lesions, while co-morbid PSA and PSD are linked to go forth hemisphere lesions ( Astrom, 1996 ) . Castillo et Al. ( 1993 ) found anxiousness more prevalent in association with posterior right hemisphere lesions, whereas worry without anxiousness upset was associated with anterior lesions. Those surveies that have found relationships between PSA and age and gender study that adult females ( Morrison, Johnston, & A ; Walter, 2000 ; Schultz, Castillo, Kosier, & A ; Robinson, 1997 ) and younger patients ( & lt ; 59 old ages ) are more susceptible to PSA ( Schultz et al. , 1997 ) , while others report no signii ¬?cant relationship ( Dennis et al. , 2000 ) . Most surveies that have examined cognitive map and PSA have besides assessed physical damage. Castillo et Al. ( 1993, 1995 ) study that PSA is non signii ¬?cantly correlated with physical operation, cognitive operation, or societal operation. While some writers likewise report no signii ¬?cant correlativity ( Starkstein et al. , 1990 ) , others report that anxiousness is linked to greater damage in activities of day-to-day populating both acutely and up to 3 old ages post stroke ( Schultz et al. , 1997 ) . To day of the month, few surveies have examined both depression and anxiousness station shot, or their differential relationships to these factors. Suzanne L. Barker-Collo ( 2007 ) found in his survey Prevalence rates for moderate to severe depression and anxiousness in the present sample were 22.8 and 21.1 % , severally. That left hemisphere lesion was related to increased likeliness of depression and anxiousness is consistent with the literature if one considers 3 months to be within the acute stage of recovery ( Astrom, 1996 ; Astrom et al. , 1993 ; Bhogal et al. , 2004 ) . There is a dearth of literature about Body Dysmorphic Disorder ( BDD ) in station shot person.Aim and aims:To depict psychiatric profile of the patient with amputation and comparison with station shot patient.Materials and methods:Study was carried out in outpatient and inpatient section of orthopedicss, plastic surgery, general medical specialty at Govt. Stanley Medical College.Time period of survey:From may 2012 to October 2012 ( 6months )Design of survey:Case -control surveyChoice of sample:A sum of 30 patient consecutively chosen, organize the sample for instances and back-to-back sample of 30 patient with shot constitute the control group. Patient were assessed within the period of two to six hebdomads after amputation and shot.Inclusion and Exclusion standards:Cases ( Patients with amputation )INCLUSION CRITERIA:Patients who underwent elected every bit good as exigency amputation. Age between 18 old ages to 60 old ages.Exclusion Standards:Patients with age less than 18 old ages and with age more than 60 old ages Previous history of psychiatric unwellness Patients with history of psychiatric unwellness before the amputation Patients with other medical unwellnessControlsINCLUSION CRITERIA:Patients with shot Age between 18 old ages to 60 old ages.Exclusion Standards:Patients with age less than 18 old ages and with age more than 60 old ages Previous history of psychiatric unwellness Patients with history of psychiatric unwellness before the oncoming of shot Patients with other medical unwellnessTools used:A structured interview agenda to analyze the demographics, clinical characteristics and other relevant factors in history. General Health Questionnair ( GHQ-28 ) Hospital Anxiety and Depression Scale ( HADS ) Hamilton Depression evaluation Scale ( HDRS/HAM-D ) Brief Psychiatric Rating Scale ( BPRS ) Yale Brown Obsessive Compulsive Scale for Body Dysmorphic Disorder. ( YBOCS-BDD )General Health Questionnaire ( GHQ 28 )The GHQ 28 was developed by Goldberg in 1978, Developed as a shouting tool to observe those likely to hold or to crush hazard of developing psychiatric upset. GHQ 28 is a 28 point steps of emotional depression medical scenes, through factor analysis GHQ 28 has been divided into 4 subscales. They are: Bodily symptoms ( 1-7 ) Anxiety/insomnia ( 8-14 ) Social disfunction ( 15-21 ) Severe depression ( 22-28 ) Each point is occupied by 4 possible responses non at all, no more than usual, instead more than usual and much more than usual. There are different methods to hit GHQ 28. It can be scored from 0-3 for each response with a entire possible mark on the runing from 0-84. Using this method, a entire mark of 23/24 is the threshold for the presence of hurt. Alternatively to GHQ 28 can be scored with a binary method where non at all and no more than usual mark 0, and instead more than usual and much more than usual mark 1, utilizing this method any mark above 4 indicates the presence of hurt. Numerous surveies have investigated dependability and cogency of the GHQ 28 in assorted clinical populations. Test-Retest dependability has been reported to be high ( 0.78+00.09 ) ( Robinson and monetary value ( 1982 ) and intra rater and inter rater dependability have both been shown to be first-class ( crnballi ‘s 20.9-0.95 ) . High internal consistences have besides been reported. ( Failde and Ramos 2000 ) . GHQ 28 correlatives good with the infirmary depression and anxiousness graduated table ( HADS ) ( Sakakibara 2009 ) and other steps of depression ( Robinson and monetary value 1982 ) .Hospital anxiousness and depression graduated table ( HADS )HADS was originally developed by Zigmond and snaitn ( 1983 ) , it is normally used to find the degrees of anxiousness and depression. Sum of 14 points in that 7 points for anxiousness and 7 for depression. Each point on the questionnaire is scored from 0-3 and this means that individual can hit between 0 and 21 for either anxiousne ss or depression. ( Scale used is a likes mark and the bow informations returned from the HADS is ordinal informations ) and subdivided into mild 8-10, moderate 11-15 and terrible greater or equal to 16. Internal consistence has been found to be first-class for the anxiousness ( 2-85 ) and adequate for the depression graduated table and besides has equal cogency for anxiousness HADS gave a specificity of 0.78 sensitiveness of 0.9. For depression this gave specificity of 0.78 and sensitiveness of 0.83.Hamilton Rating Scale for DepressionThe Hamilton evaluation graduated table for depression ( HAMD ) , developed by M.Hamilton is the most widely used evaluation graduated table to measure the symptoms of depression. The HAMD is a observer rated scale consisting of 17 to 21 points ( separately 2 portion points, weight and denary fluctuation ) . Rating is based on clinical interview, plus any extra variable information such as household members study. The points are rated on either 0-4 spectrum or a 0-2 spectrum. The HAM-D relies rather to a great extent on the clinical interviewing teguments and experience of rater in measuring persons with depressive unwellness. As most patients score zero on rare points in depression ( Depersonalization and compulsion and paranoiac symptoms ) , the entire mark on HAMD by and large consists of merely amount of first 17 points. The strength of the HAMD is first-class proof research base and easiness of disposal. Its usage is limited in person who have psychiatric upset other than primary depressionScoring0-7 aNormal 8-13 aMild depression 14-18 aModerate depression 19-22 asevere depression Greater than 23 aVery terrible depressionsBrief psychiatric evaluation accomplishment ( BPRS )Developed by JE overall and Dr.Gorhav in 1962 it is widely used comparatively brief graduated table that measures major psychotic and non psychotic symptoms in single with major psychiatric upset, peculiarly Scurophressia. The 18 points BPRS is possibly the most researched instrument in psychopathology. 18 points rated on 1-7. Items are divided into observed and reported points.Observed ItemsReported ItemsEmotional backdown Bodily concern Conceptual disorganisation Anxiety Tension Guilt feeling Idiosyncrasy and Posturing Depressive temper Motor deceleration Hostility Uncooperativeness Suspicion Blunted affect Hallucinatory behaviour Exhilaration Unusual tuocyn content Disorientation Strengths of the graduated table includes is brevity, easiness of disposal, broad usage and good rescanned position.Yale Brown Obsessive compulsive Scale for BDDYBOCS is a test/scale to rate the badness of OCD symptoms. Scale was designed by Dr.Wayne Goodman and his co-workers, is used extensively in research and clinical pattern. Modified YBOCS graduated table is used to mensurate to badness of symptoms of compulsion and irresistible impulse in a patient holding pre business with sensed defect in visual aspect ( BDD ) . It is a 12 point instrument consisting 5 inquiries on preoccupation and 5 inquiries on compulsive behavior, one on penetration and one on turning away. More specifically it assesses clip occupied by preoccupation with the sensed defect in visual aspect, intervention in operation, hurt, opposition and control. Similar buildings are assessed for compulsive behavior. Similar to the YBOCS for OCD, each points on the YBOCS-BDD measured on the 5 point likert graduated table with higher mark denoting progressively psycho-pathology. Mark on this 12 points ranges from 0-48 the YBOCS-BDD has been shown to hold good inter rated dependability, trial retest dependability and internal consistence. It has besides shown to be sensitive to alter. It was developed as mensurating badness of BDD symptoms instead than as a diagnostic tool. It should be noted that, scale first 3 points reflect the DSM IV diagnostic standards for BDD. The advantage or BDD-YBOCS is that it assists in comparing clients across surveies. It is based on the YBOCS and is hence curicitically bound to a theoretical account of an obsessional compulsive ghosts disorder. An of import different between YBOCS BDD and YBOCS for OCD is that the ideas about the organic structure defect combine the evaluation for both the stimulation and knowledge response. In OCD Rumination would be rated under the irresistible impulse.ProcedureA sum of 30 patients amputation consecutively chosen signifier to try for instances and a at the same time sample 30 patient with shot constitute to command group who free make full the exclusion and inclusion standards were taken for survey. A written informed concern was obtained. HAMD, BPRS, HADS, GHQ-28, YBOCS-BDD graduated tables were administered after clinically measuring as per 1CD-10 diagnostic standards.Ethical commission blessingThe survey was submitted for ethical commission blessing on at Govt. Stanley infirma ry and blessing was obtained.Statistical methodThe information collected will be entered in excel marker sheet and analysis utilizing SPSS for this different in frequence distribution and other evaluations on different steps appropriate statistical trial seen as t trial, cui square trial are employed. The socio demographical profile and HAMD, YBOCS BDD, HADS, BPRS GHQ-28 graduated tables were given in frequences with their percentage.HAMD, HADS, BPRS, GHQ-28, YBOCS BDD scores difference between instances and controls were analyzed utilizing chi- square trial. The place of the topic in instances and control were analyzed utilizing cui-square trial. The Association between socio demographic, psychiatric upset was analyzed utilizing cui-square trial. Incidence of psychiatric morbidity off amputees was given in per centum 95 % assurance interval.

Adventures Of Huckleberry Finn Essays - English-language Films

Adventures Of Huckleberry Finn Research paper on Mark Twains Adventures Of Huckleberry Finn Mark Twains Adventures of Huckleberry Finn is a novel about a young boys coming of age in the Missouri of the mid-1800^s. It is the story of Hucks struggle to win freedom for himself and Jim, a Negro slave. Adventures of Huckleberry Finn was Mark Twain^s greatest book, and a delighted world named it his masterpiece. To nations knowing it well - Huck riding his raft in every language men could print - it was Americas masterpiece (Allen 259). It is considered one of the greatest novels because it conceals so well Twains opinions within what is seemingly a childs book. Though initially condemned as inappropriate material for young readers, it soon became prized for its recreation of the Antebellum South, its insights into slavery, and its depiction of adolescent life. The novel resumes Hucks tale from the Adventures of Tom Sawyer, which ended with Huck^s adoption by Widow Douglas. But it is so much more. Into this book the world called his masterpiece, Mark Twain put his prime purpose, one that branched in all his writing: a plea for humanity, for the end of caste, and of its cruelties (Allen 260). Twain, whose real name is Samuel Langhorne Clemens, was born in Florida, Missouri, in 1835. During his childhood he lived in Hannibal, Missouri, a Mississippi river port that was to become a large influence on his future writing. It was Twains nature to write about where he lived, and his nature to criticize it if he felt it necessary. As far his structure, Kaplan said, In plotting a book his structural sense was weak; intoxicated by a hunch, he seldom saw far ahead, and too many of his stories peter out from the authors fatigue or surfeit. His wayward techniques came close to free association. This method served him best after he had conjured up characters from long ago, who on coming to life wrote the narrative for him, passing from incident to incident with a grace their creator could never achieve in manipulating an artificial plot (Kaplan 16). His best friend of forty years William D. Howells, has this to say about Twains writing. So far as I know, Mr. Clemens is the first writer to use in extended writing the fashion we all use in thinking, and to set down the thing that comes into his mind without fear or favor of the thing that went before or the thing that may be about to follow (Howells 186). The main character, Huckleberry Finn, spends much time in the novel floating down the Mississippi River on a raft with a runaway slave named Jim. Before he does so, however, Huck spends some time in the fictional town of St. Petersburg where a number of people attempt to influence him. Huck^s feelings grow through the novel. Especially in his feelings toward his friends, family, blacks, and society. Throughout the book, Huck usually looks into his own heart for guidance. Moral intuition is the basis on which his character rests. Before the novel begins, Huck Finn has led a life of absolute freedom. His drunken and often missing father has never paid much attention to him; his mother is dead and so, when the novel begins, Huck is not used to following any rules. In the beginning of the book Huck is living with the Widow Douglas and her sister, Miss Watson. Both women are fairly old and are incapable of raising a rebellious boy like Huck Finn. However, they attempt to make Huck into what the y believe will be a better boy. The Widow Douglas she took me for her son, and allowed she would sivilize me; but it rough living in the house all the time considering how dismal regular and decent the widow was in all her ways^ (Twain 11). This process includes making Huck go to school, teaching him various religious facts, and making him act in a way that the women find socially acceptable. In this first chapter, Twain gives us the first direct example of communicating his feelings through Huck Finn: ^After supper, the Widow Douglas got out her book

Rene Descartes Philosophy Essay Example | Topics and Well Written Essays - 1000 words

Rene Descartes Philosophy - Essay Example In fuller conclusion the issues of doubt are brought up, he says, â€Å"underthought, I embrace all that which is in us so that we are immediately aware of it, a thing which exists thinks is a thing which doubts, understands†¦.† (21). These arguments by Descartes illustrate the need for self-assessment before making conclusions. A person (thinking being) is subject to doubt, hence must first be skeptic about everything in order to end up making the informed judgment. Thus, anything that exists has properties but must be subject to some skeptic before making an informed judgment and acknowledging its, existence. For example, a person sees a bottle of water, and his eyes tell him that it is there. Since this person has the premise that what his eyes sees is in fact real (or existing) it means that he knows that the bottle exists. In a similar way, Descartes explains that man (I) exists because of some attributes like body, soul, and thoughts. He goes ahead to explain that ‘I’ denies, understands, doubts, affirms, is willing, is unwilling, has sensory perception and imagines (19). This shows that an existence comes hand in hand with knowledge of properties that something possesses. Existence without the knowledge of its properties is even more illogical than deriving a conclusion that the existence of self also encompasses the nature of self. When Renà © Descartes says that he thinks, therefore, he exists, it means that he is aware of what he is and what his nature is. Otherwise, there is no existence. Every existence has its properties; be it divine authority like God or as trivial as a plastic water bottle.

Political Philosophy (Hobbes' ideas about human nature) Essay

Political Philosophy (Hobbes' ideas about human nature) - Essay Example Both these influences seem to have greater influence over the way Hobbes political thoughts developed over the period of time. His thoughts on political philosophy were therefore strongly oriented towards separating religion from the politics and state. Hobbes strongly advocated the minimal role of religious orthodoxy into the affairs of the government and resultantly he suggests that it is the sovereign which should have an authority over the religion. What is critical to note that Hobbes suggested that a person’s duties to God must not override his duties to the sovereign? This therefore makes his overall political philosophy different from earlier thoughts on the relationship between religion and the politics. This paper will discuss the philosophy of Hobbes and will make a comparison and contrast between his philosophy and that of Locke. Hobbes on Human Nature One of the most important difficulties while one reads about Hobbes’s thoughts on the human nature is the f act that his ideas on human nature cannot be easily separated from his overall political philosophy. ... Hobbes therefore strongly believed that Man is not the social animal because a society cannot exist without the establishment of a government. This orientation of the Hobbes towards the nature of the man therefore suggests that man will be at war with each other perpetually. Such tendency of the man therefore can only be controlled if there is a strong sovereign with absolute powers to control such instinctive nature of man. It is because of this reason that Hobbes believes that absolute monarchy may be the right kind of political system to control such institutive nature of man. To better understand the political philosophy of Hobbes and his ideas on human nature, it is also important to understand his concept of the state of the nature. The state of nature is used as a hypothetical condition which preceded the government. Hobbes increasingly views human nature from the perspective of the state of the nature because he believe that the human nature in the state of nature is quite po or, brutish, solitary as well as short. He therefore argues that the man essentially is a selfish individual and in the absence of any government, his selfishness can prevent the establishment of a social or society. He therefore argues that in order to accommodate the individual rights within a society, it is important for individuals to cede some of their rights and others will also follow the same. That is how the society is created out of the essential human nature. (Martinich) He also went on to argue that a man cannot, by his nature, find god or evil and therefore in order to live in peace, it is important for him to subjugate him to an authority of the government which is strong enough to provide the required support to an individual. Another

Cars Safety Essay Example | Topics and Well Written Essays - 5000 words

Cars Safety - Essay Example That is because people today are too lazy to even put some energy in braking, and automobile companies are responding to it. The development of brakes from manual to power brakes, and from two-wheeler to four-wheeler brakes makes that obvious. The brake system of a standard car consists of disc brakes as well as drum brakes. Disc brakes comprise of a metal disc that rotates with the wheel, and two brake pads gripped in calipers facing the disc. When the break pedal is pressed, hydraulic fluid forces the pads to rub against the disc, thus stopping the disc from rotation. Drum brakes comprise of a metal cylinder that revolves with the wheel, and two brake shoes. The shoes are curved pieces of metal lined with friction material made of asbestos or some other material that can resist the heat generated by the friction. When the break pedal is pressed, the hydraulic fluid forces the shoes on the drum, and the friction helps the wheel to stop. This complex setup of brakes makes it very easy for the driver to stop the car; thus, any error in this system is a major cause of life-taking accidents. (MacVicar; Wyatt, Vol.2, 570-571, 1990) Another important safety feature in an automobile is airbags. Today, almost every saloon car has at least four airbags provided for the passengers. It saves lives yes, but some people think they are more of a headache. They are those who hit their cars quite often and the airbag pops out even on the slightest bump. It emerges out of the steering wheel or the doors whenever the car is hit hard enough to cause an injury. It was a milestone in car safety when launched properly in 1998, but had some drawbacks that appeared later. The airbag is made of nylon and is filled with nitrogen gas on collision. When the car is hit, crash sensors activate the inflator that fills the bag with nitrogen immediately deploying it. Although they are a lifesaver in major accidents, they have been known to easily injure the passenger. The speed with which it is deployed can be responsible for injury to the passenger's facial features like breakage of the nose or trauma to the eye due to spectacles. This makes the airbag a drawback in situations where it pops out on slight hits. In addition, it can be harmful to children and old people. Thus, the passengers should be seated as far away from the airbag deployment area as possible, and the river should point it towards his chest instead of the head. Moreover, the use of seatbelt is mandatory for the airbag to serve its full purpose. (Brain, 2000) Excellent car suspension is a very important feature for safe driving as it keeps the car in the driver's control. Precisely, it increases the road grip of the car thus maximizing the steering stability as well as comforts the passengers with shock absorbers. The absence of perfectly flat roads makes suspensions necessary to prevent passengers from jumping continuously inside the vehicle, and for stable driving, especially cornering at high speeds. The now vastly available power steering makes it easier to turn the wheels while shock absorbers make a mountain feel like silk. (Harris, 2005) Tires play a vital role in increasing road grip of the car as well as comforting the passengers. Tires with proper grip are mandatory for the car to run smoothly. Loss of grip can be a cause of major accidents. It can easily be

A rhetorical analysis on How Society in the United States Views Research Paper

A rhetorical analysis on How Society in the United States Views Abortion and what impact the media has on that view - Research Paper Example 8 Works Cited †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 9 Abstract The aspect of imparting living status on the fetus has profound impacts on the abortion policies which, in most cases, are advocated through the media. The media, therefore, holds a specialized and centralized place in the heart of the abortion debate. US has one of the highly opinionated public on matters pertaining to abortion controversies. Abortion had already become a diabolical issue even before the famous landmark ruling on Roe v. Wade (1973) by the US Supreme Court. This ruling and other subsequent legislations only served to provide the impetus for polarization of opinions with no point of consensus. Many of the opinions that the public holds come courtesy of the media which is accused of being biased. Biased media leads to an influence of the opinions of the public wit hout necessary changing their attitudes. Preface The reason for choosing to do a rhetorical analysis on how society in the United States views abortion and what impact the media has on that view is because of the profound connection existing among media public opinions. The public usually relies heavily on the media to bring to its attention the different issues that happen and affect the country. In this regard, the media is very important in influencing how the public generates opinion on different issues of national interest. The abortion debate has been around for a long time and has become quite contentious due to a polarized public about the way forward. In any democratic society, such an outcome is expected since everyone is entitled to their own views. Much of this polarization is caused by the media which covers news disproportionately in a biased manner. This paper brings together an analysis of different resources that are borrowed from different fields so that the true a ssociation of the media and public perception of the abortion debate can be known. These resources are qualitative in nature and they trace the effects of how the media informs public polices through its partial way of information dissemination. As such, the paper employs a multidisciplinary approach of tackling the central issue of media influence on public debates along the continuum of time. Introduction The aspect of imparting living status on the fetus has profound impacts on the abortion policies which, in most cases, are advocated through the media. Many policies have been crafted to promote fetal rights, which have negatively impacted the women’s right to abortion (Iyengar and Hahn 23). As such, the media has played a crucial role in the analysis and communication of information to the public which has had potential bias. Previous research has shown that the presentation of information to the public impacts the public’s perception of different policies and thei r preferences. Bias in how media houses present information to the public is known to have been in existence for a long time now. Therefore, the public opinion on abortion is of two extreme positions and the media seems not to favor these two extreme groups according to research (Esacove 84). Way back before the famous landmark ruling on Roe v. Wade (1973) by the US Supreme Court, abortion had already

Logic Assignment Example | Topics and Well Written Essays - 1250 words

Logic - Assignment Example from The Pew Charitable Trusts and the John Templeton Foundation as part of the Pew-Templeton Global Religious Futures Project, which aims to increase peoples knowledge of religion around the world. The text given above is one of the important findings of the survey. The source of the historical data is World Religion Database. There is a scientific validity to the survey as it involved interviews with more than 25000 people belonging to 19 countries, in more than 60 languages and it reflects the people’s beliefs, attitude towards other faiths, concerns and tries to assess the social and political order. A thorough analysis with reference to religion has been made with reference to the present state of the social order. However, the analysis is lagging behind with regard to the important aspect as to how it could be useful in repairing of the social order. The analysis of traditional religious practices provides strong clues to the reasons for the present status of the social structure. Also, motives or reasons for religious extremism with reference to the region are not touched upon. â€Å"In The Wealth of Nations, Smith (1965, pp. 740- 766) argued that self-interest motivates clergy just as it does secular producers;† (Iannaccone, L.R. and Berman, E). The report states unemployment, crime and corruption as bigger problems than religious conflict, though in some countries religious conflicts are the major problem. However, the people connected to activities of religious extremism and suicide-bombers were mostly unemployed youths from poor background according to the newspaper stories. The report has not however underlined the relationship, if any, that exists between religious extremism and unemployment or poverty. Working out a common minimum rules for the society comprising of various ethnic groups, communities and religion is the precursor to reforms. Once this is achieved, the religion could be effectively sidelined to the personal domains of the

A History of the Popes Essay Example | Topics and Well Written Essays - 250 words

A History of the Popes - Essay Example The church that was established at the site of the burial place of Peter seems to be insinuated in the film, â€Å"A History of the Popes, Saints and Sinners: Upon This Rock† as the fulfillment of the words of Jesus saying upon Peter, he will build his church. This seemed to have even been strengthened during the time of Pope Leo who very articulately explained the humaneness and divinity of Jesus, making people declare that Peter has spoken to him. The next episode of the film entitled â€Å"Between Two Empires† reflects the fight for power between the political and religious empires in Rome. The religious empire ruled by a pope, decides on what is to be rightfully implemented by the political empire headed by an emperor. However, absolute power has been quite coveted by emperors. On the contrary, popes did not like to give full authority to emperors. Therefore, a long history of contentions between the two empires has been documented. In addition, personal interests played a great role in the historical facts created by emperors and popes. Interestingly, it was not only the emperors who did not play fair for power. Instead, the popes also showed some vicious acts such as murder like the death of John VIII, Leo V and John

Flooding in South Africa Essay Example for Free

Flooding in South Africa Essay Most floods take hours or days to develop, giving residents enough time to prepare or evacuate. Others happen quickly and with little warning. These flash floods can be extremely dangerous and cause major damage to the landscape and the habitants of such an area. Disaster specialists have various ways of classifying floods according to their likelihood of occurring and the intensity of the flood. A hundred-year flood, for example, is an extremely large, destructive event that would theoretically be expected to happen only once every century. Heavy rain in a short period of time in the part of South Africa, caused more than hundreds of people to be homeless by heavy flooding. Floods caused many to seek refuge on rooftops and on trees. This catastrophe killed more than hundreds of people causing the death toll to rise. Recently these floods caused evacuation of the Kruger National, a game reserve in Northern South Africa. Floods also covered some farmlands and crops were killed as a result forcing farms to close. Most of the roads, dams and large buildings were damaged. Due to flooding some mines were forced to close, this the case of a coal mines in Limpopo. Floods frequently causes major infrastructure damage of roads, railway lines, electricity supply systems, water supply and sewage disposal systems. Bribges over rivers are particularly exposed to damage and disruption of transportation systems follows. The economic effects of flooding are often greater than the flood itself. (Parker 2000) According to Parker (2000) be cause floods frequently destroy crops and livestock, food shortages are not uncommon in the aftermath. Floods may affect food availability in a number of ways. Food stocks may be damaged if storage areas are flooded. Serious flooding usually disrupts transportation of food deficit areas, particularly in towns, which are cut off from supply sources and have inadequate food stock. Impacts of flooding may hinder the economic growth and development that is the high cost of relief and recovery may adversely impact investment in infrastructure and other development activities in the area and in certain cases may cripple the frail economy of the of the region. Recurrent flooding in a region may discourage long-term investments by the government and private sector alike. Lack of livehoods, combined with migration of skilled labour and inflation may have a negative impact on a region’s economic growth. Loss of resource can lead to high costs of goods and services, delaying its development programmes. (Drep operation international federation of Red Cross and crescent societies). Figure 2 three kid were during floods in Limpopo As discussed under various perspectives, it is clear from the assignment that floods had adverse impact on the socio-economic status of livehoods for people in South Africa more especially the residents of Limpopo. It is also evident that there are varying underlying causes of floods i South Africa. Places near the flood event are the most susceptible to the dangers of the floods. Proximity of these places and poverty were identified as being the main cause of vulnerability of people

Needs Assessment And Its Analytic Tools Information Technology Essay

Needs Assessment And Its Analytic Tools Information Technology Essay This report is based on research onto Needs assessment and its analytic tools. In addition, this paper critically examines the nature and role of needs assessment as a tool in consulting practice. Needs Assessment A Needs Assessment is a systematic exploration of the way things are and the way they should be. These things are usually associated with organizational and/or individual performance (Stout, 1995). A needs assessment should be designed to identify and prioritize needs, while a need analysis should break and identified need into its component parts and determine solution requirement. Practical and pragmatic needs assessments provide a process for identifying and prioritizing gaps between current and desired results (Kaufman, 1979). Need Assessment is defined as an investigation, undertaken to determine the nature of performance problems in order to establish the underlying causes and the way in which training can be addressed. Goldstein (1993) describes need assessment as the phase of the instructional process that provides the information necessary to design the entire program. A training gap is defined as the difference between the required standard of the job and incumbents performance. Need identification is the starting point in any training and development activity. Need identification or assessment is not a routine function, because it should conduct carefully and in a diagnostic manner. The assessment begins with a need which can be identified in several ways but is generally described as a gap between what is currently in place and what is needed, now and in the future. The purpose of a training needs assessment is to identify performance requirements or needs within an organization in order to help direct resources to the areas of greatest need, those that closely relate to fulfilling the organizational goals and objectives, improving productivity and providing quality products and services. Indeed, there are various reasons why needs assessment is not conducted as it is described as being a difficult process, time consuming and lack of resources in carrying out the tasks (Miller Osinski, 1996). On the other hand, Desimone and Werner (2002) argued that incorrect assumptions are usually made about needs analysis being unnecessary because the available information already specifies what an organizations needs are. According to Miller and Osinski (1996) the needs as sessment is the first step in the establishment of a training and development Program. It is used as the foundation for determining instructional objectives, the selection and design of instructional programs, the implementation of the programs and the evaluation of the training provided. These processes form a continuous cycle which always begins with a needs assessment. A needs assessment is a systematic methodology used to locate the need before we intervene with the solution. The assessment helps us to locate the gaps in the plan of action or the existing strategy and helps us manage at the micro and macro levels. A needs assessment is carried out for an individual, an organization, team and even society issues. Some of the scenarios where needs assessment is widely used are organization development, disease outbreak, war/terrorism, drug abuse, poverty, sports etc. Needs assessment gives us a fair amount of insights about the situation that we are dealing with, before we go ahead and intervene. Gap could be easily determined with the use of analytical tools possessed by Needs assessment. They are used to identify strategic priorities, define results to be accomplished, guide decision related to actions considered and creates an evaluation criterion to judge the success and also have continual improvement within the organization (Stout, 1995). Models of Needs Assessment There are plenty of different models proposed by the eminent researchers. Needs assessment models are based on the variety of profession and applications. All the different models and a small description of these models are mentioned below: Arthurs Performance Evaluation Matrix: (Arthur, L.1993. Improving Software Quality. New York: John Wiley and Sons) The context of Arthurs Performance Evaluation Matrix is usually used for the development or improvement of softwares. Bottom to top assessment is what this model emphasizes on. The assessment begins with very end-users such as the customers and suppliers. The model deals with identifying the defects created in the cycle and usage of data to identify the causes of the defects. It does not answer the society or the organizational results, but focuses on the development and improvement of their products (Anonymous, Models, n.d) Burton and Merrills Four Phase Model: (Burton, J. Merrill, P. 1998, Needs Assessment: Goals, Needs And Priorities) Internal and External factors are recognized by this four phase model.   Additionally, this model focuses on the application of needs assessment in the development of instructional materials at the level of a course and intentionally does not address societal and organizational results.   It avoids the society and the organizational results, because the authors Burton and Merill believe that their assessment tool helps in development of instructional materials (Anonymous, Models, n.d). Gilberts Performance Matrix: (Gilbert, T. 1978, Human Competence: Engineering Worthy Performance) The Performance Matrix, provided by Gilbert focuses on the process improvement. He provides two types of performance matrix, a Full scale model and a truncated version. The author believes that any research on performance needs to be carried out at the higher level. The author begins his discussion at the Philosophical level and then gets down to the Tactical and Logistical level and then the study is reduced to a Simplified performance matrix (Anonymous, Models, n.d). Gordons Front End Analysis Model: Gordon, S. (1994)  Systematic Training Program Design: Maximizing Effectiveness and Minimizing Liability. Englewood Cliffs, NJ: Prentice Hall. This model identifies the unavailability of resources or any faulty shortcomings. Gordons Front End Analysis Model can be used to document and analyze an individuals performance and cannot be extended to the societal or organization level (Anonymous, Models, n.d). Darraughs Six step Model: (Darraugh, B. 1991. It takes six.(six step model). Training and development journal, v45, n3, p21) The Six step model is very much similar to the Rossetts Training needs assessment model. Darraugh provides a set of fifteen question for conducting the assessment. These questions orient towards the needs but are not determine the link to the societal, organizational or individual accomplishments. Therefore this model does not provide complete guidance in conducting the needs assessment (Anonymous, Models, n.d). Ostroff and Fords Levels Perspective Model: (Ostroff, C. Ford, J.K, 1989, Assessment training needs: Critical levels of analysis) This model is based on the three content areas, Organizational, Task and Person given by Mc Gehee and Thayer. Ostroff and Fords model elevated the model to the next level by introducing a Levels dimension, which includes Organizational sub-units and Individual. Twenty seven discreet analyses can be carried out based on the similarities and differences between each level. This model is considered to cover almost every possible theory (Anonymous, Models, n.d). Hannum and Hansens Needs Analysis Model: (Hannum, W. Hansen, C. 1989, Instructional systems development in large organizations) Their model supports a top-down, Societal needs assessment. Their model can be used to examine only an individuals performance and can be used to document the process insufficiencies. The model is strong on the research methods and helps to collect hard as well as soft data (Anonymous, Models, n.d). Johnsons Training Requirements Model: (Johnson, D. 1996, Take two classes and call me in the morning: the case for training wellness) Johnsons Training Requirement Model focuses majorly on the Training requirements planning. It does not focus on the performance problems. The model utilizes the Market Survey to identify the desired training programs. Based on the survey, the requirements are to be Defined and Analyzed. The evaluation continues with short-term and long-term feedback (Anonymous, Models, n.d). All the above models are used widely. Analysis and the collected data is used to provide soulution, this are the major purpose of the above mentioned models of needs assessment. Reason for Needs Assessment The major reasons behind using Needs Assessment are as follows: Gives us the information of what will be accomplished. Expected changes in performance. Tactical solutions/requirements Economics involved (Stout, 1995) Any kind of developmental initiative needs a lot of money to be invested. Some organizations tend to implement a solution in a hurry without considering whether they are the correct intervention. This will result in heavy losses, especially if it involves huge capital or operational expenditures. Organizational development programs are one such solution that needs a thorough analysis before any intervention is carried out. A wrong solution can result in loss of lot of money and at times destabilize the working atmosphere (Stout, 1995) Process of Needs Assessment According to Stout. D (1995) the needs assessment is carried out as a Four Step Process Step 1: Perform a GAP analysis: Performing a gap analysis is the first stepping stone in performing needs assessment. Actual performance of the organization is checked and compared with the theoretical standards set already. This step involves, Analyzing the current situation: The current goals, internal and external constraints, environment and knowledge of the employees are determined. In short as the same suggests it analyzes the current overall situation of the organization. The desired situation: The desired conditions for the organizational and personal success needs to be identify. Jobs/tasks, the knowledge, skills and abilities required to attain that goal are the prime focus of this analysis. Gap between the current situation and the desired outcomes are identified once this step is completed. As we perform the GAP analysis, we look for the problems or deficits, impending charges, opportunities, strengths and different mandates such as government or foreign policies. SWOT analysis provides us with the Strengths, Weakness, Opportunities and Threats. Whereas, the PEST analysis provides us an insight into the Political, Economical, Social and Technological factors (Stout, 1995). Step 2: Identifying Priorities and Importance: The next step begins with the analysis of the collected data. Depending on the importance of the need which was achieved by step 1 the concerns are prioritized. Example: Legal mandates and Cost effectiveness becomes a priority compared to the Executive pressures. We have to focus on those needs that have more value and will have a great impact (Stout, 1995). Step 3: Identifying opportunities: Major concerns and the development/improvement opportunities are indentified once the needs are prioritized. Solution for specific needs has to be analyzed in this step. This step involves a detailed investigation and analysis at the organizational and individual level. This step not only enables the organization to handle the current situation but also prepares it for the future (Stout, 1995). Step 4: Implementation of solutions and growth opportunities: This is the final step and it involves the implementation of the solutions for the specific issues. Some of the solutions that can be implemented are, Training program: Programs such as one on one or group coaching, Mentoring, Classroom, Video learning, Workshops, Active learning, Vendor course, CBT etc. are considered as alternatives for solutions. Organizational Development program Organizational Programs include, Strategic planning exercises, Organizational restructuring, Performance management and effective team building are the different alternatives which are highlighted as solution alternates (Stout, 1995). Advantages and Disadvantages of Needs Assessment The table below summarizes the key advantages and disadvantages of major methods of assessing training and performance needs. The table below is used from (McCoy, McCoyTraining.com, n.d) which explains the advantages and disadvantages of different methods of needs assessment. Method Advantages Disadvantages Organizational Documents à ¢Ã¢â€š ¬Ã‚ ¢ Provide relevant, quantifiable data à ¢Ã¢â€š ¬Ã‚ ¢ Fast à ¢Ã¢â€š ¬Ã‚ ¢ Inexpensive à ¢Ã¢â€š ¬Ã‚ ¢ May built management Involvement à ¢Ã¢â€š ¬Ã‚ ¢ Dont build employee involvement à ¢Ã¢â€š ¬Ã‚ ¢ Not necessarily focused on HRD à ¢Ã¢â€š ¬Ã‚ ¢ May not identify causes à ¢Ã¢â€š ¬Ã‚ ¢ May not provide visibility Questionnaire and Surveys à ¢Ã¢â€š ¬Ã‚ ¢ Reach many people in short time à ¢Ã¢â€š ¬Ã‚ ¢ Build involvement à ¢Ã¢â€š ¬Ã‚ ¢ Relatively inexpensive à ¢Ã¢â€š ¬Ã‚ ¢ Yield relevant, quantifiable data that are easy to summarize à ¢Ã¢â€š ¬Ã‚ ¢ Anonymity may encourage Honesty à ¢Ã¢â€š ¬Ã‚ ¢ Require time and skill to develop à ¢Ã¢â€š ¬Ã‚ ¢ Low response rates or inaccurate responses à ¢Ã¢â€š ¬Ã‚ ¢ No opportunity to clarify à ¢Ã¢â€š ¬Ã‚ ¢ May restrict freedom of response à ¢Ã¢â€š ¬Ã‚ ¢ May lead to unrealistic expectation Group Interviews à ¢Ã¢â€š ¬Ã‚ ¢ Build involvement and support à ¢Ã¢â€š ¬Ã‚ ¢ Provide relevant data à ¢Ã¢â€š ¬Ã‚ ¢ Provide visibility à ¢Ã¢â€š ¬Ã‚ ¢ May elicit key topics not expected à ¢Ã¢â€š ¬Ã‚ ¢ On-the-spot sharing synthesis of different view à ¢Ã¢â€š ¬Ã‚ ¢ Moderately time-consuming (but less so than individual interviews) à ¢Ã¢â€š ¬Ã‚ ¢ Moderately expensive à ¢Ã¢â€š ¬Ã‚ ¢ Difficult to conduct à ¢Ã¢â€š ¬Ã‚ ¢ May be difficult to analyze and quantify data Individual Interviews à ¢Ã¢â€š ¬Ã‚ ¢ Build involvement and support à ¢Ã¢â€š ¬Ã‚ ¢ Allow for clarification à ¢Ã¢â€š ¬Ã‚ ¢ Provide relevant data à ¢Ã¢â€š ¬Ã‚ ¢ Easier to conduct than group interviews à ¢Ã¢â€š ¬Ã‚ ¢ May uncover information that wouldnt be brought up in a group à ¢Ã¢â€š ¬Ã‚ ¢ Expensive in terms of time and travel costs à ¢Ã¢â€š ¬Ã‚ ¢ Require interviewing skills à ¢Ã¢â€š ¬Ã‚ ¢ May be difficult to analyze and quantify results à ¢Ã¢â€š ¬Ã‚ ¢ May make interviewees self-conscious Advisory Committees à ¢Ã¢â€š ¬Ã‚ ¢ Build management involvement and sponsorship à ¢Ã¢â€š ¬Ã‚ ¢ Provide visibility à ¢Ã¢â€š ¬Ã‚ ¢ Inexpensive à ¢Ã¢â€š ¬Ã‚ ¢ Allows synthesis of opinions of key decision-makers à ¢Ã¢â€š ¬Ã‚ ¢ Can help identify resource à ¢Ã¢â€š ¬Ã‚ ¢ Time-consuming and difficult to manage logistically à ¢Ã¢â€š ¬Ã‚ ¢ Fails to build lower-level employee involvement à ¢Ã¢â€š ¬Ã‚ ¢ Poor source of quantifiable data à ¢Ã¢â€š ¬Ã‚ ¢ May lead to groupthink or turf war Observation of Work Situations à ¢Ã¢â€š ¬Ã‚ ¢ Builds employee involvement à ¢Ã¢â€š ¬Ã‚ ¢ Provides excellent information when coaching an individual à ¢Ã¢â€š ¬Ã‚ ¢ Builds your credibility à ¢Ã¢â€š ¬Ã‚ ¢ Generates relevant, quantifiable data à ¢Ã¢â€š ¬Ã‚ ¢ May provide excellent stories à ¢Ã¢â€š ¬Ã‚ ¢ Requires a skilled observer à ¢Ã¢â€š ¬Ã‚ ¢ Does not involve management à ¢Ã¢â€š ¬Ã‚ ¢ Time-consuming à ¢Ã¢â€š ¬Ã‚ ¢ May change performance or be perceived as spying à ¢Ã¢â€š ¬Ã‚ ¢ May be logistically difficult Benchmarking and Independent Research à ¢Ã¢â€š ¬Ã‚ ¢ Learn from industry leaders and competitors à ¢Ã¢â€š ¬Ã‚ ¢ Can build your credibility à ¢Ã¢â€š ¬Ã‚ ¢ Availability of free data on internet à ¢Ã¢â€š ¬Ã‚ ¢ Avoid rediscovering what is know à ¢Ã¢â€š ¬Ã‚ ¢ Does not build involvement à ¢Ã¢â€š ¬Ã‚ ¢ May not be directly relevant à ¢Ã¢â€š ¬Ã‚ ¢ Data from different organizations may be misleading à ¢Ã¢â€š ¬Ã‚ ¢ Requires significant Analysis Table 1: Advantages and Disadvantages of Needs Assessment, Adapted from Managing a Small HRD Department, by Carol P. McCoy. McCoy Training and Development Resources, 1993, p. 23. Needs Assessment as a tool for Consulting Practice and Critique for Best Practices Methods of needs assessment can be classified into seven main types, each of which can take many different forms in practice. The different types of needs assessment approaches are as follows: Gap or discrepancy approach Reflection on action Peer review Observation Critical incident review Practice review Learning for needs (Grant, 2001) According to Grant (2001) Peer review is rapidly becoming a favorite method for needs assessment. Grants report was accepted in 2001 by the National Center for Biotechnological Information. In peer review doctors assess each others practice and give feedback and perhaps advice about possible education, training or organizational strategies to improve performance. Internal, external, informal, multidisciplinary and physician assessment are the five different type of peer review described in a good CPD guide. (Grant, 2001). However this peer review method for needs assessment comes with ample of drawbacks. Some of these drawbacks are mentioned below: Double Blind system is rarely used due to its impracticality. Reputation of the author always have some impact on the way others judged the paper this is the most common accusation made. An uncontroversial and poor paper written by an established researcher pass the review process whereas an excellent paper written by a new and upcoming scientist can be rejected (Anonymous, Disadvantages of Peer review, 2008). Editors posses lots of decision making power who are very well connected by the author and referee. At times these authority possessed by the editors is misused. Many times their lots of omission by the editors and therefore, editors are often accused of arbitrarily rejecting manuscripts before they reach their readers (Anonymous, Disadvantages of Peer review, 2008). Source of the researchers funding is one of the major conflicts of interest which needs to be spotted by the peer reviewers. However, the research is accepted if it follows all the researching protocols (Anonymous, Disadvantages of Peer review, 2008). Peer reviews have no grading system and different journals have their own standards. This makes it difficult to rank and judge the expertise and quality of the editors and reviewers (Anonymous, Disadvantages of Peer review, 2008). A consultant is hired by a company either during a time of distress or simply to improve an existing system. Very often it is due to the peer nature of the issue that an external source is required to solve it. A consultant has a lot of pressure to solve the problems that he/she has been asked to look into. A Needs Assessment provides the consultant with insights to what he/she is going to deal with. A thorough needs analysis is essential for a large-scale learning initiative to succeed.   Needs assessment  consultants will seamlessly work with your company to interview subject matter experts and other key stakeholders, diagnose the learning gaps and help you specify learning objectives that support your business goals. Consultation is a very tricky job. When a consultant is asked to address an issue, the credibility of that consultant is at stake. Since the money involved is high, an organization expects the intervention to work wonders for them. It is the consultants job to collect the required information by using a technique that suits the organization and also the issue that is dealt with. An issue can range from sales decline to rebellious employees to scandals. The test of choice depends upon the situation. A questionnaire can be used among the employees to get information about a sales drop, but a personal interview or focus group is required to address an issue such as a rebellion or a scandal. The best practices that should be followed by the consultants with regard to prove efficient and effective for its clients are as follows: First of all the consultants need to familiarize themselves with the work environment and the culture of its clients before deciding on the method of research. The consultants need to have a different perception of its clients. Being bias would impact the performance and would hamper to analyze the problem effectively. While conducting interviews the consultants need to give enough space to the informants so that they could gather as much information as possible. Once the informants are comfortable the core of the problem could be identified. Proper mind mapping and stake holder analysis also gives a clear picture about the client and may help in further analysis of distortion which may be the reason of the clients issues. The questionnaires should be easy to understand and should not lead to conclusions. In addition, the consultants need to avoid use of buzz words and should simplify the question for easy and better understanding of the participants. I would like to conclude that needs assessment is one of the most important tools for the consultants as it helps for evaluate the situation and gives an insight of the organization. Needs assessment forms the foundation for resolving clients problems as it helps to reach the core of the problem instead of artificial makeovers. The outcome of the consultants intervention has tremendous impact due to the approach, method or techniques used for needs assessment. It is the nervous system which helps to rectify the cause of distorted heart beat of the organizations body.