Justice in Macbeth :: Macbeth essays

The Question of Justice in Macbeth In the play Macbeth, many different major choices are brought forth to a certain character and the decision that is chosen affects the entire play. The results of these actions or decisions can be a positive or negative outcome towards the character. Does justice always prevail in the play Macbeth? If a character decides to commit a crime, will he/she be punished? If a character does a noble deed, will he/she be rewarded? As is represented in the play Macbeth, justice always prevails due to the guilty character's developing sense of remorse and/or the character receiving fair punishment. For every action there is a reaction and whatever the result is, it is meant to happen and it is just. The first malevolent decision chosen by Lady Macbeth and her husband Macbeth was to kill King Duncan. The death of Duncan would mean the birth of a new Macbeth, King Macbeth. Lady Macbeth decided to have her husband kill Duncan and said in Act I scene 5, "He croaks the fatal entrance of Duncan." (p.33) This quote says how the presence of Duncan would turn fatal once Macbeth kills him. Once Duncan is killed, Macbeth has second thoughts about the murder of Duncan and his conscience starts to kick in. His wife then puts his conscience at ease. The wife was being immoral by persuading Macbeth to kill Duncan and trying to soften the blow of Duncan's death by reassuring her husband that everything was going to be all right. Macbeth was being immoral by actually killing King Duncan. Macbeth is already starting to feel guilty, but Lady Macbeth seems not to be affected, as of now. The second malicious decision chosen by Macbeth and Lady Macbeth was to have Banquo and his sons killed. This would cancel out the possibility of Banquo's sons becoming kings. In Act III scene 1, Macbeth states that Banquo and his sons would be murdered by saying, "Banquo, thy soul's flight, if it find heaven, must find it out tonight." (p.91) The consequence of the decision to kill Banquo and his sons started when Macbeth felt more guilt and developed a worried conscience in the form of a vision of Banquo's ghost.

Societal Marketing Concept Essay -- essays research papers

Individual Project 1 1.  Ã‚  Ã‚  Ã‚  Ã‚  Given the trend in obesity among American consumers, which industries stand to benefit the most? Why? Given the obesity issues in the American consumers, the food industry has benefited from this trend. Under the Societal Marketing Concept organizations have to balance company profits, customers’ wants and the society's interests. The problem is to determine what is best for the society in this case. Because there is a difference between short term consumers’ wants and long term consumers’ welfare (Brown, 2005). This issue can be very hard to handle, because it is not all companies market with a social conscience. In one hand consumers say they want healthier foods, but in the other hand, their behavior focus towards unhealthy foods. Some companies may have initiated sincere efforts to provide healthier products; however, it is complicated to modify the consumer’s behavior in this regards (Knowledge@Wharton, 2005). As indicated by The Soy Daily (2003) over recent years rates of obesity have escalated rapidly, increasing consumption of diets high in fats and sugars, and declining levels of physical activity. This behavior generates a marketing opportunity to the food industry, which benefits them due to the heavily supported marketing campaigns the do to attract consumers (Leatherhad Food International, 2004). Even though some organizations such as Children's Advertising Review Unit (CARU) announced its intentions to enforce a new level of advertising to good nutritional practices and even asked a big company like Burger King to aggressively promote healthier alternative, this efforts are not enough (Commercial Free Childhood, 2005). These policies or guidelines contradict the interests of an industry that encourages people to eat more. If people really ate less, food producers, retailers and fast-food among others, would lose business. Even schools can be affected on the income they receive from companies marketing fast foods and soft drinks. That is why food companies take full advantage of their connections in Congress and federal agencies to make sure that anti-obesity campaigns focus on individual food choices, not food marketing practices (Nestle, 2000). 2.  Ã‚  Ã‚  Ã‚  Ã‚  How would you use the information on which Americans trust for marketing purposes? These data provided by the s... ...rce Lays Responsibility on Food Industry For A Major Transformation in Diet. Retrieved on March 21, 2005 from: http://thesoydailyclub.com/Research/obesity08292003.asp Knowledge@Wharton (February 23, 2005). Marketing & Obesity. Retrieved on March 21, 2005 from: http://www.the-river.net/2005/02/marketing_obesi.html Leatherhad Food International (June 2004). Emerging Concepts in the Global Food & Drink Industry. Retrieved on March 21, 2005 from: http://www.lfra.co.uk/lfi/pdf/press820.pdf Commercial Free Childhood (March 15, 2005). Food Advertising Pushed Into Harsh Spotlight. Retrieved on March 21, 2005 from: http://www.commercialexploitation.org/news/articles/carustiffensguidelines.htm Nestle, M. (June 22, 2000). Fight on Obesity Faces Hefty Commercial Problems. Retrieved on March 21, 2005 from: http://www.commercialalert.org/obesitynestle.htm Neitlich, A. (November 21, 2003). A Revolutionary Marketing Strategy...Trust Me. Retrieved on March 21, 2005 from: http://www.sitepoint.com/article/marketing-strategy-trust Joyce, M. & Stewart, J (August 1999). What can we learn from time-use data? Retrieved on March 22, 2005 from: http://www.bls.gov/opub/mlr/1999/08/art1full.pdf

Aetna: A Target Market Analysis Essay -- Market Research

Overview: With an evolving market in the various fields marketing, companies needed to readjust their and update their marketing strategies. Centuries ago, a company that needed to market for its products would just post a paper note at the main town street and if people liked the product it would be sold. In the 21st century, marketing became an essential field and necessary branch in any company that plans to succeed. Aetna recognized this necessity and while analyzing the company’s strategies and structure, one can recognize the un-doubtful organization in identifying their target market. Through the creation of different subsidiaries, Aetna, Inc. is able to organize its target market and classify their various services based on the target market’s specific demographics. Primary and Secondary Target Markets Being a giant in the insurance market in the United States, Aetna, Inc’s target market is widely spread and can’t be simply classified in primary and secondary targets. The company’s target market’s however, can be divided into two general markets with each having different classifications. Aetna’s target markets can be divided into an American market and an international one. Within the American market, Aetna divided itself into subsidiaries each concentrating on a specific target market. Outside of the American market, Aetna created Aetna International to specifically target various non-American markets. Within Aetna’s primary target market, there are seven subsidiaries that target the various American markets. Six of these subsidiaries aim at the various markets in the United States while the seventh aim towards improving the collective services offered by Aetna through the delivery of various health ... ... About Medicity. (2011). In Medicity. Retrieved March 10, 2012, from http://www.medicity.com/about-medicity.html About Us. (2012). In ActiveHealth Management. Retrieved March 10, 2012, from http://activehealthmanagement.com/ Aenta History. (2012). In Aetna. Retrieved March 9, 2012, from http://www.aetna.com/about-aetna-insurance/aetna-corporate-profile/aetna-history/index.html Aetna Subsidiaries: Standalone Companies Owned by Aetna. (2012). In Aetna. Retrieved March 9, 2012, from http://www.aetna.com/about-aetna-insurance/aetna-corporate-profile/subsidiaries.html Miles, J., & Armstrong, R. (Narrator). (2011). Rivalry: Aetna vs Humana [Online video]. Fox News: Business. Retrieved April 6, 2012, from http://video.foxbusiness.com/v/3893197/rivalry-aetna-vs-humana/ Our Mission. (2012). In SRC. Retrieved March 10, 2012, from http://www.aetna.com/src/about/index.html

Compare the poems and comment on how the way Owen and Southey convey Es

Compare the poems and comment on how the way Owen and Southey convey their attitude towards war - Dulce et Decorum Est 'Dulce et Decorum Est' tells the story of how Wilfred Owen experiences world war first hand and tells of his bitter angst towards the government who try to persuade young men to join the army. Owen developed many of his poetic techniques at Craiglockhart Military Hospital where he spent much of the war as an injured soldier, and was able to express his ideas and feelings on paper He uses the Latin phrase 'Dulce et decorum est pro patria mori,' which translates into 'it is sweet and glorious to die for one's country.' Owen tells of how this phrase is wrong, how it is not glorious to experience the harsh reality of war with the explosions and the screeching of missiles, which he saw with his own eyes. The phrase is deceptive to the men that are called up as they look to help their country and believe that it is something to die for. The poem begins with a slow rhythm through the use of heavy, long words, in order to illustrate how slow and painstaking war was. Owens view on war is that it is a dangerous thing to do and using a Latin phrase is just a way of recruiting more troops. He states, "My friend, you would not tell with such high zest The old Lie: Dulce et decorum est Pro patria mori" 'My friend' refers to another war poet, Jessie Pope, who had a completely different aspect on war. Owen emphasises the word 'lie' as he fully believes that the phrase is one. The poem begins with the lines, "Bent double, like old beggars under sacks, Knock-kneed, coughing like hags, we cursed through sludge" This gives the audience a picture of soldiers with heavy bags on their ... ... victory." He seems to see the battle as a battle that must happen in order for something good to come of it. He uses "it was a famous victory" a few times at the end of verses, which he is determined to get across the point of this battle was worth fighting for, though he contradicts himself as he cannot explain what it is. Kaspar corrects Wilhelmine when she states that it was a wicked thing and says that it was a famous victory. I get the impression that Robert Southey believes that good can come of war, though he doesn't fully understand what the Battle of Blenheim was about. I have come to the conclusion that Wilfred Owen is fully against war and not prepared to change his mind, as he experienced first-hand how tragic it can be. Southey's attitude towards war is one that good can become of it, and Owen believes it is a terrible and tragic thing.

Application of Ethics

Understanding, acceptance, and application of ethics are important to individuals and groups for several reasons. Ethics are our basic beliefs, and they come into play constantly. Many times we are using our personal Ethics and we are not even aware of it. Acceptance of ethics is important to individuals and groups because it allows for constructive criticism, and it helps avoid and resolve conflicts. In groups it is very important for ethics to be accepted because it will give a common ground of understanding and respect that a team or group needs to be successful. Accepting ethics of others is important to individuals and groups because it allows the individual and members of a group to gain confidence in themselves which leads to morale and productivity. Application of ethics is important on individual levels because a person who applies their ethics is true to themselves. Application of ethics also makes an individual who they are or who they are perceived to be. Application of ethics on a group level is also important because it allows people to act in a way that they are proud of. It also allows a group to be responsible for their actions. If a group shares ethical beliefs the application of them will also be a common ground. Application of ethics by individuals and groups shows integrity and confidence. This can lead to pride in work, and a group mentality. These effects are important in any group situation, and the effective application of ethics will lead to success. When we work in any organization we are bound to accept the moral ethos of that organization. Relying on our own moral principles only erodes the trust and understanding that is necessary for any cooperative work to function successfully. I will discuss and evaluate these claims. In any position we hold within a company, it is important to make sure that our conduct in that company facilitates the smooth functioning of that workplace. However, if the moral ethos of the organization we work for conflicts heavily with our own, or with a common view of morality, then should we have to obey the rules and regulations of that company, or is there some way we can call the ineptitude of their moral ethos into question without risk to our position in the company? In this essay I shall discuss the problems that can arise with conflicts of organizational and individual moral values by looking at specific role moralities, the role of ethics in a company, whether the boss is really the right person to make ethical decisions and I will decide whether the ffective running of a company entails worker conformity to a company moral ethos or whether individuals should be allowed to reason ethically for themselves in the workplace. When faced with a conflict involving organizational and personal moral codes, the role we fulfill and the requirements that that role entails are important factors in resolving the conflict. Sometimes a pa rticular job will hold with it several responsibilities to be upheld which may not mesh with our own individual ethical standards and values. For instance, a lawyer may find out that their client is guilty, but cannot divulge this information to another because of the obligation of confidentiality that their job entails. In the case where keeping the confidences of another directly and negatively effects somebody else, the personal moral ethos of the lawyer may encourage her to believe that by informing someone of this private information she is doing the right thing. The moral ethos of her profession would hold that to uphold the confidentiality of the lawyer/client relationship would take precedent over doing what would commonly be seen as the ethically right thing to do. This distinction between role morality and common morality is often debated, with many believing that a professional role should provide exceptions to certain areas that are taken to be ethically black and white. Certain roles can only be carried out if a certain amount of ethical leeway is granted for their execution. Although it is widely recognized that some professions prioritize certain values above others and that this prioritization may not be consistent with a common morality view, many argue that even though specialized roles may require a certain amount of confidentiality, breaching some of the most fundamentally universal moral principles should never be condoned, even in such role related circumstances. One of the grounding features of a common view of morality is that it is seen to be universal. The role of ethics in the company is generally kept to a bare minimum, with a code of company conduct providing the skeletal structure for ethical workplace behavior. To this effect, the rules of a company are generally viewed in a more practical light as opposed to being viewed as a form of moral compass. Morality is often viewed as a highly subjective, often religiously defined way of regulating behavior and lacks the political correctness of an objective bureaucratic set of rules and regulations. Indeed displays of moral behavior can even be deemed as threatening in the workplace. They can be threatening to our position in the company if they do not gel with company policies, they can be threatening to our relationships with our co-workers, and they can make others feel uncomfortable about the way they conduct themselves in the workplace. In view of this, ethical concerns are rarely raised and an attitude which adopts company policy and coerces those who don't agree to keep their mouths shut is usually what is seen around the workplace. Raising an issue of ethics in the workplace that conflicts with company policy can lead to a breakdown of the delicate relationships which keep a company functioning. . Business decisions cannot be made based on personal values. This is why it is necessary for every business, whether large or small, to have a code of ethics in which employees can follow to ensure the success of the business. Most importantly, the leaders of a corporation Significantly affect the way the business is being conducted, and the need for strong values leads the way for employees to follow, and contributes to the success of a business (Storm, 2007). Every corporation has their own rules of conduct, or code of ethics, which refers to policy statements that define ethical standards for their conduct. Corporate codes of conduct typically do not have any authorized definition and there is great variation in the way the statements are drafted. The authors of a code are usually the founder, board of directors, CEO, top management, legal departments, and consultants. Also involved in the process, are sometimes employee representatives, or randomly selected employees When business people speak about â€Å"business ethics† they usually mean one of three things: (1) avoid breaking the criminal law in one's work-related activity; (2) avoid action that may result in civil law suits against the company; and (3) avoid actions that are bad for the company image. Businesses are especially concerned with these three things since they involve loss of money and company reputation. In theory, a business could address these three concerns by assigning corporate attorneys and public relations experts to escort employees on their daily activities. Anytime an employee might stray from the straight and narrow path of acceptable conduct, the experts would guide him back. Obviously this solution would be a financial disaster if carried out in practice since it would cost a business more in attorney and public relations fees than they would save from proper employee conduct. Perhaps reluctantly, businesses turn to philosophers to instruct employees on becoming â€Å"moral. For over 2,000 years philosophers have systematically addressed the issue of right and wrong conduct. Presumably, then, philosophers can teach employees a basic understanding of morality will keep them out of trouble. But does this position give them clear moral authority? Robert Jackall in his Drawing Lines (1988, p. 111) article from Moral Mazes believes that â€Å"†¦ people in high places i n big companies at some stage lose sight of the objectives of their companies and begin to focus on their positions†. Imagine if a manager of a grocery store had failed to evacuate his store when a fire broke out in a nearby shop. There was not a high risk of the fire spreading to the grocery store, but there was smoke coming into the store and there had been an evacuation call for the whole complex. The manager of this grocery store gave the explanation that the fire was not a great risk and it would have been unwise to cause unnecessary panic. The actual reason he did not evacuate the store was because he knew that he would not make sales targets for that day if the store had to be closed for a period of time. He may have done the right thing for his profit margins at the end of the year, but he certainly did not do the right thing ethically. In this scenario, the other employees of the store, seeing the inaction of their boss, would either have to obey his wishes and keep working and serving the customers, or they would do what they feel is the right thing and get the occupants of the store out of harm's way. It is difficult to make a decision about ethical conduct which goes against our boss, especially if this decision turns out to be the wrong one. For this reason, most people obey not necessarily the moral ethos of their company or their own personal moral ethos, but they will follow blindly what their boss tells them to do. Robert Jackall continues in Drawing lines (1988, p. 111) that â€Å"Bureaucracy transforms all moral issues into immediately practical concerns. A moral judgment based on a professional ethic makes little sense in a world where the etiquette of authority relationships and the necessity for protecting and covering for one's boss, one's network, and oneself supersede all other considerations and where accountability is the norm. This leads us back to whether conformity to an organizational moral ethos actually does create a smoother functioning and more productive workplace. Of course there needs to be a certain level of conformity in the workplace in order for there to be cooperation between employees and to hence provide a smoothly functioning work environment, but does this necessarily entail a strict fo llowing of a company's rules and regulations. On this point, even many company heads say that a company's moral ethos does not need to be followed exactly as it is written, but that compromise and flexibility are often the best way to approach work life. Of course this does not mean that company heads think it is fine for employees to freely express their own moral judgment, because this often leads to an unpredictable workplace and with this things may start to get out of hand. To keep the workplace running smoothly we often have to leave our personal ethical concerns to rest, unless of course the issue is of a very important nature. It is all about weighing up what is most important in the situation, and whether what is happening is harming anyone. If it is harming someone, then the issue should be raised and we should employ some of our own ethical standards in convincing others of the moral importance of the case. But if the issue is a minor one, it is best from both a company perspective and for our own job security that we do, in that instance, keep our mouth shut. When employees act unethically and/or without integrity, customers lose trust and confidence in organizational products and services. When leaders act unethically and/or without integrity, employees lose trust and confidence in organizational processes, systems and products. Both directly impact the bottom line and the return on investment. Organizations are built on the principle that the whole is greater than the sum of the parts. Working together creates results and outcomes for the whole that outweigh the results and outcomes of everyone working for them. The secret to success is not the principle but the way synergy is created. Synergy is defined as a dynamic state in which combined action is favored over the sum of individual component actions. Synergy is an emergent behavior that arises out a multitude of simple actions based in ethics and integrity. Everyone in an organization is expected to do the right thing at the right time in order to create synergy. Doing the right thing at the right time creates positive safety, quality, and productivity and cost results. This is ethics-the determination of right and wrong in organizations. Ethics is learned through trial and error. When behaviors are wrong, they are corrected. When behaviors are right, they are reinforced. These lessons learned and best practices are the moral code that defines the synergistic behaviors required for organizational performance. Problems occur when individuals seek to maximize their personal ends through behaviors that violate the ethics of the organization and its moral code. If one gets more, others get less. For example, employees who slow down during the week to ensure overtime pay reduce the return on investment for others. To prevent violations of the moral code, leaders and managers in organizations are entrusted with a fiduciary responsibility (something that is held or founded in trust and confidence) to reinforce and enforce the requisite synergistic behaviors required for organizational sustainability. Corruption occurs when there is an abuse of entrusted poor for personal gain whether it is financial or political. Corruption sub-optimizes the performance and jeopardizes the sustainability of the whole. Corruption often deceivingly masks itself as business reality. In order to ensure business targets are achieved and performance bonuses are distributed, an accepted practice called â€Å"does what it takes to get the job done† rears its ugly head. This may mean cutting corners, applying Band-Aid solutions, suppressing , ignoring or misrepresenting information in order that the problems or defects are knowingly or unknowingly passed on to another part of the process. Since no one wants a product or service with built in defects, the second part of this practice is â€Å"don’t get caught. † This is corruption and it destroys synergy and undermines organizational principles. Corruption spreads. Employees who do what it takes and don’t get caught are rewarded. This creates a culture of knowing where employees know that doing the wrong thing at the right time will be rewarded. In time, many embrace corruption simply because everyone is doing it. Corruption ignores the fact that unethical actions involved in doing the wrong things create a chain of consequences that far outweighs the cost of doing the right thing. For example, organizations that ship product with quality defects to meet production targets lose in product returns and warranty repairs that reduce profitability. It is a short term gain for a few, and a long term pain for the many. Government, through its regulatory agencies, intervenes to control corruption in financial, safety, human rights, and environmental areas. Unfortunately, regulators cannot legislate compliance to the law. They can only enforce consequences to violations. This is where the â€Å"don’t get caught† behavior invokes ingenuity that defies the legal system. The principle of protecting the whole and the right way to do things then falls to the integrity of the participating individuals. The commitment to comply is an integrity based decision. Integrity is defined as wholeness, unfolding and objectivity. If the ethical foundation and the moral code are sound, then individuals have trust and confidence in the organization. Wholeness is completed by doing the right thing. The unfolding is defined by doing the next right things and objectivity is enhanced by doing things the right way. Performance and sustainability are the outcome of individual commitment to compliance and collective synergies arising out of an ethical moral code. If the ethical foundation and moral code is corrupt-benefiting the few at the expense of the many, then individuals lack trust and confidence in the organization and its products. Doing the wrong thing fragments the whole. Not doing the next right thing creates chaos and objectivity is compromised when people don’t do things correctly. Performance is at risk in the short term and long term sustainability is undermined. Ethics and integrity are the cornerstones of performance and sustainability. As seen in the Enron failure, corporations consistently hold more and more impact on the shape and structure of the world as we see it. They are the large and small organizations that society places their trust in to process the economy. Whether it be a large conglomerate such as Enron, or a one person â€Å"mom and pop† shop, society places their trust in these companies and deserves to have this trust upheld. A company's culture is what determines how the company is operated. A company born of poor ethics in the culture is ultimately at risk for unscrupulous acts. The acts of Enron our probably structure from only a small percentage of its employees, however, due to the company's unethical culture, procedures and policies our allowed that did not facilitate personal ethical behaviors. I believe it is this lack of personal ethics that served as the catalyst to the demise of Enron as a company and the damage that they leave behind. Who is responsible for a company's ethical culture? I believe the leaders of the organization are responsible for these ethics through their own personal ethics. One might argue that personal ethics do not have a role, provided they are kept separate from the business world. I believe it is impossible to maintain a separation between personal and business ethics. They inevitably intermingle. The issue is then, how to foster a sense of accountability that transcends the workday. I believe one method of creating a strong sense of personal ethics in all employees, and hence a corporate ethical culture, is through social responsibility. This is done by empowering employees to create and be responsible for their own actions and environment. When employees see a correlation between their actions and direct consequences, they develop pride associated with a job well done and a sense of accountability and responsibility to their jobs. An example of a company that, through its leadership has a great sense of company ethics and has created a culture of social responsibility is Enterprise, an internationally known rental car company. The company began its operation when its founder, Jack Taylor, worked for a car salesman and was tired of the lies and gimmicks that our used by the competing car companies. With his employer, Taylor invested in a new kind of car company whose culture consisted of no tricks or hidden agendas and offered all of the facts up-front to its customers. Taylor's personal sense of ethics determined the standards of his business model. And because his personal ethics centered on straightforward dealings with customers, his customers responded positively. Relieved to find someone in the automotive business who would deal with them honestly, customers helped Enterprise become an industry leader. Its status continues to this day: it has never laid off any of its employees and is considered one of the most financially sound rental car companies by Standard & Poor's. Enterprise's success is also a testament to the influence of social ethics. Their system of promoting new employees fosters a sense of social responsibility. Its primary new employee candidates are new college graduates, who are immediately placed in a junior management program. Upon their success as a branch manager, they are offered their own store location to run. All management from junior manager on up to the board of directors are then rewarded primarily on a commissions basis based on their own individual performance and those of their subordinates. Due to the empowerment of its employees for their own success or failure and the establishment of a reward system, Enterprise has reached success rates that are otherwise non-existent in its industry. Enterprise also has one of the lowest attrition rates in its industry and in many industries around, simply because its employees want to work there. It is evident that the success of Enterprise is largely due to the company's sense of social responsibility and the company's cultural ethics, which stem from the personal ethics of its leadership

Case Study on Mutual Fund

Case study Mutual Fund Data Solution for a Bank Branch Network The Client Headquartered in Toronto, Canada, with 74,000 employees in offices around the world, our client offers a full range of financial products and services to approximately 17 million customers worldwide, managing $435 billion in assets. The bank also ranks among the world’s leading on-line financial services firms, with more than 4. 5 million on-line customers. The bank approached VAULT when it needed a new mutual fund data solution in its vast network of branches across the country. The Challenge The bank’s customer service representatives, who promoted utual fund products to their customers, traditionally relied on research and reports from many different sources, but were frustrated with the inconsistency of information they were getting and with the length of time it took to produce reports for their customers. Of course, the bank’s customers weren’t that happy either. As a company w ith web-based technical expertise that provides service to the financial-services industry, VAULT was asked to draw upon its understanding of investors’ needs, as well as its deep base of technical experience, to produce a more efficient form of customer communications for the bank.Much of the project would involve developing and implementing a plan to utilize the bank’s existing Morningstar data feeds, in a centralized web application. This application would have to adhere to the strict technical guidelines of the bank’s branch intranet environment, a variety of different printers in each branch (which had to be tested to ensure document output was consistent and properly formatted for customers), as well as an outdated, yet custom version of the Netscape browser. The Solution VAULT recommended developing a custom solution that would provide the necessary screens and functionality for the bank’s retail branches.To ensure that system and performance requi rements were met, VAULT followed a strict approach to quality assurance that was incorporated into its project plan. It also recommended creating static images for graphing components and scheduling graphs for re-creation overnight; this ensured that the graphs were up to date each workday and minimized the processing time to load and print pages. In addition, VAULT recommended that an administrative site be developed to assist with the on-going operation of the bank’s mutual fund site. The administrative site provided managers ith the business intelligence tools to generate custom reports and highlight key aspects of web-site usage. The administrative site would also increase the bank’s self-sufficiency, help ensure reliability of the application, allow operators to regularly monitor scheduled data feeds and scheduled graphing production. Early in the development process, VAULT created a working prototype of the solution to test with end users and to gain a better und erstanding of the screen/data requirements. This was a valuable exercise since it highlighted areas of concern around usability, page size, load times, data and graphing requirements.The Benefits The bank’s financial advisors, planners and branch representatives were delighted with the quality of the mutual fund information now available through the bank’s intranet site, as well as the fast load and print times. This meant they could service their customers more effectively. Of course, VAULT also paid careful attention to the design of customer reports, balancing the need to provide clear mutual fund information to customers, with the regulatory disclaimers necessary with each printed report.When the project was completed, the bank’s customer service representatives realized immediate results. They were better able to access most of the mutual fund information online, rather than refer to a multitude of hard-copy and online reference materials. In short, the new tool developed by VAULT not only helped streamline the sales process, but also allowed for more professional delivery of information since the bank’s customer service representatives now had a single online source of mutual fund information.And that meant satisfied customers for the bank. Technologies Used Language: Microsoft Internet Information Service (ASP), ChartFX charting software Database: SQL Server 2000 Web server: Microsoft IIS 5 Operating System: Windows 2000 Launch your business forward. For more information, please contact Anthony Boright, President of VAULT Solutions Inc. at [email  protected] com or call 416-361-9944.

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.