Great Depression Thesis Example | Topics and Well Written Essays - 250 words - 1

Great Depression - Thesis Example It led to lower production of staple and cash crop food like wheat, which led to low income2. Misuse of land by farmers caused soil erosion by wind storms; plagues of grasshoppers invaded their wheat and caused massive losses. It caused migration of civilians in other parts of the country, which had not been hit hard (Atlantic and southern parts). Production industries and companies: they had to reduce production, especially farm inputs, this led to dropping off of employees hence rising unemployment, few people considered luxury items therefore affecting industries producing such appliances for example cars3. Other parts of Ontario and Quebec went through unemployment since mining and forest tourists had dropped. For British Columbia province, which majors in horticulture encountered an economic downfall due to low demand hence workers were laid off. The Newfoundland province had to ask for government help for the crisis (Wiegand, 254). Very few wealthy citizens benefited from the depression since they acquired property due to the low value and cheap prices and later sold it at higher rates. In addition, few big industries capitalized on the chance of depression since they didn’t have to pay wages as many workers were dismissed. Political instability: A lot of pressure from the economy and citizens, the whole country faced to politics to try to save the situation, they overthrew the past political parties and brought in liberals lawyer Richard Bennett hoping to bring a

Social Life in Popular Music Essay Example | Topics and Well Written Essays - 500 words

Social Life in Popular Music - Essay Example Actually, certain rock and blues songs gained popularity in certain epochs. So, being popular is not just being meaningless or pop. In fact, in a given period of time and in certain circumstances popularity is gained by representatives of different musical genres. Consequently, it can be noticed that popular music is determined by consumerism and dynamic and cannot be limited by the genre of pop. Furthermore, several examples of political nature of popular music are analyzed. Firstly, the question of identity and music is risen. In terms of creation certain subcultures such a music power is clearly noticed. In fact, it is a special environment which surrounds a certain genre of music and unites a certain self-identification with the society. In particular, it can be seen in the way popular music creates ideals for them and encourages to change the world. Moreover, it is evident that for some people being a music fan is more important than their ethnicity or gender. Thus, the nature of popular music is deeply political. Then, the very ability to transform one’s self-identification in the society is transcended on the global level. Here, world music charts are surely supporting contemporary cultural imperialism which is evident in the political context. Actually, the very ability of music to cross the borders enables this role for it. For instance, cases of Cuban and Turkish music reveal a significant influence of Western trends and international music companies on them. Moreover, in Cuba this impact is even more powerful than local cultural effects. And so, it is evident that popular music is reflecting all the main political trends in the world on the global level. Finally, the real cases of causal linkage between popular music and political actions should be discussed.

Business Proposal for a Partnership Firm Assignment

Business Proposal for a Partnership Firm - Assignment Example The assignment "Business Proposal for a Partnership Firm" discusses the organizational structure and the management team of Millimeters which is supposed to be a partnership firm with three partners involved in it. They would hold the managerial positions in three separate departments and would work as full-time employees of the company. Luz having experience in the field of procurement and budgeting would be responsible for the same. Christopher having experience in the field of operations management would be responsible for the daily operations and management of the company. The daily scheduling activities related to the store and the future requirements for the store, all would be managed by Johnathan. Apart from these three, other staffs would assist them in their job. The company would also hire specialists in each field of services that are supposed to be offered by the company. There are no significant weaknesses of the company regarding the technical knowledge and relevant business activities that are required to be performed to run the company successfully. However, the three owners of the company being new in this field of running a home improvement store business can prove to be disadvantageous for the company in managing its resources effectively and efficiently. In due course of time, this deficiency could be overcome easily through increased knowledge of running the business. A well-constructed personnel plan has been developed for the company to help in running the business efficiently.... Personnel Plan A well-constructed personnel plan has been developed for the company to help in running the business efficiently. The three owners of the company, apart from getting a share in the profits of the company will also receive remuneration for their respective managerial functions being conducted in the company. The personnel plan has been as such that it would include the three managers in the form of its owners, on cashier would be handling all business matters concerned with cash inflows and outflows of the company. Initially there would be four specialists meant for four different services to be offered by the company initially and they would be on-duty at all times during the business hours. The supporting staffs and workers would total around 8 to 10, working on an average every day. The personnel plan constructed for the company has been summarized in the table give below (Table - 1). It includes the first five years’ forecasted figures regarding the salaries and wages of the employees of the company. Table – 1 (Personnel Plan) Â   Year 1 Year 2 Year 3 Year 4 Year 5 Â   Â   Â   Â   Â   Â   Luz Angela Lopez 50,000 55,000 60,000 65,000 65,000 Christopher Mong 45,000 50,000 55,000 60,000 60,000 Johnathan Douglass 40,000 45,000 50,000 50,000 50,000 Specialists 100,000 125,000 150,000 175,000 200,000 Cashier 20,000 22,000 24,200 26,620 29,282 Others 10,000 11,000 12,100 13,310 14,641 Total Payroll 265,000 297,000 339,200 376,620 404,282 Total Personnel 15 18 20 22 22 Financial Analysis Seating up of the About Millimeters business concern would require a significant amount of investment initially. The major portion of this initial funding would be borne by the three owners of the company.

Social Life in Popular Music Essay Example | Topics and Well Written Essays - 500 words

Social Life in Popular Music - Essay Example Actually, certain rock and blues songs gained popularity in certain epochs. So, being popular is not just being meaningless or pop. In fact, in a given period of time and in certain circumstances popularity is gained by representatives of different musical genres. Consequently, it can be noticed that popular music is determined by consumerism and dynamic and cannot be limited by the genre of pop. Furthermore, several examples of political nature of popular music are analyzed. Firstly, the question of identity and music is risen. In terms of creation certain subcultures such a music power is clearly noticed. In fact, it is a special environment which surrounds a certain genre of music and unites a certain self-identification with the society. In particular, it can be seen in the way popular music creates ideals for them and encourages to change the world. Moreover, it is evident that for some people being a music fan is more important than their ethnicity or gender. Thus, the nature of popular music is deeply political. Then, the very ability to transform one’s self-identification in the society is transcended on the global level. Here, world music charts are surely supporting contemporary cultural imperialism which is evident in the political context. Actually, the very ability of music to cross the borders enables this role for it. For instance, cases of Cuban and Turkish music reveal a significant influence of Western trends and international music companies on them. Moreover, in Cuba this impact is even more powerful than local cultural effects. And so, it is evident that popular music is reflecting all the main political trends in the world on the global level. Finally, the real cases of causal linkage between popular music and political actions should be discussed.

Discussion Dynamic Essay Example | Topics and Well Written Essays - 250 words

Discussion Dynamic - Essay Example The management ha s three elements thus, strategic analysis, strategic choice stage and the strategic implementation stage. Strategic management focuses on the efficiency of the organization with provisions of consistency, rationality, and flexibility (Spector, 2013). Motivation is influenced primarily by the disincentives and perceived incentives. This contributes to desirability to implement an intervention. Motivation may be both organizational or individual based and narrows down to the implemented intervention. It includes anticipated outcome, collective expectations, and the pressure for change (Pathak, 2010). Capacity of an organization is attributed to maintaining an organization’s functions such as effective leadership and sufficient staffing and connecting with the community. This includes current infrastructure, processes of the organization and culture of the organization. The capacity is linked to whether the organization is able to implement the interventions (Øystein, 2009). The capacities needed to facilitate intervention include technical, fiscal conditions and the human. These are necessary for successful implementation of an intervention that has quality and future. Every new policy and practice has its skills and the required knowledge needed for quality implementation. Similarly, the organization’s readiness for implementation of any program is expressed as R=MC2 (Lewis, 2011). The implication of this is that when one component nears zero, then it is a multiplicative relationship and it is assumed that the organization is not ready for the implementation of the

Binge eating disorder Essay Example for Free

Binge eating disorder Essay Binge eating disorder (BED) is characterized by recurrent episodes of binge eating not accompanied by inappropriate compensatory behaviors. Although it is not yet officially recognized, it was included in the current Diagnostic and Statistical Manual of Mental Disorders (DSM) as a disorder to be studied, with research criteria included. It is also slated to be included in the next DSM as one of the officially recognized eating disorders. There have been several treatment modalities employed in its treatment: pharmacotherapy, psychotherapy, and a combination of the two. Being a â€Å"young† disorder, BED still needs future research to show which modality treats it best in the long run. Approaches to Treatment of Binge Eating Disorder What Is BED? How Is It Different From Bulimia Nervosa? Binge eating disorder (BED) is characterized by recurrent episodes of binge eating not accompanied by inappropriate compensatory behaviors (Sadock Sadock, 2003). Although binge eating, by itself, is more commonly associated with bulimia nervosa, binge eating disorder is recognized as a separate entity. Unlike BED, bulimia nervosa involves excessive concern with body shape and weight, and bulimics often have a â€Å"self-perception of being too fat, with an intrusive dread of fatness† (World Health Organization [WHO], 1993). Moreover, the absence of compensatory behaviors further distinguishes BED from the non-purging type of bulimia nervosa, which is defined by the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, as when the individual â€Å"has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas† (American Psychiatric Association [APA], 2000). Diagnosis of Binge Eating Disorder Although binge eating disorder still has to gain official recognition, the Text Revision of DSM-IV (APA, 2000) lays down the following â€Å"research criteria† for diagnosing the disorder: A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: (1) eating, in a discrete period of time (e. g. , within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances (2) the sense of lack of control over eating during the episode (e. g. , a feeling that one cannot stop eating or control what or how much one is eating) B. Binge-eating episodes are associated with three (or more) of the following: (1) eating much more rapidly than normal (2) eating until feeling uncomfortably full (3) eating large amounts of food when not feeling physically hungry (4) eating alone because of being embarrassed by how much one is eating (5) feeling disgusted with oneself, depressed, or very guilty after overeating C. Marked distress regarding binge eating is present. D. The binge eating occurs, on average, at least 2 days a week for 6 months. E. The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e. g. , purging, fasting, excessive exercise, etc. ) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa. Several issues have been raised regarding the criteria mentioned above. For example, one question raised by some experts in the field is that there is no definite way to assess just how much food constitutes â€Å"an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances. † Fulfilling these criteria would at best be a subjective process. While the DSM-IV criteria for BED is usually applied to adults, Marcus and Kalarchian (2003) have proposed a separate set of provisional research criteria for diagnosing BED in children. These are: A. Recurrent episodes of being eating. An episode of binge eating is characterized by both of the following: (1) food seeking in absence of hunger (e. g. after a full meal) (2) a sense of lack of control over eating (e. g. , endorse that ‘‘When I start to eat, I just can’t stop’’) B. Binge episodes are associated with one or more of the following: (1) food seeking in response to negative affect (e. g. , sadness, boredom, restlessness) (2) food seeking as a reward (3) sneaking or hiding food C. Symptoms persist over a period of 3 months. D. Eating is not associated with the regular use of inappropriate compensatory behaviors (e. g. , purging, fasting, excessive exercise) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa. Some of the questionnaires used to diagnose binge eating disorder are: the Binge Eating Scale (BES), the Three Factor Eating Questionnaire, the Body Shape Questionnaire, the Structured Clinical Interview for the Diagnosis of DSM Disorders (SCID), and the Eating Disorders Examination (EDE). The Treatment of Binge Eating Disorder Overview In the management of BED, the primary goal is to achieve abstinence from binge eating (Bulik, Brownley Shapiro, 2007). However, studies have shown that BED has comorbid conditions that require as much attention, such as depression, generalized anxiety disorder, panic attacks and even attempts at suicide (Grucza, Przybeck Cloninger, 2007). Furthermore, since patients diagnosed with BED do not usually engage in inappropriate compensatory behaviors, they are usually obese as well, a condition that sometimes causes more concern in professionals caring for BED patients because of its health implications. Because of the different aspects of this disorder, different treatment modalities are being used, with some experts favoring one and others favoring another. Pharmacotherapy Medications used to treat binge eating disorder include appetite suppressants, anticonvulsants, selective serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants. These have been studied in double-blind placebo-controlled trials, and the results, though modest, have been promising (Appolinario McElroy, 2004). Appetite suppressants. According to Appolinario, Bacaltchuk, Sichieri, Claudino, Godoy-Matos, Morgan, Zanella Coutinho (2003), fenfluramine hydrochloride was the first antiobesity agent shown to be effective in treating binge eating disorder. However, this drug has been withdrawn from the market because of intolerable side effects. Currently, the anti-obesity agent that seems to be the most studied in the treatment of BED is sibutramine. Sibutramine is a drug that inhibits the reuptake of serotonin, norepinephrine, and, to some extent, dopamine. A study by Appolinario et al. (2003) showed that patients taking sibutramine, as opposed to those given a placebo pill, experienced a significant reduction in the number of days with binge episodes. Whereas those in the placebo group actually gained some weight, the patients given sibutramine lost an average of 7. 4 kg. The study participants were asked to fill out the Binge Eating Scale and the Beck Depression Inventory before and after their treatment program, and the sibutramine group had significantly lower scores after treatment. The study cites dry mouth and constipation as the adverse reactions commonly encountered by those taking sibutramine. The authors concluded that sibutramine is effective and well tolerated for treating obese BED patients. Another study supporting the use of sibutramine in BED was published in the American Journal of Psychiatry in January 2008. Wilfley, Crow, Hudson, Mitchell, Berkowitz, Blakesley, Walsh, and the Sibutramine Binge Eating Disorder Research Group (2008) found that patients taking sibutramine (15 mg daily for 24 weeks) were able to significantly reduce the following measures: weekly binge frequency, weight (mean of 4. 3 kg), frequency of binge days, body mass index, and eating pathology, such as cognitive restraint, disinhibition and hunger. Moreover, these patients also experienced global improvement and had a greater percentage of abstinence from binge eating (58. 7%, compared with the 42. 8% of the placebo group). Anticonvulsants. In the February 2003 edition of the American Journal of Psychiatry, McElroy, Arnold, Shapira, Keck, Rosenthal, Karim, Kamin Hudson (2003) reported that 30 patients with binge eating disorder randomly assigned to receive a flexible dose (25 to 600 mg per day) of the anticonvulsant drug topiramate had a significantly greater rate of reduction in binge frequency, binge day frequency, weight (mean loss of 5. 9 kg), and body mass index. They also had lower scores on the Yale-Brown Obsessive Compulsive Scale, which was modified for binge eating, and on the Clinical Global Impression severity scale. However, six patients receiving topiramate were unable to continue participating in the study because of adverse events, mostly headaches and paresthesias. The researchers concluded that topiramate was useful for the short-term treatment of BED. The journal Biological Psychiatry also published a study by McElroy, Hudson, Capece, Beyers, Fisher, Rosenthal, and the Topiramate Binge Eating Disorder Research Group (2007), which showed that 195 patients taking topiramate were able to reduce binge eating days per week, binge episodes per week, weight (mean loss of 4. 5 kg), and body mass index compared with those assigned to take placebo. Thirty percent of those taking topiramate left the study, mostly due to adverse effects such as paresthesia, upper respiratory tract infection, somnolence and nausea. However, thirty percent of those taking the placebo pill also were not able to continue with the program. Despite the adverse events reported, the authors concluded that topiramate is well tolerated and was efficacious in treating BED and its features, particularly obesity. Another antiepileptic drug that was evaluated for efficacy in the treatment of binge eating disorder is zonisamide. McElroy, Kotwal, Guerdjikova, Welge, Nelson, Lake, D’Alessio, Keck Hudson (2006) reported in the Journal of Clinical Psychiatry that thirty patients given zonisamide (100 to 600 mg per day for 16 weeks) had a reduction in the frequency of their binge eating episodes, body weight, body mass index, and scores on the Yale-Brown Obsessive Compulsive Scale Modified for Binge Eating and the Clinical Global Impressions Severity Scale. Eight of the patients receiving zonisamide discontinued treatment because of accidental injury with bone fracture, psychological complaints and cognitive complaints. In conclusion, the researchers noted that zonisamide was efficacious in treatment of BED with obesity but that it was not well tolerated. Selective serotonin reuptake inhibitors (SSRIs) and norepinephrine reuptake inhibitors. Several selective serotonin reuptake inhibitors have been shown to have beneficial effects in the management of binge eating disorder. Among the earliest SSRI’s shown to be useful in BED treatment was fluvoxamine. Hudson, McElroy, Raymond, Crow, Keck, Carter, Mitchell, Strakowski, Pope, Coleman Jonas (1998) reported that forty-two patients who received a flexible dose of fluvoxamine (50 to 300 mg) for 9 weeks had a significantly greater decrease in the frequency of binges and in body mass index. Furthermore, these patients given fluvoxamine achieved a greater reduction in Clinical Global Impression severity score and a greater rate of increase in Clinical Global Impression improvement scores. However, fluvoxamine did not have a significant effect on the participants’ Hamilton depression scale scores, and the proportion of patients who dropped out of the study because of adverse effects came from the fluvoxamine group. Furthermore, another study done 5 years later on a different, smaller set of patients showed that there was a reduction in binge frequency, eating concern, shape concern and weight concern in both the group receiving fluvoxamine and the group receiving placebo (Pearlstein, Spurell, Hohlstein, Gurney, Read, Fuchs Keller, 2003). The authors say this is just an example of the â€Å"inconsistent results of antidepressant studies in binge eating disorder† (Pearlstein et al. , 2003). Another SSRI shows greater promise. McElroy, Hudson, Malhotra, Welge, Nelson Keck (2003) conducted a 6-week, double-blind, flexible-dose (20 to 60 mg per day) study on the efficacy of citalopram in reducing the frequency of binge eating episodes. They reported that the 19 patients receiving citalopram, compared with those receiving placebo, had a significantly greater rate of reduction in the frequency of binge eating episodes, frequency of binge days, weight, body mass index and severity of illness. In addition, citalopram was said to be well tolerated by the participants of the study. A head-to-head comparison of two SSRI’s – sertraline and fluoxetine – was conducted by Leombruni, Piero, Lavagnino, Brustolin, Campisi Fassino (2008) and published in the journal Progress in Neuro-psychopharmacology and Biological Psychiatry. Twenty-two participants were given 100 to 200 mg of sertraline daily, while twenty were given 40 to 80 mg of fluoxetine per day. After 8 weeks, participants from both groups had significant weight loss and their scores in the Binge Eating Scale improved. There was no significant difference found between the two drugs, and the researchers concluded that both SSRI’s are effective options in treating patients with BED. A drug that inhibits both serotonin and norepinephrine reuptake was studied by Noma, Uwatoko, Yamamoto Hayashi (2008). Although the trial did not focus exclusively on individuals with binge eating disorder but consisted of 25 binge eaters, some of whom were diagnosed with anorexia or bulimia nervosa. These patients received the drug milnacipran for 8 weeks and were found to have improved scores in relation to their drive for binge eating and regret for the same. Milnacipran was noted to be more effective in patients without purging. Venlafaxine, another medication that inhibits the reuptake of both serotonin and norepinephrine, was mentioned by Appolinario et al. (2003) as effective in BED therapy. McElroy, Guerdjikova, Kotwal, Welge, Nelson, Lake, Keck Hudson (2007) examined the effects of atomoxetine, a norepinephrine reuptake inhibitor, on BED. Twenty patients who received the drug had a significant decrease in binge-eating episode frequency, binge day frequency, weight, and body mass index. Their scores on the Clinical Global Impressions Severity of Illness scale, the Yale-Brown Obsessive Compulsive Scale Modified for Binge Eating obsession subscale, and the Three Factor Eating Questionnaire hunger subscale improved as well. However, three of the patients receiving atomoxetine asked to discontinue their treatment because of increased depressive symptoms, constipation or nervousness. Tricyclic antidepressants. Bulik, Brownley Shapiro (2007), in a review of the diagnosis and management of binge eating disorder, also mentions imipramine as one of the drugs that were shown in trials to be effective in the treatment of BED. Imipramine is a tricyclic antidepressant that is used mainly for the treatment of depression and enuresis. A drug from the same family, desipramine, was also mentioned as having beneficial effects in BED. There have indeed been many drugs explored by research for the treatment of binge eating disorder. However, while a lot of studies show that they do have a beneficial effect on patients with BED, particularly with regards to a reduction in binge frequency and weight, the results are somewhat modest. In addition, there have been no long-term studies tracking the efficacy of these drugs as yet. And then, of course, there is the concern that many of those individuals taking these drugs might give them up due to the adverse effects they cause. More importantly, the drugs do not address the underlying cause of binge eating, the psychopathology in individuals that lead them to take in large amounts of food despite the knowledge that doing so could harm them physically and socially. Thus, while many experts in the field would agree that medications help to curb the comorbidities of BED, they still encourage the use of psychotherapy. Psychotherapy Cognitive behavioral therapy. The behavioral therapeutic approach to binge eating disorder that is probably the most tested is cognitive behavioral therapy, or CBT (Bulik, Brownley Shapiro, 2007). As the name implies, the theory behind this practice is the cognitive behavioral model of binge eating, which â€Å"postulates that binge eating develops in response to restrictive food intake and occurs in the context of ongoing dietary restraint and the experience of negative emotions† (Levine Marcus, 2003). In short, inaccurate thoughts and beliefs – for example, those about body shape and weight – lead to inappropriate eating behavior. CBT helps patients identify these binge-triggering thoughts and modify them so as to accomplish binge abstinence. According to Bulik, Brownley Shapiro (2007), cognitive behavioral therapy has been reported by several studies to be effective in reducing â€Å"binge frequency, related psychological aspects of binge eating (restraint, disinhibition, and hunger), depressed mood, and ratings of illness severity in individuals with BED. † Levine Marcus (2003) note that, while cognitive behavioral therapy has been traditionally used in the management of individuals with bulimia nervosa, the technique has been modified to accommodate the differences between bulimia nervosa and binge eating disorder. For example, unlike people with bulimia nervosa, those with binge eating disorder tend to be obese, so CBT can directly target cognitions about having a large body size. They explain, â€Å"Overweight individuals with BED may be helped to accept their body size and to restructure maladaptive thoughts about the amount of weight loss they are likely to achieve. That is, although modest weight loss may relate to improvements in binge eating, for most BED patients this decrease may not correspond with their desired weight loss. It is therefore important that cognitions about acceptable body sizes be targeted during treatment. † Interpersonal psychotherapy. Another type of therapy that has found success in patients with bulimia nervosa and has since been also applied to people with binge eating disorder is interpersonal psychotherapy, or IPT. While CBT focuses on the thoughts that trigger eating binges, interpersonal psychotherapy operates on the theory that binge eating stems from the internal milieu created by specific social and interpersonal problems. Thus, it â€Å"focuses on identifying and addressing specific, problematic interpersonal patterns, in an effort to ameliorate dysfunctional eating behaviors† (Levine Marcus, 2003). As with CBT, IPT is focused, structured and time-limited. However, it does not address the patient’s beliefs about eating, weight and shape and, unlike CBT, does not directly target eating behaviors. In the Archives of General Psychiatry, Wilfley, Welch, Stein, Spurrell, Cohen, Saelens, Dounchis, Frank, Wiseman Matt (2002) report on a comparative study that they conducted between CBT and IPT. Both were done in a group setting, and the participants in each group went through 20 weekly sessions of therapy. Results showed that â€Å"binge-eating recovery rates† were similar for both CBT and IPT immediately after treatment. They further conducted follow-up on each participant and noted that, while, there was a slight increase in binge eating when the treatment ended, the frequency of such binges remained significantly lower than the frequency prior to initiation of either CBT or IPT. In addition, the researchers reported significant reductions in psychiatric symptoms, and these were maintained through follow-up. They noted that, while dietary restraint decreased more quickly in patients who underwent CBT, a similar level of dietary restraint was accomplished by those who underwent IPT by the time of follow-up. The participants’ weight decreased only slightly, but significantly, and the authors then concluded that group IPT is a reasonable alternative to group CBT for dealing with overweight BED patients. Dialectical behavior therapy. Another type of therapy used for the treatment of BED is dialectical behavior therapy, or DBT. This is described by Levine Marcus (2003) as â€Å"a comprehensive treatment program based on cognitive and behavioral principles and complemented by the use of acceptance-based strategies derived primarily from Zen Buddhism. † Patients undergo a weekly individual outpatient therapy and, at the same time, a weekly group skills therapy that has the goal of increasing behavioral skills that can help them deal with binge eating. According to Bulik, Brownley Shapiro (2007), dialectical behavior therapy â€Å"fosters the development of skills in the domains of mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. † Although it is still considered an â€Å"alternative† form of behavior therapy, there have been studies showing that DBT has led to a greater reduction in binge days, binge episodes, and concerns with weight, shape and eating. Other behavioral therapies. Aside from cognitive behavior therapy, interpersonal psychotherapy and dialectical behavior therapy, Bulik, Brownley Shapiro (2007) mention self-help, exercise and virtual reality therapy as treatment modalities that have been tried in patients with BED. Self-help interventions are delivered in various formats, and may be done with or without structure, and with out without the aid of a facilitator or a therapist. It has been shown by some studies to result in greater reductions in the mean number of binge days and in the clinical severity of BED. Abstinence and cessation rates were also reported to be improved with self-help, but weight loss was not significantly achieved. Medications and Psychotherapy: Combined and Compared Several studies have explored the option of combining pharmacotherapy with psychotherapy. Bulik, Brownley Shapiro (2007) discuss the results of these studies. For example, a trial compared fluoxetine alone with CBT alone and fluoxetine plus CBT. The authors of that trial reported that CBT plus fluoxetine, and CBT alone, were more effective than fluoxetine alone in reducing the frequency of binges, concerns with eating and body shape, disinhibition and depression. Another comparison discussed in the same paper compared desipramine alone, weight loss therapy, and CBT. Bulik, Brownley Shapiro (2007) relate: â€Å"Binge eating was significantly reduced after 12 weeks in both groups receiving CBT; however, this effect did not persist at 36 weeks of treatment. Average weight loss was greatest in the weight loss therapy group in the early stages of treatment, but over time (i. e. , at 3-month follow-up) the group receiving desipramine lost the most weight. Desipramine showed no clear advantage in reducing symptoms of depression. † Claudino, de Oliveira, Appolinario, Cordas, Duchesne, Sichieri Bacaltchuk (2007) compared topiramate alone with CBT plus topiramate and concluded that â€Å"topiramate added to CBT improved the efficacy of the later, increasing binge remission and weight loss in the short run. Topiramate was well tolerated, as shown by few adverse events during treatment. † Finally, Molinari, Baruffi, Croci, Marchi Petroni (2005) conducted a comparison of CBT alone, fluoxetine alone, and CBT plus fluoxetine. Results showed that â€Å"the two groups which underwent psychotherapy resulted in a better outcome in terms of number of bingeing episodes, maintenance of weight loss reduction from baseline and psychological well being than the group treated with pharmacological therapy alone. † The authors concluded that the results of their study highlight the importance of a multidisciplinary approach to binge eating disorder. However, as with pharmacotherapy alone and with psychotherapy alone, the long-term efficacy of a combined drugs-and-talk approach to binge eating disorder still has to be proven by future studies. Practical Advice To Tell Patients Empowering patients to take control of their disorder is also important. Smith, Barston, Segal Segal (2008) offer the following tips that concerned eating disorder professionals can give their patients: †¢ Eat breakfast. Skipping breakfast often leads to overeating later in the day, so start your day right with a healthy meal. Eating breakfast also jump starts your metabolism in the morning. Studies show that people who eat breakfast are thinner than those who don’t. †¢ Avoid temptation. You’re much more likely to overeat if you have junk food, desserts, and unhealthy snacks in the house. Remove the temptation by clearing your fridge and cupboards of your favorite binge foods. †¢ Stop dieting. The deprivation and hunger of strict dieting can trigger food cravings and the urge to overeat. Instead of dieting, focus on eating in moderation. Find nutritious foods that you enjoy and avoid labeling foods as â€Å"good† or â€Å"bad. † †¢ Exercise. Not only will exercise help you lost weight in a healthy way, but it also lifts depression, improves overall health, and reduces stress. The natural mood-boosting effects of exercise can help put a stop to emotional eating. †¢ Destress. Learn how to cope with stress in healthy ways that don’t involve food. Conclusion Binge eating disorder is still relatively â€Å"young. † With its anticipated inclusion in the next edition of the DSM, a lot of studies have turned their attention to this eating disorder that has only been recognized as an entity separate from the other eating disorder in the last decade. Hopefully, these studies, and the ones still to be conducted, will provide a sound basis for how best to approach binge eating disorder. More importantly, only future research can tell which treatment modalities really work best in the long term. In the meantime, patients with binge eating disorder need help in the here and now. References American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed. Text rev. ) Washington, DC: American Psychiatric Association Sadock, B. J. , Sadock, V. A. (2003). Synopsis of Psychiatry: Behavioral Sciences / Clinical Psychiatry (9th ed. ). Philadelphia, PA: Lippincott Williams Wilkins. World Health Organization. (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva: World Health Organization. Marcus, M. D. Kalarchian, M. A. (2003). Binge eating in children and adolescents. Int J Eat Disord, 34(Suppl), S47–S57. Retrieved from PubMed database. Bulik, C. M. , Brownley, K. A. , Shapiro, J. R. (2007). Diagnosis and management of binge eating disorder. World Psychiatry, 6(3), 142-148. Grucza, R. A. , Przybeck, T. R. Cloninger, C. R. (2007). Prevalence and correlates of binge eating disorder in a community sample. Comprehensive Psychiatry, 48(2), 124-131. Appolinario, J. C. McElroy, S. L. (2004). Pharmacological approaches in the treatment of binge eating disorder. Current Drug Targets, 5(3), 301-307. Appolinario, J. C. , Bacaltchuk, J. , Sichieri, R. , Claudino, A. M. , Godoy-Matos, A. , Morgan, C. , Zanella, M. T. Coutinho, W. (2003). A randomized, double-blind, placebo-controlled study of sibutramine in the treatment of binge-eating disorder. Archives of General Psychiatry, 60, 1109-1116. Wilfley, D. E. , Crow, S. J. , Hudson, J. I. , Mitchell, J. E. , Berkowitz, R. I. , Blakesley, V. , Walsh, B. T. , the Sibutramine Binge Eating Disorder Research Group. (2008). Efficacy of sibutramine for the treatment of binge eating disorder: a randomized multicenter placebo- controlled double-blind study. American Journal of Psychiatry, 165(1), 51-58. McElroy, S. L. , Arnold, L. M. , Shapira, N. A. , Keck, P. E. Jr. , Rosenthal, N. R. , Karim, M. R. , Kamin, M. Hudson, J. I. (2003). Topiramate in the treatment of binge eating disorder associated with obesity: a randomized, placebo-controlled trial. American Journal of Psychiatry, 160(2), 255-261. McElroy, S. L. , Hudson, J. I. , Capece, J. A. , Beyers, K. , Fisher, A. C. , Rosenthal, N. R. the Topiramate Binge Eating Disorder Research Group. (2007). Topiramate for the treatment of binge eating disorder associated with obesity: a placebo-controlled study. Biological Psychiatry, 61(9), 1039-1048. McElroy, S. L. , Kotwal, R. , Guerdjikova, A. I. , Welge, J. A. , Nelson, E. B. , Lake, K. A. , D’Alessio, D. A. , Keck, P. E. , Hudson, J. I. (2006). Zonisamide in the treatment of binge eating disorder with obesity: a randomized controlled trial. Journal of Clinical Psychiatry, 67(12), 1897-1906. Hudson, J. I. , McElroy, S. L. , Raymond, N. C. , Crow, S. , Keck, P. E. Jr. , Carter, W. P. , Mitchell, J. E. , Strakowski, S. M. , Pope, H. G. Jr. , Coleman, B. S. Jonas, J. M. (1998). Fluvoxamine in the treatment of binge-eating disorder: a multicenter placebo-controlled, double-blind trial. American Journal of Psychiatry, 155(12), 1756-1762. Pearlstein, T. , Spurell, E. , Hohlstein, L. A. , Gurney, V. , Read, J. , Fuchs, C. Keller, M. B. (2003). A double-blind, placebo-controlled trial of fluvoxamine in binge eating disorder: a high placebo response. Archives of Women’s Mental Health, 6(2), 147-151. McElroy, S. L. , Hudson, J. I. , Malhotra, S. , Welge, J. A. , Nelson, E. B. Keck, P. E. Jr. (2003). Citalopram in the treatment of binge-eating disorder: a placebo-controlled trial. Journal of Clinical Psychiatry, 64(7), 807-813. Leombruni, P. , Piero, A. , Lavagnino, L. , Brustolin, A. , Campisi, S. Fassino, S. (2008). A randomized, double-blind trial comparing sertraline and fluoxetine 6-month treatment in obese patients with binge eating disorder. Progress in Neuro-psychopharmacology and Biological Psychiatry, 32(6), 1599-1605. Noma, S. , Uwatoko, T. , Yamamoto, H. Hayashi, T. (2008). Effects of milnacipran on binge eating – a pilot study. Neuropsychiatric Disease and Treatment (4)1, 295-300. McElroy, S. L. , Guerdjikova, A. , Kotwal, R. , Welge, J. A. , Nelson, E. B. , Lake, K. A. , Keck, P. E. Jr. Hudson, J. I. (2007). Atomoxetine in the treatment of binge-eating disorder: a randomized placebo-controlled trial. Journal of Clinical Psychiatry, 68(3), 390-398. Levine, M. D. Marcus, M. D. (2003). Psychosocial treatment of binge eating disorder: An update. Eating Disorders Review, 14(4). Retrieved from http://www. gurze. net/site12_5_00/newsletter16. htm. Wilfley, D. E. , Welch, R. R. , Stein, R. I. , Spurrell, E. B. , Cohen, L. R. , Saelens, B. E. , Dounchis, J. Z. , Frank, M. A. , Wiseman, C. V. Matt, G. E. (2002). A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Archives of General Psychiatry, 59, 713-721. Claudino, A. M. , de Oliveira, I. R. , Appolinario, J. C. , Cordas, T. A. , Duchesne, M. , Sichieri, R. Bacaltchuk, J. (2007). Double-blind, randomized, placebo-controlled trial of topiramate plus cgnitive-behavior therapy in binge-eating disorder. Journal of Clinical Psychiatry, 68(9), 1324-1332. Molinari, E. , Bariffu, M. , Croci, M. , Marchi, S. Petroni, M. L (2005). Bingea eating disorder in obesity: comparison of different therapeutic strategies. Eating and Weight Disorders, 10(3), 154-161. Smith, M. , Barston, S. , Segal, R. Segal, J. (2008). Binge eating disorder: Symptoms, causes, treatment, and help. Retrieved from http://www. helpguide. org/mental/binge_eating_disorder. htm.

Chapter-V Discussion, conclusion and Recommendations

Chapter-V Discussion, conclusion and Recommendations It is relatively easy to appreciate that one of the major issues in regard of the over all health scenario concerned their value to the prisons correctional system. The present research has uncovered the fact that there may included be several problem involved with the administrative, organizational and facilities regarding prison sports as well as establishing respectable physical activities program in a variety of institution including prisons. The long term inmates have suffered dispersal policy. This policy hold that prisons must be concerned with security first and for most, with other issues being unimportant. In the process sum of the program which have suffered include education and recreation. This is problematic because such programs help to lower tension in prisons and build better relationship between staff and inmates. The researcher found that most conventional social activities in prison are sedentary, non-physically active, and similar types of pursuits. One of the major problems in prison recreation and sports is that it primarily serve the purpose of alleviating boredom and passing the time more quickly. Various prisoners made demand to the researcher that there must be a provision to reduce the amount of time spent in there barracks and increase the amount of time for sports activities. They also insisted that better sports facilities must be provided. Model Prison Manual, (2003) of India, states the presence of physical educator in every jail. Despite the injunction by the model prison the researcher found no physical educator in any of the jails undertaken in the study and the allotted time for sports activities was inadequate and the necessary facilities regarding any type of physical activities had not been provided. The lack of government funds, detrimental social attitude and legislation, limited staff, over crowding, inadequate facilities, spars equipments and old fashioned recreational philosophy reduce the chances of inmate to get engage in systematic sports and physical activities. Many inmates recognize that very limited sports facilities (31.91%) are available to them whereas large number of inmates (82.82 %) are interested in sports activities which are not offered often, the stated sports facility needs of inmates are not even considered when developing any program for the jail upliftment. Another problem with prison sports programs involves factors associated with motivation. Inmates often participated in activities for the rewards such as escape from work, trophies and better diet etc. All these extrinsic motivational factor are likely to produce lesser chances of enhancing self image, confidence are likely to shallow. According Card (1983) inmates who take part in recreational activity because of there own personnel interest will likely reap greater benefits than those who become involve primarily through the persuasion. The Government of India ranked the use of sports and other physical activities, high alongwith higher education, establishing the family health and welfare, defense of the country and work for modern India to lead the country at the global plane. Recreation and other sports activities have been the means of obtaining many individual and social benefits. Constructive use of physical activities gives human beings and outlet for creativity and self expression. According to Nash (1971), this drive may be expressed high on a scale in terms of be expressed high on a scale in terms of be explorer, inventor, discoverer, or in the limitless typed of hobbies. Recreation has not only played an important part in the treatment program of the mentally ill, but it has kept patient well. In the light of the preceding discussion, sports may be potentially valuable rehabilitative tools in correction of moral behavior of prisoners. By having the discussion of the researcher with the prisoners in various jails, it had been concluded that physical activities sports and their related facilities would give more balanced life to prisoners and those who are not able are willing the participate in physically active sports should have other options available to them. McDermott. King (1989), found that prisoners are very much involve with physical education for two basic purposes. First it helps to defend against a prisoners physical mental decline. Second it help a better relationship between the prisoners and the prison staff. Following the analysis of data generated during the study following were the main findings: sports facilities and their administration were inadequate and poorly administered, the programs in relation to sports lacked specific goals, the programs help pass the time but served no rehabilitative purpose, there was very little carry-over value of prison activities because many of the sports facilities were inadequate, and attitudes towards recreational activities were mostly before ones incarceration and would rarely be changed by sparse existing rehabilitation and physical activities programs in Uttar Pradesh Mandal Jails. Flynn (1974), Observed reason for limited recreational activities is due to the staff concerned for the security. The greater amount of security that is required, the greater amount it well coast. There is usually a shortage of staff at institution which creates problems with general security procedures. If security is a problem with a general prison population, physical activities programs may provide greater burden on security. A good prison sports program must be well planned to suit the needs of inmates. Forced participation would defeat the purpose of corrections. With careful planning and developing large number of facilities and activities can be provided for the prisoners in any prison. The introduction of community based sports programs with the quality of recreation opportunity as well as the creative reintegration of an offender with his or her family and within greater social system. Security, however, must still be considered apriority for the community. Muth (1974) opined that having the capability of participating in recreational activities with ones partner and/or children gives the offender a much better opportunity to keep his/her family intact. According to World Health Organization (2003) the prisoner must be treated as complete whole person. The recreation aspect of life is stressed to help the offender in this way. During incarceration, inmates suffer the loss of many things: freedom, a sense of reality, sensory experiences, and the reality of who they are. Through participation in sports and other activities, inmates can experience some limited control over these areas for short period of time. The participation will also help on offender in the re-socialization process. Who believes that an inmates need to be seen as a total person for them to become better citizens and recreation through basic sports facilities within the prisons walls is a part of this concept. Though Model Prison Manual, 2003 of India did mention about the Physical Training Instructor under the Educational Personnel of administrative frame-work of jail personnel, but forget to mention the duties of Physical Training Instructor under the heading Duties of Educational Personnel. This itself shows the lack of awareness, among the jail policy-makers, about the importance of games and sports for the rehabilitation of incarcerated persons. Special discussion is required for the Kanpur Mandal Jail due to the fact that the Senior Superintendent of Jail denied the permission the carryout the proposed research work though the researcher produced all the relevant documents of permission and orders to collect the data from the highest authority of Uttar Pradesh Jails, i.e. the Director General of Jail, Jail Administration Reform Services, Uttar Pradesh, Lucknow. The administrator of the Kanpur District Jail did not comply with the orders and repudiate the researcher to access into the jail premise to collect the relevant data for the present study. The similar administrator told the researcher to go away from his office immediately and escorted the researcher up to the main gate of the jail to ensure the exit of the researcher from the jail premise. Hence the researcher could not collect data from the Kanpur Mandal Jail due to the preceding mishappening. Discussion On Hypothesis: The first hypothesis in the chapter-I was mentioned as Jails do not have an effective organizational set-up for sports. As it has been found during the survey of all the Mandal Jails of Uttar Pradesh that the organizational set-up is not up to the mark for sports as has been depicted in the following Figure: Figure-18 Column Diagram of Organizational Set-up of Uttar Pradesh Jails Hence, the first hypothesis of the study has been achieved. The second hypothesis in the chapter-I was mentioned as Jails do not have an effective sports administrative setup to ensure proper growth and development of jail inmates. As it has been found during the survey of all the Mandal Jails of Uttar Pradesh that the administrative set-up is not up to the mark for sports as has been depicted in the following Figure: Figure-19 Column Diagram of Administrative Set-up of Uttar Pradesh Jails Hence, the second hypothesis of the study has been achieved. The third hypothesis in the chapter-I was mentioned as Jails do not have proper infrastructural facilities in term of play fields, equipments, coaching facilities etc. As it has been found during the survey of all the Mandal Jails of Uttar Pradesh that the infrastructural facilities is not up to the mark for sports as has been depicted in the following Figure: Figure-20 Column Diagram of Infrastructural Facilities of Uttar Pradesh Jails Hence, the third hypothesis of the study has been achieved. 4. The fourth hypothesis in the chapter-I was mentioned as Jails (of All Mandals in Uttar Pradesh) do not have an ideal set-up for sports. The researcher has taken the Model Prison Manual, 2003 of India as the criterion for ideal set-up. The preceding manual states that every jail should have one physical training instructor (page no.44, chapter- 4.03.4-b) under the Educational Personnel but the researcher did not find any physical training instructor in any of the jails of Uttar Pradesh Mandal. Hence, the fourth hypothesis of the study has also been achieved. Conclusion Prisoners often appear to have high rates of recidivism partly as a result of feeling of certainty about their ability to succeed on the outside world. This study does not suggest any co-relation between the availability and use of existing facilities for use of sports and the correction in offenders behaviors. It only suggests, by review of literature and discussion with prisoners that it is possible that participating in sports can have long term effects if there continued after release from prison. Here the researcher opines that if the prisoners keep themselves physically active and goal oriented in prison, they may accomplish the same purpose outside of prison. The study suggests the inadequate facilities for sports and non-availability of physical training instructor in the prisons, often hamper the proper planned physical activities for prisoners. The respondents of the study were prisoners and various jails administrators. Almost all the respondents argued that sports acted a s a release for aggressive energy rather than contributing to further aggression. Given the results of the study in chapter four the government of India, with the prisons, should strive for two main objectives: (i) social control and (ii) rehabilitation. Recreation with the help of sports and other physical activities should be implemented for the former, while education should be implemented for the latter. Recommendations There should be a post of Physical Training Instructor to conduct program of demanding physical activities for jail inmates. Along with the unemployment and poverty, sports and recreation programs should be viewed as the establishment of a general strategy to improve the opportunity of improvement in jail inmates. Recommendations are made for the development of sports or recreation programs as a preventative role for youth-at-risk; and the development of sporting and recreation facilities and opportunities for inmates including financial assistance for sports facilities and development of any existing facilities. It is suggested that for any long term change to occur the programs need to offer follow-up program. The same is true for physical activities programs which should be considered as only a partial solution for the crime rate in India. More qualitative empirical data should be gathered for the sports programs and its inclusion in jail programs. Further researches are needed to provide holistic view of the relationship between various physical activities and crime records. It is suggested to consider a requirement to monitor program to a consistent, minimum standard for the introduction and development of sports facilities for jai inmates. Various sports federations should be encouraged to participate and promote sports activities in jails for correctional recreational. It is also suggested that a clear setup post-program opportunities for participation in various physical activities, particularly in programs with objective of developing the offenders participation to being and independent activity. Clear and systematic communication between any external organization running a physical activity program and the jail official responsible for over-seeing the program. Explicit acknowledgement of achievement by inmates participations in various games and sports, if appropriate by formal awards. A high quality of staff delivering the physical activity programs should be posted at every jail, not simply to deliver the activity but more importantly to achieve the difficult mix of being able to develop personal social skills, engender mutual respect and maintain a clear behavioral code and discipline. Consensus statement on physical activity programs promotion in prisons should be drafted by all the research agencies and universities running physical education courses in order to facilitate to raise standards in health promotion of prisoners by engaging in different forms of physical activities. It is recommended that whenever imprisonment in imposed, however, loss of freedom constitutes the punishment; health and wellbeing must not be compromise. Sports in prison communities requires immediate financial boost in this blessed land of forth-coming xix Common Wealth Games, New Delhi- 3 14 October, 2010. Government of India should establish special programs, through existing tertiary institutions and distance courses, to train jail administrators for physical activities and sports. Directorate General of Jail and other similar agency issue or verify the identity card of the researcher on their letterpad in order to smooth conductance of the research work. The use of community sports and recreational resources must be emphasized. The purpose and content of sports and other recreational programs in all the jail settings must be redefined. Physical activities, leisure services and various sports programs must become an integral component of the inmates treatment process. Recreational rehabilitative programs should be based on more extensive and reliable analysis in order to ensure high quality programs. Newer study may be taken to analyze the number of sports persons and their participation in jails. Government should allocate separate budget for intensive sports programs aiming for the rehabilitation and to promote wellness, a healthy life style and decrease medical treatment as envisaged by the World Health Organization (2003).