Marketing Communications

Introduction Some of the aspects that characterize the present-day business environment include its increasing dynamism, volatility and uncertainty. This poses challenges for businesses that are rigid and not well prepared to change with the transformations in the market (Williamson et al., 2013). On the other hand, it creates opportunities for companies that have the capability of implementing necessary changes that will make them remain relevant to their target markets. Some of the main areas that have been changing in organizations in recent years include management and communication styles, organizational structures, approaches to marketing and the utilization of technology in different departments within organizations (Shimp & Andrews, 2013; Diefenbach & Todnem, 2012). This paper intends to address several issues that relate to the changes and developments taking place in the business environment. It presents an analysis or opportunities and threats that companies like Yahoo and Google face in relation to the rapid technological advancements. It also addresses the appropriate communication approaches that companies should use to facilitate internal and external communication and the communication mix that is used at Apple to market itself to its target clients. In relation to this, the report presents an analysis of a communication campaign used by Nike, a leading sports’ equipment and apparel manufactures in the UK, to establish how effective it is in attaining its marketing objectives. Opportunities and Threats for Google and Yahoo in regard to rapid technological changes Google and Yahoo are some of the well renowned internet-based companies that offer search engine and e-mail services to a wide range of users. Both companies also deal in software development. Based on the services and products offered by these companies, they are directly affected by technological advancements, especially in the ICT sector (Segev & Ahituv, 2010). The opportunities and threat s that these advancements expose the companies to are discussed in this section. Opportunities There are several opportunities presented to these companies as a result of technological advancement. One of these is that it provides a wide range of avenues through which the companies can communicate with their clients and vice versa (Hundal & Grover, 2012). It also provides increased avenues through which the companies can market their products. Technological advancements in the ICT sector across the globe have also led to an increase in internet accessibility. For Yahoo and Google, an increase in internet accessibility provides an opportunity for them to earn more revenue through advertisements (Shih et al., 2013). This is because they are among the most visited websites internationally. Google is ranked as the most visited website, while Yahoo is ranked the fourth (Alexa, 2014). Being business oriented, technological advancement will also make it possible for them to market their products and services to a wider market base through strategic marketing communication strategies. It also provides an opportunity for them to launch e-commerce strategies, which are cost-effective for the company and convenient for clients. Among the advancements that have taken place is the development and increased use of smartphones (Persaud & Azhar, 2012). Given that both companies deal in software development, it provides an opportunity for them to create revenue from developing applications that can be used on these devices. Google has effectively taken advantage of this advancement and has developed the Android operating system (Gandhewar & Sheikh, 2011). The fact that its operating system is compatible with many mobile devices like manufactured by different companies like Samsung and LG increases its usability. With the growing number of global populations using smartphones, the company has a lot to benefit as Android is among the top smartphone operating systems (Butler, 2011). Threats With the increase in the technological advancements in the market, these companies are also exposed to a range of threats (Lovelock & Wirtz, 2011). One of these is the increase in competition from other companies that provide the same products and services. With internet companies like Twitter and Facebook having a growing number of users, they provide a threat for Yahoo and Google in terms advertising revenues (Lagrosen & Josefsson, 2011). There is also a possibility of other internet based companies coming up to provide stiffer competition. In the software business, Google’s Android operating system faces a threat from Apple’s iOS, if it decides to adjust it and make it compatible to other devices (Butler, 2011). Other technology companies may also come up with more innovative products and better marketing approaches than Google and Yahoo, which might reduce their current market shares. Another threat that is associated with technological advancements is posed to the human resources of these companies. Employees face the risk of losing jobs because a wide range of jobs that were initially handled by people can now be done even better by machines (Lovelock & Wirtz, 2011). Even though this might come as a relief for these companies as they cut salary costs, the fact that these advancements may increase unemployment undermines the social responsibility efforts that these companies may have. The increase in technological advancements also increases the levels of cyber crime. Even though the systems of Yahoo and Google may be secure from this risk, given that they have measures in place to address this issue, clients who have opened email accounts with them may not be as secure. Hackers may gain access to their emails, obtain their personal information and use it against them. Even though such cases might occur as a result of low email security measures by the user, some of them tend to blame the email hosting companies like Yahoo or Google as being the reasons for their predicaments. As a result, this ruins the reputation of these companies. Communication at GoogleInternal and external communicationCommunication is among the aspects of a business that are paramount to its success. Internal communication refers to the passing of messages or information within the organization. This could be within the same department or interdepartmental communication (Wright, 2012). External communication refers to the communication that goes on between the organization and external stakeholders, who mainly comprise of customers. When carrying out internal communication, there are several factors that have to be considered. For instance, the messages ought to be confidential to avoid access from external parties. In this case, Google has a company intranet, which consists of an internal message board and email system (Goodman, 2006). This can only be accessed by company employees who have been allocated usernames and passwords. These channels of communications have been highly secured, making it impossible for an external party to access the information or messages passed. Internal communication in organizations also has to be effective and quick. For Google, this is facilitated by the fact that it has a horizontal communication structure. According to Butler (2010), horizontal or lateral communication is the free flow of information or messages across different functional groups in the organization. Employees and managers across all departments and employee levels at Google interact freely without any hierarchical boundaries (The Financial Express, 2005). This approach to communication enhances cooperation among employees and also quickens the process of resolving conflict. On the contrary, it reduces the authority of departmental heads in the organization. External communication is meant to promote products or services offered by the company, or to advertise its clients’ products to a wide range of customers (Wright, 2012). It can also be meant to engage with customers with the aim of making them feel like they are part of the organization. Depending on the aim that is to be met by external communication, there are several measures that can be used. One of the most effective tools that the company uses to accomplish this is through its website. Based on the fact that its website is the most visited in the world, there is a high level of surety that it will communicate to a wide audience (Segev & Ahituv, 2010). Even with the high number of visits on the company’s website, many customers who may be targeted by the messages might not be among the website visitors. Thus, another alternative option that the company uses is through sending e-mail messages directed to certain clients that could be interested in the goods or services of the company. In 2012, the company spent over $231 million in marketing its products, which include the Google+ social media platform, Gmail and the Google Chrome web browser (Efrati, 2012).Market communication theories relevant to the communication str ategyThere are several marketing communication theories that can be considered as being relevant to the communication strategies utilized at Google. One of these is the heightened appreciation model (Dahlen et al., 2010). It is based on the fact that companies need to carry out consumer market research to establish the key attribute that attracts consumers to a brand. Market communication strategies are then designed to link the identified attributes of the product or service to the brand (Fill & Hughes, 2013). For instance, in the advertisement of its Google+ service, the company is aware of the need for people to interact and share instant messages and videos on social media. Google then links this need in the market to Google+, encouraging more clients to subscribe. Another model that can be used to represent the market communication strategies at Google is the advertising exposure model. This model suggests that advertisement objectives can only be met if it created five effects to the target consumer (Fill & Hughes, 2013). These effects are; creation of awareness, conveying messages about the positive attributes of the products, generation of feelings among the target audiences towards the brand, creating a brand personality and triggering purchase intentions (Dahlen et al., 2010). This model also relates to the advertisement efforts that have been implemented by Google as it markets a wider range of its products. The AIDA model can also be used in explaining marketing communication. It is regarded as one of the oldest and most popular market communication models. This model states that there is a hierarchy of events that have to occur for a marketing communication strategy to be termed as having been successful. In chronological order, these are attention, interest, desire, and action. After the attention of the target clients have been drawn, marketers are required to raise their interest in the products or services being advertised through highlighting their advantages. After this has been done a sense of desire is created in the clients by providing them with the assurance that the products or services will satisfy their needs. This will trigger action from the buyer, which is demonstrated by making the purchase. At Google, this model has been widely used, especially when it spent approximately 231 million to market its products in 2012 (Efrati, 2012). However, this model has received criticism for being out-dated and irrelevant for the present market environment.The Communication Mix of AppleThe communication mix is referred to as the specific approaches that are used by companies to promote their services or products to their target customers. There are five elements that make up a communication mix. These are discounts and promotions, public relations, direct marketing communication, advertising and personal selling (Wright, 2012). At Apple, the marketing mix element that is mainly used is direct marketing communication. This approach involves interactive communication with the aim of seeking a certain response from the target audiences. With reference to the recent development at Apple when it was preparing to acquire PrimeSense, an Israeli 3D chip developer, it was vital for the company to inform its external and internal stakeholders or the impending acquisition (Velazco, 2013). Some of the approaches that the company could use to pass this information include direct email communication, social media interaction with its clients and through its website. The company has maintained a large customer data base that contains the contacts of its customers and other Apple stakeholders (Wright, 2012). This also makes it easy for the company to pass such vital information directly to its customers and other external stakeholders. Internal stakeholders, who mainly comprise of employees, can be formally informed through circulation of a memo or posting the message on internal communication platforms.Importance of Cross-functional communicationCross-functional communication is applicable within the organization. It is referred to as the communication among people from different departments or functional groups in the organization (Shimp & Andrews, 2013). The importance of cross-functional communication that is beneficial to Apple Inc is the fact that it enhances cooperation within the organization as different teams work towards attaining the same organizational goal. Encouraging cross functional communication also promotes awareness of whatever is taking place across the entire organization, which eliminates cases of ignorance of misinformation. Some of the challenges that are associated with ineffective cross-functional communication in organizations include the failure for members of certain departments in the organization to appreciate or recognise the contributions made by other departments (Diefenbach & Todnem, 2012). This may result to destructive rivalry that may affect the attainm ent of organizational goals adversely. In a scenario where Apple might plan to acquire another company, cross-functional communication enables all the departments to be equally ready for any changes or additional responsibilities that may arise after the acquisition (Diefenbach & Todnem, 2012).Analysis of an integrated Marketing communications campaignMarketing communication campaigns are defined as strategies that are implemented by organizations with the aim of increasing market awareness about their products or services. This is usually with the aim of increasing the purchasing intentions of the target audience. According to (Bergemann & Bonatti, 2011), ideal integrated marketing communication strategies effectively coordinate all product promotional messages to ensure that they are all consistent. This section presents a market communication campaign that was launched by Nike, a company that deals in the manufacture and distribution of sports equipment (Nike, 2014). The marketin g communication campaign was implemented with the aim of increasing the company’s market share in the UK to extend its lead. This is as a result of the stiff competition from Adidas (Thomasson, 2014). The campaign intended to make use of all the available avenues to increase awareness of the UK market about the brand. It also intended to market the new products that it had launched and seen as appropriate for the target market. These mainly included sports shoes. This marketing communications campaign targeted a wide range of customers, who ranged from 18 to 50 years of age (Nike, 2014).Factors that make the campaign successfulThere are several aspects of the campaign that make this campaign successful in attaining its originally set goals. One of these is the wide range of media outlets were used to pass the message to the audience, basing on the fact that media consumption varies among individuals within different age groups (Bergemann & Bonatti, 2011). Another factor that made the communication campaign successful was the fact that it highlighted the favourable attributes of the company’s products, which included the affordable prices and the comfort of the shoes. Referring to the heightened appreciation model, this is an effective trigger of purchase intentions among the target audiences (Fill & Hughes, 2013). Given that this marketing communication campaign was strategically designed, the only aspect that could undermine its capability to attain the intended goals is the launch of a similar or better campaign by its key competitors.Media UsedDifferent forms of media were used in this campaign to increase the size of the audience that could be reached. These were classified as print, broadcast and interactive media. Print media comprised of newspapers and magazines. These targeted different clients. For instance, ads that were placed in fashion magazines targeted the fashion enthusiasts who could need Nike’s products to work out. Broad cast media basically comprise of radio and TV (Lamb et al., 2008). Different market segments were targeted by advertising on a wide range of TV and radio channels, and at different times. Given that communication campaigns in print and broadcast media are one way, they were designed to contain as much information as possible to answer any questions that clients could have regarding the product (Bergemann & Bonatti, 2011). Interactive media comprised of all the media outlets that could allow the company and its clients to engage real-time with each other (Correa et al., 2010). These comprised of social networking, mobile and via the company’s blog. As opposed to print and broadcast media platforms, interactive media provided capabilities for the company and target customers to engage constructively (Kim & Ko, 2012). Some of the major social media platforms that are ideal for such form of communication between companies and customers include Facebook, Twitter and Google+. Despi te the advantage of real-time engagement that social media presents for companies, information on a flaw of negative attribute on the product spreads very fast (Correa et al., 2010). Conclusion This paper has covered a wide range of issues that relate to the present-day business environment. In regard to the technological advancements that are taking place in the present-day business environment, Google and Yahoo have been used as cases to discuss the opportunities and threats that these advancements present to the company. The paper has also presented an overview of internal and external communication in Google, which has incorporates that factors that are considered and the channels that are used in the communication. Different marketing communication theories have also been presented. These include the heightened appreciation model and the advertising exposure model. In the paper, different organizations have been used in the explanation of various concepts presented. Based on the arguments that have been presented in the paper, companies have to ensure that they effectively communicate with their customers and also encourage cross-functional communication so as to succe ed in the current hypercompetitive business environment. Failure to implement an appropriate communication mix will not only have adverse effects on the marketing efforts of the company, but will also hamper internal operations. For future research, the marketing communication theories and models should be analyzed more broadly so as to establish their relevance to different businesses. References Adler, G., 2013. Management Communication. New Jersey: Prentice Hall. Alexa, 2014. Web company Information: Top Sites. [Online] Available at: http://www.alexa.com/topsites [Accessed 7 April 2014]. Bergemann, D. & Bonatti, A., 2011. Targeting in advertising markets: implications for offline versus online media. The RAND Journal of Economics, 42(3), pp.417-43. Butler, C.J., 2010. Internal and lateral communication in strategic alliance decision making. Management Decision, 48(5), pp.698-712. Butler, M., 2011. Android: changing the mobile landscape.Pervasive Computing. IEEE, 10(1), pp.4-7. Correa, T., Hinsley, A.W. & De Zuniga, H.G., 2010. Who interacts on the Web?: The intersection of users’ personality and social media use. Computers in Human Behavior, 26(2), pp.247-53. Dahlen, M., Lange, ?F. & Smith, ?T., 2010. Marketing Communications: A Brand Narrative Approach. California: John Wiley & Sons. Diefenbach, T. & Todnem, R., 2012. Reinventing Hierarchy and Bureaucracy: From the Bureau to Network Organizations. Bingley: Emerald Group Publishing. Ef rati, A., 2012. Once Shunning Ad Promos, Google Now Flaunts Itself. The Wall Street Journal, 27 March. [Accessed 7 April 2014]. Fill, C. & Hughes, G?., 2013. CIM Coursebook Marketing Communications. New Jersey: Routledge. Gandhewar, N. & Sheikh, R., 2011. Google Android: An Emerging Software Platform For Mobile Devices. International Journal on Computer Science & Engineering, pp.12-17. Goodman, J., 2006. Intranet Strategy. London: The Ark Group. Haigh, P., 2010. Social Network Websites: Their Benefits and Risks. London: Optimus Education eBooks. Hundal, B.S. & Grover, S., 2012. Consumer Responsiveness towards SMS Advertisements and its Effectiveness in the Present Scenario. Journal of Marketing & Communication, 7(3), pp.34-39. Lagrosen, S. & Josefsson, P., 2011. Social media marketing as an entrepreneurial learning process. International Journal of Technology Marketing, 6(4), pp.331-40. Lovelock, C. & Wirtz, J., 2011. Services Marketing: People, Technology, Strategy. Upper Saddle Ri ver: Prentice Hall. Moore, I., 2005. Does Your Marketing Sell?: The Secret of Effective Marketing Communications. Boston: Nicholas Brealey Pub. Nike, 2014. About Nike Inc. [Online] Available at: http://nikeinc.com/pages/about-nike-inc [Accessed 7 April 2014]. Persaud, A. & Azhar, I., 2012. Innovative mobile marketing via smartphones: are consumers readyMarketing Intelligence & Planning, 30(4), pp.418-43. Petit, C., Dubois, C., Harand, A. & Quazzotti, S., 2011. A new, innovative and marketable IP diagnosis to evaluate, qualify and find insights for the development of SMEs IP practices and use, based on the AIDA approach. World Patent Information, 33(1), pp.42-50. Plunkett, J.W., 2009. Plunkett’s E-Commerce and Internet Business Almanac 2009. Texas: Plunkett Research. Schultz, F., Utz, S. & Goritz, A., 2011. Is the medium the messagePerceptions of and reactions to crisis communication via twitter, blogs and traditional media. Public relations review, 37(1), pp.20-27. Segev, E. & Ahituv, N., 2010. Popular Searches in Google and Yahoo!: A â€Å"Digital Divide† in Information UsesThe Information Society, 26(1), pp.17-37. Shih, B.Y., Chen, C.Y. & Chen, Z.S., 2013. An empirical study of an internet marketing strategy for search engine optimization.. Human Factors and Ergonomics in Manufacturing & Service Industries, 23(6), pp.528-40. Shimp, T. & Andrews, J.C., 2013. Advertising promotion and other aspects of integrated marketing communications. Mason: Cengage Learning. The Financial Express, 2005. Creative motivation at Google Inc. The Financial Express, 14 May. Thomasson, E., 2014. Adidas sees hit from emerging market currency swings. Reuters, 5 March. Velazco, C., 2013. Done Deal: Apple Confirms It Acquired Israeli 3D Sensor Company PrimeSense. [Online] Available at: http://techcrunch.com/2013/11/24/apple-primesense-acquisition-confirmed/ [Accessed 7 April 2014]. Williamson, D., Cooke, P. & Jenkins, W., 2013. Strategic Management and Business Analysis . New Jersey: Routledge. Wright, M., 2012. Gower Handbook of Internal Communication. Burlington: Gower Publishing.

Crime and Interview Essay

In addition, the culture of the company may also be one of the most decisive factors in the choice of the employers. For this reason, during the interview the above knowledge may as well help employees to attract the interviewers. Secondly, practicing before going to the interview is very important. After having well understood almost everything about the company, employers should practice some typical questions with a friends. They can interview each other to have a good reaction to some unexpected questions that might be raised during the talks. Moreover, they can also use a mirror or tape recorder to practice themselves. After finishing this step, employees will talk fluently so that they can have high appreciation from the interviewers. Last but not least, the employees should check everything again carefully on the day before the interview. The white, pale blue or pale yellows are the best shirts for an interview. Besides, they must have polished dress shoes. Everyone who wants to wear a suit, it must be conservative and below knee-length. A good-looking appearance will have a good first impression on the interviewers. In addition, they must check the traffic routes to make sure the timetable, practice again and get a good night sleep. They should relax and keep calm as it is very necessary. In conclusion, if people want to get a good position in a big company, they should follow the three above works, as these are the most effective and important in the preparation for an interview. These will help them to be more confident and have bigger opportunity to apply for their favorite job. Nguyen Thi Le Thuy – Writing Experience 3 Having a good interview is a stepping stone of having a good job. However, there are some methods that would be hardly known by people. This essay above pointed three important works you should prepare before going to an interview. Easily to be seen that the topic of the essay is how to have a good interview for a job. The writer wrote this essay in the form of an example essay. In this example essay, the writer’s main idea is three main works people should do before the interview. The introduction begins with the first paragraph that has a strong thesis statement â€Å"It is necessary for people to know the preparation for the interview including three main works†. There are three main supporting ideas. The first point is research the company. With this point, she demonstrated by an example. The second is practice before going to the interview. In this advice, the writer showed the reason why they should practice before going to the interview. The final point is check everything carefully before the interview. The writer also give some ideas about clothes we should wear, timetable and have a good sleep before the interview. The linking words used in the essay is quite rare â€Å" Therefore, in addition, for example, moreover†. On the other hand, these linking words is used quite appropriate. In the conclusion, the essay ends with a strong conclusion paragraph that provided insight on the thesis statement. â€Å"In conclusion, if people want to get a good position in a big company, they should follow the three above works, as these are the most effective and important in the preparation for an interview†. To sum up, this essay obviously have a clear outline. Ideas is arranged quite logic and appropriate. Although the linking words and example are used rarely, the ideas still connect fluently. Section B. A research essay Abstract : Capital punishment  or the  death penalty  is a legal process whereby a person is put to death by the  state  as a punishment for a crime. The judicial decree that someone be punished in this manner is a  death sentence, while the actual process of killing the person is an  execution. Crimes that can result in a death penalty are known as  capital crimes  or  capital offences. Capital punishment has, in the past, been practised by most societies;  currently 58 nations actively practise it, and 97 countries have abolished it (the remainder have not used it for 10 years or allow it only in exceptional circumstances such as wartime). It is a matter of active controversy in various countries and states, and positions can vary within a single  political ideology  or cultural region. Although many nations have abolished capital punishment, over 60% of the world’s population live in countries where executions take place. Keywords : capital punishment, death penalty, crimes, abolish Outline : I. Introduction : Thesis statement: Many feel that all civilized communities should abolish the death penalty. II. Body – Wrongful execution – Closure family – Discrimination III. Conclusion Abolishing Capital punishment : A controversial issue In all societies, many cases occur where a criminal must be punished, so that they can be taught a lesson, and they can stop committing crimes. There are many different ways of punishing criminals: one is the death penalty. The issue of the death penalty has been avidly discussed throughout history. Some people support the idea of the death penalty, since they say it is only fair for one to forfeit their life if they take the life of another. Others feel that the death penalty is not fair, and fear that many innocents have been penalized for something they did not do. The issue of capital punishment deals with the moral issues of many people with different opinions within a community. It is a cruel punishment, and many have stated that legal systems should be able to devise another punishment to replace it. Prejudice is present in cases involving the death penalty. Many feel that all civilized communities should abolish the death penalty. First of all, it can seem dreadfully unfair to the families of those found to be innocent after the fact, if they are executed for crimes they did not do. If the Courts of Justice were to misjudge a person and claim them to be guilty, they cannot repair their mistake once that innocent person is dead. Executing an innocent is just as wrongful as any murder committed by in public. Perhaps it can also be considered murder if the jury causes the death of an innocent. Francois Robespierre, a well-known French revolutionist, once said, â€Å"Human judgments are never so certain as to permit society to kill a human being judged by other human beings. Why deprive ourselves of any chance to redeem such errors? † (Goldenman 1998). It is unjust for anyone to make judgments about others, and to decide whether they should live or die. Courts of Justice are known to make numbers of errors, which means it is unreasonable to allow defendants with the least doubt of guilt to be sentenced to death. John Stuart Mill, the famous philosopher, wrote that capital punishment – another term used for the death penalty – is a wrong done to innocents. It is impossible to restitute all wrongful executions ever made. â€Å"If by an error of justice an innocent person is put to death, the mistake can never be corrected; all compensation, all reparation for the wrong is impossible. (Blacks 1999). The courts of justice and all legislative bodies bear the onus, and should regard it with great respect, because if they do not, they become no different from wrong-doers in society who commit the crime of taking another’s life. It is a grave mistake to consider the death penalty as the main method to solve cases, or the best way to discourage crime, because wrongful convictions do occur, and it has been shown that the institution of the death penalty is no great disincentive. There are other methods of punishment, such a long prison terms, which can serve to exact reparation for heinous crimes. The first cause of wrongful convictions is faulty or false information given by witnesses. For example, a US Army Sergeant, named Timothy Hennis, was convicted of murder and sentenced to death in South Carolina in 1986. One witness said he saw Hennis at the site of the murder, but the witness had mistaken Hennis for someone who looked like him. Some witnesses lie to ensure the defendant is convicted of murder. This usually happens when the actual killer attempts to shift the blame to someone else, so they can get away with it. In most cases, it is rather difficult to tell who the murderer is, and is based most frequently on who can tell the most persuading story to police. Because of this, the death penalty is the worst solution in most cases, because it does little to solve the case in a more clement way. Secondly, a great number of people consider capital punishment an evil act, because it is a cruel punishment exacted without just cause. It is might seem prudent to punish murderers with death because it tortures them, but their families, and the victims’ families, might think differently. The horror of a sentence of execution is compounded by years of waiting. Death row inmates are kept in solitary cells, where they are likely to be confined for twenty-three hours of each day. Interaction with others is kept to a minimum. Perhaps this kind of treatment might be punishment enough. Many consider the ultimate form of punishment as no disincentive for the crime of murder, and feel it increases killing, rather than diminishes it. They also hold it to be morally wrong. There are many difficult issues to deal with after a death sentence, which puts the family of the convicted person into as much discomfort and strife as the sentenced person. The most horrifying part is that they are constantly reminded of what will happen. The horrors of execution, the preparation for it, the psychological infliction of pain and the actual means of execution are considered by many to be barbaric. A whole sector of the community feels that it is an evil act to have any person put into that circumstance. â€Å"In criminal justice, combining this kind of ritualism with killing is considered an aggravation of murder. Yet this is the kind of death the state imposes on those it executes. Black 1998)† To punish evil with evil, the writer continues, and to exact an eye for an eye, and measure for measure, is to become as callous as the criminals. The last point, discrimination is also created by dint of the death penalty. In some cases, the court is prejudiced against the defendant. The reasons for their prejudice might be what they consider ignorance, racial bias, or poverty, as well as other undesirable traits. These characteristics can affect the way a judge and jury adjudicates the defendant. The family of a convicted person is also made to suffer from referred guilt and connectedness to crime, which is rarely repairable. Race is often an issue. Clarence Brandley, a black school janitor, was convicted in 1981 and sentenced to death for the rape and murder of a white high school girl in Conroe, Texas. He was told by the police officer that since he was black, he had to be guilty of the murder. Judge Pickett stated about the case, â€Å"The conclusion is inescapable that the investigation was not conducted to solve the crime, but to convict Brandley† (Goldenman 1998). Prejudice in the court case proceedings has often contributed to the execution of many innocent people. Many supporters of the death penalty argue that it will deter violent crime. Dudley Sharp(2000) states, â€Å"The incapacitation effect saves lives – that is, that by executing murderers you prevent others from murdering, thereby saving an innocent life. The evidence of this is conclusive and incontrovertible. † People of this opinion believe that murderers would think twice before killing, because they fear death. This idea has been shown to be entirely false. Murderers rarely consider the consequences before they commit a crime. If all murderers think of the consequences before they kill, the murder rate would be lower in legislative areas where the death penalty exists. In fact, it has been shown that murder incidence remains the same when regions that carry the death penalty are compared with those with no form of capital punishment. There is no conclusive evidence to prove that the death penalty deters crime. To sum up, it does make sense that all criminals should be penalized to preserve peace and justice. Murderers are criminals, and deserve to be punished for their crime, but not with their own death. The death penalty has many flaws. Innocent people can lose their lives for crimes of which they bear no blame. The death penalty is considered to be highly immoral. It is a form of cruel and unusual punishment. People suffer greatly, both emotionally and physically, before their execution, and their families likewise. Capital punishment is not an antidote for violent crime. It is perfectly possible to deprive murderers of their freedom and throw them in prison for the rest of their natural lives. References Curry, Tim. Cutting the Hangman’s Noose: African Initiatives to Abolish the Death Penalty. (Archive)  American UniversityWashington College of Law. Gaie, Joseph B. R (2004). The ethics of medical involvement in capital punishment  : a philosophical discussion. Kluwer Academic. ISBN  1-4020-1764-2. Dudley Sharp (2002). Abolitionist and Retentionist Countries. Amnesty International. Law Center June 25 Francois Robespierre (1998). The Dealthe Penalty : Three things you should know. Goldenman Johnson, David T. ; Zimring, Franklin E. (2009). The Next Frontier: National Development, Political Change, and the Death Penalty in  Asia. Oxford University Press. ISBN  978-0-19-533740-2. John Stuart Mill (1999). International Polls and Studies. The Death Penalty Center Judge Pickett . Juvenille Execution. The Commandments, Neg. Comm. 290, at 269–271 (Charles B. Chavel trans. , 1967). Kronenwetter, Michael (2001). Capital punishment: a reference handbook  (2nd ed. ). ABC-CLIO. ISBN  1-57607-432-3. Kronenwetter, Michael (2001). Capital Punishment: A Reference Handbook  (2 ed. ). ABC-CLIO. ISBN  978-1-57607-432-9. McCafferty, James A (2010). Capital Punishment. AldineTransaction. ISBN  978-0-202-36328-8. Mandery,  Evan J  (2005). Capital punishment: a balanced examination. Jones and Bartlett Publishers. ISBN  0-7637-3308-3. Marzilli, Alan (2008). Capital Punishment – Point-counterpoint(2nd ed. ). Chelsea House. ISBN  978-0-7910-9796-0. Mary E. William (2006) . The Death Penalty: Opposing Viewpoint. San Diego Timothy Brook, Gregory Blue (1905). Death by a Thousand Cuts. The Times higher Education. Woolf, Alex (2004). World issues – Capital Punishment. Chrysalis Education. ISBN  1-59389-155-5. Simon, Rita (2007). A comparative analysis of capital punishment  : statutes, policies, frequencies, and public attitudes the world over. Lexington Books. ISBN  0-7391-2091-3. List of people who were beheaded

Race and Racism Essay

In comparison to the almighty universe in which people all live in, human beings are merely a speck of dust at the size of it all. Then here are these beings on planet earth, with all 7 billion people under the same moon, divided. No longer are human equals as beings, but separate because of the system of ignorance, exploitation, and power used to oppress people on the basis of ethnicity, culture, mannerisms, and culture (Marable 1). Racism is the issue Americans have swept under the rug; the problem is being ignored, leaving cultures in the dark of their own history causing blame to be shifted on to all sorts of hosts, and it’s time to pick up the rug to dust. Society as a whole seems to have broken down what makes a person unique, dehumanizing them and leaving them susceptible to oppression (Marable 2). One must not be so quick to forget that every single human being is made up of the same genetic material, to forget something so broad is to undermine the gift of thinking itself. Manning Marable writes in Racism and Sexism that stereotypes are at the heart of every form of racism today. Racism is not a topic that sits around at the front of everybody’s brain. Racism does not twist on the tip of your tongue begging to be talked about. Racism is something that is ignored and denied. Shocking statistics from Tim Wise’s On White Privilege were discussed, stating that in 1962, 80% of white folk believed that racism was not even a problem. In the same year, 90% of white folk believed that colored children had equal education opportunities as white children. To believe that racism was not even a problem would be to say that over the 750 race riots 228 people were not actually killed, 12,741 people were not critically injured, and that the 15,000 acts of arson did not leave black urban neighborhoods in ruins, in the same year of 1962 (Postrel). White people are completely unburdened by race; where as colored people constantly feel their capabilities are always being second guessed. However, Charles M. Blow, author of Escaping Slavery, explains to the reader that apparently white people think their actions are justified! And Blow goes as far as to say that â€Å"the idea that progress toward radical harmony would or should be steady and continuous is fraying† (Blow 1). In On White Privilege, the speaker Tim Wise pointed out that white people were asked in 2009 if they believed that racial discrimination is still a problem and only 6% said ‘yes. ’ To put that into perspective: more people would believe that Elvis is still alive than to believe that racial discrimination is still a problem (Wise). Perhaps the density of the universe compromised the carrying capacity of the human brain causing a malfunction making it so the only thing people can think about is them self. Definitely not progress (Blow 2). The white system of ignorance and exploitations is causing the cultures of color to completely lose track of their own histories (Marable). People who are oppressed themselves begin to lose touch with their own traditions of history, community, love, celebrations, struggle, and change (Marable). Tim Wise reminds viewers whose history we are truly learning in school- text books are filled only with white history; people of color are forced to regurgitate white history, white literature, white art, white theater, etc. , while if a white person does not know an ounce of black history, it can go virtually unnoticed in this country (Wise). Actions speak louder than words and people seem to continue to prove their ignorance. As part of the Civil Rights Movement and an effort to create a solution to unlawful discrimination in housing based on race, color, sex, nation origin, or religion, the Fair Housing Act was passed in 1968 (Russell). Fast forward 38 years later where 2006 showed the highest level of discriminating housing complaints based on race (Wise). 38 whole years later and the only thing society can show on terms of progress is the lack of acceptance being distributed around the country. There is not enough change taking place as a country in order to move forward into truly being the United States of America; home of the Brave but we still fear what we do not know. It is always easier to accuse other forces for a problem than to admit that you are actually making the mess yourself. It has been said that if one is not a part of the solution then one is a part of the problem; however, some people are purely unburdened by race, they don’t know racism because they have never had to experience it- people are completely surrounded by and completely oblivious of the problem. Failure to talk about racism feeds the denial (Wise). The finger can be pointed in any direction, and instead of calling it â€Å"blame† the word â€Å"cause† is used instead because that is more constructive, and let’s face it, we need as much progress as we can get. However, progress seems to be unbearably intangible when Blow points out that the pillars of the institution- the fundamental devaluation of dark skin and stained justifications are for the unconscionable- have proved surprisingly resilient (Blow). The ignorance and lack of education only feeds the pillars’ strength. Completely blinded by utter fear, America seems to be in a standstill of progress towards the issue on racism. Starting with Charles Blow’s work in Escaping Slavery, down to Manning Marable’s Racism and Sexism, and what Tim Wise said in On White Privilege, it can be assumed that progress will always need to be made to bring this country closer to unity. Breaking down racial barriers and stereotypes have proven to be an especially lengthy process, however that does not justify the slothfulness of it all. Open minds and hearts is what it is going to take to shatter the structure that leaves this country divided. Word Count: 1,100 Works Cited Blow, Charles. â€Å"Escaping Slavery. † New York Times 4 January 2013. Marable, Manning. â€Å"Racism and Sexism. † Race, Class, and Gender in the United States, 5th ed. Ed. Paul Rothenberg. New York: Worth Publishers, 2001. 124-129. Pring. Wise, Tim. On White Privilege: Racism, White Denial, and the Costs of Inequality. The Media Education Foundation, 2008. DVD. Postrel, Virginia. â€Å"The Consequences of the 1960’s Race Riots Come Into View. † The New York Times. N. p. , 30 Dec. 2004. Web. 18 Feb. 2013.

Solid Work Simulation Essay Example | Topics and Well Written Essays - 1000 words

Solid Work Simulation - Essay Example The concept of this analysis lies in the fact that the elements have the nods which would behave in the same way under different load conditions, thus it would be possible analyzing the three degrees of freedom of every nod can be fully translated by notation. Here probably, need to know how different load types will relate to the bending moments. The relationship between moment and loads. Since it is a look out for the build up towards the analysis methods, there is a need to explore the different load conditions. The different load conditions can be a) Moment Load, b) Point Load, c) Uniformly Distributed Load and d) Patch Load (Cprani C 2008). Solid Works Simulation writes the equations governing the behavior of each element taking into consideration its connectivity to other elements (Harmanto D 2008). The method brings up the results from hundreds of thousands of equations which relate the unknown to the knowns. Those functions which would be integrated just like any ordinary function. Then finally the solver finds the degree of freedom in every element at every nod. A number of simulation techniques have been developed to model a... Nonlinear Analysis-The stress-strain relationship of the material is not linear. -Induced displacements are large enough to change the stiffness. -Boundary conditions vary during loading (as in problems with contact) (Cprani C 2008). Buckling Analysis-this is conducted to predict critical loads and tests failure due to buckling.Frequency AnalysisThermal and Thermal Stress Analysis Optimization Analysis One can possibly make mistake in accessing a broad range of physical models and capabilities. -One should let SolidWorks Flow Simulation find the best dimensions or inlet and outletconditions that satisfy goals, such as force, pressure drop, or velocity (ProductDiscription 2009) In clearly understanding the effects of temperature changes in parts and assembles. In performing dynamic analysis on parts and assembles, it will require making a number of different studies (Product Discription 2009) The Use of Mesh Size and ShapeA number of simulation techniques have been developed to model and analyze different processes and to help decision- makers Halppin 1977). Cell-based modeling has been investigated in simulation (Zhang et al. 2005, Zhang et al. 2006). A subdivision of model during the analysis becomes necessary for the mathematical simulation. This task of subdividing is normally called to be the Meshing. Meshing helps to come up with more accurate results, at the same time it will require more computer resources. One can always make use of the mesh control to reduce the size of the element in order to improve the accuracy of the results.

Underlying depression in orthopedic patients Essay

Underlying depression in orthopedic patients - Essay Example Depression in orthopaedic patient are overlooked and seldom treated because of the misconception that it will eventually recovered by the patient itself.Depression occurs not only in adult orthopaedic patients but with children as well. The purpose of this paper is to identify the role of nurses, doctors, and other healthcare providers in the orthopedic department with regard to how we identify depression, and what needs to be done to thoroughly recognize these cases and initiate the appropriate treatment. Identifying such issues is important because it is vital both to their recovery and to the healthcare provider. How do we effectively detect depression during the assessment and carry out proper intervention in treating their depression as well as their medical illness. As part of the patient safety goal campaign of Hoag Hospital, should we change how we systematically assess our patients at the bedside and routinely screen for depression and / or suicide These are the problems that we consider because of the severity of the case that it may lead if the depression in an orthopeadic patient will be taken for granted.There are researches and study that elderly recovering from an orthopaedic surgery is normal to experience depression. According to some doctors, some depressions are caused by some of the medicines they are taking; some are the non acceptance of their situation mostly in amputated legs or arms. According to Baker and Ashbourne of Children's Mental Health Ontario (2002) on e is considered to be depressed if they have the following symptoms: depressed appearance, anxiety, irritability and frustration, lack of interest, lack of cooperation, change in appetite and sleep patterns, weight loss and gain, loss of energy, withdrawal from family and friends and others. Patients are not aware that they are having the said depression resulting in the misconception of the doctors and medical staff that the patient is recovering. The physicians and other medical staff overlooked the fact that depression may originate from the lack of communication with the patient. Doctors and nurses are ignoring the fact that orthopaedic patient may have depression during recovery. Involved medical staff should be aware of the signs and symptoms of depression in order to prevent the further development of it. The older orthopaedic patient with depression usually experience severe pain thus prolonging their rehabilitation. There are also some factors from the situation of the orth opaedic patient that may cause their depression. Since surgery is usually costly they may have financial problems causing the patient to severe depression. The patient may tend to isolate themselves from others causing a great sadness that leads to depression. There are some cases wherein patient would have any complications such as diabetics causing the patient to feel helpless. These are the common factors that causing the orthopaedic patient to feel depressed. Solution Generation The first thing to do in treating depression in an orhtopedic patient, is understanding what is depression Herbalmedicine.com (2007) defined depression as a mood disorder that is often triggered by a chemical imbalance or stressful situations. People suffering from depression experience ongoing sadness, low energy, irritability and general disinterest in daily activities. Depression is a medical condition and should not be considered a personality flaw or weakness of character. It is best to determined first if the patient is having the said condition before admission in the rehabilitation ward. As the physician you must be aware of the possibilities that your patient might have this condition because of the signs and systems that is present in the patient's attitude. Usually depression is associated with

Euthyphro (Platos Early Dialogues) Essay Example | Topics and Well Written Essays - 2500 words

Euthyphro (Platos Early Dialogues) - Essay Example Does God call something right or moral because it is right or moral or does is something right or moral because God calls it moral? Therefore, if God calls an act moral because it is moral, then morality or goodness will be seen as priori to Gods Command and thus, it is independent of God. On the other hand, if an act is moral because God says it is moral or right, then it implies that whatever God says it is right (Hamilton and Cairns 37). In addition, this also implies that Gods command of what is moral is arbitrary since the same God could have willed contrary commands. The dialogue presents the challenge that was intended to make us think about the nature of morality. Therefore, when Socrates asks Euthyphro about his definition of the word piety, Euthyphro was required to identify the nature of virtue or morality by establishing on what ground does morality or virtue stand on. It is difficult for an atheist to discover the ground on which morality stands on because they claim tha t they can have ethics or morals without God. Certainly, an atheist can behave in a way that people perceive moral or good but it is really hard to define what the term ultimately means (Plato 10a). It may imply complying with objective standard of morality or good, a policy or law given by legitimate authority without involving a transcendent law maker-the gods. This means that there can be no transcendent law maker and no corresponding duty to be good. Most Christians oppose the argument that there is an arbitrary role of God’s power and rejects the idea that there is no law or policy over God. Then, where does morality stands? Morality can be said to be grounded in the divine and immutable character of God who is perfectly good in that his commands are not whims but planted in his holiness. Christians argue that any bad things that happen are not commanded by God because his character is that he is holy and merciful. For Christians, morality is rooted in God’s chara cter which expresses itself in the commands of God and it is not above him. In sum, whatever is good is always commanded by God not that it is good so that God commands it to be good (Cooper 41). Christians argue that God ultimately determines the pious or morality and that the commands of God are expression of his desires and will for what human beings ought to do. This is because such argument presents a metaphysical foundation of piety or morality. Human beings need to be committed to the existence of moral truths in order for them to live in accordance with the will of God. This means the existence of moral truths for people since they have moral obligation to obey what God commands. This is so because Christians believe that their moral obligation comes from God in form of commands. Thus, people ought to be moral because they are morally accountable to God in that those people who do not obey him will be punished and good people will receive rewards (Plato 10b). Plato’s dialogue regarding the nature of morality or goodness is still being raised even today as a challenge to Christianity in that many Christians ask themselves is an action or act good or right because God says it is right or does god say it is good or right because the act is right. The Euthyphro dilemma is traced in

Modernisation Essay Example | Topics and Well Written Essays - 2500 words

Modernisation - Essay Example As a result of this each unit focused on a specific task and was directly accountable for it. Cowper (2001) goes on to say that post 1997, in the second phase of the reform process, the labour Government headed by Tony Blair has focused on 'partnership and collaboration within the public sector.' The focus he says has " shifted from outputs to outcomes, and there is a drive to take a longer-term view in policymaking and a consumer view in service delivery." A significant aspect of modernization has been the introduction of technology to the various areas of work. Consumerist orientation of the public sector has also been an area of focus. According to Schofield, (2003) The biggest challenge for the public sector is to ensure high quality service within a limited budget. Along with these aspects comes the key area of employee relations. As the structure and focus of the organization changes, the impact is likely to be felt most by the people who work in the organization. This paper focuses on the implications of this modernization agenda on public sector industrial relations Using the available research and publications on the modernization of the public sector and public service employment relations, this paper will begin by looking at the need for modernization and the key objectives of modernization. The next section will focus on the changing face of industrial relations in the age of modernization. The focus will then shift to the significance of employee relations in the present era. Based on the findings of Dr. Stephen Bach's paper titled 'HR and new approaches to Public Sector Management: Improving HRM Capacity' (2000) and Lynette Harris' paper titled, 'UK public sector reform and gaining commitment to the 'performance agenda," (2003) this section will deal with some of the challenges that lie ahead in the modernization or reform focus. The key issue raised will be the need for better Human resource Management Practices to ensure better employee relations and greater job satisfaction. What is Modernisation According to the Policy Brief, Organisation for Economic Co-operation and Development (2005),Today Governments all over the world are under increasing pressure to open up to public scrutiny and be more accessible to the people who elected them. It was with a view to cater to this public demand , increase public trust in the Government and to improve the quality of services offered by the public sector that the Government , Cowper (2001) says introduced its modernizing agenda with a 5 point programme: a. to make policy making more evidence-based b. to make services more responsive, more coherent public and focused on the user; c. to deliver high quality, efficient public services; d. to introduce information age, on-line government including the first corporate IT strategy for government to value and reward public service with a program of Civil Service reform e. and greater diversity in recruitment As Cowper (2001) points out, the driving force behind the modernization agenda is the outcome. This model focuses on the result for the user in terms of their life or business and for the government in terms of social or economic or political change. It is not just in the United Kingdom but across the world that public sector management is in a flux. According to a white

Food Fantastic Company Essay Example | Topics and Well Written Essays - 250 words

Food Fantastic Company - Essay Example Foods Fantastic Company is a publicly traded grocery chain with a chain of 50 stores in the US.The company has embraced technology to a great extent and uses state-of-the-art applications to monitor inventory and maintain its accounting books An ITGC review is necessary because of the degree to which the company is dependent on the data produced by its information systems for accounting and decision-making. Purpose: The purpose of an ITGC review is to ensure the reliability, consistency and security of an information system that is being used as a source of information and legal standing for accounting purposes. The idea behind an ITGC review is to check the data input streams for dependability as it will constitute a legal standing of the company. In addition, the review will cover aspects of fraud, security, back-dated entries and other loopholes that can be used for frauds or unauthorized access to confidential data. Scope: The scope of this audit and review is limited to the surf ace risk assessment of the controls used by FFC. In addition, it covers only the mainstream information system which is used for reporting and decision-making. Any other third-party systems are not covered in this review as long as they do not have any impact on financial reporting. Also, the review has been conducted in accordance with the guidelines defined and accepted as international best practices for ITGC. Findings: The information system control procedures at Foods Fantastic Company do not meet the standards of what can be termed as the best practices in the industry.

Encouraging Employee Buy-in Essay Example | Topics and Well Written Essays - 750 words

Encouraging Employee Buy-in - Essay Example Encouraging Employee Buy-in The company has more than twelve hundred employees. It is possible for line managers and the supervisors of the company to encourage employees’ engagement in an organization through positive campaign on the ban. The first important step towards encouraging employee buy-in is to critically run an evaluation of the parts of the system that impact on employee buy-in (Armstrong, 2008). Keeping employees engaged in the project to encourage smoking ban is a key element of encouraging staff buy-in. The objective of every employer is to employ staffs that are going to be a resource rather than a challenge (Armstrong, 2008). Is such an instance, the two directors should involve the employees in the company’s project from the initial stages of the system. Make familiarize the system in use to all the employees (Brief, 2008). Line managers have an easy job of setting the team together and defining the team’s direction. The challenge comes in getting the team to buy into the concept of working together for common objectives of supporting the ban (Boxall & Purcell, 2011). Emphasizing the positive benefits of working as a team to support each other is a way that may create employee buy-in to the project. The line manager should explain to employees the specific reason they have chosen to contribution to the job (Boxall & Purcell, 2011). In a way, the employee will feel proud to be associated in the business if the managers offer unbiased reasons for implementing the ban. Line managers and the supervisors should talk to employees about how to prioritize the team’s work within their regular duties.

Communication in Economics Essay Example | Topics and Well Written Essays - 500 words - 1

Communication in Economics - Essay Example And in the case of county, residents will only pay fund if they are, loyal to, or satisfied with the performance of county administration. In the case of small number of county’s residents, the county administration can have close contact with them. It can address to there problems carefully and can redress them if it thinks them legal. Due to better understanding between a resident and administration the chance of resident’s disloyalty and disappointment are reduced. Another advantage is that county administration can more easily deal with a problem than in the case of a large sized county. For example if a problem of water occurs in county, a small sized county can better deal with this problem due to its small size than a large county. Secondly, as the county’s population increases another question about providing amenities like water, security, gas etc. is also raised that is, will the county administration be able to provide these services to the residents in return of taxes e.g. property tax, paid by the residents. In this case if the size of county increases it will be very difficult for county administration to fairly administrate the system of taxation. 2. If the proposal is accepted then how county board will provide necessary services e.g. water etc., in return of taxes and funds paid by residents. As county already lacks sufficient water to support such a population increase. In this situation, how it would be possible for county board to raise sufficient funds for wanted projects. So according to my opinion it will not be adequate to permit the investors unless the county board becomes able to manage such a population change in a well-organized manner. Or on the other hand if county board still wants to permit investor for fund raising for their planned projects, then, at the least, board should permit investors to build only one housing development so that the county’s

Nietzche's Philosophical Understanding of Truth Essay

Nietzche's Philosophical Understanding of Truth - Essay Example However diverse the interpretations of the different scholars may be, they all agree that Nietzsche's philosophy is perspectival. Nietzschean thought claims that there is no singular truth or absolute truth. There is instead a multiplicity of truths. His philosophy states that there is no singular platform or vantage point from which absolute truth could be seen. However, there is also a multiplicity of perspectives, each with their distinct way of presenting the truth. Many scholars have searched for solutions to what appear to be cnradictions arising from Nietzsche's works. This paper however, only aspires to give an interpretation of his thoughts and philosophies. So that the human individual may survive and preserve his condition, given that he has none of the accouterments of beasts armed with the most deadly of natural weapons with which to defend themselves and dominate weaker specimen, Man has resorted to his intellect using the art of dissimulation. It is through "deception, flattery, lying, deluding, talking behind the back, putting up a false front, living in borrowed splendor, wearing a mask, hiding behind convention, playing a role for others and for oneself - in short, a continuous fluttering around the solitary flame of vanity", that Man is able to not only survive but also prevail over other species and his fellowmen. Given that man possesses such a nature, and such nature arises from necessity, it becomes a contradiction that Man should also possess a drive to find truth. Nietzsche states that men do not comprehend the truth through their senses, but merely receives stimuli through them. He is also deceived by his dreams, and does not have a full comprehension of himself since there are many things in his biological constitution that naturally could not be seen. Since Man's nature, mind and his senses and tools of perception do not fully reveal the truth, Nietzsche asks from where does the drive to find truth emanate As an individual needs to preserve himself against others, he also desires their company, being the social being that he is. As such, though he utilizes dissimulation for the purpose of self-preservation, he also tries to eliminate the most flagrant of this method. This compromise gives root to Man's need to find truth. Designations are given to all things and these assignations become the basis for the truths as individuals agree they should be. It is upon these designations that the difference between truths and lies are based. A person who lies is someone who applies the designation or word for one thing to describe another. If this results to harm for another individual or society, then he will be distrusted and even ostracized. Man responds in this way to lies because he is harmed by the commitment of fraud, and not the act of lying itself. It is not deception which is abhorred or condemned but the consequential negative effect it brings upon them. The greater the degree of harm, the more hostile society becomes to the fraudulent person. But the question remains on whether the words used as designations for truths are themselves consistent with what is "absolutely true". Nietzsche describes words as merely "the copy in sound of a nerve stimulus". The more incongruent or distant a word is from the nerve stimulus it is supposed to represent, the more false it becomes. Words therefore are arbitrary assignments which represent

Post-Traumatic Stress Disorder in the Military Essay Example for Free

Post-Traumatic Stress Disorder in the Military Essay I.  Ã‚  Ã‚   Abstract Stoked by an adversarial media and the run-up to Presidential elections next year, the trauma afflicting our body politic often seems more important than the deaths, physical disability and post-trauma stress disorder that afflict servicemen on the frontlines. In this paper, I review the historical origins and verify the prevalence of what was whimsically called â€Å"soldier’s heart† in the Civil War and â€Å"disordered action of the heart† (DAH) or neurasthenia at the turn of the century and has now gained cognizance as â€Å"battlefield fatigue† or PSTD.    The etiology is vast, since combat stress seems to provoke a great many physical, physiological and anxiety-related disorders.   Lastly, I investigate the treatment options.   War is ever a violent business.   If the North-South Civil War shocked Americans with unheard-of casualty counts and the violence of battles waged at the dawn of the industrial age, World War I traumatized the world with the unremitting violence brought to bear in hopes of breaking the stalemate that was the Western front.   Poison gas, the machine gun, barbed wire, and massed artillery bombardment sent casualty counts sky high.   Besides the United States, 17 other countries on both sides of the â€Å"war to end all wars† suffered no less than 5.7 million soldiers killed and another 12.8 million wounded. Soldiers at the frontline were brutalized by the sheer violence of artillery bombardments, the random deaths these caused and the experience of seeing an unceasing number of their fellow soldiers slaughtered by gas or machine gun fire.   It was then that the nervous condition first termed â€Å"war neurosis† or â€Å"neurasthenia† manifested in great numbers.   Eventually, the equivalent term â€Å"shell shock† came into wider use. Combat stress reactions first came to the attention of the medical establishment (psychiatry was in an embryonic stage then) in the second half of the 19th century and early in the 20th when physicians came to recognize adverse reactions that had more to do with sustained exposure to battle conditions than any physical injury.   In retrospect, the Civil War condition then termed â€Å"soldier’s heart† was really a form of â€Å"combat stress reaction†. During the Boer War waged by the British in South Africa (1899-1902), due notice had already been given to either â€Å"disordered action of the heart† (DAH) or neurasthenia/shellshock.   Retrospective analysis of British soldiers who had been pensioned off for these conditions (Jones, Vermaas, Beech, Palmer, et al. 2003) found no especially significant difference in mortality compared to comrades who filed for disability owing to bullet or shrapnel wounds. The Russia-Japanese War of 1904 and 1905 gave Russian physicians their first reported exposure to, and the opportunity to try and treat, nervous breakdowns owing to the stress of warfare, compounded by the demoralization of losing to the Japanese. Later in the 20th century, the evolving nature of the battlefield and the enemy – World War II, the Vietnam War, the Iraq and Afghan occupations being the more prominent examples – created unexpected new sources of stress that complicated the combat fatigue syndrome and led to the broader â€Å"post-traumatic stress disorder† coming into wide use.   So whereas â€Å"combat fatigue† referred to â€Å"a mental disorder caused by the stress of active warfare†, â€Å"PTSD† revolved on post-combat â€Å"fatigue, shock or neurosis†. V.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Statement of the Problem: In this research paper, we review the available authoritative sources to assess: The continuing prevalence of PSTD in the varied conditions of modern warfare. Short- and long-term therapy employed to resolve the disorder. The extent to which familial and community support ameliorates PSTD and improves patient outlook. For a world that has experienced unremitting conflict since World War II, whether orthodox warfare, low-intensity conflict or insurgency, chances are that anticipating and providing therapy for stress disorders will be a continuing concern. VI.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Literature Review A.  Ã‚   The Character of Modern Conflict In the aftermath of the Great War many people believed that they had seen the most terrible war the world will ever see. History would prove them wrong. In the century that followed, war became even more traumatic and horrifying in its brutality. From the Russian civil war to the present conflict in Iraq, war took an ever-heavier toll on the human psyche. Technology improved the methods by which death might be delivered but it has done nothing to strengthen the minds of those who had to bear it. The Russian civil war that succeeded until after World War I was a horror to behold. Thousands died in the fighting between the White Russians and Red Russians. Thousands more froze in the winter for lack of appropriate gear. Worse, many civilians were murdered by both sides on mere suspicion of being collaborators. World War II was a litany of terrors. Whole societies were brainwashed into supporting the war from an ideological standpoint. Millions of Jews were gassed and burned in the holocaust simply being Jews. The SS, the KGB and the Kempetai would murder anyone at whim. Thousands of women were kidnapped and raped as â€Å"comfort women† by the Imperial Japanese Army. More than the individual or large-scale slaughter of men, the true horror of WWII was the torture it inflicted on societies. Entire cities were razed to the ground in terror bombing. Cities became prison cells where starving denizens were forced to labor endlessly. Men went off to war leaving women to tend the factories and leaving no one to care for the children. Then there was the Atomic Bomb. A scant few scores of thousands died. Both cities were leveled to the ground. The radioactive damaged would endure for years. Even those who tried to help the victims were themselves victimized by the radiation. In Korea and Vietnam, millions were fielded in grueling civil wars. Korean fought against Korean backed by Communist and Imperialist masters. The same would be true for Vietnam but with the inclusion of terrible chemical weapons that defoliated forests and would cause harm for generations to come.   In turn, the Viet Cong and Khmer Rouge executed savage campaigns against their own people. The Arab-Israeli and Iraq-Iran wars would institutionalize child-soldiery. Israel had a scant 4 million citizens to oppose over 200 million Arabs. When attacked by the Arabs, Israel would be forced to deploy all its manpower, along with women, to help fight off the invaders. Chemical weapons were also used. The Israelites were left to defend their small nation against all their neighbors. Iraq and Iran would field child soldiers in countless thousands. They would be given rifles then thrown into battle against hardened veterans in the hope of at least slowing down the enemy. Muslim killed each other over essentially religious disputes. But perhaps the worst war of the 20th century would be the War on Terror. In the past the enemy was a specific country or group of countries. If they bomb our territory we can bomb theirs. But today, the enemy is not a nation. Today, servicemen in Iraq or Afghanistan do not know where or when the enemy will strike. All they know is that the enemy is out there lurking amongst a hostile population. The war on terror also has another unsavory aspect. The ‘enemy’ resort to bombing civilian targets back home. Worse, the soldiers know that their victories will only make the enemy more desperate and make them retaliate more against innocent civilians. As if the violence of outright warfare and low-intensity conflict were not enough, American and British forces of occupation as well as the soldiers of every nation that serve in U.N. peacekeeping forces confront at least equal prospects of PTSD.   Whether in the Korean DMZ, the former Yugoslavia, Iraq, Afghanistan, Somalia, Lebanon, Ireland, or Timor, every soldier on such assignments faces a multitude of perils. In many cases, peacekeeping forces are in a low-intensity-conflict situation but hampered by rules of engagement that deny them the right to shoot first and shrug it off as a mistake.   The potential for battlefield fatigue climbs higher with alien cultures and religions, a seemingly ungrateful, resentful and even hostile native population, suicide attacks, well-armed guerillas, booby traps, mortar and improvised missile attacks.   Such occupying forces are also apt to lose the public relations war for being unable to stop factions from slaughtering each other such as happened in Iraq, Afghanistan, Israel, Lebanon, East Timor and Rwanda.   And perhaps the unkindest cut of all is when their own country’s media deliberately distort the casualty count from fratricidal or genocidal conflict as having been caused by the occupying or peacekeeping forces! B.  Ã‚   Incidence of â€Å"Shell Shock†, PTSD and Precipitating Events When â€Å"shell shock† came to be widely recognized in World War I, the initial hypothesis was that it was induced by an inordinate number of fatal casualties.   In fact, about 10% of all military forces then engaged succumbed on the battlefield, double the rate in World War II (less than 5%, in great part because the wide availability of sulfanilamide averted more deaths from battlefield infection).   Later came the realization that it was total casualty count that really mattered.   Historical research shows that around 56% of soldiers on the Western Front were either killed or wounded.   When every other fellow in one’s platoon gets hit, fatally or not, it is no wonder that stress casualties were as numerous as battle casualties. The term itself, â€Å"shell shock† reveals the ingrained belief that psychiatric casualties from the horrors of the battles of the Somme, Marne, Ypres, etc. had suffered concussion (physical trauma to the head or brain) from a close call with an exploding artillery shell.   Nearly a decade elapsed before a British War Office Committee realized (Military History Companion, 2004) that battle exhaustion and other varieties of war neuroses accounted for a far greater proportion of cases than concussion did. Great Britain having entered the fray early, the numbers of servicemen afflicted with â€Å"shell shock† and assorted neuroses were significant. By 1939, some 120,000 British ex-servicemen had received final awards for primary psychiatric disability or were still drawing pensions – about 15% of all pensioned disabilities – and another 44,000 or so †¦ were getting pensions for ‘soldier’s heart’ or Effort Syndrome. (Shephard, 2000) In the post-World War II era, the Vietnam war can be counted the most traumatic for the U.S. military, not least because of the failure to achieve a clear-cut victory and the dissatisfaction of the American public with a war that dragged on so long.   Since the fall of Saigon in 1975, estimates of the long-term incidence of â€Å"post-Vietnam syndrome† (now recognized as PTSD) among veterans varied from a high of 30% in 1989 and a slightly lower 21% in 1996 (Allis, 2005). The most authoritative review in recent years, by researchers from Columbia University and other institutions, suggested that the lower end of the range was the more realistic figure: nearly 19 percent of Vietnam War veterans succumbed to PTSD as a direct result of military combat.   In addition, The more severe the exposure to war zone stresses, the greater the likelihood of developing post-traumatic stress disorder and having it persist for many years, said Bruce P. Dohrenwend, an epidemiologist at Columbia University. (McKenna, 2006). Fast forward to the current occupation of Iraq.   The Defense Department reports, based on a sample survey of over 1,600 Army soldiers and Marines, that around one-third (30 percent) of those who had been in â€Å"intense combat† were diagnosed with such mental health problems as PTSD and depression.   Incidence appeared higher among soldiers deployed to Iraq at least twice and for more than six months at a time (Bookman, 2007).   So distressing is the occupation, according to an Army study, that one in six of close 1 million soldiers â€Å"surged† to Afghanistan and Iraq will very likely be afflicted with PTSD (Allis, op. cit.). The reality turned out to be worse.   Even more appalling estimates of incidence were reported by what has to be the most thorough accounting of the prevalence of post-traumatic stress disorder (PTSD) and conditions resembling chronic fatigue syndrome (CFS), a survey by Kang, Natelson, Mahan, Lee, Murphy (2003) on the entire population of 15,000 Gulf War and 15,000 non-Gulf-War veterans.   Information was gathered in 1995-97. Gulf War veterans reported significantly higher incidence of PTSD (adjusted odds ratio = 3.1, 95% confidence interval: 2.7, 3.4) and CFS (adjusted odds ratio = 4.8, 95% confidence interval: 3.9, 5.9). Furthermore, â€Å"the prevalence of PTSD increased monotonically across six levels of deployment-related stress intensity (test for trend: p 0.01). Back home, the Department of Veterans Affairs reported on an investigation of principally Persian Gulf War veterans (79%) who had availed of the National Referral Program (NRP) and visited war-related illness and injury study centers meant for combat veterans with unexplained illnesses . Over the period from January 2002 to March 2004†¦ The more common diagnoses were chronic fatigue syndrome (n = 23, 43%), neurotic depression (n = 21, 40%), and post-traumatic stress disorder (n = 20, 38%). Self-reported exposures related to weaponry†¦ environmental hazards, stress†¦A small increase in mean SF-36V mental component scores (2.8 points, p = 0.009) and use of rehabilitation therapies (1.6 additional visits, p = 0.018) followed the NRP referral (Lincoln, Helmer, Schneiderman, Li, et al. 2006). The political furor over U.S. deployment in the Middle East has led to permutations, including what Baker (2001) refers to as â€Å"Gulf War Illness†.   The more combat exposure they had had, the greater the likelihood that veterans manifest depression, PTSD, fibromyalgia, anxiety, and have generally poorer â€Å"health-related quality of life†. For the British, a more sanguine view about involvement in Iraq may explain a finding that deployment to that strife-torn arena does not necessarily lead to increased risk of PTSD. Simon Wessely of the Kings Centre for Military Health Research at Kings College London reports that there is no evidence of anything like an Iraq war syndrome and that British troops returning from deployment were no more likely than U.K.-based soldiers to succumb to PTSD, anxiety or depression (New Scientist, 2006).   Wessely seemed heartened by the fact that PTSD casualties this time around were significantly lower than during the earlier, even less controversial Persian Gulf War of 1991. He also explained the advantage vis-à  -vis incidence of around 20% for U.S. troops on three facts.   First of all, British troops are more battle-hardened. Two-thirds of British troops have been in deployments elsewhere, compared with only 10 per cent of US troops.   Secondly the US also uses more reservists (in the form of National Guard units) and has responsibility for the worst of the hostile combat zones.   To an outside observer, the adversarial stance of the U.S. press and the inability of the American public to withstand sustained conflicts not amenable to victory over a visible enemy also count as contributing factors. It would take an Englishman to look into the topic but tongue-in-cheek analysis by Ismail et al. (2000) of U.K. Gulf War veterans revealed that the chances of falling prey to PTSD are greater with lower rank (and, presumably, lower social status) and if one leaves the service. Some research has shown that, far from being a steady state or amenable to permanent remission, PTSD has a way of recurring with the re-occurrence of the original precipitating factors or other less specific pressures, such as with serious illness or the sudden lifestyle change of retirement.   In Israel, reactivation is a constant possibility owing to the fact the nation is always in a state of war with recalcitrant enemies so this potential trigger has come under scrutiny (Nachshoni Singer, 2006).   Case studies suggested that PTSD can recur even when the call to duty is for a family member. C.  Ã‚   Symptomatology In World War I, â€Å"shell shock† was observed principally as nervous fatigue.   The famous photograph (see Figure 1, above) of a patient manifesting the â€Å"thousand-yard stare† became the enduring image of intolerable combat stress: glassy-eyed fatigue, slow reactions, indecisiveness, being detached from one’s immediate surroundings, and a certain vagueness about that needed doing first. So great were the numbers afflicted and so vividly did the novel phenomenon manifest itself that even the popular press in the U.K. could accurately report the symptoms of battle trauma: â€Å"Something was wrong. They put on civilian clothes again and looked to their mothers and wives very much like the young men who had gone to business in the peaceful days before August 1914. But they had not come back the same men. Something had altered in them. They were subject to sudden moods, and queer tempers, fits of profound depression alternating with a restless desire for pleasure. Many were easily moved to passion where they lost control of themselves, many were bitter in their speech, violent in opinion, frightening. (Shephard, op. cit.) The unfortunate circumstance of decades of unending small-scale conflict and insurgency campaigns post-World War II have enabled military psychiatrists to more fully define three key facets of combat neurosis and PTSD: fatigue, psychosomatic manifestations and neurotic symptoms. Fatigue is the common denominator behind indecision and inability to concentrate, memory loss, constant waffling about priorities, little initiative, significantly slowed reaction time, seriously downgraded alertness and thought processes, taking refuge in obsessing and nitpicking unimportant details, and, most telling of all, difficulty with even routine tasks. The element of neurosis crops up as fearfulness, anxiety, irritability, depression, confusion, paranoiac tendencies, fear of loss of control, and self-destructive behavior such as substance abuse or suicide. Consequently, PTSD patients manifest the entire spectrum of somatically-induced disorders: headaches, backaches, (see also Mayor, 2000) being constantly high-strung, shaking and tremors, sweating, nausea and vomiting, loss of appetite, abdominal distress, frequency of urination, urinary incontinence, palpitations, hyperventilation, dizziness, muscle and joint pain (see also Ricks, 1997),   insomnia and other sleep disorders.   Barrett et al. (2002) found this psychosomatic explanation incomplete.    In a telephone survey of 3,682 Gulf War veterans and control subjects of the same era, the authors revealed that â€Å"Veterans screening positive for PTSD reported significantly more physical health symptoms and medical conditions than did veterans without PTSD. They were also more likely to rate their health status as fair or poor and to report lower levels of health-related quality of life.† D.  Ã‚   Long-term Effects No doubt, psychosomatic disorders are of a piece with another syndrome physicians like to point to chronic multisymptom illness (CMI).   Building on earlier studies that demonstrated CMI being more common among veterans who deployed to Saudi Arabia and Kuwait in contrast with those who had never participated in that campaign, Blanchard, Eisen, Alpern, Karlinsky, Toomey, Reda, Murphy, Jackson and Kang (2006) set out to assess the situation ten years after deployment and found that veterans were twice as likely to develop CMI: Cross-sectional data collected from 1,061 deployed veterans and 1,128 nondeployed veterans examined between 1999 and 2001 were analyzed. CMI prevalence was 28.9% among deployed veterans and 15.8% among nondeployed veterans (odds ratio = 2.16, 95% confidence interval: 1.61, 2.90). Blanchard et al. noted that those who did suffer from CMI had already been diagnosed for anxiety and depression unrelated to PTSD prior to 1991.   Common CMI manifestations comprised frank medical symptoms, metabolic and psychiatric disorders.   And those afflicted were more likely to smoke, besides reporting distinctly inferior quality of life. M Hotopf, Anthony S David, Lisa Hull, Vasilis Nikalaou, et al. (2003) carried out one of the more comprehensive and authoritative studies of long-term effects, a two-stage cohort study on British soldiers who had deployed during the 1991 Persian Gulf War or on peacekeeping duties in Bosnia. The study relied on four instruments: â€Å"self reported fatigue measured on the Chalder fatigue scale; psychological distress measured on the general health questionnaire, physical functioning and health perception on the SF-36; and a count of physical symptoms.†Ã‚   Military personnel who had been deployed elsewhere served as control group. Table 1 Prevalence of Categorical   Outcomes (Values are percentages [.95 CL] unless otherwise indicated) Gulf Bosnia Era Stage 1 Stage 2 Ratio* (new cases/recovered cases) Stage 1 Stage 2 Ratio* (new cases/recovered cases) Stage 1 Stage 2 Ratio* (new cases/recovered cases) Fatigue cases 48.8 (45.4 to 52.2) 43.4 (39.9 to 46.8) 0.65 (0.45 to 0.85) 29.0 (25.6 to 32.4) 32.7 (28.6 to 36.8) 1.21 (0.83 to 1.59) 22.8 (20.0 to 25.6) 22.0 (18.6 to 25.4) 0.91 (0.56-1.26) Post-traumatic stress reaction cases 12.4 (10.7 to 14.2) 10.8 (9.1 to 12.5) 0.73 (0.47 to 0.99) 5.7 (4.0 to 7.4) 6.0 (4.2 to 7.8) 1.07 (0.49 to 1.65) 4.0 (2.6 to 5.3) 6.6 (4.8 to 8.4) 2.45 (0.88-4.02) General health questionnaire cases 40.0 (36.8 to 43.2) 37.1 (33.8 to 40.4) 0.79 (0.59 to 1.00) 29.2 (25.5 to 32.9) 31.5 (27.4 to 35.6) 1.25 (0.84 to 1.67) 25.3 (21.7 to 28.9) 23.8 (20.1 to 27.6) 0.88 (0.56-1.20) Self reported Gulf war syndrome 18.6 (16.2 to 21.1) 15.8 (13.3 to 18.2) 0.58 (0.25 to 0.90) All prevalence estimates are weighted for sampling. * Values of 1 indicate declining prevalence. Ratios are weighted for sampling. Gulf veterans evinced a higher prevalence of fatigue, post-traumatic stress reaction, self-reported Gulf War syndrome and general health compared to the other two cohorts. The difference is consistent throughout stages 1 and 2. However, the veterans in question did show some improvement on all four measures over time. Table 2 Scores (.95 CL) for Continuous Measures, by Cohort and Stage Gulf Bosnia Era Stage 1 Stage 2 Difference Stage 1 Stage 2 Difference Stage 1 Stage 2 Difference SF-36* physical function 90.3 (88.3 to 91.3) 88.7 (87.6 to 89.9) -1.6 (-2.5 to -0.7) 95.4 (94.4 to 96.4) 92.9 (91.6 to 94.1) -2.6 (-3.8 to -1.3) 92.1 (90.6 to 93.6) 90.8 (89.2 to 92.3) -1.3 (-2.7 to 0.1) SF-36* health perception 65.8 (64.1 to 67.5) 65.9 (64.2 to 67.6) 0.1 (-1.2 to 1.4) 76.2 (74.4 to 77.9) 72.9 (71.0 to 74.8) -3.3 (-5.1 to -1.6) 76.8 (75.0 to 78.6) 74.4 (72.4 to 76.4) -2.4 (-4.2 to -0.6) General health questionnaire 14.5 (14.1 to 14.9) 14.2 (13.8 to 14.5) -0.3 (0.1, -0.6) 13.1 (12.7 to 13.6) 13.2 (12.7 to 13.7) 0.1 (-0.4 to 0.6) 12.4 (12.0 to 12.8) 12.9 (12.5 to 13.3) 0.5 (0.05 to 1.0) Fatigue 17.8 (17.4 to 18.1) 16.9 (16.5 to 17.2) -0.9 (-1.2 to -0.6) 15.6 (15.2 to 16.0) 15.3 (14.9 to 15.7) -0.3 (-0.7 to 0.2) 14.7 (14.3 to 15.0) 14.9 (14.5 to 15.3) 0.2 (-0.2 to 0.6) Total symptoms 11.0 (10.4 to 11.6) 10.7 (10.1 to 11.3) -0.3 (-0.8 to 0.1) 6.2 (5.6 to 6.8) 7.9 (7.3 to 8.5) 1.7 (1.2 to 2.3) 5.3 (4.8 to 5.8) 6.4 (5.8 to 7.0) 1.1 (0.6 to 1.6) All scores are weighted for sampling. For SF-36 scores, negative differences in mean indicate a worsening in health. For other scales, negative scores indicate an improvement in health. * SF-36 scales range from 0-100, with higher scores indicating better health.   Table 3- Incidence and Persistence of Outcomes. (Values presented with 0.95 CLs) Incidence Persistence Cohort Risk Crude odds ratio Corrected odds ratio* Risk Crude odds ratio Corrected odds ratio* General health questionnaire cases: Gulf 20.2 (16.4 to 24.0) 1.0 1.0 61.8 (57.3 to 66.3) 1.0 1.0 Bosnia 21.2 (16.7 to 25.8) 1.1 (0.7 to 1.5) 0.9 (0.6 to 1.4) 58.9 (51.9 to 65.8) 0.9 (0.6 to 1.1) 1.1 (0.7 to 1.6) Era 15.4 (11.4 to 19.4) 0.7 (0.5 to 1.1) 0.7 (0.5 to 1.1) 48.4 (41.0 to 55.9) 0.8 (0.6 to 1.1) 0.6 (0.4 to 0.8) Fatigue cases: Gulf 18.8 (14.4 to 23.1) 1.0 1.0 69.7 (66.4 to 73.0) 1.0 1.0 Bosnia 19.8 (15.1 to 24.4) 1.1 (0.7 to 1.6) 0.9 (0.6 to 1.5) 59.9 (54.2 to 65.6) 0.6 (0.5 to 0.9) 0.7 (0.5 to 1.0) Era 11.2 (7.5 to 15.0) 0.6 (0.3 to 0.9) 0.5 (0.3 to 0.9) 58.2 (53.1 to 63.4) 0.6 (0.5 to 0.8) 0.7 (0.5 to 0.9) Post-traumatic stress reaction cases: Gulf 5.0 (3.6 to 6.4) 1.0 1.0 51.8 (44.8 to 58.9) 1.0 1.0 Bosnia 4.0 (2.5 to 5.5) 0.8 (0.5 to 1.3) 0.8 (0.4 to 1.5) 38.9 (24.3 to 53.3) 0.6 (0.3 to 1.2) 0.8 (0.4 to 1.8) Era 4.6 (3.0 to 6.2) 0.9 (0.6 to 1.5) 0.9 (0.5 to 1.5) 54.8 (37.8 to 71.9) 1.1 (0.5 to 2.4) 1.2 (0.6 to 2.7) * Controlled for demographic variables (age, sex, rank, marital status). Comparing scores for continuous measures, one sees that Gulf War veterans were less healthy at both stages of the longitudinal study, though they were stable as far as health perceptions were concerned and reported a statistically-significant, if slight, reduction in fatigue. One concedes that physical functioning declined for all three cohorts. Additionally, Gulf veterans were more likely to experience persistent fatigue compared with the Era and Bosnia cohorts, a finding that remained significant after controlling for potential confounders (P = 0.009). Overall, despite being less likely to manifest less fatigue (48.8% at stage 1, 43.4% at stage 2) and a lower prevalence of psychological distress (40.0% stage 1, 37.1% stage 2) over time, veterans of the Gulf War reported a decline in physical function on the SF-36 (90.3 stage 1, 88.7 stage 2).   By all measures used, this group also attested to worse health indicators: a higher incidence of illness and more persistent symptoms. Twelve years after helping smash the Iraqi incursion into Kuwait, the authors concluded, â€Å"Gulf war veterans continue to experience symptoms that are considerably worse than would be expected in an equivalent cohort of military personnel. However, Gulf war veterans are not deteriorating and do not have a higher incidence of new illnesses† (Hotopf et al., op. cit.) E.  Ã‚   Treatment Recommendations and Best Practice 1.  Ã‚  Ã‚  Ã‚  Ã‚   World War I Since little is known about the methods Russians used to treat their shock casualties during the Russo-Japanese War, the noted English psychologist Charles Myers – first University Lecturer in Cambridge (for the course Experimental Psychology) and appointed Consulting Psychologist to the Army in 1916 – is generally credited with the first systematic effort to treat PTSD (Bartlett, 1937). While espousing the benefits of a congenial environment, psychotherapeutic regimens and even hypnosis, Myers was very emphatic about the value of providing succor as promptly as possible.   Key to his proposals, therefore, was the establishment of special centers and rest homes close to the frontlines. By Christmas 1916, two developments led to modifications of Myers’ preferred regimen.   First, the British Adjutant General resisted physicians’ opinions that a soldier was a shock casualty and insisted on obtaining a certification from the victim’s commanding officer to the effect that the trauma was due to physical causes.   This attitude was shared by the eminent British neurologist Sir Gordon Morgan Holmes, CMG CBE FRS, who was put in charge of the very active northern part of the front in December.   Physicians reacted to the delays in committing victims to neurological centers by sending the men back to their units and urging their superiors to both monitor and engage with them. By 1917, therefore, treatment for â€Å"not yet diagnosed nervous† (NYDN) had evolved to embrace the so-called â€Å"PIE principles†: Proximity – treatment close to the front and within earshot of the fighting to convince the soldier there was nothing wrong with him; Immediacy treat without delay and give equal priority with wounded casualties; and, Expectancy – assure all victims of their return to the front after due rest and recovery. Reviewing the CSR toll after the war, the British War Office saw fit to recommend treatment programs that included: Physical therapy – baths, application of mild electric current (recall that medicine has advanced greatly in the eight decades since then), massage rest and general recuperation; Psychotherapy emphasizing â€Å"explanation, persuasion and suggestion†; and, Crafts and hobbies; Hypnotherapy in selected cases for inducing deep sleep and evoking repressed memories. As a rule, the British view of the time was weighted toward returning the afflicted soldier to useful employment in civilian life.   For the military establishment was gravely concerned about the battlefield dangers of patients who manifested severe anxiety neuroses, other neuroses that required confinement in a mental institution or expert treatment back in the U.K itself. Exhaustive research on combat stress reactions in the intervening years failed to prove conclusively that PIE-based programs were effective in forestalling PTSD (U.S. Dept of Veterans Affairs, n.d.).   Hence, American Armed Forces are now more likely to be administered some variation of the BICEPS model: Brevity Immediacy Centrality or Contact Expectancy Proximity Simplicity 2.  Ã‚  Ã‚  Ã‚  Ã‚   World War II The catastrophic experiences of World War I did not   seem to adequately inform or pervasively improve Allied preparations as war clouds loomed in Europe.   A generation had passed and British army doctors had generally served in France in the earlier conflict.   Still, Shephard notes (op. cit.), they initially floundered about and it was not until 1942 that the first psychiatric hospital was even set up (for the then-beleaguered Middle East Force).   When the time came to invade Normandy in June 1944, British army physicians quickly forsook the expectancy principle and routinely returned battle trauma patients home over the Channel. For their part, the Americans initially imposed rigid screening pressures for mental ability in the rush of patriotic fervor that followed Pearl Harbor.   Soon enough, this was abandoned for having no validity.   Too many who tested well succumbed to â€Å"battlefield exhaustion†.   In late 1943, the U.S. military approved a plan to add a psychiatrist to the T.O. E. of every Army division shipping overseas but it was not implemented until March 1944, when the drive up the Italian â€Å"boot† was well underway. This late in the war, nonetheless, the Allies made an important discovery: camaraderie and unit cohesion were effective shields against â€Å"exhaustion†.   This finding naturally enough placed a premium on strong, effective leadership. The Germans were more unequivocal in placing great reliance on the quality of the officer corps.   In their view, the â€Å"war neuroses† that sapped the will of their fighting men was tantamount to cowardice and deserved to be treated as such.   Beginning in 1942, however, when the Allies started the counterattack and the Afrika Korps was stymied, hospitalizations owing to battlefield trauma became too numerous to ignore (Belenky, 1987). 3.  Ã‚  Ã‚  Ã‚  Ã‚   New approaches in the Post-War Period Among other developments, the Israelis simplified PIE procedures by heightening the degree of support administered but keeping therapeutic confinement short.   That this works at all is testimony to a nation of citizen-soldiers who must keep the economy working while perpetually staying on a war footing. F.  Ã‚  Ã‚   Treatment Success Rates There is some evidence that proximal treatment is successful   Despite the dual stress of fighting another occupying force, the Syrian Army, and Palestinian â€Å"refugees†, nine in ten CSR were reported fit to return to their units within three days but only 40% for those evacuated to a hospital ship cruising the eastern Mediterranean or back home (Gabriel, 1986).   In turn, the U.S. Army claims in its manual â€Å"Combat Stress Control in a Theater of Operations† a similar success rate for proximate treatment (85%) in the Korean War (U.S. Army, Combat Stress Control in a Theater of Operations, n.d.).   However, neither source tracked the long-term mental health of these soldiers, precisely the context in which one would expect PTSD to manifest. A ray of hope is, however, cast by an authoritative Columbia University study (McKenna, op. cit.) suggesting that the majority of Vietnam war veterans spontaneously recovered from PTSD over time, frequently without having recourse to treatment from mental health professionals. VII.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Conclusions This review of the literature affirms that the advent of combat stress went hand-in-hand with the advent of industrial-era weaponry (in the Civil War) and mechanized warfare in succeeding conflicts.   PTSD has many manifestations, can recur without warning and is certainly debilitating. Even with the advent of psychotherapy, occupational therapy and tranquilizers, treatment centers still purvey variations on the BICEPS and PIE theoretical models, the latter developed by British physicians during World War I.   There remains a great deal of uncertainty about the proximity component of the PIE model – returning the soldier to combat – after suffering CSR.   It seems battlefront physicians take â€Å"successful cure† to mean being able to return warm bodies to the frontlines.   Critics assert that re-exposure to combat is likely to aggravate matters in the future and perhaps even precipitate PTSD altogether.   Though the longest available cohort study spanned just 10 years, there is no question now that PSTD has long-term effects. Future researchers need to investigate more thoroughly the psychosocial, military, and environmental risk factors that stimulate onset or, on the other hand, recovery.   One factor that bears investigation in-depth is the impact of victory or setbacks in a campaign. To the extent that high morale and good leadership have been shown to have a moderating or even protective effect, one wonders what are the effects of fighting for survival (e.g. Israel), of community and country united behind a war effort (the Korean War, the Malayan emergency), of service in prior conflicts (the British SAS), of guilt and angst over being the globe’s last remaining policeman, and of coping with feudal cultures whose people are just as willing to apply savage tactics against U.S. servicemen as against each other.   At the very least, further research might seek to determine the impact of attainable victory in sharp contrast with the ennui and self-destructive impatience over protracted conflict that mark American discourse today.   VIII.  Ã‚  Ã‚   References Allis, S. Globe Staff (2005). â€Å"Frontline† examines wars psychological toll  :[THIRD Edition]. Boston Globe, p .E.5. Baker, D. G. (2001). 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