Htc Introduction Essay

HTC quickly emerged on the smartphone scene with the remarkable success of The Sense, one of its first models, and broke many industry sales records. People were asking, â€Å"Who is HTC? † Our research indicates that HTC’s rapid rise to success was because of innovation and technological capabilities. Even though the HTC brand was not widely recognized, its smartphones were generating interest. In our primary research, we discovered that some people owned an HTC phone but did not know that HTC was the manufacturer. Obviously, brand awareness was relatively low. For HTC to stay relevant in the hypercompetitive smartphone industry, it needs serious revamping of its marketing plan. With smartphone market penetration increasing to more than 20 percent in the past five years and reaching 46. 8 percent in Q3 2011, HTC has tremendous opportunities to establish a solid market position. After examining the market conditions and current HTC performance in the U. S. , our team proposes that HTC position itself as a technological leader by targeting consumers ages 18 to 34. This promising segment has potential sales of $2. 5 million. We analyzed the industry and examined external factors that could impact HTC’s bottom line. This analysis gave us crucial insight into the smartphone market. We also analyzed the competitive environment that includes Apple, Motorola, and RIM (Blackberry). HTC, which has a positive reputation on the merits of its technology, needs to boldly differentiate itself in the marketplace. Through market analysis, we discovered that HTC has a strong market size, market potential, and distinct target markets. We recommend that HTC take specific steps through segmenting, targeting, and positioning to execute its marketing plan. We are confident that our plan can increase HTC’s market share by 2 percent each year. By the end of 2012, our marketing objective is to reach a 24 percent market share of the smartphone industry, which equals 18. 7 million HTC customers. The plan includes recommendations and precautions at distribution channels so that HTC differentiates itself from the other brands. We developed a budget for the marketing plan and devised procedures to monitor each effort in order to reach our projected market share increase. We are confident that our marketing plan can take HTC from an emerging brand to a dominant market leader.

Actions to Take in Response to Concerns That a Colleague May Be:

a. Failing to comply with safeguarding procedures: Failure to comply may put children and young people at risk of harm or abuse. I would follow the setting safeguarding policy or immediately report it to the safeguarding co-ordinator or the supervisor/head teacher. I would not discuss these matters with anyone else. b. Harming, abusing or bullying a child or young person: Any person working in schools who suspects that a colleague may be abusing a child or young person must act on their suspicions. This action will serve not only to protect children but also colleagues from false accusations. I would act immediately to protect the child by informing the supervisor/head teacher. If the allegation is against the supervisor/head teacher, I would report my concerns to the designated person for child protection or directly to the Education Authority. I would also fill in a CAF form within 24 hours. a. Failing to comply with safeguarding procedures: Failure to comply may put children and young people at risk of harm or abuse. I would follow the setting safeguarding policy or immediately report it to the safeguarding co-ordinator or the supervisor/head teacher. I would not discuss these matters with anyone else. . Harming, abusing or bullying a child or young person: Any person working in schools who suspects that a colleague may be abusing a child or young person must act on their suspicions. This action will serve not only to protect children but also colleagues from false accusations. I would act immediately to protect the child by informing the supervisor/head teacher. If th e allegation is against the supervisor/head teacher, I would report my concerns to the designated person for child protection or directly to the Education Authority. I would also fill in a CAF form within 24 hours.

Employee Health Plan 2010 Essay Example | Topics and Well Written Essays - 500 words

Employee Health Plan 2010 - Essay Example The Employee Health Department would schedule check-ups and administration of annual PPDs, (kindly spell out) vaccinations such as Hepatitis B, MMR, Varicella and Influenza through regular correspondences and memoranda. This 2010, the Kennedy Health System is considering administering Pertussis Vaccine to those with risk of exposure. Further, a wellness program would be launched this year with the objective of maintaining good health and improving one’s lifestyle through awareness of health risks and practice of well balanced nutritional diet and enough physical exercise. The 2010 Kennedy Health System Employee Health programs focuses on associate vaccination programs assisting in following up on body substance exposures, injuries, and communicable diseases and maintaining employee health records as required by NJDOHSS, OSHA, AOA, and the Joint Commission. In addition, pursuant to the requirements of OSHA and the Joint Commission of Accredited Hospitals Organization, standards on the Safe Patient Handling Act would be highlighted and required orientation and training, as required, would be administered. The wellness programs (weight and stress management, smoking cessation, cardiovascular health management) would be launched on a self-directed approach making it free, voluntary and addresses unique issues tailored to each employee’s needs. The EHP focuses of measuring its effectiveness through performance evaluation reports and regular assessments specifically in areas of high risk exposures such as Sharps/Fluid Exposure; Communicable Diseases; Influenza Vaccinations; Hepatitis Vaccinations, MMR Vaccines, Varicella Vaccines, among others. With the upcoming implementation of the administration for Pertussis Vaccine to those with risk for exposure, appropriate standards and rules of administration would be outlined for dissemination and appropriate guidelines. Benefits for the EHP are available to all new and

Customer Service-Customer Friendly Website-discussion Personal Statement

Customer Service-Customer Friendly Website-discussion - Personal Statement Example in order to attract customers and make them stay and shop. The website should have good navigation which actually means simple and not overloaded navigation (Singh). First, Shirts Shop website has simple color scheme in white and navy with no violent colors, thus the content on the website is rather readable. The company’s logo is also rather simple and laconic. When coming to the website’s home page, the customer sees the popups demonstrating and drawing attention to the most interesting propositions to date. The navigation is very simple with the main goods’ categories located in the line in the upper part of the page. The goods offered on the website are supplied with comprehensive description and high-quality photos (including demonstration photos of aprons on models). All the contact information of the company is put at the bottom of every page. Moreover, to my thinking, the website is accessible for every user, the fonts are highly readable, and the speed o f its operation is rather high. Taking into account these characteristics, this website can be claimed to be

The Management by Objective Approach Essay Example | Topics and Well Written Essays - 750 words

The Management by Objective Approach - Essay Example Management by objective has several principles, which include cascading of organizational objectives, setting goals for each member, participative decision making, over time, and feedback provision and performance evaluation. 1. Better utilization of resources – Here, resources can be measured in financial, human or physical terms. In management by objective, goals can be easily attained by optimum utilization of financial, physical and human resources (Bryman 1996, p.66). These resources can be regulated and efficiently managed to provide the greatest possible benefits for all employees in the company. 2. Development of Personnel – Management by objective is a valuable tool which can be used to develop and train the subordinate managers. The training techniques employed helps the subordinate managers to improve their skills in leadership, decision making, planning, directing and controlling (Migliore 1977, p.78). The flourishing future of a company largely depends on the qualifications of its employees and the quality of the services rendered to its customers. Management by objective helps a company to set several attainable goals to run a project and process oriented organization that enables employees to work in a professional, innovative and customer oriented way. Therefore, the continuous enhancement of technical and personal skills of employees is a critical issue in a company. Hence, the subordinate managers get prepared for promotion to higher posts in the future (Huselid 1995, p.65). 3. Makes planning effective – A solid business plan in a company can be the main difference between failure and success. Most of the businesses fail because they overlooked the idea of a business plan due to a lack of knowledge and time on how to make one. In management by objective, the goals and objective of a company get clearly stated.  

Diane Mathis CS5 Essay Example | Topics and Well Written Essays - 750 words

Diane Mathis CS5 - Essay Example However, some points of communication may converge where patients possess some basic level of English proficiency as opposed to when complete unfamiliarity exists. Different language proficiency levels present different interpretation needs for the practitioner, which calls for expert interpretation services. Such interpretation complications determine the complexity of communication between the patient and healthcare professionals coming from different cultural backgrounds. Ethical considerations must resolve the primary concerns of discharging service as universally required, beyond cultural biases of both the practitioner and patient. "Best practice" interpretation preparedness requires that the healthcare system facilitate both individual and organizational-level cultural competences in resolving potential communication challenges (Al-Amin et al., 2011). To this end, individual level of interpretation needs requires that the healthcare practitioners acquire cultural competences to resolve patient cultural gaps as presented during visits. Institutional-level of cross-cultural preparedness requires that the entire institution adopt elaborate translation facilitation. Ultimately, professionals in the healthcare system must overcome legal questions around competencies needed to overcome biases against universal standards of practice. Firstly, any institution may have restrictive budgets to have customized interpretation services for the language barrier as a presenting challenge. In this regard, experiencing an influx of patients from a new language and culture stretches internal capabilities of a health facility in handling such a challenge. Secondly, limited availability of qualified interpreters may present a healthcare problem to a facility irrespective of financial capability. Dreachslin et al. (2008) observed that the ability of the health

Provider Roles in Spiritual Care Essay Example | Topics and Well Written Essays - 1250 words - 1

Provider Roles in Spiritual Care - Essay Example As the discussion stresses the spiritual dimension of the client is strongly evident during illness, stress, difficulties, and end-life-care when people strongly needed the direction and comfort derived from their spiritual preferences. Faith and religion are essential components of a client’s spiritual dimension and health provider has the responsibility to have self-awareness of one’s spiritual preferences before integrating a non-biased spiritual care.This paper discusses that in order to address a holistic care, the healthcare team must involve the participation of multi-faith chaplain professionals to assist healthcare team members in providing specific cultural, religious, and faith needs of clients and families. Spiritual care is the most difficult task of a provider, specially the nurses. Most of the nurses lack adequate training for spiritual care giving and may influence the provision of adequate spiritual care. Healthcare providers such as nurses need to have formal education training or graduate programs in pastoral counseling or ministry in order to provide an excellent and competent spiritual care and to refer clients to other spiritual care providers as needed.  Organizational team members such as the Baptist Healing Trust aim to further the work of non-profit agencies in providing health services to vulnerable populations in Middle Tennessee.  Members of the Baptist Healing Trust heal with love and compassionate care in accordance with the Christian tradition.

The Influence of Family Essay Example | Topics and Well Written Essays - 5000 words

The Influence of Family - Essay Example This influence is often reflected in the childhood and adult life of the child. According to various researches, it has been proved that, children always associate themselves with the problems of the parent and worry about these issues even if they are not part of the problem. This is a regular experience faced by families which have divorced. This is the main reason why individuals ask themselves if the family can influence the way they think, act and feel in the society. It is true that the family plays a significant role in the way individuals behave in the family and society. Every concept an individual adopts are learned from the family. For instance, everything a child learns is always influenced from his or her parenthood and how they reacted to their parents. Parents are good people to emulate as they are familiar with what life entails. This is due to their life experiences. They are essential in teaching their children what they have learned, how they should act, think and feel about the modern society. However, some parents are not good role models to their children. As in the case of Cary, whose life will be discussed in the papers’ body, her mother was never a role model. Her mother was full of hatred and brought her up in a manner that she never liked. As such, she vowed to bring her children up in a manner that was completely different from her mothers. However, Cary’s mother case contradicts the claim that mothers are the primary caregivers. Mothers are considered as the primary care givers and consequently being viewed as the most influential to the child’s life. However, recent psychoanalytical studies have shown that fathers have a major role to play in influencing the behaviors and thinking of their children. The parent’s behavior can be explained from their past experiences or prominent figures in the society which they look up to and desire their children to emulate. Young maternal age is usually associated to with harsh and abusive parenting (Smithbattle 521) which can be explained by the fact that most young mothers are mostly poor and at risk of social isolation. They also go through depression and stress making them harsh and abusive parenting. However, these are not usually the only factors affecting the influence that a parent has to his children. Some parents may have prominent figures in the society who they want their children to grow up to emulate and they therefore train them to be like to people. Griffin also brings out the fact that a parent’s control over the family can have an influence on the child’s life (Griffin 302). A child whose parents exercise full control of every aspect at home grows to learn what ask and what not to ask. In exercising so much control in the family, children may not feel good while within the family and when faced by a problem they withdraw to cry alone as seen in Laura’s family (Griffin 307). Apart from the influence one gets from the family, the society plays a great role in influencing a person’s behavior. Moreover, after getting to a certain age, one starts becoming self aware and it is at this time that they start erasing whatever they do not need and developing their desired qualities. The essay on the loss of a creature by Percy tries to expound on the influence of the past knowledge and experiences to the sightseer in their visit to the tourist sites. According to Percy (2), precedent experiences and awareness determines the nature of leisure and enjoyment in any vacation. The prospects of the visit have a role to play in assessing and evaluating the intensity of satisfaction in any tour. Sightsee that satisfies the goal and objective of the vacationer

Sales force automation Essay Example for Free

Sales force automation Essay Introduction. Sales Force Automation is a technique of using software to automate the business tasks of sales, including order processing, contact management, information sharing, inventory monitoring and control, order tracking, customer management, sales forecast analysis and employee performance evaluation(Thomas, M.S Michael, S.M 1996). This revolution that is sweeping through society is changing the nature of selling. For last 150 years, traditional selling process bases on the two ways communications, that is salespeople to customers, customers to salespeople. Such face-to-face selling or in-person selling can require a lot of time, energy, and expense, but the payoff can be tremendous. Despite all of the new high-tech alternatives, an in-person sales presentation is the single most powerful marketing tool in use today. National television advertising, telemarketing, e-mail, or print advertising have nowhere near the ability to motivate a particular customer to actually place an order as does face-to-face selling (David, G. H Mckee, D 1999). Discussion. Face to face communication in sales force. Social trends point to the increasing need for face-to-face communication in efforts to change peoples attitudes and behaviors. That communication is simply a method of sending a message from one person or group of persons to another, which the communication process is the most natural and the most familiar. It is direct, immediate and responsive. We can perceive reactions at once and can modify our own behavior to clarify the message. It is vital importance to salespeople whom use this communication tool with their potential buyers of a product with the intention of making a sale; also they can focus initially on developing a relationship with the potential customers with an attempt to close the sale'(Pyle, J. 2004). Does face to face is the best way to communicate? In the small business, Personal selling involves face-to-face interaction between buyer and seller, which is a very important part of a stores effect to communicate with its customers. Sellers are able to have exclusive contact with the buyer and clearly articulate the benefits of the product or service. And buyers are able to get personal attention and have their questions answered fully (Personal selling, 2005). It creates a mutually beneficial situation in which both buyer and seller feel they are meeting their objectives. During face to face communication, one essential part of effective communication is feedback. Only in personal selling does the potential for a clear feedback channel exist. Even cashiers are salespeople in the sense that they convey a message to the customer. As salespeople interact with customers, they not only hear verbal responses, but also see smiles, frowns, and nods. The verbal responses and the nonverbal reactions provide feedback. These responses help salespeople modify the sales message to the specific needs of the customer (Personal selling, 2005). A successful selling can be made via face to face communication because it is an effective strategy that both salespeople and customer can see each others characteristics, body language, gestures, facial expression, intonation, or words to make a sufficient judgment, and it is also a powerful selling method for building a stronger relationship with the potential customer. Unquestionably, the face-to-face communication that takes place in the personal selling situation that can (1) clearly identify and translate product features into benefits and satisfactions that solve customers problems and fill their needs; (2) pinpoint the customers uncertainties about purchasing and provide knowledge and information to reduce these uncertainties; (3) provide specific rational psychological reasons that help the customer make a purchasing decision; and (4) build trust between organizations and its potential customer (The Importance of face to face selling, 2003). One research point out that most managers think that Face-to-face sales method can carefully explain the new process or product to their customers (Martin, C .2005). However, the major disadvantage of personal selling through face to face communication is the cost of employing a sales force. Sales people are expensive. In addition to the basic pay package, a business needs to provide incentives to achieve sales, such as commission, bonus arrangements, and the equipment , such as car, travel and mobile phone, to make sales calls (Personal selling, 2005). Moreover, there is not a cost-effective way of  reaching a large audience in now faster society. A sales person can only call on one customer at a time. In other words, salespeople need to go to the prospective customer in order to demonstrate or illustrate the particulars about the product or service. For reaching a large customer; salespeople will be taking a lot of time to achieve the goal (The Importance of Good Communication, 2005). Sales force automation- SFA. Following by the rapid and continuous drop in the price of computing and the businesses are increasingly global that joined with advances in communications technology; the structure and process of selling have altered the competitive environment (David, G. H Mckee, D 1999) . Technology makes salespeople more effective and productive because it allows them to provide accurate and current information to customers during sales presentations. Sales force automation (SFA) implies that technology can be used to speed up previously inefficient operations of a company, which the Internet and related technology have affected the personal selling process (Thomas, M.S Michael, S.M 1996 Yudkowsky, C, 1998). Product information on Web sites is available to customers and prospects. In the past, salespeople delivered this information to the customer by face to face. The Internet releases salespeople to focus on the most important aspects of their job, such as building long-term relationships wit h customers and focusing on new accounts. Information is shared among users in every department that contact with the customer. Also, information sharing promotes more effective channel partnership. In fact, salespeople use computers to connect them (through the Internet) to their own companys databases when they are out on sales calls. This gives them the ability to provide the customer with extensive, relevant information almost immediately (Sapru, P, 2005). It reduces administrative tasks for salespeople and makes them better prepared for every sales call. A successfully implemented SFA solution can improve the productivity and efficiency of the sales team, which can result in higher customer satisfaction and higher revenue per customer of a company (Thomas, M.S Michael, S.M 1996). Salespeople become intelligence agents in the field when they feed that information directly into the data resources shared by the  rest of the sales force and the company at large. SFA is becoming vital selling tools that can be used to communicate through a global basis; also, it is a most cost- effective way that the business can reach its large customer globally. According to the estimated, the advantages of using sales automated technology can increase at a rate of 40% annually include the ability to generate sophisticated multimedia presentations, to create internal communication systems, to monitor sales rep progress, and to keep databases of customer histories (Yudkowsky, C, 1998). In the book Virtual Selling, the author indicated that SFA is rapidly rising to the forefront salespeople of the business computing market (Thomas, M.S Michael, S.M, 1996) Conclusion. Marketing communication tools definitely has been changed. Sales force automation provides a cost-effective way of a companys salespeople expenditures, innovations in opportunity, immediately contact, activity, and account management as well as automatic quoting, product configuration, research, and reach a large customer (Yudkowsky, C, 1998). However, face to face selling can be more successful to reach peoples heart and build a stronger relationship in accomplish a selling objective. The problem is not which mode of communication is used; it is the quantity and quality of the produce/service content need to be considered. There is no one way to communicate well; each method has strengths and weaknesses. It is the balance of the methods, using their strengths and avoiding the weaknesses that will make good communications. As selling a car, house and insurance, face to face communication is a crucial requirement that salespeople need to build the trust, product value and satisfy customer needs in the entire selling process (Selling a car, 2004 Business Family Champion, 2005). Although SFA has changed the way of both selling and purchasing process, customers have more choice than ever before, as their can choice any thing by the click of a mouse. Yet face to face communication is the only way that salespeople can build a real trust, and interpersonal relationship in humans life.

MockingJay Capitol and Air Duct Surprises Essay Example for Free

MockingJay Capitol and Air Duct Surprises Essay â€Å"All right, that’s it,† Paylor says. Flames and heavy black smoke from the wreckage obscure our view. â€Å"Did they hit the hospital?† â€Å"Must have,† she say grimly. As I hurry towards the ladders at the far end or the warehouse, the sight of Messalla and one od the insects emerging from behind an air duct surprises me. I thought they’d still be hunkered down in the alley. â€Å"They’re growing on me,† says Gale. I scramble down the ladder. When my feet hit the ground, I find a bodyguard, Cressida, and the other insect waiting. I expect resistance, but Cressida just waves me toward the hospital. She’s yelling, â€Å"I don’t care, Plutarch! Just give me five more minutes!† Not one to question a free pass, I take off into the street. â€Å"Oh, no,† I whisper as I catch sight of the hospital. Some people say they think our government is bad? Well check this out; 16 year old Katniss Everdeen is visiting a hospital to give the injured and dying people of District 8 hope. But when she is done, Capitol planes sent from President Snow attack her and her crew. Katniss and Gale shoot them down, but they find the hospital in ruins. Katniss records her own message for the capitol. MockingJay by Suzanne Collins. â€Å"Oh, no,† I whisper as I catch sight of the hospital. Or what used to be the hospital. I move past the wounded, past the burning plane wreck, fixated on the disaster ahead of me. People screaming, running about frantically, but unable to help. The bombs have collapsed the roof and set the building on fire, effectively trapping the patients within. A group of rescuers has assembled, trying to clear a path inside. But I already know what they will find. If the crushing debris and the flames didn’t get them, the smoke did. Gale’s at my shoulder. The fact that he does nothing only confirms my suspicions. Miners don’t abandon an accident until its hopeless. â€Å"Come on, Katniss. Haymitch says they can get a hovercraft in for us now,† he tells me, but I cant seem to move. â€Å"Why would they do that? Why would they target people who were already dying?† I ask him. â€Å"Scare others off. Prevent the wounded from seeking help,† says Gale. â€Å"Those people you met, they were expendable. To Snow, anyways. If the Capitol wins, what will it do with a bunch of damaged slaves?† I remember all those years in the woods, listening to Gale rant against the Capitol. Me, not paying close attention. Wondering why he even bothered to dissect its motives. Why thinking like our enemy would ever matter. Clearly, it could have mattered today. When Gale questioned the existence of the hospital, he was not thinking of disease, but this. Because he never underestimates the cruelty of those we face. I slowly turn my back to the hospital and find Cressida, flanked by the insects, standing a couple of yards in front of me. Her manner’s unrattled. Cool even. â€Å"Katniss,† she says. â€Å"President Snow just had them air the bombing live. Then he made an appearance to say that this was his way of sending a message to the rebels. What about you? Would you like to tell the rebels anything?† â€Å"Yes,† I whisper. The red blinking light on one end of the cameras catch my eye. I know I’m being recorded. â€Å"Yes,† I say more forcefully. Everyone is drawing away from me–-Gale, Cressida, the insects—giving me the stage. But I stay focused on the red light. â€Å"I want to tell the rebels that I am alive. That I’m right here in District Eight, where the Capitol has just bombed a hospital full of unarmed men, women, and children. There will be no survivors.† The shock I’ve been feeling being to give way to fury. â€Å"I want to tell people that if you think for one second the Capitol will treat us fairly if there’s a cease-fire, you’re deluding yourself. Because you know who they are and what they do† my hands go out automatically, as if to indicate the whole horror around me. â€Å"This is what they do! And we must fight back!† I’m moving in toward the camera now, carried forward by my rage. â€Å"President Snow says he’s sending us a message? Well, I have one for him. You can torture us and bomb us and burn our districts to the ground, but do you see that?† One of the cameras follows as I point to the planes burning on the roof of the warehouse across from us. The Capitol seal on a wing glows clearly through the flame. â€Å"Fire is catching!† I am shouting now, determined that he will not miss a word. â€Å"And if we burn, you burn with us!† My last words hang in the air. I feel suspended in time. Held aloft in a cloud of heat that generates not from my surroundings, but from my own being. â€Å"Cut!† Cressida’s voice snaps me back to reality, extinguishes me. She gives me a nod of approval. â€Å"That’s a wrap.†

Analysis of the Child Behaviour Checklist

Analysis of the Child Behaviour Checklist Chapter II: Literature Review As suggested in the introduction, numerous researchers have explored the prevalence of emotional and behavioural problems across the globe. Researchers have also investigated correlates (e.g., age and gender) associated with emotional and behavioural problems. The psychometric properties of instruments assessing emotional and behavioural problems have also been a subject of interest. In addition, researchers have also investigated cross-cultural similarities and disparities among emotional and behavioural problems. The extensive literature that addresses these issues, and which also helped formulate the rationale for the current study, is presented in five sections. The first section highlights the problems associated with epidemiological studies and compares the two main approaches to epidemiological studies, namely the categorical and the empirical approach. The second section provides a detailed description of the CBCL including the evolution of the measure, its psychometric prope rties, its advantages and disadvantages, as well as its range of applicability. The third section provides a description of the theoretical rationale for assessing cultural similarities and disparities associated with emotional and behavioural problems. Multicultural findings based on the CBCL as well as age and gender differences associated with emotional and behavioural problems are also reported. The fourth section consists of a review of the various processes involved in assessing the psychometric properties of instruments and findings based on psychometric properties of the various translations of the CBCL. The fifth section consists of a brief cultural and socio-political description of Pakistani society followed by a description of the salient features (i.e., family, community and cultural factors) in relation to emotional and behavioural problems in Pakistani society. Finally, there is a description of the objectives of the current study. Epidemiology of Emotional and Behavioural Problems Current reviews of epidemiological studies indicate that there is a high prevalence of emotional and behavioural problems among children and adolescents around the world (Costello et al., 2004; Hackett Hackett, 1999; Waddell et al., 2002). In one review, Costello et al. compared findings across several developed countries (including Canada, the United States, the United Kingdom, Germany and Australia) to investigate the prevalence of emotional and behavioural problems as well as that of other psychological problems. Based on their findings, the overall prevalence rates of psychological problems among children and adolescents had a very broad range (0.1% to 42%), with varying rates for each category of disorder. Categories include disruptive behaviour disorders (i.e., conduct disorder, oppositional disorder and attention deficit hyperactivity disorder), mood disorders (i.e., major depressive disorder and bipolar disorder), anxiety disorders (i.e., phobias, generalized anxiety disorde r, obsessive compulsive disorder, and post-traumatic stress disorder) as well as substance abuse and dependence. A critical examination of the studies included in the review revealed that variations in prevalence rates may be attributed to methodological flaws such as substantial disparity across studies with regard to sample size and the age range assessed. Moreover, differences across studies in terms of the measures used, the criteria employed as well as the type of informant may also have influenced the findings. In contrast to Costello et al.s (2004) review, Waddell et al.s (2002) review was based on more stringent criteria; studies based on samples of similar size and age range, as well as using similar methodology were compared. Based on Waddell et al.s review, the prevalence rates of emotional and behavioural problems varied between 10% and 20%. Although findings from both reviews vary considerably, the prevalence rates of emotional and behavioural problems across developed countries is still high and warrants serious attention. Moreover, methodological disparities across studies underscore the need for a uniform methodology to investigate the prevalence of emotional and behavioural problems. In contrast to developed countries, there are few researchers investigating prevalence rates in developing countries (e.g., Bangladesh, India, Sri lanka, Sudan, and Uganda) (Costello, 2009: Fleitlich-Bilyk Goodman, 2004; Mullick Goodman, 2005; Nikapota, 1991; Prior, Virasinghe, Smart, 2005). Moreover, there is a scarcity of reviews of the existing studies. In one review, Hackett and Hackett (1999) compared results from India, Puerto Rico, Malaysia and Sudan, and the prevalence rates of psychological disorders ranged from 1% to 49%. Similar to research in developed countries, researchers attribute variations in findings to methodological problems across studies, which include an inadequate sample size, paucity of explicit and internationally accepted diagnostic criteria, as well as inconsistencies in assessment procedures (Fleitlich-Bilyk Goodman, 2004). Moreover, prevalence rates among developing countries may also partly be linked to the social, economic and medical environment. For example, lack of medical resources and awareness about psychological problems may result in parents not knowing how to seek help (Gadit, 2007). Social taboos further compound the problem, preventing people from reporting problems and deterring help-seeking behaviour (Samad, Hollis, Prince, Goodman, 2005). More importantly, cultural variations in the conceptualization and identification of psychological problems may result in varied reporting of symptoms (Gadit, 2007). These environmental differences and methodological inconsistencies across studies emphasize the need for a cross-culturally robust methodology to investigate the prevalence of emotional and behavioural problems. Along with methodological problems and environmental differences, emotional and behavioural problems merit investigation because they affect multiple aspects of childrens functioning such as academic performance and social adjustment (Montague et al., 2005; Nelson et al., 2004; Vitaro et al., 2005). Researchers also state that there is high comorbidity among emotional and behavioural problems, (SteinHausen, Metze, Meier, Kannenberg, 1998) which creates multiple problems for children and their caregivers. Moreover, many childhood disorders continue and influence functioning during adulthood. In fact, many adult disorders are now recognized as having roots in childhood vulnerabilities (Maughan Kim-Cohen, 2005; Tremblay et al., 2005). Furthermore, recognizing and treating problems early can reduce the burden of the enormous human and financial costs associated with the assessment and intervention, especially in countries where resources are scarce (Costello, Egger, Angold, 2005; Jame s et al., 2002; Waddell et al., 2002). In addition, cross-cultural epidemiology of childrens emotional and behavioural problems may also better inform current knowledge about the characteristics, course, and correlates of such problems, which in turn provide a scientific basis for appropriate mental health planning (Achenbach Rescorla, 2007; Waddell et al.). Therefore, there is a strong need for a methodology that can be utilized for clinical as well as research purposes to assess emotional and behavioural problems among children and adolescents across cultures. Current literature indicates that there are two main approaches to investigate the epidemiology of emotional and behavioural problems, namely the categorical and the empirical approach. There are several differences in both approaches including conceptualization of psychological problems as well as the methodology employed for their assessment. Both approaches will be discussed briefly. The categorical approach. The categorical approach, based on the biomedical perspective, views psychological problems as a group of maladaptive and distressing behaviours, emotions and thoughts which are qualitatively different from the typical (Cullinan, 2004). That is, similar to medical diseases, an individual may or may not have a specific psychological disorder. Traditional epidemiological studies are based on the categorical approach as embodied in various editions of the Diagnostic and Statistical Manual for Mental Disorders (DSM) (American Psychiatric Association (APA), 1980; 1987; 1994; 2000) and the International Classification of Diseases (WHO, 1978; 1992). Examples of instruments used in traditional epidemiological studies to derive DSM diagnoses include the Diagnostic Interview Schedule for Children (DISC) (Costello, Edelbrock, Kalas, Kessler, Klaric, 1982) and the childrens version of the Schedule for Affective Disorders and Schizophrenia (Kiddie-SADS) (Puig-Antich Ch ambers, 1978). At present, there is considerable debate about the validity of epidemiological studies based on the categorical approach. Researchers have highlighted that inconsistencies in prevalence rates may be due to conceptual and methodological issues linked with the DSM as well as methodological disparities among studies (Achenbach Rescorla, 2007; Waddell et al., 2002). Each of these factors will be discussed briefly. DSM related problems. Multiple conceptual and methodological problems are associated with the DSM. First, the DSM does not provide a methodology to operationally define different psychological disorders (Widiger Clark, 2000). To operationally define DSM criteria, various diagnostic interviews such as the DISC have been developed. Unfortunately, meta-analyses indicate that the diagnoses based on the DISC and other diagnostic interviews are not in agreement with diagnoses made through comprehensive clinical interviews, which indicate that, neither diagnostic nor clinical interviews provide good validity criteria for testing DSM categories (Achenbach, 2005; Costello et al., 2005; Lewczyk et al., 2003). Second, the diagnostic categories and criteria provided in the DSM continue to change as reflected in the changes across the various editions of the DSM, namely the third edition (APA, 1980), third edition revised (APA, 1987), fourth edition (APA, 1994), and fourth edition text revised ( APA, 2000), making comparisons across editions problematic (Achenbach, 2005). Third, although the current version, known as the DSM-IV-text revised (APA, 2000), aims at introducing cultural sensitivity in assessment and diagnoses by including an â€Å"outline for cultural formulation and a glossary of culture-bound syndromes† (APA., 2000, pg. 897), it does not provide criteria or guidelines regarding the use of the classification system with specific cultural groups (Paniagua, 2005). Since many of the DSM diagnostic criteria are based on Euro-American social norms, it is difficult to use the DSM criteria to identify psychopathology in individuals from other cultures. In addition, there is growing consensus among researchers that DSM categories need to be more appropriate for children and adolescents of different ages and gender (Doucette, 2002; Segal Coolidge, 2001). Turk et al. (2007) also highlight the saliency of factors such as age and gender when investigating prevalence rates. However, at present, this is not the case. Costello et al. (2005) have stated that the constant developmental changes of childhood create the need for an age- and gender- specific approach to epidemiology. Before incorporating a developmental perspective in epidemiological studies, it is essential to have a better understanding of developmental psychopathology. Developmental psychopathology is based on the view that problems arise from different causes, manifest themselves differently at each stage, and may have diverse outcomes. Developmental psychologists do not support a specific theory to explain all developmental issues. Instead, they try to incorporate knowledge from multiple disciplines (Cicchetti Dawson, 2002). Moreover, developmental psychopathology also includes an analysis of the existing risk and protective factors within the individual and also in his/her environment over the course of development (Cicchetti Walker, 2003). According to Costello and colleagues (2004), a developmental perspective in epidemiological studies is based on the inclusion of certain principles. First, precise assessment measures for the different phases in childhood and adolescence are required to compare childrens functioning with that of their same-age peers. For example, problems such as fear of dark places is considered typical for 6-year-olds but not for 12-year-olds. Furthermore, the developmental perspective would include longitudinal studies to evaluate the ways in which developmental processes influence the risk of specific psychological disorders. For example, the developmental trajectory of physical aggression is such that there is an increase in Aggressive Behavior during the first few years of childhood, but it progressively decreases until adulthood (Tremblay et al., 2004). Moreover, developmental epidemiology would include frequent assessments to determine the onset of disorders. Frequent assessments would also a ssist in the identification of environmental and individual factors that contribute to the development of psychopathology. Although the developmental perspective emphasises the need for age- and gender-specific diagnostic criteria, longitudinal studies as well as frequent assessments, it is difficult to incorporate this perspective in studies based on the categorical approach as it is not sensitive to developmental changes. Methodological disparities. A critical analysis of categorically based epidemiological studies reveals multiple methodological problems. These include inconsistencies in assessment and sampling procedures as well as absence of guidelines about using data from multiple sources. In terms of assessment procedures, both symptoms as well as significant impairment are required to identify children with disorders. This is corroborated by Costello et al. (2004), who report that the disparity in the prevalence rates of phobias (i.e., 0.1% to 21.9%) may be attributed to how phobias were assessed in each study, in particular, whether both symptoms (e.g., fear of open places, snakes) as well as significant functional impairment were taken into account in the identification of phobias. Waddell et al. (2002) state that the use of standardized measures has lead to an improvement in the assessment of symptoms; however, problems still exist with regard to how impairment is gauged or how measures may be combined to include symptoms as well as impairment. Another problem with assessment procedures is that different interview schedules (e.g., DISC and the Kiddie-SADS) and DSM editions have been used across studies, which may have contributed to differences in prevalence rates. Incompatible sampling procedures may also have led to disparities in overall prevalence rates in categorically based epidemiological studies (Waddell et al., 2002). For example, studies such as the Great Smokey Mountains study (Costello, Angold, Burns, Erkanli, Stangel Tweed, 1996) were relatively more comprehensive, and investigated a larger number of diagnostic categories than other studies. As a result, higher overall prevalence rates of psychological problems were reported compared to studies that did not assess as many disorders. Another sampling issue is that reviews were based on studies that differed with regard to the age range assessed; some studies focused on a younger age bracket (i.e., between 8 to 11 year olds), others on an older age bracket (i.e., 11 years and older), whereas some researches included a very broad age range (i.e., 6 to 17 year olds). In addition, there were inconsistencies across studies in terms of the type of informant used; some studies relied on p arents only, some on children, while some combined data from parents, children as well as teachers. Differences in the age brackets assessed as well as the use of different informants may have contributed to disparities in epidemiological findings. Another salient issue with regard to categorically based epidemiological studies concerns the coordination and interpretation of information from multiple informants. Since problem behaviours may only occur in specific situations or with specific individuals, multiple informants (e.g., teachers, parents and children) are necessary. However, since the respondents context and perception have a great impact on the identification of psychological problems, poor agreement among respondents is frequently reported. For example, children normally report higher rates of internalizing symptoms (e.g., anxiety and depression) while parents tends to report higher rates of externalizing symptoms (e.g., Conduct Problems) (Rubio-Stipec, Fitzmaurice, Murphy, Walker, 2003). Additionally, children are not considered reliable reporters of their own behaviour due to differences in cognitive abilities as well as the ability to report their own behaviour (Achenbach McConaughy, 2003). Despite such finding s, the categorical approach does not provide guidelines regarding obtaining and interpreting data from multiple sources, which complicates matters in terms of how to combine data into yes-or-no decisions about different symptoms. The various conceptual problems associated with the DSM as well as the methodological flaws in epidemiological reviews highlight the problems associated with using the categorical approach as a basis for epidemiological studies. Moreover, these issues underscore the need for an approach that is methodologically sound and culturally appropriate for cross-cultural comparisons. An alternative to problems linked to the categorical approach, where an a priori criterion is imposed, can be a system that is empirically based and identifies problems as they occur in a population. Such an approach would be helpful in highlighting cultural differences in the manifestation of different emotional and behavioural problems. Moreover, there is also a need for a methodology that can be employed in a standardized, systematic fashion. Although the empirical approach is not a panacea for problems associated with epidemiological studies, it does provide solutions to some of the types of errors in the cat egorical system. Empirical or dimensional approach. The empirical or dimensional approach, in accordance with a psychosocial perspective, views mental health as a continuum. The dimensional perspective supports the notion that all individuals experience problems involving behaviours, emotions and thoughts to varying extents. Those who experience such problems to an extreme extent (unusual frequency, duration, intensity, or other aspects) are more likely to have a psychological disorder (Cullinan, 2004). In contrast to imposing a priori criteria on childrens emotional and behavioural problems, the empirical approach identifies problems as they present themselves in the population. According to Cullinan (2004), there are certain steps involved in developing a dimensional classification system for emotional and behavioural problems. These steps include creating a collection of items that reflect measurable problem behaviours experienced by children, identifying a group of children to be studied, assessi ng every child in the group on each problem, and investigating the data to identify items that co-vary, thus leading to the identification of different dimensions or factors. After the dimensions have been derived, the pool of items can be used to assess and classify emotional and behaviour problems among new populations. Given that the empirical approach is based on the identification of co-occurring problem behaviours in the population, instead of imposing a priori criteria, it is a favourable approach for cross-cultural epidemiological studies. Within empirical approaches, the Achenbach System of Empirically Based Assessment (ASEBA) provides a good framework for epidemiological studies for multiple reasons. First, being empirically based, ASEBA identifies emotional and behavioural problems as they occur in the population. Second, it is based on a developmental perspective, has a uniform methodology, and also provides explicit guidelines about using data from multiple sources (Achenbach McConaughy, 1997; Achenbach Rescorla, 2001). Hence it provides solutions to problems that arise in the categorical approach. Moreover, Cullinan (2004) and Krol et al. (2006) state that ASEBA measures have been used more extensively compared to other measures of emotional and behavioural problems, such as the Conners Rating Scale- Revised (Conners,1990) and the Strengths and Difficulties Questionnaire (Goodman, 1997). Achenbach system of empirically based assessment (ASEBA). Although the ASEBA has a non-theoretical, empirical base per se, it is greatly influenced by the principles of developmental psychopathology. For example, Achenbach highlights that problems may include thoughts, behaviours, and emotions that may manifest themselves differently depending on the age and gender of the individual (Greenbaum et al., 2004). Therefore, each ASEBA form provides norms based on the age and gender of the child, which enables an individuals functioning to be assessed in comparison to same-age peers. Furthermore, ASEBA is a multiaxial system that encompasses a family of standardized instruments for the assessment of behavioural and emotional problems as well as adaptive functioning. The five axes of the assessment model include parent (Axis I) and teacher (Axis II) reports, cognitive (Axis III) and physical (Axis IV) assessments as well as the direct assessment of children (Axis V) (Achenbach McConaughy, 2003). The use of different ASEBA instruments provides a s tandardized and uniform methodology to incorporate information from multiple sources. Furthermore, all ASEBA instruments are empirically based. In accordance with the empirical approach, the construction of the ASEBA forms involved a series of steps (Achenbach McConaughy, 2003). Initially, a collection of potential symptom behaviours (i.e., items) was derived from multiple sources. These items were operationally defined in such a manner that respondents not trained in psychological theory could use them. In accordance with general item-development procedures, pilot tests were conducted to evaluate the clarity of items, response scales and item distribution. Finally, items that could differentiate between individuals who were not functioning well and their well functioning same-age peers were retained. Multivariate statistical analyses were applied to the retained items in order to identify syndromes of problems that co-occur. Syndromes were identified purely on the basis of co-occurrence, without any link to a particular cause. Subsequently, the syndromes of co-occur ring problem items were used to construct scales. These scales were used to assess individuals in order to assess the degree to which they exhibit each syndrome. Since all ASEBA instruments are empirically based, findings can be compared on the basis of the manifestation of different emotional and behavioural problems, thereby providing a clearer picture of cross-cultural similarities and disparities of different emotional and behavioural problems. In terms of the historical evolution of the system, ASEBA originated to provide a more differentiated assessment of child and adolescent psychopathology than the DSM. When ASEBA was developed, the first edition of the DSM (APA, 1952) had only two categories for childhood disorders, which included adjustment reactions of childhood and schizophrenic reaction childhood type (Achenbach Rescorla, 2006). In contrast to the DSM, the first ASEBA publication highlighted more syndromes of emotional and behavioural problems (APA, 1952). Moreover, based on factor analyses, Achenbach (1966) identified two broad groupings of problems for which he coined the terms â€Å"Internalizing† and â€Å"Externalizing.† As described earlier, Internalizing Problems included problems with the self, such as anxiety, depression, withdrawal, and Somatic Complaints, without any apparent physical cause. On the other hand, Externalizing Problems included problems with other people, as well as problems linked to non-conformance to social norms and mores, such as aggressive and delinquent behaviour. Although all ASEBA forms are used extensively in clinical and research environments, the Child Behavior Checklist is the most widely recognized measure for the assessment of emotional and behavioural problems (Greenbaum et al., 2004; Webber Plotts, 2008). Child Behavior Checklist An essential part and the cornerstone of Achenbachs multiaxial, empirical system is the Child Behavior Checklist (CBCL). Although the CBCL assesses social competencies as well as problem behaviours, it is widely recognized as a measure of emotional and behavioural problems as opposed to social competencies. In fact, researchers suggest that the CBCL is the most extensively utilized measure for the assessment of problem behaviours among children and adolescents as observed by their parents and caregivers (Krol et al., 2006; Greenbaum et al., 2004). Although there have been multiple revisions to the initial CBCL, all versions have the same format and consist of two distinct sections. The first section measures social competencies. Parents are asked to respond to 20 questions regarding the childs functioning in sports, miscellaneous activities, organizations, jobs and chores, and friendships. Items also cover the childs relations with significant others, how well the child plays and works alone, as well as his/her functioning at school. Finally, respondents describe any known illnesses or disabilities, the issues that concern them the most about the child, and the best things about the child (Achenbach Rescorla, 2006). The second section assesses problem behaviour and consists of 118 items that describe specific emotional and behavioural problems, along with two open-ended items for reporting additional problems. Examples of problem items include â€Å"acts too young for age†, â€Å"cruel to animals†, â€Å"too fe arful or anxious†, and â€Å"unhappy, sad or depressed†. Problem behaviours are organized in a hierarchical factor structure that consists of eight correlated first-order or narrowband syndromes, two correlated second-order or broadband factors (i.e., Internalizing and Externalizing Problems) and an overall Total Problems factor. Parents/caregivers are asked to rate the child with regard to how true each item is at the time of assessment or within the past 6 months. The following scale is used: 0 = not true (as far as you know), 1 = somewhat or sometimes true, and 2 = very true or often true. In the case of respondents with poor reading skills, a non-clinically trained clincian can also admisnter the CBCL (Achenbach Rescorla, 2006). For respondents who cannot read English but can read another language, translations are available in over 85 languages (Berube Achenbach, 2008). Development of the CBCL. The first version of the CBCL dates back to 1983. To date, there have been two revisions of the CBCL; the first one in 1991 followed by the second in 2001, leading to considerable improvements in the measure. The main weakness of the initial CBCL was that comparisons across different age groups and respondents were problematic since syndromes had the same names but different items across different age forms (i.e., 4 to 5, 6 to 11, 12 to 16 years) as well as across different respondent forms (i.e., CBCL, teacher report form [TRF], and the youth self report [YSR]) To rectify the problem, the 1991 version included two new types of syndromes, the core and cross-informant syndromes. Core syndromes represented items that clustered together consistently across age and gender groupings on a single instrument. Cross-informant syndromes were based on those items from the core syndromes that appear on at least two of the three different respondent forms (i.e., CBCL, TRF, and YSR) (Greenbaum et al., 2004). These revisions facilitated comparisons across different age groups and informants. Moreover, the 1991 version of the CBCL also had new national level norms, which included norms for seventeen and eighteen year olds. Apart from practical benefits, changes such as a broader age range and precise criteria for different developmental levels, genders and type of respondents, helped make the CBCL and ASEBA instruments more accurately representative of the developmental perspective of child psychopathology (Greenbaum et al.). Achenbach (1991) also conducted exploratory principal factor analyses of the syndrome scales. Based on the loadings of different syndromes, Achenbach identified Anxious/Depressed, Withdrawn, and Somatic Complaints as indicators of Internalizing Problems, whereas Aggressive and Delinquent Behavior were identified as indicators of Externalizing Problems. Since Social Problems, Thought Problems and Attention Problems did not load consistently on either second-order factor, they were not placed in any group (Achenbach, 1991; Greenbaum et al., 2004). Although Internalizing and Externalizing Problems identify different types of behaviour, the two categories are not mutually exclusive and may co-occur within the same individual. This is supported by research findings that indicate that there was a correlation between the two groups in both clinic-referred (.54) and non-referred (.59) samples matched on the basis of age, sex, race, and income (Achenbach, 1991). Description of the current CBCL. The current CBCL was published in 2001 and covers ages 6 to 18 years (CBCL/6-18; Achenbach Rescorla, 2001). The CBCL/6-18 (Achenbach Rescorla, 2001) provides raw scores, T- scores and percentiles for the following: (1) the three competence scales (Activities, Social, School); (2) the Total Competence scale; (3) the eight cross-informant syndromes; (4) Internalizing and Externalizing Problems and (5) Total Problems. The cross-informant syndromes of the CBCL/6-18 include Aggressive Behavior, Anxious/Depressed, Attention Problems, Rule-Breaking Behavior, Social Problems, Somatic Complaints, Thought Problems, and Withdrawn/Depressed. As far as similarities and differences from previous versions are concerned, the current CBCL introduced some major and a few minor changes. One major change was the introduction of the DSM-oriented scales, based on which CBCL and other ASEBA forms can now be scored in terms of scales that are oriented toward categories of the fourth edition of the DSM (A.P.A., 1994). The introduction of the DSM-oriented scales has combined the categorical and empirical approaches and enables users to view problems in both the categorical and dimensional approaches (Achenbach, Dumenci Rescorla, 2003; Achenbach Rescorla, 2006). The DSM-oriented scales include six categories, namely Affective Problems, Anxiety Problems, Somatic Problems, Attention Deficit/Hyperactivity problems, Oppositional Defiant Problems as well as Conduct Problems. These scales are based on problem items that mental health experts from sixteen cultures across the world rated as being consistent with particular DSM diagnostic cat egories. Similar to the empirically based syndromes, the DSM- oriented scales also have age-, gender- and respondent-specific norms. Another major change was that new normative data was collected using multistage probability sampling in forty U.S. states as well as the District of Columbia. The selected homes were considered to be representative of the continental United States with respect to geographical region, socio-economic status, ethnicity and urbanization (Achenbach Rescorla, 2001). Moreover, complex new analyses based on new clinical and normative samples were conducted. However, the eight syndromes and Internalizing and Externalizing groupings published in 1991 were replicated with minor changes. Research findings indicated that correlations between scores on the 1991 syndromes and their 2001 counterparts ranged from .87 to 1.00 (Achenbach Rescorla, 2001 Analysis of the Child Behaviour Checklist Analysis of the Child Behaviour Checklist Chapter II: Literature Review As suggested in the introduction, numerous researchers have explored the prevalence of emotional and behavioural problems across the globe. Researchers have also investigated correlates (e.g., age and gender) associated with emotional and behavioural problems. The psychometric properties of instruments assessing emotional and behavioural problems have also been a subject of interest. In addition, researchers have also investigated cross-cultural similarities and disparities among emotional and behavioural problems. The extensive literature that addresses these issues, and which also helped formulate the rationale for the current study, is presented in five sections. The first section highlights the problems associated with epidemiological studies and compares the two main approaches to epidemiological studies, namely the categorical and the empirical approach. The second section provides a detailed description of the CBCL including the evolution of the measure, its psychometric prope rties, its advantages and disadvantages, as well as its range of applicability. The third section provides a description of the theoretical rationale for assessing cultural similarities and disparities associated with emotional and behavioural problems. Multicultural findings based on the CBCL as well as age and gender differences associated with emotional and behavioural problems are also reported. The fourth section consists of a review of the various processes involved in assessing the psychometric properties of instruments and findings based on psychometric properties of the various translations of the CBCL. The fifth section consists of a brief cultural and socio-political description of Pakistani society followed by a description of the salient features (i.e., family, community and cultural factors) in relation to emotional and behavioural problems in Pakistani society. Finally, there is a description of the objectives of the current study. Epidemiology of Emotional and Behavioural Problems Current reviews of epidemiological studies indicate that there is a high prevalence of emotional and behavioural problems among children and adolescents around the world (Costello et al., 2004; Hackett Hackett, 1999; Waddell et al., 2002). In one review, Costello et al. compared findings across several developed countries (including Canada, the United States, the United Kingdom, Germany and Australia) to investigate the prevalence of emotional and behavioural problems as well as that of other psychological problems. Based on their findings, the overall prevalence rates of psychological problems among children and adolescents had a very broad range (0.1% to 42%), with varying rates for each category of disorder. Categories include disruptive behaviour disorders (i.e., conduct disorder, oppositional disorder and attention deficit hyperactivity disorder), mood disorders (i.e., major depressive disorder and bipolar disorder), anxiety disorders (i.e., phobias, generalized anxiety disorde r, obsessive compulsive disorder, and post-traumatic stress disorder) as well as substance abuse and dependence. A critical examination of the studies included in the review revealed that variations in prevalence rates may be attributed to methodological flaws such as substantial disparity across studies with regard to sample size and the age range assessed. Moreover, differences across studies in terms of the measures used, the criteria employed as well as the type of informant may also have influenced the findings. In contrast to Costello et al.s (2004) review, Waddell et al.s (2002) review was based on more stringent criteria; studies based on samples of similar size and age range, as well as using similar methodology were compared. Based on Waddell et al.s review, the prevalence rates of emotional and behavioural problems varied between 10% and 20%. Although findings from both reviews vary considerably, the prevalence rates of emotional and behavioural problems across developed countries is still high and warrants serious attention. Moreover, methodological disparities across studies underscore the need for a uniform methodology to investigate the prevalence of emotional and behavioural problems. In contrast to developed countries, there are few researchers investigating prevalence rates in developing countries (e.g., Bangladesh, India, Sri lanka, Sudan, and Uganda) (Costello, 2009: Fleitlich-Bilyk Goodman, 2004; Mullick Goodman, 2005; Nikapota, 1991; Prior, Virasinghe, Smart, 2005). Moreover, there is a scarcity of reviews of the existing studies. In one review, Hackett and Hackett (1999) compared results from India, Puerto Rico, Malaysia and Sudan, and the prevalence rates of psychological disorders ranged from 1% to 49%. Similar to research in developed countries, researchers attribute variations in findings to methodological problems across studies, which include an inadequate sample size, paucity of explicit and internationally accepted diagnostic criteria, as well as inconsistencies in assessment procedures (Fleitlich-Bilyk Goodman, 2004). Moreover, prevalence rates among developing countries may also partly be linked to the social, economic and medical environment. For example, lack of medical resources and awareness about psychological problems may result in parents not knowing how to seek help (Gadit, 2007). Social taboos further compound the problem, preventing people from reporting problems and deterring help-seeking behaviour (Samad, Hollis, Prince, Goodman, 2005). More importantly, cultural variations in the conceptualization and identification of psychological problems may result in varied reporting of symptoms (Gadit, 2007). These environmental differences and methodological inconsistencies across studies emphasize the need for a cross-culturally robust methodology to investigate the prevalence of emotional and behavioural problems. Along with methodological problems and environmental differences, emotional and behavioural problems merit investigation because they affect multiple aspects of childrens functioning such as academic performance and social adjustment (Montague et al., 2005; Nelson et al., 2004; Vitaro et al., 2005). Researchers also state that there is high comorbidity among emotional and behavioural problems, (SteinHausen, Metze, Meier, Kannenberg, 1998) which creates multiple problems for children and their caregivers. Moreover, many childhood disorders continue and influence functioning during adulthood. In fact, many adult disorders are now recognized as having roots in childhood vulnerabilities (Maughan Kim-Cohen, 2005; Tremblay et al., 2005). Furthermore, recognizing and treating problems early can reduce the burden of the enormous human and financial costs associated with the assessment and intervention, especially in countries where resources are scarce (Costello, Egger, Angold, 2005; Jame s et al., 2002; Waddell et al., 2002). In addition, cross-cultural epidemiology of childrens emotional and behavioural problems may also better inform current knowledge about the characteristics, course, and correlates of such problems, which in turn provide a scientific basis for appropriate mental health planning (Achenbach Rescorla, 2007; Waddell et al.). Therefore, there is a strong need for a methodology that can be utilized for clinical as well as research purposes to assess emotional and behavioural problems among children and adolescents across cultures. Current literature indicates that there are two main approaches to investigate the epidemiology of emotional and behavioural problems, namely the categorical and the empirical approach. There are several differences in both approaches including conceptualization of psychological problems as well as the methodology employed for their assessment. Both approaches will be discussed briefly. The categorical approach. The categorical approach, based on the biomedical perspective, views psychological problems as a group of maladaptive and distressing behaviours, emotions and thoughts which are qualitatively different from the typical (Cullinan, 2004). That is, similar to medical diseases, an individual may or may not have a specific psychological disorder. Traditional epidemiological studies are based on the categorical approach as embodied in various editions of the Diagnostic and Statistical Manual for Mental Disorders (DSM) (American Psychiatric Association (APA), 1980; 1987; 1994; 2000) and the International Classification of Diseases (WHO, 1978; 1992). Examples of instruments used in traditional epidemiological studies to derive DSM diagnoses include the Diagnostic Interview Schedule for Children (DISC) (Costello, Edelbrock, Kalas, Kessler, Klaric, 1982) and the childrens version of the Schedule for Affective Disorders and Schizophrenia (Kiddie-SADS) (Puig-Antich Ch ambers, 1978). At present, there is considerable debate about the validity of epidemiological studies based on the categorical approach. Researchers have highlighted that inconsistencies in prevalence rates may be due to conceptual and methodological issues linked with the DSM as well as methodological disparities among studies (Achenbach Rescorla, 2007; Waddell et al., 2002). Each of these factors will be discussed briefly. DSM related problems. Multiple conceptual and methodological problems are associated with the DSM. First, the DSM does not provide a methodology to operationally define different psychological disorders (Widiger Clark, 2000). To operationally define DSM criteria, various diagnostic interviews such as the DISC have been developed. Unfortunately, meta-analyses indicate that the diagnoses based on the DISC and other diagnostic interviews are not in agreement with diagnoses made through comprehensive clinical interviews, which indicate that, neither diagnostic nor clinical interviews provide good validity criteria for testing DSM categories (Achenbach, 2005; Costello et al., 2005; Lewczyk et al., 2003). Second, the diagnostic categories and criteria provided in the DSM continue to change as reflected in the changes across the various editions of the DSM, namely the third edition (APA, 1980), third edition revised (APA, 1987), fourth edition (APA, 1994), and fourth edition text revised ( APA, 2000), making comparisons across editions problematic (Achenbach, 2005). Third, although the current version, known as the DSM-IV-text revised (APA, 2000), aims at introducing cultural sensitivity in assessment and diagnoses by including an â€Å"outline for cultural formulation and a glossary of culture-bound syndromes† (APA., 2000, pg. 897), it does not provide criteria or guidelines regarding the use of the classification system with specific cultural groups (Paniagua, 2005). Since many of the DSM diagnostic criteria are based on Euro-American social norms, it is difficult to use the DSM criteria to identify psychopathology in individuals from other cultures. In addition, there is growing consensus among researchers that DSM categories need to be more appropriate for children and adolescents of different ages and gender (Doucette, 2002; Segal Coolidge, 2001). Turk et al. (2007) also highlight the saliency of factors such as age and gender when investigating prevalence rates. However, at present, this is not the case. Costello et al. (2005) have stated that the constant developmental changes of childhood create the need for an age- and gender- specific approach to epidemiology. Before incorporating a developmental perspective in epidemiological studies, it is essential to have a better understanding of developmental psychopathology. Developmental psychopathology is based on the view that problems arise from different causes, manifest themselves differently at each stage, and may have diverse outcomes. Developmental psychologists do not support a specific theory to explain all developmental issues. Instead, they try to incorporate knowledge from multiple disciplines (Cicchetti Dawson, 2002). Moreover, developmental psychopathology also includes an analysis of the existing risk and protective factors within the individual and also in his/her environment over the course of development (Cicchetti Walker, 2003). According to Costello and colleagues (2004), a developmental perspective in epidemiological studies is based on the inclusion of certain principles. First, precise assessment measures for the different phases in childhood and adolescence are required to compare childrens functioning with that of their same-age peers. For example, problems such as fear of dark places is considered typical for 6-year-olds but not for 12-year-olds. Furthermore, the developmental perspective would include longitudinal studies to evaluate the ways in which developmental processes influence the risk of specific psychological disorders. For example, the developmental trajectory of physical aggression is such that there is an increase in Aggressive Behavior during the first few years of childhood, but it progressively decreases until adulthood (Tremblay et al., 2004). Moreover, developmental epidemiology would include frequent assessments to determine the onset of disorders. Frequent assessments would also a ssist in the identification of environmental and individual factors that contribute to the development of psychopathology. Although the developmental perspective emphasises the need for age- and gender-specific diagnostic criteria, longitudinal studies as well as frequent assessments, it is difficult to incorporate this perspective in studies based on the categorical approach as it is not sensitive to developmental changes. Methodological disparities. A critical analysis of categorically based epidemiological studies reveals multiple methodological problems. These include inconsistencies in assessment and sampling procedures as well as absence of guidelines about using data from multiple sources. In terms of assessment procedures, both symptoms as well as significant impairment are required to identify children with disorders. This is corroborated by Costello et al. (2004), who report that the disparity in the prevalence rates of phobias (i.e., 0.1% to 21.9%) may be attributed to how phobias were assessed in each study, in particular, whether both symptoms (e.g., fear of open places, snakes) as well as significant functional impairment were taken into account in the identification of phobias. Waddell et al. (2002) state that the use of standardized measures has lead to an improvement in the assessment of symptoms; however, problems still exist with regard to how impairment is gauged or how measures may be combined to include symptoms as well as impairment. Another problem with assessment procedures is that different interview schedules (e.g., DISC and the Kiddie-SADS) and DSM editions have been used across studies, which may have contributed to differences in prevalence rates. Incompatible sampling procedures may also have led to disparities in overall prevalence rates in categorically based epidemiological studies (Waddell et al., 2002). For example, studies such as the Great Smokey Mountains study (Costello, Angold, Burns, Erkanli, Stangel Tweed, 1996) were relatively more comprehensive, and investigated a larger number of diagnostic categories than other studies. As a result, higher overall prevalence rates of psychological problems were reported compared to studies that did not assess as many disorders. Another sampling issue is that reviews were based on studies that differed with regard to the age range assessed; some studies focused on a younger age bracket (i.e., between 8 to 11 year olds), others on an older age bracket (i.e., 11 years and older), whereas some researches included a very broad age range (i.e., 6 to 17 year olds). In addition, there were inconsistencies across studies in terms of the type of informant used; some studies relied on p arents only, some on children, while some combined data from parents, children as well as teachers. Differences in the age brackets assessed as well as the use of different informants may have contributed to disparities in epidemiological findings. Another salient issue with regard to categorically based epidemiological studies concerns the coordination and interpretation of information from multiple informants. Since problem behaviours may only occur in specific situations or with specific individuals, multiple informants (e.g., teachers, parents and children) are necessary. However, since the respondents context and perception have a great impact on the identification of psychological problems, poor agreement among respondents is frequently reported. For example, children normally report higher rates of internalizing symptoms (e.g., anxiety and depression) while parents tends to report higher rates of externalizing symptoms (e.g., Conduct Problems) (Rubio-Stipec, Fitzmaurice, Murphy, Walker, 2003). Additionally, children are not considered reliable reporters of their own behaviour due to differences in cognitive abilities as well as the ability to report their own behaviour (Achenbach McConaughy, 2003). Despite such finding s, the categorical approach does not provide guidelines regarding obtaining and interpreting data from multiple sources, which complicates matters in terms of how to combine data into yes-or-no decisions about different symptoms. The various conceptual problems associated with the DSM as well as the methodological flaws in epidemiological reviews highlight the problems associated with using the categorical approach as a basis for epidemiological studies. Moreover, these issues underscore the need for an approach that is methodologically sound and culturally appropriate for cross-cultural comparisons. An alternative to problems linked to the categorical approach, where an a priori criterion is imposed, can be a system that is empirically based and identifies problems as they occur in a population. Such an approach would be helpful in highlighting cultural differences in the manifestation of different emotional and behavioural problems. Moreover, there is also a need for a methodology that can be employed in a standardized, systematic fashion. Although the empirical approach is not a panacea for problems associated with epidemiological studies, it does provide solutions to some of the types of errors in the cat egorical system. Empirical or dimensional approach. The empirical or dimensional approach, in accordance with a psychosocial perspective, views mental health as a continuum. The dimensional perspective supports the notion that all individuals experience problems involving behaviours, emotions and thoughts to varying extents. Those who experience such problems to an extreme extent (unusual frequency, duration, intensity, or other aspects) are more likely to have a psychological disorder (Cullinan, 2004). In contrast to imposing a priori criteria on childrens emotional and behavioural problems, the empirical approach identifies problems as they present themselves in the population. According to Cullinan (2004), there are certain steps involved in developing a dimensional classification system for emotional and behavioural problems. These steps include creating a collection of items that reflect measurable problem behaviours experienced by children, identifying a group of children to be studied, assessi ng every child in the group on each problem, and investigating the data to identify items that co-vary, thus leading to the identification of different dimensions or factors. After the dimensions have been derived, the pool of items can be used to assess and classify emotional and behaviour problems among new populations. Given that the empirical approach is based on the identification of co-occurring problem behaviours in the population, instead of imposing a priori criteria, it is a favourable approach for cross-cultural epidemiological studies. Within empirical approaches, the Achenbach System of Empirically Based Assessment (ASEBA) provides a good framework for epidemiological studies for multiple reasons. First, being empirically based, ASEBA identifies emotional and behavioural problems as they occur in the population. Second, it is based on a developmental perspective, has a uniform methodology, and also provides explicit guidelines about using data from multiple sources (Achenbach McConaughy, 1997; Achenbach Rescorla, 2001). Hence it provides solutions to problems that arise in the categorical approach. Moreover, Cullinan (2004) and Krol et al. (2006) state that ASEBA measures have been used more extensively compared to other measures of emotional and behavioural problems, such as the Conners Rating Scale- Revised (Conners,1990) and the Strengths and Difficulties Questionnaire (Goodman, 1997). Achenbach system of empirically based assessment (ASEBA). Although the ASEBA has a non-theoretical, empirical base per se, it is greatly influenced by the principles of developmental psychopathology. For example, Achenbach highlights that problems may include thoughts, behaviours, and emotions that may manifest themselves differently depending on the age and gender of the individual (Greenbaum et al., 2004). Therefore, each ASEBA form provides norms based on the age and gender of the child, which enables an individuals functioning to be assessed in comparison to same-age peers. Furthermore, ASEBA is a multiaxial system that encompasses a family of standardized instruments for the assessment of behavioural and emotional problems as well as adaptive functioning. The five axes of the assessment model include parent (Axis I) and teacher (Axis II) reports, cognitive (Axis III) and physical (Axis IV) assessments as well as the direct assessment of children (Axis V) (Achenbach McConaughy, 2003). The use of different ASEBA instruments provides a s tandardized and uniform methodology to incorporate information from multiple sources. Furthermore, all ASEBA instruments are empirically based. In accordance with the empirical approach, the construction of the ASEBA forms involved a series of steps (Achenbach McConaughy, 2003). Initially, a collection of potential symptom behaviours (i.e., items) was derived from multiple sources. These items were operationally defined in such a manner that respondents not trained in psychological theory could use them. In accordance with general item-development procedures, pilot tests were conducted to evaluate the clarity of items, response scales and item distribution. Finally, items that could differentiate between individuals who were not functioning well and their well functioning same-age peers were retained. Multivariate statistical analyses were applied to the retained items in order to identify syndromes of problems that co-occur. Syndromes were identified purely on the basis of co-occurrence, without any link to a particular cause. Subsequently, the syndromes of co-occur ring problem items were used to construct scales. These scales were used to assess individuals in order to assess the degree to which they exhibit each syndrome. Since all ASEBA instruments are empirically based, findings can be compared on the basis of the manifestation of different emotional and behavioural problems, thereby providing a clearer picture of cross-cultural similarities and disparities of different emotional and behavioural problems. In terms of the historical evolution of the system, ASEBA originated to provide a more differentiated assessment of child and adolescent psychopathology than the DSM. When ASEBA was developed, the first edition of the DSM (APA, 1952) had only two categories for childhood disorders, which included adjustment reactions of childhood and schizophrenic reaction childhood type (Achenbach Rescorla, 2006). In contrast to the DSM, the first ASEBA publication highlighted more syndromes of emotional and behavioural problems (APA, 1952). Moreover, based on factor analyses, Achenbach (1966) identified two broad groupings of problems for which he coined the terms â€Å"Internalizing† and â€Å"Externalizing.† As described earlier, Internalizing Problems included problems with the self, such as anxiety, depression, withdrawal, and Somatic Complaints, without any apparent physical cause. On the other hand, Externalizing Problems included problems with other people, as well as problems linked to non-conformance to social norms and mores, such as aggressive and delinquent behaviour. Although all ASEBA forms are used extensively in clinical and research environments, the Child Behavior Checklist is the most widely recognized measure for the assessment of emotional and behavioural problems (Greenbaum et al., 2004; Webber Plotts, 2008). Child Behavior Checklist An essential part and the cornerstone of Achenbachs multiaxial, empirical system is the Child Behavior Checklist (CBCL). Although the CBCL assesses social competencies as well as problem behaviours, it is widely recognized as a measure of emotional and behavioural problems as opposed to social competencies. In fact, researchers suggest that the CBCL is the most extensively utilized measure for the assessment of problem behaviours among children and adolescents as observed by their parents and caregivers (Krol et al., 2006; Greenbaum et al., 2004). Although there have been multiple revisions to the initial CBCL, all versions have the same format and consist of two distinct sections. The first section measures social competencies. Parents are asked to respond to 20 questions regarding the childs functioning in sports, miscellaneous activities, organizations, jobs and chores, and friendships. Items also cover the childs relations with significant others, how well the child plays and works alone, as well as his/her functioning at school. Finally, respondents describe any known illnesses or disabilities, the issues that concern them the most about the child, and the best things about the child (Achenbach Rescorla, 2006). The second section assesses problem behaviour and consists of 118 items that describe specific emotional and behavioural problems, along with two open-ended items for reporting additional problems. Examples of problem items include â€Å"acts too young for age†, â€Å"cruel to animals†, â€Å"too fe arful or anxious†, and â€Å"unhappy, sad or depressed†. Problem behaviours are organized in a hierarchical factor structure that consists of eight correlated first-order or narrowband syndromes, two correlated second-order or broadband factors (i.e., Internalizing and Externalizing Problems) and an overall Total Problems factor. Parents/caregivers are asked to rate the child with regard to how true each item is at the time of assessment or within the past 6 months. The following scale is used: 0 = not true (as far as you know), 1 = somewhat or sometimes true, and 2 = very true or often true. In the case of respondents with poor reading skills, a non-clinically trained clincian can also admisnter the CBCL (Achenbach Rescorla, 2006). For respondents who cannot read English but can read another language, translations are available in over 85 languages (Berube Achenbach, 2008). Development of the CBCL. The first version of the CBCL dates back to 1983. To date, there have been two revisions of the CBCL; the first one in 1991 followed by the second in 2001, leading to considerable improvements in the measure. The main weakness of the initial CBCL was that comparisons across different age groups and respondents were problematic since syndromes had the same names but different items across different age forms (i.e., 4 to 5, 6 to 11, 12 to 16 years) as well as across different respondent forms (i.e., CBCL, teacher report form [TRF], and the youth self report [YSR]) To rectify the problem, the 1991 version included two new types of syndromes, the core and cross-informant syndromes. Core syndromes represented items that clustered together consistently across age and gender groupings on a single instrument. Cross-informant syndromes were based on those items from the core syndromes that appear on at least two of the three different respondent forms (i.e., CBCL, TRF, and YSR) (Greenbaum et al., 2004). These revisions facilitated comparisons across different age groups and informants. Moreover, the 1991 version of the CBCL also had new national level norms, which included norms for seventeen and eighteen year olds. Apart from practical benefits, changes such as a broader age range and precise criteria for different developmental levels, genders and type of respondents, helped make the CBCL and ASEBA instruments more accurately representative of the developmental perspective of child psychopathology (Greenbaum et al.). Achenbach (1991) also conducted exploratory principal factor analyses of the syndrome scales. Based on the loadings of different syndromes, Achenbach identified Anxious/Depressed, Withdrawn, and Somatic Complaints as indicators of Internalizing Problems, whereas Aggressive and Delinquent Behavior were identified as indicators of Externalizing Problems. Since Social Problems, Thought Problems and Attention Problems did not load consistently on either second-order factor, they were not placed in any group (Achenbach, 1991; Greenbaum et al., 2004). Although Internalizing and Externalizing Problems identify different types of behaviour, the two categories are not mutually exclusive and may co-occur within the same individual. This is supported by research findings that indicate that there was a correlation between the two groups in both clinic-referred (.54) and non-referred (.59) samples matched on the basis of age, sex, race, and income (Achenbach, 1991). Description of the current CBCL. The current CBCL was published in 2001 and covers ages 6 to 18 years (CBCL/6-18; Achenbach Rescorla, 2001). The CBCL/6-18 (Achenbach Rescorla, 2001) provides raw scores, T- scores and percentiles for the following: (1) the three competence scales (Activities, Social, School); (2) the Total Competence scale; (3) the eight cross-informant syndromes; (4) Internalizing and Externalizing Problems and (5) Total Problems. The cross-informant syndromes of the CBCL/6-18 include Aggressive Behavior, Anxious/Depressed, Attention Problems, Rule-Breaking Behavior, Social Problems, Somatic Complaints, Thought Problems, and Withdrawn/Depressed. As far as similarities and differences from previous versions are concerned, the current CBCL introduced some major and a few minor changes. One major change was the introduction of the DSM-oriented scales, based on which CBCL and other ASEBA forms can now be scored in terms of scales that are oriented toward categories of the fourth edition of the DSM (A.P.A., 1994). The introduction of the DSM-oriented scales has combined the categorical and empirical approaches and enables users to view problems in both the categorical and dimensional approaches (Achenbach, Dumenci Rescorla, 2003; Achenbach Rescorla, 2006). The DSM-oriented scales include six categories, namely Affective Problems, Anxiety Problems, Somatic Problems, Attention Deficit/Hyperactivity problems, Oppositional Defiant Problems as well as Conduct Problems. These scales are based on problem items that mental health experts from sixteen cultures across the world rated as being consistent with particular DSM diagnostic cat egories. Similar to the empirically based syndromes, the DSM- oriented scales also have age-, gender- and respondent-specific norms. Another major change was that new normative data was collected using multistage probability sampling in forty U.S. states as well as the District of Columbia. The selected homes were considered to be representative of the continental United States with respect to geographical region, socio-economic status, ethnicity and urbanization (Achenbach Rescorla, 2001). Moreover, complex new analyses based on new clinical and normative samples were conducted. However, the eight syndromes and Internalizing and Externalizing groupings published in 1991 were replicated with minor changes. Research findings indicated that correlations between scores on the 1991 syndromes and their 2001 counterparts ranged from .87 to 1.00 (Achenbach Rescorla, 2001

Things Found Inside of People :: Personal Narrative Papers

Things Found Inside of People 1. Things found inside of people. There is a museum in Philadelphia called the MÃ ¼tter Museum. I went there once with an old boyfriend. We saw babies in formaldehyde with serious birth defects, two heads, four legs, five noses. Siamese twins. An eight-foot-long colon in a glass case, black, dry, and empty, beside a photograph of its former keeper, a man with a bloated, pregnant stomach. Deformed skulls. The assembled bones of the tallest man in the world, the assembled bones of the shortest man in the world. Model faces made of wax, people with leprosy, noses eaten away, people with real horns growing from their foreheads. Infectious diseases-the results. The dried and preserved veins and heart of a whole man, shellacked and hovering behind a plastic wall. We stayed for two whole hours, until the place closed. At the end we found a set of drawers. Upon opening each little drawer we found something new; there were various buttons, keys, pieces of metal, rocks, hard plastics, coins. My ex-boyfriend asked me what thes e things were. The sign said, "Things Found Inside of People." 2. The bar. This morning I listened to Joy Division with my new boyfriend. The song is called Ceremony, and he has the Joy Division version, an earlier, more distorted version of the New Order song later to come, the one that I own. I could describe the song, but I won't. Other than to say that it is very 80s, and it sounds like New York City and steel-beamed skyscrapers, and it is what I hear when I fly in my head. He had a dream for a few minutes early this morning about skydiving, and he said, "I just had a dream that I had to jump out of a plane. I'll never do that." I said I didn't think jumping out of a plane and flying would be so bad. We were up until six o'clock in the morning again, frustrating each other. I think he thinks about having sex with me too much, and I'm not sure if that's negative or just not important. He's delicate, but he's a guy all the same, and it's a little confusing. He likes Joy Division. He saw me last year with my ex-boyfriend. I was wearing a Joy Division t-shirt, a relic from the 80s, Dan's brother Marc's old shirt.

Great Gatsby Essay -- essays research papers

F. Scott Fitzgerald’s novel The Great Gatsby is about a man named Gatsby, in love with a woman, Daisy, who is married to Tom Buchannan. He dreams that one day he and Daisy will get together. Gatsby has worked hard to become the man that he believes will impress Daisy. Even though he has an extravagant house, lots of money, and wild parties, he is without the one person he wants, Daisy. Even befriending Nick deals with Gatsby getting Daisy, because Daisy is Nick’s cousin. In a meeting arranged by Nick and Gatsby, Daisy is invited over for tea and she sees Gatsby. It seems as if time is suspended for a moment, as they look at each other both thinking something. Then Gatsby tips over Nick’s clock, symbolizing that he is running out of time to try to capture what he and Daisy once lost. Through the lonely and careless characters of: Jordan Baker Jay Gatsby, Myrtle, and G. Wilson, Fitzgerald is able to illustrate the lack of spirituality in this novel.   Ã‚  Ã‚  Ã‚  Ã‚  The main place in The Great Gatsby that shows the lack of spirituality is the Valley of Ashes, where Myrtle and her husband, George Wilson live. It is a bleak, desolate valley including only one building, a car garage. One day while driving around Tom and Nick stop off at the valley to see Myrtle, Tom’s mistress. Nick describes this valley as being: â€Å"about half way between West Egg and New York... a fantastic farm where ashes grow like wheat into ridges and hills and grotesque gardens† (27). The co...

Identification of Morphological and Physiological Characteristics of Unknown Bacteria Essay

Obesity is a word that everyone is currently familiar with. The media and health professionals have been working tirelessly to make the general public aware of its prevalence and detriments to society. With the staggering statistics of 32.2% prevalence in adults and a range of 13.9% to 18.9% prevalence in children and adolescents, these outstanding numbers stand out for themselves. (1) Increasing rates of obesity are associated with higher risk factors for other diseases such as; Type 2 diabetes mellitus, cardiovascular diseases, colon cancer, diverticulitis, cancer of the endometrium, and breast cancer. (2) Knowing how to combat obesity will lead to decreased complications of the condition as well as a lower risk factor for other diseases. In light of these significant numbers, our group chose to explore the relationship of dietary fiber to aid in the prevention and treatment of obesity, therefore also reducing the incidence other diseases. Our focus was on making a hot meal with a simple modification to increase the dietary fiber available. The original recipe is a white rice pilaf with the adjustment being made with a substitution of brown rice. This change will boost the fiber intake from 0.8g per serving to 2.6g per serving. The represents a substantial jump in accessibility to a vital part of our diet. We expect favorable results in the acceptance of our modification. The texture is a bit hardier, cooking time is longer, and cost is slightly higher, but we believe the benefits outweigh these variables. The RDA recommends between 25g-30g a day, but the average American receives only 12g-13g per day.(3) With this easy alteration, we hope to increase these low numbers that the average American receives up to the reco mmended levels. Purpose The purpose of our research study is to substitute brown rice for white rice in a pilaf. This pilaf can be eaten for lunch or dinner as a hot side dish or main dish. It is intended to introduce a serving of a whole grain in the diet and with it bring an increase dietary fiber. Literature Review Introduction The frequent occurrence of this disease, as mentioned above, has produced many scientific research studies concentrating on remedying and reversing the trend. Finding and interpreting the results was uncomplicated. I used the online databases; Google Scholar, Medline, and Cinhal to gather my data. My keywords included obesity and dietary fiber. I assembled strong studies that encompassed sample sizes ranging from 11-74,091 participants, with timelines up to twelve years, and accommodating populations in the United States, Spain, Finland, Brazil, Italy, Greece, the former Yugoslavia, Japan, Serbia, Belgrade, and The Netherlands. These studies centered on three different aspects of the relationship between dietary fiber and weight. These are expanded upon below. A synopsis of the reviewed studies can be found in Appendix 1. Correlations of the Development of Obesity Seven out of the ten studies compared the connection between dietary fiber intake and the development or current status of obesity. (2, 4-9) All studies included self reported questionnaires to collect sociodemographic, health history, physical activity, anthropometric, bowel movements, and dietary data. The most common dietary form used was the Food Frequency Questionnaire, with six complying. (2, 4-5, 7-9) The last study utilized twenty-four hour recalls. (6) Other measurements included height, weight, and subscapular skinfold thickness. The entire body of findings revealed that higher fiber intake was inversely related to long term weight gain and increased body fat. Reporting measures were diverse but included the same positive trend. Higher fiber intake equated to an average weight of 1.52kg less, a 48-49% lower risk of weight gain, and a BMI that was 1.5 less when compared to low fiber intake. Some studies investigated other variables in addition to increasing fiber. One study addressed physical activity in addition to increased fiber as a therapy. (5) This study along with another explored the incorporation of a low fat diet along with the high fiber diet. In both, dietary fat was not directly associated with reduction of body fat or obesity but showed a compounding result when correlated with higher fiber. A lower BMI difference of 2.75 was established on a low fat and high fiber diet. (6) Development of Diseases related to Obesity Two studies were taken on to look into the increased use of fiber to decrease the risk of obesity leading to Type 2 diabetes. (10, 11) In a large cohort with a sample size just under 36,000, self reported dietary and weight figures were collected. (10) After six years of follow up, the statistics were analyzed and the results showed a 22% lower risk of the development of diabetes from the highest quintile of dietary fiber intake. These optimistic results were in consensus with the other study. This study had more stringent controls and divided participants into two groups. (11) One received standard care and the other received intensive exercise and dietary counseling. Oral glucose tolerance tests and body composition measurements were calculated. After a four year follow up, the high fiber group gained 75% less than their low fiber counterparts, 0.7kg gain versus 3.1kg gain, respectively. Treatment of Obesity The last study out of the ten engaged the most scientific disciplines. (12) The sample was already obese. They participated in controlled feeding in a metabolic kitchen. The cross over design allowed for six weeks on either a low or high fiber diet with a six week washout period in between them. Daily logs were kept and an OGTT and Euglycemic hyperinsulinemic clamp was used every two weeks for measuring results. At the conclusion, fasting insulin was 10% lower, the AUC was lowered, and the rate of glucose infusion was higher after the higher fiber diet. Limitations All of the studies employed self reporting figures in some form, whether the basis of all of their information or for at least some part. This may lead to underreporting, overreporting, or misinterpretation. The definition of a whole-grain or high fiber food varied among studies. Recipe and ingredient databases or non-comprehensive food frequency questionnaires may aid in inaccurate recordings of intake. Although the study utilizing the metabolic kitchen was the best scientific representation among the studies it is worth mentioning that it was sponsored and funded by the General Mills Corporation. This could lead to a possible conflict of interest and hence a limitation to the studies findings. Conclusion The complete compilation of studies supports the purpose of our recipe modification. Each emphasized the importance of replacing low fiber foods with fiber rich foods to help prevent or reduce weight gain. The significant correlation between fiber and obesity has been established in this review. The protective role of fiber, along with physical activity and dietary fat, should be included in advice and management therapies tailored to this condition and other related to it. Materials and Methods For our subjective evaluation we designed three separate score cards; demographic, evaluation, and preference. Samples of the score cards can be found in Appendix 2. Sociodemographic For the demographic background we included questions regarding age range, household income range, ethnicity, and educations. We also included six questions probing background information on exposure and open-mindedness of our products.